Mortality Rates by Occupation among US Workers: The National Health Interview Survey (NHIS)

Lora E Fleming MD PhD, William LeBlanc PhD, David Lee PhD, Alberto Caban Jr MPH, Orlando Gómez-Marín PhD MSc, Terry Pitman BSUniversity of Miami School of Medicine

Funding provided in part by NIOSH Grant number R01 0H03915; Worker Photographs by Dr David Parker http://www.rsmas.miami.edu/groups/niehs/niosh/

Objectives: This study examines overall as well as cause specific mortality rates of US workers by occupation and by gender.

MethodsThe National Health Interview Survey, conducted annually by the National Center for Health Statistics, is a continuous, multipurpose, and multistage area probability cross-sectional survey of the US civilian non-institutionalized population living at addressed dwellings. During the study period, NHIS survey response rate reportedly ranged from 95-98%.

Beginning with the 1986 survey year, information was collected by the NCHS to perform a mortality follow up through linkage with the National Death Index (NDI). The linkage is complete through December 31, 1997, and includes all participants from the 1986-94 NHIS survey years. The linkage was performed completely by computer. The linkage used an algorithm with a match class and score; on average, the linkage was 97% complete.

Because of the multi-stage sampling design, all analyses were performed with adjustments for sample weights and design effects using the SUDAAN statistical package. The study sample was defined as persons aged 18 years and older who reported working within the 2 weeks prior to their participation in the NHIS 1986-1994 surveys. Sample weights were further adjusted for analysis of data from combined survey years, as specified by Botman and Jack (1995). Mortality rates by occupation were age adjusted to the 2000 population.

Cause specific age adjusted mortality was evaluated for 206 occupations with an average of 100,000 US workers/year, as well as 13 and 41 broader occupational categories.

RESULTS

There were 440,302 total workers (205,080 women workers) in the mortality analysis with 12,181 total deaths (3,800 women worker deaths) during the study period from 1986-1994 with mortality follow up through 1997. The distribution of these deaths and the crude and age adjusted mortality rates for the broad 13 occupational categories are displayed in Table 1.  

With regards to age adjusted overall mortality by gender (Table 2), in the 206 detailed occupational categories containing at least 100,000 US workers, for women workers the highest mortality rates were seen for Vehicle Washers/Equipment Cleaners, Waitresses, Truck Drivers, Cleaners, Correctional Officers, Managers, Punch Press Machine Operators, Launders/Dry Cleaners, Interviewers, and Typists. For male workers the highest overall mortality rates were seen among Childcare Workers, Door-to-Door Sales Workers, Food Preparers, Licensed Nurse Practitioners, Health Aids, Roofers, Freight/Stock Handlers, General Clerks, Cashiers, and Private Household Cleaners/Servants. There were no or < 5 deaths among 33 occupations for female workers; Medicine/Health Managers (6.0) had the lowest recorded age adjusted mortality rate (data not shown). Only 7 occupations had no or <5 deaths for male workers; Operations Systems Researchers/Managers had the lowest age adjusted mortality rate (3.9) (data not shown).

The highest age adjusted cardiovascular mortality rates (Table 3) were seen among Messengers, Plumbers/Pipefitters, Bus/Truck Mechanics Tool/Die Workers, Operating Engineers, Pharmacists, Hairdressers, Maids/Housemen, Civil Workers, and Distribution Supervisors. The highest age adjusted cancer mortality rates (Table 4) were seen among Agricultural Supervisors, Vehicle Washers, Roofers, Mechanic Supervisors, Sales Workers, Construction Workers, Educational Counselors, Typists, and Punch Press Machine Operators.

CONCLUSIONS

The NHIS database offers an opportunity to investigate the overall and disease-specific mortality experience by specific occupation among US workers. This provides a unique view of the US worker mortality which can be used to target disease prevention programs, as well as allow for international comparisons with other worker populations.

An Occupational Mortality Monograph of the 1986-94 NHIS with follow up through 1997 is being created and will be available with downloadable and interactive tables from our Study Web page at www.rsmas.miami.edu/groups/niehs/niosh/

Table 2. Highest Age Adjusted Overall Mortality Rates by selected 206 Occupations and Gender*Occupation Number of Sample_N Age Adjusted SE

Deaths Overall Mortality Rateper 1000

Female WorkersVehicle washers and equipment cleaners 6 84 100.12 24.02Waiters/waitresses assistants 18 516 89.52 7.73Truck drivers 8 454 84.96 18.34Supervisors, cleaning and building service workers 10 251 81.03 13.77Correctional institution officers 5 191 74.34 13.88Punching and stamping press machine operators 9 150 71.00 21.15Managers and administrators 192 10201 69.90 7.28Laundering and dry cleaning machine operators 13 442 67.26 9.85Interviewers 14 507 66.76 19.13Typists 51 1937 64.92 13.47

Male WorkersChild care workers 11 94 167.31 41.58Street and door-to-door sales workers 17 255 131.57 22.93Supervisors, food preparation and service occs 15 392 128.89 20.94Licensed practical nurses 6 63 124.29 28.76Health aides, except nursing 9 202 123.63 30.82Roofers 23 592 119.59 12.41Freight, stock, and material handlers 54 1927 115.39 12.78General office clerks 44 779 114.11 11.65Cashiers 59 1343 109.88 17.09Private household cleaners and servants 6 110 108.94 21.50*(>=5 deaths/occupation)

Table 1. Mortality Data 1986-1994 NHIS Database with Follow up through 1997 for 13 Occupations by Gender

Occupation Sex Deaths Sample_NMortality Rate/1000 Mortality(age adj) Rate SE

Executive, administrative managerial Total 1,623 60,419 66.89 3.27

Male 1,230 35,407 75.15 3.53

Female 393 25,012 49.52 5.25

Professional specialty Total 1,234 62,180 55.11 3.32

Male 784 29,309 61.70 4.47

Female 450 32,871 44.50 5.18

Technicians/related support Total 264 15,340 35.83 5.60

Male 175 7,637 53.18 8.72

Female 89 7,703 15.83 2.25

Sales Total 1,360 49,626 69.52 3.17

Male 919 24,883 82.70 4.07

Female 441 24,743 51.69 5.81

Administrative support occs, including clerical Total 1,472 68,312 56.93 4.38

Male 497 13,805 82.46 6.71

Female 975 54,507 45.85 5.06

Private household Total 159 3,249 49.25 4.28

Male 10 141 113.19 28.65

Female 149 3,108 47.10 4.25

Protective service Total 276 7,393 74.40 6.30

Male 257 6,209 80.29 6.74

Female 19 1,184 35.15 10.72

Service occs, except protective/household Total 1,446 46,886 72.13 5.07

Male 702 15,398 95.08 6.83

Female 744 31,488 59.76 5.49

Farming, forestry, fishing Total 702 12,653 82.67 3.79

Male 633 10,501 87.78 3.99

Female 69 2,152 51.04 11.19

Precision production, craft, repair Total 1,550 49,095 74.88 4.86

Male 1,466 44,493 78.85 5.06

Female 84 4,602 41.44 7.58

Machine operators, assemblers, inspectors Total 850 30,682 76.49 5.16

Male 557 18,099 84.65 6.63

Female 293 12,583 67.23 8.21

Transportation/ material moving Total 714 18,607 74.62 6.94

Male 682 16,767 76.74 6.94

Female 32 1,840 35.64 13.27

Handlers, equipment cleaners, helpers, laborers Total 531 15,860 80.46 8.43

Male 469 12,573 96.39 10.38

Female 62 3,287 32.75 6.19

Table 4. Highest Age Adjusted Overall Cancer Mortality Rates by selected 206 Occupations*Occupation Number of Sample_N Age Adjusted SE

Deaths Cancer Mortality Rateper 1000

Supervisors, related agricultural occs 8 380 70.36 9.28Vehicle washers and equipment cleaners 8 656 60.79 9.24Roofers 7 600 60.32 6.76Supervisors, mechanics and repairers 20 1087 57.66 5.71Sales workers, parts 9 518 54.59 18.27Construction trades, nec. 10 649 50.06 19.52Mechanical 11 1211 48.67 14.33Counselors, Educational and Vocational 10 1010 47.00 4.14Typists 23 2042 45.55 13.54Punching and stamping press machine operators 8 494 41.64 19.43*(>=5 deaths/occupation)

Table 3. Highest Age Adjusted Cardiovascular Mortality Rates by selected 206 Occupations*Occupation Number of Sample_N Age Adjusted SE

Deaths Cardiovascular Mortality Rateper 1000

Messengers 14 475 64.03 12.96Plumbers, pipefitters, and steamfitters 25 1577 61.90 12.76Bus, truck, and stationary engine mechanics 21 1178 60.67 7.73Tool and die makers 8 539 60.07 5.93Operating engineers 13 960 54.65 6.11Pharmacists 7 617 52.03 16.08Hairdressers and cosmetologists 17 2881 48.71 6.85Maids and housemen 26 2323 47.93 6.53Civil 7 980 45.94 9.00Supervisors, distribution, scheduling, and adjusting clerks 10 694 44.78 12.04*(>=5 deaths/occupation)