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Causes of death among lead smelters in relation to the glucose-6-phosphate dehydrogenase polymorphism
  1. Pierluigi Cocco,
  2. Domenica Fadda,
  3. Sergio Atzeri,
  4. Giuseppe Avataneo,
  5. Michele Meloni,
  6. Costantino Flore
  1. Department of Public Health, Occupational Health Section, University of Cagliari, Cagliari, Italy
  1. Correspondence to:
 Dr P Cocco
 Department of Public Health, Occupational Health Section, University of Cagliari, via San Giorgio 12, 09124 Cagliari, Italy; coccop{at}


Objective: To assess, by updating a follow-up mortality study of a lead smelters cohort in Sardinia, Italy, the adverse health effects following occupational lead exposure in relation to the glucose-6-phosphate dehydrogenase (G6PD) polymorphism.

Method: The 1973–2003 mortality of 1017 male lead smelters were followed-up, divided into two subcohorts according to the G6PD phenotype: whether G6PD deficient (G6PD−) or wild-type (wtG6PD). Deaths observed in the overall cohort and the two subcohorts were compared with those expected, on the basis of the age-, sex- and calendar year-specific mortality in the general male population of the island. Directly standardised mortality rates (sr) in the two subcohorts were also compared.

Results: Cardiovascular mortality was strongly reduced among production and maintenance workers, which is most related to the healthy worker effect. However, the sr for cardiovascular diseases was substantially lower among the G6PD− subcohort (5.0×10−4) than among the wtG6PD subcohort (33.6×10−4; χ2 = 1.10; p = NS). Neoplasms of the haemopoietic system exceeded the expectation in the G6PD− subcohort (SMR = 388; 95% CI 111 to 1108). No other cancer sites showed any excess in the overall cohort or in the two subcohorts. No death from haemolytic anaemia occurred in the G6PD− subcohort.

Conclusion: With due consideration of the limited statistical power of our study, previous results suggesting that in workplaces where exposure is under careful control, expressing the G6PD− phenotype does not convey increased susceptibility to lead toxicity are confirmed. The observed excess risk of haematopoietic malignancies seems to have most likely resulted from chance.

  • G6PD, glucose-6-phosphate dehydrogenase
  • G6PD−, glucose-6-phosphate dehydrogenase deficient
  • SMR, standardised mortality ratio
  • sr, standardised mortality rate
  • wtG6PD, wild-type glucose-6-phosphate dehydrogenase

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  • Published Online First 19 December 2006

  • Competing interests: None.