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Work-Related Lung Disease (WoRLD) Surveillance Report

Table of Contents > Highlights

Highlights

The following paragraphs highlight selected findings based on data from the United States presented in this and previous WoRLD Surveillance Reports.

Asbestosis and Related Exposures
  • Asbestosis deaths among U.S. residents age 15 and over have increased from fewer than 100 in 1968 to more than 1,250 annually in 1999, the most recent year for which data are available, with no apparent leveling off of this trend. (Figure 1-1)

  • Over the 10-year period from 1990 to 1999, there were more than 10,000 asbestosis deaths and annual asbestosis death counts increased by one-third. (Table 1-1)

  • During the 10-year period from 1990 to 1999, asbestosis deaths represented about one-third of all pneumoconiosis deaths. (Table 6-6)

  • For 1998 and for 1999, asbestosis deaths outnumbered coal workers’ pneumoconiosis (CWP) deaths, displacing CWP as the most frequent type of pneumoconiosis death. (Tables 1-1, 2-1, 6-1)

  • Asbestosis was designated as the underlying cause of death in one-third of all asbestosis deaths from 1990 to 1999. (Table 1-1)

  • Residents of California, Pennsylvania, New Jersey, Texas, Florida, Washington, and Virginia together accounted for nearly half of all asbestosis deaths in the 1990 to 1999 period. (Table 1-4)

  • For the period from 1985 to 1999, four counties (one in Virginia, one in Texas, one in Mississippi, and one in New Jersey) had age-adjusted asbestosis mortality rates that exceeded the national rate by more than 20-fold. (Table 1-10)

  • Based on a large subset of the national data for which decedents’ usual occupation and industry information was available, the construction industry accounted for one-fourth of decedents with asbestosis from 1990 through 1999. Apart from construction, asbestosis deaths were reported in a wide range of industries, with no particular industry predominating. Similarly, no one occupation emerged as being particularly common, though the most frequently listed occupational group was plumbers, pipefitters, and steamfitters. (Tables 1-6, 1-7)

  • From 1990 to 1999, decedents whose death certificate indicated that they worked in the miscellaneous nonmetallic mineral and stone products industry or the ship and boat building and repairing industry had proportionate asbestosis mortality more than 15 times higher than that of all industries combined. (Table 1-8)

  • From 1990 to 1999, decedents whose death certificate indicated that they were insulation workers or boilermakers had proportionate asbestosis mortality 20 times higher than that in all occupations combined. (Table 1-9)

  • Hospital discharges associated with asbestosis have been rising rapidly between 1995 and 2000. (Table 1-11)

  • Data from the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA) indicate a trend towards lower exposure levels from 1979 to 1999, concomitant with mandated reductions in the OSHA permissible exposure limit (PEL). (Figure 1-5, Table 1-12)

  • For the period 1990 to 1999, less than 5% of the MSHA and OSHA asbestos exposures exceeded the recommended exposure limit (REL). The miscellaneous nonmetallic mineral and stone products industry, which had the highest proportionate mortality ratio (PMR) for asbestosis, also had the highest geometric mean exposure and the highest percent of exposures exceeding the PEL and REL (26% and 41%, respectively). (Table 1-13)

Coal Workers’ Pneumoconiosis (CWP) and Related Exposures
  • CWP deaths among U.S. residents age 15 and over continue a long-term decline, from well over 2,500 deaths annually in the early 1980s to just over 1,000 in the late 1990s. (Figure 2-1)

  • Similarly, among active underground coal miners examined in a federally-administered CWP screening program, the prevalence of radiographically evident CWP continues to decline – from over 10% in the early 1970s to less than 2% in the late 1990s. (Table 2-12, Figure 2-5)

  • CWP deaths accounted for nearly half of pneumoconiosis deaths during the 10-year period from 1990 to 1999, clearly outnumbering deaths associated with other types of pneumoconiosis. (Table 6-6)

  • CWP was designated as the underlying cause of death in over one-third of all CWP deaths from 1990 to 1999. (Table 2-1)

  • For the decade from 1990 to 1999, more than three-fourths of all CWP decedents were residents of Pennsylvania, West Virginia, Virginia, and Kentucky. Pennsylvania alone accounted for about half of all CWP deaths in this period. (Table 2-4)

  • For the period from 1985 to 1999, four counties (one in Virginia, one in Pennsylvania, and two in West Virginia) had age-adjusted CWP mortality rates that exceeded the national rate by more than 100-fold. (Table 2-10)

  • A large majority of CWP deaths are associated with employment in the coal mining industry, for which proportionate CWP mortality was more than 50 times higher than that of all occupations combined. (Tables 2-6, 2-8)

  • Federal “Black Lung” Program payments totaled more the $1.5 billion for nearly 190,000 beneficiaries in 1999. These figures reflect a continuing slow decline from over $1.8 billion paid out for over 500,000 beneficiaries in 1980. The number of beneficiaries is now about one-third of what it was in 1980. (Table 2-13)

  • Data from MSHA indicate that from the early 1980s to 1999 the underground coal mining industry experienced little change in level of exposure to respirable coal mine dust. Surface mine exposure levels have also remained fairly steady although there is some evidence of a decline in exposure levels since the early 1990s. (Figure 2-7, Table 2-14)

  • During the period 1995 to 1999, one-fourth of coal mine dust exposures recorded by MSHA exceeded the REL. (Tables 2-15, 2-16)

Silicosis and Related Exposures
  • Silicosis deaths among U.S. residents age 15 and over represented nearly 8% of all pneumoconiosis deaths in the U.S. during the 10-year period from 1990 to 1999. (Table 6-6)

  • Over the past several decades, silicosis mortality has declined, from well over 1,000 deaths annually in the late 1960s to fewer than 200 per year in the late 1990s. (Figure 3-1)

  • Silicosis was designated as the underlying cause of death in half of all silicosis deaths from 1990 to 1999. (Table 3-1)

  • Compared to asbestosis, CWP, and byssinosis, silicosis mortality appears to be somewhat less concentrated by geographic region or by industry. However, Pennsylvania, alone, accounts for nearly 18% of silicosis deaths for the 1990-1999 period, ranking first among all states in number of silicosis deaths and fourth in age-adjusted silicosis mortality rate behind West Virginia, Vermont, and Colorado. (Tables 3-4, 3-5)

  • For the period from 1985 to 1999, six counties (two in North Carolina and one each in Montana, Idaho, Colorado, and Georgia) had age-adjusted silicosis mortality rates that exceeded the national rate by more than 25-fold. (Table 3-10)

  • Based on a large subset of the national data for which decedents’ usual occupation and industry information was available, the construction and mining industries accounted for at least one-third of decedents with silicosis from 1990 through 1999. (Table 3-6)

  • Throughout the 1990-1999 period, silicosis mortality rates were higher among black males than among white males. (Table 3-2)

  • Based on data from the SENSOR silicosis programs in Michigan, New Jersey, and Ohio, more than 8% of confirmed silicosis cases for which duration of exposure was ascertained had less than 10 years of occupational exposure to silica dust. (Table 3-13)

  • Data from MSHA indicate that from 1979 to 1999 respirable quartz exposure levels have remained relatively constant in the coal mining industry. Levels in the metal mining and nonmetallic mining and quarrying industries appear to have declined from 1979 to 1987, increased substantially in 1988 when MSHA implemented a different quartz analytical standard, declined from 1989 to 1995 and increased thereafter. Data from OSHA indicate that from 1979 to 1999 respirable quartz exposure levels have declined in the non-mining industries during the period 1989 to 1992 when the OSHA PEL was changed from a formula for respirable dust containing quartz to a respirable quartz concentration of 0.1 mg/m3. (Figures 3-6a, 3-6b, Tables 3-16a, 3-16b, 3-2 0)

  • For the overall period 1993 to 1999, the percentages of exposures greater than the PEL were about 29% in coal mining, about 6% in metal mining and nonmetallic mining and quarrying industries, and 31% in other industries. (Tables 3-18, 3-19, 3-20)

  • For the overall period 1990 to 1999, miscellaneous nonmetallic mineral and stone products, iron and steel foundries, and structural clay products were the industries with elevated PMRs for silicosis in which at least 29% of their exposures exceeded the PEL and about half exceeded the REL. The coal mining industry had an elevated PMR for silicosis and about 30% of its exposures exceeded the MSHA PEL. (Tables 3-8, 3-17)

  • For the period 1993 to 1999, Indiana, Virginia, Tennessee, West Virginia, Oklahoma, Kentucky, Arizona, and Alabama had geometric mean respirable quartz exposure levels in the coal mining industry which exceeded 0.05 mg/m3 MRE and at least 10 samples analyzed by MSHA. (Table 3-18, Figure 3-7)

  • For the period 1993 to 1999, 16 states had geometric mean respirable quartz exposure levels in non-mining industries which exceeded the REL of 0.05 mg/m3 and at least 10 samples analyzed by OSHA. (Table 3-20, Figure 3-9)

Byssinosis and Related Exposures
  • In comparison with other pneumoconioses, byssinosis deaths among U.S. residents age 15 and over (as enumerated from death certificate data) remain very few – fewer than 20 annually since 1990, and fewer than 10 annually in 1998 and 1999. (Table 4-1)

  • Nearly one-third of byssinosis decedents in the 1990 to 1999 period were female. (Table 4-1)

  • Byssinosis was designated as the underlying cause of death in about half of all byssinosis deaths from 1990 to 1999. (Table 4-1)

  • Over one-half of byssinosis decedents in the period from 1990 to 1999 were residents of North Carolina, South Carolina, and Georgia. (Table 4-4)

  • For the period from 1985 to 1999, three counties (all in North Carolina) had age-adjusted byssinosis mortality rates that exceeded the national rate by more than 50-fold. (Table 4-10)

  • Only one industry – yarn, thread, and fabric mills – was associated with a significantly high byssinosis mortality for the 1990 to 1999 period. (Table 4-8)

  • Although cotton dust exposure data are sparse, nearly one-third of the exposures measured by OSHA exceeded the REL for the period 1990 to 1999. (Table 4-12)

Unspecified/Other Pneumoconioses
  • The pattern of deaths from unspecified/other pneumoconioses, which account for 10% of all pneumoconiosis deaths during the 1990-1999 period, tends to resemble coal workers’ pneumoconiosis (and, less so, silicosis) mortality with respect to geographic distribution, a similar peak in 1972, and similar occupations and industries associated with high PMRs. This indicates that most unspecified pneumoconiosis deaths are likely to be CWP deaths. (Tables 5-1, 5-4, 5-8, 5-9, 6-6)

  • For each year from 1979 to 1999, at least five percent of OSHA iron oxide fume exposures exceeded the REL. (Table 5-11)

All Pneumoconioses and Related Exposures
  • During the 10-year period from 1990 to 1999, there were more than 31,000 pneumoconiosis deaths nationwide, accounting for more than 300,000 years of potential life lost. (Tables 6-1, 6-3)

  • Overall pneumoconiosis mortality in the U.S. has been gradually declining over the past two-and-one-half decades, from a peak of more than 5,000 deaths in 1972 to 2,745 pneumoconiosis deaths in 1999. (Figure 6-1, Table 6-1)

  • Pneumoconiosis was designated as the underlying cause of death in over one-third of all pneumoconiosis deaths from 1990 to 1999. (Table 6-1)

  • The pattern of all pneumoconiosis mortality is largely influenced by coal workers’ pneumoconiosis (CWP), given that certified CWP deaths represent nearly half of all pneumoconiosis deaths from 1990 to 1999. However, asbestosis deaths have been increasing and exceeded CWP deaths in 1998 and 1999. (Tables 1-1, 2-1, 6-6)

  • Based on a major survey of private industry employers, annual estimates for the number of new cases of pneumoconiosis over the late 1990s have ranged from 1,700 to 3,500 among employees. There is no clear trend in these estimates since 1980. The highest estimated rates have been consistently associated with mining, particularly with coal mining. (Tables 6-12, 6-13, 6-14)

  • For the overall period 1990 to 1999, the coal mining industry had the highest PMR (33) for pneumoconiosis and over one-fourth of its exposures exceeded the REL. (Table 6-16)

Malignant Mesothelioma
  • There were nearly 2,500 malignant mesothelioma deaths among U.S. residents age 15 and over in 1999. (Table 7-1)

  • Mesothelioma was designated as the underlying cause of death in nearly 95% of all malignant mesothelioma deaths in 1999. (Table 7-1)

  • Nearly 20% of mesothelioma decedents were female. (Table 7-1)

  • For 1999, more than one-third of mesothelioma decedents were residents of just five states (California, Florida, Pennsylvania, New York and Ohio). (Table 7- 4)

  • For 1999, seven counties (two in Virginia, and one each in Ohio, Maine, New Jersey, Mississippi, and Michigan) had age-adjusted malignant mesothelioma mortality rates that exceeded the national rate by more than 5-fold. (Table 7-9)

  • Based on a large subset of the national data for which decedents’ usual occupation and industry information was available, the construction industry accounted for nearly 15% of decedents with malignant mesothelioma in 1999. (Table 7-5)

  • In addition to the construction industry, other industries associated with significantly increased mesothelioma mortality in 1999 include: ship and boat building and repairing; industrial and miscellaneous chemicals; petroleum refining; and electric light and power. (Table 7-7)

  • Occupations associated with significantly elevated mesothelioma mortality in 1999 include: plumbers, pipefitters, and steamfitters; mechanical engineers; electricians; and elementary school teachers. (Table 7-8)

Hypersensitivity Pneumonitis (HP)
  • The annual number of hypersensitivity pneumonitis (HP) deaths has been generally increasing, from less than 20 per year in 1979 to 57 in 1999. (Figure 8-1, Table 8-1)

  • HP was designated as the underlying cause of death in two-thirds of all HP deaths from 1990 to 1999. (Table 8-1)

  • The highest HP mortality rates for the 1990-1999 period are in the upper Midwest, northern Plains, Mountain, and New England states. (Table 8-5)

  • For the 1985-1999 period, two counties in Wisconsin had age-adjusted HP mortality rates that exceeded the national rate by more than 5-fold. (Table 8-10)

  • For the 1990-1999 period, Agricultural production industries (both livestock and crops) and farmers, except horticulture were associated with significantly elevated PMRs for HP. (Tables 8-8, 8-9)

Asthma
  • For the 1990-1999 period, agriculture production, livestock and farm machinery and equipment were associated with the highest proportionate mortality ratios for asthma. Among the other top five industries with significantly elevated PMRs for asthma were: child day care services; drug stores; and health services, not elsewhere classified. Among the top ten industries associated with significantly elevated PMRs for asthma are two others related to the health care industry: hospitals and offices and clinics of physicians. (Table 9-1)

  • For the 1990-1999 period, half of the 23 occupational groups associated with significantly elevated PMRs for asthma were related to health care and education. (Table 9-2)

  • Public health surveillance programs in four states (California, Massachusetts, Michigan, and New Jersey) have identified over 2,500 cases of work-related asthma over a recent seven-year period (1993-1999). About 80% represented asthma caused by occupational exposure, while 20% represented preexisting asthma aggravated by occupational exposure. (Table 9-3)

  • Of all the work-related asthma cases from California, Massachusetts, Michigan, and New Jersey associated with various categories of reported putative agents for 1993-1999, 20% were associated with miscellaneous chemicals, 12% with cleaning materials, 11% with mineral and inorganic dust, 10% with indoor air pollutants, and 4% with welding exposures, among others. (Figure 9-1)

  • Based on a recent national survey of the U.S. population in which respondents’ current industry was ascertained, elementary and secondary schools and colleges was the current industry sector associated with an estimated asthma prevalence among nonsmokers that significantly exceeded the estimated 8% prevalence of asthma among all U.S. adult nonsmokers. (Table 9-8)

  • Based on the survey noted above, teachers, librarians and counselors was the current occupation associated with estimated asthma prevalence among nonsmokers that significantly exceeded the estimated 8% prevalence of asthma among all U.S. adult nonsmokers. (Table 9-11)

Chronic Obstructive Pulmonary Disease (COPD)
  • Coal mining led the list of industries with significantly elevated PMRs for COPD in 1999. Two other mining sectors were in the top five industries for COPD mortality, as were trucking service and automotive repair and related services. (Table 10-1)

  • The top five occupations for COPD mortality in 1999 included: washing, cleaning, and pickling machine operators; helpers, mechanics and repairers; textile cutting machine operators; mining machine operators; and construction trades, not elsewhere classified. (Table 10-2)

Respiratory Conditions due to Toxic Agents
  • Based on a major survey of private employers, the average annual estimated number of new cases of respiratory conditions due to toxic agents has decreased to approximately 15,000 for 1999 and 2000, down from annual estimates of about 25,000 in the early and mid-1990s. (Table 11-1)

  • The major industry groups associated with the highest annual estimated rates of work-related respiratory conditions due to toxic agents in 2000 are manufacturing (3.0 per 10,000 full-time workers), services (1.9 per 10,000 full-time workers), and transportation and public utilities (1.5 per 10,000 full-time workers). The transportation equipment industry, with annual estimated rates of about 10 per 10,000, has consistently ranked in the top three industry sectors during the 1996 to 2000 period. (Tables 11-2, 11-3)

Respiratory Tuberculosis
  • Among the industry sectors associated with significantly elevated tuberculosis mortality in the 1990-1999 period were: health-care industries (offices and clinics of health practitioners; hospitals; and miscellaneous personal services); agricultural production, crops; and industries with significantly elevated silicosis mortality (nonmetallic mining and quarrying, except fuel; metal mining; other primary metal industries; coal mining; and construction). (Tables 12-1, 3-8)

  • Among occupations associated with significantly elevated tuberculosis mortality in the 1990-1999 period were agricultural occupations (farm workers and farmers, except horticulture), sailors and deckhands, garbage collectors, and occupations associated with significantly elevated silicosis mortality (crushing and grinding machine operators; mining machine operators; construction laborers; and laborers, except construction). (Tables 12-2, 3-9)

Lung Cancer
  • This edition of the Work-Related Lung Disease Surveillance Report is the first of the series to include a section on lung cancer – specifically PMRs by industry and occupation. A variety of industries and occupations associated with significantly elevated lung cancer mortality are listed in this section. (Tables 13-1, 13-2)

Other Interstitial Pulmonary Diseases
  • This edition of the Work-Related Lung Disease Surveillance Report is the first of the series to include a section on other interstitial pulmonary diseases – specifically PMRs by industry and occupation. A variety of industries and occupations associated with significantly elevated other interstitial pulmonary diseases mortality are listed in this section. (Tables 14-1, 14-2)

Various Work-Related Respiratory Conditions
  • Data from the Bureau of Labor Statistics Annual Survey and the Association of Occupational and Environmental Clinics Database, both of which include information on a wide range of work-related respiratory diseases, serve to remind readers that there is much more to work-related lung disease and other occupational respiratory diseases than they might otherwise realize. Data are presented on work-related upper airway disorders (e.g., allergic rhinitis, nasal septum perforation), malignant diseases (e.g., nasal and laryngeal, as well as pulmonary and pleural), infectious diseases (e.g., influenza, pneumonia, and Legionnaires’ disease), and other respiratory diseases (e.g., pneumonitis, interstitial fibrosis, etc.). (Tables 15-1, 15-2, 15-3a, 15-3b, 15-3c, 15-4, 15-5)

Smoking Prevalence by Occupation and Industry
  • This edition of the Work-Related Lung Disease Surveillance Report is the first of the series to include a section on smoking prevalence by industry and occupation. Smoking by itself is an important cause of lung disease and smoking can also compound the adverse effects of occupational exposures. Based on recent data from the National Health Interview Survey, estimated smoking prevalences range widely from 12% among elementary and secondary schools and colleges workers to over 40% among repair services workers. Similar wide-ranging smoking prevalences are seen among occupational groups. (Tables 16-1, 16-2, 16-3, 16-4, 16-5, 16-6)

 

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