| PATTERNS
OF ILL-HEALTH IN IRISH CONSTRUCTION WORKERS |
|
|
|
|
| FOREWORD |
As
Chairman of the Board of Trustees of the Construction Workers
Health Trust, I take particular pleasure in the publication
of this report. This is the first time that research of this
kind has been undertaken in relation to the health of construction
workers in Ireland. Two of the primary objectives, formulated
when the Trust was established in 1995, are to promote research
into the causes of illness and injury in the construction
industry and to promote preventative medicine among construction
workers. While we have been providing on-site health promotion
activities for a number of years, we had little knowledge
of the nature and extent of illness and injury resulting in
sickness absence and in permanent disability giving rise to
early retirement from the industry. |
 |
Michael
Brennan
Chairman, Board of Trustees
Construction Workers Health Trust |
Records
of the Construction Federation Operatives Pension and Sick
Pay Scheme have been kept for many years, and based on these,
the research by our Medical Director and Trust Secretary has
resulted in this report; not only does it reveal patterns
of illness and injury in the industry, it will also form a
basis for rational development of our health promotion activities,
both in line with the objectives of the Trust. |
Many
people were involved in this work, and their input is acknowledged
in the report. The Trustees are grateful for part funding
of the research in the form of a grant from the European Union. |
Finally, I am pleased that the findings in this report were
presented in Vienna at the recent International Symposium,
Safety and Health in the Construction Industry in the 21st
Century. |
Patterns
of Ill-Health in Irish Construction Workers |
This
report on patterns of ill-health in the Irish construction
industry is based on research undertaken by the Construction
Workers Health Trust by agreement with the Trustees of the
Construction Federation Operatives Pension and Sick Pay Scheme.
The authors of the report are:
Harold Brenner, M.B., FFPHMI., Medical Director, CWHT.
William Ahern, MIOSH, M.A., Trust Secretary, CWHT. (d,ecd
2003) |
| SUMMARY |
|
Absence
from work due to illness or injury is costly both in terms
of the health and well-being of individual workers and in
terms of industrial production. However, in the Irish construction
industry, patterns of illness and injury resulting in sick
leave, and of permanent disabilities leading to early retirement
on health grounds, are not known. The objectives of the research
were to establish these patterns, and to develop a database
to provide information which will contribute to policy formation
for health promotion in the industry. The population base
for the study comprised construction workers who were members
of the Construction Federation Operatives Pension and Sick
Pay Scheme. Over 29,000 records of absences of more than three
days duration in the 16 year period from 1981 to 1996 were
examined; medical records were available relating to these
absences from 1984. Information on early retirements in the
32 year period from 1965 to 1996 was available; over 3,000
early retirements on health grounds were identified and examined.
There was an annual average of 7.8 absences per 100 workers
due to injury or illness, the mean length of absence being
23.5 working days. The mean length of absence was longer,
and the rate of absence higher, among older workers. The reasons
for absence, based on medical certificates, were grouped into
broad diagnostic categories; injuries (30 per cent), infectious
disease (25 per cent) and musculoskeletal disorders (13 per
cent) together constituted twothirds
of the diagnoses. Over the period of the study there was an
annual average of 5.3 early retirement per 1,000 workers on
health grounds. Seventeen per cent of these retirements occurred
under the age of 50 years, accounting for 45 per cent of the
total potential years lost. The most frequent permanent disabilities
leading to early retirement were identified as cardiovascular
disease, chronic obstructive airway disease and musculoskeletal
disorders. The patterns of illness and injury established
in the study will provide information for the further development
of on-site health promotion activities in the Irish construction
industry by the Construction Workers Health Trust. |
| OBJECTIVES |
| The
objectives of the research were: |
|
|
To
establish a detailed pattern of the nature and extent
of illnesses and injuries among construction workers
in Ireland which cause temporary absence from work,
and to identify diseases and disabilities which lead
to premature retirement from the industry on health
grounds. |
|
To
establish an information base which, together with lifestyle
and other parameters of health obtained in surveys and
screening programmes, will provide the rationale for
a health promotion strategy for the industry. |
|
| BACKGROUND |
Absence
from work due to illness or injury is costly both in terms
of health and well-being of individual workers and in terms
of industrial production. |
The
spectrum of health disorders among industrial workers which
result in absence from work is well documented. However, patterns
of illness and injury giving rise to sick leave or early retirement
on grounds of ill health in Irish industry, as a whole or
in specific industries, are not known. |
Studies
in several countries reveal that construction workers have
a greater risk than that found in the general population and
in workers in other industries of developing certain health
disorders. Available information suggests that the morbidity
and mortality associated with many of these disorders are
preventable. Health and Safety at Work legislation in Ireland,
together with voluntary codes of practice introduced by the
Health and Safety Authority, can
reduce occupational hazards to health. However, effective
health promotion is a crucial element of the complex set of
events which can lead to modification of lifestyle, particularly
in relation to diet, smoking and exercise, which are risk
factors in the development of heart disease and many cancers.
Although construction workers are exposed to health promotion
initiatives directed at the general population, these need
to be complemented and reinforced
with a health promotion programme in the workplace setting. |
The
workplace as an important setting for health promotion is
recognised in the Ottawa Charter (World Health Organization
1986) and more recently in the Jakarta Declaration (World
Health Organization 1998:i). Health promotion is actively
under further development in Ireland; consistent with Target
6 of Health for all in the twenty-first century (World Health
Organisation 1998:ii), which identifies participation in the
workplace as part of a strategy to strengthen health-enhancing
lifestyles, a report on health promotion in the workplace
has been published (Department of Health 1999) and a major
conference (Better health at work - a Partnership |
Approach)
was held in Dublin in January 1999. The Construction Workers
Health Trust, a body established by the Irish Construction
Group of Unions to promote better health and lifestyles among
construction workers, is currently engaged in on-site health
promotion programmes, implemented by arrangements with the
Irish Cancer Society and the Irish Heart Foundation. The results
of this research project will be used to develop more strategically
focused health promotion modules for the construction industry. |
| |
|
| REVIEW
OF THE LITERATURE |
In
the US, specific illnesses and injuries were assessed according
to their contribution to absenteeism (Leigh 1989). Contributing
most to absenteeism were back injuries, broken bones, influenza,
upper respiratory tract infections and arthritis. The same
author (Leigh 1998) ranked occupations according to their
contribution to specific diseases; it was found that unskilled
construction labourers ranked consistently high in most lists
of specific diseases. |
The
health status of workers aged 40 to 64 years in the German
construction industry has been described (Arndt et al 1996).
In addition to examination of the skin and musculoskeletal
system, measures included hearing loss, forced expiratory
volume, blood pressure, electrocardiogram, body mass index,
cholesterol level and liver tests. Compared with white-collar
workers, the construction workers had higher prevalences of
hearing deficiencies, high body mass index, musculoskeletal
abnormalities, and signs of chronic lung disease. In a related
study (Rothenbacher et al. 1997) , eight per cent of German
construction workers aged 40 to 64 were found to have chronic
respiratory disease, tatistically significantly higher than
the percentage among white-collar employees. |
A
review (Coenraads and Nater 1984) of sickness and absence
from work in the construction industry due to skin diseases
revealed that occupational dermatoses are the most important
causes. The authors also noted that workers, despite quite
extensive skin problems, sometimes continue to work without
consulting a physician. |
A
review of alcoholism and occupations in the US (Mandell et
al 1992) showed a high prevalence of alcohol dependence and
abuse in two industries, construction and transportation.
It was found that more than one in four construction labourers
and one in five skilled construction trades workers had a
diagnosis related to alcohol abuse. |
Levels
of sickness absence in the UK were estimated, based on labour
force surveys from 1987 to 1991 (Office of Population Censuses
and Surveys 1995). In the construction industry, levels of
sickness absence were very high (over six per cent reporting
absence in the previous week, the highest of all individual
industries), there was a relatively high proportion of long
term sickness, and a high percentage of workers reporting
work limiting conditions such as musculoskeletal disorders,
respiratory disease and cardiovascular disorders. It was noted
that workers in the construction industry are known to have
unhealthy lifestyles, for example the prevalence of smoking
and drinking to excess are very high compared to other occupations;
this, along with the physically demanding nature of the work,
may be partly responsible for the high figures for long term
sickness. The same publication reported a labour force survey
carried out in the UK in 1990 recording self-reported work-related
illnesses over the previous years. The construction industry
had the second highest relative risk of work-related illnesses
(second only to the coal mining industry). Significantly raised
relative risks for lower respiratory disorders, back disorders
and trauma were found in the construction industry. Interestingly,
in nearly one half of the cases reported, the individuals
took no sickness absence on account of their work-related
illness. |
It
is well recognised that the pattern of mortality among construction
workers compares unfavourably with that in other occupations
and in the general population. In England and Wales (Office
of Population Censuses and Surveys 1995) increased proportionate
mortality ratios for several types of cancer, asbestos-related
diseases, respiratory and related problems, fatal injuries
from falls or accidents with machinery and drug dependence
were found in construction workers. |
An
analysis of occupation and industry codes on death certificates
was used to assess mortality in the construction industry
in the US (Robinson et al 1995). White male construction
workers were found to be more prone to cancer, asbestos-related
diseases, mental disorders, alcohol-related disease, digestive
disorders and traumatic fatalities. This large study also
confirmed the excess risk of specific cancers in various skilled
construction trades. It concluded that the large numbers of
excess deaths from cancer and other diseases in construction
workers observed in the study indicate the need for preventive
programmes for construction workers. |
In
another report from the US (Ringen et al. 1995), the disproportionate
share of occupational fatalities and injuries in the construction
industry is described. The authors believe that nearly all
the injuries and deaths are preventable; in relation to occupational
health in general, they advocate adequate health care delivery
systems, improved preventive medicine, disability
determination and rehabilitation programmes, and appropriate
research. |
Data
are available from the Central Statistics Office for the number
of days lost each year in the building and construction industry,
but this information is limited to occupational injury and
occupational disease. No information relating to causes of
all absences from work, or to early retirement on grounds
of ill-health in Ireland, for the work force as a whole or
for any specific industry, was found in the literature. |
| |
|
| METHODOLOGY |
The
data relating to absences from work due to illness in the
industry since 1981 is stored on computer disks; these were
created from progressively up-dated computer systems operated
by the Construction Federation Sick Pay cheme. Pertinent data
was extracted from these disks and transferred to a modern
database in a format amenable to analysis. Medical diagnoses,
available from medical certificates since 1984, had been entered
into the computer records in textual form. A computer programme
was devised to numerically code the diagnoses from text. The
data in relation to early retirement are stored on microfiche
copies of the original files. Data was extracted manually
from these and entered into a database. |
The
data contained in over 28,500 records of absences from work
and over 3,000 records of early retirement were reviewed.
Data which could not be validated were excluded from the analysis.
The data was analysed using Epi Info (version 6). |
| |
|
| RESULTS |
The
results of the survey are presented in two parts, the analysis
of absences from work
between January 1981 and August 1996, and the analysis of
premature retirements from the
construction industry on grounds of ill-health in the period
January 1972 (the first year in which
they were identifiable) to June 1996. |
Absences
from work |
Population
base
The population base for the study of absences from work consists
of construction workers who were members of the Construction
Federation Operatives Pension and Sick Pay Scheme, and thus
eligible to receive benefits, between January 1981 and August
1996. The number of eligible workers for each year is shown
in Figure 1. The workers are aged 18 to 64 years; a very large
majority is male. The figures between 1985 and 1993 reflect
a period of recession in the construction industry in Ireland;
since 1994 there has been a sustained recovery in the industry. |
|
The
age distribution of the study population for each year was
virtually the same. The overall age distribution is shown
in Table 1. |
|
Absences
An absence from work due to illness was recognised by the
Sick Pay Scheme if it entailed more than three working days.
There were 28,792 such absences recorded over the 16 year
period. Figure 2 shows these as percentages of the population
of workers for each year; the rate for 1996 was calculated
on an extrapolation for the year of the number of absences
in the first eight months. The annual average was 7.8 absences
per 100 workers. |
|
Figure
3 shows the rates standardised for age (1987 being the standard
population). Since the age distributions of the years are
remarkably similar, the standardised rates are virtually the
same as the crude rates and reveal a similar pattern. |
|
|
|
Age
at time of absence
The mean age at time of absence was 38.7 years; the median age
was 37 years. Table 2 shows the number of absences in 10 year
age groups and the age-specific rates of absence, based on the
cumulative population of the groups over the period of the study.
Overall, 78 per cent of absences were among younger workers
(age below 50) and 22 per cent among older workers (age 50 to
64). However the rate of absence rises with age. |
|
Length
of absence
For each absence the records indicated both the number of
days for which sick-pay was given and the actual length of
absence from work. From the latter, a formula was used to
calculate the number of working days involved in each absence;
this number of working days will be used as the length of
absence for the purposes of the analysis. |
Overall
the mean length of absence was 23.5 days; the median length
was 17 days. The annual trend in mean length of absence is
shown in Figure 4. The mean for 1996 is from data of the first
eight months of the year. Interestingly, there is a strong,
but spurious, inverse correlation (Pearson r2 = .81) between
the mean length of absence and the size of the population. |
|
| The
mean length of absence increased with age, as shown in Figure
5. |
|
Regional
variations in the mean length of absence and mean age at absence,
for counties with more than 350 absences over the 16 year
period, are shown in Table 3. The mean length of absence varied
from 20.8 to 25.9 days; the mean age varied from 37.7 to 40.1
years. |
|
Over
the 16 year period of the study, the number of days of absence
totaled 677,440 days, an annual mean of 42,340 days. |
| |
|
Medical
certificates (only on file since 1984) were available for
analysis in 15,682 of the absences analysed above. In the
balance of cases, no certificate was on file, no specific
diagnosis was given on the certificate, or the diagnosis was
illegible. Table 4 illustrates the main diagnostic categories
of the illnesses described in the medical certificates, grouped
by age at the time of absence. |
|
Injury
is the most frequent reason for absence from work in the period
under study, comprising 30 per cent of all reasons. Table
5 shows the categories of injury reported. Information was
present in an insufficient number of cases to report on the
proportion of injuries that were work-related. Injuries to
the limbs and back predominated. |
|
Infectious
disease, 25 per cent of cases, comprise the second
commonest reason for absence. Table 6 shows the main types
of infection reported. Respiratory infections, particularly
influenza, were commonest. |
|
| Musculoskeletal
disorders account for 13 per cent of absences. These
are shown in Table 7. Back pains and aches were most common,
followed by arthritis. |
|
Chronic
respiratory disorders are reported as reasons for
absence in 685 cases, accounting for 4.4 per cent of all absences.
These were variously described in reports as chronic bronchitis,
bronchitis and emphysema, obstructive airway disease and asthma;
for the purposes of analysis they are grouped as bronchitis,
emphysema and asthma. |
| |
|
Cardiovascular
disease accounts for 3.6 per cent of absences. Details
are shown in Table 8. Hypertension was the commonest cause
of absence in this category followed by acute myocardial infarction. |
|
Gastrointestinal
disorders account for 3.7 per cent of absences. These
are analysed in Table 9. By far the commonest gastrointestinal
disorder causing absence was gastric or duodenal ulcer. |
|
Mental
disorders were reported in 1.8 per cent of absences.
These are analysed in Table 10. Depression was the commonest
disorder followed by anxiety neurosis. |
|
Stress,
stress-related illness or nervous tension were reported as
the reason for absence in 26 cases; these are included in
the other category in Table 4. |
| |
|
Neurological
diseases were reported in 127 cases as shown in Table
11. Vertigo was the commonest cause of absence in this group. |
|
Cancer
was the diagnosis reported in 16 cases. The types of cancer,
with ages at time of absence, are shown in Table 12. |
|
| Surgical
procedures accounted for 651 absences from work, four
per cent of all reasons for absence. Table 13 categorises the
operative sites by age at time of the absence for surgery. The
commonest, 20 per cent of operative sites, was for inguinal
hernia. |
|
| Other
reasons for absence totaled 1858. These are shown in
Table 14. |
|
The
number of working days lost in relation to each of the main
diagnostic categories was examined. Table 15 shows the total
and mean days lost for each category. By far, the greatest
number of working days lost was because of injury, twice as
many as for infectious disease, the cause of the next highest
number of days lost. Although cardiovascular disease was only
fourth highest in terms of total number of days lost, it ranked
highest in mean days lost; cancer was ranked second in mean
days lost despite the comparatively low total number of days
lost. |
|
| |
|
Retirement
from the construction industry on grounds of ill-health.
|
Early
retirement records from January 1965 to June 1996 were examined;
however, prior to 1972 it was not possible to identify those
early retirements which were based on health grounds. Records
of 3,098 workers retiring on these grounds were analysed. The
number and rate of retirements granted on grounds of ill-health
in each year of the period of the study is shown in Table 16.
The rates are comparable since the age structure of the population
remains
essentially similar from year to year. |
|
Table
17 shows the age of workers at the time of being granted early
retirement. As would be expected, the majority of early retirements
occurred in the later years of working life, with 43 per cent
in workers aged 60 and over. The mean retirement age was 56.2
years, the median age being 58 years. The age at which the
greatest number of retirements took place was 63 years. |
|
Early
retirement on grounds of ill-health from the industry is based
on certification of permanent disability. Categories of medical
diagnoses on the certificates are shown in Table 18. Cardiovascular
disease and musculoskeletal isorders, in almost equal numbers,
accounted for 61 per cent of the certified disabilities. |
|
| |
|
| The
larger diagnostic categories in Table 18 were further analysed
as shown in the following tables. |
|
Coronary
heart disease and stroke together accounted for 71 per cent
of the diagnoses in this category. |
|
Cancer
of the lung and larynx accounted for nearly one third of the
diagnoses of cancers leading to early retirement. |
|
| The
commonest diagnosis in the musculoskeletal category was osteoarthritis
(45 per cent) with disc lesions accounting for 20 per cent. |
|
Gastric
and duodenal ulcers accounted for well over one half of the
diagnoses in the gastrointestinal group of disorders. |
|
|
|
Injuries
to the limbs and back together formed a third of the injuries
which led to permanent disability and subsequent early retirement. |
| |
|
Except
in 27 cases, occupations of the 3,098 construction workers
who were granted early retirement on grounds of ill health
were established. The occupation categories are summarised
in Table 26. |
|
Table
27 shows the number of persons in selected occupational groups
retiring on grounds of the four commonest diagnostic categories
- cardiovascular disease, injury, lung disease and musculoskeletal
disorders. Percentages are of all the retirements due to the
particular diagnostic category. Because of their higher numbers
within the industry, general operatives, carpenters and drivers
constitute the majority of those retiring on grounds of the
conditions shown. No assumptions can be made from the data
in this Table about specific occupational risks. |
|
Table
28 shows the percentage distribution of three selected disorders
among the occupational categories. Of those retiring with
a psychiatric disorder, 43 per cent were general operatives
and 24 per cent were carpenters. Just over one half of those
retiring with chronic vertebral disc lesions were general
operatives with carpenters and drivers together accounting
for 27 per cent. Of those retiring with arthritis of one form
or another, 54 per cent were general operatives and 12 per
cent were carpenters. Again, no assumptions can be made from
this data about
specific occupational risks. |
| |
|
