Health risks in the cleaning industry: a Belgian census-linked mortality study (1991-2011).
Cleaning work has been associated with a wide range of occupational health hazards. However, little is known about mortality risks in the cleaning industry. This study examines differences in cause-specific mortality between cleaners, manual and non-manual workers. Using exhaustive census-linked mortality data, the total Belgian working population aged 30-60 was selected from the 1991 census. Analyses were based on 202,339 male and 58,592 female deaths between 1 March 1991 and 31 December 2011. Standardized Mortality Ratios were calculated and indirectly adjusted for smoking (SMR). In addition, Cox proportional hazards regression models were used to account for age, educational level, part-time employment and marital status. Large mortality differences were observed between cleaners, manual and non-manual workers. In 2001-2011, smoking-adjusted SMRs for all-cause mortality were higher among cleaners than among non-manual workers (Men 1.25 CI 1.22-1.28; women 1.10 CI 1.07-1.13). SMRs also show cleaners had significantly more deaths due to COPD (men 2.13 CI 1.92-2.37; women 2.03 CI 1.77-2.31); lung cancer (men 1.31 CI 1.22-1.39; women 1.21 CI 1.11-1.32); pneumonia (men 1.64 CI 1.35-1.97; women 1.31 CI 1.00-1.68); ischaemic heart diseases (men 1.22 CI 1.13-1.31; women 1.40 CI 1.25-1.57) and cerebrovascular diseases (men 1.19 CI 1.05-1.35; women 1.13 CI 1.00-1.27). Mortality risks among cleaners remained elevated after adjustment for education. Respiratory and cardiovascular mortality is considerably higher for male and female cleaners than for non-manual workers.