IntroductionLung cancer is the most frequent cancer, with smoking and radon as the two leading causes. Occupational exposures are another important risk factor, with an estimated population ...attributable fraction up to 15%.ObjectivesThis study aimed at assessing the effect of occupational exposures on lung cancer mortality in Switzerland after adjustment for non-occupational lung carcinogens.MethodsWe used negative binomial regression to analyse data of 4,351,383 Swiss residents with available occupation, and assess its effect on lung cancer mortality between 1990 and 2014, accounting for socio-demographic factors, smoking probabilities (by age, geographical region, civil status, educational level, nationality, and occupation) and measured environmental exposure to radon.ResultsMale machine operators and workers in mining, stone working and building materials manufacturing showed the highest risk with a relative risk (RR) of 2.42 (95%-IC: 2.05–2.87) and 2.08 (95%-IC: 1.50–2.89) compared to health occupations, respectively. In women, two of the largest risks were identified in electronics, watchmaking, vehicle construction and toolmaking (RR : 2.33 (95%-IC: 1.75–3.10)) and transport and traffic occupations (RR : 2.23 (95%-IC: 1.75–2.83)). Smoking RRs were 1.33 (95%-IC: 1.27–1.38) in males and 1.37 (95%-IC: 1.26–1.48) in females, while radon related RRs were not statically significant. Adjusting for socio-demographic factors, the RRs by occupation decreased by 16% and 4% on average in men and women, and by 4% and 6% when adjusting for smoking, but remained statistically significant.ConclusionsThe results suggest the presence of occupational exposures to lung carcinogens in addition to non-occupational factors. Longer follow-up and analysis by histological types of lung cancer are needed to improve the estimates of occupational lung cancer.
ObjectivesTo assess lung cancer mortality across occupations and economic activities/industries in Switzerland using three statistical estimates.MethodsAll Swiss residents aged 18–65 during the 1990 ...or 2000 censuses were followed through 2014 to ascertain information on date and cause of death. For every occupation and economic activity/industry, causal mortality ratios (CMR) and standardised mortality ratios (SMR) were computed using national cause-specific mortality rates. We also calculated relative SMR (rSMR) and conducted analyses stratified by socioeconomic variables, job skill level and calendar periods.ResultsThe study sample comprised 5 834 618 participants (111 162 348 person-years). SMR and CMR led to similar results, while rSMR were generally higher. We found 18 occupations in men, 10 occupations in women and 3 industries in each sex with an excess of lung cancer mortality. Among men, rubber and plastic products machine operators, and workers in mining and quarrying, and construction industries were at high risk. Among women, motor vehicle drivers and workers in trade, repair of motor vehicles and of domestic articles and manufacture of goods industries showed the highest risks. In both sexes, hotel and restaurant workers presented an excess of lung cancer mortality.ConclusionMost of the activities and occupations in which we observed excess lung cancer mortality have previously been observed to involve occupational exposure to lung carcinogens. These findings suggest that the number of occupational lung cancer is likely underestimated by the official Swiss statistics. Further research should address this question and the exposure–effect relationships in the most at-risk occupational groups.
Purpose
To identify occupations and socio-economic groups with detrimental or protective effect on suicide mortality.
Methods
For every occupation and economic activity/industry, we computed directly ...age-standardized mortality rates (DSRs) using the age structure of the European population (2010) and standardized mortality ratios (SMRs) for suicide using national cause-specific mortality rates. We further stratified analyses by socio-economic variables, job-skill level, and by three calendar periods (1990–1998/1999–2006/2007–2014).
Results
The study sample comprised 5,834,618 participants (94,918,456 person-years). The highest DSRs were observed among unemployed/job-seeking group, in agricultural, fishery and related male workers, and in health and social activities female workers. The lowest DSRs were observed in real estate and renting, research and development, IT and other business activities in men and in agriculture, hunting and forestry industry in women. A consistent reduction in DSRs across three calendar periods was observed in men. In female corporate managers, DSRs increased over the 2007–2014 period compared with 1999–2006. Compared to general working-age population, unemployed/job-seeking people, manufacturing labourers, personal care and related workers, and motor vehicle drivers of both sexes were identified at risk of suicide. Moreover, an excess of suicide was observed among male material recording and transport clerks; nursing and midwife-associated professionals; and agricultural workers as well as among female writers and performing artists.
Conclusions
The findings suggest the detrimental effect of low socioeconomic positions, including unemployment, with respect to suicide mortality and a relationship between suicide and poor psychosocial working conditions in elementary occupations. Sex-specific results need further investigation.
ContextThe aim of this study was to describe the factors associated with mortality by suicide among women at work with a particular focus on work-related factors.Population and methodsThe study ...population was based on the data of the Swiss National Cohort (SNC) consisting in all Swiss residents recorded in the 1990 and/or the 2000 compulsory national censuses linked to emigration and mortality registers. Within the SNC we selected all working women aged between 18 and 65 at the official census dates.Following work-related variables were available in both censuses: Socio-economic status, weekly hours of work, the sector of activity according to the Swiss NOGA scheme and the job title coded according to ISCO. The date of beginning of follow-up was the date of the relevant census. The date of end of follow-up was the earliest of the 65th anniversary, dec 31 st 2014 (the end of mortality follow-up), the date of loss of follow-up or dec 4th 2010 if no declared work in the 2000 census. The risk of suicide was modelled using negative binomial regression incorporating the number of person-years as offset.ResultsThe cohort comprised 1,843,619 women and 2524 deaths by suicide corresponding to 24.9 million person-years. The most significant non-occupational predictors of suicide were age, civil status, period, nationality and geographical regions. Part-time work and long working hours were associated with increased suicide rates. Health and social activities had the highest suicide risks and education the lowest. Overall the job title according to ISCO-1d was not significant. However the rank of suicide risk among women followed approximately the skill levels associated with these codes. Of interest is however the high RR among professionals.ConclusionAfter accounting for the main non-occupational factors, the suicide risk varied significantly with some work-related factors that were specific for women.
ContextGiven the importance of harmonization in occupational epidemiology (OE) research, an European network, OMEGA-NET, is developing an inventory of occupational, industrial and population cohorts ...in Europe. We inventorized existing cohorts in Switzerland and assessed their relevance for OE.MethodsWe identified cohorts based on the review of data repositories and publications of the leading occupational and public health institutions in Switzerland. Cohorts were considered relevant for OE if data on occupation were available. The quality of these data was assessed critically.ResultsIn Switzerland, we found no industrial cohort, one retrospective occupational cohort exposed to magnetic fields 20,141 Swiss Federal Railway workers, cancer morbidity follow-up=1972–2002 and four population-based cohorts relevant for OE: the census-based Swiss National Cohort (SNC) 5.8 million adult residents in Switzerland, mortality by cause follow-up=1990–2014, the Study on Air Pollution And Lung Disease In Adults (SAPALDIA) n=9,561, lung function and morbidity follow-up=1991-present, CoLaus|PsyCoLaus 6,700 35–75 year-old residents of Lausanne, cardiovascular and mental morbidity follow-up=2003-present, the Swiss Kidney Project on Genes in Hypertension (SKIPOGH) 1134 residents of Lausanne, Geneva and Berne, kidney and metabolic morbidity follow-up=2009-present.Occupation was coded using the International Standard Classification of Occupations (ISCO) only in the SNC (ISCO-68 and ISCO-88) and SAPALDIA (ISCO-88). In SKIPOGH, the Belgian Classification of occupations was used. In CoLaus|PsyCoLaus, occupation remains uncoded. Noteworthy, the percentage of missing occupations is 43%, non-reported, 65% and 61%, respectively.ConclusionHaving detailed high-quality data on multiple health outcomes, the identified Swiss cohorts may represent a valuable contribution to OE research. However, in absence of standardisation in collecting and coding of occupational data in these cohorts, their use in OE is still challenging. Planned harmonization efforts in frame of OMEGA-NET will be beneficial for improving the quality of these data and OE research in Switzerland and abroad.
Coronary microvascular dysfunction (CMVD) is common and associated with poorer outcomes in patients with ST Segment Elevation Myocardial Infarction (STEMI). The index of microcirculatory resistance ...(IMR) and the index of hyperemic microvascular resistance (HMR) are both invasive indexes of microvascular resistance proposed for the diagnosis of severe CMVD after primary percutaneous coronary intervention (pPCI). However, these indexes are not routinely assessed in STEMI patients. Our main objective was to clarify the association between IMR or HMR and long-term major adverse cardiovascular events (MACE), through a systematic review and meta-analysis of observational studies. We searched Medline, PubMed, and Google Scholar for studies published in English until December 2020. The primary outcome was a composite of cardiovascular death, non-cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and rehospitalization for heart failure occurring after at least 6 months following CMVD assessment. We identified 6 studies, reporting outcomes in 1094 patients (mean age 59.7 ± 11.4 years; 18.2% of patients were women) followed-up from 6 months to 7 years. Severe CMVD, defined as IMR > 40 mmHg or HMR > 3mmHg/cm/sec was associated with MACE with a pooled HR of 3.42 2.45; 4.79. Severe CMVD is associated with an increased risk of long-term adverse cardiovascular events in patients with STEMI. Our results suggest that IMR and HMR are useful for the early identification of severe CMVD in patients with STEMI after PCI, and represent powerful prognostic assessments as well as new therapeutic targets for clinical intervention.
The contribution of occupation-related diseases to the global burden of disease is greatly underestimated, mainly due to a shortage of occupational exposure data. This problem is particularly salient ...in Switzerland, where no estimates of occupation-related disease burden exist, even for the well-recognised occupational cancers, such as malignant pleural mesothelioma and lung cancer. To overcome this situation, we launched a research project "Examining Cancers and Labour Indicators to assess the Burden" (ExCaLIBur). Within this project, we aimed to assess the need for and quality (i.e., completeness, accuracy and precision) of occupation registration in all cancer registries of Western Switzerland. We also aimed to find a relevant and feasible strategy to collect this information in the future. We applied a mixed research method. We observed that, independently of the level of precision (5-3-2-1-digit aggregation level), the accuracy was lesser in the registries that were able to actively search and verify occupational information. Overall, the distinction of occupations based on the 3-digit code presents an acceptable compromise in terms of precision. Having such occupations registered in all, or most, Swiss cancer registries routinely would obviously be valuable for epidemiological surveillance of occupational cancers in Switzerland. However, it seems less obvious how these data could fulfill the research objectives, since a better precision than 3-digit occupational coding is challenging to achieve. Currently, the collection of occupational data by the Swiss cancer registries remains feasible in the frame of specific research projects on occupational cancers. However, available data sources, as well as lack of financial and human resources, will continue to affect quality of the collected occupation data. Therefore, the usage of the standardised questionnaire retracing the individual occupational history to enable further assessment of individual exposure to potential occupational hazards is recommended. However, this approach will disable the Swiss registries to insuring their epidemiological surveillance mission with respect to occupational cancers in Switzerland, for which national statistics remain limited.
While previous Swiss studies have demonstrated differences in lung cancer mortality between occupational groups, no estimates are available on the association of occupation-related factors with lung ...cancer survival. This study aimed at determining whether occupation or work-related factors after diagnosis affect lung cancer survival. We used cancer registry records to identify lung cancer patients diagnosed between 1990 and 2014 in western Switzerland (
= 5773) matched with the Swiss National Cohort. The effect of occupation, the skill level required for the occupation, and the socio-professional category on 5-year lung cancer survival was assessed using non-parametric and parametric methods, controlling for histological type and tumour stage. We found that the net survival varied across skill levels and that the lowest skill level was associated with worse survival in both men and women. In the parametric models with minimal adjustment, we identified several occupational groups at higher risk of mortality compared to the reference category, particularly among men. After adjustment for histological type of lung cancer and tumour stage at diagnosis, most hazard ratios remained higher than 1, though non-statistically significant. Compared to top managers and self-employed workers, workers in paid employment without specific information on occupation were identified as the most at-risk socio-professional category in nearly all models. As this study was conducted using a relatively small sample and limited set of covariates, further studies are required, taking into account smoking habits and administrated cancer treatments. Information on return to work and working conditions before and after lung cancer diagnosis will also be highly valuable for analysing their effect on net lung cancer survival in large nationwide or international studies. Such studies are essential for informing health and social protection systems, which should guarantee appropriate work conditions for cancer survivors, beneficial for their quality of life and survival.
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