Document 829b8kQK9QYz377qBx3wjnLRo

FILE NAME: Avondale (AVD) DATE: 1 DOC#: AVD DOCUMENT DESCRIPTION::ZZKZD DZWZZZZtZ MD-462 Jm1of Qcupalional dicine Mortality Pattern in a Cohort of Asbestos Workers A Study Based on Employment Experience THO~fAS F '.\.fANCUSO, .\1 D .ind AN.\S -\ EL-.\ TT..\{t .\f B, Cn 13. Sc: D. P,tt~burgh, Pa. IN PREVIOUS PAPERS, the basic ep1denuolog1c.tl :, approaches to the study of wdustnaJ popuJat tions, demographt~ and cohort, were discussed, workers e,po!,ed to m,he,tw. ,rnd !.pt'c.1Eic <.,imt's of cle.ith For ep1dt>m1olog1cal purpo!te1>, t}1e quei,twn and their potential contributions and Hm1tat10ns ,s what combmation of resources and method.s ;, cited.1 2 3 Recently, we have conSJdered several can be brought to bear, m the absence of com- facets of long tem1 studies. the dyn.unic pany data, to establbh long-term ep1dennolog- changes of a cohort and their influence on the 1cal ~tudtes of mdrn,tnal population~, and to ap- ,statistical evaluation of a cohort's progress and p1 o,m1.1te ern 11onmc11tal e\posme and the de- observation over time, and the concept of the gree of 11!,k for the population under study. In . successive cohort approach. ~ In these studies, the ep1demiolog1cal ev,duahon of em 1ronmental ' our objectives have been to improve on the c>'<posures, dur,1tion of employment, length and . methods of studying industrial populations over contmtuty of e1'posure, and p1ovil.1on of some ling periods of titne and to cast some light on conM~tent me,tsurement of employment expo- -:'particular aspects of the o~pationaJ hazard tor the population at risk. :.iire over the ve<.1.rs constih1te the initial broad ,ep.wation of the population under study an<l a .._;, 'flie. purpose of the present paper is to carry method of denning the population more likely :o~ these objectives pertainmg to methodology , by'. introducing an essential refinement-the ,characteristic of "duration of employrnent"-to 'r)he cohort s.tudies estabhshed through the samf! ,,national resource ( Soc,aJ Security records), and _.....__ ,to- d~termine what relationship e1'ists between r. 'l"r11111 the Dep11rtm.,nt of O~upa.tlonal Health, Graduate School ()f l'ubllc lir111th. Untvcrsity or Ptthbu,rh. P1ltA-,11111r111ii l'a. "'i'~E!U'Jlporti!d by Rrsearcl, Urant CA 0T_,86 from the Ne.- ~J~~tutcs ot HMlth, U S Put,he Health Service to be at risk. This measure of risk-dt1rahon of f='rnployment-was not included in our earlier ~tudy~ because such data were not available at that time, Since then, following e,ploratory efforts which adhered to the policy of the Social Security Administration to safeguard the confidential nature of the data, arrangements were completed to obtain infonnatlon on duration of employment on a stat1~tt,.al bu:.i;:; {Qr edch mem ber of the cohort. The principal hypothesis being tested 1s . . - t~t.,..~;-,..C,.V.,,,, I _ ,-,.;....:,..:.:, ! 147 -f -~ . . . -.,.. ~ ,.- ',-\ I - ' .f' "' ,,, I I .'I ~~ ~ .~~ '\'~"~'"~ I', , I ... 148 .. MORTALITY IN ASRFc;-J'OS WORKERS \\ hetheL the duration of cumulative employ try during 1920-19.19 would be compleier' ment experience among workers m the asbestos ferent from that of 10 years of employm products industry 1s related to an increased mortality rate generally for all causes of death the same plant during 1940-1959. This was of the essential reasons for usmg the gen and particularly for specific underlymg causes cohort method for testing this hypothesis,--:: of <leath. Wagne1 1 m his p10nee1 ing observations of the Braun et al,15 in their study of asbestos J,., in Canada, established a cohort at a given. relationship between mesothelioma and a...bestos e,posure, focused attention on the b1olog1cal effects of asbestos, which studv has served as a basis for mternat1onal research and effort pertammg to experimental pathology c1nd ep1dem1olog1ca] stmhes.b-~ The importance of duration of emplo, ment in such ep1dem1olog1cnl ~iud1es ( for t'\ alu,\tmg the ~trength of u:,:,ocmt1on he- n, een a!tbesto!> :lnd maltgnancu'~ m long1tu<linal cohort '>tuches) has been well recognized hy pre- vious 1mest1gators Unfortunately, this type of inform,ltion has heen quite l11nited .md not gen- erally ,l\,11lable. rnmcquently, there arr ?nly a fPw coho, t Iepc11 ts on asbe!>tO., tn the literature wh1d1 indude ~ome hpe of 1eference to duration of emplo> ment. Further, rn each !>tudy, offic1.il nt..1l-statl!.t1cs d,lta of the g<.'neral populat1011 of the countrv, ),tate, or cmmtv were uti- h1.ed frn cnntro I p~trpo~cs. The lin;1t,lt1ons of the mt' of the general population for conhol purpmt', ha~ IK(n I cco~nizcd tn..tJ DnJII (l,fiiwd .md oh,e1 \l'd a whmt of men in hme ( 1950), the members of which had _ more years of previous employment; the in : gators observed this cohort for a period of 6 years. The cohort composition was ch tenzed by varying lengths of employment" they related to other factors such as sm - and weighted-exposure categories. An anal of this study has been made,111 citing the inlier ent lim1tahons and the lack of justification i the negative conclusion derived. \lancuso,3 through the use of 1938-39 Soeial' Security records, established a company cohort,i of a!ibestos workers who were observed to mid- 1. 1960 In this study, the need for data by dura-.'tion and the development of more appropriate controls for industnal cohort populations w expressed and !!>en.ed as the basis for the present: ~tuch S<:hkoff et t1l 1' utilized union records to es- .; t,lhhi,h a cohort of insula.hon workers as of 1943, ~. m which grot1p the elapsed time from initial .,... t,po1,ure wac; the essential cnterion, character- .-: t111ploHd 111 :..ch<"dul<'d johs; 111 ,\11 a~liC',tm tt.-,tilc pl.int \\ hn h.1d hten e111plo~C'd for 20 H'ill!. it.mg the cohort us thoc;e with a history of 20-.:t , e,Lf!) or longer !,lfiCe the first exposure to a~bes- ., rn mott 111 the ,.mi' pbnt Hf' conduded th.it tlw ,l\ t1.1u:1 111 n!!-c,uu..:1..r n,k w:h 111 tlw 01 d('t of 10 t11n1, th.it t\penenced by thr g:Pne1.1l popul.1t1011 ,111d that tilt' 1!',k Ii.id htctll111" p10(;11',- -.1, tI, I,,, ,l'l tl1t' d111 ,1!1011 of tmplo~ mc11t t'\.- to., dust The conmtency of employment for tlu, occ11p,\t1onal trade group has been h1ston<:,tll~ 1eftected in the c,press1on "once a pipe cnqrer. ,d\~:,~, ,\ pipe CO\f'r(>r." Com.eqnently, _ the tlurn.tion of employment may lHl\c been pm111 e 1111d1r ohl du,t~ wnchtmm df'c:1 e,t\Ctl ( follm\ 111!.!; tlw 11P,t1t11tlf)n ot c<1t,t111 11g11l.th1m-. l'\h.!ll'i\\e Enterlme,l'l 11hhzin~ the Social Security ap- and cont,:11111t:'.L'>111e, ,It ,L t.;1\111 prnnt 111 t111w) \)1 oath, e!.t,1bli~hed J.n industry cohort, cons1st- The-.1 <>h-.t'I\ ,1t1om, \\f'tC' t111tlw1 ..,11h.,t.111t1,1tf'<.l 111g of a number of the a~hestos-products plants, b, K110\ ,,t ul 111 ,l co11t1m1.1tmn 11f tlw, h,b1C' -.t11(h: " wlm h H\ e,1\ed ,l dc1.H',l)t1tl lt111\! ca11- ct1 11...\.. ,11h,eq\\l.nt to tlut po111t Ill t 1111t.' { l(j 3'1) ot~ ,-.orken, who were t>mployed at some time du1mg t<HB-lC),'51 and oberved to m,d-196.'3. C111m1 ts \\ e, e f'Stabli-;hed m the same manner In tlu-. rn,u11w1. the oh,en.1t1011 ol the df..:1.t1,t for cotton te,t,lc plant<:, ,.., h1ch together with nt'-., 111 the t'II\ 11011m<'ntal c,ont1ol 111l',l\111r:.. 1 t' the specific death 1ates for the US -.\ere uti- the d1..uc,ht' sn ,1,ht!>tos t\po-,111t 1t,ultrng 111 l11ed for c-omparable purposes Enterlme fnr- tlw det:1 (',I'<' nt lung c:.111te1, m1g11w11ted d,1t,\ 1111 ther cited the d1fficultv of mterpreting findings the- ptt>\ 1ow,h e~t.1hh-.hed dinct ,l'-'-<K'1,1tin11 lie- twee11 11111g c.111u1 .tml ,hhe-.tm 1..,pO'-lll<' ,,,1~ Lt :d,n upp.ucnt frum Kuo, ,lml Doll"~ nh,c1 \ ,ltlllll'> tl1,lt the dfec ti\ tm,, ot tlll' l'll\ 1 I , 1111111(11t,d <.,inti ol 111C",l!,,lt1 f''> ,tt , .111011\ pt'l 1ml~ l crnilcl h,1\ t .111 111ilt1l'IH.e 111 te~tm~ m1r pwp1hed 11'p1)t!ww, It i-, c-udt11t tlut .l 10-u.tr pP11nd 111 the ab~ence of data on duration of employ111tnt. and the hmitat1ons of the Social Security d,1ta for lh1s purpose. \Ve have been able to ,,, <'I come these problems in the pre5ent sh.1dv Th{' p1 e!lr11t ~tmly comtitutes an application nf tht' oh,;c-1 ,,ttums de, 1ved from our explora t11111!t 111 nwthoclolog\ of ,tud, ing im1mtna1 pop- n~ ,1nplm 111et1t 1\po~111t> 111 tlw ,1,lit>,l1h 111d11,- 1il.1t1n11, It d1fler<; from p,e, 1ous pro,peCtl\'C -I .\l.\.\CU>O & EL-.\TI.\R 1-19 asbei.tos i.tudies 111 the h,h1c utiliuhon of a generation cohort c1n<l mte, nc.11 <..onh ols, \\ 1th gradient level!. of tmplo~ ment ,111 .il>!.e~'>!>c.'d through Social Se<:1111 tv I ecorJ!> The p1oblem of ''adequ,,tt! conhob has been a maior ohstaclt> m mclu,t11al ht:,tlth )htches and 1s further accentu.ih'd 111 pH>l>LWCtl\ e l011g1tudmJl studies co\'ermg: ,l period of n1.111~ ~ea1:., This problem, loo. h,h lwf'n con:.,1de1ed Ill 0111 present !ltudy. The pnmary emph,1!.h and cl11ec.t1011 of th<> cohort study was to Age Tlw tllho1 t \\ ,1:., d,1-,:,1fted 111 ,tgt: gump~ ol U51-l l.'5-4 , .f5..('i-l..111d 6.=i .tnd o\'er. The d,1te trn \\ lrn:11 the ,1gt-~pc<:1nc <le,lth ratt-, \\ e1 t- c..d- wl,ttl'd ,, .,~ the d,1k ,It dc,1th, for the .,gr ,,t ent1,H1<..c gc1wr.1ho11 nwthod. the .1ge \1 ,t\ (~1lc11l,\ted ,1' ot 190 Tlw l11mt,1tmm .mJ me11b of tlw 1.u 10m nwthod, of <.:Dmp,u 1,011!'>. age ,lt tll',ttl1 .111d ,tgt" ,1t ent1 anLl', t ~t'I, t'd ,t, .1 h.1,1, for 0111 ,t'lect10;1 ,mcl d.:t'i!l1fkat1011 of the p1 C:'wut LOhort In .1ge ,it l'l-10 1 Demonstrate the nwtho<l of utihzmg ,Ill .r inlern,tl control wrth ,l geuernt1011 coho, t~ ,IC cmdmg to ,ige and ~pcc:1f1c- leHl, of emplu~ment expe11ence for ,l comp.u1~ nndrr :.,tnd~ ( ,1, derived from Socul Se<.m 1ty d.1t.1) 2 \aluate the effect\ of durat1m1 of cumu Cumulative Employment Experience F.,1d1 !>t'\-,lge g,oup \\ l)!, cl,l!.~tn<.tl ,l( U)I dmg to the c..unrnl.lti\t emplo,me11t 1,pernncl:' the\ .icq1111l'd d111mg the pe11o<l 19.38 th1ough 1111(1l<Jo-l mto tlw follm, mg .5 le\ els lahvc employment e,pe11tmc:e m1 the mm taht) pattern of workers e\(JO!led to ,1:.,he~to3, spec1fi- ~ cally m relation to mahgn,rnt neopl,t~ms. c,u - r . d1ovascular diseases, and a!,bestm,1!> To onr t 1f/nu/,rl1t t' , "'l'J,,,,,,,, ,,, ,J Jf 11t"ur1 I II II I /# m11l,J t/tJl' Uf f'J /'f I If,,, r ( 11r ) 0 l- 20 21- i 0 7 1-12 0 i .knowledge, the pre~ent ~tudy 1s the fiu,t repo1 t IV ! ~ to provide such es!>enh,ll data pe1 t,11111ng to all \ J 1.2 1-17 0 17 1-17 :;- -.:. gradie11ts of levels of <lur..ihon of cumul.1t1ve employment expenence m an a!lbe!!tos mdu:>try, . and the relationship to tlie mot tality pattern m a wel1-ddined "total" population ,1t mk, followed for a long pe11od of time ( 2.i ..5 )'ears) 111 D<',tth 1,tk!i for the l!clcctcd under!~ mg c.,u~es of d<',lth we1 e c<1kul,tted for each Sl"{-,tge leHl of c11m11lahve t'mployment e\penence and fm Le\el 11 through V rnmbmed .which a generation cohort method and internal Development of an Internal Control control IS used. I In the present study, employees of the 1938 . i and 1939 cohort who h,lcl a curnul.1b\'e employ- I ment t.'\penenC't> of 2 :-:ears or le:,s durmg the , The study was conducted m the :,ame manner . as the previous asbestos study' m the establish- period 1938 to m,<l-1964 were !.elected ,ls an mternal control. I: ': ment of the cohort for 1938 and 1939 through Average annual death rates for employees ' Social Security records, the method of follow- who had a cumulative employment e"penence up, and the detennmation of the deceased and of 2 years or less ( Level I) were computed by ~the causes of death. 1,ex and age group. For each sex and age group ,;,-Data pertaining to sex, color, year of birth, of employees havmg cumulative employment .. 'date of death, and a complete emplovment h1s- e\l)erience of rnore than 2 years ( Levels JI, Ill, , ~!JIY iJi'the asbestos plant (by quart~rs of each etc ), the expected number of deaths was de- ,:ear) were made available to us by the Social termined for the selected spec16c underlying . urity Administration for the living and the ~ eceased from 1938 and 1939 to mid-1964. The cause of death by applying the average annual death rates of the employees having cumulative @lditional data made 1t possible to classify the employment experience of :? yeari,, or less for ftk>pulation by se,c, age, and cumulative f>mploy- that age group. The standard mortality ratios . ent expenence during the period of 1938 to ( SMR) were calculated based on the observed .~ d-1964. The dynamic changes pertaining to ge; cumulative duration of employment. and ~ ars of observation in a long-tenn cohort study , ~cussed in a previous paper) were considered ~.the computation of person years and analysis We.. data. nnct e, pected number of deaths due to under lying selected causes of death for age at death and age at 19-10. - ~~,1 ... -..,&.. .,..,.. '""'"u"" . ~ menl e,:pcr1encc for an em... plo,\l!e who \\as :ih,e by mul-196+ and has ft continuous emploJ m<"nt m the a~b.,~to~ planL 5mce 1938 is 27 S }CBTS Ro~--------- - ..... :,.,. ~1..,:.-::- .. -,,-- ....,."', ~ ,. ' ....... e,,.,...,.... 'it,....~~---- .~:: :- ... -;;- "" ,,.:suw...WGW LC II - - ... __ ......!.. .. _(..:.-..:.::-_ -:: .. -:---,---.a...., -~ ~+_; R.,.. is a<ze1,r eir:::ee:<rfrtet ~-,,,..,: rn A"'" ., \l!I I r 1c110- ,111,.11Jti1 F,l,1cl\\-1'1ot Toi,,1. l'lu\lllLII o~ ol'I:, ,1<1\ Co\lPAI\Y\ \Vo111.r11~ n, ( ( I """ 1111 \'S 1)1 .,, 111111 I> I'\. T, \ I ) No\\ L1,1r-:1 ((.)OH - --------- - - - - ',I> (I))" ----- ' - - - - , ~ 1 , , rtll I, ,1.,,t. , ,,, ,., ,, ,. ,, ,. ,. "' -,,------ - -------------- ----- .,,, ;,, I I ( ,1 J ,,, I J.,r,l 11! '"'""fnl11r "'"'... r,f, 1111,/11111,uul l'JH'rwn,.r - --- - -----~---- --- II ( , ; ,,) - - -~ - - (; / 1n11) - R-- II' ( 1~ 1-l"i o) I, I I I, I I, 1 I' (I: I ~ n,r,) /) /, 1' - ------ \(Al I~ ---- ---- - I ;_2 I 2i- 11 Ii- I I ,.., 11-, I ,, ;;;_,, I - - - - - 12 ,l!O 122 7 I 1-1 1.21 r 110 114 I 21 22 ;1 117 171 II I I I 121 17 IJ'J l1fi II )(! .j';' I CJ\ rio ,! I', 'I 2, <JI I l'I II> I(, 17 lO 2(i 5(i Ii rn 11 12 (.?, -.~ \ 2,r; l"> "i 2U 1fl ;1 (, l ! - l 1 1 I:! l(J - 1(1 21 4 ,I ~ ' ,'! 2 14 :3 llJ J 2(> (,) l,i ll\4'1 21 I 'l l I _,-,._., ' - - \ I\ '!.!"' \\0 <) \"> l.!hi l'I I (, - 6 7 7 4 l l!I 8S 2fil 1-19 (I! i~ l'l(J 50 11'.J i'> ------------ --- -------- ---- - fll rn l4 112 l5H 10 R8 <J'i 22 11 :'i1 - q 1 12 ] I iO 10.5 181 - - - - - -- __-___ l'i-21 I:! 12 11 1.2 - - - I I \IALI-, ~~ -- 16 rn ----- - - - - - - - ...... 5 5 1 :i - 6 R - 2').. I I ,', 1; to l ]'', J'i 1 37 40 I 16 17 ] 5 f, :J 22 25 r,-11 1-; -18 f\ l :! i lJ ; 14 19 6 5 11 I 2 :i 1 20 21 ., - - l!",-i I -I II I> I 2 1 2 2 2 'j - - - - - - - - - '>~-HI I I 4 I 1 - - - - - - - - - - - f,'; l,, ll\t'I l l All ,ll!t, 'II 1<17 '.:.:!q 1 16 :l'J 8 11() 77 q 10 'l9 - ----- . --- J 1 2 S! ] I 5 11 16 l :J 4 l I 6 51 57 I " lud, , ,. 111 ol, "'"' ~ f<-,u, I, ,I, ,,t 1,- "" 11rrtni, 111 I fl'IA ,., 1en'! lo n1t'111111 r~ nf rohort 'li-r. J , , nr, n{ 11,:r II t clC"nth '11H" mo!,- df'afh~ ,. ~rf" code< t'- ,Int lu I n1leN I relit 1, r~ul '--Ji c 1fi1 ,I ,..._ rlu 11111.1 j rt { I ) nrlt't111sd1roht' h,11rl ,1,.,.n,r (I) n,lu,l.,,os ( .! ) : t1("l."1<lrnt ( 1), nnrl ~nteid.- {I). Tiu 1,111111 ,I, ,,11, ~r du In 1111lr,:u1n! 11111tl11.,,111 nr tJu hr11t1 (I) ,uul .1\,,,h,..,frn,11.. (I) ,\ l,o , "hHlt ,I lfl 1111 11, 11 ti,~ ,w1nn~ mn Ire: ,.,,. 11 dr,~ lfl ""~ l htt1dl\. - . ,..,. f.:, tiri:f'if-- ...- ' 1' ttb I ...'. ,-,-?. ~. \ ~~- I ~..~-. ff). ~f 1 I i' ri' 1/ ,;.~ :: 4Q Vi ~,. I , 1111 .-"'9111 . . -------------- TABLI:. 2. CAU!ti,: OF lJE'\ 111 1N 11:140.... :1.nL>-1964 FoLLOWVl' 01- A!tuu. 1o!tl'1.,1.:-., \\'0111,.1 11., ( ,., C1 -\-.,1~ 11 u - ~-- - - /,,,,,,I"/ r11mr,lr1l1t1 1m1,ln1twtlff ,,,,,1u11(, ----~ ---- - - ... - --- 1-.: T, , 1) --- -- - - - ( '1, ,r,., r,f ,I, ,,ti, ,,ml C'rJ,lc ---- -- - 1'01 '\L ---- Jfol, - .. - - I', IIIHI, j\, - Ill In,/,, I JI Ill I I I Ill/,, .I, J II fl f / I -~-------~--- --- .nu -t'J MJ (;,J ,5() j(, 11 I :-.. 'I ) h - - Tuberculm1,, ,ill form,- (001-020) 10 J h' l J - j All llt'l>l)W!\llll> ( 140-2 JB) 1>5 lJ .22 11 1 l 22 11 All m..thgn.1111 ne<1pk1sm, ( 140-2US) 6-t l l 21 11 I~ 22 II l\l,1hg11J11t neopl.i.ms of <l1ge,hve 01 g,111\ aud peritoneum (150-1.59) 26 I - (, 2 ~IJh~n.mt ncopl:isms of pe11tune11m ,mt!/ nr me.otl,cbom.ii s I 2 I I -~ M.1hgn.111t nt'tl()IJ,111s uf hmf!. hmm Im,. n .111<l 11.Khc,, ( HU-161) - " l 111~1lC'uficil 111,1!1g11,111t 11coph"m~ ( I'l')) ~ ', 'I h 'i lo ..! 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I , , . . , . - . , . - ,...... 1 .-< .... - :;.:,_._,z==~ . ~' ............. - - ....... ,-.---..,........, . ..--...-.....- .........,.,_-,~- .. - - J,,"" ---~~--~~_:i- -:.:-'.~ ....:-- -_.:.:..:.-.;___ e.~:!.f,======~=:.:=;j , i,,, ., J \ ,u, l :,. 111111 \111111 \1 11 \ J:, rn, (!, \ 1H) Jl,\,r n ol\ 01\,F.1n 111 ( 0) AND E\l'i'..C10 ( E) Nu~an,J1 o,- DEA,:'Hs Dm: TO -~tia ..,, , 11 11 ,, l ,111 111 11,, < ,1,\1 \ ,., , 111. ~ 10111 At 11 'I. H,\HS ( 11) Pi:11 100,000 Pu1l'LA'110:,,i ~uH Au: A I Hl-40 ANO ---~- --------------- '.,u-, .,, ., .,,,, ',,.,. ,: ,~ .\ ,.,," -- - - _,_ -- - \ II Ill ..,,1. MIi\ I,,., .. , '\,,, II .., \It: \,1 \I I I '' II 1: -, '7 I 17 2 l'> -, .... ) ,) IJ1 ,111 \\lo",.\..,t11,10,\\'oiu,u1-.Srun111>(,;n::T1-.\r) --- - --- ---- ---- .. I-,, ,,t i'' jtl Ar,,.: al ,l<J11lh ---- ------------ ,; (:: ,~ i ,;,; ,\ mor ,,; .! I - -- -- ~- ~ ----. -'~-H ,I.J--li4 VJ ,i-ovcr II /,' I \2 ;-, I l:--.'111 -,2'i ljH 12 H,l I/ --- 12h l'l S 'I 1(1.,! 2.,111 IJ;"' 111 12. (I () -- /-J - -0 --~- 18 i I llS I lfi'J,I- )1S:!3 --(-) lh'> 4 OU 0-l (I 8 .!,! 21 .J Jl(l .!OH 151 I 1 a~,'} 0 E 168 05 7 2-W:) !J-10 25(-1 -18 17 S 0 E in .ms l-1056 80u7 174 13 7.7 '" - - - 11 10-211> t. 210 2 \'I) H !,l) '>' .', 112 1'1211 SSh J.!52 84 ]()7 CH 687 2'56 2256 1345 I<-: '- \Ill (--) l>l 217 (+) (-) H1S 268 168 ......, - \Ldq!11,111t IW<tpl.,,111, ,\,> rif dn!t,fnr "' t! u1, fl - - .. 111d p,, ,,.,,,,11111 I .! ll I- ,. l 10 I <J 1-12 2ft ,> IO I.:! -HI ',/-1(1 211,3 ,JO() 4 16 15 90 3 00 ~{ 1H 16 2.15 128 521 ,'l 245 167 (+) , "'Ill 1 ,-;o. It;'J) ,., \l,,111,:11,11,t llt "I'' \\111' I Ill) I 20 ' y 6 3.0 l 00 - nl \h lll<Hll'l\lll ""I' H :!.! t !IS S6 43 174 OI 1111 ,01!,!'110111,1, \l.1h>!., 11>\ ,upl.,,nh - ..1 I, 111c I'""" l11" t.. 11.\lh,., Uhl lh\) ,. \I ,l,g,ll,1111 "'"I" I,. - - - - - ii, ,I 11c11pl,1,111\ ... \ !I( '\, II B ', m II < !} l'l p; 270 2h \11'\'-i r, (l 0 1-1 i;() I) so tif!I ';$)() II l I 00 'i-t 2 00 111n - (+) l 00 8W 4 00 1C) (+) I (l{J !O 201 21 90 :mo 128 234 (-; 00 86 {+l 5 77 868 l:14,5 65 l (I 0 174 ( J'l'l j) ',\Ill ( I ) (+) l I-) (+) {+) (+) - - ( Hlur tll't1j1l.1,111\ '" - - - - (IIO-ll'l lW-lhl. lll-l'l'- 2!10-::!l'J> I )1"' "' "' C ,II d111- '" , >P,.c ul.u ,\ ,t,:rn I{ :-, \flt H I 2 - ll - (--) I ) -I _,,- h'i 7 5 .'}5 100 ,CJ I.W Ill JO' y;-o 217 I (I (I 111 - (+) lih :!20 -l'l lfi lfi2-l l 00 816 (+) JO 7 I RJfn 5~25 ll 4 84 (-} :! 49 19 41'! 41 4 49 3<) 48 6 00 86 (+) 63 388 901 556 4 00 694 (+} 50 349 8077 0050 1 l m 111 t.. l011 irn~) 'i\lH Ill :? IO 1110 I-HI "n ''"' '" , ,,I 1,,1m .1- - - -,~.} 1111\ '\ '" 111 ( 17!1- II \\m _,,-I () ll ( I) 21 '17 p- 5l <>17 17 110 ll'i'> (+) ,,,,..,,"'" < -,2 12} X11 I! ~,m - l'l 00 '.!iO (+) - 12 no 886 (+) 82 -1 33 :J(} '32 J22 - 2 00 ]9 ( +) 162 31 00 443 - (+) 26 o.o 3i2 - (+) 141 6 oo 104] (+) 3 00 521 (+) Dasi.. ~-, ,,f d1w,,f1\ t.: '"il'III ('i'l1>-">B7) 01hr, t l\lN"i /'Zo }\ S\111 i'.o n ~,m - I 00 _,')- ( ) 2 :111 '>:'i 102 5-1 - 4 llO ,:,7 (+) 21 7.41 :128 106 .'JlO 5 00 369 - (+) 12 40 886 2()5 JOO - l 00 816 (+) - :J 0,0 2449 (+) -- 04 84 (-) - 4 00 39 (+} 9 6.5 87 63 138 2 00 29 - (+) 5 0.0 521 (+) 24 9.0 7 39 ; 8~';4''~-: 3p,.,_J28 . 1~15 _672. ,,, I.'.--.::-:~ _., ~~t...1. ~1._1l!1,',,'t'..., .. , 11,,~/-:~,1J' ::" \ hl\,t.., \\\\h\ h\-...tof'~ hf\'-~t.\ ~n'\ 1\1r1.\n n..,n\1a\,k fro1n SSA. 1.,u\y,. .~ '\U l111pln.,.,o.. nr 11mlh,tn~nl C-11t'("pt 1 t'aualns diealh c:od-.:lr~--- - .......~ t I h~it Rrnu1, of n111ll11n~"l nu,pln ~ ..,ncl.lfded M ._SP( - - ..... ' -~:mMm!Jo'U-tl p'-"" ~~ :i -- t..a: Vol, 9 No. 4 - ~pril 1961 \I\'.\( l ':>O ~ EL--\ rT-\H l33 Characteristic:s of the Coho1't The .t!>ht>l>to~ pl.mt h.ul 0111' \\ h1tL t111plo~tT, 111 the ~Cai!> the coho1t \1,,., ,(kctcd. 193,'i 01 1919 {T,d,le l ). .-\ho11t :,j', ,,t thl'l11 "t11 11hil1 The ..lge comp,11 ,~on .,hm, t d ,l ~om1dt1,1hlt m1mbe1 of vou11g tmphn ('(, pn 1fiL,dl). 111011 tli,lll two-tlur<ls of the ('111ploH'c, 111 thl' t11ho1 t in 19.'38 OI 1939 \\l'll' Ill !ht ,It.:(' ~1011p 15-3-l ,e,ll!> 111 19-40 Durmg IIH 1w11<;d 191S to uwl- 1964, tht c1111111l,ltl\ (' t111plrn 11H11t l'\Pl't ll'11u ,,.i~ cl.l~\1fied by !>CX ,111d ,1gc ,ti Il)-10 101 the rnlirn t population 1s illmtr.itec! 111 T,1hle 1 It noted. for c,,unpk, th,tt .1h1111t 2,', ol the m,dc cmplo:t>c~ '"-''e u1 L,111 I 2.S', I\ cit 111 Lei 11 II, ,md .r;-q: \H'II' 111 lhL l'1Hl1lH111d LCH'I, 111 IV..md V of cum11l.1t1H 1111plm 111111t t'\J)t't u:11u ,. rn the .i~bel.tos plant , During the pe110d 19-40 tn m1d-l96-t. tht1t ~ ';. \\ere 'J,'30 m,1les .m<l .H frrn,1k~ 111 tlw plant c.o- 0 , hort who cited, c'\c:lmlt11A" U ":u <..1~lt.1lhL'' i' death at ~c.1, ,1ml 6 dc.-.1th~ d111111q lCJ18-llJ:3Y. The distribution of tlw 1mmlw~ of de.1th, In ~Flevel of cunml.tli\e emplm111Lut npe11(11u : among the cohort pop11l.1t1011 1:, 1ll11:.ti ,1tcd 111 __Table l For .1ll le, els of c11nnil,1t1ve tmpl<)\ - , ment expe1 wnce. there" t'I<' 330 d<-.1tlh (:26 6'c) . in a total male popul,1tio11 ol 116:i ,md tlwt <' ~ were only '31 death, ( l.3.611-) ,11no11g 228 tot.11 female emplovees 'i;: . : In our study the cohoit population 1ep1e- :in.sented the combmed cohoi b of tho!>e cmplo} cd 1938 and those '"ho!)c fir!>t employment w,1!> lecorded by Social See111 ity as bemg in 1()'l9. ~Information was not ,1vml,1ble to charactc11ze _t~e members of the cohort hy fii!)t employment JD,.the plant prior to 1938 and this, consequent- .. y, deferred any analysis hy the :,11ccess1vc co- ~rt method i1 Howeve1, in our preliminar} lliiaJysis of the individual cohorts, employees of , ~ and those of 1939, we found an apparent , ereoce. The 1939 cohort employee!>, repre- . ting mostly new employee:.. sustamed a low- ., ,!!IOrtality for all c,m:,e:, o~ death ,md for the Iected specific cau:,es of death under sh1dy. 1 Pf the total 1265 male employees m the 1938- cohort, there were 328 male employees at belonged to the 1939 cohol't, of which there iiere 47 observed deaths clue to all causes m- -~luding 2 deaths caused hy mal1gn.1nt neo- Jasms of lung, trachea, and b1onchus, and none ue to asbestosis. Of the iemammg 937 male ., loyees in the 19'.38 coho, t, there were 2.83 ...... ..;".::) ~ ~ ,. :ft d1,1th, 111d11d111~ '31 d1.itl1~ d1w lo ,1,l,L,lm" ,uul l3 dt,1th, d11t In 111,l11!!_11.111t 1wnpl,1,111, ol tlll' 11111!.! t1m.ht,1 ,111d h11rnd111, 111 1,~t11u the IH tt, 1 \!JI, 11 .ti l!J1 11111,t 111 tli, Jl)3l) l.llhrnt .irid tlll' uli.,u,,1t1011 tli,,t 1n11w 111 t!1< t,t,t, 1>1 ,1,IH,tn,1, n<:u1111.d .11111111:,: 1111>" \\ l11i...1 II toid, ,l!}!)\',ll('d Ill 191() .1, ll'ttH.d1d I,, ",,1lt,il ~tt1111t, "111'11 to111p.t1td lo tltmc ,,heh, H 1.01d, ,1pp1..111tl 111 HJJ,"i unild 111 dw to th, 11ill11P11u ot [lll'I 1rn1, ,111plm 111t 11l p11rn t11 J<)1!, 111 tlw ,,11u1 pl.1111 .mrnn~ till' llJ1", 1,,l1rnt .:11d ,.l,o hn,111\t' 1lf th(' 1lltt11u111,, 111 illt' 111, 111111 11L111t,1I d1,t11)!n .i11d 1111p1m1111111h 111 ,111,..,1.- ,,f 'IILl-llt ,v,u, Tl11'11lm1 11111 oh" 11.d1111" 1l11 1t- d111.t1011 11,I-. .dtho11~l1 11111.t,d .11, 111 .1!!'1,1- 1111111 \\ 1th 1l11 oh,111.:1,"m 111d1u!1 d In D,dl .IIJd J..:110\ I'/ 11/. 1 1 ' Tiu ,1tl1"''111111t h11tl111c(, ( ,1 !t1t Ii lolhm) 11 - l,ttl' to th!' <.0111ln11nl llJ31'-1tJ u1l1rnt of 111lplm- 11, .,f tlll' .,,lw,to~ p111d11(.h pl.11,t T.1hlt- 2 or 1.l1.11.1tkt1/1, tlu- 1,1111tllf'I <l1.tll1, I,, tlH 1111 or d11 h 111t.: wll'dtd Lt11,1, d<-.1tli ,l\ 11ntPd Ii, ,1, :u1d 11',d of u111111l,1tn1 t111plo111u lit l'\[ll'll 111u! .\111ot1!! thl' m,1le, tlu11 "11t r5 m,1hg- 1i.mt t11111m-. 'ot tht lim~ i --11', 11! .dl 111,1h~11.1;1. cir,). of "hH:li '3 111.,(.111,1cd 111 Lt,11 I (O 1-2 o u1111111,1tn1 \t,11, ,ii e111plo)111('11t) ()f the > de,tth~ d11 t' to 1t,1rn ,1to1 v clt,c,1 ,t, 11 tlt,,th, "t't e dw to ,t,lw,tm1, Fm thu k111,1k, thc1e ,, e1e ll dt'..lth, due to nuhgn,111t ueopla:.1m :md of thi!> g1011p 6 ( 5-1'1-) "ere due to mahgnanc1es of the lung (one w,1, 1n Level I), and ,1II of the S dc.itlt!l due to H''lllrntm y dM,1~e ",:re due to ,1,liP,tm1, The1 c \\'<'I c R lll,tlign:rnt neupl.i,.,.ms of th<' pcntoneum .md/or mei.othcl1oma, 1Clen- t1n('d m the no male deaths of all causes, 1 of ,duch occurrecl rn Level I. T,thlc 2 pro" 1del, the 1111ti,1I d1:,tnb11t,on .111d 111d1cat1011 of the 111flu- ence of d111ahon of employment J\l, was seen in T,ihlc. 1, thC' age gtoup 111 e.tch corre~pon<lmg le,el ,anes and con~ef1uently influence:, the ob,en atlons I elatJ\'e to duration of cmplo}111ent nnd :,pec:1fic causes of death Table '3 applies the average annu,1! mort,1l1tv rate hy ,1ge a1Hl unde1 I~ 111g c,111~c~ of death of the rnt,1 nal lontrol ( Level I) to tl10~e with cunmlatJ\e }ears of employment e,perience of more than 2 years ( LeH:"h 11-V mclml\ e), and as such provides an "ove1 view" of the mot tality potterns of the cohort, without relating to i.pec,fic lc\cls of emplO}'mEmt It mu,t be horne m mm<l that the interual conhol (Level I) is a sub. cohort of the same cohort populatmn and <l1ffers only in hemg characte1 ,zed by the ~hortest duration of cumulative years of employment ex-  154 .\fORTALITY IN .ASBESTOS WORKERS penence (? --- I.:) m the a...hestos mdus- underJymg cause of death and SMR as c trv <luring 19,38 to mid-196-4. In Table 3 the mort.ility r.1te!> ,ue calculated by 2 methods by age at 1940 and level of cumulative e ment experience. ( l) age ,lt entrance, the "generation cohort ,Ip The mam description of the resuJ pro,ich," ao<l ( 2) age ,tt deatJt, ~!-:e '\m1al age ~pl:'c1hc tJ,-,ath rates." sented m Table 4 1s directed at the age .25-l4 age at entrance of the generation In T,il>lc 3, the S\IR c<tkulated by age at according to the corresponding cause of <le.1th and ,1ge at entrance illustrated higher in order to lessen the possible influence of'. i.1l11e,; a\ comp,1red to the control. ~foi.t of the v1011s employment. oh..e1 ved .1<l<l1tional deaths were due to malignant 11coplusm1> (spec1fic.1.Ily tho.\e of the lung, All Causes of Death t1,1d1ea, and bronchus, the <lige_.,ti,e organ~ an<l It 1~ noted that, with the etception of 1 pN1toneum, ,m<l ,11_.,o "un~pec1fied malignant and more ~ears of level of cumulative emp_ 1icopl,bm1,"), cfo,e,bC.) of the c.1rd1ova.-.cubr !>ys- ment e\'.per,ence, tl1ere 1s a consistent in tcm. <l1!>ea...t~ of the re.!iptr,ttory ~~ \tem ( \pecifi- rn the avel'uge annual mortality rates as c,tlly .1~he...to\J\), ,mcl dise,he., of d1ge,tn,e -"}'s- <.um11lat1\'e employment e11perience mere tern For e,ample, the average annual mortality ratei. Tlw ~'.\IR .md ,\\e1.\ge- ,11)111t.1I moit.ihh 1,1tes due to all causes for ,,ge group 25-44 are . tor ngel> 2=5--U. c.l..tl>Mne<l ll\ ,ige at tuti ,1nce, forO l-2.0 )'ears (c-ontrol group}; 1091 for2.l-"; \\ ,1., ll\t1Ch h1glwr th,111 tlw ,1gc -15-6-l fo1 m.1lig11.mt 1wopl.1,11l!> ot the cligt>.. tl\ e mg.m~ ,111d of , 0 ve.ir~. 2280 fo1 i.l-12 0 yea1s, 6i88 for 12.l..:.- li Oyears, an<l .'3398 for 17 l and more years of; the luo; Thb dillc1em:e wa!> 11101e m.uked fo, <.'llmul.ttive years of employment e><perie m..i.li~Mnl neopla~1m of the h111g for ,1.ge 2-5--1-1 The ~ame holds true with SMR \'alues w and \\,I~ JU t11ne~ thnt of the control group. in the same age groups, there are values of ~-. For tlw .1~c .it denth, the lughe:,,t I ate tor 11111g for .2 1-7 0, -132 for i.l-12 0, 12S7 for 12.1-17.0, eanetr o<.tt1md 111 the .tge !;!:lllllfl -15-6-l mid 6+\- for 17 1 .ind more years of employment Tht' S\IH ,111d 1nmt,tl1t\ iate:.. 101 11111g c.-.111eer t>' (WI lt'llCf' 111 thr <lldtJ ,1\!,t' :,!:I OUll .i.1-G.t ( ,H c.l,l\~1fit>CI h~ both ,l~c ,tt C't1t1.111u ,llld ,l~t" ,It de.1th I illu,- All Neoplu,mu, 11.i!t-d tla.: dlntot the mk111,d l'011trol"o11 the T,1hle ..t mdtc.1te~ .rn ,tppmtnt mcrense in the d1flp1111u 1111\utn tlw oh-.11\<'d ,111d tlit' c'\- ,11t:1,1gc -111wi.tl rno1t,d1ty 1,1te~ fo1 ,di neoplasms t, ptd1tl \\ lw11 tfu t\p111euu cit tl11, .lt(l' gro11p "1th I .-1 I 1111plo1 11wnt t'\(ll'I IL'IIU' i O 1-2 .1, tlu." l11111ul,1hH t111plo~11u11t e,penence m- u 1,1,td Fm l;'\,11nplt>, the ,\\ e, ,1ge .mnual mor t,, 11,n .. 1 h .,pphl'd to tlH' ull1npo11d111~ ,l~e -_:1p11p d, 1 t, t tlw <''\(lt->ttc-d 1.ile, the npc<.:tt>d t.1lth r.ttt_,., foi .ill 11t!oplm,nh frn the .ige gruup 2}- l ,u t l ,2 fm O 1-2 0 , e.us ( control 1.1(., \1111dd I,,, l11dw1 h\ \llhll' nl tli1 111f111e11c1i \!l1Jt1pl 3-!.'l lor 21-70 ,c,11s ,'i70 fot 71-120 111 1r11pl11,111111t p1101 to llJt') l11 t!u, 11,1wd tlw1d1111 1111 d1fl<11Jtu olN1,1d t1111,t1!11t1, .1 r:- [ u,u~ 31 B fni 1.2 l-lT0 \t',11.'>md 1061 for .l!ld TIHll f' ~ l',11 \ ot (.'llll;Ulatl\ t' c_>mploynwnt \ l'I\ ( <111,('I \ ,l(I\ (' 1,tflll.Ltl' EffC(. h of Cumul.,ti\t:~ Emplm 11w11t E,pencn<:e on the \fort:1Jit~ P,1ttern ~,rn l'\1)(1u11u Tlw ,,11111 hold-" t111e \\1th the S\IR ,,iillt'\ \\ht'!t' Ill tht' loc.llllt" ,,ge g1oup. ,.i/111, ,tll' 2(:l-! Int 2 l-10 1<.J1, .J32 fo1 7 l-120 \1,th .Hi6 fw J2.l-[70..111d Sl9 fo, l7 l .md I 111 tlw p11rpn,e nt .,~~t,,111u; tlw 11l,1t1011,l11p 111111L \1,tr, o~ cun111l.1tne emplm111t11t lwh,, c1, tlw tlllll t.d1t\ p,1Ht111 ,111d tlw d111.1tin11 ol ,111plu,r11t11! tlw r.tl1, In ,t!.!l' ,Lt 19W ,,,,,, ll'<'ci Im tlri 1.11 ri,11, 11-.1~1111, to !11 d1,(.11,,1d Tn Ualiemmt .Veop/a.~mv-Dige.Ytfoe Orgum ,md -Perifom:11111 , \,trlllnr thr, 11 l.tt11111\l11p. 11101 t,1hh r ,,t,, 11 tw ,,,1 d .,, luf!m,, ,ill t,111,1, .di ,wopl.i-111, 111.1J,g. 11.11,t 111 opl.1,111, 11t d1!!l,tn t ,,1 !,!,Ill., ,Jilt! p11 J- tlllll'I 1111 111,d1!!1J,11,t llt'opf,1,111, of 11111~ hi tJ!l- I d 111, .111d t1.1d1t.1 t,11d111,,1,c11l.11 c1 .....1,1,, ;,,,_ 1.q,t \,1,11il,11 ln11111, .dl ..l'tm~ tht' unt1.d 1111\ I 1111, ,\,r11111 ,111d ,i-1 1',tD!>I', T,d,1,, f illr1,t1,1t,,, tli, nli-. t\t d tilt' , \fH ttl'd ,t11.I tlw .111 1,t!_;t I' 1111111.il ,, .. "t.tl1h , .,t,, pt, roo ot111 f111 ... fl., tirl 1 lie1t 11.1, ., tot,d of 2':> dt'ath~ 111 the nge ,:1011p 2-~61.1, o~ l<JH> due to m.il1g-nnllt nen pl,1,11i- "t d1g(,t1\i rHgan., .md peiitone1mt o o \ 1111k .l d1,1th~ ucc1med m the cont1ol ~ro11p 1 1-~ l'Jt, n~ uir111il.1t1\" trnplO\ ment 1,. p11wnul .tttd 2~ tk,1tlh occ1111td m the l11!!l1tr I, HI, lkt.111,l ot th< \t't \ ,rn,ill 11111nher of l,h1, fill t.1ch !(,,Plot (.1111111l,1t1,t' C't11plm111rnt .11,d .1\! !_!1011p ,t 1~ d1lfic11lt to d11nn1ht1.1te ,1 \l -\:'\Ll \0 t. EL-.\ IT\l-1 rd.1t1omh1p beh\et'11 tlw 1nm I.11th , .,tc, It 0111 n('()p!,1...111.., of d1g('~!1,C' Hli!,lll\ .tnd pc11to1w11111 Jnd the cumul.1t1u r111pfm lllt'llt ,,p111enu Tltc.' ,lle1c1gc ,urnu,d m111t.1hh t.ilt,. honc>,t't "'ere higher for ,1IJ the u1111ul.1tr\ t' tniplO\ 111t11t e\penencc of J!l~ age> ~1011p th.in Im the lc111!iul forou1,. Foi e,arnplt 1 emplo~Cl'~ ,,1th 7 flw ,l\('1,1ge 111111t.il1t, 1,11c, l-120 ,1.11, of u11itul,tt1,1 emplo~meut e\JJCmi,u ,1 .1~ 12 t1111t, th.it ol th, co11ttol frn tlw ,.inw ,11 g11111p 2'>-1-t }' ,11, Malignm,t Neopfosm,;-Lung. Bronchus, nnd Trodu:(( ,h 1~ noted 111 T.1li1t ~ tlw 111uc,1,1d 11101 t,d1h rate,- 111 .~,-0<:1.itmn ,1 llh tlw 111t1l',IS1-' of ~11111111..tive emplo~ment npt1 H11u 1, .1pp.11111t 1111 tl1c age group 2,5.......J-l ~<,u, 1;.: 1,ttt, of 26 !or o 12.0 yeais, 1ates of 1~6 loi 2 1-7 0 ~t,11,, t63 lo, -; 1---110 w:an.wd 1.%7' /111 1.2 1-l';'O ,1.,i, There wi.;s, hcm,eH'1, ,, d11.:h1w m tlw r11mt,d1I~ , rate for 17 I nnd 1rn11c H,11, ot c11r111il.1t111 1111-~-- ployment e,pci renct It 1, t'\ 1d<11t th.it th<' t ,ti< and risk for hmg c,llll't'I dol'~ 111ut,1,t \\ 1th idurat10n of cmplo~ mcnt The d1l!H'l' ol 11,l: :appears h1ghei.t aftt-r 1111plm 111rnt ol 12 \ 1 .11, more At this i.t,tgt of 0111 m,e,t1g.1tion. \\ c not att,t<:h u11<lt1{' ,1g111f1c,111ce fll the rate fo, lung cancer for Le, tI I, ,mce the d,lt.l ,111d ,pec16cally the Lc1,el-l C'mplo}ee~ tmplm ment ,lit' ited to that which occurred after 1838. ,md e do not know wh.,t :.pec1flc earltl'r : e,11 -ould repre~ent the Jctu:il fir:.t ~e.u of employent m the company-m coutra!>t to the ~ e:tr ll\ .:utilized in this ~tudv fm l'II t1 .mce mto the co- ,rhort. However, Le,:ef r (0 1-2 ~e,1n,) for age group 25-44 can he com1dered d po:.!>1hlc o\ erestimate of the lung-c,mccr ute of iud1v1duals "' this age group and le, el of employment e,- ence. The cons1!ltency of the increai.e in te, recognizing the builM11 factor~ for 3t1CCes -e levels of increasing employment, p1ov1des dditional support to the relo.tionsh1p of lung ...ncer and asbestos e,posure. ' ..;,Cardiova,cular Diseases 'it is noted from Table 4 that there 1s a con- ' nt increase in the ave1 ,ige annual mortality .!tes as the cumulative employment e1:penence 'creaF - ....:..lple, the average annual ~rtality rates due to cardiov.tsculnr d1seai,es -~< ...,. . ,-.~ cept vascular lestorn. affectmg centi al nerv-.-~~-' '-- ......... 'S--44 Me .211 for 651 for71ind 849 for l-;" l ,11,,I 111,11 \ 1-.11, ol ( 1110111,dl\ 1 , 11qll11, IIWu! 1\p11 ll'lltt Th< ,,u,w p1t t1111 l1olth 11111 111111 ~\JR 1.d11n 1,!1111 111 tlll' ,,11111 .1~ !!llllljl !l1e11 ,11 (' 1 ,d111, nl I l2 1111 .2 I -; II 1, ,!l \ 30lJ /, ll -; I 1.2 0 11 ,11, t4'5 IP1 12 1-17 0 ,1,11, ,1111I -UH Im 17 I -111d 111011 11.11, 111 l lllllttl.1t ,, , 1r11pl11, 11w1d t'\f)l'l ll'ltt <' l11 T,d,11 -I 1,tl11dtu\! tlll' ':.!11111p ,11tl1 1l11 Ii" I ,1! u11111rl,1tl\ c 1111pl11, 11w11t ('\pl'!w1,1.1 111 !7 I .uni 1111111 11 .11 tlw ,11c1.1~1 ,1111111,d 111rnt,d11, 1,11!-,.t11d ',\IH ,,d11,, IIHl!,IS(' \\Ill, tli, 111(11,l\l' nf 1111' t 1111111l.111\ ,. 1 111pl,n 1111 111 1 ,p1 111 "', !,,, ,fi..ith, d111 lo ,1,l,1,10,h I 1u , \d1t1ph lur ,1!!1 '.!.l!Jlljl ]1---I-I I.Ill'\ d111 (11 .i,111 ,(II\)\ \\I It (I 11110J lrn O l-211 H,11, 11() 1111 2 1-7' CJ 11.11, _!-14 f111 7 1-!20 \\',II\ 2(1,',lj f111 !2 1-17IJ \LI" ,t11d :;.u, 1111 17 I n11d lllH \(,11\ .,J 11n,11d..t111 ,111p/01111111t <'\tHt 1('11( (' It 1, of 111t11p,t to 11011 tli,11 .t111Pl1~ 1111 Int.ii II 11lh1'1\C cl tlv,tth, d11 111 d1,1,1" 11111 ,p11,1!01\ ",ltui ; Im ,tll ,1'.!1' !.:Wllp, ol 1111pl11111, ,dm h,L\t' ,,rnl..1 d 11101e tli.w 2 \1"<11, 11, tltl ,1,l,nt11, 111dw,tn l dwl(' 1u11 H cl<-.1111, d1r( to ,1,f11 ,to'" ; d<,1th, dm t11 dH11111<.: 111tt1,t1tt.tl pth ll11111111,,. ,111d l d(.1th d11t tu ,il1u1,1,-,1 tot,d nt 17 d1,1th, l::,clw.Iinu; tlw-.1 17 <h-,tth, lium the .n \lh",{'I \ f'<I de,tlll', the I C'nl,ttndc1 will he- ~ obl>cn Cll \ en,us 17 C'\JWdc>d ( '1'> \\ ,,~ dt111 C'd b~ appl~ 111g th<- ,l\ e1 ,t)!:c ,1111111,11 mm t,1lit\ 1.1tf' of mtcin,1! eonhol) Thi, 1, .m 1IIH-.ti at1011 ot the fo(t 1h.1t the <',er,., m moit.tht\ .11no11~ mplo~et') \\ 1th p1olo11~nl t111tlld,tt1H H,11, of emplm 11wnt e,prrn'IH.L' \', ,L 11 H<" .,,!,!111hc.,rnt oh- .,N, ,ttmn ,mcl not d11C' \o am hia:. o{ -.r\C'~hon 111 thl' mfrrn.\l c-onhol T.1hle-' ,1h,o p10\ 1dei. 1,1tP~ ,uid \\IR h~ ,1ge, g1011p, Ill which the cohmt ,.., c.h,1r,1c:tc111td as of 2. l or more , e,u., of emplo) llllnt C\pe1 ie11ct m <:ompan,on to L<.>, el r ( l-2 ypa, h) Tlw coho1t ii. aho c11arac:-ten2ed :h "all lc,cl,,'' i e, 1t mdude-~ Level I, which also compares thetotal with Le\ el I ns the 1nternal tonti ol. These two acld1tional charnctenzation!> nf the coho1 t (2 I and more, and all leveh) )en e to Illustratc the a\ era~mg effect m the former ,tnd the d1luhon effect m the latter, ,\hich oc.c:ur~ In conttast to the rate:, obi.en ed for ~pec1fic lcveb of <'lll ploynwut t'\pcrience fm the corrt1.pomlmg age g1ot1p!,. Discus~ion Although we h,ne 0H1comc ~ome of the lim1tahon-s of our previous asbe!,tos 1,tudy 1 and i I ! i I I I I I ! ! . il, :1 , l d I i I I ) : I., l.'  , - - - - .............. ,,_ _;._~ ---;; ttrC-r ~--- - _ _ _ . ~-_ -..-:, _ . ~ I \HI I I "1"11\11" \lrrn1\111\ H,11,. lh,11, " ' 011-,111\111 {OJ ... ,11 l:.,.,,c."11.u (E) Nv:11111:.1101- D1.\1W, Du1-.1.0S._u,.cn.l.) l',111 Ill\ j'\I ( \l,,1 ,~, - 1.,, I,-:- r I ,,,, "' r, II I i-2 I 1-,-11 l'>-hl r.-:. 1.., 11\" "ll" '-,\II\ "I{'" ',\IH "\.,, !I '> \Ill "H " "i\H\ ~ J", --- 2ll -;j,!~ lU -2',0 I I -,'i2.i - ,,11 \10111 \I 11, r , ,. ., I I I I.: 17 lll\Jl 11 ';'702. ,, 1r,1,r,; t,: 2 i-, hi! 22 :' 12,'\ .2n-; !I f _,.,--2.\n-. 2 I >,'i2i 2:-.h Ii \II' l ii) !'111 llll)ll00 l'rnlll .. 110:-.: A,10Nr. Couum LJ1:.i.c111B1:J> --~ ---- -- - I 'ii, I ,.1 , ,11,wful1r1 , mt>l11 v,uu ut , r1nru U("C (yr ) II u - ---- ------ -------- " J; it I I~ ll -- II 1: ii~ tJ"LtJ( -. I> 1: :! l ..~ JtJOr~ (J 1-1 - - - - I - - ~ 11:l - - ,!:-, \I I Ill 2h 1110 h9 I \\'',\, -- 0 0 I 2 ~t> I l l (I --- - -- ----- 0 Uo 5 i:;1 .231:l 1 l7 238 58 44 66 132 37.l ..\2:-.ll ">2S <,78S 528 3308 528 1680 528 _,~, :-.~c., -' l/1 Iii 1 l2 -;- 'J .l~tll iii> 2~ "i1'25 ].'-, ! 1287 llJ 8 1 I 151 S 21i0-t 4~2 I 22 IOhh7 :i825 UH 644 .Jl 107 ~126 2/l04 2YO 1 04 l !'> >&5 5!12.5 264 126 9302 18 146()4 356 :JY& 2804 ,'117 7 I 5825 252 IN T1:.xT .-f II level:, (} ---r:-- J2 1!12 152 1406 l45 7l36 21 12069 151 .238 77 57.l 528 266 570 2.804 2.54 JO J7 5825 207 _,.,. ____ ....___ ~5-H i.\11 Fi-fi-t ll S\IR f,;o H ~,m ---5 -1'2 6 -88H ----- ----- - -. - l'5 57 rn, l .J.! - Al I.. '-Hll'J.A,M~ ( 14(>...2'J9) . ; I (1 h n 3 570 11.:? 3133 13:?. .!h-1 (1 16 I l~J I ~!-,(, - - -Hl (i 2 l.!1:$ ') ') h86 2376 fl 26 2080 886 --l-h'-~-------2--\U--- 235 14 1081 8 2097 17 132 SUI 34 886 237 42 598 20 1920 93 132 453 120 886 2J7 ' 47 143 435 132 3~ '86-;., 32 -, 16.0 , 1~6 . , , -, -~.1.. , 1- - ~ ,. ,. :!.L -- ........_, \ 7',.,, ll -- - - - - - ''"' H ,,.\"'"l ,13lll A'r.'\.1..,.-.1\JCL'.').TIVC ClllC.AN~ ANI> - I I ..!U -:-11 .,.'Ut ................ -- _...............::..'.'..---- ' ' I fl I """ 1; ..:( J ~, t>' _,, .-) \l' 1 ,.111 '],J/'j -.J I It JJ.~,'(~..lU 26 355 .... ;.;bo-"~c1.un- NEoP'i:UMs-Lt:Nc:, nno~<lll''i, 1Mc IIFA ( IG2-Hi1) 142 2h Hti 11 1110 102 211 45-64 No.' R SMR 8 1 l 186 26 715 4 1 2.4 -590 248 590 42 25-44 45-64 No. R SMR No R S~1R 8 -211 9 -1328 12 279 11 2734 91 2ll 132 53 1'328 206 25-4-1 No R 45-fl<I No R - 5- IHI - 1- 248 - ~:, .. J>l Mc11hr 1,,,on~ nfft-clllll! C'IS 2 03 3 () 1 6 01 !<) I 8 20 28 16.'3 26 1567 2fi 4fi1 20 2i0 2fl JS5 21'i 617 !59:m li'SI 1018 712 3 1084 J 7 1 590 317 J i' 4 'ilJO l048 2 :3 ') 'j()() (i(\.J l:S.2 l 3 12 0 ,qo ($4(1 !5!JIJ 180 - - - - - - - - - - CAl\D10\'ASCIJLAR " 8 26 - 651 211 5l) l7S Jo() ----- DISEASES ( 400-t08} -------. - - ~ (J.I /f -' !044 :!I I 81'1 211 - ------- . - 'll l<IR 170 211 108 -------- .. 41 22 R 17'J 211 '309 ,l<f'i ,40 l 2.?\ 180 11 37 211 1,', 17 ; I i') ISO l,'j 2ifl 3901 3 244 5 - -177.1 1328 72,11 I \'28 1-t"'ifi I llt- -1 \ih [12~ - ---- ____________ 294 '>4H 1 \'; ------- - _\..._:~ ------ A'il\cq1)<.1<; ('>212) ---- - ---- - - --- - - - 4 7 11 - - - 21)~<) fi IO - 270 - - - r; I - 12 - - - - 1-;n .:iri! ',',I, - 13-1'> ll1S '_),_) -- -- ----- --- !CJ 17R 12 '>'JI ~e~_, ~---= ..-:.-:-_ - '"1"r ~ - ~- -'c:;,.dsl~."'.I.~~.,-~~ ~ ;:4!.,~T.:.. &? n:.e:e "_,"'-;:: .,.:~. - ~ __ - ~ - - - - --~ ---- ------- ------~ --~--~- __ - -- i !. , J "':. I I I, 11, :1 I . 1 I. I I J.iJ(; MOL some of the problems mherent to p:;:, . ' : .. _;;; . L e u" " 'u }' u.,..,1,,-.._G...o years o fc,u.m, , ~tud1es ill general, there still remains the bu.,,_ _ . ' .. i-nP.nt ..YT1Pr1Pnce during the period f1m1tation of establi~hmg more precisely the mid-1964, could actualfy represent a hi population at m,k, as defined by department and level o{ employment when the unknown~: occ11pat10n Ill the utilization ot the Social Se-_ ploymf'nt nr,oT tn 1938 1s also considered. ' , . curtty approach in C!Jt,1bhshmg company cohorh The tot.ii popul,tt1011 of a comp,my may 11ot he at mk. lt i:. more hkel\' th.at a sm,lller The age group 25-44 lies between the'. age groups, 15-24 and ~ . relative w~. employmPnt expPrtence prior to 1938, group of employee~ in ~pec1flc departments effects on the employment clnssi.6cation are ' an<l/or opt'r<1t1orn, rather than thrn,e throtighout sented. Consequently, any comparison be ' the plant would he more directly exposed Con ~equently, the a!.bestos-company cohmt uhhzmg the Soe:1J.I Security .1pp1oach constitutes ,l com.erv.i.hve estunate of 11!,k hecam,e uf the dilul1on factor of 111cluJ111g ,1II emplo1ees. Thi~ dilution factor" w,t~ pm,ent al-;o ,mcl prohablv .. \\ ,h .mgmc11te<l m Entel'ltrl<.''-; .i~be~tos indu:,trr ,tuch \\ h1d1 comhmed .1 1H1mher of nshe,to~ comp.mit>~ '' Level l and other levels for the older age gr:',: represent a conservative comparison. In . when the emplo~ ment pnor to 1938 is ad., then the Level 1 for age 15-24 could be ,1dered to he the "actual" Level I, and for agp 25-lt when this prior employment 1s ad~ Level I could be a mixture of the equivalent of. Le\els I. 11, and III. finally, for age '5-64t Level l could be a m1'lture of Levels Ill, IV!, It mmt he Ic,1h7.ecl th.it emplo~ meut d::it,t pnor to l9,'38 ,ire not ,i, ,ulablc from Socrc1I Se l:W 1tv recorcb ,111d tlus unknown length of t>tn plo}r'ui::nt prior to lCJ38 could h,1've ~ome he,uing uri the 111terpret.1t1on nf oh~ervntiom. It ,~ weU and V. The mortality rates for Level I used in'_' the study, therefore, would for the o(der ag~ ;. groups const1h1te a rnte which represents that~ of a lt>\cl of emplovment that exceeds the limih of the designated employment dassi&a -~~ kmm II th.,t p1 mr eniplo~ me11t III the same 01 Ill Fo1 age group -15---S-t, th,s high rate of bevel I~, ,, d1tfe1 t:-nt plant depemh on the ,tge of tht eni." plo,tt 111 19.Jfl. Tht:rdort', tin e,,1111ple ,Ill e111- " l,tn 1t:'d through a!. the control comparison in ' the dc\('IO(>nWnt of tlitt e-.:pected rates and SMR plo, l'l' \\ ho.,._. .1~t ~ l~ I>~ H:l-10 h ,1\:.llllllcl to 111 t',lC:h ,uccet"dmg le.. et of employment e,peri- h,I\ t' 110 111dmt11.d P111pfov111L11t p11m to ItJ3S ,111d ,ill 1111pl11\, 1 \I lio\l' t1gt ,., ~ I,~ l Y-Hl J\ (fll L' ,iml for e,1ch ot the \ annus categories of c,1me ot dl".it11 ,1,,1rn1td lo li.t\ (' .tlm11I >IJ \l',ll' r>I ('lllplo\ IIH'llt pr tor to ll)}~ ,111tt' ,t'2;f' \/., 1, Lo11,1tlt1t1\ to lw tlll' hi \t ,l!.!t 11! ,Ll t1, c- 1111plo} JJ1t11t Tht> d,t\\l- for th<''" 1t,t1ion,. we have focu~e<l on the " ~Pm1,1t1011 cohm t 11trh:1111g the .1ge group 25-44 ,it c11t1.mce .1, ,t ho111oiie11eou~ cohort. which ht.1t11111 of th, ~ohm t Ii\ It\(! of llllll11l.tt1u: ('Ill plm 11t1 1,t ,,p,111 11lf' u hu.h 1, li,hLd 011 thl' 1111 p1m 1di, ,t mo1e 1epre,t,;t,tt1ve 111d1cat1on of the [l!O\!le"Hm ,lnd di.t111.tt~ of ,ate nccordmg to pl1,1111111t 1tl11d d111111g 193K !11 1111d-1964 do(', 11.it th, H 11111 11p11 -.111t tlu- ,1(ht.d lnd nl \ ,l1 Wlh lei tJ., ot l;'llll)lmment ,rnd ~ CJn of C'l'.- 1u11('11(.t \111u thett' ~t1ll 1t:'llMIIIS the lmut;ition t 11n11tl.1tl\ 1 , 111pl,1~ 11w11t t'\(Wllt'll<.t ,111c1 tlw ol not kno\\ 111g tlit Plllplo\ ment prior to l938, Iii ,t 11.u 11! (111pl1)1 llll'!1t m tlw ,hlw-.tn-. pl.11,t tlw 1,ttn clt11\ eel "111. 111 thb I e,pect, euw,tJtute u111ld 11nt !11 dd111111111d Tl11, 1' ,pt t1f1ulh .1 w11w1, ,lt1\ t t~llm,lte III tl11s method of es- 11111 t111 tllt' 11ld11 .r~t ~1rn1p, .i, 111 llJ-m Frn , ,1\.11 11, t I of c111plo, 11w11t tli, d,1,-.if1<..itu111 lo, 1,d,fhl1111~ 11u>1t.1l1t, 1,1tl'' howt.'\t'r, the w,e of 111 111l,11;.1l ln11trol of tlw ~.1111e .tge g1oup ( age tlu \ 1n1I!.! ,l;{t' !.!11111(1 ( 1 <' I >-2-t I is tOll\ltk1<d .1t e11t1,111Cl') l'(!11,dr1t, thl' p1ev1ou~ emplov1nent 111 lw tlw .tl tu.ti 11111" 11/ , 111pln\ 11w1tl 11, th, ,i.111 ,to, pl.111! ,111t1 tl11, ,Lt!!.' (!1011p fu, 1111 1111plo, "" 111 p, 1111 Ill 1q ;s C:tl\lW1J\H'llt"- tht .1pplil,1t11111 .. t l.1\ tI f .1, .u, 11,tt 111,d Lllllf10I !111 tf,.. ,1!.!, .!;r,n1p f'j-2-t p111\1,l1, tlw .1tt11.d t.0111- p,111,1111 lilf\11t11 thl' 1,111111" 11\tI, ol c1111111l,1111 I' ,111pl1111111 11t l'\[111 w11u I 11 tlw old11 .1~1 ~1r>11p, liu\\<'\l'I. tl11 I lllll[),11,lll\(' p1d111t' I'> d1f- f. 1, 11f I ,11 ,,,1111ph 111 tlw ,11.'. ',!11111p ,Vi-(1-( ti,, 1, 1, ,1p11\rnl nl 1111~11<>\\11 \'1!1plu1111111t ptllll t11 ll))", 1d1,d1 u1111d .1,1LL!!t' to 27 u.th I .f,) - r..; - .t:-, r,,d I f111 ti1t ~ '.!1rn1p 1'i-6! l.1dlll f,, th, ,t:,.'.1-,1t-e11 ti ,111Lt' method. ,di of the IH>p1tl.lt1011 ni the ,pt<.ifit-tl ,tge gto\lP '\\111 ~row oldt-1 !iv .1 Lo11,t,111t 1111111he1 of \t'ar~ <lunnl! the penod of olh('l\JtlOII t 19-W to ullC.l-196-n -Tlus .i~II!! 11101.t:,,. lm\\t:'\ er,\\ uul<l not 111f111cnc:e the 1t,11lh ,111(c the ~\fR ,md the e,pe<:ted num1" 1 111 tk,tth, ,ire dl'11\ ed h~ ,tppl:, rng the ,t\ cr- .1L!t1 .1111111.tl m11rt.1ht\ 1.1te, frnm the 111tctn.tl u'n1l10l ot tlw ,.iuw .1~t., \\ hich I\ he.lied ,111cf 11h,tI\ l'd 111 lht' ,alllt' -11i.1nner Thi' 111,.111 d111 .1t1l'ln ol <mplo~ 111cnf :rnd the I I ' ' VoL 9 Nq. -4 Ap,il 1967 \lA\Cl"SO ta. t::L--\TT:\R 159 degree of em 1ronment.il ~,po,we pnor to l9'lb 111m t.tht~ pwtun 101 Lt\ <'I \' \\ ,1'1 ohwtHd for would be the ~ame fm an~ !>J11lll.11 ,igt> g1 oup tlw pt:110d l%~ to mHl-1<.JM .,~ ~omp,mtl to the and d1fferf."nt for \ ,u 1m1:, .ige g1011p~ ,t!> d,1~~1fwd 1w1 ind ot 19.50 to nml-1964 !or" Lt', el I\' ,h .1 by age at 1940, Smul:lrl~, pre\01ou~ mcd1c:,d c,lH' t l)ll!>~11tnce of tlw d~-1Mm1c ch.mg<, ot the pnor to 190 \\'Q11l<I then he the -,.1111e :b \\ t-11 .i:. c.ohort' for !>uh~equent , t>,tr-,, but \\ 111 \ .ir~ ,, 1th t>ach The pr<>wnt i.tml~ tlt(l\1dt, lr11thn rnnhnn,1 age g1oup. In tlw, method, d,u,:.tl~ 111g tlw lll t1on of the h,gh Ihk ol t'.lll<'t>1 ol ~tkc.tt.d ~ih'~ 111 hort by age .1~ of iq-10 ,md folhl\\ed tor .1-\ .j .1,f (~to, prodw:t ,1 orke1 ~ ,111d .d,o 1111111,ltt", the , cah pro, ,des a <.omplrte murtaht~ p,lttt:'111 of !i,h1, of ,Ul ,l\!I.O<.i.1t1011 ot 11iut',1wd 11,k from ,1 generation of enc:h corre1,pon<lmg ,ige g, nup c.,m<cr \\Ith thf- gr,1d1ent ot tmpJm nw111 1'\Pt'11 durmg the period of oh<,crv.itton Tlw ,l~t'-,tl t>me (Tahle 4}. :\!> 1\,lS mdu..,1t<>d. tlw1l.' 1\,I\ .1 enhance ( gt:'ntr,1t1011 coho1t) mcthocl prm 1<le1, tOllllt~te11t lll(.1<,1~1 111 th< ,IH'r ,l\!t' 1llm t,tl1h 1,ttc a more pt ec1~e llle,li.uwment h~ a,trtC'tmg ,tll Im ,ti! e,Hu,e:. of dt\tth 111 gt>11t:1,;l .tml ,pn:1fK,dk the deaths to membe1:. of the (OI n~pond111g l<J, mnhg11.mt mopl,t~m, l,11d1m.1,t11l,u 1b gene1..1tlon ,It IJ!rk who h1ne 1..ommuu d1,11 ,lcte, - t,1,t.,. ,md .1,ht~ti,,1, 1t1 .1,~(l(:1,1t1011 ,, 1th moit 1st1cs pertammg to the ~ e.11 of Im th, pt,nnd of })rolonge<l <'llll}IO\ 111<11! HI ,1:.fl('~to, 111dw,tn death, changes Ill cnt 1ronnwot,1l e,pol>llT!:'. ,t11d Tiu, 111t1e,1'>1d 11u11 t.ihh r.ilt' \\ ,1, t'\ 1d<'nt tm ,ill prev11.>us emplo~ ment e,po~un: ru. \\ell .1:. c1w.. c1 111 gtm:1,1I ,md ~ptt1ficalh f111 t.,,nl't"t of changes in medical c.ttt' and :.ubsequcnt It\ tl~ l1111~. h1011<.hu,..111d ti,1<.ht>,1 .md d1gt,tl\t' or- of cmplo) ment e~penenc>. It 1s e, 1dt1nt that .u, ~,111:.. llm\ cH1, 111 t'\ .du,1hn~ muhl!11,u1t ll('O internal control, 1111~h :1\ Le\ el l. a[lplled to tlw 1>la,1m In tli11at1on nt tmplo~,;wnt. the prohlem generation coho, t method. doc1> not h:n e tht' ot t00111petmg: 11-.k :.t1l1 l1ol<h a peno11 \\ ho ,-.as ~ hm1tations of .ige at <le.1th method ,rnd h,i- .1 e\po,i-<l to ,hhl.',tno, dust rnuld dw lrom a:sbes ':~1Umber of mherent ad,antagt?s 4 lolll!t ,mcl/or t,11d1m ,l\eular dt!>l0,1:.1" ,rnd/or ma ,' In this respect, too, follow-up stud1e!, on mn- l1gn,t11t neopl,1:.1m. i I~ ;,,firmaticn of primary cause5 of death and sup- The,efrne, n11 m1poit.111t fact<lr \\lm:h mHu- plementary h1stolog1c,1l examinations when apphed to the cohm t as a whole, include the sub- <Jlt'l'<l the e,tent of the ob:.e1 \ .itiou, 1el.1tl\ e to tlw l.trength of the ,1Ssocintion m this ~tndy ,, as . \ I. . cohort designated as the internal control This the que~t,on of competit1, e rn,ks III the nnalys1s I l :. :..,.overcomes some of the problems previously e" of the causes of de,,th ~ The s1gmfitance of the :perienced of the mab1hty to apply the same frequency of asbe:,toi.is ns a cau:,e of tleath, and ,and ort of conflrmahon of diagnosis to the study control groups because of size, cornpositron, ;-'or location of the conttot group ,ts occurrence as a second.trv cause of death, ~1,,.1s note<l m our earlier stud,: Death~ at em lier ,\gei. lcsl,en the numher of ~u1 \\\or!,, \\ ho may : It was noted f1om the data presented that, h, e long enough to meet the rcqturements of with the t'Xrephon of Level V of cumulatl\e the latent penocl, to develop limg c:-a11cer or .~ployment e\perience, there 1s a consistent mc)()thehomn Ell\ mmmental e,poMtre an() ~increase in the average annual mortality rates dust concentrations wert.> undoubtedly higher U1 -~ the cumulative employment e"'perience in the earher ye,irs of manufacture and pnor to ,deaiies. This relationship was more a.pi>arent for age 25-44 than in other age groups for the "'_" ns explained above. Level V was an ex the estitbhshment of the cohort and chrvsottle was used almost e>.clus1vely.18 19 Conseq~ently, more worker!, de'-'eloped ashestoi.is more readily p_tion to the rule. In fact, the mortality rates .:~el''1J..evel V were higher than those for Level I ::.-tevel II, but were not higher than that of IV. This drop of the mortality rate f()r .-~, y _as compared to that m Level IV could i:lueto one or more of the following reasons. e employment experience for Level V differs and died at an Ntrher age and this has lessened the e'l:tent of the findings relative to malignancy. Undoubtedly, contmual long-term observation of the present cohort, with a further extension of the latent pcnod; would be moi.t appropriate, and 1n particular for the age group 15-24 imd 25-14 at entrance to tl1c generat1011 cohort. nts ' that of Level IV by the additional emplov- . iit history during 1955-1964, which repre- 3 period with much better env1ronmr~~~ 1 ~,. tlol; those who are clas.s1fie<l as Lcve1 ,.,esent sh1dy, there was an unusually high numb~r of malignaoc1es specified on the ,,,.,.,th certificate as "primary site unknown" 8 1 , ~ 1 tc males employed 2 or more years. cohort represent those with bett; v_,, :mte queries, to obta.fn fur -v:e-~-,~ .. ~\ olace employees ;1r saf.-~- 1 ,,\,:"'. ':;,,;;: , J"l--=;"'l;!:i=,.=.:o;;;!:r:,,:,i;lls.zr:_.:::1:,:1;:,;1;;:1;..,?,_.':.:.~:.;;.t.;;.~-;,;>';..*;...._ _ _ _ _ _ _ _.....,_ _ _ _ _ _ _~ _1-!,.,s,- t.~ histologkal re-  160 MORTALITY lN AS~E~'TOS WORURS view of these cases This .~1tuation was ttr,fortunate because the resolution of these "unknown" cases might have had some bParmg on the , . ,._ as compared to that of United States and ers in other industries. Our findings did in cardiovascular diseases ( excluding v-;u.q"' obse1 \ ations pcrtammg to cancer of the diges- :.!OM affecting the central nervous system), tive svstem, stomach, colon. and rectum or some other ~1te. In our fir5t study, 5uch a h1~tolog1cal review ,1C.lded to the null'ber of luug canwrs .m<l detected several mesothe!iomas. There were 9 associated with employment, as was evid by the consistent increased mortality rate ~ more p1olonged duration of employment iii' asbt:itos mdustry. The nsk of dying from, ca!>es of me!>otlieltoma of the per1toneum and pleura, which occt1rrcd among ,361 deaths of the <l1ovas<~ular disea.<,e was 2.5 times that of: mterna! control for age 45--64 ( ai; of 1940);,- cohort (2.5~}. Hammond et al. observed 10 posure to asbestos dust, therefore, might . . mesothel1omas ( pentoneum and pleura) among 307 cle,1ths. For m.ilignant neoplasm:, of the central nervous svstem, there was 1 suhiect the cardiovascular system either directly.( ... to an unknown mechanism) and/or in . (due to cor pulmonale and/or right heart~ among the femal~s who clied m 19;39 and 3 ure) among the males ""ho died between 1940 and nud-196-t There was I death due to lymphn~mcom,t ,rntl -1 deaths due to leukemia observed m the m,1le g1011p. Further mterp1etatJ01 of was, In the present study, there was a. total of deaths m which the primary cause of death clue to nsbestosis-31 m males and 8 in females!1. These ,isbestosis deaths, coded as a primary_.~. !he~e 111,tl1gnant 1,1tc~ wus deferred. c,1use of death, provided a higher mortality nu111 Of 111tr1e~t. too, \\,t\ tl1C' h1ghf'r mortaf1ty rate m a~sociation with the mcreased level ot eu,- .-.. th.111 th.it ..,peered for ~,11ctdt>~ and accidents and homicides c."<imbmcd There were 8 deaths ployment experience in the asbestos industry.':; [n ndd1tion, there were 21 deaths in which:.1:. due to ~u1c1de~ and 15 deaths clue to accidents asbestosis appeared as a secondary cause ot='f and ho1n1c1dt"s 111 tht: total "lute male coho1 t. death. As mdicated before, there was no at!+ All of tilt' ~111c1de<1 C'\<.Cpt 1 "ere emplo~ eel m tempt to utilize the secondary cause of death in the ,hhe~tos md11,ti ~ tor 1nm1' th,111 2 yeai ,. the :uulys1s of the 6nd1ngs. U,cf,d i.11pplt.11w11ta1 \ ep1dcrmolog1c:,1l mfo1- O'Donnell., 10 a pathologist who had initially m,1t1011 1l'l.it1\e tn d1,e,1,c pattC'lllS c,in he ob- 1Jh~en ed ,1 high a,~oc1atron between asbe~tosis t,11111:d ll\ <.011,1dn 1111! the n1ult1ple CJ.l!~ts of ,m<l lung cancer among the emplo~ ees of this d1,1th ,l!ld t!w11 ,t'qm.:uu fo1 l'\,1mplc, rn Olli pl.mt. h,1s nO\,\' 1epo1ted-hased upon the adm1s- p1 t",t11t ,tmh, 111dmkd III the 1-t.:! deaths of th~ ,10m to only 1 of :l mam hospitals m the com- l,t1dul\ ,t\u1l.11 ,, ,t11n I Hfl- B-l ,1ml -W0-46,',) 1111t111tv ,irea-:55 t'<bt'~ of proved asbe!>to~1s with \\ !'I<' 11 ,11h11<. h 111 ,drnm .1~h1,low, \Lh 111ch- 28 m.1hgn,111t neoplasm, 2.1 bronchogenic ,rnd <.,1ti-d nn till' de.1th Lt1t1fk,tt(' .1, .1 "c:011d,11, "i me,otht'lio111,1~ of the pe11toneum and pleura.00 t,111,l' ot dt,tth ,md I \\ 1th c-.111u1 ot tht' l,1r,ze Tim b of partic1il,1r mterest to our study be- inh-,t111t .1, .1 ,1tomb1 \ (\lll\t' ot dt',tth Th<.~e cu1~e of the 23 lung-c.-.mcer c,1ses Only 12 em- \\('ll' 6 1...1,1 ~ totkd pt 1111.11 \ ,1, to1 pul1111>11,dc, 111 plo~ eP, LOU )ti bt 1denhfied as bemg III onr .t nt "hit h ,L,he~to,1~ ",l~ t11d tc-.1tNI ,l, 3t'<.1HHb1, [Cj!8-lCJ!C) toho,t.l !>t~mficnnt factor when t ,tt1,P ot rlit' ,1 il11n 1, cll,1th . \\\:~ oh,en t'd 111 the fiHt ~t11ch tlw wnt11lm l hon d('IJ\<'d f,om f111tlwr wq1111\ ,IIH.l hm\ the w11,1de1 rd 111 light of th; finding that of the 12 111,ttdwd dP,tth, of our cohort as comp.ued with ()'1)01111cll 1s l1111gc,mcer c-.11.es, on!\ lO were ~o ~t1ppk111t"11t,u, 111fo1111,1tm11 uould h,IH.' .tlt1rl'd d,1:,,1fit,d 111. 0111 cohoit and l ,\er~ c!Jss16ed as the ,eq11C'ncc ,)f coclmg nf the c.u1w of cle,tth .1~ dtJthi. from other camr, The~e ,1d<lition.il 2 1ecrndt:'d 1111 thl' dP,1th cert1fic.1tc, l1111),!-t.1nct:r c1se~ had .tecum11lah,e emplo~ It \\ ,1, 11ot pn,,1hft> 111 du, f'\lt11,Hlll of Utll 11te11t t'\ne11ence of Lt\ eIs fl and IV, when 011g111,il ,huh to oht,1111 h11 tlwr mtor ni.tt,rnr to the,l' ,11~ ,1dded to t!w co1 re11pondmg levels of l.. ,11\\\lhfv .1dL<j\l,1tel, tlw 11l.1t1on,l11p:. h{tw<'t'tl ~cccmd.11: .wd p11111,tr~ <.,m~e, of dt',tth To ,1 u1 t,1111 t,tent., the problem ot 1111tlt1plt c-am"> n/- d1.itlt 111<1!>!..ed tht" [>toper mte1p1et,1- 111ploy111l'nt t'\pt'nence of the cohort, the mor t.d1h 1,1k ~hown in T,thle -t ,~01lld he raised uirre!>pondmgh ,llld the tot.1t'1 'nmg 1.:4_ncers for the ,d11te m,dei, 11K're,1~t>d tn ~ ' ,1..= t1on of till' c,ucl10\a~c:11k1r prohlem nlhencd Ill tnt,11 cohort. (1111 a~bt>,to, ,tmh. Entcil11w'' iud1c,\t<d ;i Thh l,1c-k of 1clf'11t1fic,1tl()n , ,1~111fa.111tl~ high 11to1 t.1l1t\ hom h\ pt>1 tPmn e rnw-1,1\th of the m.1t<.he,l c.1~ ht,ut d11hl't' rt11l1ll1:! ,1,!1:,to~ p1od11< t, 11,:ti-.<1, , 11denu, ot the ,mcle1e,trm,1ti,  ~~ORTALITY lN AS!lE~'tOS WO&ICERS view of the~e cases This sdm;;tion was ur,fortu- nate because the resolution of these '\1.nknown" cases might have had some bParmg on the ohse1 \ attons pertammg to cancer of the diges- tive svstem, stomach, colon, and rectum or some other'Mte. In our fir~t study, 5uch a h1:.tolog1cal re\'iew added to the nur11ber of lung cant.:e,s .m<l detected several mesothe!iomas. There were 9 ca~es of me~otl-ie!ioma of the peritoneum and pleura, which occurred among ,361 deaths of the cohort (2.5': ). Hammond et al. observed 10 mesothehomas ( peritonenin and pleura) among ,'30i cle,1ths. For m,ilignant neoplasmi, of the central ner\'OUS system, there was J suhiect among the females who ched m 19:39 and 3 among the males t'\,ho died between 1940 and nud-196-t There was I death due to lymphn- ~mcom,1 .111d -1 deaths due to leukemia observed m the m,1le gwup. Further mterp1etatio1 'Jf lhe!>e m,tl1gnc1nt !.ltC!> was deferred. Of rntP1c.!>t. too, \\,t<, the h1ghn mortal1cy rate th.Ill th.it ,,pcctcd for :.111c1dt'!> and accidents and homicides c."<imb111cd There were 8 deaths due to M11c1de~ and 15 deaths due to accidents and hm111c:1dt>s 111 thi:: total ,\lute male coho, t. All of the ,rnctd<''l c,c.ept l "ere emplo~ eel m the .1,lw,tos mdmt1:, tor mme th,111 2 yeai ,. U,c/111 !>t1pplenw11t,11, ep1clcrnmlog1c,tl mfm- m.1t1011 1ll.,h\e tn dt,l,1-,c patt<'lliS ('<In he ob- t1111t,d h, (Cll1,1d11 t111.! the n111lt1ple c,111~es of rl1,1th ,llld tlH11 ,t'qttt;ttu ro1 t'\,Lmplc, 111 ow p11,t11t ,tmh. 111Llmkd 111 the 1-.Q deaths of the l,ll d UI\ ,l,(.11 l,11 '"tl'lll I Hfl- 334 ,111d -!00-!6,,) ,,,.,,. 11 ,11h11c.t, 111 1,l111m ,1~h1,to,1, \\,h 111<11- Lttl'd 011 t lw d(,1th u1 t1fic,th .1, ,t ,, c:ond,11 \ C.,llM' ol dl',1th .ind l 111th c-.111<.1'1 ot tlw l.in;:e int,,t1111 .1, ,1 ,nomlan ('.111\t' ot dt',tth Th<.~e \\ett' 6 ld,1 ~ lodecl pt 1111,11 \ '" (01 pulr111H1,dc, Ill 4 ot \\ IHl h ,1,he~to,1~ ",t~ 111d 1c,1kd ,I\ 3('c_onrb1, Ltll"' ot tilt' ,11h1tLh' de.1th \\"t' olhen Pd 111 the fii ,t ~11i,h th1 <.()llh t!m- hon d1'111,d f1om f111tlwr lllqt1111 .rnd h,m tlit ,upple11w11t,u, 111fo1111,1tio11 nottld h,I\(" .tltt-rtd the ,eqn<'rl(l' ,lf coclmg nf the u11w of de.1th ,1~ H'<.'Oldt'd 011 th1 dP,tth c.ert1nc,1tc, It 11 ,1, 11ot pn"1hft> 111 tlu, C\ttn,1011 of Utll 011gm,1l ,t1t(h to oht,1111 1111 tlll'r 11dor m,1t1011 to ,ttll(>ltfv .1dtqu,1tcl, tht' H'l.1t1on,l11p~ hftwC'e11 ~ccnnd.11 ~ ,u 1d pt 1111,tr~ t,1111.e, of dt,lth To ,1 u1 t,1111 c:,tent, the probler,1 ot 1mdhple cam1, or d,.ith m.,~led tlw p1opt1 mte1p1d,1- tm11 of tlw e,ud10,a~cnl,:r prohlt:m nh,c-ncd m 0111 .t!>he,to, ,tuth. E11tc1 l11lt' 1 ' i!ld1C',1!<d n. ,1~111fil,111tl: l11gh 111ot t.1l1t\ hon1 In pe1 tPn~1\ e !u,11 t d1-,<-.1-, ntn,H ,:_: .1~h;,to, pt mi11<t, 11, 11 h<'l, J f'. as corr1pared to that of United States and ers in other industries. 0111 find.in~ did in cardiovascular diseases ( excluding v:..;.';...:...;.-.,. :;1oru affecting the central nervous system), associated with employment, as was evid by the consistent increased mortality rate ~ more prnlonged duration of employment inJ asbtastos mdustry. The nsk of dying from. " )2 d10vas<:ular disease was 2.5 times that oft mtema! control for age 45-64 ( as of 1940 ' posure to asbestos dust, therefore, might . . the. cardiovascular system either directly. { _ . to an unknown mechanism) and/or in , (due to cor pulmonale and/or right heart~ ure) 1n the present study, there was a total of deaths m which the primary cause of death wai, due to asbestosis-31 m males and S in females!1 These ,lSbestosis deaths, coded as a primary_.~. c.mse of death, provided a higher mortality nm, m a!>sociation with the mcreased level ot em- .-.. ployment experience m the asbestos industry.':; In addition, there were 21 deaths in which:,.t asbestosis appeared as a secondary cause of:.; death. As mdicated before," there was no at~+ tempt to utilize the secondary cause of death m the :11ulys1s of the Snd1ngs. O'Donnell.10 a pathologist who had initially oh~en ed ,1 high :Moc1atton between asbei.tosis ,111d lung cancer among tlie emplo~ees of this pl,rnt. h.1s no,\' 1tp0tted-hased upon the adm1s,10m, to only I of :3 matn l1osp1tals m the com111111ntv ,trea-55 <.',l!>P:. of p1ovcd asbe~to~1s with 18 malign.mt neoplasm, :2.l bronchogenic ,rnd "> rne,othl'hom,1~ of the pe1 ,toneum and pleur:i.c0 Tim J~ uf partic1il,1r rnterest to ow study bec111:.e of the 23 lung-c.-.mcer c,1ses Only 12 empl11i et>, LOU !ti bt' 1denh6ed as bemg Ill our tCJ18-ICJ39 c.ohott.1 ~~mficnnt factor when w1h1de1rd 111 light of th; lin<lmg th,1t of the 12 111,1tdwd c!e,tth, of our cohort as comp,1red with oD,mnelr's lim~-c.mcer c,1!.es, on!, 10 were ~o d,1:.,1fit,d ,a 0111' coho1t and 2 \\er~ cl..iss16ed as d1.1th;, from other came, The~e .1Jdit1on.il 2 11111~-t.weer c..1se~ had ,lCcu mu lah, e eniplo~ 11,ent t'\ne11e11ce of Lt\ els fl and IV, when tl1t''l' ,11~ ,Hided to t!it' ,oi rt>~ponding levels of 1r11ployrnent ~,penence of the cohort, the mor t.11ih 1.1k ;,hown in T,1hle -t \\01,ld he raised uJrrt';.ponclmgh ,111d the tot.:' ,.....,., <'dncers for tlie '"h1tc m,tle~ 111cre,1~td tc tnt,il coho,L Tiu~ l,1C'k of 1df'nt1fic.ittnr rnic-i,"th of the m,1t<.hed < 111drncp ot !hf' !lll(ll'1e,tr!l'. I . Vol 9 No 4 Apnl 1967 \IA\.Cl\O & EL--\TT.\H 161 m our cohort, particul..1rl\ \\ ht'n 1t ll> 1e,1hncl 1,p111t'll(.(.' th,m the 19:38 one \\ h1ch \\ a:. pn .' ' that the obsenation~ n1.1Je 011 the tot.ti matcht'd m,mh 1111l11enced h, the ~ ear!! of emploJ ment I' iI c.ases ( related to one-fourth ot the lung L,111ce1:, pnor t11 19 36 f u1 tlwr. the l9J~ cohort oh:.erva- . m our asbestos coho, t) rnmtitutt adm1!!~1011::i to t1011 p1m 1dl:'d an ind1c,1t1on of the l'ff~ctl\ ene~s I, . :: only one of the hrn,p1t,1b. O'D01111elL moreo\ er, of e11, 11011111e11t,il ch.mg<'s :1n<l control me.i,mei. I:/ reported only cases ot re:,p1n1to1, N11cer th.it 111 ,uh,tqmnt \Nn. For the p11rprn,t':!I ot our ' l' were a:,sociated \\ it/1 .1,l,e:,tm1:, ~tmh. the combmed cohort of 19'31'i-1939 \\'.tl> 'I Although we oh,e1 \ I'd 9 LI'(:, ot mcl,uthel1- uhli .td am! the le, d:-. of accumtilatl\ 1 t"tllplo~. '' ' oma, 1 of the pleur,1 ,111cl 8 of the \WI 1toneum. me11t C\[)t:rtC!lCt' frnm l 9:}s to mid-!96-l .md I. 11 O'Donnell reported 3 add1t1un,1I ca:ie1 of mc~o ,,ere c:l,1,:,1ficd .i~ follows lf'Hl l. 0.1-2 0 H',tr~, It thehoma m emplo~ eei. of the ~.imc pl.mt (wh1c.:h Lt'Hl lf. 2 l-7 Che,1r~. LeHI [If 7 1-12 0, e.11~, '! workers were not p,1rt of our 1938---1939 <.:ol101t) Li>\(l n. 110-170 ~~.us: ,md Lt,11 ,. li.1- I Another death due to me!.othelmm,1 of the 27.'5 \l'Jt, pentonemn occ.urred in ,1 f01me1 emplo~ee who was not m our tohor t .wd \\ al> not n1 O'Donnell's group of t,1:,c:. of me!)othel1om.1 This total of 13 c,1:.e~ of me:,otlwhonM ( ,ti! of employees from ,l single pl.mt Ill a ~mall rnm- 01 t111plm ee., 111 tht.' ICJ},~ ,111d lY'39 c.:ol1ort th.it h,1d ,1 c. t111111l,1t1\'c t>niplo) me11t e,1wnt'lH.e ot 2 ~ l,u, or le,, d111211g the pe, mcl ot IY 3~ to nml- ItJ().t, L<HI I "a1:,, utrhzed .,~ ,lll llltr1 ual (.tlllltol tl.1~~1n(d h~ ,tge mumty engaged in the mc.1nufoctm e of the ~c.1me The11 ,, .1~ ,1 tot.ti of '3:30 dl.ith~ .unong the asbestos products) provides a ver~ strong ac;so- c1ation for such a ra, e <l1~t',t::.e, m "luch all <'\- cept l of the IO mei,otl1t:lion1.1 of our ,t11cl~ ,, e1 l' , employed for more than 2 , e.ir~ wh1lt mJle3 ,111d 31 tor the fem,ll~) .-\mo11g the m.ile, tlw,e \\ere '35 m,ihgnant tmllml! of the lung ,111d -1:3 de,1ths <lt1e to rei.p1rator~ d1seu~e, 3l of" hwh \\ <:J e due to a.!ibestos,s. Among the . In general, the lldtholog1cal confiim<1t1011 h) fem.lie~. ot the. 11 dc,1thi. duP to 111.1lt~n.1nc1c:,, O'Donnell of lung cancer:. ,u1<l mesothehom.i. 6 \\ ere due to m,1lrgnancv of the lung ~IICI ,tll 8 I .. among former emplo} ees of tht! ~ame plant de:-ith-. elm to H.")p11,1ton di:-.e,bt'S ,, ere due to ( from which plant our col10rt \\',ts e!>tabh~he<l, ,l',he,to,1!>. There were 9 mnhgn,111t neopla:.mi. over the !Jame period of tune- l9-t0-1965) fur. of the p~ritoneum aud/or me~othehom,1, 8 m i i. ther substantiates the 1elatmnsh1p of m,,lignan the m.lle~ and l III the fem.lie~ -\monsi; the 7l I I ~- c1es and a~besto.s exposure, observed m our co- m..1hg11.111c1es for the \\h1te m,1le:, l'mplo,-.ed 2 }!iort study of employees clm,!.1fied b~ duration of or more ) ears, 8 \\ ere :,pec16ec1 on the death :~ployment. certificate Js "primary i.1te unknown." "I'. :.summary and Conclusions A cohort study of 1265 white m.1les .m<l 228 ;~white females who were employed m a plant , manufacturing asbestos products in 1938-1939 .was established through Social Security records d observed to mid-1964. ~:. The cohort study represents a series of refine- . ts in methodology pertaining to prospective .~'idemiolog1cal studies of industrial popula- . ris. The Social Security cohort approach has 'en developed to include the class1ficatton of members of a cohort by duration of employ- t from 1938 m the plant under study. A hod also is demonstrated of establishing a : inogeneous generation cohort and an mternal _.,: trol according to age and specific levels of paoyment e,cperience for a company under dy, as derived from Social Secunty. ~..I}-was observed in this study that when the ~.-1i,;,!1 ,.o!.; i ---~.- <>nn~idered as individual 1 ti.1,t I.lac J.;,vv vlltl had it lower mortality ..,"'"!;.' itv~~, ,.w'f. ~_.::~ The relutionsh,p of cumul,1tive employment e,pe11en<.e on the mortality p.ittern wa.- .1s:,c:,~ed fm all c.i.u:,ei.. all oeoplal,mi,. malignant neopl,li.111i. o~ tl1e digesh\e orgnui, and pe11tm1eum, m,1l1gnant neop)al,mS ot lung, dti.eases of c.nd1ov,1scular :,ystem (e'-cept ,ascular le~JOn!) affect111g central 11ermw, i,ystem), and asbe.'>tO.'>lS There wai. a consistent 1nc1euse m the a\erage mortality rates as the cumulative employment experience increa.'>ed This was trne for each of these categories with the exception of the d1gcstwe system, which involved a smaller number of cases and analysis could not be made The problem of "competing" 11i.ks of deaths due to asbestosis, cardiovascular d,~ense and/or malignant neoplasms, and the relationship of primary and secondary ca..ises d death are also d1~cnssed. It is concluded that the duration of cumulative employment e!<.penence among asbe.'>tos workers m the asbestos-products company was directly related 1..-; "'l!;t:neral increased mortality rate for aJI causes of death and ~pe- ..... _j l1, . I l ,. cuically for malignant nt:ov,a..:1u,.., lar diseases, and asbestosis. Addendum A few months after the dose of the cohort follow-up in mid-196-1, l l deaths among tl1e 1918-19.'39 cohort were reported. The causes of the!.e l l deaths follow 1, lymphosarcoma of the Jung, 6. cardiovascular d,~eases ( including l c,1se of cerebral embohsm), 1, pulmonary Rbrosb: .2, a~bestos,s; and I, ~111c1de. All of the decea~ed were employed m the same asbestos plant for more than i ~ ears since 1938 Acknowledgment \Ve wr~h to thank Dr -\ntomo Cwcco. Pro- fe'.->~or and Head of the Department of B1osta- tr~tics, Gr.1duate School of Public Health, Uni- ven,,ty of Pittsburgh, for 111s ath 1cc and encour- agement. F 111ur11fy of P1ft\br1r1th Gmtluat, Schon{ nf P11Mc 1/calth D"r1artllw11t of Occupntwnal lira/th P1t1,b11rgh. Pa 152 t 3 References I \I\ ,cL ,o. T f :md ( "' 1 n-:R E J \feth11d~ of ,tn<l\ 1111,l tlit> 11.:l.111011 11/ ,mplm 111e11! .111d l1111c111m 1!111~,, lohrnt .,11.11\1,1, \1111 r J r11{,l1t /fr,11,,. ,r, ,,, r /l) l',,!"j llJV) .2 \1 \ 1 .111d 1 01 1111, i- r \l111,.,<1,,1,1c1 11, 111d,1,C11.1l lu,dtl, ,cmh,,-tht> d,rnnt!1,1pl,u.. ,1p r p,0,11 It \ir 1, 111, 111111 11.,,111, r,; r; J()R 3 \h,11 '" 1 .11,d ("' ll l ll (,'. I \l.,-tllf,dol11t!t 111 u,dmt11.d !w.dtli ,t11rlw<-tli1 u,hmt .tpptn.u.h \',. 1tl1 ,pt"\ ,..t r, 1ft.t .Ptit t) ft ,tll .1d1.-.._,.,.,, t nnq1.U1\ \,, I, L1111,,,.1 !ll'flft!i n ::! Io : <Ji, J ~ \ f " I " T I ,111! F1 -\ l'I \It. -\ -\ f h 11,llllll dt,lllt!t'~ 111 111d11,t11.d cohot1I ,tt1du;-, fmfr,,lr \f,,tf "\ ,r"""' '>ur:: l'i l11'1<J l<)f,fl T r ar,dE1-.\1r111-\-\ E\.1h1,1t1on ,,, , 11li111 r ,tm1w~ 1>I 111du,11 ,.ii pop11!,1t11111~ Pro> JW Jntemattoul~ f', ...~, "fol!-~ I!.;,.!lli. Wien, Sept. l~B4.~ b, WAci-.r:R, J, C Ep1den11ology of dilmie hal tumors evidence of an assoetatiOll m South Afnra and the United Kio NY Acad Sci 132 5i5, 1965. 7 Report of the U I C C ( fntema Against Cancer), Workmg Croup on ' Cancer !\rch Environ Health 11:221, l 8 GcLSON, J C. Health hazards of ~ Soc Occupat Med 16 62, 1966. ,. 9. Gn,soN, J D, Problems and .,, changing hazards of exposure to a.sbesta..:: ' Acad Sci 132 696, 1965. .--... -C:<-( 10 ~fEYEJtS, R J Mortality of workers i!ISUrl!ICI OASD[ for the year 1955'. Socidl S e ~ tm, July 1961 H.E W.. Washington, D. 0 ~ 1J C1occo. A., ~,,._._cuso, T F. nnd THOYPSON. Fo11r years mortahty expenence ol a. the llmted States worlcmg popuhttion: Alll,r. Publtc Health 55 581, 1965. ;l',. 12 E,-,.EnLI.'.llE, P Estimatmn of e~pccted rates ~ ' cupll!lOnal d,se;ue ep1dem1ology Public ll Rep 79,973. 1964 ; ,' 11 Dol.L, R Mortality from lung cancer m asbeaai'.:::- workers Brit J lrulustr Med 12 81, 195.5, J::: l4 Kv>", J. F. DOLL, R. S. and HJLL, I. D., analrs,s of changes ID 1nc1denee of broncb1al nomn in textile asbestos factory. Ann NY AtiJd" I J2 526, 1965 --~ ,: I'5 DRAu~. D C , and TR.\mi, T. f) Ep1de1mologicol:'. ".: ~tudy of lung cancer m asbestos miners. Arch -r.} .vr J11d1111r licalth 17 6.'J4, 19.58 _:.,. IR \f.i. ,cu~o T F D1scussmn of studies. ,trin ~ ,\cat( Sci 11~ 589, 1005 17 ';~ LIKOfl'. I J . C11uRr:, I . and H,rn!>fO'l.'D, C. As- he\tm t'\Jlo"ur ,md ni-opl:lSla JA.\JA 188 22, 1%& Pi f.,nnu,E P E \fort,1l1tv among a~bestos prod 11tt, '-orler, 111 the l 111ted States .,\,111 .VY .-\cad ~u I U 1'56. 1q6') IC) () J)o..,,n.L \\ H. :intl \I~..,,,. H H Asbestos; .,11 1\trrm1c. f.,c-tclr m the p.1thogenes1s of brnncho- (!emc ~.,rt111om::i Amer I Path 13 GlO, 1957 211 0'()0,..,,1:.LL, \V \f, \fa,,, R H. and CRo.<H, r L -\,be,tns, ,in e~trm~IC' factor m the pJtho- I f t!Cilt'\I~ of hrontho~enic tarrinomn anti rnewthe- l,11,n,1 Call(,,r 19 J 14'3. 1966 OH\( r r: or \f.~(TL \PJL:s t S,-,rpt:nh \Inc ,,tc1 t"d 10 \e,t 11f.1p1U, tl1t ht:.ifn prohabl\ l,ec.i.u~(' of a ~uper- ,titwn t!l.lt tho\e .11111n.tl, h,l\t:' ,l l.1cult\ of ren('win~ their \OUth bv .t change of ,k111. Tht> \\ of\h1p of '\<,cul,ip11" I\ ,h mtmdr1ccd mto Home m a time of great ,1<.f..tt,.~. ,111d ,111 ,mlia"\ ~cnt to the temple of Ep,d.mru, to entreat the ,ud of the ~od .\e~c11l,1p111~ ''"' prr>JHtwm ,llld 011 the rt'tuin of the.ship acc:ompamed ,t m tht' form of ,t ,npent \rnrn1g 111 tlw n~er Tiber the ~erpent gilded from the ,e,,;t:>l and took lX>S'>C~!.1on of an 1..l.\Ucl in the nHr, nnd 11 temple \\ a,; there I ert'cted to Ins honor I r 2qs B,dfin< I,\ \f11tlwlo!!,y. I,~ Thom:i~ B11l6nch Thomas lt Crm\ ell c 011tp.1m. '.\e\\ York. 19-ff. p