A cohort study was conducted in 51 mills from 21 corporations selected to represent the current distribution of types of pulping operations in the United States in an effort to determine whether workers in the pulp and paper industry had a different mortality than the general population. The cohort consisted of 63,025 long term workers with 10 or more years of employment. Overall mortality and all cancer mortality rates were significantly lower in this population than the United States rates. For each of the specific causes of death, mortality rates were close to or below those expected based on the United States population, with the exception of testicular and kidney cancers and lymphosarcoma and benign neoplasms. Workers in the New England mills appeared to have a higher all cause mortality than other areas of the country. Mills in that region tended to be older and had multiple types of pulping operations in the past. The workers were also older. The determination of risks was also examined from the point of view of the pulping processes used. Workers seemed to have different risks depending on the type of pulping process, after adjusting for age, or age and calendar time. The findings suggest an association between all cause mortality, heart disease, all cancers, brain cancer, and lymphoma and work in mills using other chemical pulping. The relative risks were also elevated for kraft pulping workers as well, but not significantly. Lung cancer risk was associated with working kraft mills.

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