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Database on the Standardized mortality ratio (SMR all causes and SMR all cancer) for various professions (706 cohorts/groups): the maximum "health worker effect" for cosmonauts and doctors

https://doi.org/10.31089/1026-9428-2023-63-3-179-192

Abstract

Researchers have formed a database for work on the evaluation of the indices of the "standardized mortality ratio" (SMR±95% confidence intervals — CI) in comparison with the general population for total mortality and mortality from all malignant neoplasms ("all cancers") for various professions and types of employment (mainly men). The database includes 689 publications (706 cohorts/groups, 67 professions and types of employment).

Experts have conducted an assessment the presence of the "healthy worker effect" (HWE) in the studies included in the database based on the criterion of the upper 95% CI value of less than one.

Among all professions and types of employment, scientists have identified HWE in total mortality only in 52%, and in mortality from all types of cancer — only in 28% of cohorts/groups.

HWE for both indicators simultaneously and only for total mortality occurred in 26% of cases. For 2% of the studies, there is an inverse relationship (absence of HWE for total mortality in the presence of an effect on mortality from all types of cancer), which is most likely accidental.

There were no strict dependencies between HWE and the carcinogenic potential of activity, although there was a definite trend.

The frequency of work with HWE for specific professions identified as the most "unprofitable" work with such heavy metals as Hg, Cd, Pb, Cu (the frequency of HWE is 0% for total mortality and 5% (mercury miners) for mortality from malignant neoplasms; one publication), followed by activities related to dust exposure (talc, quartz, various minerals, etc.; 5% and 6%) and asbestos (10% and 2%). Pilots (89% and 65%), oil and petrochemical industry workers (97% and 56%), as well as doctors (94% and 96%) and cosmonauts/astronauts (100% and 67%; the sample is small) occupied leading positions in the highest frequency of HWE.

A complete sample of SMR studies of foreign doctors (1886–2017) demonstrated a strict linear decrease in the SMR value in total mortality compared with the population since the 1940s (r=–0.927; p<0.001), with SMR=0.38 (95% CI: 0.01; 0.76) achieved by the 2010s.

At the same time, mortality from all cancers among doctors was reduced in comparison with the population almost equally for all time periods since 1926 (average SMR=0.6; 95% CI: 0.53; 0.66).

Possible reasons for the reduced mortality among foreign doctors compared to the population are not only in prevention and professional skills, but probably in better access to medicine and specialists. In connection with professional solidarity, medical care and informing doctors is apparently distinguished by great attention.

Earlier treatment of non-cancerous pathologies is also important, preventing their transformation into chronic ones, which can subsequently lead to carcinogenic consequences.

Contribution:
Koterov A.N. — research concept and design, data collection and processing, writing the text, editing;
Ushenkova L.N. — data collection and processing, editing;
Dibirgadzhiev I.G. — data collection and processing, editing.

Funding. As part of the broader budget theme of the FMBA of Russia; without other sources of funding and sponsorship.

Conflict of interests. The authors declare no conflict of interests.

Received: 17.01.2023 / Accepted: 24.01.2023 / Published: 20.03.2023

About the Authors

Aleksey N. Koterov
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
Russian Federation

Alexey N. Koterov, the Head of laboratory at the Burnasyan Federal Medical Biophysical Center, Federal Medical Biological Agency, Dr. of Sci. (Biol.).

e-mail: govorilga@inbox.ru



Liliya N. Ushenkova
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
Russian Federation


Idris G. Dibirgadzhiev
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
Russian Federation


References

1. Registrar-General. Fourteenth Annual Report of the Registrar-General of Births, Deaths and Marriages in England, with abstracts for the year 1851. London: Her Majesty’s Stationery Office (H.M.S.O.); 1855.

2. Ogle W. Letter to the Registrar-General on the mortality in the registration districts of England and Wales during the ten years 1871–80. Supplement to the 45th Annual Report of the Registrar-General of Births, Deaths, and Marriages, in England. London; 1885.

3. Yule G.U. On some points related to vital statistics, more especially statistics of occupational mortality. J. Roy. Statist. Soc. 1934; 94(1): 1–84. https://doi.org/10.2307/2342014

4. Case R.A., Lea A.J. Mustard gas poisoning, chronic bronchitis, and lung cancer; an investigation into the possibility that poisoning by mustard gas in the 1914–18 war might be a factor in the production of neoplasia. Br. J. Prev. Soc. Med. 1955; 9(2): 62–72. https://doi.org/10.1136/jech.9.2.62

5. Liddell F.D.K. The measurement of occupational mortality. Br. J. Ind. Med. 1960; 17(3): 228–33. https://doi.org/10.1136/oem.17.3.228

6. Monson R.R. Occupational Epidemiology. 2nd Edition. Florida: Boca Raton, CRC Press Inc.; 1990.

7. Fox A.J., Collier P.F. Low mortality rates in industrial cohort studies due to selection for work and survival in the industry. Br. J. Prev. Soc. Med. 1976; 30(4): 225–30. https://doi.org/10.1136/jech.30.4.225

8. Ames R.G., Trent B. Mobility of diesel versus non-diesel coal miners: some evidence on the healthy worker effect. Br. J. Ind. Med. 1984; 41(2): 197–202. https://doi.org/10.1136/oem.41.2.197

9. Maksimov S.A., Skripchenko A.E., Artamonova G.V. Role of healthy worker effect in Epidemiology of arterial hypertension of miners. Ekologiya cheloveka. 2015; 22(9): 15–20 (in Russian).

10. Skriver M.V., Vaeth M., Stovring H. Loss of life expectancy derived from a standardized mortality ratio in Denmark, Finland, Norway and Sweden. Scand. J. Public Health. 2018; 46(7): 767–73. https://doi.org/10.1177/1403494817749050

11. Roessler M. Can we trust the standardized mortality ratio? A formal analysis and evaluation based on axiomatic requirements. PLoS One. 2021; 16(9): Article e0257003. https://doi.org/10.1371/journal.pone.0257003

12. Gaffey W.R. A critique of the standardized mortality ratio. J. Occup. Med. 1976; 18(3): 157–60. https://doi.org/10.1097/00043764-197603000-00007

13. Encyclopedia of Statistical Terms. In 8 volums. V. 5. Demographic and Social Statistics. Federal State Statistics Service. Moscow; 2011 (in Russian).

14. A Dictionary of Epidemiology. Ed. by J.M. Last Oxford: Oxford University Press; 2001 (in Russian).

15. Vlasov V.V. Epidemiology. 2nd Edition. Moscow: GEOTAR-Media; 2006 (in Russian).

16. Koshurnikova N.A., Buldakov L.A., Bysogolov G.D., Bolotnikova M.G., Komleva N.S., Peternikova V.S. Mortality from malignancies of the hematopoietic and lymphatic tissues among personnel of the first nuclear plant in the USSR. Sci. Total Environ. 1994; 142(1–2): 19–23. https://doi.org/10.1016/0048-9697(94)90068-x

17. Samorodskaya I.V., Semenov V.Yu. Malignant neoplasms mortality rates in Moscow and Saint Petersburg in 2015 and 2018. Sovremennaya Onkologiya. 2020; 22(3): 79–84. https://doi.org/10.26442/18151434.2020.3.200192 (in Russian).

18. Drapkina O.M., Samorodskaya I.V., Bolotova E.V., Dudnikova A.V. Analysis of the dynamics of mortality from respiratory diseases in the Russian Federation for 2019–2020. Terapevticheskii Arkhiv. 2022; 94(3): 401–8. https://doi.org/10.26442/00403660.2022.03.201403 (in Russian).

19. Guidelines for the development of regional demographic development programs. Ministry of Labor and Social Protection of the Russian Federation. Moscow; 2012 (in Russian).

20. General epidemiology with the basics of evidence-based medicine: a guide to practical exercises: studies. A textbook for high schools. Ed. by V.I. Pokrovsky, N.I. Briko. 2nd Edition., Corr. and add. M.: GEOTAR-Media; 2012 (in Russian).

21. A dictionary of epidemiology. Ed. by M. Porta. 6th ed. New York: Oxford University Press; 2014.

22. Guidotti T.L. The Handbook of Occupational and Environmental Medicine: Principles, Practice, and Problem-Solving. In 2 volumes. 2nd Edition. Praeger-ABC-CLIO, LLC; 2020.

23. Berrington A., Darby S.C., Weiss H.A., Doll R. 100 years of observation on British radiologists: mortality from cancer and other causes 1897–1997. Br. J. Radiol. 2001; 74(882): 507–19. https://doi.org/10.1259/bjr.74.882.740507

24. Monson R.R. Observations on the healthy worker effect. J. Occup. Med. 1986; 28(6): 425–33. https://doi.org/10.1097/00043764-198606000-00009

25. McMichael A.J., Spirtas R., Kupper L.L. An epidemiologic study of mortality within a cohort of rubber workers, 1964–72. J. Occup. Med. 1974; 16(7): 458–64.

26. Mastrangelo G., Marzia V., Marcer G. Reduced lung cancer mortality in dairy farmers: is endotoxin exposure the key factor? Am. J. Ind. Med. 1996; 30(5): 601–9. https://doi.org/110.1002/(SICI)1097-0274(199611)30:5<601::AID-AJIM8>3.0.CO;2-V

27. Bukhtiyarov I.V., Zibarev E.V., Betz K.V. An epidemiological study on the analysis of the mortality of civil aviation pilots in the Russian Federation. Aviakosm. Ekolog. Med. 2022; 56(4): 83–8. https://doi.org/10.21687/0233-528X-2022-56-4-83-88 (in Russian).

28. Carpenter L.M. Some observations on the healthy worker effect. Br. J. Ind. Med. 1987; 44(5): 289–91. https://doi.org/10.1136/oem.44.5.289

29. Nakamura K., Ohmi A., Suzuki S., Konuma M., Kurihara T., Tadera M., Shibata S. Observations on mortality in selected working populations. Sangyo Igaku. 1984; 26(4): 303–14. https://doi.org/10.1539/joh1959.26.303 (in Japanese).

30. Wu X.Y., Jiang R.Y., Wen J.A., Chang X.Q. Mortality of a cohort of employees in a certain factory. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2010; 28(3): 200–2 (in Chinese).

31. Kirkeleit J., Riise T., Bjorge T., Christiani D.C. The healthy worker effect in cancer incidence studies. Am. J. Epidemiol. 2013; 177(11): 1218–24. https://doi.org/10.1093/aje/kws373

32. Koterov A.N., Ushenkova L.N., Kalinina M.V., Biryukov A.P. Brief review of world researches of radiation and non-radiation effects in nuclear industry workers. Mediko-biologicheskiye problemy zhiznedeyatel’nosti (Medical and Biological Problems of Life Activity, Gomel). 2020; 1: 17–31 (in Russian).

33. Symons M.J., Taulbee J.D. Practical considerations for approximating relative risk by the standardized mortality ratio. J. Occup. Med. 1981; 23(6): 413–6. https://doi.org/10.1097/00043764-198106000-00013

34. Tsai S.P., Hardy R.J., Wen C.P. The standardized mortality ratio and life expectancy. Am. J. Epidemiol. 1992; 135(7): 824–31. https://doi.org/10.1093/oxfordjournals.aje.a116369

35. Lai D., Guo F., Hardy R.J. Standardized mortality ratio and life expectancy: a comparative study of Chinese mortality. Int. J. Epidemiol. 2000; 29(5): 852–5. https://doi.org/10.1093/ije/29.5.852

36. DeVivo M.J, Savic G., Frankel H.L., Jamous M.A., Soni B.M., Charlifue S. et al. Comparison of statistical methods for calculating life expectancy after spinal cord injury. Spinal Cord. 2018; 56(7): 666–673. https://doi.org/10.1038/s41393-018-0067-1

37. Ashmore J.P., Krewski D., Zielinski J.M., Jiang H., Semenciw R., Band P.R. First analysis of mortality and occupational radiation exposure based on the National Dose Registry of Canada. Am. J. Epidemiol. 1998; 148(6): 564–74. https://doi.org/10.1093/oxfordjournals.aje.a009682

38. UNSCEAR 1972. Report to the General Assembly, with Scientific Annex. Vol. I. ‘Level’. Annex C. Doses from occupational exposure. United Nations. New York. 1972: 173–86.

39. Lutz W., Striessnig E., Dimitrova A., Ghislandi S., Lijadi A., Reiter C. et al. Years of good life is a well-being indicator designed to serve research on sustainability. Proc. Natl. Acad. Sci. USA. 2021; 118(12): Article e1907351118. https://doi.org/10.1073/pnas.1907351118

40. Meijers J.M., Swaen G.M., Volovics A., Lucas L.J., van Vliet K. Occupational cohort studies: the influence of design characteristics on the healthy worker effect. Int. J. Epidemiol. 1989; 18(4): 970–5. https://doi.org/10.1093/ije/18.4.970

41. Greenberg R.S., Mandel J.S., Pastides H., Britton N.L., Rudenko L., Starr T.B. A meta-analysis of cohort studies describing mortality and cancer incidence among chemical workers in the United States and western Europe. Epidemiology. 2001; 12(6): 727–40. https://doi.org/10.1097/00001648-200111000-00023

42. Chen R., Seaton A. A meta-analysis of mortality among workers exposed to organic solvents. Occup. Med. 1996; 46: 337–44. https://doi.org/10.1093/occmed/46.5.337

43. Kim H.J., Kim Y., Kim S., Chin H.J., Lee H., Lee J.P. et al. Age, sex, and the association of chronic kidney disease with all-cause mortality in Buddhist priests: An analysis of the standardized mortality ratio from the Korean Buddhist priests cohort. Medicine (Baltimore). 2018; 97(45): Article e13099. https://doi.org/10.1097/MD.0000000000013099

44. Yang H.-Y., Wang J.-D., Lo T.-C., Chen P.-C Increased mortality risk for cancers of the kidney and other urinary organs among Chinese herbalists. J. Epidemiol. 2009; 19(1): 17–23. https://doi.org/10.2188/jea.JE20080035

45. Lee H.E., Kim E.A., Park J., Kang S.K. Cancer mortality and incidence in Korean semiconductor workers. Saf. Health Work. 2011; 2(2): 135–47. https://doi.org/10.5491/SHAW.2011.2.2.135

46. Kang H.K., Bullman T.A. Mortality among US veterans of the Persian Gulf War N Engl. J. of Med. 1996; 335(20): 1498–504. https://doi.org/10.1056/NEJM199611143352006

47. Groves F.D., Page W.F., Gridley G., Lisimaque L., Stewart P.A., Tarone R.E. et al. Cancer in Korean war navy technicians: mortality survey after 40 years. Am. J. Epidemiol. 2002; 155(9): 810–8. https://doi.org/10.1093/aje/155.9.810

48. Axelson O. Negative and non-positive epidemiological studies. Int. J. Occup. Med. Environ. Health. 2004; 17(1): 115–21.

49. Gerosa A., Ietri E., Belli S., Grignoli M., Comba P. High risk of pleural mesothelioma among the state railroad carriage repair workers. Epidemiol Prev. 2000; 24(3): 117–9 (in Italian).

50. Miller B.G., MacCalman L. Cause-specific mortality in British coal workers and exposure to respirable dust and quartz. Occup. Environ. Med. 2010; 67(4): 270–6. https://doi.org/10.1136/oem.2009.046151

51. Nakashima E., Neriishi K., Minamoto A. A reanalysis of atomic-bomb cataract data, 2000–2002: a threshold analysis. Health Phys. 2006; 90(2): 154–60. https://doi.org/10.1097/01.hp.0000175442.03596.63

52. Neriishi K., Nakashima E., Minamoto A., Fujiwara S., Akahoshi M., Mishima H.K. et al. Postoperative cataract cases among atomic bomb survivors: radiation dose response and threshold. Radiat Res. 2007; 168(4): 404–8. https://doi.org/10.1667/RR0928.1

53. Bernardinelli L., de Marco R., Tinelli C. Cancer mortality in an Italian rubber factory. Br J Ind Med. 1987; 44(3): 187–91. https://doi.org/10.1136/oem.44.3.187

54. Pastides H., Austin R., Lemeshow S., Klar J., Mundt K.A. A retrospective-cohort study of occupational exposure to hexavalent chromium. Am. J. Ind. Med. 1994; 25(5): 663–75. https://doi.org/10.1002/ajim.4700250506

55. Breslow N.E., Day N.E. Statistical methods in cancer research. Vol II. The design and analysis of cohort studies. Lyon: World Health Organization; 1987: 17–20.

56. Li C.Y., Sung F.C. A review of the healthy worker effect in occupational epidemiology. Occup Med (Lond). 1999; 49(4): 225–9. https://doi.org/10.1093/occmed/49.4.225

57. Koterov A.N., Ushenkova L.N., Biryukov A.P. Hill’s criteria ‘Biological plausibility’. The data integration from different disciplines in Epidemiology and Radiation Epidemiology. Radiatsionnaya Biologiya. Radioekologiya. 2020; 60(5): 453–80. https://doi.org/10.31857/S0869803120050069 (in Russian).

58. Atkinson W.D., Law D.V., Bromley K.J., Inskip H.M. Mortality of employees of the United Kingdom Atomic Energy Authority, 1946–97. Occup. Environ. Med. 2004; 61(7): 577–85. https://doi.org/10.1136/oem.2003.012443

59. Bouet S., Davesne E., Samson E., Jovanovic I., Blanchardon E., Challeton-de Vathaire C. et al. Analysis of the association between ionizing radiation and mortality in uranium workers from five plants involved in the nuclear fuel production cycle in France. Int. Arch. Occup. Environ. Health. 2019; 92(2): 249–62. https://doi.org/10.1007/s00420-018-1375-7

60. Boice J.D. Jr, Cohen S.S., Mumma M.T., Ellis E.D., Cragle D.L., Eckerman K.F. et al. Mortality among Mound workers exposed to polonium-210 and other sources of radiation, 1944–1979. Radiat. Res. 2014; 181(2): 208–28. https://doi.org/10.1667/RR13395.1

61. Rodriguez Artalejo F., Castano Lara S., de Andres Manzano B., García Ferruelo M., Iglesias Martin L., Calero J.R. Occupational exposure to ionising radiation and mortality among workers of the former Spanish Nuclear Energy Board. Occup. Environ. Med. 1997; 54(3): 202–8. https://doi.org/10.1136/oem.54.3.202

62. Veiga L.H.S. Amaral E.C.S., Colin D., Koifman S. A retrospective mortality study of workers exposed to radon in a Brazilian underground coal mine. Radiat. Environ. Biophys. 2006; 45: 125–34. https://doi.org/10.1007/s00411-006-0046-3

63. Tomaskova H., Splichalova A., Slachtova H., Urban P., Hajdukova Z., Landecka I. et al. Mortality in miners with coal-workers’ pneumoconiosis in the Czech Republic in the Period 1992–2013. Int. J. Environ. Res. Public Health. 2017; 14: Article 269. https://doi.org/10.3390/ijerph14030269

64. McGeoghegan D. Healthy worker effect (Letter to Editor). J. Radiol. Prot. 2001; 21(2): 179. https://doi.org/10.1088/0952-4746/21/2/101

65. Reynolds R.J., Day S.M., Nurgalieva Z.Z. Mortality among Soviet and Russian cosmonauts: 1960–2013. Aviat. Space Environ. Med. 2014; 85(7): 750–4. https://doi.org/10.3357/asem.3957.2014

66. Ushakov I.B., Voronkov Y.I., Bukhtiyarov I.V. Tikhonova G.I., Gorchakova T.Yu., Bryleva M.S. A cohort mortality study among Soviet and Russian cosmonauts, 1961–2014. Aerosp. Med. Hum. Perform. 2017; 88(12): 1060–5. https://doi.org/10.3357/AMHP.4701.2017

67. Frank E., Biola H., Burnett C.A. Mortality rates and causes among U.S. physicians. Am. J. Prev. Med. 2000; 19(3): 155–9. https://doi.org/10.1016/s0749-3797(00)00201-4

68. McCue J.D. The effects of stress on physicians and their medical practice. N. Engl. J. Med. 1982; 306(8): 458–63. https://doi.org/10.1056/NEJM198202253060805

69. Rimpela A., Nurminen M.M., Pulkkinen P.O., Rimpela M.K., Valkonen T. Mortality of doctors: do doctors benefit from their medical knowledge? Lancet. 1987; 1(8524): 84–6. https://doi.org/10.1016/s0140-6736(87)91919-2

70. Brayne A.B., Brayne R.P., Fowler A.J. Medical specialties and life expectancy: an analysis of doctors’ obituaries 1997–2019. Lifestyle Medicine. 2021; 2(1): Article e23. https://doi.org/10.1002/lim2.23

71. Nurminen M., Rimpela E.A., Pukkala E. Exceptionally low cancer incidence in doctors. Lancet. 1988; 1(8578): 190–1. https://10.1016/s0140-6736(88)92773-0

72. Mellemgaard A., From G., Jorgensen T. et al. Cancer risk in individuals with benign thyroid disorders. Thyroid. 1998; 8(9): 751–54. https://10.1089/thy.1998.8.751

73. Carpenter L.M., Swerdlow A.J., Fear N.T. Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants. Occup. Environ. Med. 1997; 54(6): 388–95. https://10.1136/oem.54.6.388

74. Harrington J.M., Oakes D. Mortality study of British pathologists. Br. J. Ind. Med. 1984; 41(2): 188–91. https://10.1136/oem.41.2.188


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Koterov A.N., Ushenkova L.N., Dibirgadzhiev I.G. Database on the Standardized mortality ratio (SMR all causes and SMR all cancer) for various professions (706 cohorts/groups): the maximum "health worker effect" for cosmonauts and doctors. Russian Journal of Occupational Health and Industrial Ecology. 2023;63(3):179-192. (In Russ.) https://doi.org/10.31089/1026-9428-2023-63-3-179-192

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