Summary measures of occupational history: a comparison of latest occupation and industry with usual occupation and industry

REPRINT OF: Racism, Sexism, and Social Class: Implications for Studies of Health, Disease, and Well-being

Editor's Note: This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993;9(6 suppl):82-122.

Using death certificates and medical examiner records for adolescent occupational fatality surveillance and research: a case study

Death certificates and medical examiner records have been useful yet imperfect data sources for work-related fatality research and surveillance among adult workers. It is unclear whether this holds for work-related fatalities among adolescent workers who suffer unique detection challenges in part because they are not often thought of as workers. This study investigated the utility of using these data sources for surveillance and research pertaining to adolescent work-related fatalities. Using the state of North Carolina as a case study, we analyzed data from the death certificates and medical examiner records of all work-related fatalities data among 11- to 17-year-olds between 1990-2008 (N = 31). We compared data sources on case identification, of completeness, and consistency information. Variables examined included those on the injury (e.g., means), occurrence (e.g., place), demographics, and employment (e.g., occupation). Medical examiner records (90%) were more likely than death certificates (71%) to identify adolescent work-related fatalities. Data completeness was generally high yet varied between sources. The most marked difference being that in medical examiner records, type of business/industry and occupation were complete in 72 and 67% of cases, respectively, while on the death certificates these fields were complete in 90 and 97% of cases, respectively. Taking the two sources together, each field was complete in upward of 94% of cases. Although completeness was high, data were not always of good quality and sometimes conflicted across sources. In many cases, the decedent's occupation was misclassified as "student" and their employer as "school" on the death certificate. Even though each source has its weaknesses, medical examiner records and death certificates, especially when used together, can be useful for conducting surveillance and research on adolescent work-related fatalities. However, extra care is needed by data recorders to ensure that occupation and employer are properly coded when dealing with adolescent worker deaths.

Longest Held Job in U.S. Occupational Groups: The National Health Interview Survey

OBJECTIVE

We sought to assess the validity of using current or most recent occupation as surrogate for longest-held job (and its exposures).

METHODS

The National Health Interview Survey (NHIS) is an annual, probability, cross-sectional U.S. population survey. The 1986 and 1988 NHIS occupational supplements provided information for more than 49,000 workers. Using Cohen's Kappa, concordance was assessed by occupational group and several subgroups.

RESULTS

Statistically significant results were observed for all occupational groups. More than 70% of 13 broad occupations had a Kappa of 50.0 or greater, with variable concordance by subpopulation. Among 206 occupational groups, there was more variability: Kappa ranged from 92.7 (dentists) to 9.2 (farm managers).

CONCLUSIONS

Moderate-to-high levels of agreement was observed in this large, representative sample of US workers. Therefore, current occupation can be used as a surrogate for longest-held job for many occupational subgroups.

All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 US states, 1984-1997

OBJECTIVES

We investigated mortality differences according to socioeconomic status (SES) for employed persons in 27 states during 1984-1997.

METHODS

SES was determined for persons aged 35-64 years according to the "usual occupation" listed on their death certificates. We used US Census denominator data.

RESULTS

For all-cause mortality, rate ratios from lowest to highest SES quartile for men and women were 2.02, 1.69, 1.25, and 1.00 and 1.29, 1.01, 1.07, and 1.00, respectively. Percentage of all deaths attributable to being in the lowest 3 SES quartiles was 27%. Inverse SES gradients were strong for most major causes of death except breast cancer and colorectal cancer. Heart disease mortality for highest and lowest SES quartiles dropped 45% and 25%, respectively, between 1984 and 1997.

CONCLUSIONS

Mortality differences by SES were sustained through the 1990s and are increasing for men.

Deaths due to injuries among employed adults: the effects of socioeconomic class

BACKGROUND

Few studies have investigated socioeconomic status (SES) and external causes of death (ie, deaths attributable to injuries). These deaths are of particular interest because they are potentially preventable and they represent the second leading cause of years of life lost under age 75.

METHODS

We studied 261,723 deaths from external causes in 27 states from 1984 to 1997 among employed persons age 20-64. Numerator data came from occupation on the death certificate. Occupation-specific denominator data came from the U.S. Census. A Nam-Powers SES score was assigned to each occupation based on its relative income and education in the U.S. Census.

RESULTS

After adjusting for age, sex, year and race, SES was strongly associated with mortality from all external causes combined for men (rate ratios = 2.9, 2.3, 1.5, and 1.0 by ascending SES quartile), and to a lesser extent for women (rate ratios = 1.6, 1.0, 1.1, and 1.0). A similar pattern was seen for each of the specific external causes (motor vehicle deaths, suicide, homicide, injuries other than by motor vehicle, and medical complications).

CONCLUSIONS

We estimate 41% of deaths from external causes are attributable to having a SES below the top quartile (both sexes combined).

Availability and quality of industry and occupation information in the Massachusetts Cancer Registry

BACKGROUND

Industry and occupation (I/O) data from state cancer registries can be useful in generating and evaluating hypotheses about occupational cancer risks. The quality of these data is uncertain.

METHODS

We reviewed medical records on 1,020 cases from the Massachusetts Cancer Registry (MCR). We compared the presence and detail of I/O data from this dedicated record review (DRR) with routine reporting to the MCR in order to evaluate the potential to increase the availability of I/O data.

RESULTS

Compared to routine reporting, the DRR increased the percentage of codable I/O data from 63.6 to 80.4%. The DRR also provided more detail in existing codes in 15.4% of cases. Other sections of the medical record in addition to the face sheet and sections of the record from the period before cancer diagnosis were important sources of additional information. Duration and timing of the corresponding I/O information were rarely recorded.

CONCLUSIONS

The nearly one-third (32%) of records that had some improvement in I/O information with a dedicated review indicates considerable opportunity to improve the utility of this resource.

Genetic analysis of families with nonsmoking lung cancer probands

As part of a genetic epidemiologic study of lung cancer among nonsmokers, we investigated the role of genetic predisposition in familial aggregation. Cases were identified from the Metropolitan Detroit Cancer Surveillance System. Information on lung cancer occurrence, smoking habits (active or passive), and chronic respiratory diseases in first-degree relatives was obtained for 257 nonsmoking lung cancer probands (71 males, 186 females) diagnosed at ages 40-84 years. Among the 2,021 first-degree relatives, 24 (2.6%) males and 10 (1.1%) females were reported as having lung cancer. The occurrence of lung cancer among smoking and nonsmoking relatives was 4.5% and 1.1% in males and 2.8% and 0.4% in females, respectively. To evaluate the role of a putative Mendelian gene (one locus, two alleles) in the presence of other risk factors, we performed complex segregation analyses on the data using two different regressive model approaches [Segregation Analysis of a Discrete Trait Under a Class A Regressive Logistic Model, V4.0 (REGD) and Segregation Analysis of a Truncated Trait, V2.0, Model 1(REGTL)] as implemented in the Statistical Analysis for Genetic Epidemiology (SAGE) program. Using either approach, an environmental model best explained the observed lung cancer aggregation in families ascertained through nonsmoking probands. Based on our final model, only 0.04% of this population had a very high risk and 4.2% had a moderate risk of lung cancer. The rest of the population had virtually no risk of lung cancer during their lifetime unless they have multiple risk factors. Among the high-risk individuals without any risk factor under study, the estimated risks at ages 40, 60, and 80 years in males were 16.7%, 83.6%, and 95.4%, and in females were 14.0%, 72.2%, and 88.0%, respectively. Among at-moderate-risk smokers the estimated risks at the same age and gender groups were essentially the same as in the high-risk nonsmokers. Our results suggest that the pattern of lung cancer occurrence in families of nonsmoking lung cancer patients differs from that in families of smoking lung cancer patients. Despite the profound effect of smoking on the risk of lung cancer, other environmental and/or genetic risk factors need to be identified.

Increased cancer risk among relatives of nonsmoking lung cancer cases

Lung cancer has been shown to aggregate in families of nonsmoking lung cancer cases with an earlier age at onset. The current study evaluates whether relatives of nonsmoking lung cancer cases are at increased risk of cancers at sites other than lung. Families were identified through 257 population-based, nonsmoking lung cancer cases and 277 population-based, nonsmoking controls residing in metropolitan Detroit. Data were collected for 2,252 relatives of cases and 2,408 relatives of controls. First-degree relatives of nonsmoking lung cancer cases were at 1.52-fold (95% CI, 1.02-2.27) increased risk of cancer of the digestive system after adjustment for each relative's age, race, sex, and smoking status. Relative risk estimates also were elevated, but not significantly, for tobacco-related cancers (RR = 1.39) and breast cancer (RR = 1.72). Among first-degree relatives of younger probands (age 40-59), risk was non-significantly increased 72% (95% CI 0.95-3.10) for all cancers combined and 3.14-fold for cancers of the digestive system (95% CI 0.76-12.9). Nonsmoking relatives of cases were at increased risk of all cancer sites combined (RR = 1.32; 95% CI 1.003-1.73), cancers other than lung (RR = 1.37; 95% CI 1.03-1.82), and digestive system cancers (RR = 2.01; 95% CI 1.20-3.37). These findings of moderate familial aggregation for cancers of the lung, digestive system, breast, and tobacco-related sites suggest that common susceptibility genes may act to increase risk for a variety of cancers in families.

Lung cancer risk in families of nonsmoking probands: heterogeneity by age at diagnosis

In an earlier investigation, we did not detect a major genetic component to lung cancer in families of nonsmoking lung cancer probands. However, heterogeneity with respect to familial aggregation, based on probands' age at diagnosis, was evident. We reanalyzed our previously collected data of 257 families, stratified by age at diagnosis of the probands, using complex segregation analysis. We specifically tested the effects of a Mendelian diallelic gene, history of tobacco use, and history of selected chronic lung diseases in families with a proband diagnosed at the age of 60 years or older and in families with a younger proband (i.e. , under 60 years of age). Cases were identified from the Metropolitan Detroit Cancer Surveillance System. Information on lung cancer occurrence, smoking history, and chronic respiratory diseases in first-degree relatives was obtained for 210 older probands and for 47 younger probands. In older probands' families, no evidence of a major genetic effect was detected. A history of emphysema and tobacco-smoke exposure were found to be significant risk factors. In younger probands' families, a Mendelian codominant model with significant modifying effects of smoking and chronic bronchitis best explained the observed data. Our results suggest the presence of a high-risk gene contributing to early-onset lung cancer in a population where the probands are nonsmokers.

Evidence of increasing coronary heart disease mortality among black men of lower social class

PURPOSE

Few data are available to examine coronary heart disease (CHD) mortality trends by social class in the United States, in contrast to ample data and well-documented social class disparities in CHD in Europe. In addition, previous analyses of U.S. national data indicated that the rate of decline in CHD mortality slowed substantially for blacks in the 1980s. Using a recently published method for calculating mortality rates by social class, we examined trends in CHD mortality for black men and white men aged 35-54 in North Carolina from 1984 to 1993.

METHODS

Men were assigned to one of four social classes: primary white collar (I), secondary white collar (II), primary blue collar (III), or secondary blue collar (IV), based on usual occupation as recorded on the death certificate. Population denominators for each social class were constructed using data from census Public Use Microdata Sample files. Average annual percent change in mortality rates for each race-social class group was derived from linear regression of the log-transformed age-adjusted rates.

RESULTS

For black men, CHD mortality increased by 18% in social class II, by 2% in social class III, and by 6% in social class IV over the 10-year study period. In contrast, CHD mortality decreased by 33% for black men in social class I (the highest class). CHD mortality declined for all white men, with the greatest decline in social class I and the least decline in social class IV.

CONCLUSIONS

These results suggest that CHD prevention efforts have not benefited black men of lower social class, and that public health programs need to be targeted to these men.

Work organization and atherosclerosis: findings from the ARIC study. Atherosclerosis Risk in Communities

INTRODUCTION

The aim of this investigation was to examine the extent to which work organization (i.e., occupational stress) is associated with subclinical carotid atherosclerosis.

METHODS

For that purpose we used a cross-sectional study of four U.S. community samples conducted between 1987 and 1989. Participants in the study were 10,801 adults aged 45 to 64 years. Subclinical carotid atherosclerosis was assessed by measuring the intima-media thickness (IMT) of the carotid artery wall using B-mode ultrasound. Occupational stress was defined using six indicators: substantive complexity of work, physical demands, job insecurity, skill discretion, decision authority, and physical exertion. Information from U.S. national surveys on occupational stress indicators was linked to the study participants' occupation.

RESULTS

We observed negative associations of complexity of work and skill discretion with mean IMT of the carotid artery wall among the four race-gender groups. In addition, physical demands was positively associated with mean IMT among blacks and job insecurity was positively associated with IMT among white women and black men. After adjustment for well-established risk factors, the magnitude of these associations was substantially reduced.

CONCLUSIONS

Taken in combination with results from recent European studies, our findings suggest that work organization plays a role in the etiology of atherosclerosis.

Social class and premature mortality among men: a method for state-based surveillance

OBJECTIVES

This study examined trends in mortality by social class for Black and White men aged 35 through 54 years in North Carolina, for 1984 through 1993, using an inexpensive, newly developed state-based surveillance method.

METHODS

Data from death certificates and census files permitted examination of four social classes, defined on the basis of occupation.

RESULTS

Premature mortality was inversely associated with social class for both Blacks and Whites. Blacks were at least twice as likely to die as Whites within each social class.

CONCLUSIONS

Adoption of state-specific surveillance of social class and premature mortality would provide data crucial for developing and evaluating public health programs to reduce social inequalities in health.

Occupational fatalities among older workers in the United States: 1980-1991

Workers aged 65 and older had a workplace fatality rate of 2.6 times that of workers aged 16 to 64 for 1980 through 1991 (14.1 per 100,000 vs 5.4), according to National Traumatic Occupational Fatalities (NTOF) data. The highest rates were in mining, agriculture, and construction. Compared with younger workers, older men were at an elevated risk for fatalities caused by machines, and older women for fatal falls and homicide. Prevention efforts should focus on older workers in agricultural settings, as well as those at increased risk of workplace falls or violence.

Social class and race disparities in premature stroke mortality among men in North Carolina

The purpose of this work was to examine the association between social class and premature stroke mortality among blacks and whites. For black men and white men in North Carolina, aged 35-54 years, mortality data from vital statistics files and population data from Census Public Use Microdata Sample files were matched according to social class for the years 1984-1993. Four categories of social class were defined based upon a two-dimensional classification scheme of occupations. For each category of social class, race-specific age-adjusted stroke mortality rates were calculated, and race-specific prevalences of income, wealth, education, unemployment, and disability were estimated. Women were excluded because comparable information on social class was not available from the mortality and population data sources. For both black men and white men, the highest rates of premature stroke mortality were observed among the lowest social classes. The rate ratios (RR) between the lowest and highest social class were 2.8 for black men and 2.3 for white men. Within each social class, black men had substantially higher rates of premature stroke mortality than white men (black-to-white RR ranged from 4.0 to 4.9). Among both black men and white men, the highest social class consistently had the most favorable levels of income, wealth, education, and employment. The inverse association between social class and stroke mortality for both black men and white men supports the need for stroke prevention efforts that address the structural inequalities in economic and social conditions.

Formaldehyde and cancer morbidity among male employees in Denmark

Formaldehyde, a genotoxic and potent animal carcinogen, is widespread in the working environment as well as in private homes. The risk for cancer morbidity in Denmark during 1970-84 was estimated from standardized proportionate incidence ratios (SPIR) among men whose longest employment had been held since 1964, at least 10 years before diagnosis, in 265 companies in which exposure to formaldehyde was identified. The results do not support the hypothesis that formaldehyde is associated with lung cancer (SPIR = 1.0, 410 cases). Significantly elevated risks were found for cancers of the colon (SPIR = 1.2, 166 cases), kidney (SPIR = 1.3, 60 cases), and sino-nasal cavities (SPIR = 2.3, 13 cases). For sino-nasal cancer, a relative risk of 3.0 (95 percent confidence interval = 1.4-5.7) was found among blue-collar workers with no probable exposure to wood dust, the major confounder. This study provides further evidence that occupational exposure to formaldehyde increases the risk for sino-nasal cancer.

Psychotic inpatients' social class and their first admission to state or private psychiatric Baltimore hospitals

Social class differences were investigated among patients admitted to public and private psychiatric hospitals. Participants included first admission White psychotic men admitted to Baltimore metropolitan area hospitals between 1983 and 1989. After adjusting for age and diagnosis, patients with low levels of skills/credentials were found to be more likely than patients with higher levels to be admitted to state psychiatric hospitals. These findings underscore the persistence of social class as a determinant of differences in the use of psychiatric care.

Validity of exposure in one job as a surrogate for exposure in a cohort study

Frequently, information pertaining to only one job is available or used to evaluate risk estimates of disease in occupational epidemiologic research. The amount of misclassification that such a practice could create has not, however, been examined. We used data from a mortality study of workers employed in 10 formaldehyde-producing or -using plants to address how closely several parameters of exposure based on the first, longest, or last job held in a company compared with those based on the worker's entire employment history at the plant. The best predictor for cumulative formaldehyde exposure at the plant was the longest job at that plant, with a correlation coefficient (r) of 0.70. The correlation with average exposure over the worker's employment was 0.77 for the first job and 0.74 for the longest and last jobs. Peak exposures and highest exposure levels experienced in the plant were more closely related to the first job (r = 0.72 and r = 0.74). The highest correlation with any of the measures was never with the last job. Variation between plants for each of these comparisons, however, was wide. These findings indicate that the use of a single job as a surrogate for exposure received at a particular worksite can result in different degrees of misclassification for different exposure measures. Even though the correlations were generally high, the associated misclassification of exposure could lead to a substantial underestimation of the relative risks in some situations. In this report two hypothetical examples show what effect the misclassification rates could have on estimates of disease risks.

Alcoholism and occupations: a review and analysis of 104 occupations

A review of the many attempts to establish an association between occupations and alcoholism reveals that most do not deal with data about clinically defined alcoholism but instead use data about cirrhosis mortality, self-reported alcohol problems, and frequent and heavy drinking. The present study establishes an association between occupations and diagnoses of Alcohol Dependence Disorder and Alcohol Abuse Disorder, using data from a large population-based household interview study. Statistical adjustment using logistic methods reveals that apparent associations between occupations and alcohol-related disorders previously reported in the literature are due to characteristics of those employed in various occupations. The prevalence of alcohol dependence and abuse in two high risk industries, construction and transportation, is confirmed. More than one in four construction laborers and one in five skilled construction trades workers received a DIS/DSM-III diagnosis related to alcohol abuse. In the transportation industry one in six heavy truck drivers and material movers received an alcohol diagnosis. Analyses of the data from individuals currently employed and not employed in their occupation reveals reduction in risk for those who leave some occupations and increased risk for those who leave other occupations. Evidence is presented that employment in some occupations may be protective for Alcohol Dependence. The findings support the view that occupation may be associated with Alcohol Dependence and Alcohol Abuse independent of demographic variations. Previously proposed explanatory models for associations between occupations and alcohol problems are called into question because they do not take into account the demographic characteristics and employment status of workers.

Hospital records as a data source for occupational disease surveillance: a feasibility study

To assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses--lung cancer, bladder cancer, and toxic hepatitis--were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for "usual" than for "last" categories with both cancer diagnoses, but were similar for "usual" and "last" categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work-relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work-relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely administered on admission.

Female homicides in United States workplaces, 1980-1985

BACKGROUND

Women, while noted for low occupational injury mortality rates, are more likely to die as victims of assault than from any other manner of injury at work.

METHODS

From the National Traumatic Occupational Fatality surveillance data, 950 women were identified who were fatally assaulted at work. Homicide rates were calculated for the demographic and employment characteristics of these women. Risk ratios among types of lethal injuries were examined.

RESULTS

During 1980-1985, the crude six-year workplace homicide rate was 4.0 deaths per million working women: one twentieth the homicide rate of the US female population. Decedents ranged from 16 years (the lowest age included in the data base) to 93 years of age. Working women older than 65 years had the highest age-specific homicide rate, 11.3 per million. Women younger than 20 had the lowest, 2.5 per million per year. Homicide rates for women of races other than White were nearly twice as high as those of Whites. The leading causes of death were gunshot wounds (64 percent), stabbings (19 percent), asphyxiations (7 percent), and blunt force trauma (6 percent). Nearly 43 percent of the deceased women had been employed in retail trade: 8.7 per million employed women annually.

CONCLUSIONS

During 1980-1985, only 6 percent of the nation's victims of work-related injury deaths were female: 41 percent of those women were murdered. Homicide is currently the leading manner of traumatic workplace death among women in the United States.

Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history

STUDY OBJECTIVE

The aim was to compare four different measures of women's social class (interview and census based) as predictors of well known social gradients in reproductive outcomes. The intent was to address two obstacles that confront research in the United States regarding social gradients in women's health: how women's social class should be measured, and the absence of socioeconomic data in most health records.

STUDY DESIGN

The study was a retrospective cohort analysis, using a community based random sample. Setting--Alameda County, California, 1987.

SUBJECTS

51 black and 50 white women, ages 20 to 80 years, identified by random digit dialling, were interviewed by telephone.

MEASUREMENTS AND MAIN RESULTS

Census data were linked to individual records via the respondents' addresses. Using number of full term pregnancies as an example, multiple linear regression analyses demonstrated that individual class was not significantly associated with this outcome, whereas household class was: women from non-working-class households had 0.8 fewer such pregnancies than women from working class households (95% confidence interval [CI] = -1.4, -0.1). The block group measure functioned most like the household class measure (beta = -0.7, 95% CI = -1.4, 0.1), while the census tract measure was non-significant (beta = -0.4, 95% CI = -1.2, 0.4). Similar results were obtained for the outcomes: age at first full term pregnancy, percent of early terminated pregnancies, and yearly income.

CONCLUSIONS

These results suggest block group data may offer a uniform source of social class information that can be appended to individual health records, and that this strategy is not invalidated by concerns regarding ecological fallacy.

The quality of retrospective questions about occupational history--a comparison between survey and census data

The main purpose of the present study was to assess the quality of information about occupational history obtained via retrospective interview questions. This assessment is achieved by linking interview data from the Swedish survey of Living Conditions (ULF) with occupational information about the same individuals obtained from a number of censuses. This has been done for the census years 1960, 1970, 1975 and 1980. In both ULF and the census, occupations have been classified according to the Nordic Occupational Classification (NYK). Both data sources contain errors. There are also differences in definitions and measurement procedures. Still, the survey question on occupational history gives results of good quality in terms of agreement with census data. This is especially the case for coarse levels of the classification scheme (NYK 1-digit level). The agreement is somewhat lower for the comparisons farthest back in time.

Cancer by industry: analysis of a population-based cancer registry with an emphasis on blue-collar workers

This paper uses information on occupation and industry routinely collected in a state-based cancer registry to assess potential associations between work place exposures and cancer incidence. Industry-specific proportional cancer incidence ratios (PCIR) were calculated by race and sex for all individuals and for white males with blue-collar occupations. Expected numbers of cancers were derived both from cancers occurring among all occupations and just among blue-collar occupations. This latter analysis was done as a control for differences in the prevalence of life-style habits between blue- and white-collar workers. Increased lung cancer PCIR were seen in most industries previously reported to be associated with lung cancer risk. The effects of socioeconomic status on these results are discussed. Other results include an increased ratio of melanoma in blue-collar white male rubber and plastic product workers, an increased ratio of non-Hodgkin's lymphomas in motor vehicle manufacture workers, and an increased PCIR of chronic lymphocytic leukemia in general construction workers. Uterine cancer was increased in proportion in white females for a number of industries including rubber and plastic product manufacture, apparel manufacture, and electrical equipment manufacture.

Polychlorinated biphenyls and the developing nervous system: cross-species comparisons

Polychlorinated biphenyls are stable, lipophilic industrial compounds that are present in residue levels in human tissue, wildlife, and freshwater sediment. They are toxic, and are known to cross the placenta and intoxicate the fetus. Two large outbreaks of PCB poisoning have occurred in Asia; women pregnant at or after the exposures had children who were developmentally impaired. Laboratory experiments in rhesus monkeys and rodents, designed to assess neural or developmental effects, show altered activity levels, impaired learning, and delayed ontogeny of reflexes. Children exposed transplacentally to levels considered to be background in the U.S. have hypotonia and hyporeflexia at birth, delay in psychomotor development at 6 and 12 months, and poorer visual recognition memory at 7 months. Allowing for differences in testing, effects are roughly similar across species, but current methods used to calculate allowable or reference doses give results up to 4 orders of magnitude apart, with the lowest level based on the neurotoxicology level coming from the human data.

Racial and gender discrimination: risk factors for high blood pressure?

Despite controversy as to the biologic and/or social meaning of 'race' and 'sex', few public health studies have directly examined the impact of racial or gender discrimination on health. One plausible condition they might affect is hypertension, since stress and internalized anger may constitute important risk factors for this disease. The present investigation therefore sought to determine the feasibility of asking questions pertaining to race- and gender-biased treatment plus response to unfair treatment, and to assess their predictive value regarding self-reported high blood pressure. Using random-digit dialing, 51 black and 50 white women, ages 20-80, who resided in Alameda County, CA in 1987, were identified and interviewed by phone. Among black respondents, those who stated they usually accepted and kept quiet about unfair treatment were 4.4 times more likely to report hypertension than women who said they took action and talked to others (P = 0.01 for linear trend); no clear association existed among white respondents. The age-adjusted risk of high blood pressure among black respondents who recounted experiencing zero instances of race- and gender-biased treatment was 2.6 times greater than that of black women who reported one or more such instances (95% CI = 0.7, 10.5). Among white respondents, gender discrimination was not associated with hypertension. These results suggest that an internalized response to unfair treatment, plus non-reporting of race and gender discrimination, may constitute risk factors for high blood pressure among black women. They also bolster the view that subjective appraisal of stressors may be inversely associated with risk of hypertension.

Concordance of occupational and environmental exposure information elicited from patients with Alzheimer's disease and surrogate respondents

Identification of risk factors for Alzheimer's disease through the use of well designed case-control studies has been described as a research priority. Increasing recognition of the neurotoxic potential of many industrial chemicals such as organic solvents raises the question of the occupational and environmental contribution to the etiology of this high-priority health problem. The intention of this study was to develop and evaluate a methodology that could be used in a large scale case-control study of the occupational and environmental risk factors for dementia or a population-based surveillance system for neurotoxic disorders. The specific objectives of this study were to investigate: 1) the reliability of exposure-eliciting, interviewer-administered questionnaires given to patients with Alzheimer's disease (SDAT); 2) the reliability of exposure-eliciting interviewer-administered questionnaires given to the family of patients with SDAT and the agreement with the responses of the patient or surrogate respondents; 3) the reliability and agreement of responses of age- and sex-matched control patients and their families selected from geriatric care institutions and the community, with respect to the same exposure-eliciting and interviewer-administered questionnaire; and 4) the reliability of agent-based exposure ascertainment by a single, trained rater. The results of the study demonstrate that occupational and environmental histories from which exposure information can be derived is most reliably elicited from job descriptions of cases and control subjects rather than job titles alone or detailed probes for potential neurotoxic exposures. This will necessitate the use of standardized interviewer-administered instruments to derive this information in case-control studies of Alzheimer's disease or population-based surveillance systems for occupational and environmental neurotoxicity.

Occupation and squamous cell cancers of the pharynx and sinonasal cavity

Lifetime job histories from a population-based case-control study of squamous cell carcinomas of the oro- and hypopharynx (OHPC), nasopharynx (NPC), and sinonasal cavity (SNC) were systematically examined to generate new hypotheses as well as to test previously noted associations between occupation and the cancers under study. The effects of both duration of employment in a particular job and the timing of the employment in relation to cancer diagnosis were investigated in a stratified analysis that controlled for cigarette smoking, alcohol intake, and other major risk factors. Overall, data on 231 cases and 552 controls were analyzed. Occupations at increased risk of OHPC included "food service" workers in the "retail trade" industry (odds ratio = 1.9; 95% confidence interval = 1.0-3.6), "vehicle mechanics" in the "repair services" industry (OR = 2.5; CI = 0.8-8.3), "industrial mechanics" (OR = 31.0; CI = 3.0-315.1), and "carpenters" in the "construction" industry (OR = 1.5; CI = 0.7-3.4). For NPC, similar patterns of increased risk were found for "food service" workers and "vehicle mechanics." For "carpenters" in the "construction" industry, the relative risk estimate was almost five (OR = 4.8; CI = 1.2-19.4). Increases in SNC risk were noted for "food service" workers, as well as a number of occupations in the "lumber and wood product manufacturing" industry, including "forestry and logging" (OR = 2.0; CI = 0.5-8.2), and "wood working machine operators" (OR = 7.9; CI = 1.6-39.2). In each of these instances, the relative risk estimates increased with increasing duration in the job and when a 15-year induction/latency period was taken into account.

Comparison of death certificate occupation and industry data with lifetime occupational histories obtained by interview: variations in the accuracy of death certificate entries

This study compares usual and recent occupation and industry data from lifetime work histories obtained by interview with death certificate entries for occupation and industry for 2,435 persons diagnosed with cancer. Match rates are calculated as the percent of death certificate occupation and industry entries that were confirmed by interview data and are compared for exact 3-digit 1980 U.S. Census Bureau occupation and industry codes and for groups of these codes. The overall match rate for individual usual occupation codes was 47.9% and for exact usual industry codes it was 61.8%. Significant differences between the interview data for usual occupation or industry and the death certificate entry were observed by race and gender, marital status, number of years worked, and occupation and industry groups and by age for industry. Misclassification or overreporting of occupation and industry data on the death certificate ranged from 30 to 50% in this study. Our results suggest that the utility of death certificate data for investigations into the occupational risk factors for cancer may be quite limited.