Reversal of the Healthy-worker Effect.

The well-known healthy-worker effect (HWE) may become reversed at advanced ages. The HWE deficit of deaths at younger ages must be compensated for by extra deaths at advanced ages. A hypothesized distribution of these compensating deaths illustrates how they may increase age-specific mortality rates. This can probably produce spurious associations with occupational exposures when cohort follow-up is long. This point is illustrated for lung cancer by data from a reported study of beryllium workers.