Using alternative comparison populations to assess occupation-related mortality risk. Results for the high nickel alloys workers cohort

The focus of this article is to examine how the choice of comparison group affects the identification and interpretation of cause-specific health risks in occupational cohorts when different external control populations are used. The mortality experience of approximately 31,000 high nickel alloys workers is compared with the total US population and to local populations in geographic proximity to the plants. Generally, the patterns of relative risks derived for the total cohort and various subgroups are similar across the different comparison populations. Estimated elevated risks are usually lower when cohort mortality is compared with that of local populations. An overall significant 13% risk for lung cancer is noted when compared with that of the total US population. However, no significant excess is identified when local populations are used. Subset analysis identified significant excesses of colon cancer among nonwhite males (50%-150%) and kidney cancer among white male workers employed in melting (approximately 100%), irrespective of the comparison population.