Document 2JDvngVOpoq9Z1KxgdanxBzg5

Brief Report 3J S (fl oto o JIOa- Update to Vinyl Chloride Mortality Study The mortality experience of 593 Dow Michigan. Divi sion employees potentially exposed to vinyl chloride after first exposure to vinyl chloride. Both individuals had only short-term exposure in jobs categorized as less was recently updated through 1982. An earlier study than 200 ppm time-weighted average (TWA). evaluated this group for the time period 1942 through There were six deaths from emphysema or chronic 1973 and found an excess of totai malignancies among obstructive pulmonary disease (approximately 5 ex the subgroup considered to have the highest exposure.1 pected). None of these individuals worked in areas where However, during the additional period of follow-up there was a potential for exposure to polyvinyl chloride (1974 to 1982), a deficit of malignant neoplasms was dust. observed for this subgroup. An increased risk of lung cancer was not found (stand During the 9 years of additional follow-up, the total ardized mortality ratio * 89) and the study was capable deaths in the study group increased by S3 (to 155) and of itiling out more than a 60% increase with 95% the person-years by 4,234 (to 17,114). The study's certainty. The lack of an association with lung cancer primary focus was directed at cancers of the liver is consistent with the findings from the majority of other (including angiosarcoma), biliary tract, lung, and brain, studies, especially those with the greatest statistical and to emphysema because of previous reports Uniting power to detect an excess.* these conditions to vinyl chloride exposure in some wort To examine for a dose-response relationship, subjects forces.*'9 No deaths from angiosarcoma were found and were allocated to one of four intensity-of-sxposure cat there were no statistically significant excesses for any egories (undetermined, less than 25 ppm TWA. 25 to of the other conditions of interest. 200 ppm TWA. and 200-- ppm TWA) based on their Only those employees identified for the original study highest rated job assignment held for at least 1 month. were include*! in the recent investigation and their work During the updated follow-up period (1974 to 1982), a histories and exposures were updated through 1977 to deficit of total cancer occurred in the highest exposure ensure a minimum 5-year induction latency period. Con category (3 observed v 5.4 expected); however, for the sistent with past practice, separate analyses were con entire follow-up period this subgroup experienced an ducted first including and then excluding the subset of excess which was confined principally to the men with employees with prior, competing exposures to arsenic at least 5 years of exposure above 200 ppm (7 observed insecticides.* v 2.3 expected). As was noted in the original study,* Cause-specific mortality among the study group was there was no predominant tumor site nor was there a contrasted both with expected levels based on age- and unique histologic type among this subgroup, weakening era-specific mortality rates for US white men. and also any interpretation of a causal link with vinyl chloride. with the mortality experience of 24.410 other male employees from this company location* who were not exposed to vinyl chloride or arsenic. The comparison with US men is shown in the Table. Wendy 3. Dahar, MPH Total malignant neoplasms were less than expected in Gregory G. Bond. PhD. MPH the updated follow-up period (1974 to 1982), 12 v 16.3 and for the total follow-up period (1942 to 1982), 27 v 31.7. There were no statistically significant excesses for Elsie A. McLaren, RN Fred L. Sabel, MS any of the diseases of interest. Similar results were seen Thomas E. Lipps, MI) for the comparison with other employees from this com pany location. One death from liver cancer occurred in the study group (0.6 expected). The pathology and autopsy re ports indicated that it was an intrahepatic bile duct carcinoma. There were two deaths from brain cancer Ralph R. Cook, MD, MPH The Dow Chemical Company Epidemiology Health and Environmental Sciences 1803 Building (1.2 expected), one of which occurred less than 5 years Midland. MI 48674 648 Update to Vinyl Chloride Mortality Study/Dahar et al TABLE Observed and Exacted Oeatns for SeMcted Causes Excluding Employees with Prior Exposure to Arsenic Insecticides Cause at Death (ICD-3) 1942- 1973 Obs Exp* Period of Follow-up 1974-1982 Obs Exp Obs 1942- 1982 Exp SMRt All causes 80 84.9 50 67.0 130 All cancers (140-209) 15 15.4 12 16.3 27 Digestive system cancer (150-159) 6 4.4 3 4.1 9 Liver cancer (155.156) 0 0.3 1 0.3 1 Resotratory system cancer (160-163) 4 4.9 6 6.4 10 Brain cancer (191.192) 1 0.6 1 0.5 2 All circulatory oiseaaes (390-458) 38 41.1 27 34.3 65 All nonmaiignant resotratory diseases (460-519) 6 4.2 3 4.4 9 All acncents (E300-S949) 7 8.4 1 2.5 8 ' Exsectea dumpers are based on calendar nme and age-specfic mortality rates of US wnite men. t Stancardzed mortality ratio; observed divided by expected numoer of Oeatfts x 100. i Cl, ccmidence interval of Cbs/Exo. Not calculated wnen expected numoer of deaths fewer than 5. 151.9 31.7 8.5 0.6 11.3 1.1 75.4 8.6 10.9 86 85 106 --s a9 --5 86 104 74 9s% at 72-102 56-124 48-201 4-899 42-163 23-682 67-110 48-198 32-144 References 1. Ott MG. Learner B3- Holdr 3B: Vinyl chlorids xposor* is a controlled industrial snvironsisnt. Arch Zarina 3**ith 1975:30:333339. 3. Vtcaf 0, Whortoa MD. Begisnd 3. n !: As update at an pidataiologic study of vinyl chlorids worker*. 1943-1983. Prepared for the Chsnucai Manufacturers Association. October 17. 1986. 3. Purcbsse IFH. Stafford J. Paddlo GM: Vinyl cblor.de: An uuuoii: of :be risk of occupational exposure. Teed Chma Toxicol 1987:25:187-303. 4. Ott MG. Hoidsr 3B. Gordon HI- Bespiratory cancer and oc cupational exposure to arsenical*. Arch Znriren Health I974di9:250- 235. 5. Bond GG. McLaren BA. Cartmill IB. at al: Cause-speoiSc mortality amona mala chemical workers. As I lad Mod 1987:12:353-- 383. 6. Beaumont JJ. Breslow NE: Powar ccnsidaratlons in epidemio logic studiaa of vinyl chloride workers. Am J Epidomlol 1981:114:725734. Nurses' Little Helpers: Care on the Cheap The [British] government last sees gave broad approval to the proposed changes to nurses education put forward IS months ago by the United Kingdom Central Council for Nursing and Midwifery (UKCC). Nurses at the Royal College of Nursing's xmiiai conference in Brighton gave John Moore, the Secretary of State for Health, a standing ovation. Oniy the mesh air or the nurses' recently fattened pay packets can explain the euphoria. An analysis of Mr Moore's response gives grounds for concern for two reasons: first, the changes will mean most of the hands-on-care will be done by non-nurses or "nurse helpers." putting standards of patient care at risk: second, these changes smack of a plan to make "caring" cheaper. IT * * * Who will take on nurse helper jobs? Work that has been labeled as menial and is poorly paid is unlikely to lead to a satisfied work force. Yet these are the people who will look after hospital patients in the future. --Prom "UPFRONT" by Pamela Holmes in New Statesman, 1988;115(2984);5. R&S 020422 Journal of Occupational Medicine/Volume 30 No. 8/August 1988 649