Document 2RGXMjNy7q8vry8p9Xnj5Qeza

i Brief Report /-?(c. c-- Update to Vinyl Chloride Mortality Study p-nhe mortality experience of 593 Dow Michigan DiviX sion employees potentially exposed to vinyl chloride was recently updated through 1982. An earlier study evaluated this group for the time period 1942 through 1973 and found an excess of total malignancies among the subgroup considered to have the highest exposure.1 However, during the additional period of follow-up (1974 to 1982), a deficit of malignant neoplasms was observed for this subgroup. During the 9 years of additional follow-up, the total deaths in the study group increased by 63 (to 155) and the person-years by 4,234 (to 17,114), The study's primary focus was directed at cancers of the liver (including angiosarcoma), biliary tract, lung, and brain, and to emphysema because of previous reports linking these conditions to vinyl chloride exposure in some work forces.11'3 No deaths from angiosarcoma were found and there were no statistically significant excesses for any of the other conditions of interest. Only those employees identified for the original study were included in the recent investigation and their work histories and exposures were updated through 1977 to ensure a minimum 5-year induction latency period. Con sistent with past practice, separate analyses were con ducted first including and then excluding the subset of employees with prior, competing exposures to arsenic insecticides/ Cause-specific mortality among the study group was contrasted both with expected levels based on age- and era-specific mortality rates for US white men, and also with the mortality experience of 24,410 other male employees from this company location8 who were not exposed to vinyl chloride or arsenic. - The comparison with US men is shown in the Table. Total malignant neoplasms were less than expected in 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 any of the diseases of interest. Similar results were seen 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 (1.2 expected), one of which occurred less than 5 years 648 7 . after first exposure to vinyl chloride. Both individuals had only short-term exposure in jobs categorized as less than 200 ppm time-weighted average (TWA). There were six deaths from emphysema or chronic obstructive pulmonary disease (approximately 5 ex pected). None of these individuals worked in areas where there was a potential for exposure to polyvinyl chloride dust. An increased risk of lung cancer was not found (stand ardized mortality ratio = 89) and the study was capable of ruling out more than a 60% increase with 95% certainty. The lack of an association with lung cancer is consistent with the findings from the majority of other studies, especially those with the greatest statistical power to detect an excess. To examine for a dose-response relationship, subjects were allocated to one of four intensity-of-exposure cat egories (undetermined, less than 25 ppm TWA, 25 to 200 ppm TWA, and 290+ ppm TWA) based on their highest rated job assignment held for at least 1 month. During the updated fcUow-up period (1974 to 193), a deficit of total cancer occurred in the highest exp- sure category (3 observed v 5.4 expected); however, fcr the entire follow-up period this subgroup experienced an excess which was confined principally to the men with at least 5 years of exposure above 200 ppm (7 observed v 2.8 expected). As was noted in the original study,1 there was no predominant tumor aite nor was there a unique Ifistologic type among this subgroup, weakening any interpretation of a causal link with vinyl chloride. - ` ^I Wendy S. D&har, MPH Gregory G. Bond, PhD, MPH Elsie A. McLaren, RN Fred L. Sabel, MS Thomas E. Lipps, MD Ralph R. Cook, MD, MPH The Dow Chemical Company Epidemiology Health and Environmental Sciences 1803 Building Midland, Ml 48674 Update to Vinyl Chloride Mortality Study/Dahar et ai ASI 00005264 * . -TABLE Observed end Exported Deaths lot Selected Causes Excluding Employees with Prior Exposure to Arsenic Insecticides Period of Follow-up Cause ol Death <ICD-8) 1942- i973 1974-1982 1942-1982 1 Obs Exp* Obs Exp Ob* Ex? SMRf All causes All cancers (140-209) Digestive system cancer (150-159) Liver cancer (155,156) Respiratory system canoer (160-163) Brain cancer (191,192) All circulatory diseases (390-458) All nonmafignant respiratory diseases (460-519) All accidents (E800-E949) 80 15 6 '0 4 1 38 6 7 84.9 50 15.4 12 4.4 3 0.3 1 4.9 ' 6 0.6 1 41.1 27 4.2 3 8.4 1 67.0 16.3 4.1 0.3 '6.4 0.5 34.3 4.4 2.5 ' 130 27 9 1 10 2 65 9 8 * Expected numbers are based on calendar time and age-specific mortality rates of US white men. t Standardized mortality ratio; observed divided by expected number of deaths x 100. t Cl, confidence interval of Obs/Exp. 5 Not calculated when expected number of deaths fewer then 5. 151.9 31.7 8.5 0.6 11.3 1.1 75.4 8.6 10-9 86 85 106 -- 89 - 86 104 74 95% Cl* 72-102 56-124 48-201 4-8S9 42-163 23-682 67-110 48-198 32-144 References 1. Ott MG, Lengoer R.R, Holder EB: Vinyl chloride exposure In a controlled industrial environment. Arch Environ Health 1975;S0;833833, 2. Wong O, Wborton MB, Ragland B, et al: An update of an epidemiologic study of vinyl chloride workers. 1842-1982. Prepared for the Chemical Manufacturer'* Association. October 17, 1986. 8. Purchase IFH, Stafford J, Peddle GM: Vinyl chloride: An assessment of the risk of occupational exposure. Food Cheat Toxicol - 1987;25:187-208. 4. Ott MG, Holder BB, Gordon HL: Respiratory cancer and oc cupational exposure to arsenical*. Arch Environ Health 1074:29:250255. 5. Bond GG, McLaren EA, Oartmill JB, et al: Cause-specific mortality among male chemical workers. Am JInd Med ] 087;1P:353383. 6. Beaumont JJ, Brealow HE: Power considerations in epidemio logic studies of vinyl chloride workers. Am J Epidemiol 1961;114:725734. Nurses' Little Helpers: Care on the Cheap The [British] government last week gave broad approval to the proposed changes to nurses education put forward 15 months ago by the United Kingdom Central Council for Nursing and Midwifery (UXCC). Nurses at'the Royal College of Nursing's annual conference in Brighton gave John Moore, the Secretary of State for Health, a standing ovation. Only the fresh 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. J- **** 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. Tet these are the people who will look after hospital patients in the future. --From "UPFRONT" by Pamela Holmes in New Statesman, 1988;115(2984):5. r Journal of Occupational Medicine/Volume 30 No. 8/August 1988 ASI 00005264A 649