3 Fatal Illness
Fatal illness in the workplace has been of interest
to the public health community since at least the 18th century, when Bernardino
Ramazzini compiled the first systematic description of the diseases of
workers [Ramazzini 1713]. Diseases are generally more difficult to link with
work than injuries. Many diseases related to occupational exposures (e.g.,
tuberculosis [TB], cancers, central nervous system
disorders, and asthma) are no different when encountered in the absence of occupational
exposures. Work-related aspects of illness may go unrecognized for many reasons, including
long latency periods between the exposure and development of some diseases and the failure
of health care professionals to recognize work-related illnesses or to obtain information
about work history. This chapter covers conditions generally accepted to be solely or
predominantly related to work. Excluded, for example, is lung cancer, even though 16% to
17% of cases in men and 2% of cases in women are considered to be work-related.
The pneumoconioses are a class of respiratory diseases attributed solely to workplace
factors. From 1968 through 1996, pneumoconiosis was an underlying or contributing cause
of 113,519 deaths in the United States (see Figure 1-10). The largest number of
pneumoconiosis deaths were attributed to coal workers' pneumoconiosis (CWP), but deaths from
this disease have declined over the years (Figure 3-1). By contrast, asbestosis
deaths increased from fewer than 100 in 1968 to nearly 1,200 in 1996 (Figure
3-2). Over the same period, silicosis deaths decreased (Figure 3-3),
byssinosis deaths varied substantially each year from 1979 to 1996 (Figure 3-4), and
unspecified and other types of pneumoconiosis decreased (Figure 3-5).
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Figure 3-1. Number of
deaths recorded with CWP as an underlying or contributing cause on the death
certificate-U.S. residents aged 15 and older, 1968-1996. (Source: NSSPM
[1999].)
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Figure 3-2. Number of deaths
recorded with asbestosis as an underlying or contributing cause on the death
certificate-U.S. residents aged 15 and older, 1968-1996. (Source: NSSPM
[1999].)
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Figure 3-3. Number of deaths recorded with silicosis as an
underlying or contributing cause on the death certificate-U.S. residents aged 15
and older, 1968-1996. (Source: NSSPM [1999].)
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Figure 3-4. Number of deaths recorded with byssinosis as an
underlying or contributing cause on the death certificate-U.S. residents aged 15
and older, 1979-1996. (Source: NSSPM [1999].)
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Figure 3-5. Number of deaths recorded with unspecified and other
pneumoconiosis as an underlying or contributing cause on the death
certificate-U.S. residents aged 15 and older, 1968-1996. (Source: NSSPM
[1999].)
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Pneumoconiosis Deaths by State
Asbestosis mortality is highest in northeastern, southern, and west coast
States (Figure 3-6), and CWP mortality is highest in Appalachian mining areas (Figure
3-7). Silicosis mortality appears less concentrated by geographic region than asbestosis
or CWP mortality (Figure 3-8). Byssinosis deaths are concentrated in textile-producing
States (Figure 3-9). The pattern of mortality for unspecified and other pneumoconiosis
most resembles that of CWP (Figure 3-10).
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Figure 3-6. Number of
asbestosis deaths by State-U.S. residents aged 15 and older, 1987-1996
(Source: NSSPM [1999].)
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Figure 3-7. Number of CWP deaths
by State-U.S. residents aged 15 and older, 1987-1996. (Source: NSSPM
[1999].)
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Figure 3-8. Number of silicosis
deaths by State-U.S. residents aged 15 and older, 1987-1996. (Source:
NSSPM [1999].)
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Figure 3-9. Number of byssinosis deaths by State-U.S. residents
aged 15 and older, 1987-1996. (Source: NSSPM [1999].)
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Figure 3-10.
Number of unspecified and other pneumoconiosis
deaths by State-U.S. residents aged 15 and older, 1987-1996. (Source: NSSPM
[1999].)
Pneumoconiosis Deaths by Sex and Race
The distribution of different types of pneumoconiosis deaths varies by sex
(Figure
3-11)
and race (Figure 3-12). Women accounted for 28% of byssinosis deaths
and less than 5% of deaths with all other types of pneumoconiosis. Blacks accounted for
15% of silicosis deaths, 13% of byssinosis deaths, and less than 7% of deaths with all
other types of pneumoconiosis.
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Figure 3-11. Distribution of types
of pneumoconiosis deaths by sex-U.S. residents aged 15 and older,
1987-1996. (Source: NSSPM [1999].)
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Figure 3-12.
Distribution of types of pneumoconiosis deaths
by race-U.S. residents aged 15 and older, 1987-1996. (Source: NSSPM
[1999].)
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Pneumoconiosis Deaths by Occupation
Proportionate mortality ratios (PMRs)
associating pneumoconiosis deaths with various occupations are presented in
Figures 3-13 through 3-17. A PMR above 1.0 indicates that more deaths occurred
with the condition than expected in an occupation or industry. PMRs with lower
95% confidence limits that exceed 1.0 are statistically significant. PMRs
calculated from a large subset of national data indicate that mining machine operators have extremely high relative mortality from
CWP and from unspecified and other pneumoconioses ( Figures 3-13 and 3-14). Insulation workers and related occupations had the highest PMRs for
asbestosis (Figure 3-15). Workers in metal and plastic processing, hand molding
and shaping, and crushing and grinding in mining occupations had the highest
PMRs for silicosis mortality (Figure 3-16). Textile machine operators and repairers had significant PMRs for
byssinosis (Figure
3-17).
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Figure 3-13.
PMRs (and 95% CIs) for CWP by occupation-U.S.
residents aged 15 and older, 1987-1996. (Source: NSSPM [1999].)
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Figure 3-14. PMRs (and 95% CIs)
for unspecified and other pneumoconioses by occupation-U.S. residents aged
15 and older, 1987-1996. (Source: NSSPM [1999].)
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Figure 3-15.
PMRs (and 95% CIs) for asbestosis by
occupation-U.S. residents aged 15 and older, 1987-1996. (Source: NSSPM
[1999].)
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Figure 3-16.
PMRs (and 95% CIs) for silicosis by
occupation-U.S. residents aged 15 and older, 1987-1996. (Source: NSSPM
[1999].)
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Figure 3-17.
PMRs (and 95% CIs) for byssinosis in textile
machine operators and repairers-U.S. residents aged 15 and older, 1987-1996.
(Source: NSSPM [1999].)
Malignant Pleural Neoplasm
Mortality due to malignant pleural neoplasm (cancer of the
lung lining) can serve as a surrogate for mortality due to malignant mesothelioma (often
a cancer of the lung lining) because no unique cause-of-death code is
currently available for mesothelioma. Asbestos exposure is by far
the leading cause of malignant mesothelioma. The number of deaths associated with malignant
pleural neoplasm increased during 1968-1996 (Figure 3-18). A geographic
distribution of cases is presented in Figure 3-19.
From 1987 to
1996, men accounted for 76% of the deaths from malignant pleural neoplasm (Figure
3-20), and white U.S. residents accounted for 94% of these deaths (Figure
3-21). Occupations with the highest PMRs for malignant pleural
neoplasm (Figure 3-22)
are similar to those with high PMRs for asbestosis
(Figure 3-15).
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image
Figure 3-18. Number of deaths with
malignant pleural neoplasm recorded as an underlying or contributing cause on
the death certificate-U.S. residents aged 15 and older, 1968-1996.
(Source: NCHS [1999].)
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Figure 3-19. Number of deaths due
to malignant pleural neoplasm by State-U.S. residents aged 15 and older,
1987-1996. (Source: NCHS [1999].)
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Figure 3-20.
Distribution and number of deaths due to
malignant pleural neoplasm by sex-U.S. residents aged 15 and older, 1987-1996.
(Source: NCHS [1999].)
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Figure 3-21. Distribution and
number of deaths due to malignant pleural neoplasm by race-U.S. residents
aged 15 and older, 1987-1996. (Source: NCHS [1999].)
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Figure 3-22.
PMRs (and 95% CIs) for malignant pleural neoplasm by usual
occupation-U.S. residents aged 15 and older, 1987-1996. (Source: NCHS
[1999].)
Hypersensitivity Pneumonitis
Hypersensitivity pneumonitis is a lung
disease that is often related to occupation. Examples of this disease are
farmers' lung, mushroom workers' lung, and bird fanciers' disease. The annual
number of deaths with hypersensitivity pneumonitis as an underlying or
contributing cause has generally increased since 1979 (Figure 3-23). A
geographic distribution of cases is presented in Figure 3-24.
Nearly 30% of
decedents during 1987-1996 were women (Figure 3-25), and 95% were white U.S.
residents (Figure 3-26).
The only occupation with a significantly high PMR for this disease was
nonhorticultural farmer, with a value of 11.6 (95% confidence interval [CI] =
8.5-15.6).
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Figure 3-23. Number of deaths
recorded with hypersensitivity pneumonitis as an underlying or contributing
cause on the death certificate-U.S. residents aged 15 and older,
1979-1996. (Source: NCHS [1999].)
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Figure 3-24. Number of
hypersensitivity pneumonitis deaths by State-U.S. residents aged 15 and
older, 1987-1996. (Source: NCHS [1999].)
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Figure 3-25. Distribution and
number of hypersensitivity pneumonitis deaths by sex-U.S. residents aged
15 and older, 1987-1996. (Source: NCHS [1999].)
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Figure 3-26.
Distribution and number of hypersensitivity
pneumonitis deaths by race-U.S. residents aged 15 and older, 1987-1996. (Source:
NCHS [1999].)
