Mortality from respiratory cancer and other causes in United Kingdom chromate production workers.

This report updates a 1981 study of mortality at three United Kingdom chromate producing factories, and pays special attention to workers engaged after major plant and process changes were completed during 1958-60. The study covers 2298 payroll workers in post on 1 January 1950 or entering employment up to 30 June 1976 and remaining at least one year, with mortality observed up to 31 December 1988. Expected numbers of deaths were calculated from national death rates adjusted for social class and area differences. At the two largest factories 1422 men starting work before the process changes showed a highly significant excess of deaths from lung cancer (observed deaths/adjusted expected deaths (obs/expA) 175/88.97, adjusted standardised mortality ratio (SMRA) 197). They also had a significant excess of deaths from nasal cancer (obs/expA 4/0.26, SMRA 1538); the four affected men all had over 20 years of employment. Six hundred and seventy seven men starting work after the completion of process changes showed no excess of lung cancer deaths (obs/expA 14/13.7, SMRA 102, 95% confidence interval (95% CI) 56-171), but the possibility of the risk persisting at a reduced level cannot be excluded. The risk among earlier entrants affected men with two or more years of employment and was highest among those working for 10 years or longer (SMRA 225). The relative risk was already raised 5-14 years after first employment; it was highest in the 25-40 year period, but was still raised 50 years after first exposure. The risk showed most clearly at young ages, with a SMRA of 355 for ages under 50 (obs/expA 21/5.91). The excess was greater among men in jobs with high exposure to chromates (obs/expA 151/61.73, SMRA 245) than among men in less exposed jobs (obs/expA 21/19.57, SMRA 107). Less evidence of a lung cancer excess was found among 199 men employed at a third small factory (obs/expA 12/9.91, SMRA 121). No risk was apparent in further groups of 214 salaried works staff (obs/expA 1/2.53), or 95 workers at an adjacent fertiliser plant (obs/expA 3/3.95). No significant excesses of deaths from cancers of other sites were found.     

Mortality from cancer and other causes of death among synthetic rubber workers

OBJECTIVES: This study evaluated the mortality experience of workers from the styrene-butadiene rubber industry. Concerns about a possible association of 1,3-butadiene and styrene with lymphohaematopoietic, gastrointestinal, and lung cancers prompted the investigation. METHODS: A retrospective follow up study was conducted of 15,649 men employed for at least one year at any of eight North American styrene-butadiene rubber plants. Analyses used standardised mortality ratios (SMRs) to compare styrene-butadiene rubber workers' cause specific mortalities (1943-91) with those of the United States and Ontario general populations. RESULTS: On average, there were 25 years of follow up per subject. The standardised mortality ratio (SMR) was 87 (95% confidence interval (95% CI) 85 to 90) for all causes of death combined and was 93 (95% CI 87 to 99) for all cancers. There was an excess of leukaemia (SMR 131, 95% CI 97 to 174), restricted to hourly workers (SMR 143, 95% CI 104 to 191). For causes of death other than leukaemia, SMRs were close to or below the null value of 100. Results by work area (process group) were unremarkable for non-Hodgkin's lymphoma, multiple myeloma, and stomach cancer. Maintenance workers had a slight increase in deaths from lung cancer, and certain subgroups of workers had more than expected deaths from cancer of the large intestine and the larynx. CONCLUSION: This study found an excess of leukaemia that is likely to be due to exposure to butadiene or to butadiene plus other chemicals. Deaths from non-Hodgkin's lymphoma, multiple myeloma, and stomach cancer did not seem to be related to occupational exposure. The excess deaths from lung cancer among maintenance workers may be due in part to confounding by smoking, which was not controlled for, and in part to an unidentified occupational exposure other than butadiene or styrene. Increases in cancer of the large intestine and larynx were based on small numbers, did not seem to be due to exposure to butadiene or styrene, and may be chance observations.

 

     

Mortality and cancer morbidity of production workers in the United Kingdom flexible polyurethane foam industry.

OBJECTIVE--To describe cause specific mortality and site specific cancer morbidity among workers employed in factories that produce polyurethane foams, and to determine if any part of the experience may be due to occupation, and in particular to exposure to diisocyanates. DESIGN--Historical prospective cohort study. SETTING--11 factories in England and Wales. SUBJECTS--8288 male and female production employees with some employment in the period 1958-79, and with a minimum period of employment of six months. MAIN OUTCOME MEASURES--Observed and expected numbers of deaths for the period 1958-88, and corresponding figures for cancer registrations for the period 1971-86. RESULTS--Compared with the general population of England and Wales, standardised mortality ratios (SMRs) for all causes and all neoplasms were 97 (observed deaths (Obs) 816) and 88 (Obs 221) respectively. Statistically significant excesses were found among women for cancer of the pancreas (expected deaths (Exp) 2.2, Obs 6, SMR 271, 95% CI 100-595) and cancer of the lung (Exp 9.1, Obs 16, SMR 176, 95% CI 100-285). Similar excesses were not found among male employees, and the SMRs for cancers of the lung and pancreas among the total study population were 100 (Obs 81) and 136 (Obs 14) respectively. Overall incidence of cancer was also below expectation (SRR 94, Obs 277), although statistically significant excesses among women were found for cancers of the larynx and kidney, based on three and four cases respectively. Incident cancers of the lung and pancreas among women were also in excess, although these findings were not independent of the findings for mortality. Poison regression did not indicate that ever having been employed in jobs attracting either higher or lower exposure to isocyanates was a risk factor for the mentioned cancers. A nested case-control design was used to investigate any associations with nine other occupational exposures. No statistically significant association was found. CONCLUSIONS--In general, cancer rates in this population were lower than those for the general population. All increased cancer rates among women occurred at sites of cancer known to be related to cigarette smoking, and these excesses are probably due to a combination of cigarette smoking, chance, and factors unrelated to the industry under study.     

Mortality of United Kingdom acrylonitrile polymerisation workers.

The mortality of 1111 men who worked on the polymerisation of acrylonitrile and the spinning of acrylic fibre from 1950 to 1968 was surveyed up to the end of 1978. Seventy-nine deaths were identified. The population was drawn from six factories, where polymerisation started before 1968, in England, Wales, Scotland, and Northern Ireland. In the group of men exposed to acrylonitrile for at least one year the total number of deaths was smaller than expected. An excess of deaths from all cancers was found, arising mainly from cancers of the lung, stomach, colon, and brain, but the excess was not statistically significant. Significant excesses of stomach cancer overall and in those aged 55-64, and of lung cancer in those aged 15-44 were found. Consideration of deaths according to factory indicated that the excesses of stomach cancer may have been due to regional factors. The excess of lung cancer was investigated further in view of the fact that, unusually, it occurred in relatively young men, but no consistent difference between the duration of exposure to acrylonitrile of the three young patients with lung cancer and matched controls was found. The study is limited and further analysis in the future is needed. The results are not conclusive and neither add to nor detract from existing suspicions that acrylonitrile is a human carcinogen but, taken together with evidence from other studies, indicate the necessity for the continuing surveillance of the exposed population in the United Kingdom.     

Lung cancer mortality among chromate production workers

Aims: To assess mortality in 1997 among 493 former workers of a US chromate production plant employed for at least one year between 1940 and 1972.

Methods: Cohort members were followed for mortality to 31 December 1997. Standardised mortality ratios (SMRs) were calculated for selected cause specific categories of death including lung cancer. Lung cancer mortality was investigated further by calculation of SMRs stratified by year of hire, duration of employment, time since hire, and categories of cumulative exposure to Cr(VI).

Results: Including 51 deaths due to lung cancer, 303 deaths occurred. SMRs were significantly increased for all causes combined (SMR = 129), all cancers combined (SMR = 155), and lung cancer (SMR = 241). A trend test showed a strong relation between lung cancer mortality and cumulative hexavalent exposure. Lung cancer mortality was increased for the highest cumulative exposure categories (1.05 to <2.70 mg/m³-years, SMR = 365; 2.70 to 23 mg/m³-years, SMR = 463), but not for the first three exposure groups. Significantly increased SMRs were also found for year of hire before 1960, 20 or more years of exposed employment, and latency of 20 or more years.

Conclusions: The finding of an increased risk of lung cancer mortality associated with Cr(VI) exposure is consistent with previous reports. Stratified analysis of lung cancer mortality by cumulative exposure suggests a possible threshold effect, as risk is significantly increased only at exposure levels over 1.05 mg/m³-years. Though a threshold is consistent with published toxicological evidence, this finding must be interpreted cautiously because the data are also consistent with a linear dose response.

     

Mortality from injuries and other causes in a cohort of 21,800 Brazilian steel workers.

OBJECTIVES: Injury is the leading cause of death in the male working population of Brazil. An important fraction of these deaths are work related. Very few cohort studies of steel workers, and none from developing countries, have reported on mortality from injuries. This paper analyses mortality from work and non-work related injuries among Brazilian steel workers. METHODS: Deaths during employment from 1 January 1977 to 30 November 1992 were analysed in a cohort of 21,816 male steel workers. Mortality rates specific for age and calendar year among the workers were compared with those of the male population of the state where the plant is located. Work related injuries were analysed by comparing the mortality rates for different subgroups of the cohort. RESULTS: The number of deaths (391) was less than half that expected based on death rates of the general population. Over 60% (242) of deaths were due to injuries. Mortality from most causes was substantially below that in the general population, but that from unintentional injury, was 50% above that of the general population. Standardised mortality ratios (SMRs) were highest for the youngest and the oldest employees and for labourers and clerical workers. Mortality from motor vehicle injury was twice that expected from population rates (SMR = 209, 95% confidence interval (95% CI) 176-244). There was a 67% fall in the age adjusted mortality from occupational injuries in the study period. CONCLUSION: The healthy worker effect in this cohort was greater than that commonly found in studies of occupational groups in developed countries, probably because of a greater socioeconomic gap between employed and unemployed populations in Brazil, and unequal distribution of health care resources. Mortality was especially high for motor vehicle injuries. The fall in mortality from occupational injuries during the study period was probably due to improvement in safety standards, increased automation, and better medical care. There is a need to investigate risk factors for unintentional injuries among steel workers, especially those due to motor vehicle injuries. Prevention of occupational and nonoccupational injuries should be a main priority in Brazil.     

Mortality study among workers producing chromate pigments in France

In a follow-up study of 294 men who had worked for at least 6 months in a chromate-producing factory in France between 1958 and 1987, only 16 were lost to follow-up and the number of person-years in the study was 5207. Occupational data were provided by the administration of the plant. The causes of deaths were ascertained from hospital and general practitioners' records. The observed numbers of deaths were compared with the expected numbers based on local rates with adjustment for age, sex and calendar time (standardized mortality ratio, SMR). The overall mortality did not differ significantly from that expected (SMR = 1.20, 95% CI = 0.98–1.47), whereas mortality due to lung cancer was in significant excess (SMR = 3.60, 95% CI = 2.13–5.68). Significantly higher lung cancer SMRs were found for workers whose duration of employment was more than 10 years. A non-significant excess was observed for all forms of digestive tract cancer (SMR = 1.30, 95% CI = 0.60–2.47). There were two cases of brain cancer when 0.24 was expected (SMR = 8.44, 95% CI = 1.02–30.49). No previous report has mentioned an association of brain cancer with chromate pigments; however, because of the small numbers involved, a chance excess should be considered.     

Mortality from cancer and chronic respiratory diseases among workers who manufacture carbon electrodes

OBJECTIVES—To investigate the risk of cancer and non-neoplastic respiratory diseases among workers who manufacture carbon electrodes, as this industry entails exposure to mixtures of polycyclic aromatic hydrocarbons.
METHODS—A historical cohort study was carried out of 1006 male workers employed for at least 1 year between 1945 and 1971 in a carbon (graphite) electrode production plant in central Italy, who were followed up for mortality between 1955 and 1996. The ratio of observed to expected deaths (standardised mortality ratios, SMRs) was computed from both national and (for the period 1964-96) regional age and period specific mortalities. A multivariate Poisson regression analysis was performed to investigate the relative risk (RR) of death according to duration of employment and time since first employment in the factory.
RESULTS—A total of 424 workers had died, 538 were still alive, and 44 were lost to follow up. Mortalities from all causes, all cancers, and respiratory tract cancer were in line with the regional figure. An excess was found over the expected deaths from skin cancer including melanoma (SMR 3.16, 95% confidence interval (95% CI) 0.65 to 9.23) and from non-neoplastic respiratory diseases (SMR 1.58, 95% CI 1.16 to 2.11). Poisson regression analysis including age as a covariate showed an increased risk of dying from gastric cancer with increasing duration of employment, and an increase in the RR of dying from lung cancer and from non-neoplastic respiratory diseases with increasing time since first employment, although the linear trend was not significant.
CONCLUSION—This study supports previous findings that working in the carbon electrode manufacturing industry may not increase the risk of dying from respiratory cancer. However, a possible association with non-malignant respiratory diseases cannot be excluded.


Keywords: carbon electrode manufacturing; polycyclic aromatic hydrocarbons; historical cohort study     

Mortality of United Kingdom oil refinery and petroleum distribution workers, 1951-1998

The mortality experienced by cohorts of 28 630 oil refinery workers and 16 480 petroleum distribution workers has been investigated. Study subjects were all those male employees first employed in the period 1946-1974 at one of eight UK oil refineries or at one of 476 UK petroleum distribution centres; all subjects had a minimum of 12 months employment with some employment after 1 January 1951. The observed numbers of cause-specific deaths were compared with expectations based on national mortality rates. The resultant standardized mortality ratios (SMRs) were significantly below 100 for all causes, in both oil refinery workers (observed, 9341; expected, 10 649.7; SMR = 88) and petroleum distribution workers (observed, 6083; expected, 6460.3; SMR = 94). Significantly elevated SMRs were shown in oil refinery workers for cancer of the gall bladder (observed, 24; expected, 14.0; SMR = 172), cancer of the pleura (observed, 38; expected, 15.0; SMR = 254) and melanoma (observed, 36; expected, 22.2; SMR = 162). Significantly elevated SMRs were not found in petroleum distribution workers for any site of cancer. SMRs for selected causes of death were calculated by period from commencing employment, by year of hire and by job type. The only findings that suggested the presence of an occupational cancer hazard were an excess of mesothelioma in oil refinery workers and an excess of leukaemia in petroleum distribution workers, both excesses occurring in long-term follow-up for workers first employed >30 years ago.     

Cohort mortality study of North American industrial sand workers. I. Mortality from lung cancer, silicosis and other causes

BACKGROUND: In 1997 a Working Group of the International Agency for Research on Cancer changed an earlier classification of crystalline silica as a human carcinogen from Group 2A to Group 1, though commenting that the carcinogenicity might vary with industrial circumstances and depend on additional factors affecting biological activity, including the distribution of its polymorphs.Objective: We aimed to determine whether pure quartz exposure uncomplicated by the presence of other contaminating carcinogens, as experienced by workers in the production of high-grade industrial sand, was causally related to an increased risk of lung cancer. METHODS: A cohort of 2670 men employed before 1980 for 3 years or more in one of nine North American sand-producing plants and a large associated office complex was selected for study. Of the cohort, 2644 (99%) were traced through 1994, and certificated cause of death ascertained for 1025 (99%) of the 1039 men known to have died. Standardised mortality ratios (SMRs) were calculated for the main causes of death, using both US and state or provincial male mortality rates for reference. FINDINGS: The main analyses of deaths, 20 or more years after first employment against regional rates, gave the following SMRs: all causes 109, lung cancer 139, other malignancies 98, non-malignant respiratory disease 161, and nephritis/nephrosis 244. There were, in total, 37 deaths from silicosis or silico-tuberculosis, with one or more death at least in all nine production plants. Analyses failed to show any relation between lung cancer risk and duration of employment. The increased SMR for lung cancer was wholly due to high rates in four plants in two states, whereas no increase was found in the remainder of the cohort. CONCLUSION: In the absence of information on smoking histories and risk in relation to estimated exposure, the increased SMR for lung cancer (139), although statistically significant, cannot be attributed confidently to crystalline silica. An answer to the question of attributability must await the findings of the nested case-control study, in which level of exposure and smoking habits were ascertained for cases and matched controls. The strong indication in this cohort of excess mortality from non-malignant renal disease deserves further investigation.     

Mortality from lung cancer and respiratory disease among pottery workers exposed to silica and talc

A cohort mortality study of white men employed for at least one year between 1939 and 1966 at three plants of a single United States company was conducted to evaluate the risk of lung cancer and nonmalignant respiratory disease among workers exposed to silica dust and nonfibrous (nonasbestiform) talc in the manufacture of ceramic plumbing fixtures. Follow-up of 2,055 men through January 1, 1981, indicated a substantial excess of nonmalignant respiratory disease among those with high levels of exposure to silica dust (standardized mortality ratio = 2.26). The risk of nonmalignant respiratory disease rose with the number of years exposed, was not further enhanced by talc exposure, and appeared to be appreciably lower among those exposed in more recent time periods. For lung cancer, men exposed to high levels of silica dust with no talc exposure had a nonsignificant standardized mortality ratio of 1.37. However, those exposed to nonfibrous talc in addition to high levels of silica had a significant 2.5-fold excess risk of lung cancer. Among this group, the lung cancer standardized mortality ratio rose with increasing years of talc exposure to 3.64 among those exposed for 15 or more years. Although the role of silica as a cofactor cannot be ruled out, these data suggest that nonfibrous talc exposure is associated with excess lung cancer risk.     

Mortality from pancreatic and lymphopoietic cancer among workers in ethylene and propylene chlorohydrin production.

OBJECTIVES: A previous study reported a fivefold increase in mortality from pancreatic cancer and a threefold increase in lymphopoietic and haematopoietic cancer among 278 men who were assigned to a now dismantled Union Carbide chlorohydrin unit in the Kanawha Valley of West Virginia. There were also significant trends with duration of employment. The purpose of this study was to determine whether a comparable increased risk in mortality from pancreatic cancer and lymphopoietic and haematopoietic cancer occurred among male employees assigned to the Dow Chemical Company's ethylene and propylene chlorohydrin production processes. METHODS: The cohort consisted of 1361 male employees who worked at the company's Freeport, Texas, Plaquemine, Louisiana or Midland, Michigan plants. Subjects were considered to have had a minimum of 30 days of workplace experience in 1940-92, in the ethylene chlorohydrin and propylene chlorohydrin process areas. These process areas were located within the ethylene oxide and propylene oxide production plants. A total of 300 deaths was observed to 31 December 1992. RESULTS: The standardised mortality ratio (SMR) for all malignant neoplasms was 94 (95% CI 74 to 118). There was one pancreatic cancer death compared with 4.0 expected (SMR 25, 95% CI 1 to 140). There were 10 lymphopoietic and haematopoietic cancer deaths compared with 7.7 expected (SMR 129, 95% CI 62 to 238). Additional analyses, which examined location, production process, duration of employment, and a 25 year induction latency period, were not significant. CONCLUSIONS: The results provide some assurance that the Dow Chemical cohort, to date, has not experienced increased risks of pancreatic cancer and lymphopoietic and haematopoietic cancer as previously reported in a different cohort of chlorohydrin workers. Possible reasons are discussed for the inconsistent findings between the two cohorts.     

Mortality from stomach cancer in United States cement plant and quarry workers, 1950-80

In 1978 a study of the mortality of United States cement plant and quarry workers was initiated. The vital status of a cohort of 5292 men who had been employed for at least five years in a cement plant between 1950 and 1980 was traced to 1 January 1980. The mortality experience was evaluated for 4231 white men for whom complete work histories and demographic information were available. Deaths from stomach cancer were significantly increased during 1965-9 but not over the entire follow up period (1950-80). Additionally, stomach cancer mortality was not significantly associated with tenure under separate control for age at follow up, latency, nativity, or year of birth. Evidence from this and other epidemiological studies has not confirmed an association between the constituents of cement plant dust exposure and death from stomach cancer.     

Mortality from cancer and other causes among airline cabin attendants in Germany, 1960-1997

Airline cabin attendants are exposed to several potential occupational hazards, including cosmic radiation. Little is known about the mortality pattern and cancer risk of these persons. The authors conducted a historical cohort study among cabin attendants who had been employed by two German airlines in 1953 or later. Mortality follow-up was completed through December 31, 1997. The authors computed standardized mortality ratios (SMRs) for specific causes of death using German population rates. The effect of duration of employment was evaluated with Poisson regression. The cohort included 16,014 women and 4,537 men (approximately 250,000 person-years of follow-up). Among women, the total number of deaths (n = 141) was lower than expected (SMR = 0.79, 95% confidence interval (CI): 0.67, 0.94). The SMR for all cancers (n = 44) was 0.79 (95% CI: 0.54, 1.17), and the SMR for breast cancer (n = 19) was 1.28 (95% CI: 0.72, 2.20). The SMR did not increase with duration of employment. Among men, 170 deaths were observed (SMR = 1.10, 95% CI: 0.94, 1.28). The SMR for all cancers (n = 21) was 0.71 (95% CI: 0.41, 1.18). The authors found a high number of deaths from acquired immunodeficiency syndrome (SMR = 40; 95% CI: 28.9, 55.8) and from aircraft accidents among the men. In this cohort, ionizing radiation probably contributed less to the small excess in breast cancer mortality than reproductive risk factors. Occupational causes seem not to contribute strongly to the mortality of airline cabin attendants.