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Paolo Boffetta and his coworkers presented a comprehensive cohort study comprising 6784 male and 265 female workers from four mercury mines and mills in Spain, Slovenia, Italy, and the Ukraine.1 The expected number of deaths were derived from the national rates specific for sex, age, and calender period. Slovenia was the only country with an increased mortality of ischaemic heart disease among men (SMR 1.66, 95% CI 1.35 to 2.02). In the Slovenian mine, dust measurements showed concentrations between 30 and 70 mg/m3 with 10–35% free silica in the 1960s, and about 40 mg/m3 in the 1970s. An increased mortality from pneumoconiosis was present in all countries. Mortality from ischaemic heart disease was positively correlated with duration of employment but not with cumulative exposure to mercury. Smoking habits was an unlikely confounder as mortality from …