The examinations were conducted by experienced occupational health physicians and documented according to a standardized protocol. γ-GT levels in this study were measured at 25°C with a Hitachi 705/717 system. Measures of γ-GT were missing in 818 cases because some workers either rejected providing a blood sample or provided external laboratory-analyzed findings from a recent blood analysis,

which were not included in the medical records used for our study. Information on date and Copanlisib cause of disability pension was obtained from the German pension fund in March 2006. The pension register of the German Pension Fund Baden-Württemberg provided information regarding vital status and whether the individual was still working, had retired due to age, was unemployed or under rehabilitation, or whether a disability pension (permanent or temporary) was granted. In case of missing data with respect to actual employment or pension status, which occurred mainly due to remigration Caspase activity of some foreign workers as well as due to a high occupational fluctuation in the construction industry, we also included the information from previous follow-up rounds performed from 1992–1994 and 1998–2000.17, 18 The criteria for being work-disabled

and receiving disability pension are under repeated revision. Up to the year 2000, a disability pension was granted in Germany when the ability to earn a living (i.e., working hours) has been permanently reduced by at least 50% due to injury, illness, or impairment—irrespective of whether the injury was caused by work or not—and whether the worker could not be referred to another adequate occupation. In the year 2001 the threshold was set to 3 and 6 hours of work ability per day for complete and partial work disability. Irrespective of these changes, disability pensions were granted throughout the entire follow-up, contingent on thorough medical examination by the pension fund’s medical service. Causes of disability pension were coded according to the International Classification of Diseases (ICD-9) and validated by trained medical see more officers from the pension fund.

Regarding the 818 men with missing measures of γ-GT at baseline (4.2%), we used multiple imputation to fill in the pertinent missing baseline data for γ-GT according to subject age. Another 2,083 men (10.7%) had to be excluded who had either moved to a different region or had changed employment, and for whom no information from previous follow-up rounds were available. The very strict confidentiality rules in Germany did not allow us to follow these people further. Hence, the final study population for this analysis comprised 16,520 construction workers who could be successfully linked with the pension register. Because nowadays serum activity of γ-GT is measured at 37°C in general, we converted γ-GT values to the current measure as previously described.