Fewer than expected deaths from all causes, cardiovascular disease, noncancer respiratory disease, cirrhosis of the liver, and external causes were observed, some or all of which may be attributed to a “healthy worker effect.” Metaanalyses revealed weak to moderate excesses of lung and bladder cancers likely due to occupational exposure to known human carcinogens. A 10%-15% increase in lymphatic and hematopoietic cancers was also observed. With few exceptions, the observed cause-specific mortality and site-specific cancer incidences were reassuring: overall, 10% fewer deaths were observed than expected. Additional research is required to gain a more complete understanding of the apparent increases in certain
cancers, and the potential role that methodology and environmental or occupational influences may play in the associations observed in this study. To our knowledge, this is the first comprehensive overview of the health of chemical workers, and can serve as the basis for further investigations into
specific issues associated with the health of this population. It has also raised important methodologic issues associated with reporting and publication of epidemiologic data, including the treatment of incomplete reporting and “publication bias.”