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PubMed1998

An updated mortality study of workers at a petroleum refinery in Beaumont, Texas.

The mortality experience of 7,119 workers who were employed at a Beaumont, Texas, refinery for at least 1 year between 1945 and 1987 was investigated. Mortality analyses based on standardized mortality ratios (SMRs) and 95% confidence intervals (95% CI) showed overall mortality was significantly lower than expected compared with the U.S. general population (SMR = 82, 95% CI = 79-86). Total cancer mortality was also lower than expected (SMR = 92, 95% CI = 84-100). Significant mortality deficits from several malignant and nonmalignant diseases were reported. A significant mortality increase in the broad category of lymphatic and hematopoietic cancers was found (SMR = 133, 95% CI = 103-170). This increase was attributed to a nonsignificant elevation in leukemia of all cell types combined (SMR = 139, 95% CI = 92-201) and a borderline significant increase in other lymphatic tissue cancer (SMR = 158, 95% CI = 101-235). The elevation in leukemia was confined to workers hired before 1950. Furthermore, the leukemia excess was shown to have peaked during the 1960s, with mortality no longer elevated post-1980. Analyses of cell type-specific leukemias showed a similar temporal pattern for acute myeloid leukemia (AML) which was not significantly elevated (SMR = 136, 95% CI = 59-268). Mortality from other leukemia cell types was similar to or lower than expected. Mortality from non-Hodgkin's lymphoma (NHL) (SMR = 140, 95% CI = 88-211) and multiple myeloma (MM) (SMR = 121, 95% CI = 55-230) were increased, but neither was statistically significant nor likely to be related to refinery employment. No death from asbestosis was reported, and mortality from mesothelioma and pulmonary fibrosis was lower than expected. Lung cancer mortality for the overall cohort was similar to expected. For the overall cohort, analyses by duration of employment and time since first employment showed no evidence of any trends for increasing cause-specific mortality. Separate analyses of male workers employed in operator jobs showed mortality patterns that were more favorable than those of the total cohort. Maintenance craftworkers showed statistically significant elevations in mortality for prostate cancer (SMR = 145, 95% CI = 107-194), leukemia (SMR = 179, 95% CI = 111-273), and other lymphatic tissue cancer (SMR = 233, 95% CI = 138-368). Detailed analyses indicated that, among maintenance craftworkers, mortality was elevated for AML, NHL, and MM, but none was significant. Furthermore, no upward trend by duration of maintenance jobs was observed. A small increase of lung cancer was observed among maintenance craftworkers (SMR = 120, 95% CI = 99-145), which was borderline significant. No relationship between lung cancer and duration of maintenance employment was found. In contrast, a deficit of pulmonary fibrosis was reported among maintenance craftworkers (SMR = 62, 95% CI = 17-159). These findings are discussed in conjunction with results from other refinery studies, and the limitations of the study are discussed.

Adult↗
PubMed1998

Job-related diseases and occupations within a large workers' compensation data set.

The objective of this report is to describe workers' job-related diseases and the occupations associated with those diseases. The methods include aggregation and analysis of job-related disease and occupation data from the Bureau of Labor Statistics' Supplementary Data System (SDS) for 1985 and 1986--the last years of data available with workers' compensation categories: death, permanent total, permanent partial, and temporary total and partial. Diseases are ranked according to their contribution to the four workers' compensation (WC) categories and also ranked within occupations according to the number of cases. Occupations are ranked according to their contribution to specific diseases within one of the four categories. The following diseases comprise the greatest numbers of deaths: heart attacks, asbestosis, silicosis, and stroke. Within the permanent total category, the diseases with the greatest contributions are heart attack, silicosis, strokes, and inflammation of the joints. For the permanent partial category, they are hearing loss, inflammation of joints, carpal tunnel syndrome, and heart attacks. For the temporary total and partial category, they are: inflammation of joints, carpal tunnel syndrome, dermatitis, and toxic poisoning. Hearing loss or inflammation of joints are associated with more than 300 occupations. Circulatory diseases comprise a larger share of job-related diseases than is generally acknowledged. Occupations contributing the most heart attack deaths are truck drivers, managers, janitors, supervisors, firefighters, and laborers. Ratios of numbers of deaths to numbers of disabilities are far higher for illnesses than injuries. Occupations that are consistent in their high ranking on most lists involving a variety of conditions include nonconstruction laborers, janitors, and construction laborers. The large SDS, though dated, provides a tentative national look at the broad spectrum of occupational diseases as defined by WC and the occupations associated with those diseases in 1985 and 1986. Some description of the spectrum of diseases encountered today is possible especially for occupations, such as those mentioned above for which employment has expanded in the 1990s.

Administrative Personnel↗
PubMed1998

Asbestos-related x-ray changes in foundry workers.

Michigan has a statewide mandatory occupational disease reporting system. As part of that system, reports are received from hospital, physicians, death certificates, the worker's compensation bureau, and company medical departments. Based on this reporting, the State of Michigan has a special emphasis program for the surveillance of silicosis, a known disease outcome among foundry workers. From 1985-1996, 115 cases reported to the State Surveillance System as silicosis, pneumoconiosis not specified, or pulmonary fibrosis were reclassified as having asbestos related x-ray changes after a B-reader interpretation of each case's chest x-ray. During this same period there were an additional 697 reports confirmed as silicosis and 6,724 cases reported to the surveillance system as asbestosis. Among the 115 reports reclassified as having asbestos-related x-ray changes without evidence of silicosis-related x-ray changes, 54 had worked in foundries. Only 7 (14.8%) of these individuals had their primary work in maintenance in the foundry; 40 (85.1%) had their primary foundry work in a production job; and for 10 individuals the occupation was not known. Asbestos has been used in foundries on pipe laggings, boiler coverings, as insulation in fan housings, in gloves, aprons and curtains, as insulation in cupolas, and in ladles and insulation in sand molds. Clinicians caring for foundry workers need to be aware that asbestos-related x-ray changes are not uncommon in this population and asbestos exposure should be considered as one of the carcinogens contributing to the known increased risk of lung cancer among foundry workers.

Aged↗
PubMed1999

Cellular and molecular mechanisms of asbestos-induced fibrosis.

Pleural and pulmonary fibrosis (asbestosis) are ramifications of occupational exposures to asbestos fibers, a diverse family of ubiquitous, naturally-occurring minerals. The pathogenesis of asbestos-associated fibrosis involves the participation of a number of cell types and is characterized by an early and persistent inflammatory response that involves the generation of oxidants, growth factors, chemokines, and cytokines. These mediators may also contribute directly to cell injury, proliferation, and fibrogenesis. After interaction with cells, asbestos fibers trigger a number of signaling cascades involving mitogen-activated protein kinases (MAPK) and nuclear factor kappa-B (NF-kappaB). Activation of transcription factors such as NF-kappaB and activator protein-1 (AP-1) may be linked to increases in early response genes (e.g., c-jun and c-fos) which govern proliferation, apoptosis, and inflammatory changes in the cells of the lung. The goal of this article is to review the cellular and molecular mechanisms of asbestos-induced fibrosis that may be critical to the development of effective treatment regimens.

Asbestos↗
PubMed2004

Mineral fiber problems and their management: UK 1890-1935.

BACKGROUND: The first intimation that mineral fibers other than asbestos were biologically active, is generally identified with reports of experimental studies by Stanton and Wrench, and Pott and Friedrichs, in the early 1970s. In 1890 however, man-made mineral fiber was recognized to present human health hazards; in 1912 experimental study confirmed asbestos to be fibrogenic, and by 1935 other mineral fibers came to notice as potential lung hazards. METHODS: Published and archival sources have been reviewed to trace the emergence between 1890 and 1935 of the awareness of the health hazards of various fibrous minerals, and the development of strategies for their control. RESULTS: By the early 1900s there was evidence that the asbestos substituted for the man-made mineral fiber insulation material employed to improve the thermal efficiency of steam powered engines, presented a serious health problem. In the early 1930s, other mineral fibers came to be suspected of causing pneumoconiosis. CONCLUSIONS: Containment, local exhaust ventilation and personal respiratory protection were instituted for the amelioration of asbestosis, but because of the limitations of what was perceived to be reasonably practicable on economic grounds, and what was feasible technologically, their benefits were severely limited. Initial and periodic medical examination were introduced as precautionary measures, based on hope rather than on experience. When in the early 1930s, the investigation of coal mine dust and siliceous dust, threw up the hypothesis that fibrous natural mineral dusts other than asbestos might be fibrogenic, this was ignored and no further investigations were pursued and no precautionary measures were set in train.

Air Pollutants, Occupational↗
PubMed2006

Respiratory health in Turkish asbestos cement workers: the role of environmental exposure.

AIM: Benign and malignant pleural and lung diseases due to environmental asbestos exposure constitute an important health problem in Turkey. The country has widespread natural deposits of asbestos in rural parts of central and eastern regions. Few data exists about the respiratory health effects of occupational asbestos exposure in Turkey. A cross-sectional study was conducted to investigate respiratory health effects of occupational asbestos exposure and the contribution of environmental asbestos exposure. METHODS: Investigations included asbestos dust measurements in the workplace and application of an interviewer-administered questionnaire, a standard posteroanterior chest X-ray and spirometry. Information on birthplace of the workers was obtained in 406 workers and used to identify environmental exposure to asbestos, through a map of geographic locations with known asbestos exposure. RESULTS: Asbestos dust concentration in the ambient air of the work sites (fiber/ml) ranged between 0.2 and 0.76 (mean: 0.25, median: 0.22). Environmental exposure to asbestos was determined in 24.4% of the workers. After the adjustment for age, smoking, occupational asbestos exposure, and potential risk factors environmental asbestos exposure was associated with small irregular opacities grade > or = 1/0 (44.2% vs. 26.6%, P < 0.01), FVC% (97.8 vs. 104.5, P < 0.0001), and FEV1% (92.4 vs. 99.9, P < .0001). Occupational exposure to asbestos was associated with small irregular opacities grade > or = 1/0 (OR: 2.0, 95% CI: 1.3-3.1, per 1 unit increase in the natural logarithm of fiber/ml) and FEV1/FVC% (beta: 1.1, SEM: 0.54; P < 0.05, per 1 unit increase in the natural logarithm of fiber/ml). CONCLUSIONS: Environmental exposure to asbestos could increase the risk of asbestosis and lung function impairment in workers occupationally exposed to asbestos, independent from occupational exposure and smoking.

Adult↗
PubMed1980

Radiological evidence of asbestos disease among ship repair workers.

Asbestos materials are now infrequently used in new ship construction. However, significant amounts were used in vessels constructed before 1975. As a consequence, for the next 30 or more years, the potential for asbestos exposure in the repair of such vessels will remain. We studied 286 workers who were 30 or more years from onset of employment in ship repair work. Eighty-six percent had radiological evidence of asbestosis, and five instances of previously undiagnosed lung cancer were found. This suggests that unless industrial hygiene precautions are taken in the future repair of vessels that have been built with asbestos, we will add additional decades to the legacy we already face as the result of uncontrolled shipyard exposures of the past.

Adult↗
PubMed1983

Roentgenographic evidence of asbestos exposure in a select population of railroad workers.

A volunteer population of 266 current and former railroad workers was examined with posteroanterior and oblique chest roentgenograms, and a comprehensive occupational smoking history. Seventy-five percent of participants were over the age of 60, and 80% had fewer than 10 years of railroad-related asbestos exposure. Roentgenographic evidence of asbestosis was found in only six workers (2%), whereas 20% had one or more pleural changes. Radiological abnormalities were related to latency period, age, and occupation, but not to smoking habit. While selection factors qualify the results of this study, the findings support the exposure and suggest a past and future history of asbestos mortality and morbidity among steam era railway workers.

Aged↗
PubMed1989

Mortality among employees of an Ontario factory manufacturing insulation materials from amosite asbestos.

The mortality of workers from an Ontario factory manufacturing amosite asbestos insulation materials under poorly controlled environmental conditions is reported here. Seven (58%) of 12 deaths among exposed workers 10 or more years after first exposure were due to malignancies; four (25%) were from lung cancer, and there were two deaths from peritoneal mesothelioma. Those dying from mesothelioma were 47 and 49 years of age. Three (25%) of 12 deaths were from respiratory disease, two were attributed to asbestosis (in men 42 and 53 years of ages), and one to pneumonia in a 54-year-old male.

Asbestosis↗
PubMed1990

Prophylaxis of asbestos-induced diseases: studies and perspectives.

In recent years, implementation of dust-suppressing measures in USSR asbestos mills has led to significant decrease in dust levels. New cases of asbestosis and asbestotuberculosis in annual medical examinations have not been detected. For prevention of possible future incidence of these diseases, we plan to concentrate efforts on the medical selection of new employees, taking into account not only dust exposure, but also other ascertained risk factors (social, demographic, and biological, especially genetic). It seems to us that the grounds for complete prohibition of asbestos are insufficient. Substitution with alternative materials is discussed.

Air Pollutants, Occupational↗
PubMed1991

Chrysotile asbestos and health in Zimbabwe: I. Analysis of miners and millers compensated for asbestos-related diseases since independence (1980).

Data on the health effects caused by locally mined chrysotile asbestos in Zimbabwe have been very limited. The prevailing local view has been that risk is minimal. In this report we critically reassess the cases of 51 individuals with asbestos exposure who have been compensated by the Central Pneumoconiosis Bureau since independence in 1980. Results demonstrate that the major health risks of exposure reported elsewhere--morbid asbestosis, nonmalignant pleural disease, malignant mesothelioma, and lung cancer--all occur in Zimbabwe, at least among workers in the asbestos mines and mills. It is concluded that further investigation and control measures in the industry are warranted.

Asbestos↗
PubMed1991

An algorithm for matching anonymous hospital discharge records used in occupational disease surveillance: anonymous record matching algorithm.

The expense of collecting primary data, coupled with limited authority to mandate reporting, requires alternative methods of implementing an occupational disease registry in Illinois. One alternative data source for surveillance of some occupational diseases is hospital discharge records. Because these records lack personal identifiers, it has been impossible historically to match records belonging to the same individual and obtain reliable case estimates. To circumvent this difficulty, an algorithm has been developed to match anonymous hospital discharge records collected from all Illinois hospitals. The algorithm was based on the assumption that specific combinations of occupational disease code, sex, zip code, and date of birth would identify an individual to whom multiple hospitalizations belong. Matching with the algorithm reduced the 1986 case estimates from 597 to 499 for all cases of coal workers' pneumoconiosis, asbestosis, and silicosis.

Algorithms↗
PubMed1991

Changing attitudes and opinions regarding asbestos and cancer 1934-1965.

Literature published in the years 1934-1965 was reviewed to determine attitudes and opinions of scientists as to whether asbestos is a cause of cancer. In Germany, the issue was decided in 1943 when the government decreed that lung cancer, when associated with asbestosis (of any degree), was an occupational disease. In the United States, however, there was no consensus on the issue until 1964. Opinions of scientists over a 22 year period are shown and the contributions of various cultural, social, economic and political factors to these opinions are discussed. A lack of experimental and epidemiological evidence played a major role in delaying a consensus. Other important factors included a rejection of science conducted outside of the U.S. during this period, particularly a rejection of German scientific thought during and after WWII, and a rejection of clinical evidence in favor of epidemiological investigations. Individual writers rarely changed their minds on the subject of asbestos as a cause of cancer.

Asbestos↗
PubMed1992

Irregular opacities in the lung, occupational asthma, and airways dysfunction in aluminum workers.

We examined chest X-rays, measured expiratory flows and FVC by spirometry and TLC by projected lung area, ascertained respiratory data by questionnaires, and performed chest examinations in 670 Southeastern aluminum workers and 659 unexposed regional controls. Both groups were asbestos exposed. More aluminum workers had irregular opacities and fewer had pleural abnormalities than did regional pipefitter referents. The pulmonary function tests were expressed as percentage of predicted to adjust for height, age and duration of smoking based on a randomly selected U.S. reference population. Data from aluminum workers were compared to regional controls with students "t" tests run for unequal size groups. Aluminum workers had significant reductions in FEV1 of 3.2% predicted (p less than .003), FEF25-75 of 11.3% predicted (p less than .0001), FEF75-85 of 22.5% predicted (p less than .0001), and an increased TLC of 2.0% predicted (p less than .005). The 145 who had never smoked (NS) were compared with 124 NS controls and showed this same pattern of differences; but in smokers, the differences were significant for mid and terminal flows, but not for FEV1. In aluminum workers who never smoked, asthma prevalence by history was 7.6% vs. 4.0% in controls, and wheezes were heard in 21.4% vs. 2.4% in controls. In aluminum workers who were current smokers, asthma prevalence was 16.4% vs. 9.4% in controls, and wheezes were heard in 43.7% vs. 21.1% in controls. Aluminum workers had significantly more asthma, wheezing, airways obstruction, and pulmonary parenchymal abnormalities similar to asbestosis than did regional blue collar controls not melting and casting aluminum.

Aluminum↗
PubMed1992

Use of death certificates in epidemiological studies, including occupational hazards: variations in discordance of different asbestos-associated diseases on best evidence ascertainment.

There is extensive information on discordance in general between accuracy of medical diagnoses on death certificate categorization of cause of death and available clinical and histopathological data. This is as true for occupational disease as for other conditions. But occupational illnesses bear a special problem. Discordance is not equal across the board--it may vary with each occupationally related disease, and no single formula can be applied. It may be high for angiosarcoma and low for acute hydrogen sulfide poisoning, low for bladder cancer, high for unsuspected methyl mercury poisoning. We have found that for one agent--asbestos--there were different rates of discordance for different asbestos-related diseases (e.g., lung cancer, mesothelioma, asbestosis, kidney cancer) among 4,951 deaths studied prospectively from 1967 to 1986. Caution is therefore required before accepting generalizations concerning (unstudied) discordance in occupational mortality studies, and in their use in risk assessment models.

Adolescent↗
PubMed1993

Asbestos disease risk communication conducted by the New Jersey Department of Health.

Since October 1985, the New Jersey Department of Health (NJDOH) has required hospitals to report all patients with a discharge diagnosis of asbestosis. As follow-up to a needs assessment survey of these patients, the NJDOH developed an educational packet including an information bulletin titled "Asbestos Disease: Medical and Legal Facts for Employees" and a pre-stamped postcard evaluation survey. The packet was sent to 1,418 patients reported by hospitals; 433 patients returned the evaluation questionnaire. The survey assessed attitudinal responses (were the materials helpful and easy to understand?) and behavioral responses (did the respondent plan on discussing the materials with a doctor or lawyer?) to the information in the packet. Of the postcard respondents, 85% found the materials helpful, and approximately half indicated that they would discuss the materials with a doctor or lawyer. Of the 33% who were proxy respondents, half appeared not to have understood that the materials had relevance to them as family members. Modifications to the protocol for the asbestos disease educational packet were made based on the evaluation data. Limitations of the evaluation survey and the value of process evaluations in risk communication projects are discussed.

Aged↗
PubMed1993

Characterization of asbestos fibers in lungs and mesotheliomatous tissues of baboons following long-term inhalation.

Changes in the dimensions of inhaled asbestos fibers in the lung and translocation of intrapulmonary asbestos fibers into mesothelial tissues were investigated in 17 baboons (5 exposed to amosite, 4 to chrysotile, 5 to crocidolite, and 3 unexposed). The animals received different cumulative doses of asbestos by inhalation, followed by varying recovery periods (0-69 months). All asbestos types induced pulmonary asbestosis with severity directly related to the cumulative dose. There were a larger number of asbestos bodies in the lung of the amphibole-exposed animals than in those exposed to chrysotile. A tissue burden study, using transmission electron microscopy on 25-microns paraffin sections, ashed in a low-temperature asher, was performed. Intrapulmonary amosite fibers were shorter in geometric mean length compared with a standard amosite sample (UICC) (3.3 microns). In explanation, it was considered that long fibers might not be able to reach the lower respiratory tract and/or long fibers might be fragmented into shorter fibers. Further, in the amosite-exposed group, the mean length of intrapulmonary fibers increased with the extension of recovery period, suggesting that shorter fibers had been cleared from the lung. The chrysotile standard sample (UICC) had a shorter geometric mean length (1.1 microns) than amosite. The mean length of intrapulmonary chrysotile did not noticeably change with the extension of inhalation and recovery periods; however, the mean width decreased with the extension of these periods. This finding strongly suggested that separation of thick chrysotile fibers had occurred in the lung. The crocidolite standard sample (Transvaal) had a shorter geometric mean length (1.4 microns) than amosite.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Pneumoconiosis and associated medical conditions.

Hospital discharge data from Michigan for the years 1990 and 1991 were used to examine potential associations between pneumoconiosis and pulmonary hypertension, lung cancer, obstructive lung disease, and connective tissue disease among both men and women. Lung cancer, pulmonary hypertension, and obstructive lung disease were associated with coal workers' pneumoconiosis. Pulmonary hypertension and obstructive lung disease were associated with asbestosis and silicosis. Rheumatoid arthritis was associated with silicosis. The potential is suggested that misdiagnosis is the cause of the association between lung cancer and coal workers' pneumoconiosis.

Adult↗