Citation:
K.T. Palmer, P. Cullinan, S. Rice, T. Brown, D. Coggon. Mortality from infectious pneumonia in metal workers: a comparison with deaths
from asthma in occupations exposed to respiratory sensitisers. Thorax, 2009, Volume 64, pp983-986.
Abstract:
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. Conclusion: Exposure to metal
fumes is a material cause of occupational mortality. The hazard deserves far
more attention than it presently receives.