Objectives The healthy worker effect (HWE) is widely known to bias standardised risk estimates from occupational cohort studies. Multiple factors contribute to HWE bias that is commonly characterised as confounding due to the selection of individuals with “better health status” who are more likely to gain and retain employment relative to a general population including non-employed persons. Comparisons between standardised mortality ratios (SMRs) estimated from reference population rates with different characteristics allow for quantitative evaluation of different components of the HWE.
Method Data from over five decades for a company-wide mortality registry comes from life insurance claims, and deaths are validated against the U. S. National Death Index. Average person-years at risk during five-year calendar periods for the occupational cohort population are estimated. The expected mortality counts are specific to age, sex, race, and calendar-time period strata. SMRs are calculated based on the mortality rates for the general U. S. population and the company-wide population.
Results From 1956 through 2012, the annual US employee population has ranged from 29 000 to 108 000 workers. The mortality registry includes over 80 000 deaths validated through 2010, 25% due to malignant neoplasms and 37% due to cardiovascular diseases.
Conclusions The HWE influences the interpretation of standardised estimates from occupational studies. Comparisons for different reference populations can evaluate differential HWE bias of associations between occupational exposure and mortality. Analyses based on company reference rates identify contributions from components of the HWE based on comparable demographic characteristics, a similar likelihood of obtaining and retaining employment, and an equivalent potential for ascertainment of mortality outcomes.
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