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Background: Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures., Materials and Methods: A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches., Results: One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans., Conclusions: The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.

Background: There is very limited systematic analysis of the causes and consequences of maritime accidents across the whole passenger sector during the twentieth century either in United Kingdom (UK) or in other maritime nations, but some of the larger events have been the subject of detailed investigations that led to improved safety measures. In recent years, there has been increased attention to the analysis of passenger ship accidents, especially in relation to the two now dominant markets: vehicle/passenger ferries and cruise ships., Materials and Methods: Long-term trends since 1900 in passenger and crew deaths on UK seagoing pas- senger ships that have sustained a maritime accident, as defined by Lloyds Register, have been collated and analysed., Results: Over the course of the 20th century, there has been a continuous fall in the number of incidents and in their severity. This may be a reflection of improved vessel safety, however the scale and nature of UK passenger shipping has also changed markedly over the period., Conclusions: In addition to the reducing frequency of deaths it is apparent that the majority of fatalities in both crew and passengers came from a very small number of major events during the study period. Altho- ugh there has been no major disaster involving a UK passenger ship in the last 30 years, major casualties with heavy loss of life continue in the world passenger fleet, in recent years involving flags such as Greece, Indonesia, Italy, Panama and The Philippines.

Background: To determine the causes and circumstances of vessel accidents that led to fatalities in British merchant shipping since 1925, and among British seafarers who were employed in non-United Kingdom shipping since 1985. Secondly, to establish trends in vessel accidents and crew fatalities, and associations with type of casualty and location, type of ship, cargo carried and season., Materials and Methods: Reviews of annual mortality returns, marine accident investigation reports, death inquiry files, Lloyd's casualty returns, online newspapers, shipwreck websites and other searches over the period from 1925 to 2017 but excluding 1939 to 1946., Results: The study identified 362 ship accidents in British shipping that led to 2760 crew and 605 passenger fatalities. There have been large reductions in both ship casualty and crew fatality rates, which have been greatest for vessels that were stranded, wrecked or foundered, particularly small coastal trading cargo ships. Reductions since the 1980s have coincided with proportionate increases in ship accidents and consequential crew fatalities among British seafarers employed in 'open register' shipping. Strong seasonal and geographical patterns show that most fatalities through foundering or wrecking occurred during winter months around Europe., Conclusions: Reductions in ship accidents and crew fatalities reflect major developments and improvements in ship navigational aids, improvements in rescue services and ship designs, and reductions in the volume of small coastal trading ships. Some disasters in 'open registry' shipping occurred in controversial circumstances, suggesting that substandard shipping has been flagged out or that lower cost but less competent crews have been employed.

Background: To establish the causes of mortality in the British fishing industry from 1900 up to 2010, to investigate long term trends in mortality and to identify causal factors in the mortality patterns and rates., Materials and Methods: A longitudinal study, based on examinations of official death inquiry files, marine accident investigation files and reports, death registers and annual death returns., Results: Mortality rates from accidents while working at sea remain high in the British fishing industry. Over the twentieth century there has been a progressive fall in the numbers of deaths, much of this relates to changes in fishing methods and in the types of vessels used. However in recent years, and with a fleet of smaller vessels, the mortality rates from accidents have shown little change and a larger proportion of deaths than in the past have arisen from personal injuries and drowning as compared to vessel losses. Disease makes a relatively small contribution to mortality at sea and this has dwindled with the decline in distant water fishing. Suicide and homicide both feature in a small way, but rates cannot readily be compared with those ashore., Conclusions: The pattern of change in vessels, fisheries and fishing techniques over the study period are complex. However, improved injury and drowning prevention is the most important way to reduce deaths, coupled with attention to vessel stability and maintenance. The social, economic and organisational features of the fishing industry mean that securing improvements in these areas is a major challenge.

Background and Aim: To establish the causes and circumstances of fatalities in recreational boating and sub-aqua diving inland or around the United Kingdom during the years 2006 and 2007, to comparefatal accident rates according to the type of boat, to identify causal patterns, and to discuss preventative measures to reduce the fatalities., Materials and Methods: Examinations of marine accident files and reports from the Marine Accident Investigation Branch and other sources, including the Royal National Lifeboat Institution, Maritime and Coastguard Agency, Association of Inland Navigation Authorities and the British Sub-Aqua Diving Club., Results: There were 102 fatalities in recreational boating and 28 in sub-aqua diving with corresponding fatal accident rates of 12.0 and 48.0 per million participants. In recreational boating, fatal accident rates were highest for motor and power boats (20.2), yachts (19.3) and canal boats (16.0). Most fatalities (64%) occurred from April to September, with a peak during August. In recreational boating, 24% of fatalities were recorded as alcohol-related. These were most prevalent in canal boats, occurring largely during the autumn and winter months rather than during summer holidays, among people living on boats, often asa result of fires and falls overboard., Conclusions: Causal patterns of the fatalities varied strongly according to the type of recreational boat anddiving. Prevention of fatalities should include raising awareness of hazards, adequate training in diving, yachting and canoeing, etc., installation and maintenance of smoke alarms and fire extinguishers on residential boats, and increases in the use of personal flotation devices in recreational boating.

OBJECTIVES. Evaluation of the effect of selected work environment factors on a sea-going ship on the occurrence of a sudden cardiac event and its recognition as a work-related accident. BACKGROUND. Sudden cardiac events, myocardial infarction in particular, among crews of seagoing ships are the most frequent reasons for fatal morbid events. In more than 20% of such cases, conditions and organization of work at sea are found to be of essential importance. Problems with certification are related with the assessment of the significance and impact of specific work environment factors overlapping with classic genetic and environmental factors of diseases of atherosclerotic origin. MATERIAL AND METHODS. The analysis embraced medical documentation on the state of health and working conditions at sea concerning 30 crewmembers of Polish sea-going vessels, who had suffered from sudden cardiac events in the years 1998-2009. The impact of selected work environment factors on the legitimacy of legal recognition of the event as a work-related accident was analysed by Fisher's test and multi-factorial regression. RESULTS. The presence of classic genetic and environmental risk factors of cardiovascular events was confirmed in all persons examined. A significant effect on destabilization of the disease, deterioration of health, and the occurrence of a sudden circulation event was shown to be strictly related with isometric and dynamic effort, particularly with heat discomfort in the maritime work environment. This satisfied the legal criteria for recognition of a work-related accident in half of the cases examined. CONCLUSIONS. Isometric and dynamic effort associated with work under heat stress conditions may be regarded as a decisive causative factor for a sudden cardiac event and the recognition of a work-related accident at sea.

Background: The objective was to investigate trends in work-related mortality from cardiovascular disease (CVD) among seafarers employed in British merchant shipping from 1919 to 2005, to compare CVD mortality among British seafarers at work in British shipping - and ashore in Britain - with that in the general British population, and to investigate work-related CVD mortality in British shipping during recent years according to factors such as rank, nationality, location, and type of ship., Material and Methods: A longitudinal study based on examination of death inquiry files and death registers, official death returns, and information from occupational mortality decennial supplements. The main outcome measures were population-based mortality rates and standardised mortality ratios., Results: There was an increase in work-related CVD mortality throughout much of the period from 1919 to 1962, but a subsequent reduction to 2005. Work-related mortality from CVD and ischaemic heart disease (IHD) was lower among seafarers employed in British shipping than in the corresponding general population (SMRs = 0.35 to 0.46), but mortality from CVD among British seafarers ashore in Britain was often increased. An elevated risk of work-related CVD mortality was also identified among the crews of North Sea offshore ships., Conclusions: This study shows a healthy worker effect against CVD mortality among seafarers at work in British shipping, but increased risks among British seafarers ashore in Britain, which would include seafarers discharged through CVD morbidity and other illnesses. The high risks of CVD mortality among seafarers in North Sea supply ships may reflect particular work-related hazards in this sector.

Objective: To investigate long-term trends in mortality rates for accidents to fishing vessels in the UK fishing industry from 1948 to 2008; to investigate the circumstances and causes of these fishing vessel accidents and trends in fishing vessel losses., Material and Methods: Examination of paper death inquiry files, death registers, marine accident investigative files, annual casualty and death returns., Results: Of 1039 fatalities from accidents to UK fishing vessels from 1948 to 2008, most (65%) resulted from vessels that foundered (or capsized or disappeared), followed by vessels grounding (21%), collisions (7%), and fires and explosions (5%). There was a significant increase over time of 1.04% per year in the overall fishing vessel loss rate and for vessels that foundered (5.19%), a reduction for vessels grounding (1.13%), but no trends for collisions or fires and explosions. Regarding mortality, there was a significant reduction over time for grounding (1.44%) and a non-significant reduction for vessel accidents overall, but no trends for other types of vessel accident. Mortality was highest during the winter months (for foundering and grounding), during night time (for grounding, fires and explosions), and afternoons (foundering and collisions). Since 1976, most fatalities from collisions (83%) occurred in the English Channel and North Sea, while 49% from grounding occurred off the west coast of Scotland., Conclusion: The mortality rate from fishing vessel casualties in UK fishing is still very high. Fatalities in recent years have often been linked to fishing vessels that are unstable, overloaded, and unseaworthy.

Background: Although commercial fishing has become established as the most hazardous occupation in Western countries, relatively little has been reported on mortality from disease among fishermen., Objective: To investigate the causes of work-related mortality from disease in the UK fishing industry from 1948 to 2005, trends in mortality over time and how it varies according to the sector of the fishing industry, to investigate non-work related mortality among fishermen ashore, and to compare it with that in other populations., Methods: Examination of paper death inquiry files, death registers and death returns, as well as GIS mapping for a defined population of 1.45 million fishermen-years at risk., Results: From 1948 to 2005, there were a total of 449 work-related deaths from disease identified in the UK fishing industry, with a corresponding mortality rate of 30.9 per 100,000. The mortality rate increased from about 35 per 100,000 in the late 1940s to 60 in the early/mid 1970s but fell sharply to about 10 by the late 1970s. Most of the deaths were caused by ischaemic heart disease followed by other circulatory diseases, respiratory and gastrointestinal diseases. The highest mortality rates were identified for fishermen employed on board distant water trawlers, particularly those operating in Arctic waters., Conclusions: The study shows that fishermen in distant water trawlers, particularly in Arctic conditions, have the highest risks of mortality from disease. The high risks presumably reflect lifestyle risk factors as well as extremely hazardous and stressful working and sleeping conditions.

Background: The Isle of Man is a UK crown dependency able to operate a category 1 shipping register, permitting its marine administration to register vessels of unlimited size and tonnage. Little is known about work related mortality among seafarers who are employed in Isle of Man registered shipping., Objectives: To establish the causes and circumstances of all work related deaths among seafarers who were working on board Isle of Man registered ships during the 20 year period from 1986 to 2005, to compare mortality rates with those in other merchant fleets, and to discuss preventative measures., Methods: A longitudinal population based study, based on examination of death inquiry files, and information from marine investigations of fatal accidents., Results: Over the 20 year study period, there were 65 work related deaths identified among seafarers employed in Isle of Man shipping. These deaths were caused by disease (20), accidents (34), suicide (2) and from unexplained circumstances (9). The mortality rate for accidents occurring at work was 53 per 100000 seafarer-years for the seven years 1990, 1991, 1993-1997. Over the 18 years from 1988 to 2005 it was estimated at 44 per 100000, while for confirmed suicides the suicide rate was estimated at 1.3 per 100000., Conclusions: Although the fatal accident rate was higher in Isle of Man shipping than in the national UK fleet; compared with those in other merchant fleets internationally, the fatal accident and suicide rates in the Isle of Man fleet are quite low.

Objectives: To investigate work related mortality from gastrointestinal diseases and from alcohol among seafarers who were employed in British merchant shipping from 1939 to 2002., Methods: A longitudinal study, based on official mortality files from 1976-2002 and official mortality returns from 1939-1975, with a population of 7.29 million seafarer-years at risk., Results: From 1939 to 2002, there were 864 deaths from gastrointestinal diseases and 72 from alcoholism. Overall mortality from gastrointestinal diseases fell from 18.4 per 100,000 in 1939-49 to 9.3 in 1970-79 and 0.3 in 1990-2002. Mortality from alcoholism, and from alcohol-related diseases such as liver cirrhosis and diseases of the pancreas, increased up to the 1960s or 1970s, but fell thereafter. From 1950 to 1972, mortality from gastrointestinal diseases was 1.8 times higher among Asian seafarers compared to British seafarers, largely because of liver disease, peritonitis and peptic ulcer. At the time of the last censuses of seamen in 1961 and 1971, compared with the general British male working aged population, morality among British seafarers was greatly increased for peritonitis and alcoholism but not for most other gastrointestinal diseases., Conclusions: Sharp reductions in mortality from gastrointestinal diseases and from alcoholism since the 1970s contrasts with increases among the general British population, and are largely because of the "flagging-out" of most British deep sea ships, and consequent reductions in long voyages, as well as reductions in alcohol consumption among seafarers at work. Largely because of the healthy worker effect, seafarers were usually only at increased risks from particularly acute diseases.

Objective: To analyse work related homicides among various defined populations of seafarers and fishermen during the period 1976-2002, to compare homicide rates with other occupations and general populations, and to discuss implications for maritime health and safety., Methods: A longitudinal study of work related homicides, based on official mortality files, with an aggregated population of almost two million seafarer-and fishermen-years at risk., Results: Of 46 work related homicides, 44 occurred among seafarers, and two among fishermen. Homicide rates were 1.5 per 100,000 worker-years among seafarers in British merchant shipping (1976-2002), 2.9 per 100,000 among British seafarers employed in non British shipping (1986-95), 3.7 in Singapore shipping (1984-95) and in Hong Kong shipping (1981-95), and 0.4 among fishermen in British fishing (1976-2002). The homicide rate in British shipping increased from 2.7 per 100,000 seafarer-years in 1961-65 to 4.4 per 100,000 in 1971-75, but has declined to 0.0 in 1996-2002., Conclusions: Although work related homicides were generally quite rare occurrences, among British seafarers and fishermen, they were largely caused by attacks from assailants, other than colleagues, that occurred ashore. The decline in the homicide rate in British shipping since the 1970s has coincided with the reduction in deep-sea ships trading to high risk countries for homicide. Among Asian seafarers, most homicides resulted from disputes among colleagues that mainly occurred on board ships. Prevention should include alertness to potential risks when spending off-duty time ashore in locations with high homicide rates, and conflict resolution for disputes among seafarers.

Objective: To establish and analyse the causes and circumstances of all deaths among British seafarers who were working in flags of convenience merchant shipping between 1976 and 1995, to compare mortality with British seafarers employed in British merchant shipping, and to discuss implications for health and safety., Methods: A retrospective longitudinal study of occupational mortality, based on official mortality files., Results: Out of a total of 200 deaths in flags of convenience shipping, illnesses caused 68 deaths, accidents 91, homicide 3, suicide 7, drug and alcohol intoxication 4, and disappearances at sea and other unknown causes 27. Deaths from non-natural causes and, in particular, maritime disasters accounted for a significantly higher proportion of all deaths in flags of convenience than in British shipping. The maritime disasters largely involved small cargo ships foundering or disappearing in bad weather., Conclusions: Although mortality rates could not be calculated, because of the unavailability of population information, British seafarers who work for flags of convenience registries appear to be at increased risk of mortality through maritime disasters, as well as through occupational accidents and suicide. Many of the occupational accidents, such as asphyxiation in cargo holds, were caused by hazardous working practices, and the disappearances of small cargo ships raises questions about their seaworthiness. Future efforts should focus on investigating the mortality and health of seafarers working in flags of convenience ships, and on improving mortality and population information systems for these registries.

Objective: To establish the cause and circumstances of all deaths from disease among seafarers who were working in British merchant shipping between 1976 and 1995. Further aims were to discuss implications for reducing mortality and for maritime health care., Methods: A retrospective study of occupational mortality, based upon official mortality files, with a population of 983,119 seafarer-years at risk., Results: Out of a total of 600 deaths from disease, 427 (71%) were caused by cardiovascular disease; 247 of the 427 (58%) were taken ill at sea and 180 (42%) in port. Over 60% of the 427 who died from cardiovascular disease were off-duty at the time of onset and over 40% were found dead. Rates of evacuation to hospital before death from cardiovascular disease were 7% at sea and 9% in port. Fifty-five deaths from gastro-intestinal disease (9% of all deaths) were largely due to liver cirrhoses and stomach ulcers (14 each) and acute pancreatitis (seven). Trends in crude mortality rates for both cardiovascular and non-cardiovascular disease declined between 1976 and 1995., Conclusions: Seafarers are at special risks from acute illnesses since they lack direct access to specialist medical care. Prevention should be aimed at improvements in the use of radio-medical advice and in medical training for ship's officers. Also, since many deaths were linked to lifestyle factors such as smoking, obesity and heavy alcohol consumption, primary preventative advice would be of benefit.