Austin S G, Huang N, Woernle C W
Department of Epidemiology, University of Alabama, Birmingham.
Am J Ind Med. 1995 Jan;27(1):29-36. doi: 10.1002/ajim.4700270104.
Computerized records of all Alabama deaths occurring to persons 16 years of age and over for the 5-year period 1984-1988 were obtained from the Alabama Department of Public Health. Using proportionate mortality ratio (PMR) methodology and death certificate occupation, cause-specific mortality patterns were examined for all Alabama decedents (N = 182,178), for all Alabama workers (N = 125,369), and for the occupational group of "farm operators and managers" (N = 11,691). In comparison with the U.S. general population, little difference was found between cause-specific PMR results for the total Alabama population and those for all workers, suggesting the absence of a generalized "healthy worker effect." In comparison with the U.S. population, PMR results for farmers suggested lowered mortality from all malignant neoplasms and all heart disease, and elevated mortality from all external causes of death. In comparison with the Alabama population, PMR results for farmers continued to suggest lowered mortality from all malignant neoplasms, specifically for cancers of the respiratory, digestive and lymphopoietic systems. However, significantly elevated PMRs for external causes of death appeared only among nonwhite female farmers. Further investigation of these deaths suggested that this finding was more likely attributable to an increased risk of housefire deaths associated with rural lifestyle than with occupational factors.
1984 - 1988年5年间，阿拉巴马州16岁及以上人群所有死亡的计算机记录来自阿拉巴马州公共卫生部。采用比例死亡率（PMR）方法并依据死亡证明上的职业信息，对阿拉巴马州所有死者（N = 182,178）、所有阿拉巴马州工人（N = 125,369）以及“农场经营者和管理者”职业群体（N = 11,691）的死因别死亡率模式进行了研究。与美国普通人群相比，阿拉巴马州总人口和所有工人的死因别PMR结果之间差异不大，这表明不存在普遍的“健康工人效应”。与美国人群相比，农民的PMR结果显示所有恶性肿瘤和所有心脏病导致的死亡率降低，而所有外部死因导致的死亡率升高。与阿拉巴马州人群相比，农民的PMR结果继续表明所有恶性肿瘤导致的死亡率降低，特别是呼吸系统、消化系统和淋巴造血系统癌症。然而，外部死因导致的显著升高的PMR仅出现在非白人女性农民中。对这些死亡的进一步调查表明，这一发现更可能归因于与农村生活方式相关的房屋火灾死亡风险增加，而非职业因素。
