Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study

Mortality from non-communicable diseases and associated risk factors in Zambia; analysis of the sample vital registration with verbal autopsy 2015/2016

BACKGROUND

Non-communicable diseases (NCDs) are the world's growing cause of preventable illness, disability, morbidity, and mortality which account for 71% of deaths. The aim of this study was to determine the factors associated with mortality from NCDs among persons aged 15 years and above in Zambia.

METHODOLOGY

The study used data from Sample Vital Registration with Verbal Autopsy (SAVVY) 2015/16 (Zambia). A total of 3529 Verbal Autopsy were completed in the study, with only 2599 of death where among people aged 15 years and above. Three-level data analysis was applied; univariate analysis, bivariate analysis, and multivariate analysis (binary logistic regression).

FINDINGS

The overall number of deaths from NCDs was 28.81%. Stratified analysis by gender showed that deaths from NCDs were higher among women (32.60%) as compared to men (26.25%). Among all persons, dying from NCDs was associated with tobacco use, age, and education. Tobacco use was negatively associated with mortality from NCDs (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.48-0.98). Age was positively associated with the odds of dying from NCDs among persons aged 45-59 years (aOR = 3.87, 95% CI: 2.13-7.01), 60-74 years (aOR = 12.05, 95% CI: 6.44-22.55), and 75 + years (aOR = 15.16, 95% CI: 7.93-28.97). The likelihood of dying from NCDs was higher among persons with secondary education as compared to those with no education (aOR = 1.93, 95% CI: 1.11-3.33).

CONCLUSION

The findings from this study suggest that public health interventions targeting NCDs need to consider behavioural factors, especially tobacco use which exposes people to second-hand smoke. We also recommend large-scale national-level studies to further examine the contribution of each factor leading to mortality from NCDs.

Rural and urban differences in lifetime occupation and its influence on mortality among Mexican adults

OBJECTIVE

To determine how primary lifetime occupation type is associated with mortality, and how the relationship varies by rural and urban dwelling.

MATERIALS AND METHODS

Data come from 2001-2018 Mexican Health and Aging Study (adults aged 50+, n=11 094). We created five occupation categories. Cox proportional hazard models predicted mortality using baseline covariates.

RESULTS

In both rural and urban settings, participants with manual jobs, such as agriculture and production/industrial jobs, had an increased risk of mortality compared to those with administrative/professional jobs. In urban settings, participants in the domestic/service and no main job categories had higher risk of mortality than those in the administrative/professional category. For men these differences remained, but not for women.

CONCLUSION

In a context of rural and urban demographic shifts, it is crucial to consider the implications that occupation as a socioeconomic factor can have on health and to identify the most vulnerable groups.

Evaluating the Serum Levels of Beclin-1 and Mammalian/Mechanistic Target of Rapamycin (mTOR) in Three Different Professional Categories

BACKGROUND

The possible associations between occupational factors and autophagy - a catabolic process that is evolutionarily conserved and serves as a vital cornerstone in maintaining cellular balance - remain largely unexplored.

OBJECTIVES

We assessed serum levels of beclin-1, a principal effector of autophagy, and the mammalian/mechanistic target of rapamycin (mTOR), a protein recognized for its part in suppressing autophagy, within a group of healthy individuals hailing from three different professional fields, each characterized by its unique working conditions.

METHODS

A total of 60 men were recruited from three distinct occupational categories: airline pilots, construction laborers, and fitness trainers. Each group consisted of 20 subjects who were selected during routine occupational health appointments. Serum levels of beclin-1 and mTOR were measured using commercially available immunoassays and compared among the three categories.

RESULTS

Fitness instructors had the highest concentration of beclin-1 (3.1 ± 0.9 ng/mL). Construction workers followed with a mean of 2.4 ± 0.4 ng/mL, while airline pilots had the lowest levels at 1.9 ± 0.5 ng/mL (one-way analysis of variance, P < 0.001). In terms of mTOR levels, construction workers had the highest concentration (5.9 ± 1.9 ng/mL), followed by airline pilots (4.4 ± 1.7 ng/mL). Fitness instructors, on the other hand, had the lowest mTOR levels (3.5 ± 1.2 ng/mL; one-way analysis of variance, P < 0.001).

CONCLUSIONS

Serum levels of autophagy biomarkers can vary among healthy individuals based on their professional roles. Considering the crucial function autophagy serves in both health and disease, further investigations are crucial to deepen our comprehension of the potential implications of autophagy in the field of occupational medicine.

Determination of the Level of Cardiovascular Risk in 172,282 Spanish Working Women

Introduction, objectives: Although cardiovascular events have been traditionally associated mainly with men, some data reflect an increase in women, which may even exceed their male counterparts, constituting the leading cause of death in working women in Spain. The objective of this present study was to analyze the level of cardiovascular risk in Spanish working women by assessing the influence of age, type of work, and tobacco consumption.

MATERIAL, METHODS

A descriptive cross-sectional study was carried out in 172,282 working women from different Spanish geographical areas and from different companies between January 2018 and June 2020. A range of variables and risk factors were assessed and various cardiovascular risk scales were used to analyze the data.

RESULTS

An increase in cardiovascular risk was observed in the least qualified work groups, mainly corresponding to blue-collar workers, when using the SCORE or REGICOR risk equation. The prevalence of altered values for all the parameters analyzed (overweight and obesity, hypertension, dyslipidemia, diabetes, fatty liver, hepatic fibrosis, atherogenic indexes, and cardiovascular risk scales) was higher among blue-collar women. Age was the only factor that influenced all the cardiovascular risk scales studied, increasing risk when comparing the group of women aged 50 years and older with the others.

CONCLUSIONS

Aging and belonging to the blue-collar job category meant worse results in the cardiovascular risk scales and in all the parameters analyzed. This is in line with numerous studies that argue that age and zip code are more influential than genetic code.

National estimates of occupation-related inequalities in all-cause mortality using linked Census-mortality data

OBJECTIVE

This report aims to provide national estimates of occupation-related inequalities in all-cause mortality for Australian residents aged 25-64 years.

METHOD

Data came from the 2016 Census linked to Deaths Registrations, available via the Multi-Agency Data Integration Project. Using negative binomial regression, we estimated age-adjusted relative and absolute inequalities in all-cause mortality rates in the 13 months following Census according to occupation, defined using the Australian and New Zealand Standard Classification of Occupations (eight major groups), using managers as the reference group.

RESULTS

Among 10.8M people, there were 20,987 deaths. Age-adjusted mortality rates were lowest among managers and professionals and were generally highest for manual occupations, for example, among men, relative risks (RR) for labourers ranged across age groups from 1.44 (95% CI 1.19-1.75, age 54-64) to 2.99 (1.93-4.65, age 25-34); among women, the RR for machine operators and drivers were 3.95 (1.39-11.21 in age 25-24 and 2.73 (1.66-4.49) in age 45-54, but there was relatively little variation by occupation in women aged 35-44 and 55-64. Around one in five deaths (23% for men, 17% for women) were associated with being in an occupation other than manager.

CONCLUSION

These findings highlight that there is benefit in documenting national mortality inequalities according to occupation in addition to other measures of socioeconomic position. They provide further insights into socioeconomic inequalities in mortality.

IMPLICATIONS FOR PUBLIC HEALTH

Methods that aim to reduce mortality for those in manual occupations, particularly among young men, will reduce inequalities and improve population health.

Sector of Employment and Mortality: A Cohort Based on Different Administrative Archives

Administrative data can be precious in connecting information from different sectors. For the first time, we used data from the National Social Insurance Agency (INPS) to investigate the association between the occupational sectors and both non-accidental and accidental mortality. We retrieved information on occupational sectors from 1974 to 2011 for private sector workers included in the 2011 census cohort of Rome. We classified the occupational sectors into 25 categories and analyzed occupational exposure as ever/never have been employed in a sector or as the lifetime prevalent sector. We followed the subjects from the census reference day (9 October 2011) to 31 December 2019. We calculated age-standardized mortality rates for each occupational sector, separately in men and women. We used Cox regression to investigate the association between the occupational sectors and mortality, producing hazard ratios (HRs) and 95% confidence intervals (95%CI). We analyzed 910,559 30+-year-olds (53% males) followed for 7 million person-years. During the follow-up, 59,200 and 2560 died for non-accidental and accidental causes, respectively. Several occupational sectors showed high mortality risks in men in age-adjusted models: food and tobacco production with HR = 1.16 (95%CI: 1.09-8.22), metal processing (HR = 1.66, 95%CI: 1.21-11.8), footwear and wood (HR = 1.19, 95%CI: 1.11-1.28), construction (HR = 1.15, 95%CI: 1.12-1.18), hotels, camping, bars, and restaurants (HR = 1.16, 95%CI: 1.11-1.21) and cleaning (HR = 1.42, 95%CI: 1.33-1.52). In women, the sectors that showed higher mortality than the others were hotels, camping, bars, and restaurants (HR = 1.17, 95%CI: 1.10-1.25) and cleaning services (HR = 1.23, 95%CI: 1.17-1.30). Metal processing and construction sectors showed elevated accidental mortality risks in men. Social Insurance Agency data have the potential to characterize high-risk sectors and identify susceptible groups in the population.

Mortality Associated With Occupational Exposure in Helsinki, Finland-A 24-Year Follow-up

OBJECTIVES

Our objective was to study mortality related to different obstructive lung diseases, occupational exposure, and their potential joint effect in a large, randomized population-based cohort.

METHODS

We divided the participants based on the answers to asthma and chronic obstructive pulmonary disease (COPD) diagnoses and occupational exposure and used a combined effects model and compared the results to no asthma or COPD with no occupational exposure.

RESULTS

High exposure had a hazards ratio (HR) of 1.34 (1.11-1.62) and asthma and COPD coexistence of 1.58 (1.10-2.27). The combined effects of intermediate exposure and coexistence had an HR of 2.20 (1.18-4.09), high exposure with coexistence of 1.94 (1.10-3.42) for overall mortality, and sub-HR for respiratory-related mortality of 3.21 (1.87-5.50).

CONCLUSIONS

High occupational exposure increased overall but not respiratory-related mortality hazards, while coexisting asthma and COPD overall and respiratory-related hazards of mortality.

Socioeconomic inequalities in health status and survival: a cohort study in Rome

OBJECTIVES

To analyse the association between individual and contextual socioeconomic position (SEP) with health status and to investigate the role of SEP and baseline health status on survival.

DESIGN

Cross-sectional and cohort study.

SETTING

Rome, Italy.

PARTICIPANTS, PRIMARY AND SECONDARY OUTCOMES

We selected the 25-99 year-olds included in the Rome 2011 census cohort. As a measure of health status on the census reference date (09 October 2011), we used the presence of chronic or rare conditions from the Disease-Related Co-payment Exemption Registry, a database implemented to provide free care to people with chronic or rare diseases. We used logistic regression to analyse the association between both individual (educational attainment) and contextual SEP (neighbourhood real estate price quintiles) with baseline health status. We analysed the role of SEP and the presence of chronic or rare conditions on 5-year survival (until 31 December 2016) using accelerated failure time models with Weibull distribution, reporting time ratios (TRs; 95% CI).

RESULTS

In middle-aged, subjects with low SEP (either individual or contextual) had a prevalence of chronic conditions comparable with the prevalence in high SEP individuals 10 years older. Adjusted logistic models confirmed the direct association between SEP and baseline health status in both women and men. The lowest educated were up to 67% more likely to have a chronic condition than the highest educated, while the difference was up to 86% for lowest versus highest contextual SEP. Low SEP and the presence of chronic conditions were associated with shorter survival times in both sexes, lowest versus highest educated TR was TR=0.79 for women (95% CI: 0.77 to 0.81) and TR=0.71 for men (95% CI: 0.70 to 0.73). The contextual SEP shrunk survival times by about 10%.

CONCLUSION

Inequalities were present in both baseline health and survival. The association between SEP and survival was independent of baseline health status.

Differences in mortality between temporary and permanent workers: results from the Rome Longitudinal Study

OBJECTIVE

Precarious employment is characterised by instability, lack of protection and economic vulnerability. The objective of this study was to assess the association between temporary contracts and mortality.

DESIGN

Cohort study.

SETTING

Rome, Italy.

PARTICIPANTS

All employees, aged 25-65 years, from the Rome Longitudinal Study, followed from 21 October 2001 to the first date among death, migration from Rome, or 31 December 2015.

PRIMARY AND SECONDARY OUTCOME MEASURES

We investigated all-cause, cardiovascular and accidental mortality. We considered gender, age, place of birth, education, temporary versus permanent contract and sector of employment. We used Cox models to investigate the association between type of contract and total, cardiovascular and accidental mortality in men and women, overall and by employment sector.

RESULTS

We analysed 597 834 subjects. The proportion of temporary contracts varied by gender (9.6% in men and 13.3% in women) and by employment sector, ranging from 4.5% (public administration) to 27% (recreational, cultural, sports activities) in men. During the study period, 21 136 subjects died. Men with temporary contracts, compared with those with permanent positions, had greater overall mortality risk (HR=1.16, 95% CI 1.09 to 1.24), cardiovascular mortality (HR=1.29, 95% CI 1.14 to 1.45) and accidental mortality (HR=1.27, 95% CI 1.04 to 1.57). In men, the association varied widely among different economic sectors, with greater risks in the industry, building constructions and social services sectors. In women, there was no evidence of association between temporary contracts and mortality. A statistically significant association between temporary contracts and mortality in women was found in the sector of sales and transports only.

CONCLUSIONS

Temporary work should be considered a determinant of health, particularly for specific economic sectors.

Differences in cardiovascular risk levels between cleaning staff and hotel housekeepers

Background and objective

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, with a greater incidence in the most disadvantaged social classes. In this study, we aimed to evaluate the level of cardiovascular risk in cleaning workers.

Methods

This was a descriptive, cross‐sectional study in 46.632 cleaning workers (40.169 women and 6.463 men). Thirty‐one different scales related to cardiovascular risk were studied (14 assessing overweight and obesity, 5 determining the risk of nonalcoholic fatty liver disease, 5 scales of cardiovascular risk, 4 atherogenic indices, and 3 scales of metabolic syndrome, among others). The results obtained were divided between personnel who perform their cleaning tasks in the hotel and catering industry and those in other sectors.

Results

The prevalence of obesity and arterial hypertension in cleaning workers was over 20% in both sexes. A similar amount was observed in moderate or high values on the REGICOR (Registre GIroní del COR) scale. More than 15% presented metabolic syndrome according to the NCEP ATPIII (National Cholesterol Education Program‐Adult Treatment Program III) criteria, while over 10% of women and 20% of men had a high risk of nonalcoholic fatty liver disease assessed with the fatty liver index.

Conclusion

Cardiovascular risk is higher, in both sexes, in the group of cleaning workers who work in companies other than hotels.

Educational Inequalities in COVID-19 Vaccination: A Cross-Sectional Study of the Adult Population in the Lazio Region, Italy

Several studies reported socioeconomic inequalities during the COVID-19 pandemic. We aimed at investigating educational inequalities in COVID-19 vaccination on 22 December 2021. We used the cohort of all residents in the Lazio Region, Central Italy, established at the beginning of the pandemic to investigate the effects of COVID-19. The Lazio Region has 5.5 million residents, mostly distributed in the Metropolitan Area of Rome (4.3 million inhabitants). We selected those aged 35 years or more who were alive and still residents on 22 December 2021. The cohort included data on sociodemographic, health characteristics, COVID-19 vaccination (none, partial, or complete), and SARS-CoV-2 infection. We used adjusted logistic regression models to analyze the association between level of education and no vaccination. We investigated 3,186,728 subjects (54% women). By the end of 2021, 88.1% of the population was fully vaccinated, and 10.3% were not vaccinated. There were strong socioeconomic inequalities in not getting vaccinated: compared with those with a university degree, residents with a high school degree had an odds ratio (OR) of 1.29 (95% confidence interval, CI, 1.27–1.30), and subjects with a junior high or primary school attainment had an OR = 1.41 (95% CI: 1.40–1.43). Since a comprehensive vaccination against COVID-19 could help reduce socioeconomic inequalities raised with the pandemic, further efforts in reaching the low socioeconomic strata of the population are crucial.

Inequalities in External-Cause Mortality in 2018 across Industries in Republic of Korea

Background

External-cause mortality is an important public health issue worldwide. Considering its significance to workers’ health and inequalities across industries, we aimed to describe the state of external-cause mortality and investigate its difference by industry in Republic of Korea based on data for 2018.

Methods

Data obtained from the Statistics Korea and Korean Employment Information System were used. External causes of death were divided into three categories (suicide, transport accident, and others), and death occurred during employment period or within 90 days after unemployment was regarded as workers’ death. We calculated age- and sex-standardized mortalities per 100,000, standardized mortality ratios (SMRs) compared to the general population and total workers, and mortality rate ratios (RRs) across industries using information and communication as a reference. Correlation analyses between income, education, and mortality were conducted.

Results

Age- and sex-standardized external-cause mortality per 100,000 in all workers was 29.4 (suicide: 16.2, transport accident: 6.6, others: 6.6). Compared to the general population, all external-cause and suicide SMRs were significantly lower; however, there was no significant difference in transport accidents. When compared to total workers, wholesale, transportation, and business facilities management showed higher SMR for suicide, and agriculture, forestry, and fishing, mining and quarrying, construction, transportation and storage, and public administration and defense showed higher SMR for transport accidents. A moderate to strong negative correlation was observed between education level and mortality (both age- and sex-standardized mortality rates and SMR compared to the general population).

Conclusion

Inequalities in external-cause mortalities from suicide, transport accidents, and other causes were found. For reducing the differences, improved policies are needed for industries with higher mortalities.