Occupational Mortality Research Articles

Diversity of trends in occupational injury mortality in the United States, 1980-96

Diversity of trends in occupational injury mortality in the United States, 1980-96

Human exposure to polychlorinated biphenyls and health effects: a critical synopsis.

Polychlorinated biphenyls (PCBs) are a mixture of chemicals. Some congeners of the mixture are highly persistent both in the environment and in humans. Although PCBs have not been used commercially since about 1977 in the US, they can still be detected in human blood and tissues in this country. PCB levels are declining and are often no longer detectable in younger people. A cursory review of recent animal studies is provided. Studies to determine whether PCBs cause cancer in humans, neurobehavioural effects, abnormal thyroid and immune function in children and low birth weight are discussed in more detail. These studies are inconclusive and do not provide clinical evidence that PCBs at levels encountered with human exposure produce adverse health effects. The differences in PCB blood or tissue concentrations between controls and cases, or between the upper and lower end of various environmentally exposed groups of children or adults, are small. Although some effects are statistically significantly different, they do not appear to be biologically significant. Many studies on the effects of PCBs are difficult to interpret because the range of normal values for clinical and neurobehavioural tests are not provided or appropriately considered, there was no, or inadequate, control for potential confounders. In occupational mortality studies, exposures were much higher. In some studies, various specific cancers were elevated. However, these appear to be chance observations resulting from multiple comparisons since the increase of specific cancers was not consistent between studies and was no longer present in some cohorts when studies were repeated at a later date with longer follow-up. Overall, the data fail to demonstrate conclusive adverse health effects of PCBs at concentrations encountered with human exposures.

Occupational fatalities in emergency medical services: A hidden crisis

Study objective: We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States. Methods: We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). These rates were compared with the occupational fatality rates of police and firefighters and with the rate of all employed persons in the United States. Results: The Census of Fatal Occupational Injuries database documented 91 EMS provider occupational fatalities. The National EMS Memorial Service database contained 70 fatalities, and the Fatality Analysis Reporting System identified 8 ground-transportation EMS occupational fatalities. There was also wide variation in fatality counts by cause of injury. Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period. Conclusion: This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers. [Ann Emerg Med. 2002;40:625-632.]

Occupational magnetic field exposure and cardiovascular mortality in a cohort of electric utility workers.

In electric utility workers, occupational exposure to magnetic fields has previously been associated with mortality from acute myocardial infarction (AMI) and arrhythmia but not from chronic coronary heart disease (CCHD) or atherosclerosis. To investigate these health endpoints further, the authors examined mortality from AMI (n = 407) and CCHD (n = 369) in a cohort of 35,391 male workers at the Southern California Edison Company between 1960 and 1992. Exposure was estimated according to duration of employment in occupations associated with high levels of magnetic field exposure and was calculated as cumulative exposure to magnetic fields expressed in micro-Tesla-years. Adjustment was made for age, calendar time, socioeconomic status, race, and worker status (active or inactive). The authors found that men working longer in high-exposure occupations or working as electricians, linemen, or power plant operators had no increased risk of dying from either AMI or CCHD compared with men who never worked in high-exposure occupations. For cumulative exposure, no association was observed with mortality from AMI (rate ratio per 1 micro T-year = 1.01, 95% confidence interval: 0.99, 1.02) or CCHD (rate ratio per 1 micro T-year = 1.00, 95% confidence interval: 0.99, 1.02). These results, indicating no exposure-related risk increase for AMI mortality, do not confirm previous results.

Healthy worker effect in cohort studies on chronic bronchitis.

Despite the recognition of selection biases arising from the healthy worker effect in occupational mortality studies, the possibility of similar effects in occupational cohort studies on respiratory symptoms is not well known. Two mechanisms are responsible for the healthy worker effect in respiratory cohort studies. One is health-based selection of workers into employment (healthy him effect), and the other is health-based differential losses to follow-up (healthy worker survivor effect). The aim of the present paper was to estimate the magnitude of the healthy worker survivor effect in cohort studies of symptoms of chronic bronchitis. A meta-analysis of occupational cohort studies of symptoms of chronic bronchitis was performed that included published articles identified in searches of the Medline bibliographic databases between 1980 and March 2001 and the reference lists of the located articles. Eight cohort studies were identified using an a priori selection criterion. The pooled odds ratio of the prevalence of chronic bronchitis for subjects leaving the cohorts was 1.23 when these subjects were compared with those who remained under study (95% confidence interval 1.04-1A4). The prevalence of respiratory symptoms among exposed workers may he underestimated if the healthy worker survivor effect is not taken into account

Condiciones de trabajo y salud de una universidad venezolana

To identify occupational exposure to hazards among Venezuelan university (UN) workers. A descriptive cross-sectional study was conducted in 1999 to assess occupational exposure among UN workers. Potentially hazardous events (PH) and their causes were identified. The study population consisted of 90 workers of both genders, working in any of the 24 areas classified as critical by university authorities. Work area and individual surveys were carried out. Data collected included demographic characteristics, occupational clinical history, hazardous occupational exposures, use of personal protection equipment, and knowledge about occupational risks and habits. Clinical-toxicological tests were performed. The major chemical, physical, biological, mechanical, and ergonomic PH were identified, as well as the degree of risk (DR) for each area. Central tendency and dispersion measures were calculated, in addition to association and statistical significance measures, as appropriate. A positive, significant correlation was found between time working in the university and the number of signs and symptoms reported by workers. No correlation was found between the number of signs and symptoms and age and gender. Symptoms were mainly non-specific. There are several potentially hazardous processes in the different occupational areas of the university. Recommendations are issued to implement prevention programs with appropriate recording of occupational accidents, and morbidity and mortality, to aid in the timely detection of occupational illnesses and accidents.

An alternate characterization of hazard in occupational epidemiology: years of life lost per years worked.

Standardized mortality ratios (SMRs) and other measures of relative risk by themselves may not suffice as descriptors of occupational hazards for many audiences including decision-makers and those at direct risk from hazardous work. To explore other approaches, we calculated excess years of potential life lost and excess lifetime risk for both lung diseases and fatal injuries in a cohort of uranium miners with historical records of exposure to radon gas. We used relatively simple life table (SMR) methods and also analyzed lung cancer mortality with Poisson regression methods permitting control for smoking. Among uranium miners hired after 1950, whose all-cause SMR was 1.5, 28 percent would experience premature death from lung diseases or injury in a lifetime of uranium mining. On average, each miner lost 1.5 yr of potential life due to mining-related lung cancer, or almost 3 months of life for each year employed in uranium mining. As a consequence of all excess lung disease and injury risks combined, a year of mining was associated with 5.9 months loss of potential life. For each year actually working underground, miners lost more than 8 months of potential life. When controlled for smoking (and healthy worker effect) with Poisson regression, the estimates for radon-related lung cancer effects were slightly larger. Although chronic disease deaths dominated in excess years of life lost (due to radon, silica and possibly other exposures), more years were lost on average per individual injury death (38 yr), than per excess lung cancer (20 yr) or other lung disease death (18 yr). Fatal-injury dominated the potential years of life lost up to about age 40. Years of life lost per years employed provides another, more intuitive summary of occupational mortality risk.

An analysis of the causes of mortality among seafarers in the British merchant fleet (1986-1995) and recommendations for their reduction.

This study was designed to establish the manner and causes of all fatalities among seafarers who were serving in British merchant shipping between 1 January 1986 and 31 December 1995. Other main aims were to compare mortality rates with workers in other industries and with seafarers in other merchant fleets, and to discuss recommendations for the prevention of occupational mortality. This study was based upon official mortality files with a population of 253 919 seafarer-years at risk. There was a total of 252 fatalities in British merchant shipping during the study period. One hundred and seven of the 252 deaths were due to natural causes, of which 93 (87%) were caused by cardiovascular disease. The relative risk of mortality due to accidents at work (96 fatalities) was 23.9 times higher than for all workers in Great Britain during the same time period (95% confidence interval = 14.0-40.7). The risk of a fatal accident in merchant shipping was also much higher than in other British industrial sectors, such as agriculture, forestry and fishing (relative risk = 4.5), construction (5.5), and manufacturing (22.0). Seafaring was identified as a dangerous occupation compared with shore-based employment. Many of the fatal accidents at work were caused by hazardous working practices and were often preventable, as were the many off-duty accidents and drowning that were caused by seafarers falling into docks when encountering hazardous access to their ships from the shore. Seafarers are also at special risk from acute illnesses since they lack direct access to specialist medical care.

Societal risk and societal benefits

Decisions based on risk analysis require some form of risk acceptance criteria. Presently the International Maritime Organisation (IMO) has initiated an activity on developing a risk-based approach to safety and environmental protection regulations. Explicit risk estimates are new to the organisation. A limited number of FSA trial apllications have been presented so far. Whilst giving increased general knowledge of the risk level in the industry, the debate about risk acceptance has just started. The objective of this paper is to outline an approach by which societal risk acceptance criteria may be established. The idea is to discriminate between activities representing different risks and importance to society. The societal risk acceptance criteria are calibrated against occupational fatality rates, and transportation fatality rate for scheduled air traffic worldwide. Examples are given for some different ship types. For the sake of discussion a societal risk acceptance for Near Earth objects colliding with the Earth is also derived. It should be noted that many other criteria would be needed in the decision process, like for example individual risks, criteria based on cost effectiveness, and criteria for environmental consequences. Normally a decision would have to be based on acceptance by all these criteria. Only one specific method to arrive at societal risk criteria is dealt with herein. The examples given for some ship types show that when the importance to the society is accounted for, the established FN acceptance curves vary within 1 to 2 orders of magnitude. The outlined method may be considered for any type of activity above a certain size. An obvious limitation for the method is represented by activities of high economic value with low labour intensity in remote places, for example exploitation of offshore oil and gas resources.

Occupational carbon monoxide poisoning in the State of Washington, 1994-1999.

Carbon monoxide poisonings continue to be significant and preventable for a number of work operations. This study assesses occupational carbon monoxide morbidity and mortality for the state of Washington based on a review of workers' compensation records for the years 1994-1999. The study characterizes sources, industries, and causative factors, and further attempts to identify work operations most at risk. Records were identified by both injury source and diagnostic codes. The study limits itself to non-fire-related carbon monoxide poisonings and primarily those from acute exposure. A decline in the number of claims was not evident, but the number of incidents per year showed a slight decline. Carbon monoxide poisonings were found to occur throughout all types of industries. The greatest number of claims was found in agriculture, followed by construction and wholesale trade, with these three accounting for more than half the claims and nearly half of the incidents. The more severe poisonings did not necessarily occur in industries with the greatest number of incidents. The major source for carbon monoxide poisoning was forklift trucks, followed by auto/truck/bus, portable saws, and more than 20 other sources. Fruit packing and storage had the highest number of incidents mostly due to fuel-powered forklift activity, with nearly half of the incidents occurring in cold rooms. Adverse health effects as measured by carboxyhemoglobin, hyperbaric oxygen treatment, unconsciousness, and number and cost of claims were indexed by source. Though several specific work operations were identified, the episodic nature of carbon monoxide poisonings, as well as the diverse industries and sources, and the opportunity for a severe poisoning in any number of operations, poses challenges for effective intervention.

Approaches to sharing occupational safety and health information on a global scale.

The global burden of occupational morbidity and mortality is staggering. Information sharing has been identified as a major way of reducing this burden. Past and current approaches to such sharing and application are worth examining in order to guide future efforts. Recent literature from international agencies and others was examined to identify examples of information sharing and to determine the status of such sharing and related issues. Literature was included from the areas of surveillance, priority setting, research, dissemination, and risk management. Examples of global information sharing were identified and lessons were drawn from the issues attendant to them. Results indicate that a broad range of efforts actively promote the global distribution of occupational safety and health information. To advance global approaches to the sharing of occupational and safety and health information, it is critical to improve the opportunity and capacity to access information. Important objectives in achieving this goal are developing coherent and transparent information policies, conducting research on dissemination, adaptation, and utilization of information, and overcoming barriers to information and training.

Occupational mortality from squamous cell carcinoma of the esophagus in the United States during 1991-1996.

The epidemiology of esophageal squamous cell cancer has remained poorly understood. The occupational distribution of this cancer may provide clues about its yet unknown etiology. Data files from the National Center for Health Statistics (NCHS) of the United States offer a unique source to study causes of death, broken down by occupation and industry. The number of deaths from esophageal cancer was retrieved from the computerized US vital statistics. Mortality by occupation or industry was expressed as standardized proportional mortality ratio (PMR), adjusted by age, gender, and ethnicity. Between 1991 and 1996, 63,717 subjects died from esophageal squamous cell carcinoma. Mortality was particularly high among nonwhites and men. The industrial and the occupational distributions shared a similar pattern. Mortality from esophageal squamous cell carcinoma occurred more frequently among subjects exposed to silica dust, such as brickmasons and stonemasons, concrete and terrazzo finishers, roofers, and construction laborers. It was also high in such industries as unspecified machinery or manufacturing and such occupations as unspecified material handlers, janitors, or cleaners. It was low in industries and occupations associated with agriculture, clergy, work in religious organizations, and textiles. In conclusion, mortality from esophageal squamous cell carcinoma appeared to be low in occupations associated with less consumption of alcohol and tobacco. It was high among occupations potentially associated with exposure to silica dust and chemical solvents or detergents.

Social characteristics influencing the mortality of male members of an insurance company in the years 1989 to 2000 -- A longitudinal study for the birth cohorts 1940-1949 of the Gmuend statutory insurance body

The study goal is to analyse the association between social and occupational characteristics and mortality. Data are from a longitudinal register for the members of a statutory insurance body 'Gmuender Ersatzkasse' (GEK) for the period 1989 to 2000. Included are males, born 1940 - 1949, who were GEK-members on January 1, 1989 (n = 58 705). The dependent variable is defined as 'reason for end of health insurance: deceased' (n = 2283). Independent variables are: age, occupational group, family status, nationality and insurance status. The statistical analysis was performed with the software package 'Transitional Data Analysis' (TDA). It included cumulative mortality rates based on the Kaplan-Meier method and the multivariate analysis in order to assess hazard rates (maximum likelihood estimation). Statistically significant increased mortality rates for the 12-year observation period were found for non-married persons, for persons with less qualified occupations, and for mandatory health insurance members. No significant difference was observed between study subjects with and without German nationality. The observed strong social gradient in the overall mortality rates for male members of the GEK underline the challenge to reduce the social inequities in health chances which has recently been placed on the political agenda for the German health insurance companies.

A study of fatal injuries in Nigerian factories.

A study of the pattern of occupational injury mortality rates by industry and cause of death was undertaken to indicate the high-risk types of industry and the major causes of death, which could subsequently be used in developing cost-effective strategies for prevention. This is the first such study of accidental mortality factors in Nigerian factories. This paper reports the outcome of the study of mortality in Nigerian factories over a 10 year period (1987-1996). Between 1987 and 1996, a total of 3183 injuries were reported, of which 71 (2.2%) were fatal. The annual case fatality rate ranged from 0.94 per 100 injured workers in 1990 to 5.41 in 1994, with an overall fatality rate of 2.23 per 100 injured workers. Of the 71 deaths, 12 (16.9%) were associated with power-driven machinery. Ten (14.1%) deaths were associated with explosions, while people falling accounted for nine (12.6%) of the deaths. Eleven deaths (15.4%) occurred in the chemical/pharmaceuticals industry, nine (12.6%) occurred in the basic metal industry and seven (9.8%) occurred in the food, beverage and tobacco industry. There were seven (9.8%) deaths in the textile manufacturing industry. The highest case fatality rate per injured worker (16.6%) occurred in the coal-petroleum industry, followed by 5.9% in the wood and wood products industry. A rate of 5.8% occurred in the non-metallic manufacturing industry. The case fatality rates in Nigerian factories are compared with those of other predominantly African countries. Accident prevention programmes tailored to the work activities and specific causal factors in the high-risk types of industries are recommended following a detailed study of work situations and risk factors in these types of industries. Accident prevention programmes, including the use of protective equipment, safety education, machine guarding, a work permit system, effective supervision at work sites and the enforcement of factory laws and regulations, are recommended to improve accidental injury and death in the factories.

Will Risks to Older Workers Change in the 21st Century?

Workers aged 65 and older face different risks than those in younger age groups. The occupational fatality rate for this group (13.6 per 100,000 workers) during 1980-1995 was almost three times greater than the rate for workers aged 16 to 64. This study projects the traumatic occupational fatality experience for the ten occupations with the largest number of occupational fatalities for workers 65 years and older. Although the occupational fatality rate for workers 65 years and older is projected to decrease from 12.5 in 1995 to 11.5 in year 2008, the number of occupational fatalities for this group is projected to increase from 459 in 1995 to 518 in year 2008. The overall proportion of occupational fatalities experienced by workers in the 65 years and older age group is expected to increase from 7% in 1995 to 10% in 2008. To assist in developing the most effective interventions, the five leading external causes of death associated with these fatalities were estimated for year 2008. With the aging of the American workforce, more research is needed in areas concerned with protecting older workers from injury.

The relationship between body weight and risk of death and serious injury in motor vehicle crashes

We sought to investigate the effect of increased body weight on the risk of death and serious injury to occupants in motor vehicle crashes. We employed a retrospective cohort study design utilizing data from the National Automotive Sampling System, Crashworthiness Data System (CDS), 1993–1996. Subjects in the study included occupants involved in tow-away crashes of passenger cars, light trucks, vans and sport utility vehicles. Two outcomes were analyzed: death within 30 days of the crash and injury severity score (ISS). Two exposures were considered: occupant body weight and body mass index (BMI; kg/m 2). Occupant weight was available on 27 263 subjects (76%) in the CDS database. Mortality was 0.67%. Increased body weight was associated with increased risk of mortality and increased risk of severe injury. The odds ratio for death was 1.013 (95% CI: 1.007, 1.018) for each kilogram increase in body weight. The odds ratio for sustaining an injury with ISS⩾9 was 1.008 (95% CI: 1.004, 1.011) for each kilogram increase in body weight. After adjustment for potentially confounding variables (age, gender, seatbelt use, seat position and vehicle curbweight), the significant relationship between occupant weight and mortality persisted. After adjustment, the relationship between occupant weight and ISS was present, although less marked. Similar trends were found when BMI was analyzed as the exposure. In conclusion, increased occupant body weight is associated with increased mortality in automobile crashes. This is probably due in part to increased co-morbid factors in the more overweight occupants. However, it is possibly also due to an increased severity of injury in these occupants. These findings may have implications for vehicle safety design, as well as for transport safety policy.

Utilizing Multiple Vital Status Tracing Services Optimizes Mortality Follow-up in Large Cohort Studies

PURPOSE: To compare the three national-scale death identification services used in our two-stage vital status tracing protocol, Pension Benefit Information Company (PBI), Social Security Administration (SSA), and the Health Care Financing Administration (HCFA), with respect to death identification and confirmation rate, and relevant demographic variables. METHODS: Information on 31,223 subjects with unconfirmed vital status in an ongoing occupational cohort mortality study was simultaneously submitted to PBI, SSA, and HCFA to identify subjects deceased as of December 31, 1992. Subjects whose dates of death were between 1979 and 1992 were then sent to the National Death Index (NDI) to obtain death certificate numbers and supplemental states of death. RESULTS: PBI identified and confirmed the highest number deaths in this cohort. PBI and SSA identified a higher proportion of deaths for persons who died in earlier years and/or who died at a younger age, for both confirmed and unconfirmed deaths. HCFA identified fewer deaths overall and had a smaller proportion of unconfirmed deaths. These deaths occurred in later years among older subjects and had the highest proportion of females. NDI provided exact matches for 92–96% of deaths identified by each of the three services. CONCLUSIONS: PBI was the most comprehensive service, especially for identifying younger subjects and those with an earlier date of death, while HCFA may help to identify deceased female subjects. SSA data can be purchased and used for periodic updates or interactively to identify deaths among subjects with poor identifiers (such as incorrect or missing social security numbers or misspelled names). Because each service makes a valuable contribution to the identification of deceased cohort subjects, all three should be considered for optimal mortality follow-up.

Occupational sunlight exposure and mortality from non-Hodgkin lymphoma among electric utility workers.

This case-control study examined occupational sunlight exposure and death from non-Hodgkin lymphoma (NHL) and NHL subtypes among 188 cases and 1880 controls selected from a cohort of 138,905 male electric utility workers. Exposure was classified according to work history linked to indices of cumulative sunlight exposure. Odds ratios and 95% confidence intervals were derived from conditional logistic regression models and were conditioned on the matching factors birth year and ethnicity. Mortality from NHL and intermediate/high-grade lymphomas was not related to cumulative sunlight exposure, with odds ratios around the null. For low-grade lymphomas, a dose-response gradient was observed for exposure in the past 12 to 21 years, but this result seemed to be sensitive to cut points for categorization of cumulative exposure. These data do not provide evidence for an association between occupational sunlight exposure and mortality from NHL or NHL subtypes.

Occupational mortality from inflammatory bowel disease in the United States 1991-1996.

The occupational distribution of inflammatory bowel disease (IBD) may help to shed light on its yet unknown etiology. The U.S. vital statistics offer the opportunity to study cause of death by occupation and industry. The numbers of deaths from Crohn's disease and ulcerative colitis were retrieved from the computerized 1991-1996 data files of the National Center for Health Statistics. Deaths were grouped by gender, ethnicity, disease type, occupation, and industry. Mortality by occupation and industry were expressed as proportional mortality ratio (PMR), adjusted for gender and ethnicity. Between 1991 and 1996, 2399 subjects died from Crohn's disease and 2419 subjects died from ulcerative colitis. Significant correlations were found between the PMR values of ulcerative colitis and Crohn's disease regarding their distribution by occupation, r = 0.36 and p < 0.05, as well as by industry, r = 0.37, p < 0.01. IBD mortality by occupation was significantly reduced among farmers (PMR: 70, 95% confidence interval [CI]: 42-97), mining machine operators (31, 95% CI: 0-74), and laborers (71. 95% CI: 45-98). A nonsignificant increase was found among sales persons (117, 95% CI: 95-139) and secretaries (122, 95% CI: 83-161). IBD mortality by industry was significantly reduced in agricultural production of livestock (39, 95% CI: 1-78), mining (46, 95% CI: 9-83), grocery stores (55, 95% CI: 17-94), and work in private households (64, 95% CI: 30-97). A nonsignificant increase was found in food production (128, 95% CI: 74-182), investment and insurance business (137, 95% CI: 77-198), and administration (122, 95% CI: 81-163). IBD mortality is low in occupations associated with manual work and farming and relatively high in sedentary occupations associated with indoor work. Crohn's disease and ulcerative colitis show a similar distribution.

Occupational mortality from inflammatory bowel disease in the United States 1991–1996

OBJECTIVE: The occupational distribution of inflammatory bowel disease (IBD) may help to shed light on its yet unknown etiology. The U.S. vital statistics offer the opportunity to study cause of death by occupation and industry. METHODS: The numbers of deaths from Crohn’s disease and ulcerative colitis were retrieved from the computerized 1991–1996 data files of the National Center for Health Statistics. Deaths were grouped by gender, ethnicity, disease type, occupation, and industry. Mortality by occupation and industry were expressed as proportional mortality ratio (PMR), adjusted for gender and ethnicity. RESULTS: Between 1991 and 1996, 2399 subjects died from Crohn’s disease and 2419 subjects died from ulcerative colitis. Significant correlations were found between the PMR values of ulcerative colitis and Crohn’s disease regarding their distribution by occupation, r = 0.36 and p < 0.05, as well as by industry, r = 0.37, p < 0.01. IBD mortality by occupation was significantly reduced among farmers (PMR: 70, 95% confidence interval [CI]: 42–97), mining machine operators (31, 95% CI: 0–74), and laborers (71, 95% CI: 45–98). A nonsignificant increase was found among sales persons (117, 95% CI: 95–139) and secretaries (122, 95% CI: 83–161). IBD mortality by industry was significantly reduced in agricultural production of livestock (39, 95% CI: 1–78), mining (46, 95% CI: 9–83), grocery stores (55, 95% CI: 17–94), and work in private households (64, 95% CI: 30–97). A nonsignificant increase was found in food production (128, 95% CI: 74–182), investment and insurance business (137, 95% CI: 77–198), and administration (122, 95% CI: 81–163). CONCLUSIONS: IBD mortality is low in occupations associated with manual work and farming and relatively high in sedentary occupations associated with indoor work. Crohn’s disease and ulcerative colitis show a similar distribution.