title: Underlying and multiple cause mortality in a cohort of workers exposed to aromatic amines.
abstract: BACKGROUND
  The National Institute for Occupational Safety and Health (NIOSH) has previously conducted studies of bladder cancer incidence and mortality at a synthetic dye plant that manufactured beta-naphthylamine from 1940 through 1979. This report extends the period of mortality follow-up 13 years and analyzes both underlying and nonunderlying causes of death.
  
  
  METHODS
  The vital status of each cohort member, as of December 31, 1992, was determined by using the National Death Index and information from the Internal Revenue Service and the U.S. Postal Service. The NIOSH life table analysis system (LTAS) was used to generate person-year-at-risk and the expected numbers of death for 92 categories of death, using several referent rates (U.S. underlying, Georgia underlying, U.S. multiple cause).
  
  
  RESULTS
  There were three bladder cancer deaths listed as underlying cause, yielding a standardized mortality ratio (SMR) based on U.S. rates of 2.4 (95% confidence interval (CI) = 0.5, 7.0) and a total of eight bladder cancers listed anywhere on the death certificates (SMR based on multiple cause referent rates = 5.6; 95% CI = 2.4, 11.1). Mortality from esophageal cancer, which had been significantly elevated in the previous study, was no longer significantly elevated (SMR = 2.0; 95% CI = 0.8, 4.1). Mortality from all causes was significantly higher than expected (SMR = 1.5; 95% CI = 1.3, 1.6).
  
  
  CONCLUSIONS
  The elevated bladder cancer risk in this cohort was detected by the multiple cause, but not the underlying cause, analysis. Elevated mortality from other causes of death, especially among short-term workers, may be related to regional and lifestyle factors.
authors.affiliation: Center for Health Promotion and Disease Prevention, University of New Mexico, Albuquerque 87131-5311, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Axtell
authors.forename: E M
authors.initials: EM
authors.lastname: Ward
authors.forename: G P
authors.initials: GP
authors.lastname: McCabe
authors.forename: P A
authors.initials: PA
authors.lastname: Schulte
authors.forename: F B
authors.initials: FB
authors.lastname: Stern
authors.forename: L T
authors.initials: LT
authors.lastname: Glickman
mesh_terms: D000588:Amines; D002423:Cause of Death; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality; D006801:Humans; D015993:Life Tables; D008297:Male; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure; D001749:Urinary Bladder Neoplasms / Q000401:mortality
chemical_list: D000588:Amines