High mortality in manual occupations and the role of alcohol in 2001-15.

Background: The aim was to identify specific manual occupations with high mortality and to examine whether there are differences in the role of alcohol in explaining the excess mortality among manual occupations with high all-cause mortality.

Methods: A register-based study of employees aged 30-64 years, followed for mortality 2001-15. Age standardized mortality ratios (SMRs) were calculated to compare the mortality rates of manual occupations. The contribution of alcohol-related mortality to excess mortality was obtained by comparing the excess mortality in all deaths and deaths not related to alcohol.

Results: Men had 31 and women 11 manual occupations with SMR statistically significantly over 120 compared with all employees. Mortality rates were highest among building construction labourers (SMR 180) among men and building caretakers (SMR 155) among women. With few exceptions, high mortality was a combination of high alcohol-related and high non-alcohol-related mortality. Among men, the contribution of alcohol-related mortality to the excess all-cause mortality compared with all employees was over 10% in half of the high-mortality occupations. The contribution was highest among welders and flame cutters (50%) and lowest among farmer's locums (-50%). Among women the contribution was highest among building caretakers (15%).

Conclusions: High-mortality occupations had high mortality even without alcohol-related deaths. However, alcohol-related mortality was generally higher than mortality for other causes; therefore, alcohol-related mortality increased further the excess mortality. Diminishing the alcohol-related mortality would level excess mortality of these occupations but not eliminate it.