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BMJ Open. 2014 May 14;4(5):e004516. doi: 10.1136/bmjopen-2013-004516.

Non-cancer morbidity among Estonian Chernobyl cleanup workers: a register-based cohort study.

Author information

  • 1Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
  • 2Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, Stony Brook, New York, USA.
  • 3Finnish Cancer Registry, Helsinki, Finland.
  • 4School of Health Sciences, University of Tampere, Tampere, Finland Radiation and Nuclear Safety Authority, Helsinki, Finland.
  • 5Department of Public Health, University of Tartu, Tartu, Estonia.



To examine non-cancer morbidity in the Estonian Chernobyl cleanup workers cohort compared with the population sample with special attention to radiation-related diseases and mental health disorders.


Register-based cohort study.




An exposed cohort of 3680 men (cleanup workers) and an unexposed cohort of 7631 men (population sample) were followed from 2004 to 2012 through the Population Registry and Health Insurance Fund database.


Morbidity in the exposed cohort compared with the unexposed controls was estimated in terms of rate ratio (RR) with 95% CIs using Poisson regression models.


Elevated morbidity in the exposed cohort was found for diseases of the nervous system, digestive system, musculoskeletal system, ischaemic heart disease and for external causes. The most salient excess risk was observed for thyroid diseases (RR=1.69; 95% CI 1.38 to 2.07), intentional self-harm (RR=1.47; 95% CI 1.04 to 2.09) and selected alcohol-related diagnoses (RR=1.25; 95% CI 1.12 to 1.39). No increase in morbidity for stress reactions, depression, headaches or sleep disorders was detected.


No obvious excess morbidity consistent with biological effects of radiation was seen in the exposed cohort, with the possible exception of benign thyroid diseases. Increased alcohol-induced morbidity may reflect alcohol abuse, and could underlie some of the higher morbidity rates. Mental disorders in the exposed cohort were probably under-reported. The future challenge will be to study mental and physical comorbidities in the Chernobyl cleanup workers cohort.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to


Chernobyl nuclear accident; Estonia; MENTAL HEALTH; alcohol-induced disorders; morbidity; radiation effects

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