Our estimate is in the range reported by previous investigators, although we have restricted ourselves more than others to only those diseases with well-established occupational etiology, biasing our estimates conservatively. The underlying assumptions and data used to generate the estimates are well documented, so our estimates may be updated as new data emerges on occupational risks and exposed populations, providing an advantage over previous studies. We estimate that occupational deaths are the 8th leading cause of death in the US, after diabetes (64,751) but ahead of suicide (30,575), and greater than the annual number of motor vehicle deaths per year (43,501).

Construction, one of the larger industries in the United States, employs 7.6 million workers, many in skilled trades occupations. Previously published data about potential worksite exposures and mortality of construction site workers are limited. We analyzed occupation and industry codes on death certificates from 19 U.S. states to evaluate mortality risks among men and women usually employed in construction occupations. Proportionate mortality ratios (PMRs) for cancer and several other chronic diseases were significantly elevated among 61,682 white male construction workers who died between 1984 and 1986. Men younger than age 65, who were probably still employed immediately prior to death, had significantly elevated PMRs for cancer, asbestos-related diseases, mental disorders, alcohol-related disease, digestive diseases, falls, poisonings, traumatic fatalities that are usually work-related, and homicides. Elevated PMRs for many of the same causes were observed to a lesser degree for black men and white women whose usual industry was construction. In addition, women experienced excess cancer of the connective tissue and suicide mortality. Various skilled construction trades had elevated PMRs for specific sites, such as bone cancer and melanoma in brickmasons, stomach cancer in roofers and brickmasons, kidney and bone cancer in concrete/terrazzo finishers, nasal cancer in plumbers, pulmonary tuberculosis in laborers, scrotal cancer and aplastic anemia in electricians, acute myeloid leukemia in boilermakers, rectal cancer and multiple sclerosis in electrical power installers, and lung cancer in structural metal workers. Using a standard population of blue collar workers did not result in fewer elevated PMRs for construction workers. Despite lifestyle differences and other limitations of the study, the large numbers of excess deaths observed in this study indicate the need for preventive action for construction workers.

These disease trends suggested that livestock farmers might be exposed to more carcinogens or agricultural chemicals than crop farmers.

Asbestos, which is a well‐known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of GI cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age‐adjusted and sex‐ and race‐specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non‐malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107–110), 110 (106–113), and 109 (107–110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small. Am. J. Ind. Med. 31:713–718, 1997. © 1997 Wiley‐Liss, Inc.

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OBJECTIVES: This study examined the mortality experience of 50,000 nurses using the National Occupational Mortality Surveillance database of death certificates. METHODS: Proportionate mortality ratios adjusted by race (White, Black, or other) and 5-year age groups were calculated for selected causes of death among female nurses vs all workers and white-collar workers. RESULTS: Excess deaths among nurses less than 65 years of age were seen in both comparison groups for viral hepatitis, cancer of the nasal cavities, accidental falls, suicide, and drug-related deaths. Among nurses 65 years old or older, deaths due to chronic myeloid leukemia were in excess. Proportionate mortality ratios for breast and colon cancers, diabetes, and heart disease varied by occupational comparison group. CONCLUSIONS: These findings confirm results of previous studies and identify new associations. Redoubled efforts are called for in overcoming obstacles to reducing workplace hazards.

Surveillance of cause-specific mortality patterns by occupation and industry through the use of death certificate records is a simple and relatively inexpensive approach to the generation of leads as to potential occupational disease problems. Researchers from the National Institute for Occupational Safety and Health (NIOSH) have been working with the National Center for Health Statistics, other federal agencies, and state health departments on a number of programs to foster the development of standardized, routine coding of occupation and industry entries on death certificates by state health departments. Thirty-one states and the District of Columbia are now doing such coding. These data are being analyzed currently by investigators at NIOSH and at individual state health departments for the purpose of hypothesis generation on occupation-disease relationships. The proportionate mortality ratio method is the predominant method being used, as appropriate denominator data are not generally available. This type of surveillance is particularly useful for the study of occupation and industry groups for which it is difficult to assemble cohorts, such as groups that are predominantly non-union and in small workplaces. Limitations of this surveillance include its inappropriateness for monitoring those occupational diseases which are not often fatal, and the limited scope and accuracy of death certificate information.