Jump to main content
US EPA
United States Environmental Protection Agency
Search
Search
Main menu
Environmental Topics
Laws & Regulations
About EPA
Health & Environmental Research Online (HERO)
Contact Us
Print
Feedback
Export to File
Search:
This record has one attached file:
Add More Files
Attach File(s):
Display Name for File*:
Save
Citation
Tags
HERO ID
625164
Reference Type
Journal Article
Subtype
Review
Title
The evolving concept of the healthy worker survivor effect
Author(s)
Arrighi, HM; Hertz-Picciotto, I
Year
1994
Is Peer Reviewed?
Yes
Journal
Epidemiology
ISSN:
1044-3983
EISSN:
1531-5487
Volume
5
Issue
2
Page Numbers
189-196
Language
English
PMID
8172994
DOI
10.1097/00001648-199403000-00009
Abstract
The "healthy worker survivor effect" describes a continuing selection process such that those who remain employed tend to be healthier than those who leave employment. In an analysis of exposure-response patterns in an occupational study, the healthy worker survivor effect generally attenuates an adverse effect of exposure. In practical terms, such attenuation will be more problematic when evaluating subtle rather than strong associations. The use of an internal referent does not guarantee elimination of this effect, since by definition, it manifests within an occupational cohort. Although documented over 100 years ago, there is little consensus regarding the most appropriate method to control for the healthy worker survivor effect. Four methods have been proposed for its control: (1) restriction of the cohort to survivors of a fixed number of years of follow-up, (2) lagging the exposure to exclude recent exposure incurred by those who remained on the job, (3) adjusting for employment status as a confounder, and (4) treating the healthy worker survivor effect simultaneously as an intermediate and confounding variable by means of the G-null test or its extension, G-estimation analysis, using structurally nested failure time models. This paper reviews the concept of the healthy worker survivor effect and the four methods to control for it.
Tags
IRIS
•
Chloroprene
Cited 2010 Final
•
Project 9 – Soil and Dust Ingestion
Cited October 2016
Supplemental Information - Cited
Home
Learn about HERO
Using HERO
Search HERO
Projects in HERO
Risk Assessment
Transparency & Integrity