Influence of occupational accidents and deaths related to lifestyle on mortality among merchant seafarers.

OBJECTIVES The aim of the present historical cohort study was to enhance the understanding of the unusual mortality pattern seen among seafarers. The main object was to describe the mortality pattern of Danish seafarers in recent years with special reference to the influence of accidents in the maritime workplace and ashore and the influence of diseases related to lifestyle. SUBJECTS A cohort of 24,132 male seafarers of all job categories employed on a Danish merchant ship between 1986 and 1993, was followed up. Mortality among those who left the occupation before the end of the follow-up period was analysed separately. RESULTS The standardized mortality ratio was 1.43 (95% CI: 1.33-1.54) from all causes and 3.05 (95% CI: 2.62-3.52) from accidents. An excess mortality from natural causes was attributable mostly to an excess among deck and engine room crew and was mainly caused by diseases related to lifestyle. While active as seafarers, the SMR for accidents was 2.62 (95% CI: 2.12-3.20), accidents at the workplace explaining almost half the deaths. Among those who left shipping, the risk of fatal accidents increased. All categories of seafarers continued to have a high risk of fatal accidents into older age. CONCLUSION Merchant seafarers were shown to have a higher mortality than the general population. Despite a very high risk of fatal accidents in the workplace, these accidents could only explain a proportion of the observed excess mortality. Accidents ashore and diseases related to lifestyle factors such as drinking and smoking made a major contribution to the observed excess mortality. The results indicate that people in occupations with a high risk of fatal accidents at the workplace also seem to have a high risk of accidents away from the workplace after leaving the occupation. The high risk lifestyle seems to be linked to lifestyle in general and hence the related diseases and high risk of death.