Document Ed8wg5pJxnrxGVd9L271V15Nb

DEPARTMENT OF HEALTH Republic ofSouth Africa 0 DEPARTMENT OF HEALTH Pathology Division Report: Demographic Data and Disease Rates for January - December 2002 Dr Jill Murray Dr Geoff Candy Gill Nelson Lungi Khumalo NATIONAL CENTRE FOR OCCUPATIONAL HEALTH NCOH Report 07/2003 P O Box 4788 JOHANNESBURG 2000 E-mail: murraj@health.gov.za TABLE OF CONTENTS EXECUTIVE SUMMARY 3 SECTION 1: INTRODUCTION SECTION 2: DATA DESCRIPTION Distribution of autopsies by year and ethnic group (1975-2002) Number and proportion of autopsies by age and ethnic group (2002) Distribution of autopsies by age and ethnic group (2002) Number and proportion of autopsies by type and ethnic group (2002) Number and proportion of autopsies by industry and ethnic group (2002) Distribution of autopsies by industry and ethnic group (2002) Number and proportion of autopsies by years of service and ethnic group (2002) Distribution of autopsies by years of service and ethnic group (2002) Mean duration of service and mean age by industry and ethnic group (2002) 4 5 6 6 7 7 8 8 9 9 SECTION 3: ACTIVE TUBERCULOSIS Distribution of active TB by site (2002) Number of cases and prevalence of active PTB by age and ethnic group (2002) Number of cases and prevalence of active PTB by industry and ethnic group (2002) Number of cases and prevalence of active PTB by years of service and ethnic group (2002) 10 11 11 12 SECTION 4: SILICOSIS Number of cases and prevalence of silicosis by age and ethnic group (2002) Number of cases and prevalence of silicosis by industry and ethnic group (2002) Number of silicotic islets in the lungs by years of service and ethnic group (2002) 13 14 14 SECTION 5: MASSIVE FIBROSIS, COAL WORKERS' PNEUMOCONIOSIS, MIXED DUST FIBROSIS AND ASBESTOSIS Number of cases and prevalence of asbestosis by age and ethnic group (2002) 15 SECTION 6: EMPHYSEMA Number of cases and prevalence of emphysema by age and ethnic group (2002) Number of cases and prevalence of emphysema by industry and ethnic group (2002) Number of cases and prevalence of emphysema by years of service and ethnic group (2002) 16 16 17 SECTION 7: MESOTHELIOMA Number and proportion of mesothelioma cases by age and ethnic group (2002) Number and proportion of mesothelioma cases by industry and ethnic group (2002) 18 18 SECTION 8: PRIMARY LUNG CANCER Number of cases and prevalence of primary lung cancer by age and ethnic group (2002) Number of cases and prevalence of primary lung cancer by industry and ethnic group (2002) 19 19 SECTION 9: CLINICAL CAUSES OF DEATH Causes of death by ethnic group (2002) Cause of death as given by the clinicians who submit the organs to the NCOH (2002) 20 20 APPENDIX: DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE WHERE THE DECEASED WORKED 21 2 EXECUTIVE SUMMARY South African law requires the examination of the cardiorespiratory organs of deceased miners and ex-miners for compensation purposes, provided the next of kin agrees. These examinations are performed at the National Centre for Occupational Health (NCOH) and the findings are recorded on a computerized database (PATHAUT). This database is unique and provides an important resource for surveillance and research. During 2002, 2 518 cases came to autopsy at the NCOH. Of these, 66.6% were black, 30.3% were white, 2.0% were coloured and 1.1% were submitted without information on ethnic group. No autopsies were received from Asians. Overall disease rates (per 1000 autopsies) for 2002 are shown in figure 1. FIG. 1 Emphysema (214/1000) n Silicosis (193/1000) Pulmonary tuberculosis (207/1000) Primary lung cancer (36/1000) Asbestosis (26/1000) Massive fibrosis (11/1000) Mesothelioma (11/1000) Coal workers' pneumoconiosis (4/1000) Mixed dust pneumoconiosis (2/1000) OVERALL DISEASE RATES FOR 2002 3 SECTION 1 - INTRODUCTION The Pathology Department of the National Centre for Occupational Health (NCOH) provides an autopsy service for miners and ex-miners to determine the presence of occupational lung disease. Under the Occupational Diseases in Mines and Works Act (ODMWA, 1973) it is obligatory for the last attending doctor to remove the cardiorespiratory organs and send them for examination, provided the next of kin agrees. A detailed report of each case is sent to the Medical Bureau for Occupational Diseases (MBOD). Cases certified as having a compensatable disease are then referred to the Compensation Commissioner's office, where payment of compensation is managed. Since 1975 the pathological findings from autopsy examinations have been recorded on the PATHAUT database, a unique computerized source of information for research and surveillance. PATHAUT comprises data from autopsy summary sheets and clinical files (including occupational histories). The structure of this database was changed in 1995/1996 and new programs were written, upgrading and enhancing the existing database by improving the quality of the system and making better use of existing data (SIMRAC Project GEN509). This is the sixth of the new format reports and describes autopsy cases examined during the year 2002. Data from PATHAUT are exported into the Statistical Analysis System (SAS System) where programs have been written using Structured Query Language (SQL), permitting the user to analyze data related to any aspect of the PATHAUT database. 4 SECTION 2 - DATA DESCRIPTION The number of autopsies performed since 1975 is presented in Table 2-1. TABLE 2-1 DISTRIBUTION OF AUTOPSIES BY YEAR AND ETHNIC GROUP (1975-2002) Year of autopsy 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996* 1997 1998 1999 2000 2001 2002 Total Black N% 2 190 71 2 335 68 2 351 69 2 245 67 2 118 66 2 338 64 2 209 66 2 312 63 2 096 65 1 966 64 2 275 64 2 456 68 2 594 68 2 518 67 2 138 65 2 172 64 2 143 65 2 144 66 1 863 65 1 737 61 2 830 71 766 68 2 223 69 1 977 69 1 656 65 1 798 69 1 690 67 1 677 67 58 817 66 White N% 854 28 1 072 31 1 039 30 1 090 32 1 026 33 1 274 35 1 117 33 1 302 36 1 109 34 1 098 36 1 200 34 1 125 31 1 168 30 1 165 31 1 090 33 1 155 34 1 080 33 1 049 32 956 33 1 021 36 1 059 27 329 29 897 28 836 29 832 33 761 29 813 32 763 30 28 280 32 Coloured N% 32 1 27 1 33 1 32 1 45 1 46 1 33 1 44 1 41 1 28 1 66 2 45 1 78 2 77 2 60 2 51 2 66 2 70 2 65 2 94 3 99 2 19 2 70 2 49 2 29 1 41 2 13 1 50 2 1403 2 * Data for only 6 months are available for this year Indian N% 1 1 Unknown N% 14 1.2 18 0.6 17 0.6 12 0.5 8 0.3 13 0.5 28 1.1 110 0.1 Total N 3 076 3 434 3 423 3 367 3 189 3 658 3 359 3 658 3 246 3 092 3 541 3 626 3 840 3 760 3 288 3 378 3 289 3 263 2 884 2 852 3 988 1 128 3 208 2 880 2 529 2 608 2 529 2 518 88 611 It is important to note that a referral bias exists, in that black men are infrequently autopsied after leaving employment in the mines, whereas the majority of whites come to autopsy after retirement. 5 The age distribution of autopsies for 2002 is shown in Table 2-2 and Fig 2-1. The mean age at autopsy for black miners has increased from 37.9 years in 1998 to 43.5 years in 2002. The age of white miners at autopsy has remained essentially unchanged. TABLE 2-2 NUMBERS AND PROPORTION OF AUTOPSIES BY AGE AND ETHNIC GROUP (2002) Age group (years) 19-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Unknown Total Black N% 64 3.8 461 27.5 722 43.1 290 17.3 35 2.1 14 0.8 4 0.2 0 0.0 87 5.2 1 677 White N% 8 1.1 40 5.2 82 10.8 150 19.7 198 26.0 193 25.3 81 10.6 5 0.7 6 0.8 763 Coloured N% 0 0.0 1 2.0 4 8.0 7 14.0 21 42.0 11 22.0 5 10.0 0 0.0 1 2.0 50 Unknown N% 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 28 100.0 28 All races N% 72 2.9 502 20.0 808 32.1 447 17.8 254 10.1 218 8.7 90 3.6 5 0.2 122 4.9 2 518 FIG 2-1 DISTRIBUTION OF AUTOPSIES BY AGE AND ETHNIC GROUP (2002) 19-29 30-39 40-49 50-59 60-69 70-79 Age group 80-89 90+ Black White Coloured 6 The pathologists at the NCOH perform two types of autopsy examinations. For men dying distant from Johannesburg, the cardiorespiratory organs are removed locally, preserved in formalin and sent to the NCOH. Full autopsies are undertaken on men who die close to Johannesburg. Table 2-3 shows the distribution of autopsies by ethnic group for 2002. Autopsies of only cardio-respiratory organs comprised 94.4% of all examinations. TABLE 2-3 NUMBER AND PROPORTION OF AUTOPSIES BY TYPE AND ETHNIC GROUP (2002) Autopsy type Cardiorespiratory organs only Full autopsy Total Black N% 1 675 99.9 2 0.1 1 677 White N% 624 81.8 139 18.2 763 Coloured N% 49 98.0 1 2.0 50 Unknown N% 28 100.0 0 0.0 28 TOTAL N% 2376 94.4 142 5.6 2 518 Table 2-4 and Figure 2-4 show the distribution of autopsies by industry and ethnic group for 2002. The percentage of autopsies received from the gold mining industry has continued to decline from 75.8% in 1999, to 70.7% in 2000, to 68.0% in 2001, to 67.5% in 2002. The percentage of autopsies from platinum miners increased from 8.3% in 1999, to 14.3% in 2000, to 14.4% in 2001, to 15% in 2002. As in previous years, the majority of autopsies on coloured miners came from asbestos mines (80%). TABLE 2-4 NUMBER AND PROPORTION OF AUTOPSIES BY INDUSTRY AND ETHNIC GROUP (2002) Industry Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown Total Black N% 1 157 69.0 59 3.5 334 19.9 38 2.3 19 1.1 8 0.5 0 0.0 19 1.1 43 2.6 1 677 White N% 541 70.9 49 6.4 42 5.5 27 3.5 10 1.3 11 1.4 16 2.1 31 4.1 32 4.7 763 Coloured N% 1 2.0 1 2.0 1 2.0 40 80.0 0 0.0 4 8.0 0 0.0 0 0.0 3 6.0 50 Unknown N% 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 27 100.0 28 TOTAL N% 1 700 67.5 109 4.3 377 15.0 105 4.2 29 1.2 23 0.9 16 0.6 50 2.0 109 4.3 2 518 7 FIG 2-4 DISTRIBUTION OF AUTOPSIES BY INDUSTRY AND ETHNIC GROUP (2001) Black White 69.3 71.3 2.3 4.8 5.5 -3.6 3.2 Coloured Gold Coal Platinum Asbestos Other* * Includes copper, diamond, quarry, silica (silicon smelters), manganese, tin, zinc, minerals, chrome and iron, as well as cases where information about type of mining is missing Detailed information about the years in mining service by ethnic group is given in Table 2-5. This is also presented in Fig 2-5. Cases were categorized according to the industry in which most years of service had occurred. It is important to note the large proportion of cases with missing information about the duration of service (21.6%). This proportion is similar to that found in 2001 (24.4%), 2000 (22.6%) and 1999 (22.7%) but considerably lower than the figure for 1998 (43%). TABLE 2-5 NUMBER AND PROPORTION OF AUTOPSIES BY YEARS OF SERVICE AND ETHNIC GROUP (2002) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31 + Unknown Total Black N% 18 1.1 207 12.3 253 15.1 346 20.6 305 18.2 137 8.2 49 2.9 17 1.0 345 20.6 1 677 White N% 0 0.0 50 6.6 61 8.0 66 8.7 76 10.0 87 11.4 85 11.1 185 24.3 153 20.1 763 Coloured N% 0 0.0 9 18.0 9 18.0 7 14.0 2 4.0 1 2.0 2 4.0 3 6.0 17 34.0 50 Unknown N% 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 28 100.0 28 TOTAL N% 18 0.7 266 10.6 323 12.8 419 16.6 383 15.2 225 8.9 136 5.4 205 8.1 543 21.6 2 518 8 FIG 2-5 DISTRIBUTION OF AUTOPSIES BY YEARS OF SERVICE AND ETHNIC GROUP (2002) Years of service: Black o<1 01-5 06-10 011-15 016-20 White 021-25 026-30 031 + The mean duration of service and age by industry type and ethnic group for those cases for which information was available are shown in Table 2-6. TABLE 2-6: MEAN DURATION OF SERVICE AND MEAN AGE BY INDUSTRY AND ETHNIC GROUP (2002) Industry Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown Total N 1082 59 332 38 18 8 0 18 29 1584 Black Age Mean SD 42 8 44 7 44 8 58 13 47 15 51 12 -50 12 47 13 Service Mean SD 12 8 15 10 10 9 9 10 14 10 13 11 -11 11 -- N 539 49 42 27 10 11 16 31 28 753 White Age Service Mean SD Mean SD 64 14 21 13 61 15 17 16 61 15 11 11 68 12 16 13 51 19 13 12 54 13 9 9 60 13 21 14 61 13 17 16 63 15 - - 9 SECTION 3 - ACTIVE TUBERCULOSIS The distribution of active tuberculosis (TB) by anatomical site is presented in Fig 3-1 (n=616). Active pulmonary TB was diagnosed in 20.7% (521) of all cases autopsied in 2002, in comparison with 19.2% (486) in 2001, and 16.4% (416) in 2000. 93.1% (485 cases) of men with PTB were black, 5% (26 cases) were white, 1% (5 cases) were coloured, and in 1% (5 cases) the ethnic group was unknown. 65.5% (341 cases) of all PTB cases came from the gold mines and 25% (130 cases) from platinum mines. Most (68%; 354 cases) of the PTB cases were in the age group 30-49 years. The overall rate of PTB (206/1000) has increased from 192/1000 in 2001, 159/1000 in 2000 and 123/1000 in 1999. This is attributed to the increase in the PTB rate in black miners to 287/1000, from 267/1000 in 2001, 217/1000 in 2000, and 174/1000 in 1999. The rate of PTB increased particularly in black platinum miners from 179/1000 in1999, to 251/1000 in 2000, to 345/1000 in 2001, to 383/1000 in 2002. Comparable rates for black gold miners were 171/1000 in1999, 219/1000 in 2000), 251/1000 in 2001 and 274/1000 in 2002. Fig 3-1 Distribution of active TB by site (2002) |--I Nodes & lungs (362; 58.8%) |--I Lungs only (133; 21.6%) |--I Nodes only (85; 13.8%) ^ Nodes, pericardium & lungs (19; 3.1%) |-| Pericardium & lungs (7; 1.1%) |-| Pericardium only (10; 1.6%) 10 The age distribution of cases with active PTB is shown in Table 3-1. Rates in this and the following tables are expressed per 1000. In all tables, the denominators used are all autopsies in a specific industry and ethnic group. Consequently, where the denominators are small, the rates may not be reliable. TABLE 3-1 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY AGE AND ETHNIC GROUP (2002) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Unknown Total Black N Rate 23 359 142 308 208 288 72 248 8 229 3 214 0029 333 485 289 White N Rate 02 50 1 12 8 53 7 35 4 21 4 49 00- 26 34 Coloured N Rate 01 1000 01 143 1 48 1 91 001 1000 5 100 Unknown N Rate 00000000- 5 179 5 179 Total N Rate 23 319 145 289 209 259 81 181 16 63 8 37 4 44 035 287 521 207 The distribution of active PTB cases by industry is shown in Table 3-2. 65.5% of active PTB cases came from the gold mining industry (67.8% of all autopsy cases came from that industry). TABLE 3-2 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY INDUSTRY AND ETHNIC GROUP (2002) Industry Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown Total Black N Rate 317 274 12 203 128 383 8 211 2 105 1 125 04 211 10 233 482 287 White N Rate 23 43 01 24 001 91 01 32 0- 26 34 Coloured N Rate 001 1000 2 50 02 500 000- 5 100 Unknown N Rate 1 1000 00000004 148 5 179 Total N Rate 341 201 12 110 130 34 10 95 2 69 4 174 05 10 14 128 518 206 11 Table 3-3 shows the number of active PTB cases by years of service and ethnic group. TABLE 3-3 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY YEARS OF SERVICE AND ETHNIC GROUP (2002) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31 + Unknown Total Black N Rate 3 167 66 319 80 316 88 254 78 256 31 226 14 286 4 235 121 351 485 289 White N Rate 03 60 2 33 01 13 5 57 3 35 10 54 2 13 26 34 Coloured N Rate 01 111 2 222 1 143 00001 59 5 100 Unknown N Rate 00000000- 5 179 5 179 Total N Rate 3 167 70 263 84 260 89 212 79 206 36 160 17 125 14 68 129 238 521 207 12 SECTION 4 - SILICOSIS Silicotic nodules were found in the lungs of 486 cases (19.3% of all autopsies); 88.1% of these cases came from the gold mining industry. Of all cases of silicosis, occasional silicotic nodules were found in 51.3%, a few in 20.6%, a moderate number in 24.4% of cases and a large number in 3.7%. The age distribution of cases with silicosis (Table 4-1) differed between ethnic groups. No clear trend was evident for age and rates of silicosis in black miners. One explanation is that relatively few older black miners who have retired came to autopsy. There is, however, a trend in white miners. TABLE 4-1 NUMBER OF CASES AND PREVALENCE OF SILICOSIS BY AGE AND ETHNIC GROUP (2002) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Unknown Total Black N Rate 1 16 47 102 174 241 92 317 7 200 2 143 2 500 018 207 343 205 White N Rate 03 75 9 110 16 107 36 182 41 212 27 333 2 400 1 167 135 177 Colo ured N Rate 000- 1 143 00000- 1 20 Unknown N Rate 00000000- 7 250 7 250 Total N 1 50 183 109 43 43 29 2 26 486 Rate 14 100 226 244 169 197 322 400 213 193 13 The distribution of cases with silicosis by industry and ethnic group is presented in Table 4-2. As indicated previously, cases are categorized according to the industry in which the most years of service occurred. The rate in gold miners has increased from 164/1000 in 1999, to 191/1000 in 2000, to 228/1000 in 2001 and to 252/1000 in 2002. Cases from the platinum mining industry with silicosis might be explained by unstated previous service in gold mines. TABLE 4-2 NUMBER OF CASES AND PREVALENCE OF SILICOSIS BY INDUSTRY AND ETHNIC GROUP (2002) Industry Gold Platinum Coal Asbestos Diamond Copper Iscor Other Unknown Total Black N Rate 308 266 15 45 2 34 8 211 00006 140 339 202 White N Rate 119 220 5 119 2 41 1 37 0002 65 5 139 134 176 Coloured N Rate 000001 250 000- 1 20 Unknown N Rate 1 1000 00000006 222 7 250 Total N Rate 428 252 20 53 4 37 9 86 1 34 002 40 17 156 481 191 TABLE 4-3 NUMBER OF SILICOTIC ISLETS IN THE LUNGS BY YEARS OF SERVICE AND ETHNIC GROUP (2002) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31+ Unknown Total Black N Rate 3 167 31 150 25 99 73 211 93 305 40 292 14 286 3 176 61 177 343 205 White N Rate 04 80 4 66 10 152 14 184 16 184 16 188 48 259 23 150 135 177 Coloured N Rate 0001 143 00000- 1 20 Unknown N Rate 00000000- 6 6 214 Total N Rate 3 167 35 132 29 90 84 200 107 279 56 249 30 221 51 249 91 168 486 193 14 SECTION 5 - MASSIVE FIBROSIS, COALWORKER'S PNEUMOCONIOSIS, MIXED DUST FIBROSIS AND ASBESTOSIS MASSIVE FIBROSIS There were 27 (1.07%) cases of massive fibrosis (18 black, 9 white). Twenty-six were from the gold mining industry. COAL WORKERS' PNEUMOCONIOSIS There were 10 cases of coal workers' pneumoconiosis; 6 were older than 40 years. MIXED DUST FIBROSIS There were 5 (0.2%) cases of mixed dust fibrosis. ASBESTOSIS There were 65 cases of asbestosis of which 53.8% (n=35) had slight, 44.6% (n=29) moderate and 1.5% (n=1) marked fibrosis. The distribution of asbestosis by age and ethnic group is shown in Table 5-1. No cases were younger than 40 years. TABLE 5-1 NUMBER OF CASES AND PREVALENCE OF ASBESTOSIS BY AGE AND ETHNIC GROUP (2002) Age group (years) 40-49 50-59 60-69 70-79 80-89 90+ Unknown Total Black N Rate 10 14 7 24 7 200 5 357 2 500 00- 31 18 White Coloured Unknown N Rate N Rate 017 5 25 5 26 3 37 1 200 0- 15 20 01 143 8 381 6 545 001 1000 16 320 000000- 3 107 3 107 Total N Rate 10 12 9 20 20 79 16 73 5 56 1 200 4 33 65 26 15 SECTION 6 - EMPHYSEMA There were 538 cases of emphysema, the extent of which was mild in 74.0% (n=398), moderate in 24.0% (n=129) and marked in 2.0% (n=11). The distribution of emphysema by age and ethnic group is presented in Table 6-1. TABLE 6-1 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY AGE AND ETHNIC GROUP (2002) Age group (years) 30-39 40-49 50-59 60-69 70-79 80-89 90+ Unknown Total Black N Rate 26 56 88 122 70 241 12 343 3 214 3 750 07 80 209 125 White N Rate 3 75 11 134 51 340 88 444 96 497 41 506 2 400 1 167 293 384 Coloured N Rate 004 571 12 571 7 636 2 400 01 1000 26 520 Unknown N Rate 000000010 357 10 357 TOTAL N Rate 29 58 99 123 125 280 112 441 106 486 46 511 2 400 19 156 538 214 The majority of black and white miners with emphysema 63% (n=337) were from the gold mining industry (Table 6-2). TABLE 6-2 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY INDUSTRY AND ETHNIC GROUP (2002) Industry Gold Platinum Coal Asbestos Iscor Copper Diamond Other Unknown Total Black N Rate 129 111 36 108 18 305 14 368 003 158 4 211 5 116 209 125 White N Rate 208 384 19 452 14 286 10 370 5 313 4 364 1 100 13 419 16 444 290 380 Coloured N Rate 00020 500 04 1000 002 667 26 520 Unknown N Rate 0000000010 370 10 357 TOTA L N Rate 337 198 55 146 32 294 44 419 5 313 8 348 4 138 17 340 33 303 535 212 16 TABLE 6-3 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY YEARS OF SERVICE AND ETHNIC GROUP (2002) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31 + Unknown Total Black N Rate 3 167 16 77 16 63 33 95 61 200 28 204 10 204 7 412 35 101 209 179 White N Rate 012 240 20 328 13 197 29 382 37 425 30 353 84 454 68 444 293 384 Coloured N Rate 04 444 2 222 5 714 1 500 1 1000 1 500 012 706 26 520 Unknown N Rate 0000000010 357 10 357 Total N Rate 3 167 32 120 38 118 51 122 91 238 66 293 41 301 91 444 125 230 538 214 17 SECTION 7 - MESOTHELIOMA The number of cases of mesothelioma in 2002 (n=27) was similar to that in previous years (19 in 1998, 24 in 1999, 17 in 2000, 18 in 2001). TABLE 7-1 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY AGE AND ETHNIC GROUP (2002) Age group (years) 40-49 50-59 60-69 70-79 80-89 Total Black N% 5 50.0 5 50.0 0 0.0 0 0.0 0 0.0 10 White N% 0 0.0 3 25.0 5 41.7 3 25.0 1 8.3 12 Coloured N% 0 0.0 2 40.0 2 40.0 1 20.0 0 0.0 5 TOTAL N% 5 18.5 10 37.0 7 25.9 4 14.8 1 3.7 27 The distribution of mesothelioma by industry and ethnic group is presented in Table 7-2. The highest proportion of mesothelioma cases was found in asbestos miners (51.9%). TABLE 7-2 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY INDUSTRY AND ETHNIC GROUP (2002) Industry Asbestos Coal Copper Diamond Gold Other Unknown Total Black N% 4 40.0 1 10.0 1 10.0 1 10.0 0 0.0 1 10.0 2 20.0 10 White N% 5 41.7 2 16.7 0 0.0 0 0.0 1 8.3 1 8.3 3 25.0 12 Coloured N% 5 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 TOTAL N% 14 51.9 3 11.1 1 3.7 1 3.7 1 3.7 2 7.4 5 18.5 27 *2 February 2006. In an earlier print run of this report, the total number of mesothelioma cases was given as 25. Changes have been made to the text and tables. 18 SECTION 8 - PRIMARY LUNG CANCER Ninety one cases of primary lung cancer were found at autopsy, 22% of which were in black, 70.3% in white, and 5.5% in coloured miners. Most of the cases were of the large cell type (37.4%; n=34), followed by squamous cell type (26.4%; n=24), lung adenocarcinoma (16.5%; n=15) and small cell type (18.7%; n=17). One case of bronchoalveolar carcinoma was seen. The distribution of primary lung cancer by age and ethnic group is presented in Table 8-1. TABLE 8-1 NUMBER OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY AGE AND ETHNIC GROUP (2002) Age group (years) 20-29 40-49 50-59 60-69 70-79 80-89 Unknown Total Black N Rate 08 11 5 17 2 57 2 143 03 34 20 12 White N Rate 1 125 5 61 8 53 20 101 22 114 8 99 00 64 84 Coloured N Rate 001 143 2 95 1 91 1 200 0- 5 100 In one case both age and race were unknown. TOTAL* N Rate 1 14 13 16 14 31 24 94 25 115 9 100 4 33 90 36 The distribution of primary lung cancer by industry and ethnic group is presented in Table 8-2. For white miners, the majority of cases came from the gold mining industry. TABLE 8-2 NUMBER OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY INDUSTRY AND ETHNIC GROUP (2002) Industry Gold Coal Asbestos Platinum Diamond Iscor Other Unknown Total Black White Coloured TOTAL* N Rate N Rate N Rate N Rate 10 9 44 81 0 - 54 32 1 17 4 82 1 1000 6 55 4 105 2 74 3 75 9 86 5 15 4 95 0 - 9 24 0 - 1 100 0 - 1 34 0 - 2 125 0 - 2 125 0 - 4 129 0 - 4 80 0 - 3 83 1 333 5 46 20 12 64 84 5 100 90 36 In one case both race and industry were unknown 19 SECTION 9 - CLINICAL CAUSES OF DEATH Table 9-1 and Figure 9-1 show the clinical cause of death that accompanied the cardiorespiratory organs, by ethnic group. Diseases of the respiratory system were the most frequent (64.5%) overall. The rate in black miners increased from 50.9% in 1998, to 57.6% in 1999, to 64.5% in 2000, to 69.9% in 2001, to 74.4% in 2002. Black miners had the highest proportion of unnatural causes of death (9.4%). There has been a steady decline in the proportion of unnatural deaths in black miners (19.2% in 1998, 16.8% in 1999, 13.3% in 2000 and 11.2% in 2001). In 15.5% of cases the cause of death was not stated. TABLE 9-1 CAUSES OF DEATH BY ETHNIC GROUP (2002) System Respiratory Cardiovascular Nervous Gastro intestinal Genito urinary Haematological Metabolic Unnatural Miscellaneous Not stated Total Black N% 1248 74.4 28 1.7 34 2.0 18 1.1 7 0.4 8 0.5 0 0.0 158 9.4 40 2.4 135 8.1 1677 White N% 342 44.8 83 10.9 12 1.6 16 2.1 11 1.4 1 0.1 3 0.4 42 5.5 28 3.7 225 29.5 763 Coloured N% 33 66.0 3 6.0 3 6.0 2 4.0 0 0.0 0 0.0 0 0.0 2 4.0 3 6.0 4 8.0 50 Unknown N% 1 3.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 27 96.4 28 TOTAL N% 1624 64.5 114 4.5 49 1.9 36 1.4 18 0.7 9 0.4 3 0.1 202 8.0 71 2.8 391 15.5 2518 FIG 9-1 CAUSE OF DEATH AS GIVEN BY THE CLINICIANS WHO SUBMIT THE ORGANS TO THE NCOH (2002) Black White Respiratory Cardiovascular Nervous Gastro intestinal Genito urinary Haematological Metabolic Unnatural Miscellaneous Not stated 20 APPENDIX: DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE WHERE THE DECEASED WORKED MINETYPE LAST MINE WORKED AT Asbestos African Chrysolite asbestos Asbestos Mine Blackrich Asbestos Bretby Asb Cape Blue Danielskuil Asbestos mine Elandsfontein Asbestos mine Everite Gefco Kliphuis Koegas Penge Asbestos Pomfret Asbestos Mine Rocla Asb Pipe Indus Stofbakkies Voorspoed Asbestos Mine Wandrag Asbestos Mine Total from asbestos mines Chrome Eastern Chrome Marble Lime Chrome Mooinooi Dilokong Winterveld Total from chrome mines Coal Arnot Colliery Bank Colliery Amcoal Colliery Atcom Opencast Coal Mine Cornelia Colliery Bosjesspruit Colliery Brandspruit Colliery Coalbrook Colliery Delmas Colliery Durban Navigation Douglas Colliery Ermelo Coal Duiker Colliery Durnacol Mine Forzando Colliery Goedehoop Colliery Greenside Colliery Hlobane Colliery Kleinkopje Colliery Koornfontein Coal Kriel Colliery Landau Colliery Leeufontein Colliery Matla Coal New Vaal Colliery North Feld Colliery Nyati Coal mine Navigation Coll BLACK 0 2 0 0 1 1 0 0 24 0 1 2 0 0 0 1 3 35 1 0 0 1 0 2 6 3 0 0 0 1 1 0 1 0 0 0 0 0 1 4 5 0 4 0 6 0 0 5 0 1 0 0 WHITE 2 4 0 0 3 0 0 1 5 0 4 2 1 1 0 0 0 23 0 1 1 0 1 3 0 3 2 1 1 0 0 1 3 3 2 1 1 1 0 1 2 1 0 1 1 1 1 4 1 0 1 1 COL OURED 0 2 1 1 0 0 1 0 3 3 25 0 0 0 1 0 0 37 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 UN KNOWN TOTAL 2 8 1 1 4 1 1 1 32 3 30 4 1 1 1 1 3 95 1 1 1 1 1 5 6 6 2 1 1 1 1 1 4 4 2 1 1 1 1 5 7 1 4 1 7 1 1 9 1 1 1 1 21 MINETYPE LAST MINE WORKED AT Coal Rietspruit Colliery (continued) Rooifontein SA Coal Estates Sasol Coal Mine Savemore Colliery Secunda Colliery Slater Coal Mine Spingfield Colliery Spitzkop Syferfontein Coal Tavistok Colliery Twistdraai Usutu Colliery Van Dyk's Drift Vryheid Coronation Welgedacht Witbank Collieries Witcons Colliery Total from coal mines Copper Copper Mine Messina Copper O'Kiep Copper Phalaborwa Prieska Tsumeb Copper Mine Total from copper mines Diamond Bellsbank Diamond De Beers Consolidated Diamond Mine Finch Diamond Mine Loxton Exploration Premier Diamond Unknown Total from diamond mines Gold Afrikaner GM Anglo Health Service Anglo Power GM Bambanani GM Barberton GM Bayer GM Beatrix Gold Bernetco GM Blyvoorquizicht Bracken Mines Brakpan GM Buffelsfontein Gold City Deep Consolidated Main Reef Consolidated Mod Consolidated Mur Crown Mines Daggasfontein Deelkraal Doornfontein Durban Roodepoort Deep East Driefontein BLACK 0 0 1 8 1 1 0 0 0 1 1 2 0 1 0 0 1 3 58 1 1 0 3 1 0 6 3 4 0 1 8 6 0 22 0 0 0 16 0 3 52 0 0 0 1 23 0 0 0 0 0 0 2 0 0 60 WHITE 2 2 2 1 0 2 1 3 1 0 0 0 1 1 2 2 1 0 55 0 0 1 3 1 2 7 1 4 1 0 1 4 1 12 1 1 1 0 2 0 9 1 11 3 3 23 3 1 1 1 1 2 7 13 11 17 COL OURED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 4 0 1 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 UN KNOWN 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 TOTAL 2 2 3 9 1 3 1 3 1 1 1 2 1 2 2 2 2 3 114 1 1 5 6 3 2 18 4 8 1 1 9 10 1 34 1 1 1 16 2 3 61 1 11 3 4 47 3 1 1 1 1 2 9 13 11 78 22 MINETYPE Gold (continued) LAST MINE WORKED AT East Geduld East Rand Prop Elandsrand Ellaton GM Evander GM Fairview Mine Freddies Gold Free State Geduld Free State Saaiplaas Glenhavy GM Goldfields Groenwater Asb Grootvlei Prop Harmony Hartebeesfontein J.I.C. Gold Mine Joel Kinross Kloof Kopanang GM Kuikenspoort GM Leeudoorn Leslie Libanon Marievale Masimong Gold Mine Merriespruit GM Motjabeng GM Naledi GM Oryx Placer Dome GM President Brand President Steyn Primrose GM Rand Leases Rand Mines Rand Refinery Randfontein S A Land Saaiplaas GM Sallies Savuka GM Springs GM St Helena State GM Stilfontein Target Gold Mine Tshepone GM Ubuntu Small Scale GM Unisel GM Vaal Reefs Ventersport Village Main Reef Virginia GM Vlakfontein Vogelstruisbult BLACK 0 2 2 0 34 0 28 2 2 0 2 0 1 153 74 10 12 8 60 0 0 12 0 11 0 14 1 9 1 27 27 0 37 0 0 0 0 5 0 0 0 0 0 38 1 0 1 8 5 0 223 0 0 0 0 0 WHITE 2 22 8 1 2 1 5 13 5 1 4 1 6 15 18 2 0 5 23 1 0 3 2 14 6 1 1 0 0 0 0 9 11 1 3 1 1 21 2 2 2 1 1 6 0 11 1 0 0 1 45 8 1 3 3 2 COL OURED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 UN KNOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 2 24 10 1 36 1 33 15 7 1 6 1 7 168 92 12 12 13 83 1 2 15 2 25 6 15 2 9 1 27 27 9 48 1 3 1 1 26 2 2 2 1 1 44 1 11 2 8 5 1 268 8 1 3 3 2 23 MINETYPE LAST MINE WORKED AT Gold Waterpan GM (continued) Welkom GM West Driefontein West Rand Consolidation West Witwatersrand Western Areas Western Deep Levels Western Holdings Western Keef GM Winkelhaak Wit Nigel GM Zandpan GM Total from gold mines Platinum Amadelbult Platinum (Rustenburg) Atok Platinum Bafokeng Eastern Platinum Impala Platinum Karee Platinum Lebowa Platinum Madikwa Platinum Messina Platinum Northam Platinum R.U.C Platinum Rustenburg Platinum Swartklip Platinum Western Platinum Zondereinde Platinum Total from platinum mines Cementation Cementation Iron Boshoek Iron Mine Fluorspar Vergenoeg Mine Maandaghoek Iron Sishen Iron Mine Thabazimbi Iron Mine Iron & Associated Manganese Manganese Minerals African Rainbow Minerals Manganese Hotazel Manganese mine National Manganese S A Manganese Phosphate Foskor Beperk Quarries Hippo Quarries Quarries Mines Silica Silicon Smelters Sinkers Shaft Sinkers Steel Highveld Steel and Vanadium Steel & Iron Iscor Tin Rooiberg Mineral Division Vanadium Rhovan Vanadium Zinc Maranda Mine Zinc Corporation Non Miner Industry Non Miner BLACK 0 2 42 0 0 12 50 11 0 2 0 0 1 086 WHITE 2 2 21 7 1 19 29 13 1 3 3 1 512 COL OURED 0 0 0 0 0 0 0 0 0 0 0 0 3 UN KNOWN 0 0 0 0 0 0 0 0 0 0 0 0 1 TOTAL 2 4 63 7 1 31 79 24 1 5 3 1 1 602 51 90 10 10 123 20 01 22 01 02 90 10 191 27 12 24 15 1 360 61 07 01 01 31 10 01 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 6 9 1 1 143 1 4 1 2 9 1 219 3 6 16 422 7 1 1 4 1 1 1 40 3 10 10 10 20 10 02 01 30 01 33 0 27 01 10 10 01 52 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 43 1 1 1 2 1 2 1 3 1 6 27 1 1 1 1 7 4 24 MINETYPE Unknown TOTAL LAST MINE WORKED AT Unknown Lime Acres Concor Plant Min BLACK 41 1 1 1677 WHITE 35 0 0 763 COL OURED 3 0 0 50 UN KNOWN 27 0 0 28 TOTAL 106 1 1 2 518 25