Background To explore explanations for elevated mortality from diabetes among male garment manufacturers and repairers in England and Wales during 1979-1990, analysis was extended by 10 years, looking also at other textile workers and at deaths from ischaemic heart disease (IHD).

Methods Data on some 3.5 million deaths were used to compute proportional mortality ratios (PMRs) for diabetes and IHD, standardised for age and social class, in 10 textile-associated job groups, with additional analyses by place of birth for 1993–2000.

Results Male mortality from diabetes was elevated in nine of the 10 textile jobs, with overall PMRs of 147 (95% CI 131 to 165) during 1979–90 and 170 (95% CI 144 to 199) during 1991–2000. Proportional mortality from IHD was also consistently high. Female mortality from both diseases was close to that for other occupations. In both sexes, mortality from diabetes and IHD was increased among people born in the Indian subcontinent (PMRs 353 and 139 in men; 262 and 130 in women). In men, the proportion of deceased textile workers born in the Indian subcontinent (11.4%) was much higher than for all occupations (1.8%), but not in women (1.1% vs 0.7%). PMRs for male textile workers standardised for place of birth were lower but still significantly elevated (133, 95% CI 110 to 159 for diabetes; 109, 95% CI 105 to 114 for IHD).

Conclusions No obvious occupational hazard explains the increased risk specific to men across a wide range of textile occupations. One possible explanation is uncontrolled residual confounding related to place of birth. This could be tested through suitably designed morbidity surveys.