Firefighters and on-duty deaths from coronary heart disease: a case control study.
BACKGROUND
Coronary heart disease (CHD) is responsible for 45% of on-duty deaths among United States firefighters. We sought to identify occupational and personal risk factors associated with on-duty CHD death.


METHODS
We performed a case-control study, selecting 52 male firefighters whose CHD deaths were investigated by the National Institute for Occupational Safety and Health. We selected two control populations: 51 male firefighters who died of on-duty trauma; and 310 male firefighters examined in 1996/1997, whose vital status and continued professional activity were re-documented in 1998.


RESULTS
The circadian pattern of CHD deaths was associated with emergency response calls: 77% of CHD deaths and 61% of emergency dispatches occurred between noon and midnight. Compared to non-emergency duties, fire suppression (OR = 64.1, 95% CI 7.4-556); training (OR = 7.6, 95% CI 1.8-31.3) and alarm response (OR = 5.6, 95% CI 1.1-28.8) carried significantly higher relative risks of CHD death. Compared to the active firefighters, the CHD victims had a significantly higher prevalence of cardiovascular risk factors in multivariate regression models: age >or= 45 years (OR 6.5, 95% CI 2.6-15.9), current smoking (OR 7.0, 95% CI 2.8-17.4), hypertension (OR 4.7, 95% CI 2.0-11.1), and a prior diagnosis of arterial-occlusive disease (OR 15.6, 95% CI 3.5-68.6).


CONCLUSIONS
Our findings strongly support that most on-duty CHD fatalities are work-precipitated and occur in firefighters with underlying CHD. Improved fitness promotion, medical screening and medical management could prevent many of these premature deaths.
Kales
Stefanos N
SN
The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA. skales@challiance.org
Soteriades
Elpidoforos S
ES
Christoudias
Stavros G
SG
Christiani
David C
DC
D016022:Case-Control Studies; D003327:Coronary Disease / Q000401:mortality*; D005390:Fires / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009314:National Institute for Occupational Safety and Health, U.S.; D009784:Occupational Diseases / Q000401:mortality*; D016272:Occupational Health / Q000706:statistics & numerical data*; D015995:Prevalence; D012044:Regression Analysis; D018635:Rescue Work; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014940:Work Schedule Tolerance / Q000502:physiology; D000078329:Workforce