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PubMed1988

A mortality study of vinyl chloride monomer workers employed in the United Kingdom in 1940-1974.

The mortality experience of 5,498 male workers employed for at least one year during 1940-1974 in the vinyl chloride industry of the United Kingdom was followed through to 31 December 1984. There was a significant excess of nonsecondary liver tumors with 11 deaths, of which seven were angiosarcomas. All the angiosarcoma deaths occurred in autoclave workers with a median latency of 25 years from date of first exposure. A strong healthy worker effect was seen. Other than that for liver cancer, no increased incidence of cancer deaths attributable to vinyl chloride monomer exposure was found. There was no evidence of increased mortality from chronic liver disease. The incidence of death from respiratory disease was low and was not affected by polyvinyl chloride dust exposure.

Adult↗
PubMed1995

Mortality among Icelandic nurses.

OBJECTIVE: The goal of the study was to investigate the mortality pattern of female nurses in a retrospective cohort study with special focus on suicide. METHODS: The mortality of nurses was compared with that of the general female population. The main outcome measure was the standardized mortality ratio (SMR). The participants were 2159 female nurses (ie, all registered nurses in Iceland between 1920-1979). RESULTS: A long-lasting healthy worker effect was found in the cohort. A moderate excess of suicide was observed. A deficit was found for stomach cancer, ischemic heart disease, and respiratory disease. When the cohort was divided according to employment time, there was an excess of brain cancer among those with an employment time of less than 20 years, and all the suicides occurred in that group. The deficit of ischemic heart disease and respiratory disease was more pronounced in the group employed more than 20 years. CONCLUSIONS: It was concluded that nurses, primarily those with a long employment time, enjoy the benefits of their initial good health, but the moderate excess of suicide could be associated with stress and frustration, which the nurses relate to their work situation.

Adult↗
PubMed2001

Reevaluation of lung cancer risk in the acrylonitrile cohort study of the National Cancer Institute and the National Institute for Occupational Safety and Health.

OBJECTIVES: The present study provides additional analyses of data obtained earlier on lung cancer risk among workers with acrylonitrile exposure. METHODS: The original authors provided the data. For total mortality and the cancer sites of a priori interest (lung, stomach, brain, breast, prostate, and the lymphatic and hematopoietic systems), standardized mortality ratios (SMR) and 95% confidence intervals (95% CI) were computed, the total United States and surrounding counties being used as standard populations. Regional rate-based SMR values were also computed between lung cancer and cumulative acrylonitrile exposure. RESULTS: Except for lung cancer, the external comparisons corroborated the earlier internal comparisons (no increased cancer mortality risk). For lung cancer, the external comparisons revealed death deficits for the unexposed workers (SMR 0.68, 95% CI 0.5-0.9) and all categories of acrylonitrile-exposed workers. The SMR obtained using external rates and the most exposed group (SMR 0.92. 95% CI 0.6-1.4) differed from the corresponding relative risk (RR) of the internal rates (RR 1.5, 95% CI 0.9-2.4). CONCLUSIONS: The analysis of the present study provides little evidence that acrylonitrile exposure increases the mortality risk of cancers of a priori interest, including lung cancer. The lung cancer findings of the external comparison differed from the earlier findings of the internal comparisons. Selection bias (as the healthy worker effect) was probably not responsible. Additional follow-up and analyses, especially of the unexposed workers with low lung cancer rates, may help elucidate the internal and external comparison differences. Results from both comparisons should be presented when the relative risks differ markedly, as both have advantages and disadvantages.

Acrylonitrile↗
PubMed2005

Time to pregnancy among Danish laboratory technicians who were a part of the National Birth Cohort.

OBJECTIVES: The Danish National Birth Cohort was used to examine whether laboratory work was associated with reduced fecundity. METHODS: Self-reported data on laboratory work and waiting time to pregnancy (0-2, 3-5, 6-12 and > 12 months) were used for 829 female laboratory technicians interviewed in 1997-2003. Altogether 6250 female teachers formed the reference group. A discrete-time survival analysis with a complementary log-log link was applied to estimate the fecundability ratio between the exposed and unexposed women, with adjustment for maternal age, gravidity, smoking, prepregnancy body mass index, and paternal job. RESULTS: No difference in time to pregnancy was found between the laboratory technicians and teachers or between the laboratory technicians with different exposures. The adjusted fecundability ratio for the laboratory technicians was 0.94 [95% confidence interval (95% CI) 0.86-1.02] for all pregnancies and 0.98 (95% CI 0.86-1.13) for first pregnancies. A healthy worker effect was found for the laboratory technicians working with the work processes under study. CONCLUSIONS: The results do not suggest that laboratory work in Denmark at present impairs female fecundity.

Adult↗
PubMed1995

Mortality in the New South Wales coal industry, 1973-1992.

OBJECTIVE: To study the mortality of coalminers in New South Wales (NSW) between 1973 and 1992. DESIGN AND PARTICIPANTS: An inception cohort of all male coal industry employees who entered the industry between 1 January 1973 and 31 December 1992 was constructed from the records of Joint Coal Board medical examinations. This cohort was matched with the NSW Death Register to determine the number and causes of deaths in cohort members. RESULTS: The cohort consisted of 23,630 men; 491 died during the study period. The standardised mortality ratio (SMR) for all causes of death was 0.76; that is, after age correction, coalminers have a 24% lower mortality than the general NSW population. Deaths from cancer were lower than expected, and there was a 27% lower mortality from respiratory disease. However, a substantial excess of non-motor-vehicle accidents (SMR, 1.60) was found. Most of these deaths can be attributed to occupation, and some to specific incidents. These excess death rates are confined to underground miners; open cut miners have a substantially lower rate than the general population. CONCLUSIONS: A "healthy worker" effect may explain the lower overall mortality. Although "black lung" is no longer a problem, accidents are still common in underground coalmining. The major expansion of open cut mining in recent years has improved the situation.

Accidents, Occupational↗
PubMed1999

[Immunological reactions and health complaints in biological refuse personnel and composting by biological aerosol exposure].

Employees in waste treatment industries are exposed to high levels of airborne microorganisms. Concentrations of 10(7) cfu/m3 air were measured in composting facilities, whereas exposures of bio-waste collectors were two orders of magnitude lower with exposure peaks up to 10(6) cfu/m3 air. These exposures were compared to specific antibody levels against molds and actinomycetes, work related health complaints, and diseases of the workers. 72 bio-waste collectors and 77 compost workers were examined and interviewed for work related symptoms, current occupational exposures, smoking habits, and exposures from other sources (farming, bird breeding, gardening) by physicians specialized in occupational medicine, using a standardized protocol. Levels of specific IgG antibodies to molds and actinomycetes occurring regularly at these workplaces were determined as biomarkers of exposure. The exposure data from the workplaces indicate a higher exposure of compost workers compared to bio-waste collectors. This corresponds with significantly increased health complaints of the upper airways and the skin and higher concentrations of specific antibodies against molds and actinomycetes in the compost workers. Atopic diseases were underrepresented in the compost workers compared to bio-waste collectors and population based data, indicating a healthy worker effect in this group. Occupational diseases from airborne microorganisms eligible for insurance compensation were observed in waste treatment facilities. More detailed studies are needed for exact assessment of health risks of workers in these industries.

Actinomycetales↗
PubMed2000

[The assessment of the coronary risk in a work setting. The results of the SEMM study and the outlook for prevention in Italy. Surveillance of Employees Municipality of Milan].

BACKGROUND: The goals of the present report are to assess the differences in distribution of traditional coronary risk factors in a work setting, aimed at identifying specific groups at risk and to compare mean values of such risk factors and of an overall risk score of the entire working sample with the results observed in the third WHO-MONICA population survey carried out in northern Italy (Area Brianza). METHODS: In the SEMM study 7872 employees (2601 men and 5271 women) were enrolled between 1992 and 1996. The third MONICA survey in Brianza was carried out on an age- and gender-stratified random sample of 831 men and 884 women in 1993-1994, selected from the 25-64-year-old residents of five municipalities, representative of the study population. In both studies coronary risk factors were measured according to the MONICA protocol, adopting standardized methods. RESULTS: In comparison with the MONICA population sample, the entire working group showed lower mean levels of blood pressure and total cholesterol, higher prevalence of current cigarette smokers and lower mean levels of HDL cholesterol, in both gender groups. Prevalence of overweight subjects was higher among men in the working group, but the opposite pattern was detected in women. The overall risk score, calculated using the coefficients of a proportional hazard survival equation estimated in a large collaborative Italian follow-up study, resulted lower in the working sample, in both gender groups. This result may be attributed to a selection bias known in occupational epidemiology as "healthy worker effect". In contrast to this finding, the prevalence of smokers, in particular among women, was higher in the employed sample, indicating that working stress conditions may play some role. CONCLUSIONS: In order to extend the assessment of cardiovascular risk factors as well as prevention activities in work settings, some advantages are highlighted: the high participation rates, the feasibility to adopt standardized protocols, and easier and cheap procedures for censoring in follow-up studies. Moreover, due to the recently adopted legislation in Italy which increases the number of working categories to be included in periodic clinical examinations, prevention activities in work settings to contrast the epidemic of widespread chronic diseases, like cardiovascular diseases, are encouraged. This will also allow for the investigation of individual variations over time of coronary risk factors.

Adult↗
PubMed2001

Cancer mortality in rubber tire workers in Poland.

The study aimed at assessing cancer risk in a cohort of workers employed in the rubber tire production. The cohort consisted of 17,747 workers (11,660 men and 6087 women) employed in a rubber tire plant for at least three months during the years 1950-1995. The cohort follow-up was completed on December 31, 1995. Deaths by causes were analyzed using standardized mortality ratio (SMR) calculated by the person-years method. The mortality pattern of the general population of Poland was used as the reference. The study indicated significantly lower total mortality in the cohort (men: SMR = 72; women: SMR = 62) as compared to the general population, which is an example of a well known "healthy worker effect". The number of deaths from malignant neoplasms was also lower than expected (men: SMR = 67; women: SMR = 64). Only in a very small sub-cohort of men involved in dosing and mixing of raw material for the production of rubber, an excess of total mortality (SMR = 104) and from all cancers (SMR = 115) was found. Mortality from all neoplasms was enhanced (SMR = 108) in the sub-cohort of women employed in the technical service work area. When analyzing individual cancer sites in men of the whole cohort or sub-cohorts, the observed number of deaths from cancers of the lip, tongue, pharynx, stomach, gallbladder, pancreas, peritoneum, articular cartilage, connective tissue, skin, testis, prostate, bladder, kidney, brain, as well as from Hodgkin's disease, multiple myeloma and leukemia was larger than the expected number. Among women the excess mortality was due to cancers of the large myeloma and leukemia. The SMR calculated for these sites were statistically insignificant. The cohort under study was "young" and thus relatively small numbers of deaths were recorded. The excess mortality, based quite frequently on single cases of selected cancer sites, cannot be regarded as a basis for final conclusions. Nevertheless, the fact that these observations are in agreement with the findings of other authors who carried out studies in the rubber industry of other countries justifies the need to follow-up this cohort in the future.

Adult↗
PubMedDate not supplied

[Anxiety, life style and obstetric history of women working in a high-fashion clothing industry].

Women with a mean age of 38 years (range 20-62) were employed in an industry producing clothes of high fashion. A part of them (n = 210) performed their activities with hands and others (n = 90) utilising machines with more repetitive procedures. All the recruited women answered to a questionnaire including the state-trait anxiety inventory (STAI) test, working activities, lifestyle and obstetric history. There was no relation between obstetric history and working activities. The group of women with age ranging from 35 to 42 years showed the score of the STAI higher than that of the younger women and slightly lower than that of the subjects with older age. This may depend on the "healthy worker effect" in the old subjects able to continue their job. The scores of the STAI were also slightly influenced by the repetitive tasks utilising machines. On the whole, the working activity of women had beneficial effect on their role inside the family and in the social life.

Adult↗
PubMedDate not supplied

[Cause of death among workers of a refinery in Rome].

We evaluated mortality among subjects employed in an oil refinery plant in Rome, Italy. We studied two subgroups of refinery employees: blue collar and white collar workers. A total of 682 men (505 blue collars, 148 white collars, 29 unknown) employed between 1965 and 1992, were followed up for mortality since employment in the plant to July 1999. Standardized Mortality Ratios (SMR), and their 90% Confidence Intervals (90% CI), comparing mortality rates of the cohort members with those of the general population of the Lazio region. For blue collar workers, we performed analyses by latency since first employment and by duration of employment for selected cancer sites. We observed 94 total deaths (100.8 expected) (SMR = 0.93; 90% CI = 0.78-1.11) among blue collar workers and 16 total deaths (31.7 expected) (SMR = 0.50; 90% CI = 0.32-0.77) among white collar workers, and a large deficit of deaths from non-neoplastic cardiovascular diseases (respectively SMR = 0.60; 90% CI = 0.41-0.86 and SMR = 0.18; 90% CI = 0.03-0.56). All cancer mortality was slightly increased only in blue collars (SMR = 1.27 CI = 0.97-1.65). There was an excess risk from cancer of the lung (20 obs SMR = 1.80, 90% CI = 1.19-2.62), bladder (5 obs SMR = 3.19, 90% CI = 1.26-6.72), and benign/unspecified cancer of the brain (4 obs SMR = 4.11, 90% CI = 1.12-10.6). The lower mortality from cardiovascular disease indicates the presence of a strong healthy worker effect. The findings of elevated mortality from cancer of the lung and bladder in blue collar workers are in agreement with those of other studies. Confounding factors from cigarette smoking might have played only a marginal role in influencing the results. Exposure to polynuclear aromatic hydrocarbons (PAHs) is a plausible explanation for the excesses found.

Cardiovascular Diseases↗
PubMed2001

[Exposure to electromagnetic fields and risk of central nervous system diseases among employees at Danish electric companies].

INTRODUCTION: Occupational exposure to electromagnetic fields has been associated with neurological diseases, such as amyotrophic lateral sclerosis, senile dementia, Parkinson's disease and Alzheimer's disease. MATERIAL AND METHOD: I studied the incidence of disease in the central nervous system in 30,631 persons employed at Danish electric companies between 1900 and 1993. I linked the cohort to the nationwide, population-based Danish National Register of Patients and compared the number of cases of these diseases found between 1978 and 1993 with the corresponding rates in the general population. In addition, I fit the data on utility workers to a multiplicative Poisson regression model in relation to estimated levels of exposure to 50 Hz electromagnetic fields. RESULTS: Overall, there was an increase in the risk of senile dementia and motor neuron diseases combined. The incidences of Parkinson's disease, Alzheimer's disease and other diseases of the central nervous system were essentially unrelated to exposure to electromagnetic fields. A decreased risk of epilepsy compared with the general population probably reflects a healthy worker effect; I observed an increased risk of epilepsy based on internal comparisons. DISCUSSION: The increased risk of senile dementia and motor neuron diseases may be associated with above average levels of exposure to electromagnetic fields.

Alzheimer Disease↗
PubMedDate not supplied

Mortality of a cohort of road construction and maintenance workers with work disability compensation.

BACKGROUND: Surveillance systems of occupational mortality are useful tools to identify cases of diseases suspected as occupational and to monitor their occurrence over time, in space and in population subgroups. Many surveillance systems make use of administrative data in which information about occupations and/or economic sectors of the subjects enrolled is reported, such as death certificates, hospital discharge data, census data, tax and pension records, and workers' compensation archives. OBJECTIVES: In the present study we analyzed the mortality of a cohort of road construction and maintenance workers enrolled through the Italian national archive of work disability compensations, also in order to evaluate the possible use of this administrative source to monitor occupational mortality. METHODS: 8,000 subjects (7,879 males) receiving a disability compensation while working in the "road construction and maintenance" sector were identified from INAIL (National Institute for Insurance of Accidents at Work) archives. Vital status of these subjects was ascertained using the information available in INAIL archives and in the national tax register. For those found to be deceased from INAIL or tax archives, or without any information on vital status, a mail follow-up was started. We considered as observation period the years from 1980 to 1993. A record linkage with the ISTAT (Italian Institute of Statistics) national mortality registry was performed and the cause of death was retrieved for 964 out of 1,259 subjects. The analysis was restricted to males, leaving altogether 863 observed deaths with ascertained cause (84.7% of 1,019 total male deaths). SMR for overall mortality and PMR for specific cause mortality were computed, using the general Italian male population as reference. RESULTS: Overall mortality was significantly reduced (SMR = 79.0; 95% CI = 74.2-84.0). Proportional mortality analysis revealed significant excess risks for all malignant tumours (332 deaths, PMR = 1.08) and for digestive diseases (87 deaths, PMR = 1.34), while mortality for cardiovascular diseases was significantly decreased (288 deaths, PMR = 0.90). Among specific causes of death, significant excess mortality was found for cancer of testicles (2 deaths, PMR = 5.98), liver and biliary ducts (32 deaths, PMR = 1.40), and for silicosis (10 deaths, PMR = 3.07) and cirrhosis (64 deaths, PMR = 1.40). CONCLUSIONS: The excess mortality observed for all cancers, digestive diseases and silicosis, and the decreased risk for cardiovascular diseases are in agreement with the results of other studies conducted on workers in road construction and maintenance. As expected, the low overall mortality and the reduced risk from cardiovascular diseases indicate that these workers present a strong "healthy worker effect".

Cause of Death↗
PubMed2003

Cause-specific mortality among employees of a Texas-based chemical manufacturing facility, 1940 through 1996.

We identified and followed 27,795 Texas-based employees of The Dow Chemical Company from 1940 through 1996. Overall, the study population experienced favorable mortality patterns when compared with external populations. We observed lower death rates for several major causes of death, including heart disease and many cancers, which may be indicative of the "healthy worker effect" and the absence of major health hazards from these manufacturing facilities. Previous studies of the chemical company found higher-than-expected rates of lung, kidney, and brain cancer. More lung cancer deaths than expected continue to occur when the plant population is compared with the US and Texas populations but not with the local 5-county region. The numbers of brain and kidney cancers were also greater than expected, but the risk is attenuating. These findings, taken together with previously reported studies that examined these lung, kidney, and brain cancers relative to exposures to specific hazardous agents, do not suggest an occupational etiology.

Cause of Death↗
PubMedDate not supplied

[Epidemiologic study of workers exposed to vinyl chloride in Porto Marghera: mortality update].

The investigation describes mortality of vinyl chloride exposed workers in the Montedison-Enichem plant located in Porto Marghera, near Venice, Italy. A total of 1658 workers employed from start of production (1950), present in 1956 or successively hired until 1985, were followed up between 01.01.1973 and 31.07.1999, for a total of 41.037 person years at risk: 248 deaths were observed. Mortality from all causes compared with regional population was lower than expected, (SMR 0.75; 90% CI 0.68-0.83) and from all malignant neoplasms similar to expected (SMR 0.94; 90% CI 0.81-1.09). SMR for primary liver cancer was significantly increased (SMR 2.78 90% CI 1.86-4.14). In the first year since leaving employment observed mortality was significantly above the null value for all causes (SMR 2.76; 90% CI 1.94-3.91), all malignant neoplasms (SMR 1.89; 90% CI 0.97-3.92) and cardiovascular diseases (SMR 2.37; 90% CI 1.13-4.95). Mortality rates for liver angiosarcoma (6 cases) increased with latency (trend test x 2 (1df) = 25.20 p < 0.001) and cumulative exposure (trend test x 2 (1df) = 61.00 p < 0.001), there were no cases with duration of employment less than 12 years, latency less than 10 years and for cumulative exposure less than 2.379 ppm-years. Mortality rates for hepatocellular carcinoma (12 cases) and liver cirrhosis (20 cases) showed a similar pattern for cumulative exposure. Observed mortality from lung cancer was higher than expected among those workers whose only job title was bagger. In the analysis accounting for latency, age and calendar period the RR for only bagger was 2.31 (90% CI 1.15-4.61). Mortality pattern for all causes, all malignancies and cardiovascular disease increased by time since employment, as expected in presence of a particularly strong Healthy Worker Effect (HWE). These results and the increased SMR values during the first year since leaving employment indicate that workers were selected into employment on the basis of good health conditions and early selective removal of weaker ones followed. The study results confirm the causal relationship between VCM exposure and liver angiosarcoma, and add supplementary evidence in favour of a causal explanation of the excess risk for hepatocellular carcinoma and liver cirrhosis as well as lung cancer among only baggers.

Cause of Death↗
PubMed2003

Myocardial infarction (MI) at the work-site among Polish seafarers. The risk and the impact of occupational factors.

OBJECTIVES: To study the incidence of myocardial infarction (MI) on board ship, the impact of conditions of work on the mortality and survival rate, to analyze the recommendations and possible preventive interventions to reduce the loss of life at the work-site among Polish seafarers and deep-sea fishermen. METHODS: To use various sources of information for the retrospective study of the MI incidence among 11,325 Polish seamen and deep-sea fishermen. To analyse the impact of the marine environment and work-related factors on the course, treatment and prognosis of MI. The results were compared with the incidence and mortality rate of MI among general male workers population in Poland. RESULTS: In this retrospective study, 106 cases of the MI at sea were included. Their diagnosis was based on the medical documentation and legal investigation of cases. The most significant findings seem to indicate that the incidence of MI at the work-site among Polish seafarers was not higher than among general population of Polish males in the same decade, probably due to the "healthy worker" effect. However, the pre-hospital and one-month mortality due to MI were higher in the group of seafarers as compared to the group of general male population. The analysis of conditions of seafarers' work and life and the possibility of treatment at sea in a case of the MI on board strongly suggest that the work-related factors had significant impact on the loss of life among them. The preventive measures, very complex and difficult from the organizational and economic point of view, are still far from being recommended and implemented in the shipping industry. CONCLUSIONS: The study has confirmed that seafarers are at high risk of death in case of a MI on board. The impact of their work environment and work-related factors reduce significantly the chance of survival at sea in such cases. The preventive measures are difficult to implement.

Adult↗
PubMed1992

[Risks of cancer among workers of the nuclear industry].

The epidemiological studies on cancer incidence or mortality among workers in the nuclear industry have been reviewed in a comparative manner. The results concerning workers monitored for external radiation or internal contamination and those on female workers have been analysed separately. A lower cancer risk was found in most studies, which is explained by the "healthy worker effect"; no difference was found between the workers with or without a radiation record. A high rate was found for a few cancers at specific sites, but results were variable in the different studies and no relationship was found between cumulative dose and excess mortality due to cancer. A link between ionizing radiation, multiple myeloma and prostatic cancer was indicated in more than one study; in the latter case, there might be a relationship with internal contamination, especially by tritium. In spite of the difficulties and limitations involved, it is important to pursue these studies and pool them, in order to directly evaluate the risks of cancer following exposure to low-dose radiation and low dose rates, instead of calculating these by extrapolation from high doses.

Adult↗
PubMed1992

Mortality of former prisoners of war and other Australian veterans.

OBJECTIVE: This second summary article from an epidemiological review of the health of former prisoners of war (POWs) and other Australian veterans, commissioned by the Sir Edward Dunlop Medical Research Foundation, reports on studies of mortality. DATA SOURCES: The MEDLARS database, from 1966 to the present, under the terms military personnel, veterans, veterans' disability claims, combat disorders and prisoners (matched against war); databases of the Department of Veterans' Affairs (Victoria) and the Central Library, Commonwealth Department of Defense, under the term "prisoner of war"; and the microfiche listings of the Department of Veterans' Affairs, under "prisoner of war" and "repatriation". Only studies in English or French were reviewed, reaching a total of 172. STUDY SELECTION: Four studies in this paper constitute the main evidence about postwar mortality in Australians who were POWs of World War II or Vietnam veterans. Other mortality studies are cited in the complete literature review published elsewhere. DATA EXTRACTION: Only the data with an epidemiological basis are considered here. DATA SYNTHESIS: All-cause mortality rates were no greater in former POWs or Vietnam veterans than in the general Australian male population. There was, however, evidence of increased mortality among former POWs compared with other non-POW veterans, and among Vietnam veterans in one particular corps compared with veterans of the same era who served in Australia. CONCLUSIONS: Elevated early postwar mortality of young former POWs implicates diseases with short latent periods (including psychiatric disorders). This is consistent with the greater health risks of this group of survivors that were identified in the earlier review of morbidity. Mortality among former POWs and other veterans requires continued surveillance because a "healthy worker effect" (or exclusion of unfit persons from the armed forces) may partly conceal increased morbidity or mortality that should be attributed to war service.

Adult↗
PubMed2005

Development of a decision model to identify workers at risk of long-term disability in the construction industry.

OBJECTIVE: This study presents a decision model that predicts long-term disability among construction workers. METHODS: Risk factors were identified in two cohort studies among construction workers and evaluated in validation samples of smaller cohort studies among Dutch construction workers. The risk estimates (odds ratios) were used in a logistic regression model to calculate the probability of long-term disability in the next 4 years for a particular construction worker, subject to a specific combination of risk factors. The a priori probability was set equal to the overall long-term disability risk among the youngest construction workers (< 30 years) with a relatively short exposure history. RESULTS: According to literature findings, the risk estimate for work ability was set with the odds ratio at 2.0 for good work ability, 5.0 for moderate work ability, and 10.0 for bad work ability. Age-dependent risks were set at odds ratios of 1.5, 2.0, and 3.0 for the age groups of 30-34 years, 35-44 years, and 45-54 years, respectively. A sickness absence period of > or = 3 months had an odds ratio of 2.0, and severe musculoskeletal complaints had an odds ratio of 3.0. Since the number of construction workers older than 55 years was rather small and heavily biased by a healthy worker effect, it was decided to limit the applicability of the decision model to workers aged 20-55 years. The decision model used four risk factors and predicted a 40-fold difference in disability risk between construction workers with all four risk factors present (0.79) and those without any risk factor (0.02). CONCLUSIONS: The decision model presented the combined effect of different risk factors on the risk of an individual worker becoming disabled within 4 years. Evaluation studies will need to demonstrate whether the application of this decision model is helpful in identifying workers at risk for long-term disability and will facilitate appropriate intervention at the individual level.

Adult↗