Impact of Secondary Prevention on Mortality in the Building Trades National Medical Screening Program: Effectiveness of Occupational High‐Risk Management

BACKGROUND: Since 1997 the Building Trades National Medical Screening Program (BTMed) has offered medical exams to construction workers employed in US nuclear weapons facilities. The process consists of two steps: (1) a detailed work history interview; and (2) a medical exam. Some participants only completed the work history interview, and we compared their mortality experience to those who also completed medical exams. METHODS: We compared the mortality of 3470 work-history-only participants to 23,452 participants who completed both the work history interview and medical exams and, of these, 1720 who additionally participated in lung cancer screening. We used Cox proportional hazard and Poisson regression models to estimate hazard ratios and risk ratios while controlling for potential confounders. RESULTS: Medical exam participants experienced a reduction in mortality risk of 28% for all causes combined; 27% for all respiratory diseases combined; 37% for chronic obstructive pulmonary disease; 30% for cardiovascular diseases combined; 32% for all cancers combined; 36% for lung cancer; and 53% for colorectal cancer. The more medical exams they undertook the greater the mortality risk reduction (25%, 29%, and 43% for one, two, and three medical exams, respectively), demonstrating a clear trend. BTMed has prevented approximately 2911 premature deaths among our participants through 2021 and added 35,178 years of life, an average of 1.5 years per participant, at a cost of $2757 per year of life saved. CONCLUSIONS: Secondary prevention in occupational high-risk groups is very effective. Continued surveillance beyond retirement age is important to reduce mortality.