Heavy manual work throughout the working lifetime and muscle strength among men at retirement age.

INTRODUCTION: Reductions in heavy manual work as a consequence of mechanisation might adversely impact muscle strength at older ages. We investigated the association between grip strength at retirement age and lifetime occupational exposure to physically demanding activities. Grip strength is an important predictor of long-term health and physical function in older people. METHODS: Grip strength (maximum of three readings in each hand) was measured in men from the Hertfordshire Cohort Study at a single examination when their mean age was 65.8 (SD 2.9) years. Associations with lifetime occupational exposure (ascertained by questionnaire) to three activities (standing/walking ≥ 4 h/day; lifting ≥ 25 kg; and energetic work sufficient to induce sweating) were assessed by multivariable linear regression with adjustment for various potential confounders. RESULTS: Complete data were available from 1418 men who had worked for at least 20 years. After adjustment for age, height and weight, those with longer exposures to walking/standing and heavy lifting had lower grip strength, but the relationship disappeared after further adjustment for confounders. Working at physical intensity sufficient to induce sweating was not significantly associated with grip strength. CONCLUSIONS: We found no evidence that physically demanding occupational activities increase hand grip strength at normal retirement age. Any advantages of regular physical occupational activity may have been obscured by unmeasured socioeconomic confounders.

Exposure to heavy physical occupational activities during working life and bone mineral density at the hip at retirement age.

BACKGROUND: People in sedentary occupations are at increased risk of hip fracture. Hip fracture is significantly associated with low bone mineral density (BMD) measured at the hip. Physical activity is important in the development and maintenance of BMD, but the effects of occupational physical activity on bone health are unclear. We investigated the influence of lifetime physical activity on BMD at the hip. METHODS: This was a cross-sectional epidemiological study of the associations between total hip BMD measured by dual-energy X-ray absorptiometry at retirement age and lifetime exposure to occupational physical workload (standing/walking ≥4 h/day; lifting ≥25 kg; energetic work sufficient to induce sweating and manual work). RESULTS: Complete data on occupational exposures were available for 860 adults (488 men and 372 women) who had worked ≥20 years. Their mean age was 65 years, and many reported heavy physical workplace activities over prolonged durations. There were no statistically significant associations between total hip BMD and any of these measures of lifetime occupational physical activity in men or women. CONCLUSIONS: Lifetime cumulative occupational activity was not associated with hip BMD at retirement age. Our findings suggest that, if sedentary work conveys an increased risk of hip fracture, it is unlikely that the mechanism is through reductions in BMD at the hip and may relate to other physical effects, such as falls risk. Further studies will be needed to test this hypothesis.

Epilepsy, diabetes mellitus and accidental injury at work.

AIMS: To assess the contribution of epilepsy and diabetes to occupational injury. METHODS: The Clinical Practice Research Datalink logs primary care data for 6% of the British population, coding all consultations and treatments. Using this, we conducted a population-based case-control study, identifying patients aged 16-64 years, who had consulted over two decades for workplace injury, plus matched controls. By conditional logistic regression, we assessed risks for diabetes and epilepsy overall, several diabetic complications and indices of poor control, occurrence of status epilepticus and treatment with hypoglycaemic and anti-epileptic agents. RESULTS: We identified 1348 injury cases and 6652 matched controls. A total of 160 subjects (2%) had previous epilepsy, including 29 injury cases, whereas 199 (2.5%) had diabetes, including 77 with eye involvement and 52 with a record of poor control. Odds ratios (ORs) for occupational injury were close to unity, both in those with epilepsy (1.07) and diabetes (0.98) and in those prescribed anti-epileptic or hypoglycaemic treatments in the previous year (0.87-1.16). We found no evidence of any injury arising directly from a seizure and no one had consulted about their epilepsy within 100 days before their injury consultation. Two cases and six controls had suffered status epilepticus (OR versus never had epilepsy 1.61). Risks were somewhat higher for certain diabetic complications (OR 1.44), although lower among those with eye involvement (OR 0.70) or poor diabetic control (OR 0.50). No associations were statistically significant. CONCLUSIONS: No evidence was found that diabetes or epilepsy are important contributors to workplace injury in Britain.

Vaccinating welders against pneumonia.

BACKGROUND: In 2011, the Department of Health in England recommended that welders should each receive a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23). AIMS: To assess the evidence behind the advice and its practical implications. METHODS: The review was informed by a systematic search in Medline, which related pneumonia to welding and/or exposure to metal fume, and was supplemented using the personal libraries of the authors. RESULTS: There is consistent evidence that welders die more often of pneumonia, especially lobar pneumonia, are hospitalized more often for lobar and pneumococcal pneumonia, and more often develop invasive pneumococcal disease (IPD). It is estimated that one case of IPD may be prevented over a 10-year period by vaccinating 588 welders against pneumococcal infection. CONCLUSIONS: A good case exists that employers should offer PPV23 vaccination to welders and other employees exposed to metal fume. Additionally, reasonable measures must be taken to minimize exposure to welding fume, and welders should be encouraged not to smoke.

Shift work and pregnancy outcomes: a systematic review with meta-analysis of currently available epidemiological studies.

BACKGROUND: Varying work schedules are suspected of increasing risks to pregnant women and to fetal wellbeing. In particular, maternal hormonal disturbance arising from sleep deprivation or circadian rhythm disruption might impair fetal growth or lead to complications of pregnancy. Two independent meta-analyses (from 2000 to 2007) reported a small adverse effect of shift work on the risk of preterm delivery (PTD). However, these reviews were based on few high-quality studies. OBJECTIVES: To provide an updated review of the associations of shift work with PTD, low birthweight (LBW), small-for-gestational-age (SGA) infants and pre-eclampsia. SEARCH STRATEGY AND SELECTION CRITERIA: We conducted a systematic search of MEDLINE using combinations of keywords and MeSH terms. DATA COLLECTION AND ANALYSIS: For each relevant paper we abstracted standard details, used to summarise design features and rate methodological quality. We calculated pooled estimates of relative risk (RR) in random-effect meta-analyses. MAIN RESULTS: We retrieved 23 relevant studies. The pooled estimate of RR for PTD was 1.16 (95% CI 1.00-1.33, 16 studies), but when five reports of poorer methodological quality were excluded, the estimated RR decreased to 1.03 (95% CI 0.93-1.14). We also observed increased RRs for LBW (RR 1.27, 95% CI 0.93-1.74) and for SGA (RR 1.12, 95% CI 1.03-1.22), which varied little by study quality. Little evidence was found on pre-eclampsia. CONCLUSIONS: These findings suggest that overall, any risk of PTD, LBW, or SGA arising from shift work in pregnancy is small.

Musculoskeletal pain in elite professional musicians from British symphony orchestras.

BACKGROUND: Professional musicians have high rates of musculoskeletal pain, but few studies have analysed risks by work activities or the psychosocial work environment. AIMS: To assess the prevalence and impact of musculoskeletal pain, and its relation to playing conditions, mental health and performance anxiety, in musicians from leading British symphony orchestras. METHODS: Musicians from six professional orchestras completed a questionnaire concerning their orchestral duties and physical activities at work, mental health (somatizing tendency, mood, demand, support and control at work, performance anxiety) and regional pain in the past 4 weeks and past 12 months. Prevalence rates were estimated by anatomical site and associations with risk factors assessed by logistic regression. RESULTS: Responses were received from 243 musicians (51% of those approached), among whom 210 (86%) reported regional pain in the past 12 months, mainly affecting the neck, low back and shoulders. Risks tended to be higher in women, in those with low mood, and especially in those with high somatizing scores. Only weak associations were found with psychosocial work stressors and performance anxiety. However, risks differed markedly by instrument category. Relative to string players, the odds of wrist/hand pain were raised 2.9-fold in wind players, but 60% lower in brass players, while the odds of elbow pain were 50% lower among wind and brass players. CONCLUSIONS: Musculoskeletal pain is common in elite professional musicians. A major personal risk factor is somatizing tendency, but performance anxiety has less impact. Risks differ substantially by instrument played, offering pointers towards prevention.

Regional trends in awards of incapacity benefit by cause.

BACKGROUND: Since the early 1990s, rates of incapacity benefit (IB) in Britain for musculoskeletal complaints have declined, and they have been overtaken by mental and behavioural disorders as the main reason for award of IB. AIMS: To explore reasons for this change. METHODS: Using data supplied by the Department for Work and Pensions, we analysed trends in the ratio of new IB awards for mental and behavioural disorders to those for musculoskeletal disorders during 1997-2007 by Government region. RESULTS: In Great Britain overall, the above ratio more than doubled over the study period, as a consequence of falling numbers of new awards for musculoskeletal disorders. The extent to which the ratio increased was smallest in London (50%) and South-East England (56%), and was progressively larger in more northerly regions (>150% in North-East England and Scotland). CONCLUSIONS: The differences in trends between regions seem too large to be explained by differential changes in working conditions, patterns of employment or the rigour with which claims were assessed. An alternative explanation could be that the main driver for the trends has been culturally determined changes in health beliefs and expectations, and that these cultural changes began in London and the South-East, only later spreading to other parts of Britain.

The burden of sickness absence from musculoskeletal causes in Great Britain.

BACKGROUND: National initiatives to prevent and/or manage sickness absence require a database from which trends can be monitored. AIMS: To evaluate the information provided by surveillance schemes and publicly available data sets on sickness absence nationally from musculoskeletal disorders (MSDs). METHODS: A grey literature search was undertaken using the search engine Google, supplemented by leads from consultees from academia, industry, employers, lay interest groups and government. We abstracted data on the outcomes and populations covered and made quantitative estimates of MSD-related sickness absence, overall and, where distinguishable, by subdiagnosis. The coverage and limitations of each source were evaluated. RESULTS: Sources included the Labour Force Survey (LFS) and its Self-reported Work-related Illness survey module, the THOR-GP surveillance scheme, surveys by national and local government, surveys by employers' organizations and a database of benefit statistics. Each highlighted MSDs as a leading cause of sickness absence. Data limitations varied by source, but typically included lack of diagnostic detail and restriction of focus to selected subgroups (e.g. work-ascribed or benefit-awarded cases, specific employment sectors). Additionally, some surveys had very low response rates, were completed only by proxy respondents or ranked only the perceived importance of MSD-related sickness absence, rather than measuring it. CONCLUSIONS: National statistics on MSD-related sickness absence are piecemeal and incomplete. This limits capacity to plan and monitor national policies in an important area of public health. Simple low-cost additions to the LFS would improve the situation.

Occupation and mortality related to alcohol, drugs and sexual habits.

BACKGROUND: To identify opportunities for targeted prevention, we explored differences in occupational mortality from diseases and injuries related to alcohol consumption, sexual habits and drug abuse. METHODS: Using data on all deaths among men and women aged 16-74 years in England and Wales during 1991-2000, we derived age- and social class-standardized proportional mortality ratios (PMRs) by occupation for cause of death categories defined a priori as potentially related to alcohol consumption, sexual habits or drug abuse. RESULTS: The highest mortality from alcohol-related diseases and injuries was observed in publicans and bar staff (both sexes) and in male caterers, cooks and kitchen porters and seafarers. Male seafarers had significantly elevated PMRs for cirrhosis (179), 'other alcohol-related diseases' (275), cancers of the liver (155), oral cavity (275) and pharynx (267) and injury by fall on the stairs (187). PMRs for human immunodeficiency virus infection (HIV)/acquired immunodeficiency syndrome (AIDS) were particularly high in tailors and dressmakers (918, 95% CI: 369-1890, in men; 804, 95% CI: 219-2060, in women) and male hairdressers (918, 95% CI: 717-1160). Most jobs with high mortality from HIV/AIDS also had more deaths than expected from viral hepatitis. Of seven jobs with significantly high PMRs for both drug dependence and accidental poisoning by drugs, four were in the construction industry (male painters and decorators, bricklayers and masons, plasterers, and roofers and glaziers). CONCLUSIONS: Our findings highlight major differences between occupations in mortality from diseases and injuries caused by alcohol, sexual habits and drug abuse. Priorities for preventive action include alcohol-related disorders in male seafarers and drug abuse in construction workers.

Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitisers.

BACKGROUND: National analyses of mortality in England and Wales have repeatedly shown excess deaths from pneumonia in welders. During 1979-90 the excess was attributable largely to deaths from lobar pneumonia and pneumonias other than bronchopneumonia, limited to men of working age and apparent in other occupations with exposure to metal fumes. The findings for 1991-2000 were assessed and compared with the mortality pattern from asthma in occupations exposed to known respiratory sensitisers. METHODS: The Office of National Statistics supplied data on deaths by underlying cause among men aged 16-74 years in England and Wales during 1991-2000, including age and last held occupation. Data were abstracted on pneumonia for occupations with exposure to metal fumes and on asthma for occupations commonly reported to surveillance schemes as at risk of occupational asthma. The expected numbers of deaths were estimated by applying age-specific proportions of deaths by cause in the population to the total deaths by age in each occupational group. Observed and expected numbers were compared for each cause of death. RESULTS: Among men of working age in occupations with exposure to metal fumes there was excess mortality from pneumococcal and lobar pneumonia (54 deaths vs 27.3 expected) and from pneumonias other than bronchopneumonia (71 vs 52.4), but no excess from these causes at older ages or from bronchopneumonia at any age. The attributable mortality from metal fume exposure was 45.3 excess deaths compared with an estimated 62.6 deaths from occupational asthma. CONCLUSION: Exposure to metal fumes is a material cause of occupational mortality. The hazard deserves far more attention than it presently receives.

Occupational physical activities, working hours and outcome of pregnancy: findings from the Southampton Women's Survey.

OBJECTIVES: To investigate risks of physical activity at work by pregnancy trimester, including the effects on head and abdominal circumference. METHOD: At 34 weeks of gestation we interviewed 1327 mothers from the prospective Southampton Women's Survey (SWS); we asked about their activities (working hours, standing/walking, kneeling/squatting, trunk bending, lifting and night shifts) in jobs held at each of 11, 19 and 34 weeks of gestation, and subsequently ascertained four birth outcomes (preterm delivery, small for gestational age (SGA) and reduced head or abdominal circumference) blinded to employment history. RESULTS: Risk of preterm delivery was elevated nearly threefold in women whose work at 34 weeks entailed trunk bending for >1 h/day. Small head circumference was more common in babies born to women who worked for >40 h/week. However, no statistically significant associations were found with SGA or small abdominal circumference, and preterm delivery showed little association with long working hours, lifting, standing or shift work. CONCLUSIONS: There is a need for more research on trunk bending late in pregnancy, and on the relationship of work to reduced head circumference. Our findings on several other occupational exposures common among pregnant workers are reassuring.

Drivers of international variation in prevalence of disabling low back pain: Findings from the Cultural and Psychosocial Influences on Disability study.

BACKGROUND: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally. METHODS: Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline ('pain propensity index'). After a mean interval of 14 months, 9055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression. RESULTS: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58). CONCLUSIONS: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine. SIGNIFICANCE: Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age.

How common is repetitive strain injury?

OBJECTIVE: Statistics from Labour Force Surveys are widely quoted as evidence for the scale of occupational illness in Europe. However, occupational attribution depends on whether participants believe their health problem is caused or aggravated by work, and personal beliefs may be unreliable. The authors assessed the potential for error for work-associated arm pain. METHODS: A questionnaire was mailed [corrected] to working-aged adults, randomly chosen from five British general practices. They were asked about: occupational activities; mental health; self-rated health; arm pain; and beliefs about its causation. Those in work (n = 1769) were asked about activities likely to cause arm pain, from which the authors derived a variable for exposure to any "arm-straining" occupational activity. The authors estimated the relative risk (RR) from arm-straining activity, using a modified Cox model, and derived the population attributable fraction (PAF). They compared the proportion of arm pain cases reporting their symptom as caused or made worse by work with the calculated PAF, overall and for subsets defined by demographic and other characteristics. RESULTS: Arm pain in the past year was more common in the 1143 subjects who reported exposure to arm-straining occupational activity (RR 1.2, 95% CI 1.1 to 1.5). In the study sample as a whole, 53.9% of 817 cases reported their arm pain as work-associated, whereas the PAF for arm-straining occupational activity was only 13.9%. The ratio of cases reported as work-related to the calculated attributable number was substantially higher below 50 years (5.4) than at older ages (3.0) and higher in those with worse self-rated and mental health. CONCLUSIONS: Counting people with arm pain which they believe to be work-related can overestimate the number of cases attributable to work substantially. This casts doubt on the validity of a major source of information used by European governments to evaluate their occupational health strategies.

Chronic health problems and risk of accidental injury in the workplace: a systematic literature review.

OBJECTIVES: To investigate whether common important health conditions and their treatments increase risks of occupational injury. METHODS: A systematic search was conducted of MEDLINE, EMBASE and PsycINFO databases from inception to November 2006 employing terms for occupational injury, medications, and a broad range of diseases and impairments. Papers related solely to driving, alcohol, or substance abuse were excluded, as were studies that did not allow analysis of injury risk. For each paper that was retrieved we abstracted standard information on the population, design, exposure(s), outcome(s), response rates, confounders and effect estimates; and rated the quality of information provided. RESULTS: We found 38 relevant papers (33 study populations): 16 studies were of cross-sectional design, 13 were case-control and 4 were prospective. The overall quality was rated as excellent for only two studies. Most commonly investigated were problems of hearing (15 studies), mental health (11 studies) and vision (10 studies). For impaired hearing, neurotic illness, diabetes, epilepsy and use of sedating medication there were moderate positive associations with occupational injury (odds ratios 1.5-2.0), but there were major gaps in the evidence base. Studies covering vision did not present risks by category of eye disease; no evidence was found on psychotic illness; for diabetes, epilepsy and cardiovascular disease there were remarkably few papers; studies seldom distinguished risks by sub-category of external cause or anatomical site and nature of injury; and exposures and outcomes were mostly ascertained by self-report at a single time point, with a lack of clarity about exposure timings. CONCLUSION: Improved research is needed to define the risks of occupational injury arising from common health complaints and treatments. Such research should delineate exposures and outcomes in more detail, and ensure by design that the former precede the latter.

The Southampton Examination Schedule for the diagnosis of musculoskeletal disorders of the upper limb.

BACKGROUND: The optimum classification of upper limb disorders (ULDs) remains a cause of debate. Recent efforts to address the issue have focused on translating the consensus criteria of experts into workable protocols for use in field epidemiology. OBJECTIVES: This paper describes the development and assessment of one such protocol, the Southampton Examination Schedule for ULDs. RESULTS AND CONCLUSIONS: In the absence of a reliable gold standard, the schedule has so far been evaluated in terms of its repeatability within and between-observers in clinical and community settings, and in terms of its capacity to distinguish groups with different severity of disease, different treatment needs, different risk factors and different prognoses. Findings to date are briefly summarised. The most pressing future goal in this field is for researchers to collect data on the component elements of diagnosis according to common evidence-based standards such as the Southampton Schedule in order to facilitate communication, the effective pooling of data and the empirical assessment of alternative choices of case definition.

Employment characteristics and job loss in patients awaiting surgery on the hip or knee.

AIMS: To investigate the factors, including size of organisation, associated with job loss in patients awaiting surgery to the hip or knee joint. METHODS: A questionnaire was mailed to 498 consecutive patients of working age listed at a district general hospital for major joint replacement, knee arthroscopy, or periacetabular osteotomy. Questions were asked about level of physical disability, duration of symptoms, employment circumstances at the time the joint problem began, and job changes since the onset of symptoms with their reasons. Analysis focused on those in work when their health problem began. Cox regression was used to examine risk factors for job loss related and unrelated to the joint problem, and results were summarised as adjusted hazard ratios (HRs) with 95% confidence intervals (95% CI). RESULTS: Responses came from 370 (74%) of those mailed, including 278 who were in work when their joint problem began. Of these, 82 (30%) had left their original job mainly or partly because of their joint disorder. Such job loss was more common in those employed in small businesses (HR for <10 v > or =10 employees: 1.9, 95% CI 1.2-3.0) and those whose work involved standing for >2 hours per day (HR 2.7, 95% CI 1.2-6.1) No similar associations were found when jobs were left for other reasons. After adjustment for non-sedentary work the association with small business employment remained but was weaker (HR 1.5, 95% CI 0.9-2.5). Modifications to work and access to occupational health advice were not associated with better job retention. CONCLUSIONS: In subjects with disabling hip or knee disease, job retention is poorer in those from small companies-a matter of concern given the rising prevalence of serious joint disease in the British workforce and the tendency of businesses to downsize and subcontract services to smaller enterprises.

Community-acquired Legionnaires' disease following minimal exposure to a contaminated source.

A case of community-acquired Legionnaires' disease (LD) is described. The source of infection was traced to a push-on tap at the end of a long spur from the hot circulation system in a large old residential building which had been unoccupied for several weeks. Legionella pneumophila serogroup 1 subgroup Pontiac was isolated from the patient's sputum and from the contaminated water supply. Isolates were shown to be indistinguishable from one another when subtyped by pulsed field gel electrophoresis of chromosomal DNA.

Quantifying the advantages and disadvantages of pre-placement genetic screening.

BACKGROUND: Tests of genotype may enable workers at unusual risk of future ill-health to be identified. Using them to select for employment, however, entails gains and losses to employers and employees. Ensuring a fair balance between the rights and obligations of each group requires a value judgement, but the advantages and disadvantages to interested parties must first be quantified in a meaningful way. METHOD AND RESULTS: The purposes of pre-employment screening are reviewed, and several simple measures relevant to the separate interests of employers and job applicants proposed-number screened to prevent a single adverse outcome; number excluded to prevent a case; expected incidence of the adverse outcome in those excluded; and preventable fraction. The derivation of these measures is illustrated, and the factors that influence them (the prevalence of the prognostic trait, the relative risk that it carries for an adverse outcome, and the overall incidence of disease) are related algebraically and graphically, to aid judgement on the utility of screening under different circumstances. CONCLUSIONS: In sensitive areas such as genetic testing the onus should be on the employer to justify plans for pre-placement screening. Several quantitative measures can be used to inform the ethical and economic debate about screening and to evaluate alternative strategies for prevention.

Cigarette smoking, occupational exposure to noise, and self reported hearing difficulties.

AIMS: To explore the interaction of smoking and occupational exposure to noise as risk factors for hearing difficulty in the general population. METHODS: A questionnaire was mailed to 21 201 adults of working age, selected at random from the age-sex registers of 34 British general practices, and to 993 members of the armed services, randomly selected from pay records. Questions were asked about smoking habits, years spent in a noisy occupation, difficulty in hearing conversation, and wearing of a hearing aid. Associations of hearing difficulty with smoking habit were examined by logistic regression and compared across strata of noise exposure, with adjustment for potential confounders. RESULTS: Around half of the respondents had ever smoked, and half of these still smoked. Among 10 418 who provided details on hearing, 348 were classed as having moderate and 311 as having severe hearing difficulty. Risk of hearing difficulty was 3-5-fold higher in those employed for >5 years in noisy work compared with those never employed in a noisy job. Within strata of noise exposure (including those who had never worked in a noisy job), ex- and current smokers had a higher risk of hearing difficulty than lifetime non-smokers. The additional risks were small compared with those of long term noise exposure, and the combination of effects was more consistent with an additive than a multiplicative interaction. CONCLUSIONS: Smoking may adversely affect hearing, and workers should be encouraged to refrain from both smoking and exposure to noise. However, the extra risk to hearing incurred by smoking in high ambient noise levels is small relative to that from the noise itself, which should be the main target for preventive measures.

Mortality of workers exposed to ethylene oxide: extended follow up of a British cohort.

AIMS: To obtain further information about the risks of cancer associated with occupational exposure to ethylene oxide METHODS: Follow up was extended by 13 years for a cohort of 2876 men and women with definite or potential exposure to ethylene oxide in the chemical industry or in hospital sterilising units. Subjects were traced through National Health Service and social security records, and their mortality was compared with that expected from rates in the national population by the person-years method. RESULTS: Analysis was based on 565 deaths, of which 339 had occurred during the additional period of follow up. Mortality was close to or below expectation for all causes (565 deaths v 607.6 expected), all cancers (188 v 184.2), and for all specific categories of malignancy including stomach cancer (10 v 11.6), breast cancer (11 v 13.2), non-Hodgkin's lymphoma (7 v 4.8), and leukaemia (5 v 4.6). All five deaths from leukaemia occurred in the subset of subjects with greatest potential for exposure to ethylene oxide, but even in this group the excess of deaths was small (2.6 expected). CONCLUSIONS: The balance of evidence from this and other epidemiological investigations indicates that any risk of human cancer from ethylene oxide is low, particularly at the levels of occupational exposure that have occurred in Britain over recent decades. This may reflect the capacity of human cells to repair DNA damage caused by the chemical, which is a potent genotoxin and animal carcinogen.