title: Incidence of myocardial infarction in Swedish chimney sweeps 1991-2005: a prospective cohort study.
abstract: OBJECTIVE
  Previous studies of chimney sweeps have shown an excess mortality from cardiovascular diseases, although the extent of confounding from tobacco smoking is uncertain. The present study used referents of similar socioeconomic background as the chimney sweeps in order to reduce confounding, included both lethal and surviving cases of myocardial infarction, and investigated dose-response in terms of duration of employment.
  
  
  METHODS
  A cohort of 4436 male chimney sweeps was identified from nationwide trade union records from 1918 to 2006. Myocardial infarctions during 1991-2005 were identified from the Swedish nationwide register of first-time myocardial infarctions. Standardised incidence ratios (SIRs) were estimated using skilled manual workers in the service sector in Sweden to calculate expected numbers.
  
  
  RESULTS
  There was a strong and statistically significant excess of myocardial infarction among the chimney sweeps, SIR 1.39 (95% CI 1.24 to 1.55). The excess was observed among both short- and long-term employed.
  
  
  CONCLUSIONS
  While the excess of myocardial infarction among the short-term employed may be due to tobacco and, possibly, alcohol use, it is likely that the excess noted among the long-term employed was caused by the high exposure to combustion products, particles or metals still occurring among chimney sweeps. Preventive measures to reduce hazardous occupational exposures as well as smoking and alcohol use among chimney sweeps are urgently needed.
authors.affiliation: Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. per.gustavsson@ki.se
authors.forename: Per
authors.initials: P
authors.lastname: Gustavsson
authors.forename: Catarina
authors.initials: C
authors.lastname: Jansson
authors.forename: Christer
authors.initials: C
authors.lastname: Hogstedt
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016273:Occupational Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D053260:Soot / Q000009:adverse effects*; D013548:Sweden / Q000453:epidemiology
chemical_list: D000395:Air Pollutants, Occupational; D053260:Soot