Comparison of Mesothelioma Deaths between the Education Sector and Other Occupations.

Transcription

1 Comparison of Mesothelioma between the Education Sector and Other Occupations. The incidence of teachers mesothelioma deaths is significantly greater than some other occupations. Asbestos exposure normally takes place in manual occupations and trades that frequently come into contact with asbestos, therefore one should not expect the members of a white collar profession such as teaching to be dying of asbestos related disease at a rate on par with, or greater than, some manual occupations. And yet they are. Male teachers have a proportionately greater number of mesothelioma deaths than for instance bakers, bus drivers/conductors, cooks and motor mechanics. The difference is even more pronounced when a comparison is made with outdoor occupations such as farmers and forestry workers where the incidence is less than half that of secondary teachers. 1 Both of which demonstrate that teachers have been exposed to significantly more asbestos. If they are compared with broadly similar professions such as solicitors, doctors, the clergy, government administrators or police officers the teachers deaths are proportionately higher than all of them. 2 Again this shows that as a profession they have suffered a significantly greater extent of asbestos exposure than other similar professions. If female teachers are compared with a similar profession such as nursing then marked differences are also shown, this is particularly relevant as there are similar numbers of people. In the twenty year period the incidence of mesothelioma amongst female school teachers was twice that of female nurses. One would have thought that neither profession should experience asbestos exposure, however the statistics demonstrate that both professions have experienced significant exposure, with the exposure of the teachers being twice that of the nurses. 3 The statistics between 2003 and 2012 continue to show a consistently higher mesothelioma incidence amongst female teachers than female nurses. Although the difference was less the numbers of deaths and the incidence increased in both occupations. The statistics show that female primary teachers are dying at a greater rate than the similar profession of nursing and it is a reasonable conclusion that they have had a proportionately greater asbestos exposure. 1 HSE statistics Mesothelioma Occupational statistics Highest and lowest risk occupations for males p7 Table 5, HSE Statistics Unit/Lees 15 Jul Mesothelioma deaths in the education sector for males and females HSE Mesothelioma mortality in Great Britain: Analyses by Geographical area and occupation 2005 Tables 11, 13 ( ). 2 HSE statistics Mesothelioma Occupational statistics Table 1-8 table 3-5 year time period.. HSE Statistics Unit/Lees 15 Jul Mesothelioma deaths in the education sector for males and females HSE Mesothelioma mortality in Great Britain: Analyses by Geographical area and occupation 2005 Tables 11, 13 ( ) Howie. From the HSE mesothelioma statistics for the period , excluding 1981 and 2001, there were 109 male and 59 female teacher deaths, 55 deaths of male nurses, clergy and doctors and 51 deaths of female nurses. If the number of deaths in nurses, clergy and doctors are corrected for the all causes deaths in these occupations for the period , excluding 1981, the mesothelioma rates in male teachers are about 60% higher than for male nurses, clergy and doctors and female teachers are about 70% higher than in female nurses. From official statistics it can be therefore considered that school teachers have experienced at least 60% higher mesothelioma rates than those in comparative professions. Howie 6 Jan Drever F 1995 Occupational Health Decennial Supplement OPCS. HSE 2008 Mesothelioma mortality in Great Britain. Analyses by Geographical area and occupation HSE Mesothelioma occupational statistics. Male and female deaths aged in Great Britain. 3 HSE statistics Mesothelioma Occupational statistics Table 6

2 Schools support staff have died of mesothelioma In addition school support staff have died of mesothelioma. 4 Nursery nurses, education assistants, midday assistants and childcare related occupations have died of mesothelioma. They also work with children, many of them in classrooms in schools, the only difference in most cases being that they do not hold a professional qualification and hence they are not coded in the occupational statistics under the "professions." It is only since 1991 that these occupations have been listed separately, in the ten year period from there were 17 deaths in this group and in the five year period from there were 12 deaths. The weighted average Proportional Mortality Ratios (s) for the group in both periods are above 100, which indicates a significant asbestos exposure in occupations where one should expect none. Although the numbers are not high enough to be statistically significant on their own, they tend to confirm all the other evidence of asbestos fibre release in schools and the exposure of the occupants whatever their occupation. There is anecdotal evidence that school secretaries commonly remain in the job for long periods of time, and therefore the occupation on their death certificate is probably an accurate record of their main lifetime occupation. Their Proportional Mortality Ratio in the period was high at 135.7, but the total number of deaths is relatively small and therefore is not statistically significant. However their deaths do add to the evidence of asbestos exposures of the occupants of schools. There are a significant number of deaths amongst cleaners and caretakers, and the individual occupational code with the greatest number of mesothelioma deaths amongst females, are cleaners. However the occupational codes include caretakers and cleaners in every occupation and not just schools 5, therefore it is not possible to state how many had worked in schools. It is known however that school cleaners and caretakers have died of mesothelioma. If asbestos fibres have been released in a school then it is the cleaners who invariably, and unknowingly, clean it up so that inevitably they are exposed. It is relevant that the statistics for show a significantly greater for female primary school teachers at than female cleaners at School caretakers are also acknowledged to be at risk as they are likely to disturb asbestos materials. There are numerous cases of school maintenance men and caretakers drilling walls to hang up notice boards, fitting ceiling tiles, removing ceiling tiles to mend leaks, patching up dents in walls and a whole plethora of other tasks all of which can potentially disturb asbestos. HSE and DfE highlight the risk by stating School caretakers have been identified as a particular group at risk due to the nature of their work (ie. Drilling and fixing.) 6 4 For further information see: 5 National Statistics Standard Occupational classification Vol 1 6 HSE Asbestos An important message to schools Mar & Aug DfES Asbestos An important update for schools Jun 2006

3 Misleading statements based on HSE case control study. In 2009 an HSE case control study examined the significance of lifetime occupational and residential histories from a large number of mesothelioma patients and population controls. 7 The report and its conclusions were generally well written, however the study made a statement about the teachers occupational exposures and subsequent mesotheliomas that cannot be justified from the data. The statement in the study is incorrect and misleading but has been repeated by senior HSE officials, 8 Ministers 9 and the DfE. 10 The study incorrectly stated: Among teachers, for example, 7 of the 11 male mesotheliomas and 7 of the 18 female cases had also worked in higher risk jobs. 11 The numbers quoted for teachers in the statement are incorrect. The group in question, as examined in the study, comprised Teachers and school workers, and therefore it was not just the teachers mentioned in the statement, for in addition to primary and secondary school teachers it also included school workers and higher education teachers and workers. In addition some of the occupations that had been included in the data had been misclassified and were later removed, although the published study has not been corrected. Based on data provided in 2011 by the HSE Epidemiology Unit, 12 one can make a more accurate statement that: Among school teachers, for example, 2 of the 5 male mesotheliomas and 1 of the 7 female cases had also worked in higher risk jobs. School teachers mesothelioma deaths should be examined separately from teachers in higher and further education, but the study made an error in combining the two sets of data. That is because their career patterns are different and their environments can also be different, most school teachers also teach younger children which is most relevant. Consequently false lessons can be learnt when the two sets of data are combined. Despite the error being privately acknowledged by HSE both they and DfE 13 continue to make statements on the mesothelioma deaths of teaching professionals by combining the two sets of data, which leaves a misleading impression. One reason for instance is that the deaths and incidence amongst higher and further education teaching professions is leveling off whereas the deaths amongst school teachers continue to increase, but that is masked when the two sets of data are combined. 7 HSE RR696 Occupational, domestic and environmental mesothelioma risks in Britain British Journal of Cancer (2009) 100, HSE Chief Medical Adviser and Head of Epidemiology Dr J Osman/ Lees 24 Mar Parliamentary written answer Mann/ Minister of State for Schools Gibb 8 Feb Parliamentary written answer Brooke/Minister of State for Employment Grayling 13 Dec s DfE 20 Jun 2011 and 7 th September 2011 Senior Press Officer/Speechwriters' Team 11 HSE RR696 Occupational, domestic and environmental mesothelioma risks in Britain para HSE Epidemiology unit Darnton/Lees 25 Feb For instance The management of asbestos in schools. A review of Department for Education policy Mar 15 Asbestos p11

4 In addition DfE and HSE continue to make statements based on the study which are equally misleading as they compare teachers with office workers. In 2011 DfE stated Recent research commissioned by the HSE, indicates that the risk of mesothelioma among men or women who worked for at least 5 years as teachers, was no higher than to individuals who had only ever done other low risk jobs (i.e. office work), and that a substantial proportion of men and women with mesothelioma who had done teaching work had also worked in higher risk occupations. 14 The comparison between teachers mesothelioma deaths and office workers incorrectly implies that as both are low risk and few office workers die, the teachers deaths are therefore not statistically significant. This gives a misleading impression as considerable numbers of office workers have died of mesothelioma and their incidence is higher than one would expect. HSE s use of office workers as a reference group in the study must therefore be questioned. 642 office workers died of mesothelioma between 1980 and. The incidence of mesothelioma amongst male office workers for instance is more than twice as great as farmers, and for females the incidence among office workers is almost twice as great as nurses. 15 Rather than female office workers having a low incidence of mesothelioma, the very opposite is true as they have one of the highest incidences of mesothelioma and this is emphasised by HSE in their explanation of the mesothelioma occupational statistics. They state The occupations with the highest risk for females were labourers in process and plant operations n.e.c. ( 230, 95% CI 142 to 351, 21 deaths) General office assistants/clerks ( 125, 95% CI 82 to 183, 26 deaths) 16 The fact that teachers and school workers have a similar incidence of mesothelioma to office workers shows that both groups have suffered significant asbestos exposure. This was acknowledged by the HSE Epidemiology unit who were careful to explain that: It's important to note that these results do not imply that there is no risk to teachers. However, it really does appear that the risk to teachers is very much on a par with that in the reference category of office workers. Clearly there have been mesothelioma deaths among teachers, as there have also been among other low risk groups such as health care workers, retail workers various others - and some of these cases will have been caused by asbestos exposure during the course of their work in these jobs. 17 Because others are dying it doesn t make teachers deaths acceptable, rather than accepting them as being the same as other occupations HSE should instead examine the implications. The fundamental difference between the school teachers deaths and the office workers is that there are many children 14 s DfE 20 Jun 2011 and 7 th September 2011 Senior Press Officer/Speechwriters' Team 15 HSE Mesothelioma occupational statistics Male and Female deaths aged in Great Britain tables 5 and 6 16 HSE Mesothelioma Mortality in Great Britain: Analyses by Geographical Area and Occupation 2005 P HSE Statistics Branch Darnton/Lees GB Mesothelioma case control study 6 Apr 2009

5 in a classroom with each teacher and they are more vulnerable to asbestos exposure. 18 If the teachers are being exposed to asbestos then so are their children. Conclusion The mesothelioma deaths amongst school teachers continues to increase as do the mesothelioma deaths amongst many other occupations where one should not expect asbestos exposure. Comparison of the data shows that people who work in buildings are dying at a greater rate than outdoor occupations such as farmers and forestry workers. This indicates that people are being exposed to asbestos in buildings. Further comparison shows that over the last thirty five years the incidence of mesothelioma deaths amongst school teachers has consistently been greater than some manual workers and consistently greater than some similar occupations. This indicates that the asbestos exposure of school teachers has consistently been higher than these other occupations. The concern is that the school teachers deaths show that there has been widespread asbestos exposure in schools over many years. As a profession they are different from other occupations because for every teacher there are twenty to thirty children, and they are more vulnerable to asbestos exposure. Everyone attends school as a child. The statistics for the education sector therefore only show the tip of the iceberg as they do not show how many people have subsequently died from their asbestos exposure as a child at school. Any comparison with other occupations should take that into consideration. It is therefore reasonable to conclude that if the subsequent deaths caused by exposure at school as a child were included in the statistics then the mesothelioma deaths in the education sector would be amongst the worst of all sectors. Michael Lees 5 th January 2011 Updated 28 th August 2015 See also: Increasing mesothelioma deaths amongst school staff and former pupils. Analysis to Notes on tables: s and Expected The incidence of mesothelioma between occupations is compared by the Proportional Mortality Ratio (). The number of people in each occupation is different, therefore a large number of deaths from mesothelioma in an occupation employing very few people would be more remarkable than the same number of deaths in an occupation employing many thousands of people. A of 100 shows that the number of mesothelioma deaths in a particular occupation is average for all the 18 Committee on Carcinogenicity (COC) final statement The relative vulnerability of children to asbestos exposure 7th June 2013

6 occupations. However that includes the high risk professions such as ship-building and the construction industry where asbestos exposure is known to occur. In those occupations the number of actual deaths is understandably far higher than the number of "Expected " and consequently the s are far higher than 100. The term "Expected " is used in the HSE tables. It is a misleading term for all it shows is the numbers of mesothelioma deaths that can be "Expected" in each profession based purely on a mathematical calculation of proportions. What it does not show is the number of deaths one would expect in each profession based on the assumed risk from asbestos exposure. One would presume that a teacher should suffer little or no asbestos exposure, and hence the number of deaths that one would expect should be in line with people who have had no exposure or only background levels of exposure. The HSE mesothelioma statistics have a section entitled "Interpretative issues which describes a hypothetical scenario where a group of females with zero exposure to asbestos would record a of approximately As well as comparing the incidence of mesothelioma between occupations it is therefore equally relevant to compare the actual with the background. School teachers s significantly greater than background levels. From 1980 to 2005 the for female school teachers was 92 20, which is just under the average for all occupations. This shows that there has been a significant level of asbestos exposure among female school teachers, for the would be considerably lower at 36 if there was no exposure or it was at purely background levels. The number of deaths is more than two and a half times higher than one should expect in an occupation where the asbestos fibre levels should be no more than that of normal background levels. Male teachers' deaths also significantly exceed the number that one should expect in a profession with little or no asbestos exposure. The same interpretative issues give a of 6 for men with a hypothetical zero exposure. (This figure is less than that of females purely because the total number of male mesothelioma deaths is far greater than that of females, and the number of background cases represents a smaller proportion of the whole.) 21 Between the of male teachers in higher education was 100 and for male school teachers was When one considers that these s are formulated from a comparison with other occupations, including high risk ones such as asbestos stripping, boiler lagging and the building maintenance trades, one can see that male teachers' deaths in higher and further education is 17 times higher than they would have been if there had been purely background exposure and the male school teachers deaths are 10 times greater. It can therefore be concluded that male teachers' deaths from mesothelioma far exceed the number that one would expect from an occupation where there should be minimal or no asbestos exposure. 19 HSE Mesothelioma occupation statistics male and female deaths aged page 5 interpretative issues 20 HSE Mesothelioma occupational statistics Table 2 and 6.. HSE Mesothelioma mortality in Great Britain: Analyses by Geographical area and occupation 2005 Tables 11 ( ) 21 HSE Mesothelioma occupation statistics male and female deaths aged page 5 interpretative issues 22 HSE Mesothelioma occupational statistics Table 1 HSE Mesothelioma mortality in Great Britain: Analyses by Geographical area and occupation 2005 Table 13 ( )

7 FEMALES: aged Occupation description Minor or unit group code 95% Confidence interval Observed deaths Expected deaths Lower Upper Higher education teaching professionals Further education teaching professionals Education officers, school inspectors Secondary education teaching professionals Primary and nursery education teaching professionals Special needs education teaching professionals Senior professionals of educational establishments Teaching and other educational professionals not elsewhere classified Teaching professionals School secretaries Nursery nurses and assistants Childminders and related occupations Playworkers Educational assistants Childcare and related personal services School midday assistants Comparison Medical practitioners Nurses Although the for female nurses increased to 79.1 between 2003 and 2012 it is relevant that the for female primary teachers increased to Statistically the is significant as it is considerably greater than the of 100 which is the average for all occupations and the lower confidence interval is also above HSE Table 2: Male and female mesothelioma deaths aged for selected occupations in the education and health sectors FOI Freedom of Information Request Reference No: 20142

8 FEMALES aged Code & Occupation description Expected 95% Confidence interval SOC Lower 95% Confidence interval SOC Upper Education Sector Higher education teaching professionals Further education teaching professionals Education officers, school inspectors Secondary education teaching professionals Primary & nursery education teaching professionals Special needs education teaching professionals Registrars & senior administrators of educational establishments Teaching professionals n.e.c School secretaries Nursery nurses Childminders & related occupations Playgroup leaders/assistants Educational assistants Comparison Nurses Cleaners, domestics (not just schools) The for primary school teachers is with a relatively close confidence interval and is therefore significant. The of further education teachers, school secretaries, and nursery nurses are also all high which tends to show an above average asbestos exposure. However the statistics for the latter groups should be treated with caution as there are relatively few deaths and wide confidence intervals. 24

9 FEMALES aged Code Occupation Total Total Expected Average (exclude 1981) exclude SOC code No SOC Code No Teachers Higher Education School Teachers Nursery Nurses soc 6124 Education Assistants 4213 School Secretaries soc Nurses Caterers Cooks Kitchen porters 44 Retailers Dealers 53 Office workers cashiers HSE Mesothelioma Occupation statistics and

10 MALES aged Code & Occupation description Expected 95% Confidence interval SOC Lower 95% Confidence interval SOC Upper Higher education teaching professionals Further education teaching professionals Education officers, school inspectors Secondary education teaching professionals Primary & nursery education teaching professionals Special needs education teaching professionals Registrars & senior administrators of educational establishments Teaching professionals n.e.c Educational assistants Caretakers (Not just school) Comparison Medical practitioners Solicitors & lawyers, judges & coroners Farmers Horticultural trades Gardeners & groundsmen/groundswomen Agricultural & fishing trades n.e.c Farm workers Forestry workers

11 MALES aged Code Occupation Total Total Expected Average (exclude 1981) exclude SOC SOC Teachers Higher Education School Teachers (nec) Lawyers Government Administrator s Doctors Clergy Nurses Police Farmer Farm manager workers HSE Mesothelioma Occupation statistics and

12 Code Occupation Total Death s Total Expecte d Average (exclude 1981) exclude SOC code SOC code Forester Fishing Agricultural Fishing trades nec 42 Butchers Bakers Food Processors 59 Cooks Kitchen 5434 Porters 133 Motor Mechanic Bus Coach Drivers 185 Bus Conductors 53 Office workers cashiers Michael Lees 5 th January 2011 Updated 28 th August