......................................................................................................... The European Journal of Public Health, Vol. 30, No. 2, 247–252 ß The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckz129 Advance Access published on 3 September 2019 ......................................................................................................... Mortality among Italian male workers in the construction industry: a census-based cohort study Gianfranco Alicandro 1,2 , Paola Bertuccio 3 , Gabriella Sebastiani 1 , Carlo La Vecchia 2 , Luisa Frova 1 1 Italian National Institute of Statistics (Istat), Rome, Italy 2 Department of Clinical Sciences and Community Health, Universita ` degli Studi di Milano, Milan, Italy 3 Department of Biomedical and Clinical Sciences, Universita ` degli Studi di Milano, Milan, Italy Correspondence: Gianfranco Alicandro, Italian National Institute of Statistics (Istat), Viale Liegi 13, Rome, Italy, Tel: +39 (06) 64737387, Fax: +39 (02) 50320866, e-mail: gianfranco.alicandro@istat.it Background: Advances in technologies, occupational hygiene and increased surveillance have reduced the excess mortality previously found in the construction industry. This study is aimed to evaluate cause-specific mortality in a recent cohort of construction workers. Methods: We carried out a record-linkage cohort study based on the 2011 Italian census and the mortality archives (2012–2015), including 1 068 653 construction workers. We estimated mortality rate ratios (MRR) using Poisson regression models including terms for age and geographic area. Results: Compared with non-manual workers, construction workers showed an excess mortality from all causes (MRR: 1.34), all neoplasms (MRR: 1.30), head and neck (MRR: 2.05), stomach (MRR: 1.56), liver (MRR: 1.62), lung (MRR: 1.80), prostate (MRR: 1.24) and bladder (MRR: 1.60) cancers, respiratory (MRR: 1.41) and liver (MRR: 1.79) diseases, all external causes (MRR: 1.87), falls (MRR: 2.87) and suicide (MRR: 1.58). Compared with manual workers in other industries, construction workers showed excess mortality from prostate (MRR: 1.27) and non-melanoma skin cancers (MRR: 1.95), all external causes (MRR: 1.14), falls (MRR: 1.94) and suicide (MRR: 1.18). Most of this excess mortality disappeared after adjusting for education, with the exception of prostate and non-melanoma skin cancers, all external causes, falls and suicide. Conclusions: Construction workers are at high risk of dying from external causes, while the excess mortality found for several cancers, liver and respiratory diseases may be at least partially due to the high prevalence of low education and unfavorable lifestyle factors. The excess mortality from prostate cancer requires further evaluations. ......................................................................................................... Introduction C onstruction represents one of the industrial sectors with the highest incidence of work-related accidents and illness, including musculoskeletal diseases, dermatitis, hearing loss, but also life-threatening conditions. 1,2 Workers employed in the con- struction industry are exposed during demolition, reconstruction and maintenance to a mix of hazardous substances, including asbestos, silica dust, gas, fumes, diesel exhaust and solvents. 3,4 In addition, workers in the construction industry have a high prevalence of smoking and heavy alcohol drinking. 5–8 Some studies found higher mortality from respiratory cancers and non-malignant respiratory diseases among cohorts of construction workers as compared with other workers. 9–11 These workers are also at increased risk of fatalities, since their job entails risky activities, such as working in high places and carrying heavy loads. 12 Over the last few decades, however, advances in technologies, occupational hygiene and increased surveillance have substantially decreased the workplace exposure to harmful substances, as well as more rigorous regulations have improved the working condition. 13 In Italy, the construction sector represents an important part of the national economy accounting for 18.8% of the GDP in 2017. Between 2010 and 2017, this industrial sector had experienced a severe crisis that led to 9.8% drop in the number of companies and 23.3% decline in the number of workers, with the largest decline reported in unskilled occupations. Difficulties in access to credit, late payments, time and cost of obtaining building permits and licenses were the main drivers of the crisis in the Italian con- struction sector. 14 Moreover, the Italian workforce in this sector is being replaced by foreign workers who are often underpaid with less protection, high risk of illegal labor and increased risk of work- related injuries. 15,16 In 2017, 34 812 injuries at work (excluding those occurred while reaching the workplace) have been officially reported in the construction industry in Italy, 125 of which resulted in death. 17 Intervention programs to enforce two national laws that laid down safety and health requirements for construction sites resulted in a reduction of work-related injuries. 18 These considerations call for new studies on more recent cohorts of workers for which available data are scanty. In this regard, we carried out a census-based cohort study to evaluate cause-specific mortality in a large cohort of Italian construction workers. Methods Study population We carried out a cohort study based on a sample of Italian male residents registered in the 2011 census and the mortality archives. The list of residents in all Italian municipalities was also used to track residents who moved abroad. These individuals were linked with the census and censored at the date of emigration. A detailed description of the study procedures can be found elsewhere. 19 Construction workers were identified by two items of the census questionnaire: the first one asked the subject the type of occupation he/she did in the week preceding the census date and the second question asked about the industrial sector. We extracted all workers involved in unskilled or skilled manual occupations and personnel in manufacturing, machinery, assembly lines or drivers working in the construction sector aged between 20 and 64 years at the beginning of the follow-up. Non-manual workers employed in the construction sector were excluded. The final cohort included 1 068 653 construc- tion workers. Mortality in the construction industry 247 Downloaded from https://academic.oup.com/eurpub/article/30/2/247/5559545 by guest on 20 June 2022