Mortality patterns among workers exposed to styrene in the reinforced plastic boatbuilding industry: an update

BACKGROUND: Mortality was updated through 1998 for 5,204 workers exposed to styrene between 1959 and 1978 at two reinforced plastic boatbuilding plants. The a priori hypothesis: leukemia and lymphoma excesses would be found. METHODS: Standardized mortality ratios (SMR) and 95% confidence intervals (CI) used Washington State and U.S. rates. RESULTS: Overall, 860 deaths occurred (SMR 1.09, CI 1.02-1.17), with excess mortality for esophageal cancer (n = 12, SMR 2.30, CI 1.19-4.02), prostate cancer (n = 24, SMR 1.71, CI 1.09-2.54), and accidents (n = 99, SMR 1.26, CI 1.02-1.53). Among 2,062 highly exposed workers, urinary tract cancer (n = 6, SMR 3.44, CI 1.26-7.50) and respiratory disease (n = 12, SMR 2.54, CI 1.31-4.44) rates were elevated. Urinary tract cancer SMR increased with duration of employment. CONCLUSIONS: We found no excess leukemia or lymphoma mortality. Unanticipated excess urinary tract cancer and respiratory disease mortality, possibly associated with styrene exposure, are difficult to interpret and could be chance findings.     

Spontaneous abortions among women employed in the plastics industry

A matched case-control study was done to analyze whether certain occupational exposures in the plastics industry were related to the risk of spontaneous abortions. Information on spontaneous abortions (cases) and births (controls) was obtained from the hospital discharge register; data on occupational exposures were obtained from the occupational health services of the workplaces. No increased risk of spontaneous abortions was observed among workers processing polymerized plastics or heated plastics made of vinyl chloride or of styrene. Owing to the low statistical power of the study, only strong effects can be ruled out. The odds ratio for workers actually processing polyurethane was increased (1.9, not statistically significant), and that for all workers in polyurethane-processing factories was significantly increased (3.0, p = 0.02). The finding needs to be investigated further in future studies.     

Predictors of occupational exposure to styrene and styrene-7,8-oxide in the reinforced plastics industry

Objective

To identify demographic and work related factors that predict blood levels of styrene and styrene‐7,8‐oxide (SO) in the fibreglass reinforced plastics (FRP) industry.

Methods

Personal breathing‐zone air samples and whole blood samples were collected repeatedly from 328 reinforced plastics workers in the Unuted States between 1996 and 1999. Styrene and its major metabolite SO were measured in these samples. Multivariable linear regression analyses were applied to the subject‐specific levels to explain the variation in exposure and biomarker levels.

Results

Exposure levels of styrene were approximately 500‐fold higher than those of SO. Exposure levels of styrene and SO varied greatly among the types of products manufactured, with an 11‐fold range of median air levels among categories for styrene and a 23‐fold range for SO. Even after stratification by job title, median exposures of styrene and SO among laminators varied 14‐ and 31‐fold across product categories. Furthermore, the relative proportions of exposures to styrene and SO varied among product categories. Multivariable regression analyses explained 70% and 63% of the variation in air levels of styrene and SO, respectively, and 72% and 34% of the variation in blood levels of styrene and SO, respectively. Overall, air levels of styrene and SO appear to have decreased substantially in this industry over the last 10–20 years in the US and were greatest among workers with the least seniority.

Conclusions

As levels of styrene and SO in air and blood varied among product categories in the FRP industry, use of job title as a surrogate for exposure can introduce unpredictable measurement errors and can confound the relation between exposure and health outcomes in epidemiology studies. Also, inverse relations between the intensity of exposure to styrene and SO and years on the job suggest that younger workers with little seniority are typically exposed to higher levels of styrene and SO than their coworkers.     

An analysis of exposure to styrene in the reinforced plastic boat-making industry

To evaluate patterns of occupational exposure to styrene monomer in the boat-building industry, we conducted industrial hygiene surveys in seven fiberglass-reinforced plastic boat-fabrication plants. A total of 397 personal breathing zone air samples were collected on workers in four key job categories: gel coating and hull, deck, and small-parts lamination. We found that exposure to styrene in 234 (59%) of the personal samples exceeded the NIOSH-recommended time-weighted average (TWA) standard of 50 parts per million (ppm), and 96 (24%) of these samples exceeded the OSHA eight-hour TWA permissible exposure limit of 100 ppm. From highest to lowest average exposure potential, the job categories ranked in the following order: hull lamination (range 2–183 ppm, mean 78 ppm), deck lamination (range 12–160 ppm, mean 73 ppm), gel coating (range 5–94 ppm, mean 48 ppm), and small-parts lamination (range 9–130 ppm, mean 45 ppm). The former two categories composed a higher-exposure group, and the latter two tended to form a lower-exposure group. Exposures in these jobs appear to be proportional to resin consumption. Statistical analyses indicated that the parameter that most affects exposure potential is job category. Within a job category, part size, configuration, and surface area are important determinants of exposure. The principal reason for high exposures was the absence of control technologies and, in particular, the absence of adequate ventilation.     

Biological monitoring of styrene in the reinforced plastics industry in Emilia Romagna,Italy

Summary Biological monitoring of styrene exposure among workers in the reinforced plastics industry is widely implemented in the region of Emilia Romagna, Italy. More than 18000 urine samples measurements of the main metabolites of styrene, mandelic (MA) and phenylglyoxylic acid, were retrieved for the period 1978–1990, and 4689 values of MA in postshift urine samples were analyzed for various variables thought to influence styrene exposure. The job performed was found to be the most important predictor of styrene exposure. Hand laminators had the highest exposure (mean MA 682 mg/g creatinine); spray laminators showed lower values (404 mg/g), while levels in semiautomatic process operators(243 mg/g) were only slightly higher than in nonprocess workers (186 mg/g). The use of ventilation resulted in lower exposure, but differences in average values were not particularly wide. Exposure decreased weakly during the study period in all work categories, but the percentage of measurements exceeding the current biological limit value (900 mg/g creatinine, 1300 mg/1 corrected for density) is still very high (20% of measurements among hand laminators in 1990). These results indicate that the control measures implemented are only partially effective for the prevention of styrene exposure.The work was done at the International Agency for Research on Cancer (Lyon, France) and at the Documentation and Information Center on Occupational and Environmental Health and Safety (Bologna, Italy)     

Delivery outcome among women employed in the plastics industry in Sweden and Norway

In Sweden and Norway separate case-control studies of pregnancy outcome for the period 1973-1981 among female workers in the plastics industry were carried out with similar design. Employment records were obtained from companies producing and/or processing plastics and these were matched with the national medical birth and malformation registers. Within the cohorts of pregnancies during which the mother held employment in a plastics industry (1.397 in the Swedish and 288 in the Norwegian study), cases of stillbirths or infant deaths, selected malformations, or low birthweight (less than 2,000 g) were identified. For each case two controls from the same source were individually matched with regard to date of birth, age of mother, and parity. Exposure data concerning the 44 Swedish and ten Norwegian triplets were obtained from the employers. An increased odds ratio was found for processing of polyvinylchloride (PVC) plastics (95% CI Sweden 1.0-5.1; total material 1.1-4.5). However, processing of cold plastics yielded a higher odds ratio than processing of heated plastics. No increased odds ratio was found for processing of styrene or polyurethane plastics. Since not all of the plastics industries in the two countries participated in the studies and the number of cases was small, the result must be interpreted with caution.     

Exposure assessment for study of olfactory function in workers exposed to styrene in the reinforced-plastics industry

BACKGROUND: This study was undertaken in conjunction with an evaluation of the olfactory function of 52 persons exposed to styrene vapors to provide quantitative styrene exposure histories of each subject for use in the interpretation of the results of olfactory function testing. METHODS: Current and historic exposures were investigated. Historic exposures were reconstructed from employment records and measurements of styrene exposure made in the subject facilities over the last 15 years. Current exposures were estimated for every exposed subject though personal air sampling and through pre- and post-shift measurements of urinary metabolites of styrene. RESULTS: The study population had been employed in the reinforced-plastics industry for an average of 12.2 +/- 7.4 years. Their mean 8-hr time weighted average (TWA) respirator-corrected annual average styrene exposure was 12.6 +/- 10.4 ppm; mean cumulative exposure was 156 +/- 80 ppm-years. The current respirator-corrected 8-hr TWA average exposure was 15.1 +/- 12.0 ppm. The mean post-shift urinary mandelic and phenylglyoxylic acid (PGA) concentrations were 580 +/- 1,300 and 170 +/- 360 mg/g creatinine, respectively and were highly correlated with air concentrations of styrene. CONCLUSIONS: This quantitative exposure evaluation has provided a well-characterized population, with documented exposure histories stable over time and in the range suitable for the purposes of the associated study of olfactory function.     

Olfactory function in workers exposed to styrene in the reinforced-plastics industry

BACKGROUND: Impairment of olfactory function in humans has been associated with occupational exposure to volatile chemicals. To investigate whether exposure to styrene was associated with olfactory impairment, olfactory function was examined in workers with a minimum of 4 years exposure to styrene in the reinforced-plastics industry (current mean exposure: 26 ppm, range: 10-60 ppm; historic mean dose: 156 ppm-years, range: 13.8-328 ppm-years) and in a group of age- and gender-matched, unexposed controls. METHODS: Olfactory function was assessed using a standardized battery that included tests of threshold sensitivity for phenylethyl alcohol (PEA), odor identification ability, and retronasal odor perception. Odor detection thresholds for styrene were also obtained as a measure of specific adaptation to the work environment. RESULTS: No differences were observed between exposed workers and controls on tests of olfactory function. Elevation of styrene odor detection thresholds among exposed workers indicated exposure-induced adaptation. CONCLUSIONS: The present study found no evidence among a cross-section of reinforced-plastics industry workers that current or historical exposure to styrene was associated with impairment of olfactory function. Taken together with anatomical differences between rodent and human airways and the lack of evidence for styrene metabolism in human nasal tissue, the results strongly suggest that at these concentrations, styrene is not an olfactory toxicant in humans.     

Cancer mortality among workers in abattoirs and meatpacking plants: An update

Workers in abattoirs and meatpacking plants have potential for exposure to bovine leukemia virus (BLV) and bovine papilloma viruses (BPV), which are oncogenic in cattle. These workers also have increased exposure to human papilloma viruses (HPV) and certain chemical carcinogens. We investigated whether such a group showed increased risk of cancers. We report mortality results after an additional 9-year follow-up of a previously studied group of 5,522 workers in abattoirs and 4,589 workers in meatpacking plants. Excess risk of all cancers combined, cancers of the lung, buccal cavity and pharynx, esophagus, colon, bladder, kidney, and bone was observed. Since factors such as tobacco smoking, alcohol, and diet, which have known associations with some of these cancers, were not taken into account, the significance of these findings is not known, except for lung cancer, for which occupational factors are probably involved. Because some of these findings have been consistently reported before, studies that will control for confounding factors as well are now urgently needed.     

An updated cohort mortality study of workers exposed to styrene in the reinforced plastics and composites industry.

Mortality data have been updated for a further 12 years for a cohort of workers in the reinforced plastics and composites industry with exposures to styrene monomer and other chemicals. The cohort consisted of 15,826 male and female employees who were exposed to styrene for at least six months between 1948 and 1977 at 30 participating manufacturing plants in the United States. A total of 1628 deaths were reported during the extended observation period, 1948-89. Mortality from several causes showed significant increases--namely, all causes, all cancers, oesophageal cancer, lung cancer, cancer of the cervix uteri, cancer of other female genital organs, hypertensive heart disease, certain non-malignant respiratory diseases, motor vehicle accidents, and homicides. When, however, mortality data were examined in terms of duration of employment, durations of styrene exposure, and cumulative styrene exposure no upward trend was detected in any of these causes of death. Most of the increases in mortality were among workers who were employed for only six months to a year or who had very low cumulative exposure (< 10 ppm-years). Therefore, the increased mortality was not likely to be related to exposure to styrene. Several explanations for the increased mortality are offered, including low socioeconomic class, smoking, and lifestyle factors characteristic of short term workers. There was no increased mortality from lymphatic and haematopoietic cancers overall or from any specific haematological malignancies. In particular, no increase in mortality from non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, or leukaemia was found. Furthermore, detailed exposure-response analyses did not show any relation between exposure to styrene and any of these haematological malignancies. The lack of an exposure-response relation further supports the conclusion that workers in the reinforced plastics industry in this study did not experience any increased risk of lymphatic and haematopoietic cancers as a result of their exposure to styrene.     

A cohort mortality study and a case-control study of workers potentially exposed to styrene in the reinforced plastics and composites industry

The cohort consisted of 15,908 men and women who worked for at least six months between 1948 and 1977 in 30 participating manufacturing plants in the reinforced plastics and composites industry. These workers were occupationally exposed to the working environment in the industry, which included exposure to styrene. Cause specific mortality analyses were performed based on the standardised mortality ratio (SMR) with the United States population as a comparison. No significant excess of cause specific mortality was found for the total cohort. Mortality from cancer was slightly less than expected (SMR = 88.1). For cancer of the respiratory system, a small non-significant excess was detected (SMR = 116.1). For lymphatic and haematopoietic cancer, a non-significant deficit was found (SMR = 73.3). The observed mortality from leukaemia was similar to that expected (five observed v 4.76 expected deaths). The plants with hot processes (injection moulding, centrifugal casting, compression moulding, continuous lamination, and pultrusion) experienced a significantly increased SMR (177.9) for respiratory cancer, which was more than twice that (78.3) for those with cold processes (resin mixing, lay up and spray up, bag moulding, and filament winding). As potential exposure to styrene from hot processes is considerably less than that from the cold processes, this finding could not be attributed to occupational exposures. A subsequent nested case-control study consisting of 40 cases of deaths from respiratory cancer was conducted. Further information on detailed work history, occupational exposures, and smoking history was collected. The case-control study did not show any significant association between respiratory cancer and direct exposure to styrene (contained in polyester resins), duration of exposure to styrene, the type of process (hot or cold), or whether a resin was used. A statistically significant association (relative risk = 7.33) was found between cigarette smoking and respiratory cancer among the study subjects.     

A cohort mortality study and a case-control study of workers potentially exposed to styrene in the reinforced plastics and composites industry.

The cohort consisted of 15,908 men and women who worked for at least six months between 1948 and 1977 in 30 participating manufacturing plants in the reinforced plastics and composites industry. These workers were occupationally exposed to the working environment in the industry, which included exposure to styrene. Cause specific mortality analyses were performed based on the standardised mortality ratio (SMR) with the United States population as a comparison. No significant excess of cause specific mortality was found for the total cohort. Mortality from cancer was slightly less than expected (SMR = 88.1). For cancer of the respiratory system, a small non-significant excess was detected (SMR = 116.1). For lymphatic and haematopoietic cancer, a non-significant deficit was found (SMR = 73.3). The observed mortality from leukaemia was similar to that expected (five observed v 4.76 expected deaths). The plants with hot processes (injection moulding, centrifugal casting, compression moulding, continuous lamination, and pultrusion) experienced a significantly increased SMR (177.9) for respiratory cancer, which was more than twice that (78.3) for those with cold processes (resin mixing, lay up and spray up, bag moulding, and filament winding). As potential exposure to styrene from hot processes is considerably less than that from the cold processes, this finding could not be attributed to occupational exposures. A subsequent nested case-control study consisting of 40 cases of deaths from respiratory cancer was conducted. Further information on detailed work history, occupational exposures, and smoking history was collected. The case-control study did not show any significant association between respiratory cancer and direct exposure to styrene (contained in polyester resins), duration of exposure to styrene, the type of process (hot or cold), or whether a resin was used. A statistically significant association (relative risk = 7.33) was found between cigarette smoking and respiratory cancer among the study subjects.     

Cancer mortality in workers exposed to organochlorine compounds in the pulp and paper industry: an international collaborative study

The objective of this study was to evaluate cancer mortality in pulp and paper industry workers exposed to chlorinated organic compounds. We assembled a multinational cohort of workers employed between 1920 and 1996 in 11 countries. Exposure to both volatile and nonvolatile organochlorine compounds was estimated at the department level using an exposure matrix. We conducted a standardized mortality ratio (SMR) analysis based on age and calendar-period-specific national mortality rates and a Poisson regression analysis. The study population consisted of 60,468 workers. Workers exposed to volatile organochlorines experienced a deficit of all-cause [SMR = 0.91; 95% confidence interval (CI), 0.89-0.93] and all-cancer (SMR = 0.93; 95% CI, 0.89-0.97) mortality, with no evidence of increased risks for any cancer of a priori interest. There was a weak, but statistically significant, trend of increasing risk of all-cancer mortality with increasing weighted cumulative exposure. A similar deficit in all-cause (SMR = 0.94; 95% CI, 0.91-0.96) and all-cancer (SMR = 0.94; 95% CI, 0.89-1.00) mortality was observed in those exposed to nonvolatile organochlorines. No excess risk was observed in cancers of a priori interest, although mortality from Hodgkin disease was elevated (SMR = 1.76; 95% CI, 1.02-2.82) . In this study we found little evidence that exposure to organochlorines at the levels experienced in the pulp and paper industry is associated with an increased risk of cancer, apart from a weak but significant association between all-cancer mortality and weighted cumulative volatile organochlorine exposure.