Document 2NKpKLOBjbYa1pk9EXDDngb6L

-4`1 PLAINTIFF'S EXHIBIT '6 ^ojc*. y <-*?i>(U<"6'a-4 Update of a Mortality Study of Workers in Petroleum Refineries Samuel D Kaplan. MD. SM Hyg A Urge cohort ef petroleum refinery where ellh long 4ind ef employment. long Umm;, ud relatively young i(t ti kin kid lu *IUi iutw Umfk Dm 3), 1900. !% lUadsrtlMd mortality ratio (SMB) tar all mu*-- tu 7ft. |ek ><mnfilrr1n qmm ted an SMB bolew 100. (seled- li| *u* id ti tar m^tmm ud (or til iU***.es at kte gvnttanrlaary ijwiem ud d 71 Car ehrtmie eephrltte. Tte 0ME tar til --vn* ST. SMli for tymtfUi asopUew '~-1--* dig-Mtir* jijmsm. 90; leng, SS; kidney, 48; brain. 89; l*kfla (01; aaeltiple ee. 1SS. enapeeUUd tytkcm. lift; petyvythestie wt (taw telkt), 488. yUflbr--kt {tkm 4mtte), ftOl; and wnltn tad usped/Ud brain mo- ptM--. (Oft. Thera nr* ale* deaths ta* mesothelioma; til ala* impln)m bad air* Ite 90 ^ui at Mapteymral. with utKIdMl. January 1978. Tatisrehaw-Cooper Associates, Incor rporated (TCA), under the fpoaeorehip of the Am*rIcu Petroleum Institute (API), bsgun a ntnxpKtlvt oobort mortality study of worker* la a sample of Called States petroleum rofiaertee. The original report w widely distributed by API. Bscsum the oobort la not oaly large but la aiae one with long Latency ud durabos of expewun witb early age *4 bln. this study (a likely to be a particularly valuable addition to tba Litart,tun. Thenfon. tba cohort * vital flatus baa 6a updated, aAd a detailad analysis waa earned out. UMhodft The vital ftatua of the cohort vaa updated through Dae 81. 1000. Date wan eaalyted by a modified ,j* table program adapted from tee one described oy Manses1 and a computer program (rota tea Nations; Institute tor Occupational Safety and HcaJte (NI0SR) ` For study oobort members lost to fol]<rw-up pence- yean wen accumulated until time of loaa. Tha naad utiteed mortality ratio (8MB) for multiple mjeiom* (which wm not available in either tea Mooted cr N10SH program) was oaiouiated from data provided by Dr Gary Marsh. SMBs for meenlhcUoma ware calculated from erpected oamber* yeaarated by igwepecific ravaa (or white maias for tbo yean I960 to 1871 from tea Third National Canosr Sumy (M. Myers, perwun] oommuiucation. 1904) and annual agw-epaclilc r*tee tar xaje* (bom the dKAfc Program for tee yean 1973 to 1978 * Is aD tbo above analyen, black males wen aoaiyied in oomparteoo with tbs mortality expamuce of soewiute reaJM All other trodj oobort mamban bad tea^r aor tality azperiaoea ocaspared with teat of white axles and tba roaulta wen oombtaad. Bated on the Ainnhutiao by plant of those oobort matnbarv with known r*c* ** estimate teat 99-8% of those whose mortality *rp*noc wma compared with that of white anise ware ebiu TCA oollected 90,109 Individual noortia for tiu* rtvfly Of these. 178 (0.9%) wen for the following reasons: from tee acayau 1. Seventy-nine worker* from one refinery ear* *t_m- tested because the records for mas who bad or wen discharged were kept for only 1 jeer oejew to* employe* bad died on the job. ft. Forty-one had worked leas than 1 year 2963 and 1071. froa SKI (aUruuecsJ SU AanarveoC 4*e. MeWe Pvt CA MOW (Dr Kaelaa. Sealer tfidMAtoiofim>. til in-- **n wpuyteOL* tv. PepejTuim a( SmIU terM. 44lt BmJU tecOoa. 714 f S*. boom tea 9uhmm Ce Wit (Dr 3. One w*s female. A FUty-esvoo wen duplicate records, ujclucia* ua of tmvlojam who qnaUfled te non than one paj-uc:pa<iAg refinery. With tbe elimination of tbcee rwonlj, tee < jls. yyusn ttee for foUow-up and analyvla becauie 13 /vl Jey h ud a i ~*ru# | x'wr1 I 34 . ^ D'* j 3*cv ^ | ICDv c'p ] 1or 1 jj w ^ j ye l 10 * rtudjr ' 'flUr'' ~La" ' 'E* " j ' c*~ { ^ ia< -bre* ^ *rUl0" ut>m. 'r -- ''"tl ^*ar' t>_ Patroietim Ssflrery Wotn/Kicfoft <iKirr v?-** Cmtmm TABLC--CnttHWd 0M*O*d Oulu tuwetee OeeWe SM* MW CeoAOence Doooms at gervaxmary ty*t*m CUrcrtcnepnma Ooeeae* o< dw Mi nd cutaneous beau* pHiHM 0* ire rnuscous**t*i aysum erw corv necw* ossue Symptoms anO a-o*<nao conanore Acooarts poacrey. and w ctenc* *1 >ooo*no Motor eno* *coo*no Suck* aj arm au*i mnown 33 S2&2 S3 *3-66 t3 73 39-124 3 3 15 95 19-278 3 7 S4 40 8-116 $4 63 78 U 64-110 260 375 52 69 61-7 164 237 56 66 59-60 77 106 32 77 57-91 V 61 95 70 53-90 12 19 14 63 32-110 60 Nc at *ot**rf i9t Mo otptnan-ytn 297 591 9 pacific ciumi ot death. T%* 96.6% follow-up rat* oom- p^nt f**orxbly with follow-up rate* usually achieved la retrwpacuv* cohort mortality atudie* aad fewer th*a 9 6% at th* dam.tb cartiieate* were not obtained. Part of th* explanation for the** low SMBa pp**n to bo the well-known healthy worker effect Anecdotally. popl with petroleum reflnenee boy* noted that heavy unok>r or* sot likely to work there btonu* of lh iaaku( reetncuon* for safety purpo*** that or* imposed at work, to combination with th* uxual healthy workor effect. th* anecdotally aotad low making prwv- alenca among refinery workan may explain thee* find ing*. "Hu aocnrwcy of th* diagnoaae oad the tppropnato ne** of th* eempanaou data oouid hae* affected tho reerult* for maaothaUoma. Th# probable oat r-eeult t* that tho erpectad number of daatha from thia cause ta dightly overestimated. which mean* that the SUE la. if any thing. und*ra*tlmat*d. Thor* were aio* obarv*d death* oad 7 93 rp*ctod death* from 1CD Cod* 909.8 la th* Eighth Eanaioo (other primary malignant aaoplaaai* of lyopboid tl**u*) for an dkifu of 1(3 with a 95% confidence interval of 68 to 816. For th* remainder of Cod* 90S (othr than 909 8) la lb* Eighth EUvUioo (ted for Codes 202 906 lq th* Seventh Revision. whicb equate to Cvj< 2C- la th* Eighth Revision) tber* wr* ao* ooeervta jti. and l 03 expected death*, for aa 3MU a( 37 T-.r cytbeau* v*r* tber* were four observed deaths mo j 4 expected death* from tbi* cause for oa 3MR of 1*5 ir 96% confidence interval of 190 to 1.164 The 86 obaerved death* from neoplasm* of :,=tPi; oad bemotopoietic tlo*u* or* three more ih*o . *erved death* from each of the component* i l/^noiir coma and reticulum call sarcoma. Bodykin 1 i.ifi4l. leukemia. aad cancer of other lymphatic u**ue> T-, difference t* th* three death* from myelofibrotn 7-, expected number of death* wo* 1 49. which , SMB for that caua# 0/ 901 with * 96% csnnce-c, interval of 41 to 688. tt would appear that the concern about geopixsirs th* lymphatic and hematopoietic eyetea one#* pr-*r Jy from polycythemia yam. and perhap* frets n.r ;f broeut. Tber* 1* toai quectioa a* to whether 'ze-it 1-. really aeopliam*. aad the Seventh Revtaioa pieces - bath under ill****** of th* blood aad blood :crr organ*. However, the number* or* too smaij ',,r ;c cytheaua vera end myelofibroei* to warrao: .r - mveetigatioo at praeent. Achnowfodynant* Thu twl *u tuoparua a pen *7 * csoireci '.ms Pv*ua leeuiute Tb* eaain*ouoe4 at Or Wlliua ft 0*21*7 ud Dr to CO* Mi*Ukel rtitdj rlwifn Uie e*viee ud ikuiici eaerev* wp<a7*ee to t*a p>inua aduewr *as . dMUae* <e toe TU*r ai Or Irrue P Te*eriOe RelarwncM l Maw* UL OeeiTtae at reteuv* rarrr**d ud grocors.^ot leUry Comoat her IP7* 7 3SA-U* 9 WerwUer OJ Weanmnei JJ Bren Jl n u t ' tMH eaeiyu ir<ua for aeeon nttdiae. J Joeup Um PU : 3 Walker I . I*u*eii4 1TL Pnedleoeer EB- u * llMtoe i9a0-9009 / Jceup Uoa \ 3*3 i. Pelrol^tim Refinery Worterr Raca"