Time-related aspects of the healthy worker survivor effect
Abstract
Health is important for continued employment and therefore continued accrual of occupational exposure; furthermore, steady employment can benefit health. Consequently, bias can occur in estimates of cumulative exposure-mortality associations. This has been called the healthy worker survivor effect (HWSE). The processes associated with the HWSE tend to lead to variation in mortality rates with time-since-termination of employment, most notably a peak in mortality shortly after termination of employment. We use simulations and an empirical example to demonstrate that time-since-termination can be a confounding factor in analyses of occupational-exposure-mortality associations. Simulation data were generated for 20,000 workers followed for 40 years under a model of no effect of employment duration (a proxy for cumulative exposure) on mortality. Proportional hazards regression methods were used to quantify exposure-mortality associations and evaluate methods to control for the HWSE. Results were derived after 100 iterations of the simulation. Relationships between employment duration and mortality were also investigated in a cohort of 122,247 male utility workers with adjustments for time since termination. Simulation data show a p...Continue Reading
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Quantification of the healthy worker effect: a nationwide cohort study among electricians in Denmark
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