Cause-specific mortality in the Belgian cleaning industry (1991-2011)

Laura Van den Borre, Vrije Universiteit Brussel
Patrick Deboosere, Vrije Universiteit Brussel

BACKGROUND Cleaning improves hygiene and controls diseases. Paradoxically, cleaners may experience a number of work-related health hazards, including exposure to various chemicals, difficult physical working conditions and psychosocial risk factors. Mortality research is scarce for cleaning personnel. AIM Cause-specific mortality among specific groups of cleaners is assessed to identify potential health improvement opportunities in this growing industry. METHOD The total working population (30-60 years) in Belgium is selected from an anonymous record linkage between the 1991 Belgian Census, the Population register (1991-2011) and death-certificate data (1991-1997/2001-2011). Approximately 3% of working men (48,290 out of 1,562,551) and 10% of working women (96,777 out of 953,443) are active in the cleaning industry at the time of the census. 171,529 and 50,085 deaths are analysed separately for men and women using multivariate Cox proportional hazards regression models. Covariates include age, region, Belgian nationality, educational level, part-time employment and manual labour. RESULTS Cleaners experience significantly higher all-cause mortality compared to the total working population. Results also show significantly higher mortality due to respiratory malignancies and diseases. The comparison with a relatively risk-free occupation, e.g. secondary school teachers, is striking as cleaners experience 40% more deaths due to respiratory cancers (men HR 1.4; CL 1.2-1.6; women HR 1.4; CL 1.1-1.7). Male cleaners have an HR 1.7 (CL 1.4-2.0) for respiratory diseases whereas female cleaners have an HR of 1.4 (CL 1.0-1.9). Elevated respiratory mortality is found in all examined types of cleaners. CONCLUSION Results demonstrate the adverse health effects of professional cleaning on population level. Recently, chronic respiratory symptoms and carcinogenic effects have been associated with exposure to cleaning products. Further research efforts should investigate causal pathways, including possible selection effects and co-exposures, as well as temporal changes in working conditions.