Mortality among sheet metal workers participating in a medical screening program.
BACKGROUND
The Sheet Metal Occupational Health Institute Trust (SMOHIT) was formed in 1985 to examine the health hazards of the sheet metal industry in the U.S. and Canada through an asbestos disease screening program. A study of mortality patterns among screening program participants was undertaken.


METHODS
A cohort of 17,345 individuals with 20 or more years in the trade and who participated in the asbestos disease screening program were followed for vital status and causes of death between 1986 and 2004. Data from the screening program included chest X-ray results by International Labour Office (ILO) criteria and smoking history. Standardized mortality ratios (SMRs) by cause were generated using U.S. death rates and Cox proportional hazards models were used to investigate lung cancer risk relative to chest X-ray changes while controlling for smoking.


RESULTS
A significantly reduced SMR of 0.83 (95% CI = 0.80-0.85) was observed for all causes combined. Statistically significant excess mortality was observed for pleural cancers, mesothelioma, and asbestosis in the SMR analyses. Both lung cancer and COPD SMRs increased consistently and strongly with increasing ILO profusion score. In Cox models, which controlled for smoking, increased lung cancer risk was observed among workers with ILO scores of 0/1 (RR = 1.17, 95% CI = 0.89-1.54), with a strong trend for increasing lung cancer risk with increasing ILO profusion score >0/0.


CONCLUSIONS
Sheet metal workers are at increased risk for asbestos-related diseases. This study contributes to the literature demonstrating asbestos-related diseases among workers with largely indirect exposures and supports an increased lung cancer risk among workers with low ILO profusion scores.
Dement
John
J
Division of Occupational & Environmental Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. john.dement@duke.edu
Welch
Laura
L
Haile
Elizabeth
E
Myers
Douglas
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003252:Construction Materials / Q000633:toxicity*; D005260:Female; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000453:epidemiology / Q000401:mortality; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008403:Mass Screening; D008670:Metals / Q000633:toxicity*; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009784:Occupational Diseases / Q000453:epidemiology / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D016272:Occupational Health / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D008670:Metals