The “healthy worker effect” in pilots and radiation: a systematic review and meta-analysis. Comparison with indexes for nuclear workers

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Abstract

Pilots are included in the list of professions with the most serious selection for health reasons, and therefore the standardized mortality ratio (SMR) indexes for them and the corresponding levels of the “Healthy worker effect” (HWE) can be considered as reference, despite the fact that this professional group is exposed to chronic radiation exposure due to cosmic radiation, which includes a significant proportion of protons and neutrons. A systematic review, combined analyzes (by means of samples) and meta-analysis of papers for SMR estimation for all causes and all cancer mortality for pilots were conducted; final samples included 16 and 13 publications. The presence of HWE was judged based on the fact that the upper limit of the 95% confidence interval (CI) for SMR should be <1.0. As a result of the combined analysis and meta-analysis, values for SMR all causes were 0.60 (95% CI: 0.50; 0.69) and 0.57 (95% CI: 0.48; 0.66), respectively, and for SMR all cancer, equal to 0.61 (95 % CI: 0.51; 0.72) and 0.62 (95% CI: 0.52; 0.75). Thus, compared to the general population, pilots have a 40% reduction in mortality from all causes and from all cancers. This is due to the special health of the pilots, as well as their selection, since studies of SMR all causes and SMR all cancer in flight attendants exposed to the same adverse factors (with the possible exception of occupational stress), but not undergoing rigorous selection, did not reveal a single SMR index which would demonstrate the presence of HWE. SMR all causes and SMR all cancer levels for pilots have remained largely unchanged since the 1970s to 2019 of cohort follow-up, despite the fact that during these periods, due to an increase in flight altitude, both the radiation exposure rate and accumulated radiation doses increased. A review of the sources showed that attempts to detect a dose-dependent increase of the translocation rate in pilots (that is, chromosome aberrations – indicators of carcinogenesis) turned out to be untenable. Thus, the radiation factor is unlikely to affect pilot mortality, but hormesis effects, based on SMR data for flight attendants, are unlikely. Comparison of HWE levels for all causes for pilots and nuclear workers found high effects for some cohorts of workers, especially in the early decades (SMR for all causes in the range of 0.3–0.6 for UK and French personnel). Although such a high level of HWE is not characteristic of most nuclear workers, this effect is reproduced over and over again in cohorts from different countries. The fact that nuclear workers can have SMR comparable to the ‘standard’ occupational selection group, i.e. pilots, enhances the image of both the nuclear industry and employment in the nuclear power branch.

About the authors

A. N. Koterov

State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency

Author for correspondence.
Email: govorilga@inbox.ru
Moscow, Russia

L. N. Ushenkova

State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency

Email: ushenkova2011@mail.ru
Moscow, Russia

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