Underlying and multiple cause mortality in a cohort of workers exposed to aromatic amines

• Published in: American journal of industrial medicine 1998-11, Vol.34 (5), p.506-511
• Main Authors: Axtell, Catherine D., Ward, Elizabeth M., McCabe, George P., Schulte, Paul A., Stern, Frank B., Glickman, Lawrence T.
• Format: Article
• Language: English
• Subjects: Amines; aromatic amines; Biological and medical sciences; bladder cancer; Cause of Death; Chemical and industrial products toxicology. Toxic occupational diseases; cohort; Cohort Studies; Esophageal Neoplasms - mortality; Humans; Life Tables; Male; Medical sciences; mortality; multiple cause of death data; Occupational Diseases - mortality; Occupational Exposure; Toxicology; Urinary Bladder Neoplasms - mortality; Various organic compounds
• ISSN: 0271-3586; 1097-0274
• DOI: 10.1002/(SICI)1097-0274(199811)34:5<506::AID-AJIM12>3.0.CO;2-5

Background The National Institute for Occupational Safety and Health (NIOSH) has previously conducted studies of bladder cancer incidence and mortality at a synthetic dye plant that manufactured beta‐naphthylamine from 1940 through 1979. This report extends the period of mortality follow‐up 13 years and analyzes both underlying and nonunderlying causes of death. Methods The vital status of each cohort member, as of December 31, 1992, was determined by using the National Death Index and information from the Internal Revenue Service and the U.S. Postal Service. The NIOSH life table analysis system (LTAS) was used to generate person‐years‐at‐risk and the expected numbers of death for 92 categories of death, using several referent rates (U.S. underlying, Georgia underlying, U.S. multiple cause). Results There were three bladder cancer deaths listed as underlying cause, yielding a standardized mortality ratio (SMR) based on U.S. rates of 2.4 (95% confidence interval (CI) = 0.5, 7.0) and a total of eight bladder cancers listed anywhere on the death certificates (SMR based on multiple cause referent rates = 5.6; 95% CI = 2.4, 11.1). Mortality from esophageal cancer, which had been significantly elevated in the previous study, was no longer significantly elevated (SMR = 2.0; 95% CI = 0.8,4.1). Mortality from all causes was significantly higher than expected (SMR = 1.5; 95% CI = 1.3, 1.6). Conclusions The elevated bladder cancer risk in this cohort was detected by the multiple cause, but not the underlying cause, analysis. Elevated mortality from other causes of death, especially among short‐term workers, may be related to regional and lifestyle factors. Am. J. Ind. Med. 34:506–511, 1998. © 1998 Wiley‐Liss, Inc.