title: Cohort mortality study of Swedish pulp and paper mill workers-nonmalignant diseases.
abstract: OBJECTIVE
  The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems.
  
  
  METHODS
  The cohort of 18 163 men and 2 291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented.
  
  
  RESULTS
  There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98-1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90-0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12-1.32) and SMR 1.11 (95% CI 1.02-1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07-1.54), paper production (SMR 1.26, 95% CI 1.06-1.49), and maintenance (SMR 1.16, 95% CI 1.02-1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased.
  
  
  CONCLUSIONS
  Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).
authors.affiliation: Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. Eva.Andersson@amm.gu.se
authors.forename: Eva
authors.initials: E
authors.lastname: Andersson
authors.forename: Bodil
authors.initials: B
authors.lastname: Persson
authors.forename: Ing-Liss
authors.initials: IL
authors.lastname: Bryngelsson
authors.forename: Anders
authors.initials: A
authors.lastname: Magnuson
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
authors.forename: Gun
authors.initials: G
authors.lastname: Wingren
authors.forename: Håkan
authors.initials: H
authors.lastname: Westberg
mesh_terms: D000328:Adult; D000368:Aged; D004391:Dust; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008171:Lung Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D009790:Occupations; D012189:Retrospective Studies; D013431:Sulfates; D013447:Sulfites; D013548:Sweden / Q000453:epidemiology; D014934:Wood
chemical_list: D004391:Dust; D013431:Sulfates; D013447:Sulfites