Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitisers.
BACKGROUND
National analyses of mortality in England and Wales have repeatedly shown excess deaths from pneumonia in welders. During 1979-90 the excess was attributable largely to deaths from lobar pneumonia and pneumonias other than bronchopneumonia, limited to men of working age and apparent in other occupations with exposure to metal fumes. The findings for 1991-2000 were assessed and compared with the mortality pattern from asthma in occupations exposed to known respiratory sensitisers.


METHODS
The Office of National Statistics supplied data on deaths by underlying cause among men aged 16-74 years in England and Wales during 1991-2000, including age and last held occupation. Data were abstracted on pneumonia for occupations with exposure to metal fumes and on asthma for occupations commonly reported to surveillance schemes as at risk of occupational asthma. The expected numbers of deaths were estimated by applying age-specific proportions of deaths by cause in the population to the total deaths by age in each occupational group. Observed and expected numbers were compared for each cause of death.


RESULTS
Among men of working age in occupations with exposure to metal fumes there was excess mortality from pneumococcal and lobar pneumonia (54 deaths vs 27.3 expected) and from pneumonias other than bronchopneumonia (71 vs 52.4), but no excess from these causes at older ages or from bronchopneumonia at any age. The attributable mortality from metal fume exposure was 45.3 excess deaths compared with an estimated 62.6 deaths from occupational asthma.


CONCLUSIONS
Exposure to metal fumes is a material cause of occupational mortality. The hazard deserves far more attention than it presently receives.
Palmer
K T
KT
MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK. ktp@mrc.soton.ac.uk
Cullinan
P
P
Rice
S
S
Brown
T
T
Coggon
D
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000395:Air Pollutants, Occupational / Q000633:toxicity; D001249:Asthma / Q000139:chemically induced / Q000401:mortality*; D004739:England / Q000453:epidemiology; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D008669:Metallurgy; D008670:Metals / Q000633:toxicity; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D052638:Particulate Matter / Q000633:toxicity; D011014:Pneumonia / Q000139:chemically induced / Q000401:mortality; D014852:Wales / Q000453:epidemiology; D014896:Welding; D055815:Young Adult
D000395:Air Pollutants, Occupational; D008670:Metals; D052638:Particulate Matter
Am Rev Respir Dis. 1988 Jun;137(6):1494-8
2849334
Am J Epidemiol. 2003 Feb 1;157(3):227-33
12543622
Br J Ind Med. 1991 May;48(5):323-6
2039744
Occup Environ Med. 2000 Dec;57(12):823-9
11077011
Chest. 2002 Jan;121(1):264-72
11796461
Lancet. 1999 May 22;353(9166):1750-4
10347988
Occup Environ Med. 1997 Aug;54(8):529-34
9326155
Am J Epidemiol. 1986 Dec;124(6):1004-11
3776966
Respiration. 1997;64(1):111-3
9044486
Occup Environ Med. 2003 Feb;60(2):136-41
12554842
Am J Ind Med. 2002 Jul;42(1):50-4
12111690
Am J Ind Med. 1994 Dec;26(6):799-802
7892830
Am J Ind Med. 2000 May;37(5):451-8
10723039
Lancet. 1994 Jul 2;344(8914):41-3
7912307
Am J Ind Med. 1999 May;35(5):465-71
10212699