title: [Causes of death of COGEMA active workers, 1980-1995].
abstract: BACKGROUND
  Populations exposed to risks at work show a deficit in deaths in comparison with the national population, the "healthy worker effect". This effect has been observed among former nuclear workers. The aim of our cross-sectional study was to evaluate the mortality in a metallurgy worker population, and to study the impact of the choice of the reference population on the estimation of the Standardized Mortality Ratio (SMR).
  
  
  METHODS
  The studied population was the COGEMA Metallurgy Department workers, aged 25 years to 64, during the period 1980-1995 in two regions of France (North--La Hague; South--Cadarache, Marcoule, Miramas and Pierrelatte). In order to account for geographical variability and the difference in mortality between the working population and the non-working population, we used several reference populations: national population, regional population, "working" national population (farmers not present in COGEMA and non-workers excluded), and "working" regional population.
  
  
  RESULTS
  All SMRs were increased when we used a "working" regional reference compared with the national reference population. Among men, eight pathologies presented a significant deficit with a national reference, whereas only two pathologies showed a deficit with the "working" regional reference.
  
  
  CONCLUSIONS
  The use of a reference population close to the study population enabled us to reduce the Healthy Worker Effect among metallurgy workers at COGEMA plants.
authors.affiliation: Laboratoire d'Epidémiologie, IRSN, BP 17, 92262 Fontenay-aux-Roses. madeline.valenty@irsn.fr
authors.forename: M
authors.initials: M
authors.lastname: Valenty
authors.forename: M
authors.initials: M
authors.lastname: Tirmarche
authors.forename: N
authors.initials: N
authors.lastname: Mitton
authors.forename: D
authors.initials: D
authors.lastname: Laurier
authors.forename: J M
authors.initials: JM
authors.lastname: Gelas
authors.forename: B
authors.initials: B
authors.lastname: Quesne
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000401:mortality; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D015989:Healthy Worker Effect; D006801:Humans; D008297:Male; D008669:Metallurgy; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009369:Neoplasms / Q000401:mortality; D009787:Occupational Medicine; D012179:Retirement; D012306:Risk; D012737:Sex Factors