LETTER TO THE EDITOR Excess Mortality Among Golf Course Attendants KEY WORDS: occupational mortality; golf course workers In a recent issue of this journal, Kross et al [1996] published the first study which provides mortality figures for male golf course attendants. It was found that these employ- ees had an excess mortality from arteriosclerotic heart disease and from respiratory diseases, compared with the general population. This is an unexpected finding because, as a result of health-based selection, mortality from these diseases is usually lower among people in employment than in the population at large [Checkoway et al., 1989]. Kross et al. interpreted this excess mortality—without further discus- sion—as being caused by heavy smoking. However, no data with regard to smoking habits were available, and no clear increase was found for typical smoking-related cancers, such as lung cancer and bladder cancer. An alternative explanation might be that golf course work attracts persons who are not fit enough to find employment in industries with a heavy work-load. Another remark which I would like to make concerns the finding of a significant increase of mortality from prostate cancer. Kross et al. limited themselves to stating that associations were found to exist between prostate cancer risk and firefighting and farming. It might be of interest to mention that the literature points to an association between the use of pesticides and other agricultural chemicals and prostate cancer [Van der Gulden, Vogelzang 1996;Aronson et al., 1996]. In these reports, there is also some evidence to indicate that prostate cancer risk may be related to exposure to combustion products, such as diesel exhaust from agricultural machinery. These types of exposure are relevant to golf course work. J.W.J. van der Gulden, MD, PhD University of Nijmegen Nijmegen, The Netherlands REFERENCES Kross BC, Burmeister LF, Ogilvie LK, Fuortes LJ, Fu CM (1996): Proportionate mortality study of golf course superintendents. Am J Ind Med 29:501–506. Checkoway H, Pearce NE, Crawford-Brown DJ (1989): ‘‘Research meth- ods in occupational epidemiology.’’New York: Oxford University Press. Van der Gulden JWJ, Vogelzang FPJ (1996): Farmers at risk for prostate cancer. Br J Urol 77:6–14. Aronson KJ, Siemiatycki J, Dewar R, Ge ´rin M (1996): Occupational risk factors for prostate cancer: Results from a case-control study in Montre ´al, Que ´bec, Canada. Am J Epidemiol 143:363–373. Correspondence to: J.W.J. van der Gulden, MD, PhD, Department of Occupa- tional Medicine, University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Accepted for publication 23 December 1996 AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 32:98 (1997) r 1997 Wiley-Liss, Inc.

Excess mortality among golf course attendants

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LETTER TO THE EDITOR

Excess Mortality Among Golf Course Attendants

KEYWORDS: occupational mortality; golf course workers

In a recent issue of this journal, Kross et al [1996]published the first study which provides mortality figures formale golf course attendants. It was found that these employ-ees had an excess mortality from arteriosclerotic heartdisease and from respiratory diseases, compared with thegeneral population. This is an unexpected finding because,as a result of health-based selection, mortality from thesediseases is usually lower among people in employment thanin the population at large [Checkoway et al., 1989]. Kross etal. interpreted this excess mortality—without further discus-sion—as being caused by heavy smoking. However, no datawith regard to smoking habits were available, and no clearincrease was found for typical smoking-related cancers,such as lung cancer and bladder cancer. An alternativeexplanation might be that golf course work attracts personswho are not fit enough to find employment in industries witha heavy work-load.

Another remark which I would like to make concernsthe finding of a significant increase of mortality fromprostate cancer. Kross et al. limited themselves to stating

that associations were found to exist between prostate cancerrisk and firefighting and farming. It might be of interest tomention that the literature points to an association betweenthe use of pesticides and other agricultural chemicals andprostate cancer [Van der Gulden, Vogelzang 1996; Aronsonet al., 1996]. In these reports, there is also some evidence toindicate that prostate cancer risk may be related to exposureto combustion products, such as diesel exhaust from agricul-tural machinery. These types of exposure are relevant to golfcourse work.

J.W.J. van der Gulden, MD, PhDUniversity of NijmegenNijmegen, The Netherlands

REFERENCES

Kross BC, Burmeister LF, Ogilvie LK, Fuortes LJ, Fu CM (1996):Proportionate mortality study of golf course superintendents. Am J Ind Med29:501–506.

Checkoway H, Pearce NE, Crawford-Brown DJ (1989): ‘‘Research meth-ods in occupational epidemiology.’’ New York: Oxford University Press.

Van der Gulden JWJ, Vogelzang FPJ (1996): Farmers at risk for prostatecancer. Br J Urol 77:6–14.

Aronson KJ, Siemiatycki J, Dewar R, Ge´rin M (1996): Occupational riskfactors for prostate cancer: Results from a case-control study in Montre´al,Quebec, Canada. Am J Epidemiol 143:363–373.

Correspondence to: J.W.J. van der Gulden, MD, PhD, Department of Occupa-tional Medicine, University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, TheNetherlands.

Accepted for publication 23 December 1996

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 32:98 (1997)

r 1997 Wiley-Liss, Inc.