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Background High mortality is concentrated in low socioeconomic positions which may largely be explained by excessive use of alcohol. The aim was to identify specific manual occupations with high mortality and to examine whether there are differences in the role of alcohol in explaining the excess mortality among manual occupations with high all-cause mortality. Methods A register-based study of employees aged 30-64, followed for mortality 2001-2015. Age standardized mortality ratios (SMR) were calculated to compare the mortality rates of manual occupations. The contribution of alcohol related mortality to excess mortality was obtained by comparing the excess mortality in all deaths and deaths not related to alcohol. Results Men had 31 and women 11 manual occupations with SMR statistically significantly over 120 compared to all employees. Mortality rates were highest among building construction labourers (SMR 180, 95% CI 163-199) among men and building caretakers (SMR 155, 95% CI 135-179) among women. With few exceptions, high mortality was a combination of high alcohol-related and high non-alcohol-related mortality. Among men, the contribution of alcohol-related mortality to the excess all-cause mortality compared to all employees was over 10% in half of the high mortality occupations. Among women excluding the alcohol-related deaths had a minor effect on all-cause mortality. Conclusions Diminishing the alcohol-related mortality would level excess mortality of high mortality manual occupations but not eliminate it. Targeting the improvement of working conditions and occupational health care to certain occupations would diminish the mortality differences between occupations and social classes. Key messages To prevent the high mortality of manual occupations, improvements should be targeted to several different aspects of working conditions. Occupational health care of manual occupations with high mortality should be improved and provide with early interventions towards risky alcohol behaviour.

High mortality in manual occupations and the role of alcohol in 2001-2015 in Finland