Electricity Supply Industry (ESI) Mortality Study

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

[1 paragraph unchanged] This is a Data Sharing Agreement (DSA) with the University of Warwick [13 words unchanged] below. The previous Data controller was the University of Birmingham (UoB). Under this DSA (v5), v5 of the DSA, the Controllership is transferring transferred from the University of Birmingham to the University of Warwick. This The DSA permits permitted the transfer of Data from the UoB to the UoW. [16 paragraphs unchanged]

Processing activities

[1 paragraph unchanged] Upon signing of v5 of this the DSA the master study file, containing month and year of birth and employment history and death and cancer registration Data supplied previously by NHS Digital, will be was transferred from the University of Birmingham (UoB) to the University of Warwick (UoW). [20 paragraphs unchanged]

Benefits reported

[5 paragraphs unchanged] Update 03/03/2026. No further yielded benefits have been identified since the previous iteration. Additional data will be required to complete further research, however the legal basis to request this is currently being addressed.

Unchanged: Expected output, Expected measurable benefits.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Data controllers: + UNIVERSITY OF WARWICK · − UNIVERSITY OF BIRMINGHAM

Objective for processing

This is a Data Sharing Agreement with University of Birmingham to permit retention of mortality and cancer registration data provided by NHS Digital under a previous iteration of this agreement. University of Warwick (UoW) requires access to NHS England Data for the purpose of the following research project, Electricity Supply Industry (ESI) Mortality Study. This study was instigated by the Central Electricity Generating Board (CEGB) of England and Wales in 1975, to discover whether any of its employees have suffered long-term health effects from occupational exposures received in the course of employment in the electricity supply industry. Financial support, administrative support and technical support have been provided to the study by the successor companies of the CEGB which came into being after the privatisation in 1990. This is a Data Sharing Agreement (DSA) with the University of Warwick (UoW) to retain NHS England Data for an established cohort of individuals described below. The previous Data controller was the University of Birmingham (UoB). Under this DSA (v5), the Controllership is transferring from the University of Birmingham to the University of Warwick. This DSA permits the transfer of Data from the UoB to the UoW. The aim of this study is to monitor the long-term health experience of workers in the electricity supply industry, using mortality and cancer registration data in order to identify unrecognised health hazards in that industry. The study also has a specific aim which is to identify and quantify any health effects from exposure to extremely low frequency electric and magnetic fields (ELF-EMF) and the study is probably the single most important source of information in the UK on this topic. The study continues to provide ever more extensive information as to whether exposure to magnetic fields is a risk factor for leukaemia, brain tumours or neurodegenerative disorders (Alzheimer’s disease, Parkinson’s disease and motor neuron disease). The Data were pseudonymised in 2013 at UoB and identifiers were replaced by a unique study ID. The study maintains the original data collected from employer records on dates of birth (month and year only) and dates of employment because these form an integral part of the analysis of the data, both in the statistical adjustment of age effects and the development of exposure histories. NHS Digital has provided record-level mortality and cancer registration data for a cohort of patients, to the Institute of Applied Health Research at the University of Birmingham. Cohort members were all employed in the electricity supply industry and consented to the processing of his or her personal data for the purposes of this study. Membership of the cohort is fixed and there will be no new study participants. The following is a summary of the aims of the research project provided by the University of Warwick: The GDPR Lawful basis for processing the requested data under this agreement are; “This study was instigated by the Central Electricity Generating Board (CEGB) of England and Wales in 1975, to discover whether any of its employees have suffered long-term health effects from occupational exposures received in the course of employment in the electricity supply industry. Financial support, administrative support and technical support have been provided to the study by the successor companies of the CEGB which came into being after the privatisation in 1990. The aim of this study is to monitor the long-term health experience of workers in the electricity supply industry, using mortality and cancer registration Data in order to identify unrecognised health hazards in that industry. The study also has a specific aim which is to identify and quantify any health effects from exposure to extremely low frequency electric and magnetic fields (ELF-EMF); this study is probably the single most important source of information in the UK on this topic. The study continues to provide ever more extensive information as to whether exposure to magnetic fields is a risk factor for leukaemia, brain tumours or neurodegenerative disorders (Alzheimer’s disease, Parkinson’s disease and motor neurone disease).” Article 6(1)(e) (Public Task processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller). The level of the Data held by the UoW will be Pseudonymised. Article 9(2)(j) (processing is necessary for reasons of public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interest of the data subject. The Data is minimised as follows: The University of Birmingham was approached to undertake this work by the Energy Networks Association (ENA) a Trade Association whose members include the successor companies of the CEGB . The University of Birmingham was selected due to its track record in the identification, quantification, and control of occupational health risks. · Limited to a study cohort of 75,143 employees. The University of Birmingham is the sole Data Controller and sole Data Processor of data provided under this agreement. · Limited to people that were employed between 1973-82 with some employment in the electricity supply industry in that period. National data is required because the study was setup as a national study of all employees with some employment in the electricity supply industry in the period 1973-82. This national coverage provides maximum statistical power and provides findings that have national application. The study would be weakened with only regional subsets of data and the findings would be less credible. Given the potential impact of the findings on national policy for exposure to EMF it is essential to minimise uncertainty. University Of Warwick is the Controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above. The study is long-running and follow-up data on deaths and cancer registrations have been supplied by NHS Digital and its forerunners for many decades. This enables a full investigation of possible long-term effects of occupational exposures to be carried out for the electricity supply industry, including data on any disease that might have a long interval between exposure and appearance of disease (long latency). The lawful basis for processing personal data under the UK GDPR is: The data at the University of Birmingham were pseudonymised in 2013 and all information on names, addresses, postcodes, National Insurance (NI) numbers, and NHS numbers were destroyed and replaced with a unique identifier (Study-ID) that NHS Digital uses to identify study members. Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. The study requires record-level, pseudonymised data containing unique identifier (study-ID), dates of death and ICD codes for causes of death, dates of cancer registrations and ICD codes for site and type of cancer. The lawful basis for processing special category Data under the UK GDPR is: The study is using the minimum amount of data possible to achieve the study objectives. There is no other way beyond those described in this application in which the study objectives can be met. Article 9(2)(j) (processing is necessary for reasons of public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to Data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interest of the Data subject. It is in the public interest to know the health effects of employment in the electricity supply industry/exposure to ELF-EMFs. There are no known harms involved in disseminating the findings of research on this cohort. The study maintains the original data collected from employer records on dates of birth (month and year only) and dates of employment because these form an integral part of the analysis of the data, both in the statistical adjustment of age effects and the development of exposure histories. The funding is provided by Northmere Trust via a contract with the Energy Networks Association (ENA). The funding is specifically for the study described. Funding is in place until 31st January 2026. Administrative support and technical support have been provided to the study by the successor companies of the CEGB which came into being after the privatisation in 1990. Administrative support has been provided in the past by the Human Resources departments of the successor companies to update work histories of study subjects. Such updates have not been possible since 2013 when all participants were pseudonymised. Cloud hosting at the UoW is provided by Microsoft. Microsoft provides IT back up services to UoW and will store copies of the Data as contracted by UoW. Technical support has been provided in the past by the successor companies such that exposure to magnetic fields has been estimated for each power station, for each calendar year of operation and for each department. The cohort was assembled prior to PPIE being established. When the cohort was assembled in the 1990s it had the support of the successor companies and unions. The study continues to receive financial support for some time from the Northmere Trust, a fund set up at the time of privatisation to enable studies to be carried out into possible long-term health effects of exposure to electric and magnetic fields. Upon transfer, only substantiative Employees of University of Warwick will access the Data.

Processing activities

The cohort for this study is fixed and no further flow of data to NHS Digital England is required. Historical data that flowed to forerunners of NHS Digital England comprised names and dates of birth of employees in the electricity supply [24 words unchanged] and NHS numbers were destroyed and replaced with a unique identifier (Study-ID). Civil Registration (Deaths) Upon signing of v5 of this DSA the master study file, containing month and Cancer Registration year of birth and employment history and death and cancer registration Data flowed supplied previously by NHS Digital, will be transferred from NHS Digital the University of Birmingham (UoB) to the University of Birmingham to provide pseudonymised record-level data containing study-ID, dates of death and ICD codes for causes of death, dates of cancer registrations and ICD codes for site and type of cancer. Warwick (UoW). On receiving the NHS Digital datasets, study-ID, dates of death, causes of death, dates of cancer registrations and site and type of cancer was transferred to a ‘new follow-up’ spreadsheet, and saved into the same restricted area of the University server as the master study file. The main study file contains the study-ID, dates of birth (month and year only), work histories, in addition to death and cancer registration data supplied previously by NHS Digital (and its forerunners). Upon transfer to the UoW: Death data are transferred from the new follow-up file into the main study file if a matching Study-ID is found and if there are no death data already present in the master file for that ID. If death data are already present in the master file, new and old data are reviewed to establish whether this is just a case of duplicate data or whether there is a genuine clash of data (death details for two separate individuals have become confused). In the very few instances of genuine clashes of data, assistance of NHS Digital staff is sought. Cancer registration data are transferred from the new follow-up file into the main study file if a matching Study-ID is found. A separate program seeks evidence of duplicate entries. For any cases where it is not possible to resolve discrepancies between data in the main study file and new data from NHS Digital, the new data will be destroyed. The Data will be accessed by authorised personnel via onsite premises or via remote access. Analyses of these data is used to calculate standardised mortality ratios (SMRs) for different causes of death, using national mortality rates as a basis of comparison. These SMRs are adjusted for age, sex and calendar year. Analyses of these data is used to calculate standardised registration ratios (SRRs) for different sites of cancer death, using national registration (incidence) rates as a basis of comparison. These SRRs are also adjusted for age, sex and calendar year. Estimates of cumulative occupational exposure to magnetic fields have also been calculated for each study member and, in separate analyses, Poisson regression is used to calculate relative risks for cumulative exposure categories, using risks in the lowest exposure group as a baseline or reference category. Such analyses seek evidence of dose-response effects i.e. does the risk of a disease increases with increasing exposure. Personnel are prohibited from downloading or copying Data to local devices. Data supplied by NHS Digital will not be linked to any data other than pseudonymised employment history data held by the University of Birmingham, containing details on dates of birth (month and year only) and work histories (dates of employment and job titles). There will be no attempt to re-identify individuals from the data. The data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide. E.g., in the form of peer-reviewed academic literature. The Data will be accessed by authorised personnel via remote access. The data provided by NHS Digital was downloaded to a University of Birmingham computer, saving it in a restricted area of the University server that is only accessible to specified members of the research team. Data within this area of the server is backed up internally, so that data can be securely deleted within two weeks of a deletion request from NHS Digital. All data is stored and processed by the Institute of applied Health Research (IAHR) department in the Institute of Occupation and Environmental Medicine (IOEM) building at the University of Birmingham. The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract. Data will only be accessed by substantive employees from the Institute of Applied Health Research at the University of Birmingham. There will be no attempt to re-identify individuals from the data. For remote access: - Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA; - Access controls granting users the minimum level of access required are in place; - Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data; - Multifactor authentication (MFA) is required for remote access; - Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access; - All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy. The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose). Access will be restricted to employees or agents of the University of Warwick who have authorisation from the Principal Investigator. Cloud hosting is provided by Microsoft. Microsoft provides IT back up services to UoW. The Data will not leave England at any time. All personnel accessing the Data have been appropriately trained in Data protection and confidentiality. The Data will not be linked with any other Data. There will be no requirement and no attempt to reidentify individuals when using the Data. Researchers from the University of Warwick will process the Data for the purposes described above.

Expected output

[1 paragraph unchanged] 1) Harrington JM, McBride DI, Sorahan T, Paddle GM, van Tongeren M. Occupational exposure to magnetic fields in relation to mortality from brain cancer among electricity and transmission workers. Occup Environ Med 1997;54:7-13. 2) Harrington JM, Nichols L, Sorahan T, van Tongeren M. Leukaemia mortality in relation to magnetic field exposure: findings from a study of United Kingdom electricity generation and transmission workers, 1973-97. Occup Environ Med 2001;58:307-314. 3) Sorahan T, Nichols L, van Tongeren M, Harrington JM. Occupational exposure to magnetic fields relative to mortality from brain tumours: updated [7 words unchanged] United Kingdom electricity generation and transmission workers, 1973-97. Occup Environ Med 2001;58:626-630. 4) Sorahan T, Nichols L. Mortality from cardiovascular disease in relation to magnetic field exposure: findings from a study of UK electricity generation and transmission workers, 1973-1997. Am J Ind Med 2004;45:93-102. 5) Nichols L, Sorahan T. Mortality of UK electricity generation and transmission workers, 1973-2002. Occup Med 2005;55:541-548. 6) Sorahan T, Kheifets L. Mortality from Alzheimer’s, motor neurone and Parkinson’s disease in relation to magnetic [6 words unchanged] of UK electricity generation and transmission workers, 1973-2004. Occup Environ Med 2007;64:820-826. 7) Sorahan T. Cancer incidence in UK electricity generation and transmission workers, 1973-2008. Occup Med 2012;62:496-505. 8) Sorahan T. Magnetic fields and brain tumour risks in UK electricity supply workers. Occup Med 2014;64:157-165. 9) Sorahan T. Magnetic fields and leukaemia risks in UK electricity supply workers. Occup Med 2014;64:150-156. 10) Sorahan T, Mohammed N. Neurodegenerative disease risks and magnetic field exposures in UK electricity supply workers. Occup Med 2014;64:454-460. 11) Sorahan T Cancer incidence in UK electricity generation and transmission workers, 1973-2015. Occupational Medicine 2019;69:342-351. doi:10.1093/occmed/kqz082. All publications contained The outputs will not contain NHS England Data and will only contain aggregated outputs information with small numbers suppressed as appropriate in line with the HES Analysis Guide (http://doc.ukdataservice.ac.uk/doc/8681/mrdoc/pdf/nextsteps_hes_user_guide_v1.pdf) relevant disclosure rules for the dataset(s) from which the information was derived. The outputs will continue to be disseminated to the relevant stakeholders during the project and after its completion. Specifically: The scientific community The outputs will be communicated to relevant recipients through the following dissemination channels: Further high-quality academic papers will be published. For example, work is currently on-going to produce an updated analysis of motor neurone disease (MND) risks in relation magnetic field exposure. Earlier findings on this topic were presented in paper 10 above. The 2014 paper found no convincing evidence that magnetic fields were involved in risks of MND. But in the light of the recent positive findings from Holland between magnetic field exposure and ALS risks (Koeman et al, Occup Env Med, 2017 doi 10:1136/oemed-2016-103780) the UK study needs to be re-analysed for this topic. The new analyses will make use of more detailed work history data and an additional eight years of mortality data. The paper will be entitled “Motor Neuron Disease in UK electricity generation and transmission workers, 1987-2018”, and will be offered in the first instance to the medical journal Occupational Medicine. The publication is planned to appear before the end of 2022. If it were not to be accepted by that journal it will be offered to the International Journal of Environmental Research and Public Health (IJERPH). The paper will be published in Open Access format to enable study participants and the general public to read the study findings without charge; funding for Open Access publication has been provided by the Study Sponsor. • Journal article Policymakers: • Article in pension newsletter The findings will also be reported to the relevant policymakers through direct bilateral engagement using new and established relationships. • Briefing documents provided to HSE, IARC, EU Scientific Committee Communication channels: • ENA website To ensure that information about the project and its results reaches interested groups and civil society a simplified version of the findings will be made available both on the website of the Energy Networks Association (ENA) and in pensioner magazines for former employees of the electricity supply industry. The Press Office of the University of Birmingham will provide a media release for newspapers. All reports from this study of electricity supply industry will be sent to 1).The Director of the IARC Monographs Programme, International Agency for Research on Cancer, 2). The Chief Statistician, UK Health and Safety Executive (HSE), 3). The Chair of the HSE’s Workplace Health Exposure Committee (WHEC), and 4). the Scientific Secretary of the EU Scientific Committee on Occupational Exposure Limits (SCOEL). Magnetic field exposure is subject to EU directives and the world literature on magnetic fields and health outcomes will be the subject of future reviews,

Expected measurable benefits

[1 paragraph unchanged] There were previous excess cancer risks in female employees for nasal cancer and cancer of the small intestine (paper 7). intestine. These findings were not matched by similar excesses in male employees, but [30 words unchanged] women in this industry, and the UK HSE would have to consider what the appropriate action was appropriate to take. Earlier work in this cohort also indicated that the workforce had suffered an occupational excess of mesothelioma without any matching excess of lung cancer. Earlier work in this study also indicated that the workforce had suffered an occupational excess of mesothelioma without any matching excess of lung cancer. Probably the most important current use of the study is to assist [7 words unchanged] their on-going work to set appropriate exposure levels for magnetic fields. The study cohort will also assist academic study into the investigation of health effects of magnetic field exposure. If in the future, the positive findings from a Dutch findings for study of magnetic field exposure to magnetic fields and development of motor neuron disease (MND) (Koemen et al, Occup Env [5 words unchanged] to be true this would have a major impact on modern life. All reports from this study of electricity supply industry will be sent to 1).The 1) The Director of the IARC Monographs Programme, International Agency for Research on Cancer, 2). Cancer; 2) The Chief Statistician, UK Health and Safety Executive (HSE), 3). (HSE); 3) The Chair of the HSE’s Workplace Health Exposure Expert Committee (WHEC), (WHEC); and 4). the 4) The Scientific Secretary of the EU Scientific Committee committee on Occupational Exposure Limits (SCOEL). Toxicity, Ecotoxicity and the Environment. Magnetic field exposure is subject to EU directives and the world literature on magnetic fields and health outcomes will be the subject of future reviews, reviews. The prevalence of EL-EMF ELF-EMF means there could be significant changes to policy to reduce occupational and public exposure levels. The magnitude of the impact it will have - have, for example, the number of patients affected/potential cost people affected and efficiency savings. potential costs, are significant. The impact would involve the population of the UK and beyond. Any [12 words unchanged] and the HSE. Benefits could potentially be measured using population level health data. Data.

Benefits reported

The worldwide literature on exposure to magnetic fields and cancer risks was [69 words unchanged] was inadequate evidence of carcinogenicity in adults. Papers 1, 2 and 3 produced from the UK this study were included in this evaluation; later papers were published after the IARC evaluation. But However, papers 5, 7, 8 8, 9, 10, 11 and 9 12 will be evaluated when the topic of cancer risks and electric and magnetic field exposure is next evaluated by IARC. An International Workshop on neurodegenerative disease risks and magnetic field exposure was organised by the German Federal Office for Radiation Protection, was held in Munich in December 2017. Findings from paper 10 were included in a meta-analysis presented at the meeting by Dr Leeka Kheifets. Conclusions from the Workshop that received general approval were that there was enough evidence to both continue and improve the studies on neurodegenerative diseases and magnetic field exposure. Two papers from this study have been published since the last DSA application; these are papers numbered 11 and 12. Benefits from paper 11, Cancer incidence in UK electricity generation and transmission workers, 1973-2015 (2019). Paper 12 Benefits from paper 12, Motor neuron disease risk and magnetic field exposures (2022). These may assist IARC when the topic of cancer risks and electric and magnetic field exposure is next assessed.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits, Benefits reported.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

The study was instigated by the Central Electricity Generating Board (CEGB) of England and Wales in 1975, in an attempt to discover whether any of its employees have suffered long-term health effects from occupational exposures received in the course of employment in the electricity supply industry. Financial support, administrative support and technical support have been provided to the study by the successor companies of the CEGB which came into being after the privatisation in 1990. Financial support has been obtained for some time from the Northmere Trust, a fund set up at the time of privatisation to enable studies to be carried out into possible long-term health effects of exposure to electric and magnetic fields. Administrative support has been provided in the past by the Human Resources departments of the successor companies to update work histories of study subjects. Such updates will not be possible in the future because the study was pseudonymised in 2013. Technical support has been provided in the past by the successor companies such that exposure to magnetic fields has been estimated for each power station, for each calendar year of operation and for each department. This represents one of the most extensive job-exposure-matrices (JEM) ever created, and was only possible because of in-house scientific expertise. The only organisation that will have access to the record level data being requested from NHS Digital is the Institute of Applied Health Research at the University of Birmingham. This is a Data Sharing Agreement with University of Birmingham to permit retention of mortality and cancer registration data provided by NHS Digital under a previous iteration of this agreement. The University of Birmingham was approached to undertake this work by the Energy Networks Association (ENA) a Trade Association whose members include the successor companies of the CEGB. The University of Birmingham has a track record in the identification, quantification and control of occupational health risks. This study was instigated by the Central Electricity Generating Board (CEGB) of England and Wales in 1975, to discover whether any of its employees have suffered long-term health effects from occupational exposures received in the course of employment in the electricity supply industry. Financial support, administrative support and technical support have been provided to the study by the successor companies of the CEGB which came into being after the privatisation in 1990. The general aim of the work this study is to monitor the long-term health experience of workers in the electricity [36 words unchanged] to extremely low frequency electric and magnetic fields (ELF-EMF) and the study is, currently, is probably the single most important source of information in the UK on [25 words unchanged] tumours or neurodegenerative disorders (Alzheimer’s disease, Parkinson’s disease and motor neuron disease). The study is long-running and follow-up data on deaths and cancer registrations have been supplied by NHS Digital and its forerunners for many decades. For the last twenty years the focus of the study has been possible health effects from magnetic field exposure. Membership of the cohort is fixed and there will be no new study participants. The study wishes to continue to receive follow-up data on deaths and cancer registrations in order to increase the number of cases of disease available for analysis and to have data on any disease that might have a long interval between exposure and appearance of disease (long latency). Follow-up data (deaths and cancer registrations) continue to be required to enable a full investigation of possible long-term effects of occupational exposures to be carried out for the electricity supply industry. NHS Digital has provided record-level mortality and cancer registration data for a cohort of patients, to the Institute of Applied Health Research at the University of Birmingham. Cohort members were all employed in the electricity supply industry and consented to the processing of his or her personal data for the purposes of this study. Membership of the cohort is fixed and there will be no new study participants. The GDPR Lawful basis for processing the requested data under this agreement are; Article 6(1)(e) (Public Task processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller). Article 9(2)(j) (processing is necessary for reasons of public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interest of the data subject. The University of Birmingham was approached to undertake this work by the Energy Networks Association (ENA) a Trade Association whose members include the successor companies of the CEGB . The University of Birmingham was selected due to its track record in the identification, quantification, and control of occupational health risks. The University of Birmingham is the sole Data Controller and sole Data Processor of data provided under this agreement. National data is required because the study was setup as a national study of all employees with some employment in the electricity supply industry in the period 1973-82. This national coverage provides maximum statistical power and provides findings that have national application. The study would be weakened with only regional subsets of data and the findings would be less credible. Given the potential impact of the findings on national policy for exposure to EMF it is essential to minimise uncertainty. The study is long-running and follow-up data on deaths and cancer registrations have been supplied by NHS Digital and its forerunners for many decades. This enables a full investigation of possible long-term effects of occupational exposures to be carried out for the electricity supply industry, including data on any disease that might have a long interval between exposure and appearance of disease (long latency). The data at the University of Birmingham were pseudonymised in 2013 and all information on names, addresses, postcodes, National Insurance (NI) numbers, and NHS numbers were destroyed and replaced with a unique identifier (Study-ID) that NHS Digital uses to identify study members. The study requires record-level, pseudonymised data containing unique identifier (study-ID), dates of death and ICD codes for causes of death, dates of cancer registrations and ICD codes for site and type of cancer. The study is using the minimum amount of data possible to achieve the study objectives. There is no other way beyond those described in this application in which the study objectives can be met. The study maintains the original data collected from employer records on dates of birth (month and year only) and dates of employment because these form an integral part of the analysis of the data, both in the statistical adjustment of age effects and the development of exposure histories. Administrative support and technical support have been provided to the study by the successor companies of the CEGB which came into being after the privatisation in 1990. Administrative support has been provided in the past by the Human Resources departments of the successor companies to update work histories of study subjects. Such updates have not been possible since 2013 when all participants were pseudonymised. Technical support has been provided in the past by the successor companies such that exposure to magnetic fields has been estimated for each power station, for each calendar year of operation and for each department. The study continues to receive financial support for some time from the Northmere Trust, a fund set up at the time of privatisation to enable studies to be carried out into possible long-term health effects of exposure to electric and magnetic fields.

Processing activities

The cohort for this study is fixed and no further flow of data to NHS Digital was historical and has now ceased. This historical is required. Historical data that flowed to forerunners of NHS Digital comprised names and dates of birth of employees in the electricity supply industry. The Identifiable data held at the University of Birmingham were pseudonymised in 2013 and all information [7 words unchanged] numbers, and NHS numbers were destroyed and replaced with a unique identifier that NHS Digital uses to identify study members in its own files. NHS Digital supplies individual record data containing the pseudonymised unique identifier (and no other identifier), dates of death and ICD codes for causes of death, dates of cancer registrations and ICD codes for site and type of cancer. (Study-ID). Data will only be accessed by individuals within the Institute of Applied Health Research who have authorisation from NHS Digital to access the data for the purposes described, all of whom are substantive employees of the University of Birmingham. Civil Registration (Deaths) and Cancer Registration Data flowed from NHS Digital to the University of Birmingham to provide pseudonymised record-level data containing study-ID, dates of death and ICD codes for causes of death, dates of cancer registrations and ICD codes for site and type of cancer. Data supplied by NHS Digital will not be linked to any data other than pseudonymised individual level study data containing details on dates of birth (month and year only) and work histories (dates of employment and job titles). There will be no attempt to re-identify individuals from the data. The data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide. On receiving the NHS Digital datasets, study-ID, dates of death, causes of death, dates of cancer registrations and site and type of cancer was transferred to a ‘new follow-up’ spreadsheet, and saved into the same restricted area of the University server as the master study file. The main study file contains the study-ID, dates of birth (month and year only), work histories, in addition to death and cancer registration data supplied previously by NHS Digital (and its forerunners). Data is required for such a long time because cancer and neurodegenerative disorders can have very long intervals between exposure to a risk factor and the final clinical presentation of disease. National data is required because the study has been set up as a national study of all employees with some employment in the electricity supply industry in the period 1973-82. This national coverage provides maximum statistical power and provides findings that have national application. The study would be weakened with only regional subsets of data and the findings would be less credible. Given the potential impact of the findings on national policy for exposure to EMF it is essential to minimise uncertainty. Death data are transferred from the new follow-up file into the main study file if a matching Study-ID is found and if there are no death data already present in the master file for that ID. If death data are already present in the master file, new and old data are reviewed to establish whether this is just a case of duplicate data or whether there is a genuine clash of data (death details for two separate individuals have become confused). In the very few instances of genuine clashes of data, assistance of NHS Digital staff is sought. Cancer registration data are transferred from the new follow-up file into the main study file if a matching Study-ID is found. A separate program seeks evidence of duplicate entries. For any cases where it is not possible to resolve discrepancies between data in the main study file and new data from NHS Digital, the new data will be destroyed. It would not be appropriate to filter the outputs for specific conditions because occupational exposures in this industry have the potential for a wide variety of possible harms. The study maintains the original data collected from employer records on dates of birth (month and year only) and dates of employment because these form an integral part of the analysis of the data, both in the statistical adjustment of age effects and the development of exposure histories. Analyses of these data is used to calculate standardised mortality ratios (SMRs) for different causes of death, using national mortality rates as a basis of comparison. These SMRs are adjusted for age, sex and calendar year. Analyses of these data is used to calculate standardised registration ratios (SRRs) for different sites of cancer death, using national registration (incidence) rates as a basis of comparison. These SRRs are also adjusted for age, sex and calendar year. Estimates of cumulative occupational exposure to magnetic fields have also been calculated for each study member and, in separate analyses, Poisson regression is used to calculate relative risks for cumulative exposure categories, using risks in the lowest exposure group as a baseline or reference category. Such analyses seek evidence of dose-response effects i.e. does the risk of a disease increases with increasing exposure. The data requested from NHS Digital will be downloaded to a University of Birmingham computer, saving it in a restricted area of the University server that is only accessible to specified members of the research team. Data within this area of the server will be backed up internally (not on to tape), so that data can be fully deleted within two weeks of a deletion request from NHS Digital. All data will be processed and stored at the University of Birmingham. Data supplied by NHS Digital will not be linked to any data other than pseudonymised employment history data held by the University of Birmingham, containing details on dates of birth (month and year only) and work histories (dates of employment and job titles). There will be no attempt to re-identify individuals from the data. The data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide. E.g., in the form of peer-reviewed academic literature. On receiving the NHS Digital datasets, data on the pseudonymised id, dates of death, causes of death, dates of cancer registrations and site and type of cancer will be transferred to a ‘new follow-up’ spreadsheet, and saved into the same restricted area of the University server as the master study file. The main study file contains information on the pseudonymised ID, dates of birth (month and year only), work histories and death and cancer registration data supplied previously by NHS Digital (and its forerunners). The data provided by NHS Digital was downloaded to a University of Birmingham computer, saving it in a restricted area of the University server that is only accessible to specified members of the research team. Data within this area of the server is backed up internally, so that data can be securely deleted within two weeks of a deletion request from NHS Digital. All data is stored and processed by the Institute of applied Health Research (IAHR) department in the Institute of Occupation and Environmental Medicine (IOEM) building at the University of Birmingham. Death data are transferred from the new follow-up file into the main study file if a matching pseudonymised ID is found and if there are no death data already present in the master file for that ID. If death data are already present in the master file, new and old data are reviewed to establish whether this is just a case of duplicate data or whether there is a genuine clash of data (death details for two separate individuals have become confused). In the very few instances of genuine clashes of data, assistance of NHS Digital staff will be sought. Cancer registration data are transferred from the new follow-up file into the main study file if a matching pseudo ID is found. A separate program seeks evidence of duplicate entries. For any cases where it is not possible to resolve discrepancies between data in the main study file and new data from NHS Digital, the new data will be destroyed. Data will only be accessed by substantive employees from the Institute of Applied Health Research at the University of Birmingham. There will be no attempt to re-identify individuals from the data. Analyses of individual level data are used to calculate standardised mortality ratios (SMRs) for different causes of death, using national mortality rates as a basis of comparison. These SMRs are adjusted for age, sex and calendar year. Analyses of individual level data are used to calculate standardised registration ratios (SRRs) for different sites of cancer death, using national registration (incidence) rates as a basis of comparison. These SRRs are also adjusted for age, sex and calendar year. Estimates of cumulative occupational exposure to magnetic fields have also been calculated for each study member and, in separate analyses, Poisson regression is used to calculate relative risks for cumulative exposure categories, using risks in the lowest exposure group as a baseline or reference category. Such analyses seek evidence of dose-response effects i.e. does the risk of a disease increases with increasing exposure. All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data). There will be no data linkage undertaken with NHS Digital data provided under this agreement that is not already noted in the agreement.

Expected output

The following outputs have been produced and published in high quality peer-reviewed journals. journals: 1. 1) Harrington JM, McBride DI, Sorahan T, Paddle GM, van Tongeren M. Occupational exposure to magnetic fields in relation to mortality from brain cancer among electricity and transmission workers. Occup Environ Med 1997;54:7-13. Occupational exposure to magnetic fields in relation to mortality from brain cancer among electricity and transmission workers. 2) Harrington JM, Nichols L, Sorahan T, van Tongeren M. Leukaemia mortality in relation to magnetic field exposure: findings from a study of United Kingdom electricity generation and transmission workers, 1973-97. Occup Environ Med 2001;58:307-314. Occup Environ Med 1997;54:7-13. 3) Sorahan T, Nichols L, van Tongeren M, Harrington JM. Occupational exposure to magnetic fields relative to mortality from brain tumours: updated and revised findings from a study of United Kingdom electricity generation and transmission workers, 1973-97. Occup Environ Med 2001;58:626-630. 2. Harrington JM, Nichols L, Sorahan T, van Tongeren M. 4) Sorahan T, Nichols L. Mortality from cardiovascular disease in relation to magnetic field exposure: findings from a study of UK electricity generation and transmission workers, 1973-1997. Am J Ind Med 2004;45:93-102. Leukaemia mortality in relation to magnetic field exposure: findings from a study of United Kingdom electricity generation and transmission workers, 5) Nichols L, Sorahan T. Mortality of UK electricity generation and transmission workers, 1973-2002. Occup Med 2005;55:541-548. 1973-97. 6) Sorahan T, Kheifets L. Mortality from Alzheimer’s, motor neurone and Parkinson’s disease in relation to magnetic field exposure: findings from the study of UK electricity generation and transmission workers, 1973-2004. Occup Environ Med 2007;64:820-826. Occup Environ Med 2001;58:307-314. 7) Sorahan T. Cancer incidence in UK electricity generation and transmission workers, 1973-2008. Occup Med 2012;62:496-505. 3. Sorahan T, Nichols L, van Tongeren M, Harrington JM. 8) Sorahan T. Magnetic fields and brain tumour risks in UK electricity supply workers. Occup Med 2014;64:157-165. Occupational exposure to magnetic fields relative to mortality from brain tumours: updated and revised findings from a study of United Kingdom 9) Sorahan T. Magnetic fields and leukaemia risks in UK electricity supply workers. Occup Med 2014;64:150-156. electricity generation and transmission workers, 1973-97. 10) Sorahan T, Mohammed N. Neurodegenerative disease risks and magnetic field exposures in UK electricity supply workers. Occup Med 2014;64:454-460. Occup Environ Med 2001;58:626-630. 11) Sorahan T Cancer incidence in UK electricity generation and transmission workers, 1973-2015. Occupational Medicine 2019;69:342-351. doi:10.1093/occmed/kqz082. 4. Sorahan T, Nichols L. All publications contained only aggregated outputs with small numbers suppressed in line with the HES Analysis Guide (http://doc.ukdataservice.ac.uk/doc/8681/mrdoc/pdf/nextsteps_hes_user_guide_v1.pdf) Mortality from cardiovascular disease in relation to magnetic field exposure: findings from a study of UK electricity generation and transmission workers, The outputs will continue to be disseminated to the relevant stakeholders during the project and after its completion. Specifically: 1973-1997. The scientific community Am J Ind Med 2004;45:93-102. Further high-quality academic papers will be published. For example, work is currently on-going to produce an updated analysis of motor neurone disease (MND) risks in relation magnetic field exposure. Earlier findings on this topic were presented in paper 10 above. The 2014 paper found no convincing evidence that magnetic fields were involved in risks of MND. But in the light of the recent positive findings from Holland between magnetic field exposure and ALS risks (Koeman et al, Occup Env Med, 2017 doi 10:1136/oemed-2016-103780) the UK study needs to be re-analysed for this topic. The new analyses will make use of more detailed work history data and an additional eight years of mortality data. The paper will be entitled “Motor Neuron Disease in UK electricity generation and transmission workers, 1987-2018”, and will be offered in the first instance to the medical journal Occupational Medicine. The publication is planned to appear before the end of 2022. If it were not to be accepted by that journal it will be offered to the International Journal of Environmental Research and Public Health (IJERPH). The paper will be published in Open Access format to enable study participants and the general public to read the study findings without charge; funding for Open Access publication has been provided by the Study Sponsor. 5. Nichols L, Sorahan T. Policymakers: Mortality of UK electricity generation and transmission workers, 1973-2002. The findings will also be reported to the relevant policymakers through direct bilateral engagement using new and established relationships. Occup Med 2005;55:541-548. Communication channels: 6. Sorahan T, Kheifets L. To ensure that information about the project and its results reaches interested groups and civil society a simplified version of the findings will be made available both on the website of the Energy Networks Association (ENA) and in pensioner magazines for former employees of the electricity supply industry. The Press Office of the University of Birmingham will provide a media release for newspapers. Mortality from Alzheimer’s, motor neurone and Parkinson’s disease in relation to magnetic field exposure: findings from the study of UK electricity All reports from this study of electricity supply industry will be sent to 1).The Director of the IARC Monographs Programme, International Agency for Research on Cancer, 2). The Chief Statistician, UK Health and Safety Executive (HSE), 3). The Chair of the HSE’s Workplace Health Exposure Committee (WHEC), and 4). the Scientific Secretary of the EU Scientific Committee on Occupational Exposure Limits (SCOEL). Magnetic field exposure is subject to EU directives and the world literature on magnetic fields and health outcomes will be the subject of future reviews, generation and transmission workers, 1973-2004. Occup Environ Med 2007;64:820-826. 7. Sorahan T. Cancer incidence in UK electricity generation and transmission workers, 1973-2008. Occup Med 2012;62:496-505. 8. Sorahan T. Magnetic fields and brain tumour risks in UK electricity supply workers. Occup Med 2014;64:157-165. 9. Sorahan T. Magnetic fields and leukaemia risks in UK electricity supply workers. Occup Med 2014;64:150-156. 10. Sorahan T, Mohammed N. Neurodegenerative disease risks and magnetic field exposures in UK electricity supply workers. Occup Med 2014;64:454-460. 11. Sorahan T Cancer incidence in UK electricity generation and transmission workers, 1973-2015. Occupational Medicine 2019;69:342-351. doi:10.1093/occmed/kqz082. Work is currently on-going to produce an updated analysis of motor neurone disease (MND) risks in relation magnetic field exposure. Earlier findings on this topic were presented in paper 10 above. The 2014 paper found no convincing evidence that magnetic fields were involved in risks of MND. But in the light of the recent positive findings from Holland between magnetic field exposure and ALS risks (Koeman et al, Occup Env Med, 2017 doi 10:1136/oemed-2016-103780) the UK study needs to be re-analysed for this topic. The new analyses will make use of more detailed work history data and an additional eight years of mortality data. The paper will be entitled “Motor Neuron Disease in UK electricity generation and transmission workers, 1987-2018”, and will be offered in the first instance to the medical journal Occupational Medicine. The publication is planned to appear before the end of 2022. If it were not to be accepted by that journal it will be offered to the International Journal of Environmental Research and Public Health (IJERPH). The paper will be published in Open Access format to enable study participants and the general public to read the study findings without charge; funding for Open Access publication has been provided by the Study Sponsor. All outputs will only contain data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. A simplified version of the findings will be made available both on the website of the Energy Networks Association (ENA) and in pensioner magazines for former employees of the electricity supply industry. The Press Office of the University of Birmingham will provide a media release for newspapers. The study will also engage with the academic research community by presenting pre-publication results at the forthcoming EPICOH 2021 meeting in Montreal, Canada (date and venue still to be announced, may be virtual meeting).

Expected measurable benefits

Most of the expected measurable benefits from this study will be felt [26 words unchanged] only come from improved working conditions experienced by later generations of workers. There were previous excess cancer risks in female employees for nasal cancer and cancer of the small intestine (paper 7). These findings were not matched by similar excesses in male employees, but if a similar excess for either site of cancer were to be found in the updated analysis, this would be a strong indication that a real risk is present for women in this industry, and the UK HSE would have to consider what action was appropriate to take. Earlier work in this study also indicated that the workforce had suffered an occupational excess of mesothelioma without any matching excess of lung cancer. Probably the most important current use of the study is to assist the HSE and the EU authorities in their on-going work to set appropriate exposure levels for magnetic fields. The study will also assist academic study into the investigation of health effects of magnetic field exposure. If the recent positive Dutch findings for exposure to magnetic fields and development of motor neuron disease (MND) (Koemen et al, Occup Env Med 2017 doi:10:1136/oemed-2016-103780) turn out to be true this would have a major impact on modern life. There were previous excess cancer risks in female employees for nasal cancer and cancer of the small intestine (paper 7). These findings were not matched by similar excesses in male employees, but if a similar excess for either site of cancer were to be found in the updated analysis, this would be a strong indication that a real risk is present for women in this industry, and the UK HSE would have to consider what action was appropriate to take. Earlier work in this study also indicated that the workforce had suffered an occupational excess of mesothelioma without any matching excess of lung cancer. Probably the most important current use of the study is to assist the HSE and the EU authorities in their on-going work to set appropriate exposure levels for magnetic fields. The study will also assist academic study into the investigation of health effects of magnetic field exposure. If the positive Dutch findings for exposure to magnetic fields and development of motor neuron disease (MND) (Koemen et al, Occup Env Med 2017 doi:10:1136/oemed-2016-103780) turn out to be true this would have a major impact on modern life. [1 paragraph unchanged] The prevalence of EL-EMF means there could be significant changes to policy to reduce occupational and public exposure levels. The magnitude of the impact it will have - for example, the number of patients affected/potential cost and efficiency savings. The impact would involve the population of the UK and beyond. Any actions taken to realise benefits of this study would involve UK government and the HSE. Benefits could potentially be measured using population level health data.

Benefits reported

[1 paragraph unchanged] An International Workshop on neurodegenerative disease risks and magnetic field exposure was organised recently by the German Federal Office for Radiation Protection. It Protection, was held in Munich in December 2017. Findings from paper 10 were included in a meta analysis meta-analysis presented at the meeting by Dr Leeka Kheifets. Conclusions from the Workshop [12 words unchanged] continue and improve the studies on neurodegenerative diseases and magnetic field exposure.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Expected output

[35 paragraphs unchanged] Work is currently on-going to produce an update of Paper 7 and will include an additional seven years of cancer registration data. The paper will be entitled “Cancer incidence in UK electricity generation and transmission workers, 1973-2015”, and will be offered in the first instance to the medical journal Occupational Medicine. The publication is planned to appear before the end of 2019. If it were not to be accepted by that journal it will be offered to the International Journal of Environmental Research and Public Health (IJERPH). The paper will be published in Open Access format to enable study participants and the general public to read the study findings without charge; funding for Open Access publication has been provided by the Study Sponsor. 11. Sorahan T Cancer incidence in UK electricity generation and transmission workers, 1973-2015. Occupational Medicine 2019;69:342-351. doi:10.1093/occmed/kqz082. Work is currently on-going to produce an updated analysis of motor neurone disease (MND) risks in relation magnetic field exposure. Earlier findings on this topic were presented in paper 10 above. The 2014 paper found no convincing evidence that magnetic fields were involved in risks of MND. But in the light of the recent positive findings from Holland between magnetic field exposure and ALS risks (Koeman et al, Occup Env Med, 2017 doi 10:1136/oemed-2016-103780) the UK study needs to be re-analysed for this topic. The new analyses will make use of more detailed work history data and an additional eight years of mortality data. The paper will be entitled “Motor Neuron Disease in UK electricity generation and transmission workers, 1987-2018”, and will be offered in the first instance to the medical journal Occupational Medicine. The publication is planned to appear before the end of 2022. If it were not to be accepted by that journal it will be offered to the International Journal of Environmental Research and Public Health (IJERPH). The paper will be published in Open Access format to enable study participants and the general public to read the study findings without charge; funding for Open Access publication has been provided by the Study Sponsor. [1 paragraph unchanged] A simplified version of the findings will be made available both on [22 words unchanged] Office of the University of Birmingham will provide a media release for the updated cancer incidence paper. newspapers. The study will also engage with the academic research community by presenting pre-publication results at the 13th UK + Ireland Conference on Occupational and Environmental Epidemiology forthcoming EPICOH 2021 meeting in Montreal, Canada (date and venue still to be announced). announced, may be virtual meeting). An analysis of neurodegenerative disease risks and magnetic field exposure was published in 2014 (paper 10) and analysed health outcome data for the period 1973-2010 (Sorahan T, Mohammed N, Neurodegenerative disease and magnetic field exposure in UK electricity supply workers. Occ Med 2014;64:454-460 doi:10.1093/occcmed/kqu105). The study found no convincing evidence that magnetic fields were involved in risks of these diseases. But in the light of the recent positive findings from Holland between magnetic field exposure and ALS risks (Koeman et al, Occup Env Med, 2017 doi 10:1136/oemed-2016-103780) the UK study needs to be re-analysed for this topic, when further follow up has been added providing meaningful additional data. Funding has yet to be requested for this proposal.

Unchanged: Objective for processing, Processing activities, Expected measurable benefits, Benefits reported.