The Healthy Worker Effect and Nuclear Industry Workers

Fornalski, Krzysztof W.; Dobrzyński, L.

doi:10.2203/dose-response.09-019.fornalski

Cited by 27 publications

(12 citation statements)

References 47 publications

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“…In line with this, Flanders showed that time-since-hire was associated with decline in health and could therefore cause an artificial adverse effect of cumulative exposure [28] in the opposite direction as HWE. Consistently, Howe argues that the maximal lowered mortality is observed during the first five years of employment [10]. These results seem in line with ours indicating an effect modification by age.…”

Section: Discussionsupporting

confidence: 91%

Quantification of the healthy worker effect: a nationwide cohort study among electricians in Denmark

et al. 2011

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BackgroundThe healthy worker effect (HWE) is a well-known phenomenon. In this study we used the extensive registration of all Danish citizens to describe the magnitude of HWE among all Danish electricians and evaluated strategies for minimizing HWE bias of the association between occupation and mortality.MethodsAll Danish male citizens aged 26-56 years in the period 1984-1992 were followed for three years in several registers. We evaluated HWE bias among electricians because they were unexposed to detrimental occupational exposures. We compared electricians to three reference groups (general population, construction industry and carpenters/brick layers) and utilized analytical methods for minimizing HWE bias (lag time analyses, age-stratified analyses, marginal structural model and restriction to employed, newly employed or long-term workers).ResultsThe mortality rate was higher among electricians, who the year following active employment received incapacity benefits or were on long-term sick leave. Electricians receiving incapacity benefits, on long-term sick leave, unemployed, or with increased comorbidity index had lower odds of re-employment. Electricians had lower mortality rate (rate ratio,0.60;95%CI,0.52-0.69) compared to the general population, while electricians leaving employment had increased mortality (1.90;1.50-2.40). Adjusting for several social events slightly attenuated the estimates, while the marginal structural model did not minimize bias. Electricians had the same mortality as the construction industry and carpenters/brick layers. Mortality was comparable to the general population after three or more years of lag time.ConclusionsIn this nationwide study, employment as electricians had marked effect on mortality. Appropriate reference selection and lag time analyses minimized the HWE bias.

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Section: Discussionsupporting

confidence: 91%

Quantification of the healthy worker effect: a nationwide cohort study among electricians in Denmark

et al. 2011

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“…Most studies find an average underestimation of about 25% of the association of a noxious stimulus on mortality as a result of HWE. [ 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ] This underestimation of risk implies that being exposed to the noxious stimulus was protective. [ 17 18 19 20 21 ] HWE may not be complete and may only partially mask the excess mortality[ 19 ] and in rare cases may not be protective.…”

Section: U Nderstanding H Ealthymentioning

confidence: 99%

Healthy worker effect phenomenon: Revisited with emphasis on statistical methods – A review

Chowdhury

Shah

Payal

2017

Indian J Occup Environ Med

192

134

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Known since 1885 but studied systematically only in the past four decades, the healthy worker effect (HWE) is a special form of selection bias common to occupational cohort studies. The phenomenon has been under debate for many years with respect to its impact, conceptual approach (confounding, selection bias, or both), and ways to resolve or account for its effect. The effect is not uniform across age groups, gender, race, and types of occupations and nor is it constant over time. Hence, assessing HWE and accounting for it in statistical analyses is complicated and requires sophisticated methods. Here, we review the HWE, factors affecting it, and methods developed so far to deal with it.

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“…The so-called healthy worker effect is a commonly found phenomenon in occupational epidemiology [20], which is reflected in the standardized rate ratio as being less than one when compared to the external control, i.e. , the general population.…”

Section: Discussionmentioning

confidence: 99%

Cancer Risk in Diagnostic Radiation Workers in Korea from 1996–2002

Choi

Lee

et al. 2013

IJERPH

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This study was aimed to examine the association between the effective radiation dose of diagnostic radiation workers in Korea and their risk for cancer. A total of 36,394 diagnostic radiation workers (159,189 person-years) were included in this study; the effective dose and cancer incidence were analyzed between the period 1996 and 2002. Median (range) follow-up time was 5.5 (0.04–7) years in males and 3.75 (0.04–7) years in females. Cancer risk related to the average annual effective dose and exposure to more than 5 mSv of annual radiation dose were calculated by the Cox proportional hazard model adjusted for occupation and age at the last follow-up. The standardized incidence ratio of cancer in radiation workers showed strong healthy worker effects in both male and female workers. The relative risk of all cancers from exposure of the average annual effective dose in the highest quartile (upper 75% or more of radiation dose) was 2.14 in male workers (95% CI: 1.48–3.10, p-trend: <0.0001) and 4.43 in female workers (95% CI: 2.17–9.04, p-trend: <0.0001), compared to those in the lower three quartiles of radiation exposure dose (less than upper 75% of radiation dose). Cancer risks of the brain (HR: 17.38, 95% CI: 1.05–287.8, p-trend: 0.04) and thyroid (HR: 3.88, 95% CI: 1.09–13.75, p-trend: 0.01) in female workers were significantly higher in the highest quartile group of radiation exposure compared to those in the lower three quartiles, and the risk of colon and rectum cancers in male workers showed a significantly increasing trend according to the increase of the average annual radiation dose (HR: 2.37, 95% CI: 0.99–5.67, p-trend: 0.02). The relative risk of leukemia in male workers and that of brain cancer in female workers were significantly higher in the group of people who had been exposed to more than 5 mSv/year than those exposed to less than 5 mSv/year (HR: 11.75, 95% CI: 1.08–128.20; HR: 63.11, 95% CI: 3.70–1,075.00, respectively). Although the present study involved a relatively young population and a short follow-up time, statistically significant increased risks of some cancers in radiation workers were found, which warrants a longer follow-up study and more intensive protective measures in this population.

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The Healthy Worker Effect and Nuclear Industry Workers

Cited by 27 publications

References 47 publications

Quantification of the healthy worker effect: a nationwide cohort study among electricians in Denmark

Quantification of the healthy worker effect: a nationwide cohort study among electricians in Denmark

Healthy worker effect phenomenon: Revisited with emphasis on statistical methods – A review

Cancer Risk in Diagnostic Radiation Workers in Korea from 1996–2002

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