Precarious transition: a mortality study of South African ex-miners

Abstract

BackgroundDespite their burden of a triple epidemic of silicosis, tuberculosis and HIV infection, little is known about the mortality experience of miners from the South African mining industry once they leave employment. Such information is important because of the size and dispersion of this population across a number of countries and the progressive nature of these diseases.MethodsThis study included 306,297 South African miners who left the industry during 2001–2013. The study aimed to calculate crude and standardised mortality rates, identify secular trends in mortality and model demographic and occupational risk factors for mortality.ResultsCrude mortality rates peaked in the first year after exit (32.8/1000 person-years), decreasing with each year from exit. Overall mortality was 20% higher than in the general population. Adjusted annual mortality halved over the 12 year period. Mortality predictors were being a black miner [adjusted hazard ratio (aHR) 3.30; 95% confidence interval (CI) 3.15–3.46]; underground work (aHR 1.33; 95% CI 1.28–1.39); and gold aHR 1.15 (95% CI 1.12–1.19) or multiple commodity employment (aHR 1.15; 95% CI 1.11–1.19).ConclusionsThis is the first long-term mortality assessment in the large ex-miner population from the South African mining industry. Mortality patterns follow that of the national HIV-tuberculosis epidemic and antiretroviral treatment availability. However, ex-miners have further elevated mortality and a very high mortality risk in the year after leaving the workforce. Coordinated action between the mining industry, governments and non-governmental organisations is needed to reduce the impact of this precarious transition.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5749-2) contains supplementary material, which is available to authorized users.

Excess Mortality Due to External Causes in Women in the South African Mining Industry: 2013–2015

“…It was and still is thought that mining is not a woman's job [17], although by 2017 at least 12% of miners were female. In a study by Bloch et al (2018) using mining recruiter data, ex-miner mortality from 2001-2013 was investigated, where 5.1% of ex-miners were female [16]. In our study of registered deaths from 2013 to 2015, a similar proportion (5.7%) of miners were female.…”

“…In our study of registered deaths from 2013 to 2015, a similar proportion (5.7%) of miners were female. Bloch et al (2018) found no excess mortality in women ex-miners, while an average of 20% excess mortality was found in men. Their finding of a lack of excess mortality in women miners was limited by the fact that the mortality rate in ex-miners decreased over the years in the study and women were only employed in the later years.…”

“…A recent study by Bloch et al (2018) found that women miners did not have excess mortality compared to male miners. They reported an excess of mortality overall in miners which was 20% higher than the general public, although they found that the mortality rate decreased over time [16]. Although research on mortality in mining generally focuses on men, recent reports by Benya et al, 2019 highlighted the violence faced by women due to a masculine occupational culture in mining [17,18].…”

“…Further, in the USA, fatal injury rates in mining were found to be four times higher than the average for all industries [7]. In South Africa, studies reported miners to be at increased risk of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) [8,9], respiratory diseases [10][11][12][13], and injuries [14][15][16]. In a 2008 mortality cohort study of platinum miners in South Africa, external causes were found to be the second most common cause of death after HIV [15].…”

“…Despite this finding, men in the cohort exhibited lower rates of unnatural deaths overall than the average South African population (Incidence rate ratio 0.89, 95% confidence interval (CI) 0.82-0.95) [15]. A recent study by Bloch et al (2018) found that women miners did not have excess mortality compared to male miners. They reported an excess of mortality overall in miners which was 20% higher than the general public, although they found that the mortality rate decreased over time [16].…”