Document 71rmdde0j97EeQgmoLVBGjwg

ORM OH.tMVD REV, 1171 / INTER OFFICE MEMO TO See Distribution A-T 0fc 10 1975 VC On date5, FROM W. L. Hollingsworth AT ' Stamford COPT TO SUBJXCT OCCUPATIONAL SAFETY AND HEALTH ACT-V,m Vu C Please note checked items: Attached is copy of Request for Information. Attached is copy of NIOSH criteria document. Attached is copy of Proposed Standard. Attached is copy of Final Standard. Attached is copy of 0 .R.C. Split-Sheet Analysis. Attached is O.R.C. Task Force Membership. Attached is report from O.R.C. Attached is report from Olin's representative on O.R.C. Task Force is If interested, please furnish comments to me by If interested, advise promptly name of a suitable employee to serve on an O.R.C. Task Force if one is established. * Ip <vod.tioa.al 1*0 StTMtPcAD c-^t-L nf tJAi t^T vnio WLH:ra DISTRIBUTION: R. L. O'Connell, M.D. R. Y. LeVine G. H. Henrich L. W. Roznoy W. V. Hollander F. H. Roberts, Jr. A. P. Jackson ^ R. Henderson r Ik. J W. L.Hollingsworth OLI 2733 WHY F ILK THIS COPY? IF Y U MUET RETAIN IT. SPECIPtY A DEFINITE RETENTI N PERI D* ONE YEAR, OTHER. Organization Resources Counselors. Inc. 1625 I Street. N.W. Washington, D. C. 20006 Cable Address: ORESCON Memorandum November 26, 1975 To: From: Participants in ORC Occupational Safety and Health Standards Group Leo Teplow, Special Consultant William Nichols, Study Administrator Attached is the "Interim Report on Mortality Data Collected by ORC Concerning the Effects of Vinyl Chloride Exposure in PVC Fabrication, " issued October 10, 1975. The report is based on an analysis of death certificates from 10 companies having completed records in August 1975 for employees who died during the period 1964-1973. An additional eight companies had certificates in vari us stages of completion and their data will be included in the final report. Other companies are now attempting to retrieve their records and they may also be included. The final report will be submitted in December 1975. It is difficult to estimate the total number of companies participating in the final study but it will probably be 18-20. Dr. Leonard Chiazze, who prepared the analysis In this report, joined the National Cancer Institute, effective September 1, 1975, and is no longer in his role as consultant to ORC. If there are any questions regarding this interim report, please feel fr e to contact us. OLX 2734 Interim Report MORTALITY DATA COLLECTED BY ORC CONCERNING THE EFFECTS OF VINYL CHLORIDE EXPOSURE IN PVC FABRICATION October 1975 Organization Resources Counselors, Inc. OLI 2735 CONTENTS Page STUDY DESIGN................................................................................ 3 STUDY PROCEDURES ....................................................................... 6 FINDINGS................................................................................................... 9 CONCLUSIONS................................................................................ 20 Tables 1. Distribution of Deaths from Selected Causes Among Employees of 10 PVC Fabricators by Color and Sex, 1964-1973 ......................................................................................... 2. Observed and Expected Deaths due to Selected Causes Among Employees of 10 PVC Fabricators, 1964-1973. 3. Distribution of Deaths Among Employees of 10 PVC Fabricators, By Year of Death, 1964-1973 ..... 4. Distribution of Deaths Among Employees of 10 PVC Fabricators, By Sex and Color, 1964-1973 .......... 5. Distribution of Deaths Among Employees of 10 PVC Fabricators, By Color, Age, and Sex, 1964-1973 , . 6. Distribution of Deaths Among Employees of 10 PVC Fabricators, According to Whether or Not Employee Died in Hospital, 1964-1973 11 12 15 16 17 19 OLI 2736 INTERIM REPORT ON MORTALITY DATA COLLECTED BY ORC CONCERNING THE EFFECTS OF VINYL CHLORIDE EXPOSURE IN PVC FABRICATION October, 1975 In March 1974, representatives of the polyvinyl chloride (PVC) producers who were members of the ORC Occupational Safety and Health Standards Group asked ORC to conduct a study of health risks to workers engaged in fabrication of PVC products. They were concerned over the effect on manufacturers using PVC resins, as well as on the general public, of the implication that vinyl chloride was an occupational carcinogen -- and particularly that it was an apparent cause of angio sarcoma of the liver. * Since the fabrication of PVC would expose workers only to very low levels of vinyl chloride, the producers hypothesized that the apprehension of users might be allayed by a survey of the experience of employees working directly with the resin in fabrication processes. Such a survey might also provide evidence that could be submitted to OSHA concerning a possible safe concentration of vinyl chloride. To * In January, 1974, B. F. Goodrich Chemical Company disclosed three deaths at its Louisville, Kentucky plant which were diagnosed as caused by angiosarcoma of the liver, a rare form of cancer. OLI 2737 2 2 PVC fabricators, the predicted standard of less than 50 ppm then being considered by OSHA was unnecessarily stringent because (1) there was no evidence in studies to date of danger at low exposure levels, and (2) compliance would require costly changes in equipment and facilities which might make use of PVC resins unfeasible economically. Accordingly, the study was designed to answer three basic questions: 1. What is the incidence of angiosarcoma of the liver in the population selected for study? 2. What is the mortality experience from cancer and liver disease among that population? 3. How does the mortality experience from the above causes in the study group compare with the rate in an appropriate general population? This interim report summarizes the findings and conclusions to date of the ORC study. They are based on an analysis of death certifi cates of employees in plants processing PVC who died in the period 1964-1973 while working for, or retired from, their respective companies. The protocol of the study was developed by Leonard Chiazze, Jr., Sc.D., until August 1, 1975, Director, Division of Biostatistics and Epidemiology, Department of Community Medicine and International In January, 1974, the Threshold Limit Value for occupational exposure to vinyl chloride was 500 ppm; an emergency temporary-standard pro mulgated by OSHA reduced the concentration to 50 ppm. OLI 2738 3 Health, Georgetown University School of Medicine, Washington, D, C., and the analysis contained in this report is his. The administration f the study was under the supervision of William E. Nichols, Ph. D., of the ORC staff. The nosologist was Clara Walden. Most of the field work was conducted by Claire Goodwin, RRA, and Patricia Walker, RRA. STUDY DESIGN pie original design of the study called for review of death certificates supplied from life insurance underwriters over the study period. The use of a third party was desirable to enhance the objectivity of the study and hence its credibility. Moreover, it was expected that insurance company records would provide a relatively complete source of information and that retrieval would not be difficult. In prac tice, however, insurance carriers often were unable to provide all the certificates for the 1964-1973 period, and a combination of insurance company and employer files had to be used. Study of death certificates for the 1964-1973 period made it possible to develop a data base from company experience large enough for comparison with official published data on deaths in the general popu lation during that period. Additionally, the total work history of the sample population spanned most of the period that PVC had been in use. OLI 2739 4 As already noted, only those companies with plants fabri cating PVC resin into finished products were considered for participa tion. Additional criteria for selection included: 1. At least one death from any cause among current or former employees in the study period. 2. A history of PVC use in excess of the 10-year period, 1964-1973. (The period of possible exposure had to be equal to or greater than the known or expected latency period of angiosarcoma of the liver in plants where deaths from that cause had occurred.) 3. A recordkeeping system that would identify all deaths in the work population, of both active and retired employees, during the 10-year period. It was also considered desirable to find out from plant records the levels of vinyl chloride exposure at given times. In practice few fabricators had regularly monitored exposures prior to 1974, and there were no records. ^ At the outset, over 500 companies were identified as fabri cators using PVC resin. Of these, 22 actually met the above criteria and agreed to participate. This number was further reduced, however, for two main reasons: 1. Records were not available or were so incomplete as to compromise their validity. a. In many cases they had been destroyed after a short period of time, usually five years. b. Plants had been acquired and sold without records being maintained. (One plant, now closed, had had four owners in the 10-year period.) Monitoring in 1974 and 1975 showed concentrations to be under appli cable limits set by OSHA. OLI 2740 5 c. Some collective bargaining agreements provided that the administration of health and welfare benefits, in cluding life insurance, was the function of the union; the employer, therefore, had no supporting documents for the deaths of employees, d. Some companies did not require a death certificate in all cases. 2. In some plants, both polymer production (known sometim s to have had high-risk exposure levels) and PVC fabrication were in the same complex. Because it would not be possible to separate high exposures from low exposures, bias would be introduced into a study of presumed low levels. Thus, by August 1975, refinement of the study population had led to selection of 16 companies, data from 10 of which are included in this interim report. Both single and multiplant companies are repre sented. The size of plants ranges from one with approximately 70 em ployees currently to one with over 7, 000, with the size of most plants clustering around 300 to 500 employees. Over the study period, plant size was found to have changed drastically in many cases. In one instance a plant employing 300 em ployees in 1973 employed fewer than 10, ten years ago. At the other extreme, one plant employing 5, 000 people in 1964 had only 2, 000 in 1973. Such developments show not only the rapid changes taking place in the industry over the 10-year study period, but also the difficulty of determining average industry employment. For these reasons, there is little significance in breaking down study population by plant. Plants are located in both urban and small rural communities throughout the country. The employees are predominantly white males. OLI 2741 6 The six companies whose plants originally were to be covered in the study that are not included in the interim report had to be eliminated from the sample because of difficulties in retrieving death records of employees* Assuming these death records can be obtained, the experience of these plants will be reflected in the final report. STUDY PROCEDURES To date, records have been processed on a total of 4, 205 employees, including a number for deaths occurring in 1962, 1963, or 1974. Since these years are not within the study period, the related records were eliminated from the analysis made for this report. In total, the sample consists of death certificates of 3,274 active or retired employees. All available death certificates were examined by a trained 4 nosologist and classified according to 1CDA number by cause of death. Sex, color, age and place of death were also abstracted (see Appendix) for all certificates. From the total, certificates were separated into two groups as follows: a. All deaths with cancer (ICDA 140-205 up to 1967; ICDA 140209 for 1968 on) or liver disease (ICDA 580-586 up to 1967; ICDA 570-576 for 1968 on) or suspected liver condition men tioned on the death certificate. International Classification of Diseases Adapted for Use in the United States, 8th Revision. OLX 2742 7 b. All deaths from causes other than cancer or liver disease. (Although the analysis focused on cancer and liver-related diseases, as the study proceeded it became clear that infor mation on deaths from other diseases could be retrieved at the same time.) Death records mentioning cancer or liver disease and giving a hospital as the place of death were segregated and sorted by hospital. Where there was a significant number of death records for a single hospital or several hospitals in the same area, arrangements were made for a trained Medical Records Administrator (MRA) to visit the hospitals and to review their medical records. In the hospitals visited, an additional element of the investigational strategy was to contact the hospital pathologist to inquire whether there were any angiosarcoma cases in the pathology records. If so, an attempt was made to deter mine whether or not the angiosarcoma could be related to vinyl chloride exposure. The procedure of contacting the hospital pathologist turned up five cases of angiosarcoma, but none involved individuals employed 5 at any time in PVC fabricating plants. Hospitals which could not be visited personally were contacted by mail. Incorporation of hospital visits in the investigation was designed as a control to verify death certificate data and as a means of supplementing incomplete information given on many of the certificates. 5 The existence of these five deaths were reported to OSHA and NIOSH by ORC. OXiX 2743 8 The purpose was to cut "leakage" resulting from transfer of an employee from a PVC plant to a non-PVC plant within the same company. Such an investigation also ensured coverage of a fairly wide geographic area' and permitted records of workers from other companies in the locality to be examined. This step revealed any people who formerly worked for a PVC fabricator who had contracted angiosarcoma since terminating their employment. In total, 409 hospital contacts were made as a result of the review protocol. To date, hospital information has been obtained on 296 deaths or just over 50 percent of the total cancer and liver deaths reported in the analysis* (See Table 1, page 11). Death certificates not mentioning a hospital as a place of death required an added step. First, the physician certifying the death was asked by mail for information on recent hospitalizations of the decedent and if there was any indication that he or she had cancer or liver disease. Where hospitals were identified, a hospital contact was made as described above. Because the population at risk could not be determined, mortality rates as measures of risk could not be computed, and Pro portionate Mortality Ratios (PMR), adjusted for age, had to be used instead. Briefly, the PMR utilizes relative frequencies of specific causes of death (by age) in a comparison population to obtain expected OLI 2744 9 numbers of deaths from that cause in the study population. Despite the well known deficiencies of the PMR, it can provide clues on unusual distributions of causes of death, where true rates cannot be calculated. Selection of an appropriate comparison population, however, poses a number of difficulties. Ideally, it would be desirable to have a cause of death distribution for a similar group of workers dying during the same time period, but not subjected to the factor under study. Such a comparison population was not available, and the study, in accordance with standard practice, utilized mortality for the United States specific for color and sex for comparative purposes. FINDINGS 1. No angiosarcoma of the liver was found in the employee population studied. Overall, the incidence of all cancer in this study fell within the range of expectation for the comparison population, as did the incidence of liver disease. 2. Of 3, 274 deaths which occurred among employees of the 10 PVC fabricators during 1964-1973, the majority were among white men (77 percent). Proportionate mortality ratios based upon the distri bution of deaths among U. S. white men and women in 1968 indicate that there may have been an excess of deaths from diseases of the circula tory system for white men and deficits for cancer of the genitals and OLI 2745 10 cirrhosis of the liver. There appears to have been an excess of cancers among white women, especially in urinary cancers. Despite the vari ability of PMR's, they would appear to be within the range of expected variability, with the exceptions noted above. 3. As Table 1 shows, of deaths tabulated for whites and non whites, 554 (18 percent) were due to cancer or liver disease. Additional analyses are planned for a more detailed cause of death list. Among white men, nearly 64 percent of the deaths are from diseases of the circulatory system (ICDA-Sth Revision Rubrics 390-458) and 16 percent were deaths from cancer. The corresponding percentages for the total U. S. population of white males in 1968^ (midpoint of the study) were 54 percent for diseases of the circulatory system and 16 percent for cancer. Among white women in this study, 52 percent of deaths were from diseases of the circulatory system (compared with 57 percent for 7 all U. S. white women in 1968 ) and 26 percent were due to cancer (compared with 18 percent for all U. S. white women in 1968). 4. Distribution of deaths in the study group, compared with the corresponding U. S. distribution of deaths but adjusted for age, are shown in Table 2 in the form of Proportionate Mortality ^ U. S, Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics, "Vital Statistics of the United States, 1968," Vol. II -- Mortality Part A, Table 1-25. 7 Ibid. OLI 2746 Table 1 DISTRIBUTION OF DEATHS FROM SELECTED CAUSES AMONG EMPLOYEES OF 10 PVC FABRICATORS BY COLOR* AND SEX, 196^f - 1973 11 Cause of Death ,CDA -------------- CfelS-------------- Code Number Percent ------------- Fcmale Number Percent WHITE ALL CAUSES ALL CANCERS Buccal Cavity and Pharynx Digestive Liver Respi ratory Breast Genitals Ur inary Brain Lymphatic Others a 2,521 140 - 209 140 - 149 150 - 159 155 160 - 163 174 180 - 187 188 - 189 191 200 - 209 e 403 10 146 4 112 e* 22 26 7 33 43 100.0% 16.0 0.4 5.8 0.2 4.4 e 0.9 1.0 0.3 1.3 1.7 427 111 32 8 24 13 10 ee 6 18 100.0% 26.0 * 7.5 e 1.9 5.6 3.0 2.3 1.4 4.2 DIABETES 250 37 1.5 7 1.6 DISEASES OF C IRCULATORY SYSTEM 390 - 458 1,608 63.8 221 51.8 CIRRHOSIS OF LIVER ALL OTHER CAUSES 571 17 0.7 a 456 18.1 3 0.7 85 19.9 NONWHITE ALL CAUSES ALL CANCERS Buccal Cavity and Pharynx Digestive Liver Respiratory Breast Genitals Urinary Brain Lymphatic Others *a 140 - 209 140 - 149 150 - 159 155 160 - 163 174 180 - 187 188 - 189 191 200 - 209 e 77 15 5 1 2 a 1 2 ee 3 1 100.0% 19.5 aa 6.5 1.3 2.6 aa 1.3 2.6 ae 3.9 1.3 9 100.0% 4 44.4 aa a 2 22.2 aa aa aa a 2 22.2 aa a aa aa * a aa a aa * * DIABETES 250 1 1.3 aa m DISEASES OF C IRCULATORY SYSTEM 390 - 458 37 48.1 3 33.3 CIRRHOSIS OF LIVER ALL OTHER CAUSES 571 e aa aa 24 31.2 *Color was unknown in 240 cases which are not shown in this table 1 11.1 1 11.1 OLI 2747 12 Table 2 OBSERVED AND EXPECTED DEATHS DUE TO SELECTED CAUSES AMONG EMPLOYEES OF 10 PVC FABRICATORS, 1964- 1973 Cause of Death Observed WHITE MALE ALL CANCERS SELECTED TYPES OF CANCER Buccal Cavity ahd Pharynx Digestive Liver Respi ratory Genitals Urinary Lymphatic Breast 403 10 146 4 * 112 22 26 33 ee DIABETES 37 DISEASES OF CIRCULATORY SYSTEM 1,608 CIRRHOSIS OF LIVER 17 WHITE FEMALE ALL CANCERS SELECTED TYPES OF CANCER Buccal Cavity and Pharynx Digestive Liver Respiratory Genitals Urinary Lymphatic Breast 111 e 32 e 8 13 10 6 24 DIABETES 7 DISEASES OF CIRCULATORY SYSTEM 221 CIRRHOSIS OF LIVER 3 Expected 432.2 12.6 126.2 3.2 133.6 43.1 25.9 42.2 e 38.6 1,444.2 44.9 89.0 1.2 24.5 0.4 7.4 14.5 3.3 8.2 19.8 11.2 236.1 7.1 PMR* 0.93 0.79 1.16 1.25 0.84 0.51 1.00 0.78 ea 0.96 1.11 0.38 1.25 1.31 ee 1.08 0.90 3.03 0.73 1.21 0.63 0.94 0.42 aPMR ratio of Observed to Expected where the expected number Is calculated on the basis of the 1968 U.S. white male (or female) distribution of deaths specific for cause and age. OLI 2748 13 Ratios (PMR) for selected causes of death among white men. "Expected" numbers of deaths have been calculated on the basis of cause-age-specific distribution of deaths among U. S. white men in 1968, applied to the total number of deaths by age among white men in the study group. Of several possible comparison groups to be examined, 1968 deaths among U. S. white men was selected for the interim report because 1968 is in the middle of the study period, and distributions were available accord ing to the Eighth Revision of the ICDA, which was easily accessible. The expected number gives the number of deaths to be expected among white men in this study, if the proportion of total deaths ascribed to a given cause in the study group were the same as for all U. S. white men, while accounting for differences in the age distribution between the study group and all U. S. white male deaths in 1968. The PMR's would seem to indicate that there is not much difference between the distribution of deaths by cause for white men employed by the 10 PVC fabricators and the distributions by cause for all U. S. white men, with three possible exceptions. There would appear to be an important excess of deaths due to diseases of the cir culatory system among the study group and deficits for cancers of the genital organs and cirrhosis of the liver. Certainly, for all cancers, the observed and expected numbers are quite close. OLI 2749 14 Proportionate Mortality Ratios for white women, based upon the 1968 distribution of deaths among U. S. white women are also given in Table 2. In contrast to the results for white men, there appears to be an important excess for all cancers for white women. Any potential excess would appear to be concentrated in urinary cancer and perhaps digestive cancer. However, given the number of deaths in most categor ies, variability is such that, except for the two exceptions noted above, observed and expected numbers of deaths are quite close. 5. The number of deaths varies by year (Table 3), but there is no reason to believe that ascertainment was better or worse for any given year. The variation is more likely a reflection of the changing number of employees engaged in PVC fabrication during the study years. Details of this are being explored. 6. Other findings based on analysis of the study popula tion by age, color and sex, and whether death occurred in or out of a hospital are as follows: -- Table 4 distributes deaths among employees under study by sex and color. -- Distributions by age at death for decedents of known color are given in Table 5 for whites and nonwhites respectively. For both white men and white women, over 60 percent of the deaths are among employees aged 65 or over. All the OLI 2750 Table 3 DISTRIBUTION OF DEATHS AMONG EMPLOYEES OF 10 PVC FABRICATORS, BY YEAR OF DEATH, 1964- 1973 Year of Death 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 Total Number 280 290 324 317 382 338 340 355 380 268 3,274 Percent 8.6% 8.9 9.9 9.7 11.7 10.3 10.4 10.8 11.6 8.2 100.0 15 % OLI 2751 Table 4 DISTRIBUTION OF DEATHS AMONG EMPLOYEES OF 10 PVC FABRICATORS, BY SEX AND COLOR, 1964 - 1973 Category Male Female Unknown TOTAL White NonwhIte Unknown TOTAL Number BY SEX 2,794 464 16 3,274 BY COLOR 2,948 86 240 3,274 Percent 85.3% 14.2 0.5 100.0 90.0% 2.6 7.3 100.0 16 OLI 2752 17 Table 5 DISTRIBUTION OF DEATHS AMONG EMPLOYEES OF 10 PVC FABRICATORS, BY COLOR*, AGE, AND SEX, 1964 - 1973 Total Age Number Percent All Ages Under 35 35-44 45-54 55-64 65 and Ove r Unknown 2,948 84 112 297 591 1,859 5 100.0% 2.8 3.8 10.1 20.0 63.1 0.2 Male Number Percent WHITE 2,521 70 89 248 515 1,594 5 100.0% 2.8 3.5 9.8 20.4 63.2 0.3 NONWHITE Female Number Percent 427 14 23 49 76 265 100.0% 3.3 5.4 11.5 17.8 62.1 A11 Ages 86 100.0% Under 35 11 12.8 35-44 10 11.6 45-54 14 16.3 55-64 13 15.1 65 and Over 38 44.2 Unknown ee 77 100.0% 11 14.3 9 11.7 11 14.3 11 14.3 35 45.4 e ee 9 e 1 3 2 3 e *Color was unknown In 240 cases which are not shown In this table. 100.0% e 11.1 33.3 22.2 33.3 OLI 2753 18 companies in this interim report maintained noncontribu tory life insurance policies as a retirement benefit; there fore it was possible to identify all the death claims among retired employees. The proportions of death occurring among the individuals in the total U. S. over age 65 is somewhat lower for U. S. white men (about 59 percent) than the study group and somewhat higher for the U. S. white white women (about 71 percent). ^ The number of deaths among nonwhites is rather small, so that the relative fre quencies by age are not very stable, especially for non white women. /'"S-* ----- Nearly half of the death certificates (1,565 of 3, 272) indi cated that death occurred in a hospital (Table 6). CONCLUSIONS Several factors militate against drawing definitive conclu sions from the results, and these should be pointed out or reiterated. 1. We do not have a known population base for computa tion of rates as direct measures of risk. 2. Some "leakage" or incompleteness has been unavoid able. Some bias is introduced because of employees who may have Ibid. OLI 2754 19 Table 6 DISTRIBUTION OF DEATHS AMONG EMPLOYEES OF 10 PVC FABRICATORS, ACCORDING TO WHETHER OR NOT EMPLOYEE DIED IN HOSPITAL, 1964 - 1973 Death In Hospital Number Percent Yes No Unknown 1,565 1,191 518 47.8% 36.4 15.8 TOTAL 3,274 100.0 G t OLI 2755 20 worked less than five yean, then left the company and died. Also limitation of a death certificate review to those available from life underwriters would not include any employee who left the company and died without coverage provided by life insurance underwriters. Still further leakage could occur because of the difficulty of obtaining data on the transfer within a company of employees from a job in an opera tion using PVC to a job in a non-PVC operation. Whenever possible death certificates were obtained on a companywide basis to minimize this factor. 3. There are no direct measures of exposure levels for the working life of deceased employees. 4. At least with respect to angiosarcoma, the expected numbers are low enough to make a negative result (absence of angio sarcoma of the liver among decedents) in a study group of this size noncondusive. At this stage, there are some tentative conclusions that can be drawn with respect to future epidemiological studies. There will no doubt be continuing concern over occupational exposure to chemicals or physical agents. If standards are to be set at a level that protects em ployee health but does not impose unnecessary requirements on employers in equipment and procedures, it would be desirable to base these rules on well documented work histories of a broad population. One would OLI 2756 21 conclude from this study that few companies can provide data complete enough for epidemiological research and that probably no major industry in the United States could be studied on a broad basis. It will be necessary for companies to improve and expand recordkeeping. Current OSHA standards require long retention of records. More important, in order to take proper remedial action, an employer must be able to determine whether an occupational exposure has adverse effects on employees' health. If the employer (either a single company or an industry) can demonstrate that there are no dis cernible health problems, the opportunity of avoiding unnecessarily restrictive standards will be greater. OLI 2757 ! i App-1 Appendix MORTALITY STUDY 1-7 -13 14 IS 16-17 18-23 24 25-26 27-30 31-34 35-38 39 40-41 ID NUMBER: NAME: DATE OF DEATH: month day y a." SEX: [ 3 Male (1) C 3 Female (2) C 3 Unk (9) RACE: E 3 White Cl) E 3 Non-White (2) E 3 Unk (3) AGE: year* DATE OF BIRTH: month day year MARITAL STATUS: E 3 Ewer (1) E 3 Never (2) [ 3 tMc (9) PLACE OF DEATH: State: County: CAUSE OF DEATH: DEATH IN HOSPITAL; C 3 Yes Cl) IF YES. NAME OF HOSPITAL: IF NO . STREET ADDRES:: RESIDENCE AT TIME OF DEATH: State: County: City: Street: CERTIFYING PHYSICIAN: C 3 No C2) Street CODED: Initial City Date State VERIFIED: Initial zip Date 42 43 i HOSPITAL FOLLOW-UP CONTACT: t 3 Yes Cl) OLI 2758 E 3 No (2) HOSPITAL INFORMATION: E 3 Yes Cl) E 3 No C2) E 3 Not Approved C9) App-2 REVISION or PAGE 2 01* ABSTRACT TOW DIAGNOSIS FROM DISCHARGE SUMMARY> t/31/74 PATHOLOGY REPORT Angiosarcoma: ( )Yaa - with othar livsr disease (1) { )Yas - with no othar livar disease (2) ( )**o - with othar livar disease (3) ( )Mb - with no other livar disease (4) ( )B0 PATHOLOGY. REPORT (9) Date of Diagnosis; Other Cancer: ( )Yes (1) Date of Diagnosis: Diagnosis:_________ _ ( )Mo (2) ___ OTHER LIVER/CANCER (FROM AUTOPSY OR CLINICAL) ( )Yes-Autopsy(1) . ( )Yes-Clinical(2) ( )o (9) Data of Dx (liver) Diagnosis:_ Date of Dx (cancer): Diagnosis: HOSPITAL PATHOLOGIST CONTACTED OLI 2759 Any Angiosarcoma in Pathology Records: ( ) Yes (1) ( ) NO (2) If yes, Name:_________________ Address: Date of Death: Date of Diagnosis: Bnplovment: ________ ___ -- OTHER LIVER DISEASE FROM SURGICAL PATHOLOGY REPORT Date of Diagnosis: Diagnosis: --