Dissertations / Theses on the topic 'Occupational mortality'

Thesis (M.S.)--West Virginia University, 2001.
Title from document title page. Document formatted into pages; contains v, 104 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 48-54).

Heat stress due to ambient outdoor temperatures is a workplace hazard that has not been well studied or characterized. The incidence of occupational heat-related illness is unknown. Heat-related morbidity and mortality have been well-studied at the population level, however it cannot be determined if these findings extend systematically to workers exposed to high heat conditions. Remarkably, there is no U.S. federal standard to protect workers from the peril of elevated environmental temperatures and few states have protective regulations. This dissertation research will add to the limited knowledge base of occupational heat-related illnesses, by characterizing worker fatalities due to environmental heat stress. Three independent, but related, research strategies were designed, executed, and completed to evaluate the current research, as well as knowledge gaps, and to thoroughly describe these fatalities based on available information.

This work was initiated with a thorough literature review to summarize research findings that characterize U.S. occupational heat-related morbidity and mortality and identify gaps in the existing research literature. This review of science, health, and medical databases found that few studies examine ambient heat stress or characterize the incidence of occupational heat-related illnesses and outcomes. Significantly more research examining the heterogeneity of worker and environmental risk factors to heat exposure is needed to identify unsafe working conditions and implement practical, evidence-based heat-stress policies and interventions. The subsequent study describes the epidemiological characteristics of heat-related deaths among workers in the U.S. from 2000 to 2010. Fatality data were obtained at the Bureau of Labor Statistics from the confidential on-site Census of Fatal Occupational Injuries database. Fatality rates and risk ratios with 95% confidence intervals were calculated by year, sex, age group, ethnicity, race, state, and industry. Between 2000 and 2010, 359 occupational heat-related deaths were identified in the U.S., for a yearly average fatality rate of 0.22 per 1 million workers. Highest rates were found among Hispanics, men, the agriculture and construction industries, the states of Mississippi and Arkansas, and very small establishments. This study provides the first comprehensive national profile of heat-related deaths in the U.S. workplace. Prevention efforts should be directed at small businesses, states, industries and individuals who may be at increased risk of heat stress.

Lastly, to further characterize these fatalities, research was performed to: 1) determine the ranges of heat index and temperature at which workers fatally succumb to environmental heat; 2) identify risk factors that may influence heat-related deaths; and 3) translate these findings to policy recommendations. The Census of Fatal Occupational Injuries and the National Climate Data Center were used to identify worker heat-related deaths in the U.S., 2000- 2010, and to assign a maximum daily temperature and heat index to each case. Demographic, meteorological, and geographical variables were analyzed to evaluate any differences in fatal heat exposure. The National Weather Service temperature alert tools, the Excessive Heat Event warning and the heat index category chart, were utilized to assess community threshold suitability for workers subjected to exertional heat stress. Of the 327 cases that qualified for the analysis, there were no differences found in mean temperatures and heat indexes between the sexes, races, age groups, ethnic groups, and industries. Southern workers died at significantly higher temperatures than workers in the North. This study supports the use of heat index and temperature as a guide when evaluating environmental conditions for workers.

Population-level heat index threshold alerts are unsuitable for preventing exertional heat stress and new warning systems should be developed. Since heat-related health hazards at work can be anticipated before they manifest, preventive measures can be implemented before illness occurs. With no federal regulatory standards to protect workers from environmental heat exposure, and with climate change as a driver for adaptation and prevention of heat disorders, it is increasing sensible and imperative for the Occupational Safety and Health Administration to take action. National leadership is needed to promulgate regulations, develop new heat alert tools using the heat index as a metric, and promote state-specific occupational heat stress prevention policies.

This thesis describes a retrospective cohort study of cancer mortality among employees of the Celanese Canada Inc. synthetic textiles plant in Drummondville, Quebec. The study was commissioned by the company to confirm or refute a previous observation (Vobecky et al., Cancer 54:2537-2542, 1984) that there were higher mortality rates from colorectal cancer among male employees of the textiles unit, the cellulose acetate fiber manufacturing unit, and the cellulose triacetate and polypropylene extrusion units and to investigate whether mortality rates for other sites of cancer were associated with employment in each area of the plant and with occupational exposures.
Workers with more than one year experience at the plant were eligible for study if they were employed on January 1, 1947 or if they were newly hired between that date and December 31, 1977. Vital status as of December 31, 1986 was ascertained for 7,422 men and 2,720 women through a probabilistic record linkage to the Canadian Mortality Data Base. Among men, there were about 220,000 person-years of observation and 1,738 deaths and, among women, there were about 89,000 person-years of observation and 241 deaths.
Three reference regions were used to derive standardized mortality ratios (SMR): the entire Province of Quebec, semi-rural regions of the Province, and the area in which the plant is located. Results based on rates for these regions were generally similar. For men, the SMR for all causes of death was significantly less than unity (SMR = 0.71, 95%CI:0.68-0.74), as were the SMRs for most sites of cancer (SMR all neoplasms = 0.73, 95%CI:0.66-0.80). The SMR for colorectal cancer was 0.68 (95%CI:0.51-0.91). Of the 20 cancer sites examined in men, reticulum cell sarcoma was the only one having a significantly elevated SMR, and this occurred only among the subcohort of men hired prior to 1947 (SMR = 2.84, 95%CI:1.04-6.18, 6 deaths). For women, the SMR for all causes of death was 0.75 (95%CI:0.66-0.85) and there were moderately elevated SMRs for a number of sites of cancer, but none were significantly greater than expectation (SMR all neoplasms = 0.97, 95%CI:0.80-1.17).
SMRs were also calculated according to employment in each processing unit and exposure to occupational agents, and case-control analyses were carried out within the cohort for selected sites of cancer. Of the scores of associations tested, very few were significantly elevated. There were excesses of biliary cancers and non-Hodgkin's lymphomas among workers in the cellulose acetate fiber manufacturing unit. There were also significant associations between stomach cancer and exposure to cutting oils, and between prostate cancer and exposure to glycol monobutyl ether. However, none of these associations were persuasive.
With regards to colorectal cancer, there was a nonsignificant elevation in risk among workers who had ever worked in the polypropylene and cellulose triacetate extrusion unit (OR$ sb{ rm e}$ = 2.3, 95%CI:0.5-9.9) but there was no apparent increase in risk with increasing duration of employment. Thus, the evidence for an association was not convincing. For the cellulose acetate fiber manufacturing unit, the evidence of an increase, although based on few cases, was slightly more persuasive (OR$ sb{ rm e}$ = 1.9, 95%CI:1.0-3.6), but no trend was observed with duration. No association was observed with employment in the textiles unit (OR$ sb{ rm e}$ = 1.1, 95%CI:0.6-2.2) nor were there any noteworthy associations between colorectal cancer and any of the agents evaluated in the case-control analyses.

Thesis (Ph. D.)--West Virginia University, 2004.
Title from document title page. Document formatted into pages; contains vii, 146 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 74-83).

A community-based surveillance system was developed and implemented in rural areas in Cambodia. The system aimed to provide timely and representative information on major health problems and life events that would permit rapid and effective control of outbreaks and communicable diseases in general in rural communities. In the system, lay people were trained as Village Health Volunteers to report suspected outbreaks, important infectious diseases, and vital events occurring in their communities to local health staff who analysed the data and gave feedback to the volunteers during their monthly meetings. An evaluation conducted one year after implementation of the community-based surveillance system began found that the system was able to detect outbreaks early, regularly monitor communicable disease trends, and to continuously provide updated information on pregnancies, births and deaths in the rural areas. The sensitivity and specificity of case reporting by Village Health Volunteers were found to be quite high. In addition, the community-based surveillance system triggered effective responses from both health staff and Village Health Volunteers in outbreak and disease control and prevention. The results suggest that a community-based surveillance system can successfully fill the gaps of the current health facility- based disease surveillance system in the rapid detection of outbreaks, in the effective monitoring of communicable diseases, and in the notification of vital events in rural Cambodia. Empowered local people and health staff can accurately report, analyse and act upon significant health problems in their community within a surveillance system they develop, own and operate. The community-based surveillance system could easily be integrated with the current disease surveillance system. Its replication or adaptation for use in other rural areas in Cambodia and in other developing countries would be likely feasible and beneficial, as well as cost-effective.

Background: There is no on-going information on the number, rate or circumstances of work-related fatal injury in Australia. This thesis reports on a study aimed to identify and describe all work-related fatalities that occurred in Australia during the four-year period 1989 to 1992, in order to make a significant contribution to the effectiveness of activity designed to prevent work-related traumatic death. Methods: A broad definition of work was used, with particular focus on workers and bystanders. The study also included the injury-related deaths of volunteers, students, persons performing home duties and persons fatally injured on farms but not due to obvious farm work. The data were obtained primarily from coronial files. Files were found for 99.7% of the deaths of interest. Detailed results are presented on the work-related deaths of workers, bystanders and persons fatally injured while engaged in home duties. The results for workers are also compared with those from an earlier study of work-related fatalities in Australia, which covered the years 1982 to 1984 inclusive. Other aspects of work-related deaths are considered in detail, including the effect of employment arrangements; their coverage by occupational health and safety and compensation agencies; their handling by the coronial system; the role of External Cause codes in identifying and monitoring work-related injury deaths; and the reliability and validity of the definitions used to classify work-related injury deaths. Results: There were 2,413 persons fatally injured while working or commuting during the study period (1,787 working; 626 commuting), with a rate of death for working persons of 5.5 per 100,000 persons per year. This compared to the rate of 6.7 for working deaths during 1982 to 1984, with just under half of the decline probably due to changes in the industry distribution of the workforce. Another 802 persons were fatally injured as a result of someone else’s work activity, and 296 persons aged 15 years and over were fatally injured while undertaking active tasks in an unpaid and informal capacity in their own home or in someone else’s home. Thirty-four percent of working deaths were not covered by either occupational health and safety (OHS) or compensation agencies. A consideration of External Cause codes for the period 1979 to 1997 inclusive suggested there was a yearly decrease in the rate of workplace deaths of 2.6% per year, with less than half of this change due to industry changes in the workforce. Deaths occurring in a small number of particular circumstances were found to pose classification problems. Conclusion: Fatal work-related trauma remains an important problem for the Australian community. By understanding how and why these deaths occur, appropriate steps can be taken to prevent similar incidents recurring. It is expected that the results reported here, and other information that has arisen from the study, will make an important contribution to developing this understanding and preventing the occurrence of work- related traumatic death in Australia.

Doctor of Philosophy(PhD)
Background: There is no on-going information on the number, rate or circumstances of work-related fatal injury in Australia. This thesis reports on a study aimed to identify and describe all work-related fatalities that occurred in Australia during the four-year period 1989 to 1992, in order to make a significant contribution to the effectiveness of activity designed to prevent work-related traumatic death. Methods: A broad definition of work was used, with particular focus on workers and bystanders. The study also included the injury-related deaths of volunteers, students, persons performing home duties and persons fatally injured on farms but not due to obvious farm work. The data were obtained primarily from coronial files. Files were found for 99.7% of the deaths of interest. Detailed results are presented on the work-related deaths of workers, bystanders and persons fatally injured while engaged in home duties. The results for workers are also compared with those from an earlier study of work-related fatalities in Australia, which covered the years 1982 to 1984 inclusive. Other aspects of work-related deaths are considered in detail, including the effect of employment arrangements; their coverage by occupational health and safety and compensation agencies; their handling by the coronial system; the role of External Cause codes in identifying and monitoring work-related injury deaths; and the reliability and validity of the definitions used to classify work-related injury deaths. Results: There were 2,413 persons fatally injured while working or commuting during the study period (1,787 working; 626 commuting), with a rate of death for working persons of 5.5 per 100,000 persons per year. This compared to the rate of 6.7 for working deaths during 1982 to 1984, with just under half of the decline probably due to changes in the industry distribution of the workforce. Another 802 persons were fatally injured as a result of someone else’s work activity, and 296 persons aged 15 years and over were fatally injured while undertaking active tasks in an unpaid and informal capacity in their own home or in someone else’s home. Thirty-four percent of working deaths were not covered by either occupational health and safety (OHS) or compensation agencies. A consideration of External Cause codes for the period 1979 to 1997 inclusive suggested there was a yearly decrease in the rate of workplace deaths of 2.6% per year, with less than half of this change due to industry changes in the workforce. Deaths occurring in a small number of particular circumstances were found to pose classification problems. Conclusion: Fatal work-related trauma remains an important problem for the Australian community. By understanding how and why these deaths occur, appropriate steps can be taken to prevent similar incidents recurring. It is expected that the results reported here, and other information that has arisen from the study, will make an important contribution to developing this understanding and preventing the occurrence of work- related traumatic death in Australia.

"The aim of the study is to analyse occupational traumatic fatalities in Victoria from the period 1990 through to 1993, to identify opportunities for prevention."
Thesis (Master of Applied Science)

Although already known that Maori were over-represented in terms of Work-Related Fatal Injury, because of flawed identification processes, both in numerator and denominator data, little progress has been made in understanding the true extent, nature and distribution of work-related fatal injury among Maori. The present study aimed to more accurately describe the problem, identifying specific circumstances associated with Maori deaths that will assist in developing preventive strategies for Maori. Coronial files with an ICD 9-CM E-Code between E800 and E989 and a decedent aged 15-84, were reviewed as part of the study of all New Zealand work-related fatal injuries occurring between 1985 and 1994. Basic descriptive and causal information concerning each incident were abstracted and coded. Maori were identified within this dataset by either the classification recorded upon death certificates or if they were identified as Maori within Coroners files. In all, 91 Maori deaths were identified within the 817 work-related fatalities. Notably, agreement between the data sources used to identify ethnic status was only around 52%. Crude rates were significantly higher for Maori and did not show the significant linear decline across years, compared with the non-Maori rates. Rates adjusted for employment patterns based on ethnicity did not differ. Specific event sequences leading to death were examined by age industry and occupational group for both Maori and non-Maori workers. This study is the first to specifically investigate work-related injury for Maori. It confirms that overall inequities exist, and that they are largely due to differing employment patterns between Maori and non-Maori.

Orientador: Ericson Bagatin
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução:O asbesto é uma fibra mineral utilizada por suas características distintas, e usada como matéria-prima para produtos na indústria têxtil e construção civil. O asbesto é considerado carcinogênico para humanos. O Brasil está entre os quatro maiores produtores mundiais. Há diversos trabalhos internacionais relacionando a exposição ocupacional a este agente com doenças das vias aéreas. Entretanto não há estudos de mortalidade entre os trabalhadores expostos no Brasil. Objetivos: Estudar a mortalidade entre os trabalhadores expostos ao asbesto no Brasil, na atividade de mineração. Métodos: Os trabalhadores foram divididos em dois grupos, de acordo com o tipo de exposição que tiveram. O primeiro grupo foi composto pelos trabalhadores expostos entre 1940 e 1980. O segundo foi composto pelos trabalhadores admitidos após 1980. Foram consultadas as declarações de óbito dos ex-trabalhadores para se estabelecer a causa básica do óbito. Foram codificados para a CID-10, para posterior análise descritiva. Resultados:Dos 616 casos estudados, foi possível estabelecer a causa básica do óbito em 429. O grupo exposto à maior carga de amianto apresentou menor proporção de mortes por doenças relacionadas ao asbesto. Conclusões:A exposição ocupacional apontou maior proporção de mortes no grupo com menor exposição, e isto pode estar relacionado com a qualidade da informação disponível.A qualidade da informação foi um fator limitante do estudo
Abstract: Introduction: Asbestos is a mineral fiber used for its distinct characteristics, as raw material for products in the textile industry and construction. Asbestos is considered carcinogenic to humans. Brazil is among the four largest global producers. There are many international studies relating occupational exposure to airway diseases. However, there are no studies of mortality among exposed workers in Brazil. Objectives: To investigate mortality among workers exposed to asbestos in Brazil, in mining activity. Methods: The workers were divided into two groups according to the type of exposure. The death certificates of former employees with underlying cause of death were consulted. They were coded to ICD-10 for further descriptive analysis. Results: Of the 616 cases studied, it was possible to establish the cause of death in 429.The group exposed to the greater burden of asbestos showed a lower proportion of deaths from asbestos-related diseases. Conclusions: The quality of information was a limitation of the study. Occupational exposure showed higher proportion of deaths in the group with less exposure, and this may be related to the quality of information available
Mestrado
Epidemiologia
Mestre em Saude Coletiva

Background Studies based on a cohort design requires access to both subject-specific and period-specific information. In order to conduct an occupational cohort study, access to exposure information and the possibility and permission to link information on outcomes from other registers are generally necessary. The analysis phase is also aggravated by its added complexity because of the longitudinal dimension of the cohort’s data.This thesis aims at increasing the knowledge on hazards from work on fatalities and cancer within the domain of cohort studies on miners and metal refiners and to study the complexity of the analysis by discussing and suggesting analytical strategies. Methods The study population for this thesis consisted of a cohort of 2264 blue-collar aluminium smelter workers (paper I) and a cohort of 13000 blue-collar iron-ore miners (papers II-IV), both followed for over 50 years. The outcomes were collected from the Swedish Cause of Death Register and the Swedish Cancer Register. The primary methods of analysis were either Standardized Morbidity Ratios (SMR) or internal comparisons based on Cox or Poisson regression modeling. In paper IV, a g-estimation based on an accelerated failure-time model was performed to estimate the survival ratio. Results The results from paper I suggested that working as a blue-collar worker metal refiner was associated with increased rates of incidental lung cancer. Elevated rates among short term workers were observed for several outcomes. Paper I also showed that the choice of reference population when calculating SMR could influence the conclusions of the results. In paper II, several outcomes were elevated among the miners compared to the reference population from northern Sweden. However, no outcome except lung cancer was associated with cumulative employment time. The most recurrent pattern of the results was the negative association between cumulative employment time underground and several outcomes. The results from paper III showed that cumulative employment time working outdoors was associated with increased rates of cerebrovascular disease mortality. However, employment with heavy physical workloads did not explain the previously observed decreasing rates in the selected groups of outcomes. The adjustment for the healthy worker survivor effect by g-estimation in paper IV suggested that exposure from respirable dust was associated with elevated mortality risks that could not be observed with standard analytical methods. Conclusion Our studies found several rates from the cohorts that were elevated compared to external refererence populations but also that long term employments generally were associated with decreasing rates. Furthermore, incidental lung cancer rates was found elevated for the metal refiners. Among the miners, mortality rates of cerebrovascular diseases depended on if work was performed outdoor (higher rates) or underground (lower rates). Methodologically, this thesis has discussed different analytical strategies for handling confounding in occupational cohort studies. Paper IV showed that the healthy worker survivor effect could be adjusted for by performing g-estimation.

O trabalho de enfermagem oferece constantes perigos para o enfermeiro ao expô-lo às diversas cargas de trabalho que são geradoras de acidentes e doenças, com graves consequências pessoais, institucionais e sociais. O enfermeiro exerce suas atividades em um contexto que por suas próprias características é insalubre e possui muitos estressores, dada a forma de organização adotada, com trabalho em turnos, duplo emprego, carência de informações sobre seus riscos, falta de recursos e instalações inadequadas. Essas condições possibilitam os acidentes de trabalho e a contaminação por doenças e, em seu extremo, causam a morte do enfermeiro, subentendida pela gravidade da exposição no trabalho. Nesse sentido, esse estudo tem como objetivo identificar as melhores evidências sobre as causas de morte do enfermeiro, relacionadas às suas condições de trabalho e que permitam evidenciar o seu perfil de mortalidade. O estudo é de revisão sistemática, segundo o modelo do Instituto Joanna Briggs. Pauta-se na seguinte questão norteadora: Qual é a melhor evidência sobre as causas de morte dos enfermeiros, relacionadas ao trabalho? A população foi de estudos realizados com enfermeiros e escritos em português, inglês e espanhol; pesquisados até julho de 2011. As buscas foram realizadas nas bases de dados preconizadas pelo Instituto Joanna Briggs por meio dos seguintes descritores: mortalidade ocupacional; morbidade, câncer ocupacional, envelhecimento; suicídio; depressão; grupo de risco; riscos ocupacionais; compostos químicos; anormalidades induzidas por radiação; trabalho em turnos; morte súbita; tabaco; usuários de drogas; estresse fisiológico; trabalhadores; condições de trabalho; enfermagem do trabalho; esgotamento profissional; serviços de saúde do trabalhador; infecção; enfermeira, enfermeiro; enfermagem; profissionais da saúde; morte; pessoal de saúde. De acordo com a estratégia, foram selecionados oito artigos e sua análise permitiu identificar que as causas de mortalidade estão relacionadas aos diferentes tipos de cânceres e suicídios entre os enfermeiros e, ainda, avaliar as evidências apresentadas segundo o Instituto Joanna Briggs. Os resultados assinalam que a mortalidade dos enfermeiros relaciona-se, principalmente, à exposição às cargas químicas e psíquicas na vida profissional. Demonstram, ainda, a necessidade de novas pesquisas, dado o pequeno número de publicações existentes que abordam os prejuízos causados à saúde do enfermeiro nas funções exercidas no cotidiano de sua prática profissional
The nursing work offers constant dangers for nurses due to exposure to many workloads that generate accidents and diseases with serious personal consequences, institutional and social. The nurse carries out its activities in a context that by own characteristics has many unhealthy stressors, due form of organization adopted, with shift work, double job, lack of information about its risks, lack of resources and inadequate facilities. These conditions make it possible workplace accidents and contamination by disease and, in extreme cases, cause the death of the nurse by the severity of the exposure at work. Thus, this study aims identify the best evidence on the causes of death of the nurse related to their working conditions, and to evidence their profile of mortality. The study is a systematic review by model of the Joanna Briggs Institute. It is guided by the following question: \"What is the best evidence on the causes of death among nurses, work-related?\" The chosen population was studies about nurses, written in Portuguese, English and Spanish, searched by July 2011. The searches were conducted in the databases recommended by the Joanna Briggs Institute and identified the following key words: occupational mortality, morbidity, occupational cancer, aging, suicide, depression, risk group; occupational hazards, chemicals, radiation-induced abnormalities, shift work, sudden death, tobacco, drug users, physiological stress, workers, working conditions, occupational nursing, burnout, health care worker infection; nurse, nursing, occupational health, death, health personnel. According to the strategy, we selected eight articles and their analysis allowed identify that the causes of death are related to different types of cancers and suicide among nurses and also assess the evidence presented according to the Joanna Briggs Institute. The results show that the mortality of nurses is related mainly to exposure to chemical and psych workloads in professional life. Demonstrate the need for further research, given the small number of existing publications that approach the damage caused to the health of nurses in the roles played in the daily professional practice

Background Most environmental epidemiological studies are conducted in high income settings. The association between ambient temperature and mortality has been studied worldwide, especially in developed countries. However, more research on the topic is necessary, particularly in India, given the limited evidence on the relationship between temperature and health in this country. The average global temperature is increasing, and it is estimated that it will go up further. The factors affecting vulnerability to heat-related mortality are not well studied. Therefore, identifying high-risk population subgroups is of particular importance given the rising temperature in India. Objectives This research aimed to investigate the association of daily mean temperature and rainfall with daily deaths (Paper I), examine the relationship of hot and cold days with total and cause-specific mortality (Paper II), assess the effects of heat and cold on daily mortality among different socio-demographic groups (Paper III) and estimate the effect of maximum temperature on years of life lost (Paper IV). Methods The Vadu Health and Demographic Surveillance System (HDSS) monitors daily deaths, births, in-out migration and other demographic trends in 22 villages from two administrative blocks in the rural Pune district of Maharashtra state, in western India. Daily deaths from Vadu HDSS and daily weather data (temperature and rainfall) from the Indian Meteorological Department were collected from 2003 through 2013. Verbal autopsy data were used to define causes of death and classified into four groups: non-infectious diseases, infectious diseases, external causes and unspecified causes of death. Socio-demographic groups were based on education, occupation, house type and land ownership. In all papers, time series regression models were applied as the basic approach; additionally, in Paper III, a case-crossover design and, in Paper IV, a distributed lag non-linear model (DLNM) were used. Results There was a significant association between daily temperature and mortality. Younger age groups (0-4 years) reported higher risk of mortality due to high and low temperature and heavy rainfall. In the working age group (20-59 years), mortality was significantly associated only with high temperature. Mortality due to non-infectious diseases was higher on hot days (>39°C), while mortality from infectious diseases and from external causes were not associated with hot or cold days. A higher heat-related total mortality was observed among men than in women. Mortality among residents with low education and those whose occupation was farming was associated with high temperature. We found a significant impact of high temperature on years of life lost, which confirms our results from the previous research (Papers I-III). Conclusion The study findings broadened our knowledge of the health impacts of environmental exposure by providing evidence on the risks related to ambient temperature in a rural population in India. More specifically, the study identified vulnerable population groups (working age groups, those of low education and farmers) in relation to high temperature. The adverse effect of heat on population is preventable if local human and technical capacities for risk communication and promoting adaptive behavior are built. Furthermore, it is necessary to increase residents’ awareness and prevention measures to tackle this public health challenge in rural populations.

Reliable estimates for differences in life expectancy (LE) by socio-economic position (SEP), that can be assessed in an international context and are comprehensive in terms of considering different SEP dimensions, are missing for the German population so far. The aim of the present study is to fill this gap by providing estimates for differences in LE by education, household income, work status and vocational class. The lack of national mortality data by SEP required an innovative methodological approach to estimate LE from survey data with a mortality followup. The main strengths of the method are the low demand on the data, its simple applicability and the estimation of a set of age-specific probabilities of dying. We employed the method to the German Life Expectancy Survey and estimated period life tables for 45 male and 32 female SEP subpopulations. The results show striking differences in LE across all analysed SEP indicators. Among men, LE at age 40 ranges by more than five years between the lowest and highest household income quartiles, more than six years between individuals with low and high education, around ten years across the work status groups, and almost 15 years across the vocational classes. The proportion of those who reach the classic pension age of 65 years also varies considerably, as does the remaining LE at this age. The corresponding differences among women are smaller, yet still notable. The results yield an interesting finding for the ongoing discussion about the various consequences of an increased pension age. Moreover, they provide policy-makers, doctors, researchers and public health workers with insights into Germany's most disadvantaged SEP subpopulations and the potential extent of their disadvantages in terms of longevity and mortality.

Physical inactivity is a major public health problem, and evidence suggests that it is a contributing factor in numerous chronic diseases and conditions. Along with smoking and poor dietary habits, physical inactivity is one of the main risk factor for chronic diseases that can be modified through behavior change Performing physical activity on a regular basis has been linked with positive effects on health and well-being, and physical activity improvement has been appointed as the leading health indicator for the next decades. The availability of health data is important for national discussions on health policies. Such data can highlight real variations in health status and the factors affecting health across communities. Moreover, it could be useful to guide policy-related discussions on best practices to improve the health of population. The objectives of this thesis are to describe changes on leisure time and occupational physical activity status at the community level and to evaluate sociodemographic, health related, and life style determinants of such changes, and also evaluate the association of different physical activity domains for women and men, with overall mortality. The thesis is composed by two original articles based on two population-based cohorts studies: the Cornellà Health Interview Survey Follow-Up Study and the Barcelona Health Interview Study. The studies included in this thesis suggest that there were changes in the population on the physical activity status whereas no clear determinants of such changes were recognized. Moreover the effects of all domains of physical activity were associated with a substantial decreased mortality. Therefore, promoting moderate levels of leisure time physical activity, occupational physical activity and walking seems to be essential in comprehensive health promotion programs at community levels.
La inactividad física o el sedentarismo es un problema central de la salud pública, la evidencia científica muestra que es un factor de riesgo para numerosas enfermedades de las denominadas crónicas o no transmisibles. Junto al hábito de fumar y a la alimentación es un factor de riesgo de enfermedad que puede ser modificado por cambios de comportamiento y hábitos. Se postula que realizar actividad física de manera regular permite lograr efectos positivos sobre el bienestar y la salud; además, el mejoramiento en los niveles de actividad ha sido señalado como un indicador líder de las ganancias en salud. En este sentido disponer de datos poblacionales es fundamental para discutir las políticas públicas sanitarias: las variaciones a nivel poblacional de los indicadores de salud son los que guían las discusiones para desarrollar guías que mejoren la salud comunitaria. Los objetivos de la presente tesis son: describir los cambios en la actividad física de ocio y la ocupacional a nivel comunitario y evaluar los determinantes de dichos cambios tales como los sociodemográficos, los relacionados con el status de salud, y los estilos de vida; Identificar la asociación de los distintos dominios de actividad física con la mortalidad general tanto en hombres como en mujeres en estudios de cohortes de base poblacional. La tesis se compone de artículos originales desarrollados en el marco de dos estudios de cohortes con base poblacional, el Estudio de Seguimiento de la Cohorte de Cornellà y el de La Encuesta de Salud de Barcelona año 2000. Los estudios analizados evidencian que hubo cambios en los niveles de actividad física a nivel poblacional, y que no se demostraron determinantes claros de esos cambios más que los sociodemográficos. También demostraron que todos los dominios de actividad física realizada tanto en mujeres como en hombres decrecen la mortalidad por todas las causas evaluada a nivel poblacional. Por lo tanto para el diseño de programas abarcativos de promoción de la salud a nivel comunitario deben incluirse recomendaciones apropiadas para la realización de actividad física de ocio y del caminar y laboral

La grotte du Vallonnet (Alpes-Maritimes, France) a livré une industrie lithique archaïque associée à une faune, riche en matériel et en nombre d'espèces, caractéristique de la transition Villafranchien/Galérien, dans des niveaux datés d'environ un million d'années. Au carrefour de niches écologiques diversifiées dans le temps et dans l'espace, la grotte a accumulé progressivement trois niveaux archéostratigraphiques principaux subdivisés chacun en plusieurs unités. Les ossements, peu minéralisés, n'ont pas enregistré de marques de charriage, mais une fragmentation importante due en partie au piétinement et à la pression du sédiment. La présence de ces ossements dans la grotte semble liée directement à la cause de mortalité des individus, d'âges distincts selon les espèces. L'observation exhaustive et systématique des ossements a établi que les ours ont dû mourir naturellement dans la grotte, que la caverne a servi de repaire à quelques carnivores, notamment la hyène, et que les hommes y ont exploité des parties de carcasses, de grand cervidé principalement, mais aussi de bison et de cervidé de taille moyenne. La grotte a connu une alternance d'occupations humaine et animale et après chaque passage, un enfouissement progressif des ossements a permis d'une part à des carnivores de ronger des os déjà dépourvus de chair, d'autre part à des porcs-épics de ronger des os encore frais. De nombreux ossements portant la trace de plusieurs intervenants différents témoignent de cette succession d'actions sur le matériel osseux.

L'objectif principal de cette thèse est d'évaluer le coût social des cancers des voies respiratoires d'origine professionnelle en France. Une synthèse des données épidémiologiques disponibles dans la littérature est réalisée. La méthode des risques attribuables est mobilisée pour estimer les nombres de cas (incidents, prévalents et de décès) de cancers du poumon, des naso-sinus et des mésothéliomes de la plèvre imputables à l'amiante, aux fumées d'échappement des moteurs diesel, aux peintres, à la silice cristalline, aux poussières de bois et aux poussières de cuir. Nous évaluons ensuite le coût que représentent ces cas de cancer pour la société selon la méthode du coût de la maladie. Pour prendre en compte de manière exhaustive les coûts indirects nous développons un arbre de décision permettant d'estimer la probabilité d'être concerné par chaque catégorie de coût. Nous mettons en place des modèles d'évaluations spécifiques des cancers pour chaque catégorie de coût qui nous permettent d'estimer, selon les approches par l'incidence et par la prévalence, les coûts directs (hospitaliers et soins de ville), indirects de morbidité (absentéisme et présentéisme) et de mortalité dans les sphères marchande et non marchande. Pour l'année 2010, le coût social des cancers du poumon, des naso-sinus et des mésothéliomes de la plèvre imputables à l'amiante, aux fumées d'échappement des moteurs diesel, aux peintres, à la silice cristalline, aux poussières de bois et aux poussières de cuir est estimé en France entre 986 et 1 248 millions d'euros selon l'approche par la prévalence et entre 1 223 et 1 586 millions d'euros selon l'approche par l'incidence dont 760 à 806 millions d'euros uniquement pour l'amiante.

Purpose. To determine the extent to which the MOR and PMR correctly identify true underlying associations between certain occupations/industries and mortality from specific cancers and what the important determinants are that contribute towards valid estimation of risk when they are employed Methodology. A literature review of relevant occupational risk factors for lung cancer, pleural cancer, acute myeloid leukemia and soft tissue sarcoma was conducted to determine the extent to which the study findings were supported by other studies. Death certificate data from 26 states in the United States that routinely code occupation and industry on the death certificates of decedents between 1985 and 1998 were used for this study. Both proportionate mortality and case-control studies were used to investigate the extent to which PMR and MOR were influenced by: (1) the choice of three different reference populations; and (2) reliability of the cause of death information as measured by detection and confirmation rates. It also determined whether the direction of bias remained consistent for cancers with well established (asbestos, benzene) and those with less established (solvents, diesel) carcinogens in certain occupations. Finally, similar but limited analyses were made using industry rather than occupation to determine whether estimates of the MOR and PMR differed Results. The results from the MOR and PMR investigation correctly identified risks for lung cancer, mesothelioma and acute myeloid leukemia, although they did not reflect the estimates published in the literature. An improvement in the odds ratio was observed for only lung and pleural/peritoneal cancer and soft tissue neoplasms when cancers caused by the same exposure under investigation were removed from the control group. In the case of the PMR, the proportionate cancer mortality ratio (PMCR) was an improvement over the PMR since it was possible to control for the healthy worker effect Both the MOR and PMR were influenced by the use of different measures of exposure (occupation titles, industry titles and a combination of both) Conclusions. The choice of reference diseases, type of exposure coding and confirmation and detection rates determines whether the MOR and PMR reliably identify associations between certain occupations and industries and mortality from specific cancers. Investigations based on exclusively on death certificate data ought not to be interpreted without substantial support of other rigorous investigations such as cohort studies, but are a valuable tool in epidemiological investigations for hypothesis generating
acase@tulane.edu

碩士
大仁科技大學
環境管理研究所
100
In recent years, occupational-related disease and died incidents and the issue itself has been getting more and more attention in Taiwan. Recent studies show that the number of occupational diseases seems to be underestimated. Mortality data for the years 1987 through 2007 were retrieved from Taiwan’s National Mortality Registry, Department of Health. The International Classification of Disease-9th Revision-Clinical Modification(ICD-9-CM) code was used to identify deaths in which the underlying-cause-of-death. The occupational types were derived from the Directorate General of Budget, Accounting and Statistics, Executive Yuan, R.O.C.. To investigate the birth cohort effect on occupational disease mortality in Taiwanese between 1987 and 2007, an age-period-cohort (APC) model analysis is employed to study the effects of age, time periods, birth cohorts and occupational types of disease and cancer and suicide and accident. In these studies, we have the following findings：（1）The Agricultural was higher than service workers and shop and market sales workers in all causes of mortality trends. The occupational LRS（deviance=215374.44, df=9）：the service workers and shop and market sales workers had the highest RR,5.06 in age-period-cohort (APC) model.The age LRS（deviance=531492.07, df=9）：the older had the higest RR.（2）the higher death of disease species were heart and cerebrovascular disease for executives , professionals , agricultural etc., service workers and shop and market sales workers. The Relative risk estimate were very similar of the occupational, but the second highest disease at diabetes mellitus of agricultural etc..（3）the men and women of lung and liver cancers were the higher at agricultural etc., service workers and shop and market sales workers.（4）The men accidents ratio were the higher than women 4-7 times, and all mortality trends a gradual fall was evident.

碩士
高雄醫學大學
公共衛生學系公共衛生學碩士班
105
Background : According to Taiwan''s current labor insurance payment situation, the manufacturing sector accounted for about 31.8% of the total number of insurance. While the Republic of China from 1994 to 104 labor insurance cash paid occupational diseases total up to 1,422. Collecting domestic and foreign rheumatology literature has confirmed the association of toxicants and diseases exposed to carcinogens in plastic products. According to the literature, workers engaged in plastic products exposed to exposure to toxicants, have a higher risk of cancer, including colorectal cancer, oral cancer, liver cancer, lung cancer, esophageal cancer, leukemia, bladder cancer and prostate cancer. Study Purpose : To study whether the plastic products manufacturing industry has a higher risk of cancer, cancer mortality and occupational injury rate ratio. Study Methods :This study was designed for retrospective generation tracing. Analysis of plastic products manufacturing labor and control group of workers occupational injury cash payment file, the death of the statistical file, cancer registration file, labor insurance and health insurance database. Male and female in the study group and the control group were used to match the ratio of 1: 1 with Propensity-Score matching. Pairing variables include age stratification, age stratification, income stratification, CCI comorbid index stratification, presence or absence of injury record and regional differences. The use of logistic regression analysis of occupational injuries and occupational prevalence, in the incidence of cancer and the death rate of whole death is the use of cox regression analysis of plastic products manufacturing workers suffering from disease situation. Results : Using the trend score matching method, there were 58,051 male samples and 45,655 female samples in the study group and the control group. The male and female samples were matched with the sample, and the final sample was 103,706. The incidence of cancer in the study group and the control group was 339.069 and 344.008, the incidence rate was 0.985 (0.945,1.027) , The risk of Cox regression cancer was 1.00 (0.95, 1.04). The death rate of total death was 282.826 and 245.970 in the study group and the control group, the incidence ratio was 1.149 (1.097,1.205), and the risk of Cox regression death was 1.20 (1.13,1.27), p <0.001. The relative risk of occupational injury was 3.49 (3.28 - 3.71), p <0.001. Conclusion : Compared with the control group, the study group had a high risk of cancer, the risk of death of all deaths and the risk of occupational injury. Doing the prevention of the disease, the safety measures at work are the best way to reduce the incidence of cancer and occupational injuries.

by Chiu Yuk Lan.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1998.
Includes bibliographical references (leaves 127-133).
Abstract also in Chinese.
TABLE OF CONTENTS
ABSTRACT (ENGLISH) --- p.a
ABSTRACT (CHINESE) --- p.b
ACKNOWLEDGEMENTS --- p.iv
Chapter CHAPTER 1 --- INTRODUCTION --- p.1
Chapter 1.1 --- Cancer in Food-service Workers --- p.1
Chapter 1.2 --- Carcinogenicity of Cooking Fumes --- p.1
Chapter 1.3 --- High Risk of Lung Cancer in Chinese Women --- p.2
Chapter 1.4 --- Why do We Conduct This Study? --- p.3
Chapter 1.5 --- Implication of This Study --- p.4
Chapter 1.6 --- What Types of Cancer were Included in This Study? --- p.4
Chapter 1.7 --- Aims and Hypothesis of This Study --- p.5
Chapter 1.8. --- Outline of the Thesis --- p.5
Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.8
Chapter 2.1. --- Occupational Epidemiological Studies --- p.8
Chapter 2.1.1 --- Studies of occupation and cancer occurrence based on routine records --- p.8
Chapter 2.1.2 --- Retrospective cohort studies among food service workers --- p.21
Chapter 2.1.3 --- Case-control studies --- p.27
Chapter 2.1.4 --- Case reports --- p.29
Chapter 2.1.5 --- Summary --- p.29
Chapter 2.2. --- Mutagens and Carcinogens in Cooking Fumes --- p.39
Chapter 2.2.1 --- Mutagens and carcinogens in cooking fumes --- p.40
Chapter 2.2.2 --- Summary --- p.42
Chapter CHAPTER 3 --- METHODS --- p.44
Chapter 3.1 --- Study Design --- p.44
Chapter 3.2 --- Study Population and Subjects --- p.46
Chapter 3.3 --- Reference Population --- p.48
Chapter 3.4 --- Sample Size Estimation --- p.48
Chapter 3.5 --- Data Sources and Data Collection --- p.49
Chapter 3.6 --- Data Processing --- p.53
Chapter 3.7 --- Data Analyses --- p.54
Chapter 3.7.1 --- Standardised proportional mortality ratio (SPMR) --- p.54
Chapter 3.7.2 --- Adjusted' SPMRs --- p.56
Chapter 3.7.3 --- Mortality odds ratio (MOR) --- p.58
Chapter 3.8. --- Exploring if Smoking could be a Confounding Factor --- p.62
Chapter CHAPTER 4 --- RESULTS --- p.64
Chapter 4.1 --- Characteristics of the Food-service Workers --- p.64
Chapter 4.2 --- Cancer Mortality Patterns of Food-service Workers --- p.69
Chapter 4.3 --- Adjusted SPMRs --- p.72
Chapter 4.4 --- Mortality Odds Ratios (MORs) --- p.76
Chapter 4.5 --- Mortality Odds Ratios Using Multiply Reference Diseases --- p.77
Chapter 4.6. --- Comparing SPMRs with MORs --- p.82
Chapter 4.7. --- Internal Comparison --- p.83
Chapter 4.8 --- Summary of Results --- p.90
Chapter 4.9. --- Survey on Smoking and Drinking Prevalence among Current Food-service Workers --- p.92
Chapter 4.9.1 --- Smoking habit --- p.92
Chapter 4.9.2 --- Drinking habit --- p.94
Chapter CHAPTER 5 --- DISCUSSION OF FINDINGS --- p.95
Chapter 5.1 --- Outcomes for This Study --- p.95
Chapter 5.1.2 --- Cancer risks for the kitchen workers --- p.96
Chapter 5.1.3 --- Cancer risks for the outside kitchen workers --- p.102
Chapter 5.2 --- Limitations of the Methods Adopted in the Present study --- p.107
Chapter 5.2.1 --- Standardised proportional mortality ratio (SPMR) --- p.107
Chapter 5.2.2 --- Morality odds ratio (MOR) --- p.109
Chapter 5.3 --- Bias and Control --- p.111
Chapter 5.3.1 --- Selection bias --- p.111
Chapter 5.3.2 --- Information bias --- p.113
Chapter 5.3.3 --- Confounding --- p.116
Chapter 5.4 --- Implications from the Results of the Present Study --- p.117
Chapter 5.5 --- Conclusion --- p.119
APPENDIX --- p.121
Appendix 1 --- p.121
Appendix 2 --- p.123
Appendix 3 --- p.124
Appendix 4 --- p.125
REFERENCES --- p.127

The Missouri Poultry Cohort is a historical cohort investigation of mortality among workers highly exposed to the poultry oncogenic viruses which are suspected cancer causing agents in humans. Workers were also exposed to fumes from PVC-wrapping activities that contain chemicals known or suspected to produce cancer in humans The cohort mortality pattern is similar to what is often observed in occupational studies, where the healthy worker effect takes place As a group, cancer mortality also does not shows excess. However, cancer of bronchus, trachea & lung and cancer of kidney present statistically significant excess when the plants are introduced in the analysis. A positive dose response relationship was found for cancer of bronchus, trachea & lung, and cancer of kidney by means of latency and duration of employment analysis. In lesser extent, some cancers of the lymphopoietic system are also excessive: Lymphosarcoma & Reticulosarcoma, Leukemia & Aleukemia, and Cancer of All Other Lymphopoietic Tissues. Several other cancers also are excessive as cancer of stomach, cancer of large intestine, cancer of pancreas, cancer of bladder, cancer of cervix, cancer of thyroid, and cancer of central nervous system The cohort experienced an excessive mortality of Non-Malignant Respiratory Diseases. From the external causes of death, Motor Vehicle Accidents and Homicides & Other External Causes are also in excess. All other causes of death, covering a broad spectrum of diseases, also presents excess By taking race into consideration in the PMR analysis it was identified that the cancer of bronchus, trachea & lung excess is greater in the nonwhite female group. In lesser extent, it also suggests nonwhite-male excess of cancer of bronchus, trachea & lung The major limitations of this investigation are the relative short time of follow-up, the potential role of confounding factors that were not taken into account in the assessment of risk, and the small number of observed deaths in the cancers of interest The major strengths are the high intensity of chicken oncogenic viruses exposure in a homogeneous population, the assessment of missing information in the SMR analysis, and the consistency of the positive cancer results of this investigation with previous findings from occupational investigations in the Chicken Slaughtering/Processing Industry
acase@tulane.edu

The study described and analysed the self-reported stress burden resulting from occupational exposure to maternal death among professional midwives working in rural health care units, and the effect of the identified stress burden on their physical and psychological well-being in order to recommend coping mechanisms and support for these midwives. Quantitative research using an exploratory, descriptive, and correlation design was used to collect data from midwives working in two rural districts, Mubende and Mityana in Uganda. Data was collected using a self-administered questionnaire which comprised of three standardised scales, and permission was granted by the developers of the scales. The study population comprised of 238 midwives and a response rate of 95.2% was obtained. Simple random sampling was used to select the study sites and the whole target population was studied. Data was analysed using the SPSS version 20. The findings revealed that occupational exposure to maternal death experienced by midwives working in rural districts of Uganda, may result into significant stress burden in the form of moderate to high death anxiety, mild to moderate death obsession and mild death depression. The respondents also experience physical un-wellness because of experiencing maternal death at the workplace, however, their psychological well-being was sustained. Although the midwives were using effective problem focused coping strategies to reduce their stress burden resulting from occupational exposure to maternal death, the study uncovered a number of factors that were non-modifiable that could be preventing this. However, midwifery educators, employers and managers should address the modifiable factors such as: midwives' education, involvement in other health care activities, lack of functional communication and ambulance services, support given at the work place after experiencing a maternal death, and professional training on how to handle death situations which exaggerate the stress burden resulting from occupational exposure to maternal death. Based on the key findings, proposed interventions, responsible persons and recommendations for practice to promote the coping mechanism and well-being of rural midwives in view of occupational exposure to maternal death were suggested.
Health Studies
D. Litt. et Phil. (Health Studies)

This dissertation examines lead exposure and effects across the lifespan among vulnerable populations. The vulnerable population that this dissertation focuses on are the elderly, newcomers to the US, which represents immigrants, as well as adolescents and women of childbearing age. The first chapter gives an introduction and highlights the history of lead as it relates to environmental and occupational exposure having deleterious effects on the human system. The second chapter highlights the association between blood lead level and subsequent Alzheimer’s disease (AD) mortality in those 65 years and older. Chapter 3 looks at whether length of time in the United States is a predictor of adolescent and adult blood lead levels. The fourth chapter assesses whether early life lead exposure is associated with AD mortality later in life. Adaptations of Chapter 2 and Chapter 3 of this dissertation have been submitted for publication.

Chapter 2 presents a longitudinal study of 8080 elders (≥60 years) with BLL data from the 1999-2008 National Health and Nutrition Examination Survey, where mortality was determined from linked 1999-2014 National Death Index data. In this study, a causal diagram presented causal assumptions and identified a sufficient set of confounders: age, sex, poverty, race/ethnicity, and smoking. Cox proportional hazard models were used to determine the association between BLL and subsequent AD mortality. Impacts of competing risks and design effect were also assessed. Adjusted hazard rate ratio (HRR) and 95% confidence interval (CI) were reported. Results showed that those with BLL of 1.5 μg/dL and 5 μg/dL had 1.2 (95% CI: 0.70, 2.1) and 1.4 (95% CI: 0.54, 3.8) times the rate of AD mortality compared to those with BLL of 0.3 μg/dL, respectively, after accounting for competing risks. Adjusted HRRs were 1.5 (95% CI 0.81, 2.9) and 2.1 (95% CI 0.70, 6.3), respectively, after considering design effect. This longitudinal study demonstrated a positive, albeit statistically non-significant association between BLL and AD mortality, after adjustment for competing risks or design effect.

Chapter 3 included cross-sectional 1580 women of childbearing age (15-45 years) and 5933 men and women (≥15 years) from the 2013-2016 United States National Health and Nutrition Examination Survey. Linear regression models adjusted for race/ethnicity, education, blood cotinine, age, sex (as appropriate) and accounted for complex survey design. Results showed that women of childbearing age who have lived 0-4 years in the US have, on average, a 43% (95% confidence interval (CI): 31%, 56%) higher BPb compared to women born in the US. Corresponding results for all adults and adolescents was 40% (95% CI: 28%, 51%). Similar, statistically significant, results were observed for other time periods (5-9 years, 10-19 years, and ≥20 years); the magnitude of the association decreased with increasing time in the US. Higher BPb was also significantly associated with Asian (vs. white), lower education, higher age, and male (vs. female).

Chapter 4 is an ecologic study utilizing data from the United States Census Bureau and American Fact Finder. This ecologic study uses publicly available data from the 1930s US census and the Centers for Disease Control and Prevention to compare estimated historic lead exposure with AD mortality rates among US states and Indiana counties. Occupations were assigned a numeric weight based on the likelihood of lead exposure. The proportion of workers in each occupation multiplied by this weight was used to create a historic lead exposure index; quintiles of this index were used in analyses. AD mortality rates among persons ≥ 65 years old from 1999-2016 were obtained from the Centers for Disease Control and Prevention. The relationship between the historic exposure index and mortality was evaluated using correlation coefficients and linear regression models adjusting for age, sex, education, socioeconomic status (SES). Maps to characterize spatial pattern of historic lead exposure and AD mortality were completed using Geographic Information System (GIS) spatial analysis tools for the U.S. at state level and at county level for Indiana. Results showed that among states, the average AD mortality rate was 202.2 per 100,000 (SD=44.4). Within Indiana, the average AD mortality rate was 209.6 per 100,000 (SD= 64.9). Among Indiana counties, the unadjusted model shows an association of higher HEI with higher AD mortality, with the fifth quintile reaching statistical significance. Results for the adjusted model were not statistically significant. Results for US states for both unadjusted and adjusted regression models show that the third, fourth, and fifth quintiles of the historic exposure index were associated with a significantly lower AD mortality rate when compared to the lowest quintile.

Conclusion: The first study, using a longitudinal design, shows a positive but non-significant association between BLL and subsequent AD mortality after adjustments for competing risks or design effects. The second study, using a cross-sectional design, showed that newcomers to the US may be a population at higher risk for elevated BPb. The third, ecological study, did not find any significant association between historic lead exposure and AD mortality rates for Indiana counties, however there was a significant association of higher historic lead exposure index with lower AD mortality rates for states in the US.