Exposure to workplace carcinogens and work-related fatalities and injuries: comparing migrant and Australian-born workers

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1 Exposure to workplace carcinogens and work-related fatalities and injuries: comparing migrant and Australian-born workers Alison Reid School of Public Health

2 Migration and work 232 million migrants globally (3.2%) 115 million work. 3 D Jobs Dirty, Dangerous and Difficult and 3 C Jobs Cooking, Caring and Cleaning International literature immigrants/migrants have more work-related accidents/injuries. Fewer studies have examined exposure to workplace hazards

3 Work-related accidents and injuries and disease 313 million work-related non-fatal accidents globally per year 2.3 million workers die from a work-related injury or disease 160 million suffer from a work-related disease Deindustrialisation in the United States 10-15% decline in work-related injury fatalities But work-related fatalities increased among foreign-born workers in US ( per 100, ) Increased risk among migrant compared with native-born workers in US, Canada, Germany, the Netherlands, Switzerland, France, Spain..

4 Exposure to work-hazards Differential exposure reported among migrants and nativeborn workers in the US, New Zealand and Spain. Immigrants have greater exposure even when working in the same industry or occupation than native-born worker Few studies, those that have been conducted - limited Asked about self-reported exposures Different perceptions and awareness of hazards among ethnic groups Migrants had to speak the dominant language to participate

5 Post WWII immigration to Australia 6 million European immigrants post WWII Assisted Package Schemes United Kingdom, Greece, Italy, Southern Europe, Lebanon 1970s restrictions on non European immigration eased ending of the White Australia Policy South East Asians

6 Recent immigration to Australia Mid 1990s focus on skilled immigration Since /3 visas issued skilled visa Skilled immigrants come from >180 countries majority from UK, India, China and South Africa Feminisation of immigration - Thailand, Japan 1 in 4 Australians born abroad (6.6 million) 4.1 million (20%) at least 1 parent born abroad 10.6 million (53%) 1 or both grandparents

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10 Italians at Wittenoom Italians Largest non-english speaking group Recruited in Italy on two year contracts Indebted to the Company for flights, accommodation and work-tools High cost of living Low wages and double shifts Height Dirtier jobs Followed up those who returned to Italy Those employed directly below the conveyor belt were showered with fibre which fell on them constantly from above (McCulloch, 2006) The conditions were harsh, and the language barrier made life more difficult (McCulloch, 2006) The last to arrive were sent to the mill. The millers needed fewer skills, were paid less, and yet his job was dirtiest and most dangerous (Cappelletto & Merler, 2003).

11 Cumulative asbestos exposure f/ml-years 50% 45% 40% 35% Australia, UK and Ireland born Italians in Australia Italians in Italy Proportion 30% 25% 20% 15% 10% 5% 0% < >15 Fibre/ml-year Who went underground? They were all Italians, scrapers and drillers. Did the British go? No way! They didn t like work. Not even the slaves went underground. No even inmates. Just Italians (Cappelletto & Merler, 2003)

12 Standardised Mortality Ratios WA population, Cause of death Australia/UK/Irelandborn Italian-born Obs SMR 95% CI Obs SMR 95% CI All causes All cancers Lung cancer Pleural mesothelioma Reid A, Merler E, et al, in preparation

13 Italians had higher asbestos exposure Mesothelioma among Australian/UK-born and Italianborn workers at Wittenoom N HR (95% CI)* p N HR (95% CI)** p Australia and UK/Ireland-born Italian-born ( ) ( ) 0.26 *Adjusted for age at start of employment. **Adjusted for age at start of employment and log cumulative exposure

14 Summary Racist and discriminatory work practices at Wittenoom led to Italian workers being given the dirtier jobs resulting in heavier asbestos exposure and their higher risk of malignant mesothelioma

15 Ethnic Minority Australian Workplace Exposure Study (EM-AWES) Cross-sectional telephone-based study conducted in Australia in Participants: Arabic, Chinese or Vietnamese ancestry Australian-born or foreign-born Aged between 18 and 65 years Currently employed Residing in Sydney, Melbourne or Perth 749 people completed the study (53.5% response) Arabic = 210, Chinese = 307, Vietnamese = 232

16 Interview and Exposure Assessment Interviewed in English, Arabic, Cantonese, Mandarin or Vietnamese Job title and tasks of their current occupation. Used to determine whether the participant was potentially exposed at work to any of 38 priority workplace carcinogens from a predetermined list. metals (e.g. lead, nickel) dusts (e.g. asbestos, wood dust) radiation (e.g. ionizing radiation, solar radiation) combustion products (e.g. diesel engine exhaust, second-hand tobacco smoke) other agents such as benzene and shiftwork Based on their answers to the questions about their job tasks, participants were classified as unexposed, possibly exposed or probably exposed to each of the 38 carcinogens.

17 Prevalence of occupational exposure to carcinogens in ethnic minority workers 237 (31.6%) of the 749 ethnic minority workers were assessed as having probable exposure to at least one of the carcinogens. Prevalence varied by ethnicity & sex. Arabic = 38.6% Chinese = 27.4% Vietnamese = 31.0% Males = 41.5% Females = 19.3%

18 Prevalence of occupational exposure to carcinogens in ethnic minority workers Most common carcinogen exposures among males: Solar ultraviolet radiation (20.6% exposed) environmental tobacco smoke (17.3%) diesel engine exhaust (15.1%) silica (9.6%) Most common carcinogen exposures among females: environmental tobacco smoke (6.9%) other polycyclic aromatic hydrocarbons (4.5%) ionising radiation (3.9%) solar ultraviolet radiation (3.3%)

19 Proportion of participants with probable exposure to one or more carcinogens by Ethnicity and interview language Interviewed in English Interviewed in LOTE All Arabic Vietnamese Chinese

20 Exposure by Language of Interview Total Arabic Vietnamese Chinese Solar UV % % % % English LOTE Diesel English LOTE PAHs English LOTE ETS English LOTE

21 Occupational group by Language of interview Total Arabic Vietnamese Chinese RR (95%CI) RR (95%CI RR (95%CI RR (95%CI Managers/Professionals Technicians/Trades workers 1.64 ( ) Community/Personal service workers Clerical/Administrative/ Retail workers Machinery operators/ drivers 1.44 ( ) 1.08 ( ) 1.45 ( ) Labourers 2.14 ( ) 1.05 ( ) 1.26 ( ) 0.95 ( ) 1.00 ( ) 1.40 ( ) 1.12 ( ) 1.12 ( ) 1.15 ( ) 1.59 ( ) 3.94 ( ) 2.34 ( ) 1.57 ( ) 1.02 ( ) 1.80 ( ) 1.94 ( )

22 Comparison with Australian-born working population Compared with participants in the Australian Workplace Exposure Study: Conducted in 2012 using same methodology. Participants only able to complete the study interview in English participants. In this analysis only included Australian-born participants residing in Sydney, Melbourne or Perth (n = 952).

23 Comparison of OVERALL occupational exposure to carcinogens in ethnic minority workers and the general Australian-born working population Australianborn workers Ethnic Minority Workers ANY CARCINOGEN (n=952) All (n=749) Arabic (n=210) Vietnamese (n=232) Chinese (n=307) % Exposed RR (95% CI) a ( ) 1.23 ( ) 1.07 ( ) 1.07 ( ) RR (95% CI) b ( ) 0.98 ( ) 0.95 ( ) 0.93 ( ) a. Controlled for age-group, sex, city of residence, socioeconomic status and education b. As above, and also controlled for occupational group

24 Comparison of occupational exposures in ethnic minority workers and the general Australian-born working population, unadjusted for occupational group Exposure Solar UVR RR (95% CI) Australian-born workers (n=952) 1.00 All (n=749) 0.89 ( ) Ethnic Minority Workers Arabic (n=210) 1.33 ( ) Vietnamese (n=232) 0.85 ( ) Chinese (n=307) 0.56 ( ) ETS RR (95% CI) ( ) 1.31 ( ) 0.86 ( ) 1.07 ( ) Diesel Exhaust RR (95% CI) ( ) 1.44 ( ) 0.81 ( ) 0.48 ( ) Silica RR (95% CI) ( ) 2.85 ( ) 2.11 ( ) 1.33 ( ) Other PAHs RR (95% CI) a ( ) 1.56 ( ) 2.35 ( ) 3.10 ( ) Benzene RR (95% CI) a ( ) 1.46 ( ) 1.11 ( ) 0.41 ( )

25 Comparison of occupational exposures in ethnic minority workers and the general Australian-born working population, adjusted for occupational group Australianborn workers Ethnic Minority Workers Exposure (n=952) All (n=749) Arabic (n=210) Vietnamese (n=232) Chinese (n=307) Solar UVR RR (95% CI) ETS RR (95% CI) ( ) 0.95 ( ) 1.10 ( ) 1.06 ( ) 0.83 ( ) 0.85 ( ) 0.61 ( ) 0.91 ( ) Diesel Exhaust RR (95% CI) ( ) 1.22 ( ) 0.96 ( ) 0.57 ( ) Silica RR (95% CI) ( ) 2.56 ( ) 1.87 ( ) 1.72 ( ) Other PAHs RR (95% CI) a ( ) 1.19 ( ) 1.46 ( ) 1.91 ( ) Benzene RR (95% CI) a ( ) 1.15 ( ) 1.07 ( ) 0.50 ( )

26 Approximately one-third of workers of Arabic, Vietnamese and Chinese ancestry were exposed to known workplace carcinogens in Australia in The overall prevalence was similar to that of the general Australian-born working population. But for some individual carcinogens, the likelihood of exposure was higher or lower why?

27 Possible reasons for exposure differences 1) Ethnic minority workers working in different occupations to the general Australian-born working population. e.g. Solar UVR higher among Arabic workers Greater proportion of Arabic participants working in occupations with a high likelihood of exposure to this carcinogen, such as vehicle drivers, construction workers and painters. e.g. Other PAHs higher in all ethnic minority groups Greater proportion of food service workers in ethnic minority groups. Controlling for occupation attenuated risk estimates.

28 Possible reasons for exposure differences But even after controlling for occupation and demographic factors: Workers in all three ethnic minority groups more likely to be exposed to silica and other polycyclic aromatic hydrocarbons than the general Australian-born working population. Chinese workers less likely to be exposed to solar ultraviolet radiation, diesel engine exhaust and benzene.

29 Possible reasons for exposure differences 2) Workers with similar occupations conducted different tasks. 3) Different perceptions and awareness of occupational exposures between different ethnic groups. 4) Some ethnic groups may be less likely to self-report occupational exposures. 5) Residual confounding by occupation. Boyle T, Carey R, Peters S, Glass D, Fritschi L, Reid A Demographic and occupational differences between ethnic minority workers who did and did not complete the telephone survey in English. Annals of Occupational Hygiene. In press Boyle T, Carey R, Peters S, Glass D, Fritschi L, Reid A Prevalence of occupational exposure to carcinogens among workers of Arabic, Chinese and Vietnamese ancestry in Australia. American Journal of Industrial Medicine. In press

30 Work-related accidents and injury - Australia Overall rate of work-related fatalities similar among foreign and Australian-born workers Higher fatality incidence rates: Among foreign-born workers in mining and rural occupations Among those in Australia for < 5 years Migrants from Non English Speaking Background Convergence toward Australian rate with increased duration of residence Since then: deindustrialisation work-related mortality intake skilled migration Rates for foreign-born workers haven t been examined since 1980s

31 Methods - Denominator National Censuses, 1991, 1996, 2001, 2006 & 2011 Numerator Death records (Occupation not recorded > 2002) Individual level hospital admission record for work-related injury admission 2001/ /10

32 Mortality rate ratios for deaths from work-related injuries by region of birth and sex Males Females Region of birth Southern Africa & All Other Countries 8 Asia 7 Americas 6 North Africa & 5Middle East New Zealand 4 Europe Mainland UK & Ireland Australia RR (95% CI) RR (95% CI) adjusted for age, census time point and employment skill level

33 Morbidity Rate ratios for admissions for workrelated injuries by country and region of birth and sex Region of birth Males RR (95% CI) Females All Other 17 Countries Sub Saharan 16 Africa South Africa 15 Malaysia 14 Philippines 13 Germany 12 China 11 Greece 10 India & Sri 9Lanka Americas 8 Viet Nam 7 Italy 6 North Africa 5 & Middle East New Zealand 4 Southern 3& Eastern Europe UK & Ireland 2 Australia RR (95% CI) adjusted for age and census time point

34 Discussion First examination of deaths and hospital admissions due to work-related injuries since transition to services-based economy and increased skilled migration Consistent pattern of lower mortality and likelihood of hospital admissions for foreign-born workers Including workers from countries historically thought to be at greater risk men and women from Eastern Asia In contrast men from New Zealand had greater risk of hospital admission due to work-related injury Overall the rates of work-related mortality fell.

35 Discussion Our results contrast with findings from other countries where migrants have higher work-related mortality rates In those countries migrants/foreign-born workers: More likely to work in agriculture and construction More likely to be unskilled and temporary workers In Australia, Australian-born workers: More likely to work in agriculture and construction More likely to work without paid leave entitlements Less likely to work in the services industry New Zealanders an exception Older age More likely to work in construction and manufacturing

36 Limitations/Strengths Limitations Hospital admissions - paid for by workers compensation Underestimates the risk of work-related injuries Particularly among foreign-born workers if differential access to compensation Death certificates as a source of work-related mortality Unable to examine traffic incidents Strengths National Data deaths and hospital admissions 16 year time span Population-based not limited to high risk industries Reid A, Peters S, Felipe N, Lenguerrand E, Harding S. The impact of migration on deaths and hospital admissions from workrelated injuries in Australia. Accepted Australia and New Zealand Journal of Public Health Reid A, Lenguerrand E, Santos I, Read U, LaMontagne AD, Fritschi L, Harding S. Taking risks and survival jobs: foreign-born workers and work-related injuries in Australia. Safety Science 2014:70:

37 Conclusion Work for migrants still hazardous Differential exposure to carcinogens than Australian-born Language or not speaking English is an important determinant of more hazardous work Australia may be doing better than many countries for WRI Still room for improvement!

38 Acknowledgments Italians at Wittenoom Nimashi Jayasinghe Susan Peters Enzo Merler Vittoria Bressan Exposure to carcinogens Terry Boyle Renee Carey Susan Peters Lin Fritschi Deb Glass Work-related injuries Nieves Felipe Susan Peters Erik Lenguerrand Seeromanie Harding