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PubMedDate not supplied

The healthy worker effect in major league baseball revisited.

We investigated the "healthy worker effect" (HWE) in major league baseball. Ages of death of major league baseball players who debuted between 1900 and 1939 were obtained and differences between those ages and age-adjusted life expectancies were examined to determine if longevity increased with career length, controlling for decade in which a player debuted, player position, and handedness. Major league baseball players (N = 4,492) lived an average of 4.8 (+/- 15.0 Standard deviation [SD]) years longer than age-matched controls from the general public. Career length significantly and incrementally increased longevity of players from an average of 4.1 years for players playing one season to 7.4 years for players playing 11 or more years. None of the other factors, nor any of the interactions, was statistically significant. These data provide strong support for the HWE in professional baseball.

Baseball↗
PubMedDate not supplied

The healthy worker effect in professional football.

We investigated the "healthy athlete effect" (HAE) in American professional football. Ages of death of professional football players who debuted prior to 1940 were obtained and differences between those ages and age-adjusted life expectancies were examined to determine if longevity increased with career length, controlling for birth year, body mass index (BMI), position, and type. Professional football players (N=1,512) lived an average of 6.1 (+/- 11.9 SD) years longer than age-matched controls from the general public. Career length significantly and incrementally increased longevity of players from an average of 5.5 years for players playing one season to 6.7 years for players playing 4 or more seasons. Both birth year and BMI had a statistically significant association with longevity, but position type did not. These data provide strong support for the healthy worker effect (HWE) in professional football.

Body Mass Index↗
PubMed1996

[Methodology for controlling healthy worker effect on coal miners' mortality].

This paper reports how to control the healthy worker effect (HWE) in a mortality study of coal miners. We used four methods, namely (1) age-specific corrective coefficient, (2) proportional mortality ratio (PMR), (3) corrective standarized mortality ratio (CSMR), and (4) a control group composed of factory workers. The results showed that all these methods could control HWE, and the total mortality in the coal miner group was significantly higher than that of the general population group (P < 0.05). However, the best way for controlling HWE awaits further studies.

Adult↗
PubMed1989

Occupational cohort studies: the influence of design characteristics on the healthy worker effect.

A cross-sectional analysis of the relation between the estimated healthy worker effect (HWE), as measured by a total Standardized Mortality Ratio (SMR) less than 100, and relevant design characteristics in 270 published retrospective occupational cohort studies is presented. The majority of the reviewed studies showed a HWE, varying in SMR from 50 to 99 (mean: 84). The estimated HWE seemed to influence the final outcomes of the studies to a great extent. A tendency for a positive relation between the study size in terms of the number of exposed workers, total number of person-years of follow-up, and the HWE emerged. Studies with a comparatively short follow-up period had an increased chance of resulting in a HWE. Cross-sectional cohorts did not show a stronger HWE than open cohorts. Studies of chemical exposures revealed a fivefold excess of having a HWE compared with other studies.

Cohort Studies↗
PubMed1999

A review of the healthy worker effect in occupational epidemiology.

This review article aims to anatomize sources of the healthy worker effect (HWE) and to summarize advantages and limitations of several approaches frequently proposed to eliminate the HWE. Although the HWE is frequently addressed in the context of selection bias, our review suggests that the selection of occupational cohorts with advantageous health status would preferably be addressed as a source of confounding biases. The authors also conclude that the exclusion of unhealthy workers at employment and the study of active workers are the two main sources of HWE, and that the use of the general population as a comparison group in occupational epidemiology should be avoided if possible. The authors encourage investigators to make distinctions between the underlying factors related to the use of the general population as the comparison group in occupational epidemiology.

Bias↗
PubMed1984

Mobility of diesel versus non-diesel coal miners: some evidence on the healthy worker effect.

Workers who are particularly susceptible to the effects of their occupational exposure, from the perspective of the healthy worker effect, soon leave the workplace. The result of this mobility, called survival bias, is that cross sectional studies based on the survivors underestimate the true risk of occupational exposures. Two questions are addressed in this empirical study of the "survival bias" component of the "healthy worker" effect. Do miners with respiratory impairment or symptoms disproportionately leave jobs that have a potentially harmful respiratory exposure? And does the presence of an additional potentially harmful respiratory exposure, in this case diesel emissions, accelerate the rate of mobility for miners with respiratory impairment or symptoms? No confirmation was found for the survival effect in a study of 738 diesel and 420 non-diesel US underground coal miners. No additional increment in mobility was associated with exposure to both coal mine dust and diesel emissions.

Adolescent↗
PubMed1988

Mortality odds ratio, proportionate mortality ratio, and healthy worker effect.

The standardized proportionate mortality ratio (PMRi) and the mortality odds ratio (MORi) are two statistics used to approximate the cause specific standardized mortality ratio (SMRi) when death data are available but the population at risk is not known. When there is a healthy worker effect, the MORi will always overestimate the SMRi and will always be greater than the PMRi. The PMRi is influenced by the relative frequency of the cause of death. For rare causes, such as brain cancer or leukemia, the PMRi will overestimate the SMRi to essentially the same degree as the MORi. For more common conditions, such as lung cancer, the PMRi will overestimate or underestimate the SMRi depending on the magnitude of the healthy worker effect. When the SMRi = 1 and there is a healthy worker effect, both the PMRi and MORi are in excess of one (1) regardless of the disease rate. As the SMRi increases it is more likely to be bounded by the PMRi (lower) and the MORi (upper). We therefore recommend that each statistic be derived when death certificates are the only source of data used to assess risk due to occupational exposures.

Environmental Exposure↗
PubMed1980

Healthy worker effect in the total Finnish population.

The selection due to the "healthy worker effect" was estimated from a random sample of the total Finnish population. The sample of 20 000 people was followed for changes in occupations from 1960 to 1970 and for deaths in 1971-5. Those entering the active work force had a standard mortality ratio of 70, indicating a healthy population selection effect. Those staying in the same occupational category from 1960 to 1970 had a 20% lower mortality than those who did not. This survivor population effect was due to changes to another occupational group and to early retirement. These factors had an inverse effect on the survival history of an occupational group.

Adult↗
PubMed2007

Lung function and farm size predict healthy worker effect in swine farmers.

BACKGROUND: Swine farmers are exposed to a number of airborne contaminants associated with respiratory ill health. OBJECTIVES: To examine the factors associated with healthy worker effect in the swine industry from a longitudinal follow-up of farmers at 4 years and 13 years. DESIGN: A prospective study of swine farmers and nonexposed rural residents was conducted using similar questionnaires and same spirometer at each time point. RESULTS: In the original observations in 1990/1991, we studied 302 swine farmers and 261 nonfarming control subjects. Four years later in 1994/1995, 217 swine farmers and 171 nonfarming control subjects of the original group participated again. In 2003/2004, 163 swine farmers and 118 control subjects were retested. Of the 163 swine farmers, 52 remained active swine farmers and 111 were no longer swine farming, thus providing the opportunity to evaluate work continuity in the industry. Among farmers studied in 2003/2004, mean values for percentage of predicted FEV(1)/FVC ratio and forced expiratory flow between 25% and 75% of FVC were lower in those who had quit swine farming compared to those still swine farming and nonfarming control subjects. The herd size in the barn at baseline in 1990/1991 and at interim follow-up in 1994/1995 was a significant predictor of quitting swine farming. In addition, percentage of predicted FEV(1)/FVC at the interim observation was a significant predictor of quitting swine farming. CONCLUSIONS: There is a significant healthy worker effect among swine farmers. The continuation of work in the facilities may be predicted by herd size and interim lung function.

Adult↗
PubMed1987

Models of the healthy worker effect in industrial cohorts.

The patterns of standardized mortality ratios (SMRs) with duration of follow-up and duration of service which are characteristic of the healthy worker effect in occupational cohort studies have been simulated using models of selection and survivor effects. The models support current theories about the population dynamics which underlie the selection effect but highlight inadequacies in our understanding of the survivor effect. Several possible models were tested and methods of generating appropriate data are discussed. It is important that the healthy worker effect should be better understood as it can present so large a problem in the interpretation of occupational risk estimates.

Adolescent↗
PubMed2001

Mathematical procedure to adjust for the healthy worker effect: the case of firefighting, diabetes, and heart disease.

This article presents a mathematical procedure to adjust for one component of the healthy worker effect (HWE), namely, the healthy hired effect, on diabetes in the case of firefighting and heart disease. Three examples from real studies are given to illustrate, step-by-step, the application of the mathematical procedure. The mathematical procedure can be applied to adjust for other components of the HWE (e.g., the low-risk hired effect on obese individuals and smokers). In such cases, additional information will be needed to use the mathematical procedure. Results of applying the mathematical procedure in the case of firefighting and heart disease revealed the rather unexpected results that adjusting for diabetes selection on hiring leads to only a 3% to 9% increase in the magnitude of ratio statistics such as the standardized mortality ratio. It might be argued that the HWE from one component such as the healthy hired effect on diabetes might be small, but together with other components, the HWE might be large. Further investigation will be needed to support this argument.

Adult↗
PubMed1976

Standardized mortality ratios and the "healthy worker effect": Scratching beneath the surface.

The age-standardized mortality ratio (SMR) is a relative index of mortality, expressing the mortality experience of the study population relative to that of a comparison ("standard") population. With the general population as the "standard", the SMR for an occupational population will underestimate the mortality experience of that latter population (since it comprises individuals necessarily healthy enough to be employable --and whose mortality risk is therefore initially lower than the general population average). However, this "healthy worker effect" does not equally to all groups within the study population. Therefore, if one attempts to adjust for this effect, the summary nature of the SMR must be recognized, and allowance must be made for variation in the healthy worker effect between different age groups, different races, different work-status groups, different causes of death, and different elapsed-time periods of observation.

Adult↗
PubMed1999

Is there a healthy worker effect for cancer incidence among women in Sweden?

BACKGROUND: Our aim was to evaluate whether there is a healthy worker effect (HWE) for cancer incidence among women. HWE is a bias found in occupational studies that compare rates of disease among employed people to disease rates for the general population, which includes unemployed people (who may be less healthy than those who are employed). METHODS: Data from the 1960 and 1970 Swedish censuses were used to identify all 1,659,940 Swedish women who were employed in either year. They were followed during 1971-1989 through linkages to the national cancer and death registers. Standardized incidence ratios (SIRs) were computed comparing employed women to the 1,627,873 women who were not employed in either 1960 or 1970. RESULTS: For the 545,857 women employed in both 1960 and 1970, the SIR for all cancers combined was 1.05 (1.04-1.06). When specific cancer sites were analyzed separately, the highest cancer risks were for cancers of the lung and bladder (SIR = 1.2) and reproductive organs (breast, ovary, endometrium, and cervix SIR = 1.1). Overall cancer risks were highest among full-time workers, younger workers, urban workers, and workers with the highest socioeconomic status (based on the woman's job title). CONCLUSIONS: These results show no general HWE for cancer incidence among employed Swedish women.

Adult↗
PubMed1995

A Mailed-questionnaire Survey of Ex-workers: A Tool to Evaluate the Healthy-worker Effect in Cross-sectional Studies.

In order to evaluate a possible healthy-worker effect in a cross-sectional study in a viscose rayon plant, a survey of ex-workers was conducted. From the personnel records of this factory, 475 male, Caucasian, Dutch-speaking, carbon disulfide (CS&inf2;)-exposed workers who had been employed ten years prior to the cross-sectional study were selected for study. Of these, 142 were still employed in the same plant, and 64 were deceased. Retrieval of the causes of death proved impossible. A questionnaire was mailed to the remaining 269 men, of whom 149 completed and returned it. Eighty-nine subjects reported having left the plant for health reasons. Among the health reasons specified, eye-irritation complaints were most often mentioned (53.7%), followed by gastrointestinal complaints (32.8%), complaints concerning the central nervous system (19.4%) and the peripheral nerves (11.9%), heart or lung problems (14.9%), and problems affecting the skin (9.0%). The average duration of employment decreased significantly with the intensity of the exposure to CS&inf2;. The results suggest that the findings of a cross-sectional study of current workers in the same viscose rayon plant may represent underestimates of some conditions, in particular the acute eye-irritation complaints. Other complaints with high prevalences in the cross-sectional study, such as complaints consistent with polyneuropathy, seemed less, while others, such as impotence, seemed not at all, subject to underestimation.

Journal Article↗
PubMed1986

Observations on the healthy worker effect.

Follow-up mortality data from ten groups of employed persons are compared to the mortality rates of the United States general population. Comparisons related to the healthy worker effect (HWE) are computed. As measured by a relative comparison, the standardized mortality ratio (SMR), the HWE is seen to have a dynamic phase and a plateau phase in relation to length of follow-up. In contrast, the HWE as measured by an absolute comparison has little relationship to length of follow-up. Age at entrance into follow-up is strongly related to the absolute risk of mortality, but has little or no relation to the relative risk (SMR). Issues related to the evaluation and minimization of the healthy worker effect are discussed.

Adult↗
PubMed2005

Effect of psychiatric illness and labour market status on suicide: a healthy worker effect?

STUDY OBJECTIVE: To describe the association between labour market status and death by suicide with focus on admission with a psychiatric disorder. DESIGN: Nested case-control study. Data from routine registers. SETTING: Entire Danish population. PARTICIPANTS: 9011 people aged 25-60 years who committed suicide during 1982-1997 and 180 220 matched controls. MAIN RESULTS: In the general population, not being fully employed is associated with a twofold to threefold increased relative risk of death by suicide, compared with being fully employed. In contrast, fully employed people who have been first admitted to a psychiatric hospital within the past year are at increased suicide risk. Patients who are unemployed, social benefits recipients, disability pensioners, or otherwise marginalised on the labour market have a suicide risk of 0.60 (95% CI: 0.46 to 0.78), 0.41 (0.23 to 0.74), 0.70 (0.45 to 1.08), and 0.86 (0.53 to 1.41), respectively. Although a similar risk decrease is found in women, men, people younger than 30 years, people older than 45 years, and in people who become unemployed, the reversed effect attenuates with time since admission, and little association is seen when a marginal structural model is applied. CONCLUSIONS: Although the results show an increased suicide mortality associated with unemployment and labour market marginalisation in the general population, the results suggest little or an inverse association between unemployment and suicide in people with psychiatric illness. The associations seen suggest the need to consider healthy worker selection effects when studying the causal pathway from unemployment and psychiatric illness to suicide.

Adult↗
PubMed1989

[Healthy worker effect on Japanese industry workers: a commentary from the viewpoint of industrial health management].

Healthy worker effect (HWE), which can be described as a lower death rate within a work force when compared to the general population, has been observed in many epidemiological mortality studies on industrial work populations free of significant life-shortening hazards. The purpose of this report is to evaluate this effect on the active work populations engaged in large scale manufacturing companies in Japan, and to appreciate the possible attributable factors to this phenomenon. Standardized mortality ratios (SMRs) were calculated for workers in the member companies of The Japan Iron and Steel Federation (JISF) and The Japan Chemical Fibers and Textile Association (JCFTA), where mortality surveillance systems have been established. SMRs for all causes of death from 1969 to 1981 were within the range of 50 to 81 in JISF, and 34 to 41 in JCFTA. These results point to the existence of strong HWE, equal to or even lower than the reported values in some industrial populations in the United States. An evident HWE for cancer was also observed in the study populations, but it was reported to be of little significance, if at all, in the United States. HWE can be considered as a composite result of factors such as: (1) selection of healthier work force, (2) risk reduction due to life style modification during employment, and (3) methodological characteristics of the SMR, which are dependent on the percentage of active workers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗