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Mortality from cancer and other causes in commercial airline crews: a joint analysis of cohorts from 10 countries
  1. Gaël P Hammer1,2,
  2. Anssi Auvinen3,5,
  3. Bianca L De Stavola6,
  4. Barbara Grajewski7,
  5. Maryanne Gundestrup8,
  6. Tor Haldorsen9,
  7. Niklas Hammar10,
  8. Susanna Lagorio11,
  9. Anette Linnersjö12,13,
  10. Lynne Pinkerton7,
  11. Eero Pukkala3,4,
  12. Vilhjálmur Rafnsson14,
  13. Isabel dos–Santos–Silva6,
  14. Hans H Storm15,
  15. Trond-Eirik Strand16,
  16. Anastasia Tzonou17,
  17. Hajo Zeeb18,
  18. Maria Blettner1
  1. 1Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
  2. 2Registre Morphologique des Tumeurs, Laboratoire National de Santé, Luxembourg, Luxembourg
  3. 3School of Health Sciences, University of Tampere, Tampere, Finland
  4. 4Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
  5. 5(STUK) Radiation and Nuclear Safety Authority, Helsinki, Finland
  6. 6Departments of Non-Communicable Disease Epidemiology and Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  7. 7National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Cincinnati, OH, USA
  8. 8Clinic of Aviation Medicine, University Hospital, Copenhagen, Denmark
  9. 9Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
  10. 10Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  11. 11National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
  12. 12Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  13. 13Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
  14. 14University of Iceland, Reykjavik, Iceland
  15. 15Danish Cancer Society, Copenhagen, Denmark
  16. 16Norwegian Armed Forces Medical Services, Institute of Aviation Medicine, Oslo, Norway
  17. 17University of Athens, Athens, Greece
  18. 18Leibniz Institute for Prevention Research and Epidemiology—BIPS GmbH, Bremen, Germany
  1. Correspondence to Dr Gaël Paul Hammer, Registre Morphologique des Tumeurs, Laboratoire National de Santé E.P., L-3555 Dudelange, Luxembourg; gael.hammer{at}


Background Commercial airline crew is one of the occupational groups with the highest exposures to ionising radiation. Crew members are also exposed to other physical risk factors and subject to potential disruption of circadian rhythms.

Methods This study analyses mortality in a pooled cohort of 93 771 crew members from 10 countries. The cohort was followed for a mean of 21.7 years (2.0 million person-years), during which 5508 deaths occurred.

Results The overall mortality was strongly reduced in male cockpit (SMR 0.56) and female cabin crews (SMR 0.73). The mortality from radiation-related cancers was also reduced in male cockpit crew (SMR 0.73), but not in female or male cabin crews (SMR 1.01 and 1.00, respectively). The mortality from female breast cancer (SMR 1.06), leukaemia and brain cancer was similar to that of the general population. The mortality from malignant melanoma was elevated, and significantly so in male cockpit crew (SMR 1.57). The mortality from cardiovascular diseases was strongly reduced (SMR 0.46). On the other hand, the mortality from aircraft accidents was exceedingly high (SMR 33.9), as was that from AIDS in male cabin crew (SMR 14.0).

Conclusions This large study with highly complete follow-up shows a reduced overall mortality in male cockpit and female cabin crews, an increased mortality of aircraft accidents and an increased mortality in malignant skin melanoma in cockpit crew. Further analysis after longer follow-up is recommended.

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