Mortality in employees of a Scottish paper mill.

To assess possible health risks associated with the manufacture of paper, we carried out a retrospective analysis of mortality among 4,242 men and women employed at a Scottish paper mill between 1955 and 1992. During follow-up to 1994, 959 subjects had died giving an SMR of 0.85 (95% CI 0.80-0.90) in comparison with the national population. Mortality from all cancer (SMR 0.77, 95% CI 0.68-0.88) and particularly from lung cancer (SMR 0.64, 95% CI 0.50-0.81) was lower than expected. An excess of lymphatic and hematopoietic cancer (11 deaths, SMR 2.17) was observed in the making department. These findings do not support an occupational hazard of lung cancer as suggested by several earlier studies. The excess of lymphatic and hematopoietic cancer in the making department was unexpected, and may be a chance occurrence.

Work related respiratory symptoms in radiographers.

OBJECTIVE: To determine the prevalence of work related symptoms among radiographers compared with a control group of physiotherapists. METHOD: A postal questionnaire was used to collect information from radiographers and physiotherapists who registered in the United Kingdom during 1985-9. RESULTS: Satisfactory questionnaires were returned by 2354 (65%) of the radiographers and 3048 (69%) of the physiotherapists. There was a clear excess of work related symptoms among the radiographers. In particular, they were more likely to complain of symptoms that were worse at work, mouth soreness, sore, itchy, or runny eyes, persistent blocked nose, persistent itchy nose or sneezing, sore throat, headache, and of lower respiratory tract symptoms, which were also worse on workdays. These symptoms were associated particularly with the use of automatic processing machines. 235 radiographers gave a history of wheeze or chest tightness that had been worse at work or on days when at work. CONCLUSIONS: Work related symptoms suggesting irritation of the eyes and upper airways were more common in radiographers than controls, and may be related to exposure to x ray film processing chemicals. Men and women who reported work related wheeze or chest tightness will be followed up in more detail to assess the prevalence of occupational asthma in the cohort.

Upper aerodigestive cancer in battery manufacturers and steel workers exposed to mineral acid mists.

OBJECTIVE: To assess the risk of cancer from inhalation of mineral acid mists. METHODS: A cohort study and nested case-control study of upper aerodigestive tumours were carried out in men employed since 1950 at two battery plants and two steel works in Britain. The cohort was identified from personnel records and included 2678 men with definite exposure to acid mists (mainly sulphuric acid), 367 with possible exposure, and 1356 who were unexposed. Mortality was compared with that in the national population by the person-years method. Cases of upper aerodigestive cancer were identified from death certificates and cancer registrations, and their exposure to acids was compared with that of age matched controls (five per case) from the same plant by conditional logistic regression. RESULTS: In follow up to 31 December 1993, 93% of men were traced, including 1277 who had died. Among the men definitely exposed to acid mists, overall mortality was less than in the national population (standardised mortality ratio (SMR) 0.92, 95% confidence interval (95% CI) 0.85-0.98) as was mortality from all cancers (SMR 0.92, 95% CI 0.79-1.05) and specifically from cancer of the larynx (SMR 0.48, 95% CI 0.01-2.70) and lung (SMR 0.98, 95% CI 0.78-1.22). A total of 15 incident or fatal cases of upper aerodigestive cancer were identified during follow up. When these men were compared with controls, risk was moderately increased in those who had worked for at least five years in jobs entailing exposures to sulphuric or hydrochloric acid in excess of 1 mg/m3 (OR 2.0, 95% CI 0.4-10). CONCLUSIONS: These findings are consistent with those from other studies which have indicated a hazard of upper aerodigestive cancer from acid mists. However, they indicate that any risk from exposures to sulphuric and hydrochloric acid below 1 mg/m3 is small.

Mortality of butchers and cooks identified from the 1961 census of England and Wales.

OBJECTIVES: To explore a suspected hazard of lung cancer in butchers and cooks. METHODS: 4018 male butchers and 2062 male cooks were identified from the 1961 census of England and Wales. 4857 (79.9%) of these men were traced through the National Health Service Central Register, and 3518 deaths were recorded during follow up to the end of 1992. Mortality from lung cancer and other causes was compared with that of the general population by the person-years method. RESULTS: Mortality from all causes was significantly below that of the national population in both butchers (standardized mortality ratio (SMR) 0.94, 95% confidence interval (95% CI) 0.90-0.98) and cooks (SMR 0.89, 95% CI 0.84-0.95). When allowance was made for a latency of 20 years from entry to follow up, the deficit in butchers was reduced, but that in cooks persisted, and was largely explained by a shortfall of deaths from cancer and circulatory disease. Mortality from lung cancer was close to expectation in the butchers (SMR 1.01, 95% CI 0.90-1.13) and below expectation in the cooks (SMR 0.93, 95% CI 0.75-1.13). Cooks had increased mortality from cancers of the oral cavity (SMR 5.57) and pharynx (SMR 2.66). CONCLUSIONS: The findings provide no support for an occupational hazard of lung cancer in either butchers or cooks. The possibility of excess risk in sub-groups of these occupations cannot be discounted. The high rates of oral and pharyngeal cancer in cooks are probably a consequence of high alcohol consumption.

The relationship between pneumonia in early childhood and impaired lung function in late adult life.

This study related respiratory illness documented in the first 2 yr of life to the lung function of 618 men and women with a mean age of 70 yr living in Derbyshire, England. Pneumonia before 2 yr of age was associated with a lower mean FEV1, adjusted for age and height. In men, the difference was -0.65L (95% CI: -1.02, -0.29; p = 0.0005). This estimate did not diminish after adjustment for smoking and asthma. In women, the reduction in mean FEV1 associated with pneumonia before 2 yr of age was smaller and nonsignificant. Bronchitis, measles, and whooping cough before 2 yr of age were not associated with diminished adult lung function in either sex. The findings in men support a causal relationship between pneumonia in early childhood and COPD in late adult life.

Housing in early life and later mortality.

STUDY OBJECTIVES: The aim was to examine the influence of domestic crowding and household amenities in early life on later mortality from all causes and specifically from stomach cancer, chronic obstructive pulmonary disease, and rheumatic heart disease. DESIGN: This was a retrospective cohort study of people whose houses had been surveyed in 1936 and whose household size was known from the 1939 census. Subjects were followed through the National Health Service Central Register from 1951 to 1989. SETTING: The housing survey had been carried out in the midland town of Chesterfield. SUBJECTS: Subjects comprised 8138 men and women born after 1900. RESULTS: A total of 2929 deaths were observed during the follow up period. All causes mortality in the full cohort was not consistently related to any of the housing variables examined, but among subjects who were still children at the time of the housing survey, death rates were higher in those whose houses were crowded or lacked a hot water tap. No associations could be shown between stomach cancer and domestic crowding or food storage facilities; chronic obstructive pulmonary disease and domestic crowding or use of gas for cooking; or rheumatic heart disease and domestic crowding. There were few deaths from these causes, however, in subjects who were children at the time of housing survey. CONCLUSIONS: The findings suggest that the housing of young adults in Chesterfield during the 1930s had little effect on their later mortality. Further follow up of the cohort is needed before firm conclusions can be drawn about the influence of housing at younger ages.

Mortality of army cooks.

The possible hazard of lung cancer among cooks was studied in a cohort of 1798 cooks who had retired from the Army Catering Corps and 1310 referents retired from the Royal Army Pay Corps. During the follow-up from 1974 to 1989 the mortality of the referents was similar to that of the national population, apart from a moderate increase in lung cancer [standardized mortality ratio (SMR) 1.38]. Mortality from lung cancer among the cooks was significantly higher than among the national population [SMR 1.82, 95% confidence interval (95% CI) 1.25-2.57], as was mortality from cancer of the large intestine (SMR 3.03), ischemic heart disease (SMR 1.42), cerebrovascular disease (SMR 2.05), and digestive disease (SMR 2.27). The high rate of lung cancer among the cooks supports the hypothesis of an occupational hazard, although at least part of the excess was probably due to smoking. Possible explanations for the elevated mortality from other diseases include poor nutrition in early life, smoking, and high consumption of alcohol.

The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life.

OBJECTIVE: To determine how fetal growth is related to death from cardiovascular disease in adult life. DESIGN: A follow up study of men born during 1907-24 whose birth weights, head circumferences, and other body measurements were recorded at birth. SETTING: Sheffield, England. SUBJECTS: 1586 Men born in the Jessop Hospital. MAIN OUTCOME MEASURE: Death from cardiovascular disease. RESULTS: Standardised mortality ratios for cardiovascular disease fell from 119 in men who weighed 5.5 pounds (2495 g) or less at birth to 74 in men who weighed more than 8.5 pounds (3856 g). The fall was significant for premature cardiovascular deaths up to 65 years of age (chi 2 = 5.0, p = 0.02). Standardised mortality ratios also fell with increasing head circumference (chi 2 = 4.6, p = 0.03) and increasing ponderal index (weight/length3) (chi 2 = 3.8, p = 0.05; for premature deaths chi 2 = 6.0, p = 0.01). They were not related to the duration of gestation. Among men for whom the ratio of placental weight to birth weight was in the highest fifths the standardised mortality ratio was 137. CONCLUSION: These findings show that reduced fetal growth is followed by increased mortality from cardiovascular disease. They suggest that reduction in growth begins early in gestation. They are further evidence that cardiovascular disease originates through programming of the body's structure, physiology, and metabolism by the environment during fetal life. Maternal nutrition may have an important influence on programming.