Document 5D2bYJmVVg8D5Y3GE6ezvxyY0

Brief Report 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 total malignancies among obstructive pulmonary disease (approximately 5 ex the subgroup considered to have the highest exposure.' 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 63 (to 155) and of ruling 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 linking power to detect an excess.* these conditions to vinyl chloride exposure in some work To examine for a dose-response relationship, subjects forces.8 3 No deaths from angiosarcoma were found and were allocated to one of four intensity-of-exposure 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 included 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 2.8 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 with the mortality experience of 24,410 other male any interpretation of a causal link with vinyl chloride. 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 8. Dakar, MPH 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 Gregory G. Bond, PhD, MPH Elsie A. McLaren, RN 31.7. There were no statistically significant excesses for Fred L. Sabel, MS 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 Thomas E. Lipps, MD Ralph R. Cook, MD, MPH The Dow Chemical Company Epidemiology Health and Environmental Sciences 1803 Building Midland. MI 48674 >48 Update to Vinyl Chloride Mortality Study/Dahar et a! BFG65430 TABLE Observed and Expected Deaths tor Selected Causes Excluding Employees with Prior Exposure to Arsenic Insecticides Cause et Death (ICO-S) 1942-1973 Oba Exp* Parted of Follow-up 1974-1982 Oba Exp Oba eA .<h0 1932 Exp SMRf All causes AH cancers (140-209) Digestive system cancer (150-159) Liver cancer (155.156) Respiratory system cancer (160-163) Brain cancer (191,192) All circulatory diseases (390-456) All nonmalignant respiratory diseases (460-519) All accidents (E800-E949) 80 84.9 15 15.4 6 4.4 0 0.3 4 4.9 1 0.6 38 41.1 6 4.2 7 8.4 50 67.0 130 12 16.3 27 3 4.1 9 1 0.3 1 6 6.4 10 1 0.5 2 27 34.3 65 3 4.4 9 1 2.5 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. $ Cl, confidence interval of Obs/Exp. Not calculated when expected number 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 --- 89 -- 86 104 74 95% Cl* 72-102 56-124 48-201 4-899 42-163 23-682 67-110 48-198 32-144 References 1. Ott MQ, Laagnar RR, Holder BB: Vinyl chloride expoeure in a controlled induetrial environment. Arch Environ Health 1975:30:333339. S. Wong 0, Whorton MD, Ragland D, at al: An update of an epidemiologic study of vinyl chloride workere. 194S-1988. Prepared for the Chemical Manufacturer^ Aaaoeiation. October 17, 1986. 3. Purchase IFH, Stafford J, Paddle QM: Vinyl chloride: An aaaeeament of the risk of occupational exposure. Food Cbaa Toxicol 1987;25:187-208. 4. Ott MO, Holder BB, Gordon HL: Respiratory cancer and oc cupational expoeure to areenicals. Arch Environ Health 1974:29:250255. 5. Bond OQ. McLaren EA, Cartmill JB. et al: Cause-specific mortality among male chemical workers. Am J Ind Mod 1987;12:353383. 6. Beaumont JJ, Breslow NE: Power considerations in epidemio logic studies of vinyl chloride workers, am J Epidemiol 1981:114:725734. 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 (UKCC). 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. **** 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. Journal of Occupational Medicine/Volume BFG65431 649 PROPOSAL FOR SUMMER 1980 INVESTIGATION AT B. F. GOODRICH BACKGROUND The vinyl chloride Medical Surveillance Program has provided data indicating that most of the standard biochemical (blood) tests for liver dysfunction are not effective in the detecting of early liver injury. The tests with Indocyanine Green (ICG) dye clearance performed at the B. F. Goodrich Louisville Plant by the University of Louisville have shown it to be the most sensitive and specific test yet evaluated for detecting early damage. However, this test requires injection of dye into the vein, and a few (12/6000), minor reactions have occurred. Bile acids (natural substances made by the liver for the gall bladder) were found to work similarly to ICG and are very effective as a screening test for liver disease.. Again, however, the bile acids have to be injected intra venously and can cause phlebitis (inflammation of the vein). A recent report (Gilmore and Thompson, GUT, Feb. 1980) indicates that bile acids could be administered orally, with the tests results being as or more sensitive in detecting chronic liver disease than when intravenously administered. OBJECTIVE We propose to compare the ability of ICG and orally administered bile adds in detecting early liver damage. The advantages of the oral procedure would be several fold. It does, not require any substance to be injected. It does not have to be analyzed immediately as does ICG (i.e. bloods can be mailed to central lab). If it is as good as ICG, it can be recommended to OSHA as a replacement for all the presently re quired federal tests, significantly reducing the expense of the large number of blood tests currently being done. BFG65432 NUMBER OF EMPLOYEES! Biostatistically, 50 employees would be required. Most of these could be seen at the time of their regular blood work. Additional workers could be tested during the physical examination period, thus reducing additional time away from their job. LENGTH OF TEST; The oral bile acid/ICG test will require 1 hour to be completed from the time of employeeTs arrival at testing place. If the oral test is found to be effective, it could be done in 15-20 minutes in the future (i.e. will not need to do ICG confirmation tests at that time). NUMBER OF TESTS: 6 times x 2 (duplicate) x 50 - 600 BFG65433 COST Test done locally: Bile acid R1A testing kit cost $350./100 tests. It would cost $2,100.00 to do the test locally and complete results by the end of the summer. Test done via Abbott Laboratories: none - results take 4-5 months BFG65434