title: Mortality from cancer and other causes in commercial airline crews: a joint analysis of cohorts from 10 countries.
abstract: BACKGROUND
  Commercial airline crew is one of the occupational groups with the highest exposures to ionising radiation. Crew members are also exposed to other physical risk factors and subject to potential disruption of circadian rhythms.
  
  
  METHODS
  This study analyses mortality in a pooled cohort of 93 771 crew members from 10 countries. The cohort was followed for a mean of 21.7 years (2.0 million person-years), during which 5508 deaths occurred.
  
  
  RESULTS
  The overall mortality was strongly reduced in male cockpit (SMR 0.56) and female cabin crews (SMR 0.73). The mortality from radiation-related cancers was also reduced in male cockpit crew (SMR 0.73), but not in female or male cabin crews (SMR 1.01 and 1.00, respectively). The mortality from female breast cancer (SMR 1.06), leukaemia and brain cancer was similar to that of the general population. The mortality from malignant melanoma was elevated, and significantly so in male cockpit crew (SMR 1.57). The mortality from cardiovascular diseases was strongly reduced (SMR 0.46). On the other hand, the mortality from aircraft accidents was exceedingly high (SMR 33.9), as was that from AIDS in male cabin crew (SMR 14.0).
  
  
  CONCLUSIONS
  This large study with highly complete follow-up shows a reduced overall mortality in male cockpit and female cabin crews, an increased mortality of aircraft accidents and an increased mortality in malignant skin melanoma in cockpit crew. Further analysis after longer follow-up is recommended.
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Gaël P
authors.initials: GP
authors.lastname: Hammer
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
authors.forename: Bianca L
authors.initials: BL
authors.lastname: De Stavola
authors.forename: Barbara
authors.initials: B
authors.lastname: Grajewski
authors.forename: Maryanne
authors.initials: M
authors.lastname: Gundestrup
authors.forename: Tor
authors.initials: T
authors.lastname: Haldorsen
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.forename: Susanna
authors.initials: S
authors.lastname: Lagorio
authors.forename: Anette
authors.initials: A
authors.lastname: Linnersjö
authors.forename: Lynne
authors.initials: L
authors.lastname: Pinkerton
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Vilhjálmur
authors.initials: V
authors.lastname: Rafnsson
authors.forename: Isabel
authors.initials: I
authors.lastname: dos-Santos-Silva
authors.forename: Hans H
authors.initials: HH
authors.lastname: Storm
authors.forename: Trond-Eirik
authors.initials: TE
authors.lastname: Strand
authors.forename: Anastasia
authors.initials: A
authors.lastname: Tzonou
authors.forename: Hajo
authors.initials: H
authors.lastname: Zeeb
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
mesh_terms: D000060:Accidents, Aviation / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology / Q000401:mortality*; D000401:Aircraft; D001932:Brain Neoplasms / Q000209:etiology / Q000401:mortality; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D002940:Circadian Rhythm; D015331:Cohort Studies; D003359:Cosmic Radiation / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007938:Leukemia / Q000209:etiology / Q000401:mortality; D008297:Male; D008545:Melanoma / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000401:mortality; D009784:Occupational Diseases / Q000209:etiology / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects; D009790:Occupations; D012307:Risk Factors; D012737:Sex Factors; D012878:Skin Neoplasms; D014481:United States / Q000453:epidemiology; D000096142:Cutaneous Malignant Melanoma