Avoidable mortality for causes amenable to medical care, by occupation in Canada, 1991-2001.

Mustard, Cameron A. ; Bielecky, Amber ; Etches, Jacob 等

The specific contribution of health care in reducing socioeconomic health inequalities continues to be an important policy focus in the funding, organization and delivery of health care in Canada. Arising from this policy focus, the monitoring of socio-economic equity in access to health services and the quality of health services is an important research priority. (1-5)

The concept of avoidable mortality has been applied in mortality surveillance studies to identify geographic or temporal differences in cause-specific mortality which is amenable to primary or secondary prevention. (2,6-13) When the definition of avoidable mortality is restricted to those causes of death which can be prevented by timely access to medical care, approximately 30% of population mortality is defined as avoidable and this proportion is higher in working-age adults. (13)

Relatively few studies have reported on socio-economic differences in avoidable mortality. A recent report examined changes in avoidable mortality in urban Canada over the 25-year period 1971-1996 following the introduction of universal health insurance for medically necessary services. (2) For deaths before age 75, differences between the richest and poorest 20% of the urban population in age-standardized expected years of life lost due to deaths amenable to medical care decreased 60% for men and 78% for women. The decrease in income-related disparities due to non-amenable causes was much smaller (15% for men and 9% for women).

The surveillance and monitoring of population health trends in most countries includes the use of large, nationally-representative population-based cohort studies of mortality, usually formed by linking records for national census respondents to vital statistics death registrations. (14-18) Until recently, no nationally-representative census-based cohort had been established in Canada. To address this limitation, Statistics Canada, the Institute for Work & Health and the Direction de la Sante Publique de Montreal-Centre collaborated in the creation of a database (the 1991-2001 Canadian census mortality follow-up study) linking a 15% sample of 1991 census respondents to the Canadian Mortality Data Base. (1)

The objective of this study was to examine differences in the incidence of avoidable mortality for causes amenable to medical care among occupationally-active adults in Canada aged 30-69 by occupation and skill level as well as for persons who were not occupationally active. Occupation and skill level were used to estimate socio-economic differences in mortality amenable to medical care.

METHODS

Study design

The study is based on a cohort consisting of a 15% sample of the non-institutionalized population of Canada aged 25 years and over at the time of cohort inception in 1991 who were followed for mortality until the end of 2001.

Study population and study sample

The Canadian census mortality follow-up study was designed to be representative of the non-institutional population of Canada in 1991. (1) Cohort members were selected from among the approximately 20% of households who completed the "long-form" census questionnaire in 1991. Records for long-form census respondents were linked to mortality records to ascertain date and cause of death over the follow-up period from June 1, 1991 to December 31, 2001. A description of the record linkage procedure is provided elsewhere. (1) For the specific purpose of this study--reporting on occupational differences in mortality amenable to medical care--the study sample was restricted to individuals aged 30 to 69 at baseline, representing 1,704,100 persons who were occupationally active (929,300 men and 774,800 women), and 397,500 who were not occupationally active (133,100 men and 264,300 women) in the year preceding the census. Occupationally-active individuals were defined as persons who had worked any time in the year prior to the census.

Measures

In this report, we estimate the relationship between avoidable mortality and occupation, where occupation was classified to the 80 minor group categories of the 1980 Standard Occupational Classification and five ordinally-ranked occupational skill categories based on the 1990 National Occupational Classification. (19,20)

Causes of mortality amenable to medical care are those where timely access to medical care may prevent death (Appendix A). (2,6-11,21,22) For persons dying during the study period, the underlying cause of death had been previously coded to the World Health Organization's International Classification of Diseases, Ninth Revision (ICD-9) (23) for deaths occurring in the period 1991 through 1999, and to the Tenth Revision (ICD-10) (24) for deaths occurring in 2000 or 2001. For persons aged 65-69 at the time of cohort inception, any deaths occurring at ages 75 or older were classified as not amenable to medical care.

Statistical analysis

For each member of the cohort, we calculated person-days of follow-up from the beginning of the study (census day--June 4, 1991) to the date of death, emigration (ascertained from the name file and known for 1991 only), or end of the study (December 31, 2001). Person-days of follow-up were then divided by 365. (25) to estimate person-years at risk.

Age-standardized mortality rates were calculated using the direct method, with the 1991 mid-year population estimates used as the standard population. Standardized rate ratios (SRR) were calculated from the age-standardized mortality rates and 95% confidence intervals for the SRRs were estimated. In addition, we calculated simple ratios of the age-standardized avoidable-cause mortality rate to the age-standardized non-avoidable-cause mortality rate to detect differences in the proportion of all deaths due to avoidable causes. Results for occupational groups in which fewer than three deaths were observed over the follow-up period were suppressed as required by data release protocols. We incorporated a covariance adjustment in the calculation of confidence intervals that accounts for the comparison of subgroups nested within the reference population. No adjustment for multiple comparisons was performed in the estimates of confidence intervals. (25)

[FIGURE 1 OMITTED]

The Canadian census mortality follow-up study was approved by the Statistics Canada Policy Committee after consultations with the Statistics Canada Confidentiality and Legislation Committee, the Data Access and Control Services Division, and the Federal Privacy Commissioner. The protocol for this research was reviewed and approved by the Health Sciences I Research Ethics Board of the University of Toronto.

RESULTS

Of the 43,361 deaths observed over the 11-year follow-up among women aged 30-69 at baseline, 37% were attributed to causes amenable to medical care. Of the 82,059 deaths observed among men, 34% were attributed to such causes (Table 1).

Among occupationally-active women, there was a gradient in mortality rates for causes of death amenable to medical care and all other causes relative to the five-level ranking by occupational skill level. For women in professional occupations, the age-standardized mortality rate for causes amenable to medical care and for all other causes was lower than the age-standardized rates observed for all occupationally-active women. For women in unskilled occupations, the age-standardized mortality rate for causes of death amenable to medical care and for all other causes were higher than the age-standardized rates observed for all occupationally-active women. For women across the five occupational skill levels, ratios of mortality rates for causes amenable to medical care to all other cause mortality rates were generally similar: 0.61 for professional occupations, 0.66 for managerial occupations, 0.60 for skilled, technical and supervisory occupations, 0.61 for semi-skilled occupations and 0.58 for unskilled occupations.

Among occupationally-active men, there was a stronger gradient both for causes amenable to medical care and for all other causes relative to the five-level ranking by occupational skill level. For men in professional and managerial occupations, the age-standardized mortality rate for causes amenable to medical care and for all other causes was lower than the age-standardized rates observed for all occupationally-active men. For men in semi-skilled and unskilled occupations, the age-standardized mortality rate for causes amenable to medical care and for all other causes was higher than the age-standardized rates observed for all occupationally-active men. For men across the five occupational skill levels, ratios of mortality rates for causes amenable to medical care to all other cause mortality rates were generally similar: 0.46 for professional occupations, 0.46 for managerial occupations, 0.48 for skilled, technical and supervisory occupations, 0.50 for semi-skilled occupations and 0.49 for unskilled occupations.

Men and women who were not occupationally active at the time of cohort inception had elevated age-standardized mortality rates both for causes amenable to medical care and for all other causes of death.

For occupationally-active women and men classified to the 80 minor group categories of the 1980 Standard Occupational Classification, Figure 1 depicts the correlation of age-standardized mortality rates for causes amenable to medical care compared to all other causes. Details are provided in Appendix B (for women) and Appendix C (for men). (Note that for women, information for 20 occupational categories was suppressed due to data release protocols.) For women, age-standardized all-cause mortality rates ranged from a low of approximately 120 deaths per 100,000 person-years to a high of 540 deaths per 100,000 person-years, while for men, the rates ranged from a low of approximately 450 deaths per 100,000 person-years to a high of 900 deaths per 100,000 person-years. Across the 80 minor groups, for both men and women, there was a generally linear trend in the correlation of mortality for causes amenable to medical care and mortality for all other causes of death. There was no evidence that at higher rates of mortality, a higher proportion of deaths were attributed to causes amenable to medical care.

DISCUSSION

Applying occupation as a measure of socio-economic status, this study found a similar gradient in mortality for causes amenable to medical care and for all other causes of mortality for both men and women in Canada over the period 1991-2001. While the proportion of deaths attributable to causes amenable to medical care was higher for women than for men, for both men and women the ratio of age-standardized mortality rates for causes amenable to medical care relative to all other causes of death was similar across a five-level ranking of occupations by skill level.

Results recently reported by Mackenbach and colleagues investigating socio-economic inequalities in mortality among 22 countries in Europe11 found that mortality due to causes amenable to medical intervention accounted for approximately 6% of the difference in mortality between those with the lowest and those with the highest levels of education. In contrast, smoking-related conditions accounted for 21% of the socio-economic inequality in mortality among men and 6% among women.

A number of recent studies have reported on trends in avoidable mortality. Using the same definitions applied in this study, Wheller and colleagues documented strong reductions in mortality due to causes amenable to medical care among men and women in the United Kingdom over the period 1993-2005. (12) Over this period, the age-standardized mortality rate for deaths due to causes amenable to medical care declined by 43% for men and 38% for women. In contrast, mortality due to all other causes declined by 14% for men and 8% for women. A recent Canadian study applying a definition of mortality amenable to medical care with minor differences to the classification applied in this study, documented a reduction of 47% in deaths at ages less than 65 due to such causes over the period 1975-1999 compared to a reduction of 25% in mortality not amenable to medical care. (13) Nolte and McKee recently described trends in deaths before age 75 classified as amenable to health care for 19 countries over the period 1997-2003. (10) Among men, medically-amenable mortality fell by an average of 17% over this period and deaths due to non-amenable causes fell by an average of 8%. Among women, medically-amenable mortality fell by an average of 14% and deaths due to non-amenable causes fell by an average of 6%.

None of these studies, however, described socio-economic gradients in avoidable mortality. As noted in the introduction, a recent Canadian study reporting on trends in avoidable mortality relative to socio-economic status documented greater reductions in absolute mortality differences for causes of death amenable to medical care than for all other causes of death over a 25-year period. (2) This study complements this earlier work by documenting limited evidence for differences in the proportion of all-cause mortality due to causes amenable to medical care across occupational groups in Canada. This finding may be interpreted to indicate that the Canadian health care system provides access to effective care equitably across socio-economic groups. Alternatively, the higher mortality rate due to causes amenable to medical care for persons in lower socioeconomic positions may indicate that barriers to access are present if the underlying prevalence rates are similar across groups. Further research is required to resolve the implications of these findings.

There are a number of important strengths of the Canada census mortality follow-up study, including a very large sample broadly representative of the non-institutional adult population of Canada in 1991. There are also a number of limitations to acknowledge. Occupation and labour force activity were known only at baseline and the census contained no information on behavioural risk factors. Also, while the shift in 2000 from the use of ICD-9 to ICD-10 for the classification of deaths (26) may have influenced the socioeconomic distribution of certain causes of death, we believe the potential impact of this influence to be small.

In conclusion, this study found a similar occupational gradient in mortality for causes amenable to medical care and for all other causes of mortality for both men and women in Canada over the period 1991-2001. Avoidable mortality is a valuable indicator of population health, providing information on outcomes pertinent to the organization and delivery of health care services.

Appendix A. Causes of death considered amenable to medical care,
showing International Classification of Diseases codes for each
cause according to the 9th and 10th revisions

Cause of Death                            Age    9th Revision

Tuberculosis                              0-74   010-8, 137
Other infections (diphtheria, tetanus,    0-74   032,037,038,045
  septicaemia, poliomyelitis)
Malignant neoplasm of colon and rectum    0-74   153-4
Malignant neoplasm of skin                0-74   173
Malignant neoplasm of the female breast   0-74   174
Malignant neoplasm of cervix uteri        0-74   180
Malignant neoplasm of the body of the     0-44   179,182
  uterus, part unspecified
Malignant neoplasm of testis              0-74   186
Hodgkin's disease                         0-74   201
Leukaemia                                 0-44   204-8
Diseases of the thyroid                   0-74   240-6
Diabetes                                  0-49   250
Epilepsy                                  0-74   345
Chronic rheumatic heart disease           0-74   393-8
Hypertensive disease                      0-74   401-5
Ischaemic heart disease: 50% of deaths    0-74   410-4
Cerebrovascular disease                   0-74   430-8
Influenza                                 0-74   487
Pneumonia                                 0-74   480-6
Peptic ulcer                              0-74   531-3
Appendicitis                              0-74   540-3
Abdominal hernia                          0-74   550-3
Cholelithiasis and cholecystitis          0-74   574-5.1
Nephritis and nephrosis                   0-74   580-9
Benign prostatic hyperplasia              0-74   600
Misadventures to patients during          0-74   E870-6,E878-9
  surgical and medical care
Maternal death                            0-74   630-76
Congenital cardiovascular anomalies       0-74   745-7
Perinatal deaths, all causes              0-74   760-79
  (excl. stillbirths)

Cause of Death                            10th Revision

Tuberculosis                              A15-9,B90
Other infections (diphtheria, tetanus,    A36,A35,A40-1, A80
  septicaemia, poliomyelitis)
Malignant neoplasm of colon and rectum    C18-21
Malignant neoplasm of skin                C44
Malignant neoplasm of the female breast   C50
Malignant neoplasm of cervix uteri        C53
Malignant neoplasm of the body of the     C54,C55
  uterus, part unspecified
Malignant neoplasm of testis              C62
Hodgkin's disease                         C81
Leukaemia                                 C91-5
Diseases of the thyroid                   E00-7
Diabetes                                  E10-4
Epilepsy                                  G40-1
Chronic rheumatic heart disease           I05-9
Hypertensive disease                      I10-3,I15
Ischaemic heart disease: 50% of deaths    I20-5
Cerebrovascular disease                   I60-9
Influenza                                 J10-1
Pneumonia                                 J12-8
Peptic ulcer                              K25-7
Appendicitis                              K35-8
Abdominal hernia                          K40-6
Cholelithiasis and cholecystitis          K80-1
Nephritis and nephrosis                   N00-7,N17-9,N25-7
Benign prostatic hyperplasia              N40
Misadventures to patients during          Y60-9,Y83-4
  surgical and medical care
Maternal death                            O00-99
Congenital cardiovascular anomalies       Q20-8
Perinatal deaths, all causes              P00-96
  (excl. stillbirths)

Source: Ref. 10 (Causes of death exclusive to children aged
0-14 have been excluded)

Appendix B. Mortality for causes amenable to medical care and for all
other causes, by occupation minor group, non-institutionalized women
aged 30 to 69 at cohort inception, Canada 1991-2001

Sorted by occupation minor group codes of the 1980 Standard
Occupational Classification

Occupation Minor Group

                                                           Person-
                                                             years
Code          Label                                        at Risk

111           Govt officials/administrators                 59,415
113/114/115   Other managers/administrators                587,966
117           Management/administration                    282,487
211           Physical sciences                             12,818
213           Life sciences                                 13,345
214/215       Architects/engineers/community planners       24,301
216           Other architecture/engineering                20,356
218           Math/stats/systems analysis/related           55,911
231           Social sciences                               26,886
233           Social work/related                          144,226
234           Law/jurisprudence                             30,793
235           Library/museum/and archival sciences          36,668
239           Other social sciences/related                 16,804
251           Religion                                      14,968
271           University teaching/related                   30,470
273           Elementary-secondary teaching/related        482,096
279           Other teaching/related                       126,872
311           Health diagnosing/treating                    32,287
313           Nursing/therapy/assisting related            623,761
315/316       Other medicine/health                        148,275
331           Fine/commercial art/photography/related       48,807
333           Performing/audio-visual arts                  18,831
335           Writing                                       36,388
336/337       Sports/recreation                             15,971
411           Stenographic/typing                          692,813
413           Bookkeeping/account-recording/related        838,865
414           Office machine/related equip operating       145,601
415           Material recording/scheduling/                85,479
                distributing
416           Library/file/correspondence                   46,283
                clerks/related
417           Reception/information/mail/message dist      268,480
419           Other clerical/related                       425,158
513/514       Sales in commodities                         535,508
517           Sales in services                            121,302
519           Other sales                                   15,824
611           Protective services                           52,498
612           Food-beverage prep/related                   423,093
613           Lodging/Other accommodation                   61,416
614           Personal service                             303,924
616           Apparel/furnishings service                   37,166
619           Other service                                251,616
711           Farmers                                       47,758
718/719       Other farm/horticultural/animal              108,094
                husbandry
731           Fishing/trapping/related                      12,557
751           Forestry/logging                                6469
771           Mining/quarrying incl oil and gas field         1709
811           Mineral ore treating                              --
813/814       Metal processing/related                        3291
815           Clay-glass-stone processing/forming             2875
816/817       Chemicals/petroleum/rubber/plastic/             9806
                related
821/822       Food/beverage/related processing             102,141
823           Wood processing                                   --
                (except pulp/papermaking)
825           Pulp/papermaking/related                        3144
826/827       Textile processing                            16,771
829           Other processing                                3198
831           Metal machining                                 6439
833           Metal shaping/forming                           9408
                (except machining)
835           Wood machining                                  1272
837           Clay-glass-stone-related machining              2100
839           Other machining/related                         2264
851/852       Fabricate/assemble (metal products)           26,421
853           Fabricate/assmbl/install/repair               31,686
                elctr equip
854           Fabricate/assemble/repair                       7707
                (wood products)
855/856       Fabricate/assemble/repair                    189,272
                (txtl/fur/leather)
857           Fabricate/assemble/repair                       9479
                (rubber/plastic)
858           Other mechanics/repairers                       6569
859           Other product fabricate/assemble/repair       22,173
871           Excavating/grading/paving/related               2128
873           Electric power/lighting/wire comm equip         7567
878/879       Other construction trades                     16,453
911           Air transport operating                         2683
913           Railway transport operating                     1174
915           Water transport operating                         --
917           Motor transport operating                     60,634
919           Other transport equipment operating               --
931           Other material handling/related               67,421
951           Printing/related                              30,846
953           Stationary engine/utilities equip oper.         2496
955           Other elctrnc communication equip oper.         2436
959           Other crafts/equipment operating                6119
991/992       Occupations not elsewhere classified          71,110
              All Occupations (Reference Group)          8,104,376

                                                           Mortality
                                                          Amenable to
Occupation Minor Group                                   Medical Care

Code          Label                                     Deaths    ASMR

111           Govt officials/administrators                 47   140.5
113/114/115   Other managers/administrators                476   132.9
117           Management/administration                    204   131.0
211           Physical sciences                              5    33.5
213           Life sciences                                  4    44.3
214/215       Architects/engineers/community planners       13    73.7
216           Other architecture/engineering                14   103.5
218           Math/stats/systems analysis/related           28   105.2
231           Social sciences                               15   136.3
233           Social work/related                          138   137.0
234           Law/jurisprudence                             20   204.7
235           Library/museum/and archival sciences          35   114.6
239           Other social sciences/related                 16   196.8
251           Religion                                      28   120.5
271           University teaching/related                   22    73.8
273           Elementary-secondary teaching/related        387   128.9
279           Other teaching/related                        87    92.9
311           Health diagnosing/treating                    14    63.4
313           Nursing/therapy/assisting related            514   121.5
315/316       Other medicine/health                        100   147.3
331           Fine/commercial art/photography/related       35   113.4
333           Performing/audio-visual arts                  18   139.7
335           Writing                                       25    95.9
336/337       Sports/recreation                             14   154.7
411           Stenographic/typing                          561   116.1
413           Bookkeeping/account-recording/related        771   133.8
414           Office machine/related equip operating       123   145.8
415           Material recording/scheduling/                82   151.8
                distributing
416           Library/file/correspondence                   42   109.8
                clerks/related
417           Reception/information/mail/message dist      302   151.6
419           Other clerical/related                       474   156.4
513/514       Sales in commodities                         610   138.9
517           Sales in services                            104   130.9
519           Other sales                                   11    85.8
611           Protective services                           70   182.1
612           Food-beverage prep/related                   489   158.0
613           Lodging/Other accommodation                   79   136.0
614           Personal service                             296   135.5
616           Apparel/furnishings service                   48   127.7
619           Other service                                335   140.2
711           Farmers                                       81   133.6
718/719       Other farm/horticultural/animal              119   119.3
                husbandry
731           Fishing/trapping/related                      --      --
751           Forestry/logging                              --      --
771           Mining/quarrying incl oil and gas field       --      --
811           Mineral ore treating                          --      --
813/814       Metal processing/related                      --      --
815           Clay-glass-stone processing/forming            4   171.5
816/817       Chemicals/petroleum/rubber/plastic/            6    93.9
                related
821/822       Food/beverage/related processing              95   116.7
823           Wood processing                               --      --
                (except pulp/papermaking)
825           Pulp/papermaking/related                      --      --
826/827       Textile processing                            11    61.9
829           Other processing                              --      --
831           Metal machining                               --      --
833           Metal shaping/forming                         12   148.5
                (except machining)
835           Wood machining                                --      --
837           Clay-glass-stone-related machining            --      --
839           Other machining/related                       --      --
851/852       Fabricate/assemble (metal products)           23   159.0
853           Fabricate/assmbl/install/repair               22    75.4
                elctr equip
854           Fabricate/assemble/repair                      9   107.4
                (wood products)
855/856       Fabricate/assemble/repair                    169    96.6
                (txtl/fur/leather)
857           Fabricate/assemble/repair                      9    93.5
                (rubber/plastic)
858           Other mechanics/repairers                     --      --
859           Other product fabricate/assemble/repair       14    96.1
871           Excavating/grading/paving/related             --      --
873           Electric power/lighting/wire comm equip       --      --
878/879       Other construction trades                     18   170.8
911           Air transport operating                       --      --
913           Railway transport operating                   --      --
915           Water transport operating                     --      --
917           Motor transport operating                     63   133.4
919           Other transport equipment operating           --      --
931           Other material handling/related               76   132.1
951           Printing/related                              19    62.1
953           Stationary engine/utilities equip oper.       --      --
955           Other elctrnc communication equip oper.       --      --
959           Other crafts/equipment operating               8   196.2
991/992       Occupations not elsewhere classified         100   198.5
              All Occupations (Reference Group)           7595   132.3

                                                          Mortality
                                                        Amenable to
Occupation Minor Group                                 Medical Care

                                                                95%
                                                         Confidence
Code          Label                                          Limits

111           Govt officials/administrators              96.2-205.3
113/114/115   Other managers/administrators             118.1-149.5
117           Management/administration                 108.9-157.6
211           Physical sciences                           13.3-83.9
213           Life sciences                              15.4-126.9
214/215       Architects/engineers/community planners    37.8-143.4
216           Other architecture/engineering             55.0-194.5
218           Math/stats/systems analysis/related        63.1-175.4
231           Social sciences                            62.9-295.1
233           Social work/related                       111.2-168.8
234           Law/jurisprudence                         102.6-408.5
235           Library/museum/and archival sciences       78.6-167.2
239           Other social sciences/related              74.2-521.8
251           Religion                                   78.7-184.7
271           University teaching/related                46.7-116.6
273           Elementary-secondary teaching/related     108.0-153.9
279           Other teaching/related                     71.9-120.0
311           Health diagnosing/treating                 34.7-115.9
313           Nursing/therapy/assisting related         107.0-138.0
315/316       Other medicine/health                     110.9-195.8
331           Fine/commercial art/photography/related    77.6-165.7
333           Performing/audio-visual arts               84.8-230.0
335           Writing                                    62.2-147.7
336/337       Sports/recreation                          82.3-290.9
411           Stenographic/typing                       104.8-128.6
413           Bookkeeping/account-recording/related     122.7-145.9
414           Office machine/related equip operating    114.7-185.3
415           Material recording/scheduling/            113.4-203.2
                distributing
416           Library/file/correspondence                77.7-155.2
                clerks/related
417           Reception/information/mail/message dist   132.2-173.8
419           Other clerical/related                    140.0-174.8
513/514       Sales in commodities                      126.8-152.1
517           Sales in services                         103.4-165.9
519           Other sales                                43.2-170.4
611           Protective services                       139.2-238.1
612           Food-beverage prep/related                141.1-176.9
613           Lodging/Other accommodation               106.1-174.3
614           Personal service                          118.8-154.6
616           Apparel/furnishings service                91.8-177.6
619           Other service                             124.2-158.4
711           Farmers                                   107.0-166.8
718/719       Other farm/horticultural/animal            98.9-143.8
                husbandry
731           Fishing/trapping/related                           --
751           Forestry/logging                                   --
771           Mining/quarrying incl oil and gas field            --
811           Mineral ore treating                               --
813/814       Metal processing/related                           --
815           Clay-glass-stone processing/forming        60.2-488.8
816/817       Chemicals/petroleum/rubber/plastic/        39.5-223.2
                related
821/822       Food/beverage/related processing           88.9-153.4
823           Wood processing                                    --
                (except pulp/papermaking)
825           Pulp/papermaking/related                           --
826/827       Textile processing                         33.3-114.9
829           Other processing                                   --
831           Metal machining                                    --
833           Metal shaping/forming                      80.6-273.5
                (except machining)
835           Wood machining                                     --
837           Clay-glass-stone-related machining                 --
839           Other machining/related                            --
851/852       Fabricate/assemble (metal products)        72.3-349.7
853           Fabricate/assmbl/install/repair            47.7-119.2
                elctr equip
854           Fabricate/assemble/repair                  55.4-208.1
                (wood products)
855/856       Fabricate/assemble/repair                  80.7-115.6
                (txtl/fur/leather)
857           Fabricate/assemble/repair                  48.2-181.5
                (rubber/plastic)
858           Other mechanics/repairers                          --
859           Other product fabricate/assemble/repair    44.0-209.8
871           Excavating/grading/paving/related                  --
873           Electric power/lighting/wire comm equip            --
878/879       Other construction trades                  95.6-305.3
911           Air transport operating                            --
913           Railway transport operating                        --
915           Water transport operating                          --
917           Motor transport operating                  93.4-190.6
919           Other transport equipment operating                --
931           Other material handling/related            99.5-175.3
951           Printing/related                            38.8-99.5
953           Stationary engine/utilities equip oper.            --
955           Other elctrnc communication equip oper.            --
959           Other crafts/equipment operating           92.0-418.5
991/992       Occupations not elsewhere classified      154.4-255.2
              All Occupations (Reference Group)         128.7-136.1

                                                       All Other Cause
Occupation Minor Group                                     Mortality

Code          Label                                     Deaths    ASMR

111           Govt officials/administrators                 74   214.3
113/114/115   Other managers/administrators                722   209.1
117           Management/administration                    319   216.9
211           Physical sciences                             11    85.9
213           Life sciences                                 13   325.6
214/215       Architects/engineers/community planners       13   174.8
216           Other architecture/engineering                21   224.1
218           Math/stats/systems analysis/related           44   186.7
231           Social sciences                               28   173.8
233           Social work/related                          219   241.3
234           Law/jurisprudence                             35   233.0
235           Library/museum/and archival sciences          46   168.0
239           Other social sciences/related                 25   324.1
251           Religion                                      36   152.5
271           University teaching/related                   27   135.8
273           Elementary-secondary teaching/related        456   179.8
279           Other teaching/related                       160   225.4
311           Health diagnosing/treating                    28   161.4
313           Nursing/therapy/assisting related            788   190.6
315/316       Other medicine/health                        136   192.0
331           Fine/commercial art/photography/related       62   202.2
333           Performing/audio-visual arts                  24   206.4
335           Writing                                       34   147.8
336/337       Sports/recreation                             16   141.1
411           Stenographic/typing                          926   222.7
413           Bookkeeping/account-recording/related       1151   217.9
414           Office machine/related equip operating       186   246.9
415           Material recording/scheduling/               124   235.3
                distributing
416           Library/file/correspondence                   64   218.1
                clerks/related
417           Reception/information/mail/message dist      474   252.1
419           Other clerical/related                       608   228.5
513/514       Sales in commodities                         850   208.7
517           Sales in services                            168   230.7
519           Other sales                                   18   144.7
611           Protective services                          104   299.7
612           Food-beverage prep/related                   785   266.5
613           Lodging/Other accommodation                  157   318.4
614           Personal service                             442   228.0
616           Apparel/furnishings service                   74   253.2
619           Other service                                514   238.7
711           Farmers                                      112   182.7
718/719       Other farm/horticultural/animal              187   199.2
                husbandry
731           Fishing/trapping/related                      --      --
751           Forestry/logging                              --      --
771           Mining/quarrying incl oil and gas field       --      --
811           Mineral ore treating                          --      --
813/814       Metal processing/related                      --      --
815           Clay-glass-stone processing/forming            5   173.0
816/817       Chemicals/petroleum/rubber/plastic/           14   199.9
                related
821/822       Food/beverage/related processing             153   230.5
823           Wood processing                               --      --
                (except pulp/papermaking)
825           Pulp/papermaking/related                      --      --
826/827       Textile processing                            25   219.5
829           Other processing                              --      --
831           Metal machining                               --      --
833           Metal shaping/forming                         19   385.7
                (except machining)
835           Wood machining                                --      --
837           Clay-glass-stone-related machining            --      --
839           Other machining/related                       --      --
851/852       Fabricate/assemble (metal products)           35   262.2
853           Fabricate/assmbl/install/repair               41   266.1
                elctr equip
854           Fabricate/assemble/repair                     16   228.0
                (wood products)
855/856       Fabricate/assemble/repair                    276   200.8
                (txtl/fur/leather)
857           Fabricate/assemble/repair                     15   186.1
                (rubber/plastic)
858           Other mechanics/repairers                     --      --
859           Other product fabricate/assemble/repair       32   188.5
871           Excavating/grading/paving/related             --      --
873           Electric power/lighting/wire comm equip       --      --
878/879       Other construction trades                     24   368.6
911           Air transport operating                       --      --
913           Railway transport operating                   --      --
915           Water transport operating                     --      --
917           Motor transport operating                     77   211.8
919           Other transport equipment operating           --      --
931           Other material handling/related              118   248.4
951           Printing/related                              59   291.2
953           Stationary engine/utilities equip oper.       --      --
955           Other elctrnc communication equip oper.       --      --
959           Other crafts/equipment operating               9   241.4
991/992       Occupations not elsewhere classified         104   182.2
              All Occupations (Reference Group)         11,404   218.6

                                                        All Other Cause
Occupation Minor Group                                     Mortality

                                                                 95%
                                                          Confidence
Code          Label                                           Limits

111           Govt officials/administrators              155.7-294.9
113/114/115   Other managers/administrators              189.3-230.9
117           Management/administration                  186.4-252.4
211           Physical sciences                           43.5-169.6
213           Life sciences                              162.7-651.4
214/215       Architects/engineers/community planners     76.9-397.6
216           Other architecture/engineering             107.4-467.6
218           Math/stats/systems analysis/related        102.7-339.2
231           Social sciences                            103.0-293.3
233           Social work/related                        202.2-288.1
234           Law/jurisprudence                          137.6-394.7
235           Library/museum/and archival sciences       118.6-238.0
239           Other social sciences/related              167.4-627.6
251           Religion                                   107.1-217.0
271           University teaching/related                 86.7-212.6
273           Elementary-secondary teaching/related      152.8-211.5
279           Other teaching/related                     183.9-276.3
311           Health diagnosing/treating                 103.7-251.1
313           Nursing/therapy/assisting related          171.2-212.1
315/316       Other medicine/health                      147.9-249.2
331           Fine/commercial art/photography/related    149.6-273.1
333           Performing/audio-visual arts               134.6-316.5
335           Writing                                    102.0-214.0
336/337       Sports/recreation                           76.2-261.1
411           Stenographic/typing                        205.1-241.8
413           Bookkeeping/account-recording/related      202.7-234.2
414           Office machine/related equip operating     198.4-307.2
415           Material recording/scheduling/             185.2-298.8
                distributing
416           Library/file/correspondence                161.3-295.0
                clerks/related
417           Reception/information/mail/message dist    225.7-281.6
419           Other clerical/related                     206.4-252.9
513/514       Sales in commodities                       192.9-225.8
517           Sales in services                          191.7-277.6
519           Other sales                                 83.9-249.7
611           Protective services                        240.7-373.1
612           Food-beverage prep/related                 243.2-292.0
613           Lodging/Other accommodation                266.5-380.5
614           Personal service                           203.8-255.2
616           Apparel/furnishings service                191.3-335.2
619           Other service                              215.4-264.4
711           Farmers                                    151.3-220.6
718/719       Other farm/horticultural/animal            171.3-231.7
                husbandry
731           Fishing/trapping/related                            --
751           Forestry/logging                                    --
771           Mining/quarrying incl oil and gas field             --
811           Mineral ore treating                                --
813/814       Metal processing/related                            --
815           Clay-glass-stone processing/forming         70.5-424.4
816/817       Chemicals/petroleum/rubber/plastic/         99.4-402.2
                related
821/822       Food/beverage/related processing           181.8-292.2
823           Wood processing                                     --
                (except pulp/papermaking)
825           Pulp/papermaking/related                            --
826/827       Textile processing                         123.4-390.6
829           Other processing                                    --
831           Metal machining                                     --
833           Metal shaping/forming                      158.5-938.7
                (except machining)
835           Wood machining                                      --
837           Clay-glass-stone-related machining                  --
839           Other machining/related                             --
851/852       Fabricate/assemble (metal products)        135.6-507.1
853           Fabricate/assmbl/install/repair            166.2-426.0
                elctr equip
854           Fabricate/assemble/repair                  127.3-408.3
                (wood products)
855/856       Fabricate/assemble/repair                  170.5-236.5
                (txtl/fur/leather)
857           Fabricate/assemble/repair                  108.8-318.4
                (rubber/plastic)
858           Other mechanics/repairers                           --
859           Other product fabricate/assemble/repair    118.7-299.2
871           Excavating/grading/paving/related                   --
873           Electric power/lighting/wire comm equip             --
878/879       Other construction trades                  219.8-618.2
911           Air transport operating                             --
913           Railway transport operating                         --
915           Water transport operating                           --
917           Motor transport operating                  149.4-300.2
919           Other transport equipment operating                 --
931           Other material handling/related            191.2-322.8
951           Printing/related                           204.0-415.7
953           Stationary engine/utilities equip oper.             --
955           Other elctrnc communication equip oper.             --
959           Other crafts/equipment operating           108.6-536.8
991/992       Occupations not elsewhere classified       143.5-231.5
              All Occupations (Reference Group)          213.6-223.8

The counts of deaths for occupations recording fewer
than three deaths are suppressed.

Appendix C. Mortality for causes amenable to medical care and for
all other causes, by occupation minor group, non-institutionalized
men aged 30 to 69 at cohort inception, Canada 1991-2001

Sorted by occupation minor group codes of the 1980 Standard
Occupational Classification

Occupation Minor Group

                                                          Person-
                                                            years
Code          Label                                       at Risk

111           Govt officials/administrators               113,181
113/114/115   Other managers/administrators             1,214,450
117           Management/administration                   325,769
211           Physical sciences                            48,202
213           Life sciences                                38,201
214/215       Architects/engineers/community planners     239,422
216           Other architecture/engineering              136,642
218           Math/stats/systems analysis/related         124,459
231           Social sciences                              30,872
233           Social work/related                          49,582
234           Law/jurisprudence                            64,796
235           Library/museum/and archival sciences           8728
239           Other social sciences/related                  9938
251           Religion                                     43,191
271           University teaching/related                  62,355
273           Elementary-secondary teaching/related       208,111
279           Other teaching/related                       86,523
311           Health diagnosing/treating                   90,361
313           Nursing/therapy/assisting related            58,046
315/316       Other medicine/health                        52,420
331           Fine/commercial art/photography/related      53,066
333           Performing/audio-visual arts                 34,056
335           Writing                                      32,494
336/337       Sports/recreation                            24,109
411           Stenographic/typing                            7644
413           Bookkeeping/account-recording/related       102,373
414           Office machine/related equip operating       36,924
415           Material recording/scheduling/              189,924
                distributing
416           Library/file/correspondence                    5284
                clerks/related
417           Reception/information/mail/message dist      88,727
419           Other clerical/related                      117,533
513/514       Sales in commodities                        547,136
517           Sales in services                           178,559
519           Other sales                                  26,224
611           Protective services                         302,102
612           Food-beverage prep/related                  151,732
613           Lodging/Other accommodation                  20,076
614           Personal service                             39,240
616           Apparel/furnishings service                  16,345
619           Other service                               236,566
711           Farmers                                     207,987
718/719       Other farm/horticultural/animal             149,957
                husbandry
731           Fishing/trapping/related                     63,807
751           Forestry/logging                            100,163
771           Mining/quarrying incl oil and gas field      87,370
811           Mineral ore treating                         10,135
813/814       Metal processing/related                     57,434
815           Clay-glass-stone processing/forming          14,064
816/817       Chemicals/petroleum/rubber/plastic/          40,311
                related
821/822       Food/beverage/related processing            128,568
823           Wood processing                              47,295
                (except pulp/papermaking)
825           Pulp/papermaking/related                     54,389
826/827       Textile processing                           17,759
829           Other processing                               4176
831           Metal machining                             106,048
833           Metal shaping/forming                       182,699
                (except machining)
835           Wood machining                               12,683
837           Clay-glass-stone-related machining             8706
839           Other machining/related                      16,281
851/852       Fabricate/assemble (metal products)         101,122
853           Fabricate/assmbl/install/repair elctr       127,254
                equip
854           Fabricate/assemble/repair                    45,950
                (wood products)
855/856       Fabricate/assemble/repair                    48,083
                (txtl/fur/leather)
857           Fabricate/assemble/repair                    23,693
                (rubber/plastic)
858           Other mechanics/repairers                   434,224
859           Other product fabricate/assemble/repair      75,045
871           Excavating/grading/paving/related           160,985
873           Electric power/lighting/wire comm equip     190,601
878/879       Other construction trades                   681,154
911           Air transport operating                      28,776
913           Railway transport operating                  35,536
915           Water transport operating                    26,145
917           Motor transport operating                   509,257
919           Other transport equipment operating          10,683
931           Other material handling/related             178,409
951           Printing/related                             59,100
953           Stationary engine/utilities equip oper.      72,994
955           Other elctrnc communication equip oper.      12,351
959           Other crafts/equipment operating               7191
991/992       Occupations not elsewhere classified        248,614
              All Occupations (Reference Group)         9,602,356

                                                           Mortality
                                                          Amenable to
Occupation Minor Group                                   Medical Care

Code          Label                                     Deaths    ASMR

111           Govt officials/administrators                170   196.1
113/114/115   Other managers/administrators               1637   182.2
117           Management/administration                    463   187.1
211           Physical sciences                             39   116.9
213           Life sciences                                 33   139.1
214/215       Architects/engineers/community planners      247   153.9
216           Other architecture/engineering               143   205.7
218           Math/stats/systems analysis/related           74   163.1
231           Social sciences                               31   148.1
233           Social work/related                           80   266.7
234           Law/jurisprudence                             73   166.3
235           Library/museum/and archival sciences          10   145.2
239           Other social sciences/related                 18   211.4
251           Religion                                      86   151.6
271           University teaching/related                   61   118.2
273           Elementary-secondary teaching/related        179   152.1
279           Other teaching/related                        99   166.9
311           Health diagnosing/treating                   115   143.0
313           Nursing/therapy/assisting related             71   238.7
315/316       Other medicine/health                         70   171.8
331           Fine/commercial art/photography/related       60   165.5
333           Performing/audio-visual arts                  35   185.2
335           Writing                                       51   206.5
336/337       Sports/recreation                             52   273.5
411           Stenographic/typing                           22   268.1
413           Bookkeeping/account-recording/related        208   243.5
414           Office machine/related equip operating        52   232.2
415           Material recording/scheduling/               350   252.1
                distributing
416           Library/file/correspondence                   11   267.6
                clerks/related
417           Reception/information/mail/message dist      158   245.0
419           Other clerical/related                       234   239.8
513/514       Sales in commodities                         968   220.9
517           Sales in services                            320   198.7
519           Other sales                                   45   282.9
611           Protective services                          649   284.4
612           Food-beverage prep/related                   273   252.0
613           Lodging/Other accommodation                   80   339.1
614           Personal service                              90   254.4
616           Apparel/furnishings service                   32   190.9
619           Other service                                653   254.7
711           Farmers                                      589   204.0
718/719       Other farm/horticultural/animal              358   240.5
                husbandry
731           Fishing/trapping/related                     127   226.5
751           Forestry/logging                             147   230.2
771           Mining/quarrying incl oil and gas field      144   257.9
811           Mineral ore treating                          17   268.1
813/814       Metal processing/related                     117   297.6
815           Clay-glass-stone processing/forming           33   283.5
816/817       Chemicals/petroleum/rubber/plastic/           49   177.0
                related
821/822       Food/beverage/related processing             198   228.7
823           Wood processing                               58   149.3
                (except pulp/papermaking)
825           Pulp/papermaking/related                      85   300.7
826/827       Textile processing                            28   178.6
829           Other processing                              12   306.5
831           Metal machining                              156   201.2
833           Metal shaping/forming                        284   227.2
                (except machining)
835           Wood machining                                22   394.1
837           Clay-glass-stone-related machining            16   235.1
839           Other machining/related                       29   232.8
851/852       Fabricate/assemble (metal products)          135   207.5
853           Fabricate/assmbl/install/repair elctr        194   234.2
                equip
854           Fabricate/assemble/repair                     76   205.9
                (wood products)
855/856       Fabricate/assemble/repair                     94   220.2
                (txtl/fur/leather)
857           Fabricate/assemble/repair                     39   303.6
                (rubber/plastic)
858           Other mechanics/repairers                    610   219.7
859           Other product fabricate/assemble/repair      142   255.2
871           Excavating/grading/paving/related            337   248.5
873           Electric power/lighting/wire comm equip      227   216.4
878/879       Other construction trades                   1093   209.7
911           Air transport operating                       23   150.7
913           Railway transport operating                   52   202.6
915           Water transport operating                     59   240.0
917           Motor transport operating                   1102   276.6
919           Other transport equipment operating           15   140.9
931           Other material handling/related              363   262.9
951           Printing/related                             108   271.0
953           Stationary engine/utilities equip oper.      123   228.0
955           Other elctrnc communication equip oper.       19   275.2
959           Other crafts/equipment operating               9   285.7
991/992       Occupations not elsewhere classified         544   256.0
              All Occupations (Reference Group)         15,875   216.6

                                                           Mortality
                                                         Amenable to
Occupation Minor Group                                  Medical Care

                                                                 95%
                                                          Confidence
Code          Label                                           Limits

111           Govt officials/administrators              163.8-234.9
113/114/115   Other managers/administrators              172.1-192.8
117           Management/administration                  169.0-207.2
211           Physical sciences                           81.3-168.1
213           Life sciences                               91.8-211.0
214/215       Architects/engineers/community planners    133.7-177.2
216           Other architecture/engineering             165.2-256.1
218           Math/stats/systems analysis/related        113.0-235.4
231           Social sciences                             99.5-220.4
233           Social work/related                        205.7-345.8
234           Law/jurisprudence                          130.5-211.9
235           Library/museum/and archival sciences        72.6-290.2
239           Other social sciences/related              114.3-390.8
251           Religion                                   122.3-187.8
271           University teaching/related                 89.3-156.4
273           Elementary-secondary teaching/related      118.6-195.0
279           Other teaching/related                     132.3-210.5
311           Health diagnosing/treating                 118.7-172.2
313           Nursing/therapy/assisting related          170.8-333.5
315/316       Other medicine/health                      134.0-220.2
331           Fine/commercial art/photography/related    126.3-216.9
333           Performing/audio-visual arts               129.3-265.1
335           Writing                                    154.5-276.0
336/337       Sports/recreation                          203.9-366.7
411           Stenographic/typing                        173.9-413.2
413           Bookkeeping/account-recording/related      211.0-281.0
414           Office machine/related equip operating     161.8-333.4
415           Material recording/scheduling/             221.3-287.2
                distributing
416           Library/file/correspondence                145.0-494.0
                clerks/related
417           Reception/information/mail/message dist    205.3-292.3
419           Other clerical/related                     208.6-275.6
513/514       Sales in commodities                       206.3-236.5
517           Sales in services                          177.1-222.8
519           Other sales                                196.3-407.7
611           Protective services                        262.1-308.6
612           Food-beverage prep/related                 219.0-290.1
613           Lodging/Other accommodation                270.6-424.9
614           Personal service                           204.7-316.2
616           Apparel/furnishings service                131.8-276.5
619           Other service                              234.6-276.5
711           Farmers                                    187.8-221.7
718/719       Other farm/horticultural/animal            216.4-267.4
                husbandry
731           Fishing/trapping/related                   186.4-275.2
751           Forestry/logging                           183.2-289.2
771           Mining/quarrying incl oil and gas field    206.7-321.8
811           Mineral ore treating                       135.0-532.5
813/814       Metal processing/related                   224.6-394.2
815           Clay-glass-stone processing/forming        188.3-427.0
816/817       Chemicals/petroleum/rubber/plastic/        130.8-239.4
                related
821/822       Food/beverage/related processing           190.8-274.1
823           Wood processing                            114.4-194.8
                (except pulp/papermaking)
825           Pulp/papermaking/related                   203.0-445.3
826/827       Textile processing                         116.4-274.2
829           Other processing                           169.5-554.0
831           Metal machining                            165.9-243.9
833           Metal shaping/forming                      195.2-264.5
                (except machining)
835           Wood machining                             211.7-733.6
837           Clay-glass-stone-related machining         138.0-400.5
839           Other machining/related                    144.5-375.0
851/852       Fabricate/assemble (metal products)        160.8-267.8
853           Fabricate/assmbl/install/repair elctr      194.1-282.5
                equip
854           Fabricate/assemble/repair                  160.5-264.2
                (wood products)
855/856       Fabricate/assemble/repair                  176.7-274.5
                (txtl/fur/leather)
857           Fabricate/assemble/repair                  193.5-476.3
                (rubber/plastic)
858           Other mechanics/repairers                  197.5-244.4
859           Other product fabricate/assemble/repair    209.9-310.4
871           Excavating/grading/paving/related          217.3-284.2
873           Electric power/lighting/wire comm equip    178.6-262.3
878/879       Other construction trades                  195.0-225.6
911           Air transport operating                     85.0-267.4
913           Railway transport operating                140.3-292.5
915           Water transport operating                  178.6-322.5
917           Motor transport operating                  257.6-297.1
919           Other transport equipment operating         84.1-236.1
931           Other material handling/related            232.0-298.0
951           Printing/related                           208.9-351.5
953           Stationary engine/utilities equip oper.    183.0-284.1
955           Other elctrnc communication equip oper.    160.2-473.0
959           Other crafts/equipment operating           133.0-613.8
991/992       Occupations not elsewhere classified       232.7-281.7
              All Occupations (Reference Group)          212.8-220.4

                                                        All Other Cause
Occupation Minor Group                                     Mortality

Code          Label                                     Deaths    ASMR

111           Govt officials/administrators                364   411.4
113/114/115   Other managers/administrators               3280   377.7
117           Management/administration                    872   380.7
211           Physical sciences                             95   370.7
213           Life sciences                                 63   290.0
214/215       Architects/engineers/community planners      550   341.9
216           Other architecture/engineering               296   331.3
218           Math/stats/systems analysis/related          160   342.8
231           Social sciences                               63   337.7
233           Social work/related                          151   479.5
234           Law/jurisprudence                            151   337.5
235           Library/museum/and archival sciences          26   404.2
239           Other social sciences/related                 20   235.8
251           Religion                                     196   348.9
271           University teaching/related                  146   274.6
273           Elementary-secondary teaching/related        411   362.3
279           Other teaching/related                       259   412.0
311           Health diagnosing/treating                   246   311.8
313           Nursing/therapy/assisting related            166   414.4
315/316       Other medicine/health                        135   352.0
331           Fine/commercial art/photography/related      157   417.7
333           Performing/audio-visual arts                  85   404.8
335           Writing                                      101   431.0
336/337       Sports/recreation                            101   584.1
411           Stenographic/typing                           32   430.9
413           Bookkeeping/account-recording/related        401   496.8
414           Office machine/related equip operating        92   414.1
415           Material recording/scheduling/               636   479.1
                distributing
416           Library/file/correspondence                   18   457.2
                clerks/related
417           Reception/information/mail/message dist      326   497.4
419           Other clerical/related                       425   453.3
513/514       Sales in commodities                        1844   447.5
517           Sales in services                            591   385.7
519           Other sales                                  102   593.1
611           Protective services                         1222   568.3
612           Food-beverage prep/related                   581   513.2
613           Lodging/Other accommodation                  135   578.5
614           Personal service                             175   497.2
616           Apparel/furnishings service                   69   478.1
619           Other service                               1234   529.1
711           Farmers                                     1139   414.4
718/719       Other farm/horticultural/animal              697   485.8
                husbandry
731           Fishing/trapping/related                     256   532.3
751           Forestry/logging                             374   512.0
771           Mining/quarrying incl oil and gas field      289   555.3
811           Mineral ore treating                          34   437.9
813/814       Metal processing/related                     194   444.6
815           Clay-glass-stone processing/forming           66   554.8
816/817       Chemicals/petroleum/rubber/plastic/           97   437.0
                related
821/822       Food/beverage/related processing             424   467.5
823           Wood processing                              153   447.2
                (except pulp/papermaking)
825           Pulp/papermaking/related                     168   586.4
826/827       Textile processing                            58   362.1
829           Other processing                              19   499.6
831           Metal machining                              301   385.2
833           Metal shaping/forming                        617   502.0
                (except machining)
835           Wood machining                                30   287.8
837           Clay-glass-stone-related machining            24   368.1
839           Other machining/related                       49   451.7
851/852       Fabricate/assemble (metal products)          274   439.9
853           Fabricate/assmbl/install/repair elctr        345   429.3
                equip
854           Fabricate/assemble/repair                    130   367.5
                (wood products)
855/856       Fabricate/assemble/repair                    205   472.5
                (txtl/fur/leather)
857           Fabricate/assemble/repair                     65   549.2
                (rubber/plastic)
858           Other mechanics/repairers                   1327   475.3
859           Other product fabricate/assemble/repair      263   515.9
871           Excavating/grading/paving/related            632   525.7
873           Electric power/lighting/wire comm equip      445   418.2
878/879       Other construction trades                   2490   510.3
911           Air transport operating                       59   323.3
913           Railway transport operating                  110   415.3
915           Water transport operating                    111   463.7
917           Motor transport operating                   2152   551.3
919           Other transport equipment operating           46   587.0
931           Other material handling/related              677   532.2
951           Printing/related                             192   517.8
953           Stationary engine/utilities equip oper.      217   391.8
955           Other elctrnc communication equip oper.       20   286.8
959           Other crafts/equipment operating              23   497.3
991/992       Occupations not elsewhere classified        1078   530.6
              All Occupations (Reference Group)         31,827   449.3

                                                        All Other Cause
Occupation Minor Group                                     Mortality

                                                                 95%
                                                          Confidence
Code          Label                                           Limits

111           Govt officials/administrators              363.5-465.5
113/114/115   Other managers/administrators              362.5-393.6
117           Management/administration                  353.0-410.5
211           Physical sciences                          285.9-480.8
213           Life sciences                              211.0-398.5
214/215       Architects/engineers/community planners    310.8-376.2
216           Other architecture/engineering             282.8-388.0
218           Math/stats/systems analysis/related        262.6-447.4
231           Social sciences                            255.0-447.3
233           Social work/related                        393.9-583.7
234           Law/jurisprudence                          284.2-400.9
235           Library/museum/and archival sciences       264.7-617.1
239           Other social sciences/related              133.6-416.2
251           Religion                                   302.7-402.2
271           University teaching/related                228.9-329.3
273           Elementary-secondary teaching/related      304.2-431.5
279           Other teaching/related                     356.4-476.1
311           Health diagnosing/treating                 274.5-354.2
313           Nursing/therapy/assisting related          334.2-513.7
315/316       Other medicine/health                      294.2-421.1
331           Fine/commercial art/photography/related    352.9-494.5
333           Performing/audio-visual arts               318.5-514.5
335           Writing                                    349.5-531.4
336/337       Sports/recreation                          470.9-724.4
411           Stenographic/typing                        301.0-616.9
413           Bookkeeping/account-recording/related      447.3-551.8
414           Office machine/related equip operating     312.5-548.6
415           Material recording/scheduling/             433.2-529.9
                distributing
416           Library/file/correspondence                280.9-744.4
                clerks/related
417           Reception/information/mail/message dist    438.3-564.5
419           Other clerical/related                     407.7-503.9
513/514       Sales in commodities                       425.4-470.7
517           Sales in services                          354.3-419.8
519           Other sales                                466.2-754.5
611           Protective services                        535.2-603.4
612           Food-beverage prep/related                 465.2-566.1
613           Lodging/Other accommodation                486.4-688.1
614           Personal service                           425.7-580.6
616           Apparel/furnishings service                365.4-625.5
619           Other service                              497.9-562.2
711           Farmers                                    390.0-440.3
718/719       Other farm/horticultural/animal            450.3-524.1
                husbandry
731           Fishing/trapping/related                   460.4-615.5
751           Forestry/logging                           441.6-593.6
771           Mining/quarrying incl oil and gas field    465.0-663.2
811           Mineral ore treating                       275.8-695.1
813/814       Metal processing/related                   360.3-548.5
815           Clay-glass-stone processing/forming        419.1-734.4
816/817       Chemicals/petroleum/rubber/plastic/        320.0-596.6
                related
821/822       Food/beverage/related processing           412.1-530.3
823           Wood processing                            362.2-552.1
                (except pulp/papermaking)
825           Pulp/papermaking/related                   441.6-778.7
826/827       Textile processing                         268.7-488.1
829           Other processing                           311.6-801.0
831           Metal machining                            335.4-442.4
833           Metal shaping/forming                      450.9-558.9
                (except machining)
835           Wood machining                             174.5-474.8
837           Clay-glass-stone-related machining         233.0-581.4
839           Other machining/related                    306.4-666.0
851/852       Fabricate/assemble (metal products)        365.7-529.2
853           Fabricate/assmbl/install/repair elctr      370.3-497.7
                equip
854           Fabricate/assemble/repair                  301.9-447.4
                (wood products)
855/856       Fabricate/assemble/repair                  407.1-548.4
                (txtl/fur/leather)
857           Fabricate/assemble/repair                  388.0-777.5
                (rubber/plastic)
858           Other mechanics/repairers                  441.4-511.7
859           Other product fabricate/assemble/repair    444.1-599.3
871           Excavating/grading/paving/related          473.2-584.1
873           Electric power/lighting/wire comm equip    364.0-480.4
878/879       Other construction trades                  485.5-536.5
911           Air transport operating                    231.5-451.7
913           Railway transport operating                322.1-535.5
915           Water transport operating                  372.2-577.7
917           Motor transport operating                  523.5-580.7
919           Other transport equipment operating        405.9-848.9
931           Other material handling/related            482.3-587.3
951           Printing/related                           425.1-630.8
953           Stationary engine/utilities equip oper.    331.4-463.2
955           Other elctrnc communication equip oper.    168.1-489.2
959           Other crafts/equipment operating           301.2-821.1
991/992       Occupations not elsewhere classified       494.8-568.9
              All Occupations (Reference Group)          443.6-455.0

The counts of deaths for occupations recording fewer than three
deaths are suppressed.

Received: February 8, 2010 Accepted: July 6, 2010

REFERENCES

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(5.) Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 1999;341:1359-67.

(6.) Pampalon R. Avoidable mortality in Quebec and its regions. Soc Sci Med 1993;37(6):823-31.

(7.) Tobias M, Jackson G. Avoidable mortality in New Zealand, 1981-97. Aust N Z J Public Health 2001;25(1):12-20.

(8.) Carr-Hill RA, Hardman GF, Russell IT. Variations in avoidable mortality and variations in health care resources. Lancet 1987;1(8536):789-92.

(9.) Manuel D, Mao Y. Avoidable mortality in the United States and Canada, 1980-1996. Am J Public Health 2002;92:1481-84.

(10.) Nolte E, McKee CM. Measuring the health of nations: Updating an earlier analysis. Health Affairs 2008;27(1):58-71.

(11.) Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE. Socioeconomic inequalities in health in 22 European countries. NEngl J Med 2008;358:2468-81.

(12.) Wheller L, Baker A, Griffiths C, Rooney C. Trends in avoidable mortality in England and Wales, 1993-2005. Health Stat Q 2007;34:6-25.

(13.) James PD, Manuel DG, Mao Y. Avoidable mortality across Canada from 1975 to 1999. BMC Public Health 2006;6:137.

(14.) Elo IT, Preston SH. Educational differentials in mortality: United States, 1979-85. Soc Sci Med 1996;42(1):47-57.

(15.) Rogot E, Sorlie PD, Johnson NJ, Glover CS, Treasure D. A mortality study of one million persons by demographic, social, and economic factors: 1979-1981 follow-up. (First data book). (NIH Publ No. 88-2896.) Washington, DC: US DHHS, Public Health Service,1988.

(16.) Leclerc A, Chastang JF, Menvielle G, Luce D. Socioeconomic inequalities in premature mortality in France: Have they widened in recent decades? Soc Sci Med 2006;62(8):2035-45.

(17.) Valkonen T, Martelin T, Rimpela A. Socio-economic mortality differences in Finland 1971-85. Population Series. Helsinki: Statistics Finland, 1990.

(18.) Diderichsen F, Hallqvist J. Trends in occupational mortality among middle-aged men in Sweden 1961-1990. Int J Epidemiol 1997;26(4):782-87.

(19.) Statistics Canada. Standard Occupational Classification 1980. Catalogue 12565E. Ottawa, ON: Minister of Supply and Services Canada, 1981.

(20.) Employment and Immigration Canada. National Occupational Classification: Occupational descriptions. Ottawa: Canada Communications Group, 1993.

(21.) Charlton JR, Hartley RM, Silver R, Holland WW. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet 1983;1:691-96.

(22.) Holland WW (Ed.). European Community Atlas of "Avoidable Death". European Community Health Services Research Series No. 3. Oxford: Oxford University Press, 1988.

(23.) World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, Ninth Revision. Geneva: WHO, 1977.

(24.) World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Geneva: WHO, 1992.

(25.) Aronson KJ, Howe GR, Carpenter M, Fair ME. Surveillance of potential associations between occupations and causes of death in Canada, 1965-91. Occup Environ Med 1999;56(4):265-69.

(26.) Geran L, Tully P, Wood P, Thomas B. Comparability of ICD-10 and ICD-9 for mortality statistics in Canada. Cat no. 84-548-XIE. Ottawa: Statistics Canada, 2005.

Cameron A. Mustard, ScD, [1,2] Amber Bielecky, MSc, [1] Jacob Etches, PhD, [1] Russell Wilkins, Murb, [3,4] Michael Tjepkema, MPH, [4] Benjamin C. Amick, PhD, [1,5] Peter M. Smith, PhD, [1,2] Kristan J. Aronson, PhD [6]

Author Affiliations

[1.] Institute for Work & Health, Toronto, ON

[2.] Dalla Lana School of Public Health, University of Toronto, Toronto, ON

[3.] Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON

[4.] Health Analysis Division, Statistics Canada, Ottawa, ON

[5.] School of Public Health, University of Texas, Houston, Texas

[6.] Department of Community Health and Epidemiology, Queen's University, Kingston, ON

Correspondence: Cameron Mustard, Institute for Work & Health, 481 University Ave, Suite 800, Toronto, ON M5G 2E9, Tel: 416-927-2027, ext. 2143, E-mail: cmustard@iwh.on.ca

Conflict of Interest: None to declare.

Table 1 Avoidable Mortality for Causes Amenable to Medical Care and for
All Other Causes, by Occupational Skill Level, Non-institutionalized
Persons Aged 30-69 at Cohort Inception, Canada, 1991-2001

                                          Number     Person-
                                              of       years
        Occupational Skill Level          Deaths     at Risk

Women   Causes amenable to medical care
          Professional                       987   1,395,200
          Managerial                         529     585,420
          Skilled/Technical/Supervisory     2025   2,222,070
          Semi-skilled                      2981   3,040,850
          Unskilled                         1073     860,830
          No occupation                     8637   2,679,240
          All occupations (reference)       7595   8,104,380

        All other causes of death
          Professional                      1364   1,395,200
          Managerial                         751     585,420
          Skilled/Technical/Supervisory     3137   2,222,060
          Semi-skilled                      4491   3,040,850
          Unskilled                         1661     860,830
          No occupation                   15,725   2,679,240
          All occupations (reference)     11,404   8,104,380

Men     Causes amenable to medical care
          Professional                      1385   1,286,350
          Managerial                        1989   1,482,000
          Skilled/Technical/Supervisory     5501   3,377,130
          Semi-skilled                      4665   2,517,960
          Unskilled                         2335     937,920
          No occupation                   11,663   1,235,860
          All occupations (reference)     15,875   9,602,360

        All other causes of death
          Professional                      2938   1,286,350
          Managerial                        4020   1,483,000
          Skilled/Technical/Supervisory   11,197   3,377,130
          Semi-skilled                      9124   2,517,960
          Unskilled                         4548     937,920
          No occupation                   22,694   1,235,860
          All occupations (reference)     31,827   9,602,360

                                              Crude
                                          Mortality
        Occupational Skill Level               Rate     ASMR

Women   Causes amenable to medical care
          Professional                         70.7    108.3
          Managerial                           90.4    140.1
          Skilled/Technical/Supervisory        91.1    129.8
          Semi-skilled                         98.0    135.2
          Unskilled                           124.6    151.2
          No occupation                       322.4    223.9
          All occupations (reference)          93.7    132.3

        All other causes of death
          Professional                         97.8    176.4
          Managerial                          128.3    211.0
          Skilled/Technical/Supervisory       141.2    217.7
          Semi-skilled                        147.7    222.9
          Unskilled                           193.0    261.0
          No occupation                       586.9    363.5
          All occupations (reference)         140.7    218.6

Men     Causes amenable to medical care
          Professional                        107.7    158.7
          Managerial                          134.1    178.9
          Skilled/Technical/Supervisory       162.9    213.9
          Semi-skilled                        185.3    248.0
          Unskilled                           249.0    270.4
          No occupation                       943.7    544.2
          All occupations (reference)         165.3    216.6

        All other causes of death
          Professional                        228.4    343.0
          Managerial                          271.1    386.8
          Skilled/Technical/Supervisory       331.6    444.3
          Semi-skilled                        362.4    500.0
          Unskilled                           484.9    557.0
          No occupation                      1836.3    972.6
          All occupations (reference)         331.4    449.3

                                                  95%
                                           Confidence
        Occupational Skill Level             Interval    SRR

Women   Causes amenable to medical care
          Professional                     99.1-118.3   0.82 *
          Managerial                      125.2-156.7   1.06
          Skilled/Technical/Supervisory   123.2-136.8   0.98
          Semi-skilled                    129.4-141.3   1.02
          Unskilled                       140.7-162.5   1.14 *
          No occupation                   218.5-229.5   1.69 *
          All occupations (reference)     128.7-136.1   1.00

        All other causes of death
          Professional                    162.8-191.1   0.81 *
          Managerial                      191.7-232.3   0.96
          Skilled/Technical/Supervisory   208.6-227.1   1.00
          Semi-skilled                    214.8-231.3   1.02
          Unskilled                       245.9-277.1   1.19 *
          No occupation                   356.7-370.3   1.66 *
          All occupations (reference)     213.6-223.8   1.00

Men     Causes amenable to medical care
          Professional                    149.5-168.5   0.73 *
          Managerial                      169.9-188.4   0.83 *
          Skilled/Technical/Supervisory   207.6-220.4   0.99
          Semi-skilled                    239.8-256.4   1.14 *
          Unskilled                       258.9-282.4   1.25 *
          No occupation                   528.7-560.2   2.51 *
          All occupations (reference)     212.8-220.4   1.00

        All other causes of death
          Professional                    328.9-357.6   0.76 *
          Managerial                      372.6-401.5   0.86 *
          Skilled/Technical/Supervisory   434.9-453.8   0.99
          Semi-skilled                    487.8-512.5   1.11 *
          Unskilled                       539.7-574.9   1.24 *
          No occupation                     951-994.6   2.16 *
          All occupations (reference)       443.6-455   1.00

                                                 95%
                                          Confidence
        Occupational Skill Level            Interval

Women   Causes amenable to medical care
          Professional                     0.75-0.89 *
          Managerial                       0.95-1.18
          Skilled/Technical/Supervisory    0.94-1.03
          Semi-skilled                     0.99-1.06
          Unskilled                        1.07-1.22 *
          No occupation                    1.63-1.76 *
          All occupations (reference)

        All other causes of death
          Professional                     0.75-0.87 *
          Managerial                       0.88-1.06
          Skilled/Technical/Supervisory    0.96-1.03
          Semi-skilled                     0.99-1.05
          Unskilled                        1.13-1.26 *
          No occupation                    1.61-1.71 *
          All occupations (reference)

Men     Causes amenable to medical care
          Professional                     0.69-0.78 *
          Managerial                       0.79-0.87 *
          Skilled/Technical/Supervisory    0.97-1.01
          Semi-skilled                     1.11-1.18 *
          Unskilled                        1.20-1.30 *
          No occupation                    2.43-2.60 *
          All occupations (reference)

        All other causes of death
          Professional                     0.73-0.79 *
          Managerial                       0.83-0.89 *
          Skilled/Technical/Supervisory    0.97-1.01
          Semi-skilled                     1.09-1.14 *
          Unskilled                        1.20-1.28 *
          No occupation                    2.11-2.22 *
          All occupations (reference)

ASMR: Age-standardized mortality rate, SRR: Standardized rate ratio.
Bold font in SRR column indicates statistically significant (p<0.05)
compared to the reference group.

Note: * SRR column indicates statistically significant (p<0.05)
compared to the reference group.