Document 9Jqwjx7EVYkde34zyXgw4Lndq

March 16, 1984 Mr. Mike Ezzell Bureau of State Health Planning and Resource Development Texas Department of Health 1100 West 49th Street Austin, Texas 78756 Dear Mr. Ezzell: I have enclosed a copy of my talk, "Brain Cancer Mortality in Texas Chemical Plants", which was presented at the Seminar on Cancer Prevention and Control in January per your request dated February 3, 1984. As this paper has not been submitted for publication elsewhere, please feel free to publish it in the proceedings of the conference. I would appreciate receiving a copy of the proceedings when available. Thank you. S*nreralv SGA/rjk Enc. cc: J. B. Browning D. tf. Glenn, M.D. T. A. Lincoln, M. F. S. Provenzano R. C. Wise Susan G. Austin, Sc.D. Corporate Director of Epidemiology J, UCC 097537 BRAIN CANCER MORTALITY IN TEXAS CHbl^lCATFLAN 15~~ By Ur. Busan b. Austin Corporate Director of Epidemiology Union Carbide Corporation DANBURY, CT January, 1984 I am very pleased to have an opportunity to * participate in this very timely conference on the subject OF CANCER IN THE STATE OF TEXAS. THE QUESTION OF AN ASSOCIATION BETWEEN BRAIN CANCERS AND EMPLOYMENT WITHIN 4> the Petrochemical industry surfaced in the late '70's and WAS THE SUBJECT OF A NATIONAL ACADEMY OF SCIENCE Conference in New York in 1980.1 unfortunately, ALTHOUGH A NUMBER OF VERY DISTINGUISHED SCIENTISTS ATTENDED THIS CONFERENCE, AND MICH WORK AND STUDY WAS* UNDERWAY, TOO FEW RIGOROUS STUDIES HAD BEEN COMPLETED AND RESULTS WERE TOO INCONSISTENT TO PERMIT PROPER SCIENTIFIC CONCLUSIONS TO BE DRAWN. HOWEVER/ THE PICTURE IN 1984 IS SOMEWHAT DIFFERENT AS A NUMBER OF VERY GOOD STUDIES HAVE BEEN COMPLETED AND REPORTED IN ThE OPEN SCIENTIFIC 4 LITERATURE. 4357B v - Vcc 097538 t 2- - Because Union Carbide operates several chemical plants # in Texas/ our Epidemiology Department has been actively INVOLVEDWITH INVESTIGATIONS* OF OUR EMPLOYEES AND HAS FOLLOWED VERY CLOSELY THE PUBLICATION OF RESULTS OF OTHER t COMPANIES WHO HAVE STUDIEDTHIS SAME QUESTION. IN THE NEXT FEW ^ ft MINUTES/ I WOULDLIKE TO BRIEFLY REVIEW THE METHODS AND RESULTS OF STUDIES WHICH HAVE BEEN CONDUCTED IN UNION CARBIDE'S PLANTS IN TEXAS AND PROVIDE AN INTERPRETATION OF THESE RESULTS IN VIEW OF THE RESULTS OF OTHER STUDIES THAT HAVE BEEN SUBSEQUENTLY RELEASED. IN 1978/ THE DIAGNOSIS OF BRAIN CANCER IN TWO TEXAS OSHACity employees prompted an investigation of that PLANT. CLOSER INSPECTION OF DATA AVAILABLE THROUGH THE PLANT MEDICAL DEPARTMENT INDEED REVEALED WHAT APPEARED TO BE A CLUSTER OF BRAIN*CANCER CASES. / UCC 097539 -3- This prompted two OSHA/NIOSH publications; one in the * Morbidity and Mortality Weekly Reports2 and -------- 7----------------------------------------------------------A the American Journal Industrial Medicine.3 the otter in ' Various OSHA REPORTS POSTULATED THAT THE EXCESS WAS AS LARGE. AS TWO TO FOUR-fOLD OVER NORMAL BACKGROUND RATES AND SUGGESTED THAT VINYL CHLORIDE, OR DIETHYL * SULFATE MAY HAVE BEEN RESPONSIBLE. MOREOVER, THE AUTHORS SUGGESTED THAT THE SPECIFIC CELL TYPE "GLIOBLASTOMA MULTIFORME", WAS PROPORTIONATELY OVER-REPRESENTED IN THE SAMPLE OF CASES AVAILABLE FOR SCRUTINY. < AS AN APPROPRIATE FOLLOW-UP TO TTCSE ALLEGATIONS, A COLLABORATE UCC/NIOSH INITIATED A COHORT MORTALITY STUDY OF ALL E/^PLOYEES WHO WORKED ONE DAY OR MORE AT T>C PLANT BETWEEN 1941 AND 1979 WAS INITIATED. ** UNION CARBIDE PLANT PERSONNEL PROVIDED THE CLERICAL SUPPORT TO IDENTIFY 4 AND CODE DEMOGRAPHIC AND WORK HISTORY DATA FOR SOfC 9,000 CURRENT AND FORMER EMPLOYEES. 4357B V- UCC 097540 4- - NIOSHUnion Carbide plant staff also assisted in the ,, TRACING OF TERMINATED EMPLOYEES AND THE LOCATION OF DEATH # Ar CERTIFICATES FOR DECEDENTS. M ANALYSIS TAPE WAS GIVEN TO union Carbide at the completion of follow-up which PROVIDED THE BASIS FOR UNION CARBIDE'S OWN ANALYSIS AND * INTERPRETATION OF THIS STUDY. \ TWO CASE CONTROL STUDIES WERE ALSO CONDUCTED SIMULTANEOUSLY.5'6 BOTH THE UNION CARBIDE STUDY AND THE NIOSH STUDY DEFINED A "CASE" AS A PRIMARY BRAIN TUMOR, ALTHOUGH NIOSH RESTRICTED ITS ANALYSIS TO GLIOMAS. UCC'S < ANALYSIS WAS BASED ON 21 CONFIRMED BRAIN TUMORS, 17 GLIOMAS AND 4 MENINGIOMAS. THOSE TWO STUDIES DIFFERED IN THEIR METHODS AND SELECTION OF CONTROLS. THE UNION Carbide study selected two control groups of 80 deaths EACH, RANDOMLY, FROM ALL DEATHS KNOWN TO THE COMPANY IN 1979. * 4557B UCC 097541 -5- NIOSHThe study employed stringent matching criteria, . SELECTING FOUR TO SIX CONTROLS PER CASE FROM AMONG ALL # 4` COHORT (AMBERS. BOTH STUDIES FOCUSED ON THE SAME 37 CHEMICALS TO WHICH AT LEAST FOUR OF THE BRAIN TUMOR CASES HAD BEEN EXPOSED DURING EMPLOYMENT. (TABLE 1) IN ESSENCE, BOTH STUDIES ADOPTED A RESEARCH STRATEGY THAT SAID "IF ANYTHING IN THE PLANT IS CAUSING THESE' BRAIN TUMORS, IT HAS TO BE AT LEAST ONE OF THESE CHEMICALS". UCC ALSO LOOKED AT AN ADDITIONAL 5 CHEMICALS, SUSPECTED OR KNOWN TO BE CARCINOGENIC POTENTIAL. (TABLE 2) During the course of the Texas City investigation, a NIOSH SEARCH OF STATE-WIDE CANCER CASES REVEALED A BRAIN TIMOR DEATH AMONG UNION CARBIDE EMPLOYEES AT THE SEADRIFT PLANT. This LED TO THE INITIATION of a SIMILAR INVESTIGATION BY NIOSH OFFICIALS AT THAT PLANT.7 UNION * Carbide's Epidemiology Department monitored the progress M357B UCC 097542 -6- OF THAT INVESTIGATION BUT DID NOT ACTIVELY PARTICIPATE IN THE ANALYSIS OR INTERPRETATION OF RESULTS. # A r The RESULTS OF THAT STUDY, WHICH HAVE NOT BEEN PUBLISHED IN THE OPEN LITERATURE, INDICATED NO EXCESS OF BRAIN CANCERS AT SEADRIFT. I BELIEVE NIOSH WILL INCLUDE i THIS STUDY IN THEIR REPORT, THUS THERE IS NO NEED TO MENTION IT FURTHER AT THIS TIME, The RESULTS OF BOTH THE NIOSH AND THE UNION CARBIDE ANALYSIS OF THE TEXAS CITY COHORT STUDY INDICATED NO < CWERALL EXCESS OF "ALL CAUSE* MORTALITY OR "ALL CANCER* MORTALITY. (TABLE 3) HOWEVER, AN APPROXIMATE TWO-FOLD EXCESS OF BRAIN CANCER DEATHS AMONG HOURLY MALE EMPLOYEES was found. (Table 4). this excess was based on deaths THAT OCCURRED BETWEEN 1945 AND 1979 IN THE NIOSH STUDY. UCC`$ ANALYSIS WENT ONLY THROUGH 1977. 4357B / UCC 097543 -7- The question of whether or not there is an excess AMONG, THIS OCCUPATIONAL COHORT IS NO LONGER IN DOUBT. Ar HOWEVER/ THIS RESULT IS NOT ALTOGETHER SURPRISING SINCE 4 THE STUDY WAS CONDUCTED BECAUSE OF THE SUSPICION OF AN EXCESS AT THE OUTSET. * * THE REAL QUESTION BECAME WHETHER OR NOT THIS EXCESS COULD BE DEMONSTRATED IN OTHER SIMILAR PLANTS AND BE RELATED TO OCCUPATIONAL FACTORS/ SUCH AS SPECIFIC EXPOSURES AND LEVELS OF EXPOSURE. < This single cohort study provided little information WITH WHICH TO EVALUATE THE QUESTION OF CAUSALITY. LENGTH OF EMPLOYMENT ANALYSES AND LATENCY ANALYSES ARE INTERESTING/ BUT DIFFICULT TO INTERPRET IN AND OF THEMSELVES. IN THE LENGTH OF E^LOYTCNT ANALYSIS/ 4 (Table 5)/ it can be seen that both short-term employees AND LONG-TERM EMPLOYEES HAD AN ELEVATED RISK WHEN A LATENCY PERIOD OF TWENTY YEARS WB WAS BUILT INTO THE UCC 097544 `Vi iHMTrtWryJ':`-" 8- - analysis. Different grouping of LOF categories may resist IN AN APPARENT INCREASING TREND/ AS WAS SEEN IN THE NIOSH / ANALYSIS/ HOWEVER THE INTERPRETATION OF THESE SMRS IS DIFFICULT/ AT BEST. The case control studies failed to indicate that any OF THE 37 CHEMICALS/ OTHER THAN CARBON DIOXIDE IN THE NIOSH STUDY/ WERE SIGNIFICANTLY RELATED TO THE BRAIN CANCERS/ AND THE ASSOCIATION WITH CO^ WAS DISCOUNTED BY NIOSH FROM BEING A CAUSAL ONE. (TABLE 6) IT IS TRUE THAT NEITHER OF THESE STUDIES ATTEMPTED TO LOOK FOR < ASSOCIATIONS WITH EXPOSURE TO TWO OR MORE CHEMICALS. IT WAS CONCLUDED/ HOWEVER/ THAT INSUFFICIENT EVIDENCE WAS AVAILABLE TO RELATE THESE BRAIN TUMORS TO SPECIFIC OCCUPATIONAL FACTORS. VINYL CHLORIDE IN PARTICULAR WAS EXONERATED. * IT IS IMPORTANT TO NOTE THE TYPES OF BRAIN TUMORS THAT WERE INCLUDED IN THIS CASE SERIES. (TABLE 7) ALTHOUGH THE 4357B UCC 097545 -9- f MAJORITY OF THE MALIGNANT TUMORS WERE OF THE CELL TYPE CLASSIFIED AS ASTROCYTOMA OR GLIOMA (TUMORS ARISING FROM t A r THE GLIAL CELLS - SPECIFICALLY THE ASTROCYTES)/ THERE WERE ALSO FOUR NENINGIOMAS/ AN ANATOMICALLY DIFFERENT TYPE OF TUMOR/ AND SOME TUMORS THAT WERE INCORRECTLY CLASSIFIED ON THE DEATH CERTIFICATES. x CONTRARY TO THE INITIAL SUSPICION/ GLIOBLASTOMA MULTIFORTC WAS NOT OVERREPRFSENTED IN THIS CASE SERIES. IT HAS BEEN REPORTED BY DR. FRED HOCHBERG THAT THIS TUMOR TYPE REPRESENTS 80% OF ALL PRIMARY MALIGNANT BRAIN TUMORS ASSOCIATED WITH MORTALITY IN ADULT MALES. ONE CAN BE MISLED IF MORBIDITY STATISTICS OR STATISTICS ON ALL PRIMARY BRAIN TUMORS ARE REFERENCED/ AS THIS DIAGNOSIS REPRESENTS THE SECOND LEADING CAUSE OF CANCER AMONG CHILDREN AND IN THIS POPULATION GROUP/ GLIOBLASTOMA MULTIFORME IS EXTRENELY RARE. ,4357b UCC 097546 - 10 - f In conclusion, an excess (which is smaller than had * BEEN ORIGINALLY ANTICIPATED) HAS BEEN CONFIRMED AT THE 9 A r LARGER OF TWO UNION CARBIDE CHEMICAL PLANTS IN TEXAS. THE "HYPOTHESIS" OF AN OCCUPATIONAL ASSOCIATION -WITH THE PETROCHEMICAL * INDUSTRY WAS (AND IS) IN NEED OF CONFIRMATION FROM CASE CONTROL STUDIES AS WELL AS OTHER STUDIES CONDUCTED ON INDEPENDENT CHEMICAL PLANTS (WHERE NO A PRIORI EXCESS HAD BEEN SUGGESTED). Three other major petrochemical employers in the Texas Gulf Coast have undertaken similar investigations, and the -< REPORTED FINDINGS HAVE NEITHER CONFIRMED THE PRESENCE OF A BRAIN CANCER RISK NOR ELUCIDATED ITS POSSIBLE CAUSE. Thus, Neither the case control studies conducted at this PLANT NOR OTHER COHORT AND CASE CONTROL STUDIES CONDUCTED IN OTHER CHEMICAL PLANTS IN THE TEXAS-GULF COAST REGION HAVE PROVIDED SUFFICIENT CONFIRMATION FOR THE ORIGINAL HYPOTHESIS. M357B UCC 097547 -11 - DuPont reported the findings for over 2 million of its ,, ACTIVE EMPLOYEES AS WELL AS 2.2 MILLION OF ACTIVE AND / *O INACTIVE EMPLOYEES BETWEEN 1956 AND 1979. BOTH THE INCIDENCE AND MORTALITY RATES FOR MALIGNANT BRAIN TUMORS WERE CONSISTENT WITH EXPECTATION BASED ON U.S STATISTICS. The OVERALL STANDARDIZED INCIDENCE RATIO (SIR) WAS 1.02/ AND FOR MALE HOURLY WORKERS WAS 0.99.' -THE STANDARDIZED MORTALITY RATIO (SMO WAS 0.90 FOR ALL EMPLOYEES AND 0.81 FOR HOURLY MALE EFPLOYEES. Gulf reported on a study of 16/000 of its workers who WERE EMPLOYED AT A TEXAS REFINERY BETWEEN 1935 AND Sffi1978,9 The overall for malignant brain tumors was 0.91; FOR THOSE EMPLOYED LESS THAN 20 YEARS IT WAS 0.65 AND FOR THOSE EMPLOYED MORE THAN 20 YEARS IT WAS 1.09. NIOSH REPORTED THE FINDINGS OF ITS INVESTIGATION OF DOW Chemical Corporation in Texas between 19*j0 and 1977.10 Based on a 5K safele of some 2/000 current and former /4357B UCC 097548 --run - 12 - 1 EMPLOYEES/ THE OVERALL SMR WAS ESTIMATED TO BE 57 BASED ON - 25 OBSERVED BRAIN CANCER DEATHS. / j. ALLOWANCES FOR MIGRATION T INDICATED THAT THE MAXIMUM THE Sffi COULD HAVE BEEN WAS 1.27. These studies/ as with all epidemiologic INVESTIGATIONS/ HAVE CERTAIN LIMITATIONS THAT PRECLUDE A DEFINITIVE ANSWER TO THE QUESTION OF WHETHER THERE IS AN INCREASED BRAIN CANCER RISK ASSOCIATED WITH EMPLOYMENT IN CHEMICAL MANUFACTURING PLANTS. HOWEVER/ AT A MINIMUM/ THEY DO PROVIDE SOME ASSURANCE THAT THERE IS NO EPIDEMIC OF BRAIN CANCER IN THE TEXAS PETROCHEMICAL COUNTIES. IF INDEED THERE IS ANY RISK OF BRAIN CANCER ASSOCIATED WITH THE CHEMICAL INDUSTRY/ IT IS LIKELY THAT THIS RISK WILL BE ASSOCIATED WITH A SPECIFIC SUBSTANCE OR GROUP OF SUBSTANCES AND NOT ASSOCIATED WITH "CHEMICALS" IN GENERAL. WE MUST KEEP IN MIND THAT PRESENT EXPOSURE LEVELS ARE DIFFERENT AND LOWER THAN PAST. *657B UCC 097549 - 13 - CLEARLY/ THERE IS SOME ELEVATION OF BRAIN CANCER - MORTALITY RATES IN SOME AREAS OF TEXAS COMPARED TO THE # GENERAL TEXAS POPULATION. MORE ATTENTION SHOULD BE GIVEN TO THE POSSIBILITY OF A PHENOMENON FIRST DESCRIBED BY DR. GREENWALD AS "THE DIAGNOSTIC SENSITIVITY, BIAS".11 THE POSSIBILITY EXISTS THAT Tl-E INCREASED RATE OF CERTAIN v DISEASES MAY BE INFLUENCED BY IMPROVED MEDICAL DETECTION AND ATTENTION TO THESE DISEASES. Health services in the Houston area appear to be EXTREMELY SOPHISTICATED AND WELL DEVELOPED/ AND IF THIS < TRANSITION HAS TAKEN PLACE IN THE PAST 10 TO 20 YEARS/ IT WOULD NOT BE SURPRISING TO SEE SOME DIFFERENCES IN DISEASE TRENDS RESULTING FROM AN IMPROVED MEDICAL CARE DELIVERY SYSTEM. THE QUALITY OF MEDICAL CARE MAY ALSO BE INFLUENCED TO SOME EXTENT BY THE ADEQUACY OF HEALTH INSURANCE COVERAGE THAT A PATIENT CARRIES. THEREFORE/ EMPLOYED POPULATIONS WITH SUBSTANTIAL HEALTH CARE COVERAGE 4357B UCC 097550 - 14 - f MAY RECEIVE BETTER HEALTH CARE THAN OTHER SEGMENTS OF THE ' POPULATION WITH LESS ADEQUATE COVERAGE. j> MOST IMPORTANTLY# r THE BRAIN TUMOR PROBLEM NEEDS TO BE PLACED IN PROPER PERSPECTIVE WITH OTHER HEALTH CARE PRIORITIES IN.TEXAS. * A GREAT DEAL OF TIME AND EFFORT ON THE PART OF BOTH < x PRIVATE AND PUBLIC SECTOR FEALTH AGENCIES HAS BEEN DEVOTED TO THE CONSTRUCTION OF OCCUPATIONAL DATA BASES WHICH MAY PROVE USEFUL FOR TESTING SPECIFIC HYPOTHESES THAT ARISE IN THE FUTURE. Until a specific# consistently identified association is FOUND# NO REMEDIAL OR PREVENTIVE ACTIONS CAN BE IMPLEMENTED. A SCIENTIFIC CONSENSUS REGARDING THE PROPER INTERPRETATION OF THE EVIDENCE AVAILABLE TO DATE IS GREATLY NEEDED IN ORDER TO DETERMINE THE APPROPRIATE NEXT * STEP. 4357b UCC 097551 References f 1. New York Academy of Sciences: Brain Tumors in the Chemical Industry, tew York, 1980. # 2. "Glioblastoma Cluster in a Chemical Plant - Texas" MWR 29 : 359-365, 1980. J.3. Alexander, V., Leffingwell, S. S., Lloyd, w., et. al., "Brain Cancer in Petrochemical Workers: A Case Report.." Am. J. Ind. Med. 1: 115-123, 1980. A. A. Austin, S. G,, Schnatter, A. R., "A Cohort Mortality Study of Petrochemical Workers." JCM 25(A): 30A-312, 1983. B. WAXWEILLER, R. J., A.EXANDER, V., LEFFINGWELL, S. S., Haring, M., Lloyd, J. M., "Mortality from Brain Tumor and Other Causes in a Cohort of Petrochemical Workers." JNCI 70: 75-81, 1983. 5. Ajstin, S. G., Schnatter, A. R., "A Case Control Study of Chemical Exposures and Brain Tumors in < Petrochemical Workers." JOM 25(A): 313-320, 1983. 6. Leffingwell, S. S., Waxvciller, R., Alexander, V., Ludwig, H. R., Halperin, W., "Case-Control Study of Brain Cancers Mong Workers Et-ployed by a Texas City, Texas Petrochemical Plant." (Unpublished), May, 1983. 7. Reeve, G. R., Waxweiller, R. J./ Leffingwell, S. S., "fa Investigation of Brain and Lymphopoietic Cancer at NIOSH,a union Carbide Plant in Seadrift, Texas." September, 1983. A357B UCC 097552 8. PELL/ S. O'BERG/ M. T,/ KARRHz B. 'W., "CANCER Epidemiologic Surveillance in the DuPont Company." JOM 20: 725-740/ 1978. 9. jf/EN/ C. P./ Tsai/ S. P./ Gibson/ R. L./ "A Report on Brain Tumors from a Retrospective Cohort Study of Refinery Workers." Proceedings of the tew York Academy of Sciences Workshop on Brain Tumors in the Chemical Industry/ tew York City/ October 27-29/ 1980. 10. Reeve/ G. R,/ BOND/ G. G,/ Lloyd/ J. M./ et. al./ "An Investigation of Brain Tumors Among Chemical Plant Employees Using a Sample - Based Cohort Method." 25: 387-393/ 1983.1 JOM H, GREENWALD/ p./ FRIEDLANDERz B. R.Z LAWRENCE/ C. E.Z et. al./ "Diagnostic Sensitivity Bias: An Epidemiologic Explanation from an Apparent Brain Tumor Excess." JOM 23: 690-694/ 1981. 4357B UCC 097553 TABLE 1. 37 CHEMICALS INCLUDED IN THE TEXAS CITY BRAIN CANCER CASE-CONTROL STUDY Acetaldehyde Acetle Acid Acetone Butadiene Carbon Dioxide Diethanolamine Ethane Ethanol Ethylene Ethylene Glycol Hydrochloric Acid Isopropyl Acetate Methane Methanol Methyl Ethyl Ketone Methyl Isobutyl Ketone Monoethanolamine Propylene Sodium Carbonate Sodium Hydroxide A Styrene Sulphuric Acid Toluene Vinyl Acetate Tergitols Chlorine Trlchloroethane Sodium Sulphite UCC 097554 TABLE 2. KNOWN OR SUSPECT CARCINOGENS EVER USED AT TEXAS CITY Benzene Dl Ethyl Sulfate Ethylene Bichloride Ethylene Oxide Vinyl Chloride U C C 097555 TABLE 3 * OBSERVEDJ\ND EXPECTED DEATHS AND SMBs BY CAUSE FOR EMPLOYEES AT TEXAS CITY PLANT (WHITE HALES 1941-1977) CAUSLPE DEATH NO,-OF. DEATHS, OBSERVED EXREC.TED SMR ALL CAUSES MALIGNANT NEOPLASMS BENIGN AND UNSPECIFIED NEOPLASMS CIRCULATORY DISEASES RESPIRATORY D*ISEASES DIGESTIVE DISEASES EXTERNAL CAUSES OF DEATH COHORT CHARACTERISTICS: TOTAL NO. OF PERSONS, 6,588 TOTAL PERSON-YEARS, 137,745,2 AVERAGE ENTRY AGE, 27.51 765 150 7 348 26 21 153 923.82 174.14 2.98 422.65 44.97 53.92 147.20 83t 86 235 ,, 58t 39t 103 (95% Cl*-] (77-89) (73-101) (94-483) (74-91) (38-85) (24-60) (88-122) csi OO U C C 097556 Cl INDICATES CONFIDENCE INTERVAL t P<.05 A TABLE A OBSERVED AND EXPECTED DEATHS AND SMRs__ FOR EMPLOYEES WITH fiRFATFR than SiX- flQNTHS,. EMPLOYMENT BY CAUSE ANO PAYROLL STATUS HFOPIASMS flNt Y (WHITE MALES 1991-1977) CAUSE OF DEATH MALIGNANT NEOPLASMS LARGE INTESTINE LIVER PANCREAS LUNG BRAIN AND CNS PROSTATE BLADDER KIDNEY r LEUKEMIA BENIGN AND UNSPECIFIED NEOPLASMS EMERJHOURLY Q E SMR 109 121.21 90 7 9.99 70 9 2.19 183 8 6.53 122 36 39.72 91 10 5.01 200* 2 9.98 95 1 2.82 35 5 3.27 153 8 5.22 153 7 2.02 396* NEVER HOURLY . 0E 16 21.91 2 1.73 1 0.37 1 1.12 3 6.89 0 1.06 0 0.63 0 0.99 0 0.58 0 1.10 0 0.92 SMR 73 116 270 89 99 0 0 0 0 0 0 Table 5: Observed and Expected-Deaths Standardised Mortality Ration (SMRs) for Malignant Brain Tuaors for Hourly Bxployeea Surviving a Minimus of Twenty Years Following Initial Baploynent at UCC-TC by Length of Bnployeent Length of Eteployeent 0 - 4.9 5 - 9.9 10 - 14.9 15 - 19.9 20. + Ho. of NO. of Bnplovees PSYRS 1,350 215 121 181 1,503 11,672 1,840 934 1390 13,125 Age 48.24 46.57 48.68 54.98 48.52 0B * 4 1.14 0 0.17 0 0.09 1 0.17 4 ' 1.37 SMR 3.51 0 0 5.78 2.92 TOTAL 3,370 28,959 48.62 9 r 2.94 3.06 U C C 097558 S. G. Austin S/17/R2 TABLE 6A. PROPORTIONS OF CASES AND CONTROLS "EVER EXPOSED" 15 YEARS OR MORE PRIOR TO DEATH DY CHEMICAL CHEMICALS Propylene Sodium Carbonate Sodium Hydroxide Sodium Sulftte Styrene Sulphuric Acid Tergftols Tetraethylene Glycol Toluene Trlcbloroetbane Triethylene Glycol Vinyl Acetate ALL CASES No. % 9 33.3 9 33.3 11 81.8 9 44.4 10 20.0 10 80.0 10 40.0 10 30.0 10 20.0 9 44.4 10 30.0 10 5G.Q GLIOMAS No. _5L 8 37.5 6 37.5 9 77.8 7 42.9 9 22.2 8 75.0 9 44.4 9 33.3 9 22.2 7 42.9 9 33.3 9 55.6 CONTROL I No. 34 61.8 34 41.2 37 81.1 30 26.7 33 39.4 34 ' 70.6 33 42.4 31 '25.8 33 39.4 30 30.0 31 25.8 33 36.4 CONTROL II No. % 25 48.0 28 57.1 31 80.6 23 2&1 27 29.6 25 64.0 27 48.1 ' 26 23.1 27 33.3 23 30.4 . 26 23.1 29 37.9 UCC 097559 TABLE 6B. PROPORTIONS OF CASES AND CONTROLS "EVER EXPOSED" 15 YEARS OR MORE PRIOR TO DEATH SY CHEMICAL CHEMICALS Acetaldehyde Acetic Add Acetone' Butadiene Carbon Dioxide Chlorine Diethanolamine Diethylene Glycol Ethanol Ethylene Ethylene Glycol Hydrochloric Acid Hydroxypropyl Acrylate ALL CASES No. % 9 22.2 10 20.0 10 70.0 9 44.4 9 55.6 9 44.4 10 40.0 GLIOMAS No. % 8 25.0 9 22.2 9 77.8 7 42.9 8 62.5 7 42.9 9 44.4 10 30.0 9 33.3 10 40.0 9 33.3 9 88.9 8 87.5 10 30.0 9 33.3 10 50.0 9 55.6 10 20.0 A 9 22.2 CONTROL I' No. % 32 3U 35 48.6 37 . 70.3 31 58.1 34 44.1 30 26.7 33 42.4 31 , 25.8 32 40.6 34 55.9 33 39.4 35 48.6 32 21.9 CONTROL II No. % 28 46.4 30 46.7 31 74.2 24 58.3 28 57.1 23 26.1 27 48.1 26 23.1 27 25.9 25 52.0 30 50.0 28 57.1 27 29.6 U C C 097560 TABLE 6C, PROPORTIONS OF CASES AND CONTROLS "EVER EXPOSED'1 15 YEARS OR MORE PRIOR TO DEATH SY CHEMICAL CHEMICALS Isopropanol Isopropyl Acetate Isopropyl Peroxydicarbonate Lubricating Oils Methane Methanol Methyl Ethyl Ketone Methyl Isobutyt Ketone Monoethanolamine Nonane Phosphoric Acid Potassium Hydroxide ALL CASES No. % 10 40.0 10 20.0 10 30.0 9 33.3 8 62.5 10 40.0 10 30.0 10 20.0 10 40.0 10 20.0 A 10 20.0 10 30.0 GLIOMAS No. % 9 44.4 9 22.2 9 33.3 8 37.5 7 57.1 9 44.4 9 33.3 9 22.2 9 44.4 9 22.2 9 22.2 9 33.3 CONTROL I No.- % 35 37.1 35 42.9 32 21.9 34 44.1 32 53.1 33 63.6 33* 27.3 33 27.3 33 48.5 32 21.9 31 22.6 31 25.6 CONTROL II No. % 28 42.9 .30 > 46.7 27 29.6 29 62.1 25 52.0 27 59.3 27 29.6 27 29.6 27 48.1 27 29.6 27 22.2 ' 26 23.1 U C C 097561 TABLE 6D. PROPORTIONS OF CASES AND CONTROLS EXPOSED TO FIVE CHEMICALS AT UCC TEXAS CITY AT LEAST 15 YEARS PRIOR TO DEATH ALL CASES GLIOMAS CONTROLI CONTROL II CHEMICAL %%%% Total Exposed Total Exposed Total Expoaod Total Exposed Benzene 9 11.1 8 12.5 30 26.7 23 4.3 Oiethylsulfate 10 40.0 9 33.3 33 42.4 27 29.6 Ethylene Bichloride 10 40.0 9 44.4 31 32.3 26 34.6 Ethylene Oxide 9 22.2 8 25.0 30 '20.0 26 23.1 Vinyl Chloride 10 30.0 9 33.3 33 30.3 27 33.3 TABLE 7. DESCRIPTION OF 21 DRAIN TUMOR CASES DY TYPE OF TUMOR GHona Mantoglona Trial 17 4 21 U C C 097563 *