[Health status of redundant ship employees. Results of a cross-sectional study in a 3-year prospective study].
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Biomedical subjects
Publications and source records attributed to S Sabroe.
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The effect of moderate to heavy exposure to alcohol and tobacco on the risk of cancer of the hypopharynx is estimated in a case-control study. All incident hypopharyngeal cancer patients in Denmark who were under 75 years of age were compared with incident cases of laryngeal cancer and population sampled controls. The ascertainment of cases and controls took place during March 1980 to March 1982. Thirty-two patients with cancer of the hypopharynx, 321 patients with cancer of the larynx, and 1141 population sampled controls participated in the study. The effect of combined exposure to alcohol and tobacco seemed to be multiplicative rather than additive, a finding which is similar to that in laryngeal cancer patients. However, as there were only small numbers, only major deviations from the additive or multiplicative model for interaction would be detectable.
The purpose of the study was to examine the occupational history of laryngeal cancer patients, and especially their exposure to welding. The investigation was conducted as a case-control study where all newly diagnosed patients less than 75 yr of age with cancer of the larynx in Denmark during March 1980 to March 1982 were selected as cases. For each case, four age- and sex-matched controls were identified from the municipal person register in which the case was listed. Data were collected partly by means of questionnaires and partly by abstracting information from the medical records of cases. Workers exposed to welding fumes had a slightly increased risk of cancer of the larynx, most predominantly of cancer of the subglottic area.
In a case-control study of all new cases of laryngeal cancer in Denmark from 1980 to 1982, 326 cases and 1134 community selected controls participated. Questionnaires were used to obtain information on education, occupation, and number of occupational exposures as well as smoking and drinking habits. High risk ratios for laryngeal cancer were found for semiskilled and unskilled workers, workers exposed to dust, out of doors workers, drivers, and people working in the cement industries and port services. The study hypothesis was that exposure to chromium or nickel increases the incidence rate of laryngeal cancer. No support for this was found concerning chromium, but exposure to nickel had a statistically significant risk ratio of 1.7.
Summing up information from interview or questionnaire data into a single number, an index, is not uncommon in social medical research, but the conceptual and mathematical background for this is too often neglected. The so-called "Rasch models" specify circumstances where a single index can be used. The necessary computer programs for doing this are now generally available (10, 11). Two often used questionnaires concerning neurotoxicity due to solvent exposure are tested using a Rasch model. None of the questionnaires were found to be in agreement with the necessary requirements for the model and no single number describes the respondent's degree of neuropsychiatric dysfunction. Much more work is needed before a suitable screening questionnaire is available.
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The objectives of this study were to estimate the incidence of receiving an early retirement pension among a group of skilled workers and to examine the pattern of the major categories of diagnoses for which pensions were awarded. During the period April 1, 1971 to March 31, 1976, 589 union members were awarded disability pensions and 361 were awarded early old-age pensions. The incidence density of disability pensions is very low among young union members but is observed to increase with age. The Standard Disability Ratio also increases with age, indicating that the age-specific disability pensioning rate increases more rapidly among union members than among the standard population of all men in Denmark. The low rate of pensioning observed among young union members is probably due to healthy worker selection. Low Standard Disability Ratios are found for early old-age pensioners when a standard population of all men in Denmark is used. An examination was made of the diagnoses for which disability pensions were awarded in the two largest occupational sub-groups of the union, cabinet makers and carpenters. Carpenters were found to have high Standard Proportional Ratio for the category "accidents" while cabinet makers have high ratio for the category "diseases of the nervous system".
A case-reference study was conducted to estimate the association between neuropsychiatric diseases leading to early retirement pensioning and exposure to organic solvents in the Danish wood industry. Cases were defined as all members of the Carpenter/Cabinet Makers' Trade Union who were diagnosed with a neuropsychiatric disease and received disability or early old-age pensions during the period January 1, 1971 to December 31, 1975. The case group comprised 171 disability pensioners and 35 early old-age pensioners. A reference group of equal size was selected among union members with other diseases who were pensioned over the same time-period. Controls were matched to cases according to age and type of pension. Among a total of 412 eligible study subjects, 342 (i.e., 287 disability pensioners and 55 early old-age pensioners) could be located in 1978. Of these, 9.8% of the disability pensioners and 12.7% of the early old-age pensioners did not respond to the questionnaire. Information regarding occupational exposure and vocational training was obtained both directly from study subjects and from the files of the trade union. Medical diagnoses were obtained through registry linkage and by manual search of hospital records. Former employees with high levels of exposure to organic solvents were more likely to receive disability pensions for neuropsychiatric reasons compared to more modestly-exposed individuals. Cabinet-makers and especially cabinet-makers with high exposure to lacquers and glues had a higher risk of receiving a disability pension for a neuropsychiatric disease than carpenters. Possible sources of bias are discussed in the article.
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The effect of selection on the mortality of members of the Danish carpenters and cabinet makers trade union is reported. Some 40 000 persons entering or leaving the Union between January 1971 to June 1976 were followed until September 1977, and deaths identified by record linkage with the central person-register. The male leaving cohort had a statistically significant higher age adjusted mortality rate than the male entry cohort with a relative death risk of 1.65. For females the difference was not significant but the relative death risk was estimated to be 1.42. Males leaving to or coming from well paid and socially esteemed jobs had significant lower mortality rates than the remainder. The influence of these results on the choice of study design is discussed.