Trends in occupational diseases in Finland, 1975-2013: a register study.

OBJECTIVES: The objective was to investigate trends in the incidence of recognized and suspected cases of occupational diseases in Finland from 1975 to 2013, including variations by industry - and describe and recognize factors affecting variations in incidence. DESIGN: A register study. SETTING: The data consisted of recognized and suspected cases of occupational diseases recorded in the Finnish Registry of Occupational Diseases (FROD) in 1975-2013. PARTICIPANTS: Altogether 240 000 cases of suspected and recognized ODs were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: From the annual workforce statistics and FROD data, we calculated the incidence of ODs and suspected ODs per 10 000 employees. For time trends by industrial sector, we used a 5-year moving average and a Poisson regression analysis. RESULTS: Annual average rates of ODs have varied from year to year. The total number was 25.0/10 000 employees in 1975 and 20.1/10 000 employees in 2013. Screening campaigns and legislative changes have caused temporary increases. When the financial sector was the reference (1.0), the highest incidence rates according to industrial sector were in mining and quarrying (9.87; 95% CI 8.65 to 11.30), construction (9.11; 95% CI 9.98 to 10.43), manufacturing (9.04; 95% CI 7.93 to 10.36) and agriculture (8.78; 95% CI 7.69 to 10.06). There is a distinct decreasing trend from 2005 onwards: the average annual change in incidence was, for example, -9.2% in agriculture, -10.3% in transportation and -4.7% in construction. The average annual decline was greatest in upper limb strain injuries (-11.1%). CONCLUSION: This study provides a useful overview of the status of ODs in Finland over several decades. These data are a valuable resource for determining which occupations are at an increased risk and where preventive actions should be targeted. It is important to study long-term trends in the statistics of ODs to see beyond the year-to-year fluctuations.

Evaluation of a national register on occupational exposure to carcinogens: effectiveness in the prevention of occupational cancer, and cancer risks among the exposed workers.

OBJECTIVES: The objective of this study was to evaluate the performance and effectiveness of a register of employees exposed to carcinogens (the ASA Register) which has been in operation in Finland since 1979, and to study cancer risks among the notified workers. METHODS: The impact of ASA at workplaces was studied by questionnaires mailed to 1448 work departments, which were notified to ASA in 1996, and to 1033 departments, which departed ASA in 1991-1996. The mailing was responded by 69% of departments. The cancer incidence of 35,138 workers notified to ASA in 1979-1988 was followed up through the files of the Finnish Cancer Register for the period 1980-2003. RESULTS: Changes eliminating or substantially reducing exposure to carcinogens were reported by 73% of departments notified to ASA in 1996. The ASA notification process had directly prompted measures to reduce exposure (8% of cases) or contributed to them (24% of cases). Estimations based on responses of the workplaces suggested that the ASA registration had decreased exposure of 600 workers year(-1) (out of approximately 15,000 notified workers, which is <1% of the employed in Finland), preventing thereby an unknown number of occupational cancers. Other benefits of ASA included the saving of the treatment costs of prevented cancers, the prevention of other health outcomes of carcinogens, improved safety behaviour of exposed workers and avoidance of human suffering among cancer patients and their families. The labour safety authorities had better possibilities to direct their activities against carcinogen exposure. These benefits should be considered against the annual costs, mainly due to 7-8 person-years of work required by tasks related to ASA. The results of the cancer incidence study among notified workers were based on a relatively short follow-up (on average 19 years). The incidence of mesothelioma was significantly increased in the ASA cohort, probably due to exposure to asbestos. CONCLUSIONS: These results suggest that a national exposure register may stimulate preventive measures at workplaces. Partially based on the results of the present study the Finnish Ministry of Social Affairs and Health continues ASA registration.

The impact of education and occupation on the employment status of cancer survivors.

We explored the effect of a diagnosis of cancer on employment according to cancer type, education, occupation, age, gender, mother tongue (Swedish or Finnish), calendar time and hospital district. All 12,542 new cancer cases diagnosed in 1987-1988 and 1992-1993, aged 15-60 years at the time of the diagnosis were identified from the Finnish Cancer Registry. The employment rate of the cancer survivors 2-3 years after the diagnosis was only 9% lower than their gender- and age-matched referents. However, we found that education and occupation modified the effect of cancer on the employment; the difference between cancer survivors and their referents in the probability of being employed was greater in the lower than in the higher educational groups. A modifying effect of education on the probability of employment was found among people with cancer of the lung, stomach, rectum and cervix uteri and those with cancers of the nervous system.

Work injuries among Finnish farmers: a national register linkage study 1996-1997.

BACKGROUND: Farming is one of the most injury-prone occupations in Finland as it is in other countries. Our goals were to describe work injuries of Finnish farmers and to compare occupational injury rates between various subgroups. METHODS: A national cohort of 69,629 full-time farmers and their 11,657 compensated injuries were identified from an insurance company database. Cohort data were merged with a population census and farm register. Relative incidence rates were calculated using Poisson regression. RESULTS: Men had higher injury rates than women, except with regard to injuries caused by animals. Dairy and hog farming were the riskiest activities, and injury rates increased with the number of dairy cows. CONCLUSIONS: One-half of insured farmers in Finland are full-time farmers, which may have lead to underestimation of risk in Finnish injury statistics. Dairy farming is of particular concern because it is both common and has a high injury rate.

Mortality and cancer incidence of workers in Finnish road paving companies.

BACKGROUND: This study, a component of the International Agency for Research on Cancer (IARC) Multicentric Study on Cancer Risk Among European Asphalt Workers, aimed at identifying major mortality risks among workers in Finnish road paving companies. METHODS: The Finnish cohort was comprised of 9,643 men and women from six road paving companies. The mortality of men employed during at least one season (5,676) was followed up from 1964 until end of 1994; an average of 17 years. Standardized mortality ratios (SMR) and relative risks (RR), the latter based on multivariate Poisson regression models were estimated by occupational group and by various metrics of occupational exposures. RESULTS: All-cause mortality was elevated (SMR 1.11, 95% confidence interval, CI 1.03-1.20), mainly due to excesses in accidents, poisonings, and violence (1.29; CI 1.12-1.49), and lung cancer (1.38; 1.03-1.81). Workers exposed to bitumen fumes had a slightly elevated mortality from lung cancer (1.16; 0.69-1.83). Multivariate Poisson regression models with 15-year lag period suggested trends by cumulative exposure to coal tar, organic vapors, silica dust, diesel exhaust, and bitumen fume. CONCLUSIONS: The elevated mortality from external causes among Finnish building/ground construction workers was probably due to living conditions and related lifestyles. Some evidence was found for a risk of lung cancer due to occupational exposure, but the confirmation of these findings would require a longer follow-up and improved control for confounding.

Socioeconomic inequalities in cardiovascular mortality and the role of work: a register study of Finnish men.

BACKGROUND: In Finland, socioeconomic inequalities in mortality have been well documented. However, the role of working conditions in the emergence of those inequalities has not been thoroughly examined. METHODS: Data came from the Longitudinal Census file, which included censuses since 1970 (every 5 years). The cohort consisted of men who were in the same occupation in 1975 and 1980, and who were between 25 and 64 years old in 1980. Farm work, mining and military occupations were excluded. Cardiovascular mortality of this cohort was followed up 1981-1994 (5.4 million person-years). Information on marital status, education and income was updated in 1985 and 1990. Working conditions were evaluated at occupational level (job exposure matrix). Poisson regression analyses were conducted to estimate the impact of independent variables on mortality. Inequalities were assessed in relation to occupational class and occupational category. RESULTS: According to the models, elimination of unfavourable working conditions would have reduced the number of all cardiovascular deaths by 8%, myocardial infarctions by 10%, and cerebrovascular deaths by 18%. The most influential job exposures appeared to be high workload, low control, noise, and shift work. Income had a strong effect on mortality. CONCLUSIONS: Working conditions explained a relatively small portion of socioeconomic inequalities in mortality. Inequalities associated with occupational category and class were more attributable to varying levels of education and income.

Exposure to environmental tobacco smoke in Finland in 2000.

OBJECTIVES: Exposure to environmental tobacco smoke at workplaces, homes and other places was assessed. METHODS: Exposure to environmental tobacco smoke was defined as occurring when a person reported inhaling, at least occasionally, tobacco smoke from other people's smoke. Some of the exposed were also smokers themselves. Questionnaire-based survey data and industrial hygiene measurements on environmental tobacco smoke were used to estimate the numbers of exposed persons by exposure level in Finland in January 2000. RESULTS: About 340,000 workers (16% of the employed population) were exposed to environmental tobacco smoke at work, of them 30,000 were exposed almost continuously (1.4% of the employed population). The mean level of exposure was 1 microg/m2 as measured by nicotine in workroom air. The nicotine concentration ranged from < 1 to > 100 microg/m3. Nearly 600,000 Finns (1% of the population) were exposed to environmental tobacco smoke at home. According measurements abroad, their mean nicotine exposure corresponded to about 4 microg/m3 at work. In addition, over 1 million Finns were exposed during leisure time to an unknown mean level of environmental tobacco smoke. Annual exposure of the Finnish population in January 2000 was estimated to originate mainly from smoking at home (48%) and leisure time in smoky restaurants (45%). Smoking was restricted at workplaces in 1995 and occupational exposure constituted 7% of the total population exposure in January 2000. New restrictions on smoking in restaurants should decrease the exposure of restaurant workers and customers even further. CONCLUSIONS: In spite of regulations, environmental tobacco smoke still remains the most common occupational exposure to chemical carcinogens in Finland.