title: Enduring health effects of asbestos use in Belgian industries: a record-linked cohort study of cause-specific mortality (2001-2009).
abstract: OBJECTIVE
  To investigate cause-specific mortality among asbestos workers and potentially exposed workers in Belgium and evaluate potential excess in mortality due to established and suspected asbestos-related diseases.
  
  
  METHODS
  This cohort study is based on an individual record linkage between the 1991 Belgian census and cause-specific mortality information for Flanders and Brussels (2001-2009).
  
  
  METHODS
  Belgium (Flanders and Brussels region).
  
  
  METHODS
  The study population consists of 1,397,699 male workers (18-65,years) with 72,074 deaths between 1 October 2001 and 31 December 2009. Using a classification of high-risk industries, mortality patterns between 2056 asbestos workers, 385,046 potentially exposed workers and the working population have been compared.
  
  
  METHODS
  Standardised mortality ratios (SMRs) and 95% CIs are calculated for manual and non-manual workers.
  
  
  RESULTS
  Our findings show clear excess in asbestos-related mortality in the asbestos industry with SMRs for mesothelioma of 4071 (CI 2327 to 6611) among manual workers and of 4489 (CI 1458 to 10,476) among non-manual workers. Excess risks in asbestos-related mortality are also found in the chemical industry, the construction industry, the electrical generation and distribution industry, the basic metals manufacturing industry, the metal products manufacturing industry, the railroad industry, and the shipping industry. Oral cancer mortality is significantly higher for asbestos workers (SMR 383; CI 124 to 894), railroad workers (SMR 192; CI 112 to 308), shipping workers (SMR 172; CI 102 to 271) and construction workers (SMR 125; CI 100 to 153), indicating a possible association with occupational asbestos exposure. Workers in all four industries have elevated mortality rates for cancer of the mouth. Only construction workers experience significantly higher pharyngeal cancer mortality (SMR 151; CI 104 to 212).
  
  
  CONCLUSIONS
  The study identifies vulnerable groups of Belgian asbestos workers, demonstrating the current-day health repercussions of historical asbestos use. Results support the hypothesis of a possible association between the development of oral cancer and occupational asbestos exposure.
authors.affiliation: Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Laura
authors.initials: L
authors.lastname: Van den Borre
authors.affiliation: Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001194:Asbestos / Q000633:toxicity*; D001195:Asbestosis / Q000401:mortality; D001530:Belgium / Q000453:epidemiology; D015331:Cohort Studies; D006801:Humans; D007221:Industry / Q000706:statistics & numerical data; D007822:Laryngeal Neoplasms / Q000401:mortality; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008654:Mesothelioma / Q000401:mortality; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects; D055815:Young Adult
chemical_list: D001194:Asbestos
keywords: Asbestos; Belgium; EPIDEMIOLOGY; Mortality studies; OCCUPATIONAL & INDUSTRIAL MEDICINE; PUBLIC HEALTH