Document EdLK7XRgrjvGZqLEjQ6xX0B6L

CATE OF REQUEST: 4/3/87' NOT NEEDED AFTER: INTERLIBRARY LOAN SCHOOL OF VETERINARY MEDICINE LIBRARY LOUISIANA STATE UNIVERSITY BATON ROUGE, LCUISIANA 70803-8414 .n/o V- XXXXXX Mail request Fax request DATE SENT_ DATE DUE__ PANAFAX NO. (504) 346-3295 FOR USE OF: Leila Hopewell STATUS: DEPT: PERIODICAL TITLE, VOL. AND DATE OR (BOOK AUTHOR) JOURNAL OF OCCUPATIONAL MEDICINE. Vol. 16, 1974. /tyP/ PERIODICAL ARTICLE AUTHOR, TITLE, PAGES OR (BOOK TITLE, EDITION, PIACE, Tabershaw, I.R.;Gaffey, W.R. : Mortality study of worker* in_the manufacture of vinyl chloride & it* polymers. Pg. 509-18. NOT SENT BECAUSE: ( ) TN USE VERIFIED: im Vol. 15, 1974. pg. 2967. ( ) NOT OWNED ( ) OTHER LENDING: LIBRARY LU-M DATE RECEIVED_ a DATE RETURNED Request complies with 108(g)(2) Guidelines (CCG) ^jlL ocher provision of copyright law (cct) FROM LU-U 04/01/86 AUTHORIZED BY? TITLE 09:18 P. 3 .Turfy Blarlreh.jr -ILL. TOTAL P. 3 25000001 5,>n SfSSS&u*BE PROTECTED Journal of Occupational Medicine OOWi August 1974 Vol. 16 No. 8 Mortality Study of Workers in the Manufacture of Vinyl Chloride and its Polymers* Irving R. Tabershaw, M.D. and William R. Caffey, Ph.D. Animal studies have shown that inhalation of vinyl chloride produces in rats angiosarcoma of the liver as well as cancers of the lung, kidney, skin and other sites. Although workers in occupations involving exposure to vinyl chloride have been found to have an increased risk of hemangiosarcoma. no excess of other cancers has so far been reported. This historical prospective mortality study of 8384 men who had at least one year of occupational ex posure to vinyl chloride before December 31, 1972, demonstrated that cancers of the digestive system (primarily angiosarcoma), respiratory system, brain, and cancers of unknown site, as well as lym phomas. occurred more often than expected in those members of the study population with the greatest estimated exposure. The mortality from other cancers was lower than that of the general male population, with the exception of cancers of the buccal cavity and pharynx. There was an excess of these cancers, which however was inversely related to estimated exposure. The explanation for the fatter finding is not apparent The other major findings of the study are: (1) The overall mortality of the study population was ap proximately 75% of what would be expected in a comparable population of U.S. males; (2) No cause of death showed a statistically significant excess over what would be expected in a comparable U.S. male population; and, (3) No deaths identified as angiosarcoma of the liver were found other than those previously identified. This is the first epidemiological study which suggests that in humans vinyl chloride may also be associated with cancer of multiple sites. On. r*b*h*w nd Gtffry *rv from Tibvntuw-Coofm Aifo6M. toe. Suit* XI8, 6000 Exitculfv* Rockville. MO 20052. * the rc-*rch oa which th report it bdv*d wit supported by 4 Rroup comperor* endued ,n 'vnrhei* jndTor the putymenufton ol vinyl chlonde. 4ftd Aimnniered n thew birfulf by the Mjnuftctunny Qwnms AMQcudon of Occupational Medicine/Vol. 16, No. S/August 1974 GOC 002123 u? o o o5 509 fco Vmyl chloride m its manufacture and polymerization has been identified as a narcotizing agent,' as a liver toxin,1 > and as a vasospastic agent producing a specific occupational disease. acrooiieolvsis.* Recently, virrvl chloride has been incriminated as a carcinogen producing in a group of workers engaged in the manufacture of polyvinyl chloride a rare fatal liver tumor, hemangiosarcoma.5 Urge doses of the chemical in rats reportedly produced cancer of the skin, lung and other organs.4 Unpublished but public in formation7 indicates that inhalation ex periments with rats in doses easily reached in manufacturing operations produces in addition to angiosarcoma of the liver, skin, kidney and other malignant lesions. The present study, however, was not restncted to the conditions and sites suggested by the above investigations, but concerned itself with the entire spec trum of causes of death, to the extent permitted by the size of the study group. The objectives of the study were: (1) To compare the mortality of individuals who have worked in vinyl chloride plants with that of the general population; (2) To compare mortality patterns within the population of vinyl chloride workers, based upon estimated occupational exposure; and (3) To com pare mortality among vinyl chloride workers with the morality of other oc cupational groups. The study population consisted of in dividuals from 33 plants who had worked for at least one year in a job in volving exposure to vinyl chloride before December 31,1972. and included retired and terminated as well as active workers, for each such worker the date of birth and an employment history were obtained, and the vital status of the worker as of December 31, 1972, was ascertained. For those found to have died, those death certificates that were available were obtained and the cause of death determined. The observed mor tality was compared with that of the United States male population. particularly those producing the monomer, this determination could be made on the basis of tob titles. Usually, however, exposure was a function of both job title and the location of the job in the plant, so that the assessment of ex posure had to be made on a case-by case basis by plant officials. Data were collected for as far back in time as complete records were kept. In most cases this covered the entire history of the plant. In others, records were kept for a fixed period such as a decade. In a few, records were kept for different periods, depending on whether the worker had died on the job or had left employment. In most plants it was impossible to quantify exposure. However, industrial hygiene and safety personnel in each plant were able to identify certain jobs and locations as involving the highest exposures in the plant, and to classify other exposures as medium or low relative to the "high" represented by the jobs with the greatest exposure. Con sequently. each exposed job in a worker's history was scored 1, 2. or 3 to indicate low. medium or high estimated exposure. This gross classification has two major failings, as a result of the subjective nature of the estimates. The first is that the scores represent estimated relative exposure within a given plant. It is therefore possible that, in objective terms, a "high" score in one plant corresponds to a "medium" or even "low" score in another. The second is that the scores usually do not take into account changes in exposure over time. A worker with long service may therefore have had jobs in the remote past which involved "tow" exposure relative to other jobs at that time, but which might be "high" in comparison with current exposures in the same job. This subjective classification is therefore of questionable validity in characterizing the exposure of a given worker, for epidemiological purposes, however, those who have high scores can reasonably be expected, on the average. to have had ihe greatest exposure those with low scotes will have least, even though the true exposUrfl>V each group may vary considerably (r "* person to person r'v>l The estimated exposure history 0f worker was summarized by calcuij,** an Exposure Index (1). This by multiplying the number of montt*"** each job by the exposure score. tonii"*' these overall exposed iobs. and div,^ by the total number of months q( ^ posure. ^ Follow-up of Study Population A follow-up procedure was mstn^^. for those who had left employment Jvj whose vital status could not be de,,, mined at the local plant, using <jlrer, mail follow-up and retail credit burn investigations. Table l shows the v,u' status of the population as of Oecemo. 31. 1972. Follow-up is 85% compi*.. Those who were not found were txy(and began their exposure)- about years before the group on which folio* up was complete, and had about ly. the duration of employment in expose jobs with a slightly higher El. Aithourthere appears to be nothing very unusua about this group in terms of work history and exposure, it is nevertheless true tty their exposures took place further back in time than that of the group 5u( cessfully traced. It is therefore possitx* that their mortality, after a substanna latent period, might show a somevstudifferent pattern from that of the traced group. All of the subsequent analysis is co" cemed with the 7128 workers on wlyyfollow-up was complete. Table 2 shews their distribution by duration of expose? employment and the year in which thr employment began. Although tlmo half the study group first entered n posed employment in 1960 or late there are nevertheless 854 workers 20 years or more exposure, and 164" with 15 years or more. Table 3 shows ttv relationship between duration of posure and El. There does not appear tbe a close relationship between the f- Data Collection In each plant, data were collected for each worker stated by the plant management to have been employed for at least one year in a job involving ex posure to vinyl chloride. In some plants. 510 Mortality Study of Workers in Manufacture of Vinyl Chloride/Tabers, r tn. jd. (*he duration of exposure, that is workers with a higher El do not differ .UHtantially in duration of exposure -t>m those with a lower 1. One im; .cjtiod is that in assessing the relation' >.Sp between mortaiity and exposure. s<n duration and level of exposure can V examined separately, as well as in i mbination. Calculation of Risk of Death (he risk of death is expressed as a Ojndardized Mortality Ratio (SMR), hich is the ratio of the number of (nerved deaths in the study population vs the number of deaths to be expected n a comparable population of US. males. SMR's were calculated for overall mortality and for 33 major cause groups. Table 4 shows observed and expected A-nhs, and the SMR, for each of these ^ rauses For the total study group. In tabulating the SMR's for specific cause*, t* 24 deaths for which no certificate* ere found were assumed to have the >ame cause distribution as those for Ixch certificates were available. In the standard population, each SMR ould be equal to 100. Therefore, the viistical significance of the deviation of "ch SMR in the study population from ** stpected value of 100 was tested.* A wsgle dagger indicates those SMR's |l *Neh differed significantly from 100 at " ** 5% level, that is, which had a 3'ndability of .05 or less of occurring by '*"nce- A double dagger indicates those hch were significant at the 1% level. * ' based on fewer than five ob- cases were not tested lor `tf'Scance. r*ble s shows the same SMR's for nrVers with an Exposure Index below xersus those at 1.5 or above. The . Point of 1.5 represents a level "**> between "low'' and "metfium." | 6 shows similar results for with less than five years ex Titm 2. -- HstriMiM 4 Herts i tom** Imttrrmmt Sr Tssr it NMc* Eotnrt Itfn, tor 1121 nyt CMonts Milan tits CmuM*4 fatlotsio. Tm 0*. Start* i9n 19*049 19S0-S* 196M9 1979-71 T*4 Tot* rtt 3i 2 1041 135 IH2 iw 3JU 1714 71S 715 nn n to-tu 4 M 257 1442 129-171 1 119 313 195 tftte f Vmmn \mn 24+m 46 151 m 431 in 3(9411 13 5 w 34 TOIT* 199 50 25ft 39 ttafcMVf 2 20 17 39 posure versus those with five years or mote. In order to examine the possible in teraction between duration and level of exposure, the study population was divided into four groups on the basis of both El (low vs high) and duration of ex posure (short vs long) using the same dichotomization as Tables 5 and 6. Table 7 shows the results for short ver sus long exposure in the low El group, and Table 8 shows the same comparison in the high El group. In each of the above tablfes, deaths for which certificates had not been received were assumed to be distributed as a uniform percentage of all causes. The cause specific SMR's were therefore ad justed upward by a percentage which varied in each subgroup. Results of Analysis The overall mortality of the study population is statistically significantly lower than that of the U.S. male population. There were 352 observed deaths compared with 467 expected, for an SMR of 75. Table 4 shows that no specific cause of death was statistically significantly greater than expected. Several, par ticularly heart disease, accidents and "other diseases" not detailed in the tables, were significantly below their ex pected values. When the study population is divided according to intensity and duration of exposure (Tables 5 and 6) and com binations of these measurements (Tables 7 and 8) three major patterns emerge. For malignant neoplasms as a whole, the SMR increases with increasing ex posure. whether measured by level, duration, or both. In the high exposure group with 5 years or more exposure (Table 8) there are 36 observed cases and 26.11 expected. For cardiovascular -- renal diseases as a group, there are also increases in the SMR with increasing exposure, but the numbers of observed cases remain less than expected, the differences being statistically significant in all groups ex cept the high exposure, long duration group in Table 8. For all other causes, there are no con sistent relationships with exposure. Within the malignant neoplasms, the largest (although not statistically) significant SMR is in cancers of the buc cal cavity and pharynx, with five ob served, 2.84 expected, and an SMR of 189. However, Tables S to 8 show that all these cases have Exposure Indexes below 1.5 and four out of the five have less than five years exposure. Table 10 is a listing of these deaths with age at death, duration of exposure, and cause as stated on the death certificate. Cancer of the digestive system shows Z 50Gi)004 TalM i -- Da. m4 4 rt TUt Majt OM* Mars Of *1 taint Ceslafit ef fean a taw '*U u* ~ has EM H* mu tion asr (ion im < a* t mi tut 1210 (*)> an (so nan ht ita on m ton 12M0S) I2M2I ht m nn a (in won 1US is mi on won won itom si 7 (7) m on W ID WHO a utn l (SI mm *** Occupational MtdicineAol. IS. No. 8/Aupnt 1974 MMU HI torn a o> 8 0) -- a a in 511 GGC 0002211 30 TtM* 4. -- OtumO Orithj ini StaitfartoW Uartality tttws i* CJW*ii Warfttrt. ^ 1' Cat M Out* ** IC.9. ***** U CMMI 352/417.21 TutarntoM (OOt-OtJ) M mwitanr iptm <001-000 1/5.71 ----175.34 " fcUiitnwt Mopmm* 114C-2Q5) WihftMt MttitMK. toct* MX ((40(44) MjiifiMt Mwtoms. 4i|str* rpfi) a*# ptntOMviw (ISO 139) M*iifum nwgiuon. 'nifo*v *r*t* (I90-IS4) MattptMt ixoodwu. jrnttii orpws (170-171) Mtliftuit fxotiium. *0*1 MSO-ltl) hUhgnnt ito*ittm. im *4 wuMofai vtn (190 199) (.*** Mi MtthcAeg (204) lympRomts (200-203. 205) OiiMo mtMitvs (2(0) Min* eariimscvur v4 r** 4um* (330-334. 4004R 592 394) Vnc4r Itsxns *en CAS 030-334) IttmmtfK knf A tikrmc i*mwuk Kurt dti. (400*402. 410-4IS) ArtvNKMrrt* <N*t 4t*UU (420) NiwrkMMMic Mitariitrt (*?I. 422) Hwirtimw Mart SiittM (440443) OtlMr kmnmHn*1Stkat (444447) Chtofttc A ftcoftrtm A Klrm (392 394) 71777.lt ---- 5/3.M 118 13771.S7 75/73.13 ** 3/3.55 " 1/3.50 *' 17A1.75 * 3/3.77 H ______w__o_t ____________________ lo11t _ _. 1557707.0 13/74.41 S* 17MI7J3 15.51 M.J3 3/7.M 0/4.77 --- InflMwai m iw*wmh (410493) S4.H ~ir~~ Uk* * Avne* Mi <Mdmm* (340. 34!) DWotn (550-551) . O/D.tt ^ , ~~ Hew Mi MtutMUi rtaWKtm (SM. SCI. 570) MM ,, Gstnta. tmdwitn. M awtn (SO. 571. 5771 171.11 a Cirrtam 4 torn (Sit) MS.tO n of pUU (SI01 ML31 , -- S/Wftafu. wiliti Mi if-itlMi n*irt>Mi (790-793) 1AJ4 ;j M rttar Siwna (nsOul) 21/45.71 4,T~ Mat* tMtcM scaittts (110435) 1702.79 st > On* icaiwh (100403. S40-9SZ) 11/30.14 u Svid4t (SS3. S79-171) 11/ltJ! IK Homo* (914. 9S0M3) im.M ) * <4 ***! PlTMHHn 712S TTM ' StBTt rttntM 'tor Mans Mt am i no excess in the study population as a whole. However, in those workers with an El of 1.5 or higher, there are 12 ob served cases where 9.14 are expected (Table 5). In the subgroup of the above workers with five years or more ex posure. there are 11 observed cases and 7.47 expected. Respiratory cancer shows a slight ex cess in the total group, and a similar pat tern (or different exposure categories, with 13 observed versus 10.28 expected when the Exposure Index is 1.5 or higher, and 12 observed versus 8.50 ex pected when, in addition, the duration of exposure is five years or more. 512 Malignant neoplasms of other and un specified sites show an excess in the total group, and an increase with both level and duration of exposure (Tables 5 and 6). The relationship with exposure is more pronounced, since those with ex posures of less than five years have fewer cases than expected. The lymphomas, although occurring at about the expected rate when the whole group is considered, are concentrated almost entirely in the high exposure, long duration group. In that category there are four cases observed and 1.84 expected. Cancers of the genital and urinary organs, and leukemia, have fewer caw^ than expected. The number of case* itoo small to examine any trends. 3 5 % Discussion The favorable overall mortality of it study population is a phenomenon com monly observed in working population- 4 ' standardized Mortality Ratios in the lm> 80's and below have been found* * Even in occupations with well defini-rf hazards which cause an increased "i, from a specific cause, the overall moj tality may still be favorable because txJr the low risk from other major cause* death, frequently in the cardiovascuirg -- renal category." tnMortality Study of Workers in Manufacture of Vinyl Chloride/Tabetsha*. GjKeO OOC TM 1 -- OkurtW OaitlBiCawM tata *< Rjn4gf4i4 XrtM titioa ia may* CMri(t Xalm. by EstiauM Ut4 oI Cuama. Cm 4 0t* ** VC.9L ft* a<u Oil) u tmm faMieuMsa (001 013) UMrcvtasts it 'B&intom tntw* (001001) nwuvnt (140 205) UritpMrt iwMittf*!. ducal arty >nft oftimi (1*0-1**) UtiipMl t*oo>utn. dtftslm v|*is \ 150-1 Hi OHipmi rnputor-r sysxm OM-IW) woouim, pmtH pns U 70-179) Moouunt. uonwy vpw (IKMIl) iNHMtfM. ti unjp*af*4 urn (190-199) IMU 1m Mini (23*1 IflfB (200-205. 205) ofa.ii* 1IL278.U Mil 0/3.14 37/4471 5/1 U M2.50 lt/tl.54 2/2.30 1/2.57 9/1.57 1/111 1/3.U SMI* A* 0 5 90 330 ar $4 93 51 1*4 19 31 OfaAl* 137/29111 Mil 5/2.13 41(32,57 ds\2l 12.9-1* 13/1078 m.43 0/1.52 1/452 2/1.57 5/2.5* 3MB* M* a 9 13* 0 Ut 135 75 (1 190 134 212 mtMfa (260) few *4 rout ftwuM (330-334. 400JU. 392 9*) fwaut Iomri jflww* CHS (330-534) ItaMUbc 4 cftramc ffa*inc fairt 4i*. (*00-402. Artmtfaqu hum *im> (420) mhm Mccuatu (42). 421) *1WW feat tw> (44*443) Mnr IffMwwi dttfiM (444447) rtrwc t ihmM ntunth 1 rm uunut (SS2 5541 5/3.45 54024.11 7/14.42 3/3.M 5*72)4 5/4.20 LA.U t/I.52 MM 1*4 n si * m n 9 11 m 9 Z/7.65 ssdtn 5/10.01 mss 51A1QS 1/2.0 2/ltl 2A.07 0/1.77 81 15 ' 44 75 95 54 20t 0 Mwan ax pommi <4*0-4*31 <* * ua M AnMmn (540. 5411 SABO 1/221 92 0/4.13 a I/I.W 0 48 Swtitt (55*553) "ns mt XtfncMn OU. 5(1. 5IP) 0AJ9 ojo 0 M77 0 0 LP.U 171 kn nxnm. mmh m* an (S4i 521. std OnWM a 'em (511) WOii a aam (nai 'mil. art* mt 114M MOKM (2I7IS) * * 4B (oMm.) *0.75 2AM M2S WJ2 14/21.98 i 1A5J 23 1A84 9 QAtl 0 lAOO onus 191 14 0 34 41 * * not xznxi (iiaais) 8/lftM 4S * VU44 72 - "4n (000-001 34*M2) *-- (Ml vun> iim.n n a ' 5/1257 M 7/7.02 50 * 107 "nn (5(4. 93**5) M.M 0 1/4.14 21 h " N5n Mew 4(8 *5394 302 mo ' Manx hr mi 5% Irai '**** It iMt 90000352 view of these facts. SMR's which ** higher than expected may be worthy attention even if they are not ^'tically significant. This is especially hw nT ** p,*,*n* study since the num(i from minv causes is quite Jnd even a relatively high SMR U n* relCh statistical significance. *n Edition, a particular cause ' * consistent pattern of increase V ,**PO,Ur* or estimated exposure. r*dings are particularly interesting, 'bese criteria, mortality from cancer, respiratory cancer, can- cer of other and unspecified sites, and lymphomas, appear to be related to ex posure as defined in this study. In view of the association between vinyl chloride exposure and angiosar coma of the liver, the digestive cancers were examined further to see what con tribution angiosarcoma made to the ob served mortality pattern. Of the 19 digestive cancers, seven were liver cancers, of which two were angiosarcomas according to the death certificate. However, among angiosar coma deaths in vinyl chloride workers identified by other investigators, there were six which occurred in the present study population during the study period. They were all found in the course of the study. Table 11 shows these cases with the cause of death as given on the death certificate. Note that one case was certified as cirrhosis, and was so considered throughout this study, since the validity of comparisons with population data required that cause of death be 'determined only from in formation on the death certificate. The other five were correctly classified as ot Occupational MedicmeiVol. IS. Mo. 8/Aujust 1974 513 GGC 00213: -- isemee Tab* 5. -- 0b*m5 Daatto&wctM Otatla Mt SUn*tf#in* Maatalit) *#* in Wyl CMuiU Hactaia by OwatiM at Eipew* Emalny*,^ tn * Dart* wife* Itft. to AM CttM Tufecrcutaus (001-OH) TubffcBtaas at mwiun tnttm <001-000 MihCRMt Mptum (1*0-205) MiHfani waatwm. fence* c**rfr M ttttryn (1*014|) UikQtMt MfOsn, feifMift grpi N pvtemv* (ISO-159) -town. rtww**rj spun (IM-tfeA) Mifeyto wntmn, fwrt* vpn (170 179) MikfmK Maoism. *mnj vprn (Itt-lll) mofttvn, to to vmeacsto win (190 199) Inibaai* IM Hntowi (JO*) lytotoMi (200-203. 205) Oiafectn iilHw (210) aw catowucato an* final taauu ()335. 100-153 552 555) inaim femn aMton CHS <33 334> Jttomfeit h*cr 4 c*nm ^wn tori fen. (400402. 410-felt) l/tanuctotoc total tuun (525) NoMtMMkabc wfetQfe(ii (421. <22) hurt femes* (440443) Otto Ipfewiw ferwnt (444447) Ctoonic 1 wiwcia< aaatoits 1 ml idtmn (552554) < H nanns (Mm SHI* 9444033 47* 0/7.23 a?o; 0 0 13/13H 4*70 7/521 3/5.52 0fl.S3 04)43 2/3.40 1/3.35 1/2.01 71 Ul a (3 0 0 71 90 to ?n 134 24/51.45 4/5.17 2/2.31 71/32.54 o/i.M 1/2.42 0/0.79 0/1.55 * tl 101 71 * 0 49 0 0 L M nnafto Otetx* 251/129.31 0/3.55 0/3.33 S5A7.il 1/2.15 17/11.55 71/11.51 3/2.75 1/2.79 15/1.23 2/253 5/4.07 5/451 125/157.35 mm 3/5.55 SM05J3 1/3JS 2/7.01 3/1.12 0/2.74 SM* 71 * a nt 4) 101 US 112 11 117 tl 125 tl) II *9* SI % 20 30 170 0 Inftmut Mfe to--m (440493) 3/2.53 123 2/7.05 29 liter * totoh to 0Minin (540. 541) 1/1.07 112 1/2.74 37 tomdnto (55DW3) Ort-25 0 M.43 0 Hm to ***** flMnctoi (5M. 541. 570) 0.52 0 1/1,10 93 Cactnot. toatontv Manta wt atitu <511 571. 577) lfl.5# 301 04.92 0 Cutton * tor (511) 1/0.4* 25 7/11.1S II ******* * toU (010) M.07 0 0/0.33 0 Sintunt anility Hi iH*a**a* anlmani (110-735) 1/22* 53 0/5.03 0 M ata *taam (mtutn 4/31*7 IWI.35 S3 ? Mat* aMa acaaana (51W35) 10/14.14 75 7/15.55 43* OOm icntmn (NMR. 14*30) 7/12.3* (5 10/17J2 5* * SwcMa ML 37*573) %AM 114 1040.21 too H--oto (3b*. N5) 1/5.10 20 0A20 0 to * tote* 7--nyaaa 2955 34201 4134 4C SM I afenia* to tun* < out utoan. tSifniaU H 5* In* Sifnfcaat it li Into S iOOOOOSiJ 5H Mortality Study ol Workers in Manufacture of Vinyl CMoride/Tabershaw, rjTii: 0021' Tablk 7. -- flbn0 OutftiiCisKttd Duns iflO S&ndi/OijtO NorU/iTr Kite ' Vmjt CMa/iM Wo/tara >itli Eigouart InOicis Siltrm 1.5. St Duration 06 Expo*4 Emotormant Can * Outk writ IC-D. In. 4 Cmm> fdMrcutow (0010191 Tvbwotiom & mewtorr rrstM (001 OOt) HalieiMl mWaam (140-245) Hihfim nm. tact* (Ms wtf dutrai (144 146) Men* imattan. *tt*m grpa* aM ntiImms (ISO-159) OalipM MwiauM. rnciranrv ir#M (160164) ValilMM imtksau. iMit* van (170-1/1) tftfiptMi r*o#***mi. undarr vpM <180-181) Kakeum Montana. om> aM wanM uta (190-191) Intmt mo (MOmu 1244) Wmoa (204203. 201) ta*4* mMb (2(0) m OfOMnaoiW M ra* tarn (334334. W-U*. 1)2 554) ViM* Mow WhOMO CM (MUM) tMMK km ( ttran Mo kart fit. (404402, 410410) ktom&tm kart Oman (420) Imkonnn inQac*0iBi (421.422) kart Oiuaa (440443) War frwrtwiiw dncm (444-447) Cknnc 0 mwoM k*u 1 <tM teuton (552-514) '"win MO 4MMXHU (4*0453) "* <4 rtMUtk M* 4M0MOM (540. 541) NwMiulia (550553) '*' aM Mtotml *OMW (560. Ml. 570) OwOmOh. atarite aM cakM (5*). 521. 572) crtow 0 In* (511) *,*i*"" <4 unman (61*) naiMy aM OMOmO tnWni (750-755) - ** **" 4i*Ma (noMoa) " naOon (HOW) * "* (MOOtZ. MOM2) 1963 970575) --l***0* (554. H0-MS) ^Virt* **** (8 Mantto OHfi* 1M* S4/W-23 0/U1 Q/Ul U11W 4,0*5 1/143 2151 08(9 0/0.55 1/0.57 00.75 0/1.24 2/us 2173138 2/153 2/150 1S/2U4 0A.il 1/15* 00.54 04)52 3/1.55 00.4* M.1S 04.22 40 25 1(2.14 00.05 0/1.43 4/7.45 1/5.12 S/7 98 1/4 41 4/3 55 U* 9 0 n 1031 34 9 9 120 9 0 243 73 * 55 155 n 0 74 0 0 in 0 0 0 4 42 8 0 u 35 a 10 Q 1215 2141* 1.60 Mm(a Eimwa OtvCa SMI* 132AI1J* 0/1.97 9A .15 29/31.44 I/I.17 S/108 9/19.00 m.iz m.si I/4.4J 1/1*0 1/223 1/150 1X44.12 5/14.51 1/165 52/52J2 0/3.02 0/3.10 IA.0Z M.U 2/3.95 IA.U 0/0.24 0*11 010.11 1/1.05 00.20 9/2.79 19A192 5/5,22 1/505 6/UI a/14) 71* 0 0 95 N U 93 122 62 1K7 73 41 124 75* 45* 41 93 0 9 101 0 53 67 9 0 9 IS 0 9 79 54 61 109 0 1112 23928 *kam M aan M> can imhmm. 1% W*L SOODOOSZ . '***! #< 0upatioMl Medicine/Vol. IS. No. 8/Au|ust 197* GC 0021.54 515  T | TtM* t -- Okwntd DtiBo,titttd Otitta m Sta*4irdi4 Mortlrtr lititt in n|t CMtridt Kxtin rt Cspaurt Mot d 1.S V Ciutti, 0) Ouritx* d Eiyaad EmpMyatnL 1 1 j ] Can V 0n *M Ittl Iv u cm TvkcraiMM (001-019) rvtwtawvt it ntydvy wan (001-00*) , unymi utility (HO20S) Vtlywl i--my tactV mu ad tuny (140144) HtHfttai TOioim. tyfim vpn M ymt USOlSS) MahfM* --imm. rvumtanr tram (IW-ltt) Utlyy MttttiM. ym van (1/0-175) UrtfiMf watl--i. **> arpM (ltt-111) HttaMnl ttotltivi vtv Md vnnatM na (1S0-1N) UMvit md twMn (201) Irmtvnt (200203. m> BiMMt vttn (240) 1 thy cvdyucdv Md M mv (330334. MWtt. 5525*0 Kmfcr hvtn May CHS (130130 -...nil Imr 4 dran niitw Hurt tit (MMOL MM14) Mvydvd* Mart tatat (00) avvttfii vtitv*at (i2i. tin Hyntnnt bty turn (44044}) On* l|)irtwiw 4imn (144447) (Mi o imn*M wm t wt tawM (sn-sat) Mlaatis la* tmmmm (440493) Uk* 1 tfaaacfc m4 4mtmm (S44. 5*1) Hut*not (SSOSB) H*a* Mi j**OM< mm* (M#. 941. 570) MH. OMM, mm at cM (SU. S/1. $72) Cintyt d Ml (Sll) : Monday d yahh (tit) . Tyahvi. aaday tad land caMm (TOOTS) 41 atfe* tmmm (miM) : Ody KM (RIC MOK) SwM (ML noun Maadddt OM. MOW) i*. * nan** f**> )*rt < IS liatlt (span Mute ir* 9x47.93 fl 007* 0 00.71 0 SAS7 94 Mi) 0 1/1*7 74 1/1.7* 71 Mi) 9 M.n 0 t/uo 107 1A /n vt.n in MS) 0 mist S4* 2/1J7 IS (M)J2 0 5/10.41 41 QAS7 0 041.71 0 Mi) 0 MSI 9 MJ9 0 IAS 342 MM 0 MM 0 1A1I 404 MM 0 M0I 0 1AM 151 MB 0 /AM 144 4*73 107 3)2.4* 154 1/2.11 51 1140 iant -* "A* /my. Ota/t* Oh- 11IA47J1 TP " On.S/ MM 3Mt.ll 00.99 11/7.47 ISj 12A.50 1/1.41 on.24 144 7) 7/3.51 in.i) 4/1.49 704 90 222 2/2.04 111 ` 2/70.44 4/119 2/7.04 44/47.43 1/2J2 2)3.10 20.11 0/173 14 " 54 100 n u tt 213 0 aa.13 4 MiS 1 MI.19 1A4) 70S 04.41 1 (AM 04.13 9 WJ0 0 sniii 51 * 2/7.43 a 2/7.54 25 474.(2 tt M.74 0 1117 19315 Start it|iitl tv ttdto Mk cmm aMt tSifiifcM V St Irat lififcvl V It Ind. I I 516 Mortality Study of Workers in Manufacture of Vinyl Chloride/Tabershaw. Gi*v ooc eOQOQOQZ OTOQQQGZ liver cancer, but only two wspecilied as angiosarcoma If there had been no angiosarcomas, the number of deaths c'asvhed as cirrhosis in this study vsculd have decreased by one. anc :-e number classified as digestive cancer would have decreased by five. The pattern of duration and intensity cf esoosure in these five cases was such tra: if they had not been present there wouic have been no relationship between essosure and digestive cancer. The mort*"tv pattern in this cause group is therefore attributable to angiosarcomas of the iiver The other cause grouo worth further investigation is cancer of other and un specified sites, both because it is a heterogeneous category and because it seems, unlike the other cancers, to be more related to duration than to level of exposures. Table 9 shows a list of the specific causes included in this category, which is essentially brain cancer and generalized cancer with primary site unknown. About 40% of the observed deaths were due to brain cancer. In the general male population, about 22% of this category is due to brain cancer, so that not only is the mortality from cancer of other and unspecified sites excessive, but brain cancer is overrepresented within the category. The possibility exists based on the lack of specificity of some of the listed causes that some of the brain cancers were not primary, but metastases from another unidentified site such as the lung. The cancers of the buccal cavity and pharynx are difficult to explain because of their occurrence in the low exposure, short exposure group. It is possible that this is a chance occurrence, that ex posures to other substances were in* volved. or that the mouth and pharynx may be peculiarly susceptible because of the gaseous nature of the chemical. Possible Biases in the Calculation of Risk There are two major potential sources of bias in the study. The first is that the follow-up rate is lower than is desirable. The second is that observations of workers with long exposures followed by a long latent period are not adequately represented, so that the power of the study to detect causes of death associated with long exposure and long latency is impaired. Populations with such characteristics exist and 518 rM 10. -- ili|Mt NmUmim at Incest Csrity >* nuryu (J40-14S Leo is KM tpiSamMaiy Stotj PaaMas. ' ItUf u ftft It feat* re IamM Cana m kmm 1001 11 1431 # 3001 V 7345 54 3354 M 49 CarcMpau at mi ib hl wa mb (5 r\ 1 30 Mmi (50 mtn) Nkirear? BWm <Carcuomc. ia>rir twtfv* imndiSIt) 71 Matartat* umiww tali u. etiaarf toMft Mutt 40 iwBdtasttiHiA <4 m.1 Muttialc return** to lt*. In* | notastMMim (IfI aatoa reoaama oi uui onaryu i2 yn.) *$tn ktmoertoft mo traeftaa-crat Statvs pm bnfmederyivmipwy. M rWtaf aact 4euactoa N>a4i4kraatita4 ItratreiMt wia off reoreaa af left pyrriorai aw Imre) 4 % re re re T>tf< 11. -- krgituramt Duttu i* KB EpOtaMafy 3Wy NHlillat 1 3Mv Ml <n om Iks (imM i i--, 4250 54 203 Ckrtaitt at lhar (mv. *ha) re 1 <255 to 211 UaaOiaf ImR (3 4an) (lareaao prrHosni re 5785 45 7305 30 7378 52 n>5 43 117 Hapwirraau ft lab* 4 lhar <10 ret) 174 Lire (Met (1 iia.) Caare af lire, preary (15 ret) 23t Cjrtiac tiaawiO *4 aiuai M ifatten* (rere) Niaaty antaatate eniaaarcaau af lhar (4 ere) 214 Mreabc t*re ftmtej t*mm* km re 1 1 ------------ i i i i i re j i should be investigated. References 1. Lester O. Greenbeig LA. Adams WR. ffeeis of single and repeated exposures of humans and rats ro vmyl chloride. Am Ind Hyg AlUK I 24:265-75. 1963. 2. Marsielle* HI. Lelbach WK. Muller R. e< al: (Chronic toxic liver lesions in ihe PVC Ipolyvmyl chloride) -- producing workers.| Otsch Med Woehemetv 98 2311-14 1973 3. Kramer CC. MutcNer It: The correlation of clinical and environmental measurements for workers exposed to vinyl chloride. Am Ind Hyg Assoc / JJ 19-30. 1972 4. Ondton VN. Dtnman BO. Whiiehmue WM. et aI. Occupational acroosteoJysis HI A dmicai ttudv* A/ch Environ Hlth 22:83-91. 1971 5 Creech ft. lohnson MN- Angiosarcoma of liver in the manufacture of polyvinyl chloride. ; Occup Med 16 150-51. 1974. 6. VfOla 71. Bigofh A. Cupuio a f cecgenic response of rat skirt, lungs bones to vinyl chloride. Cancer Res 31 v t- . 1971. 7 Occupational Safety and * ministration Occupational Safety and >u . Standards Emergency Temporary Sunti*- Exposure to Vinyl Chloride. Federal K% 39 (67) 12342-44. April 5. 1974 8 Chang Cl. Standard error of tt* * adjusted death rate. Vira/ Jutisno v- - ffepnrre. 47 0961) pp 273-385 vv 9 llovd NV. Ciocco A long-term m. -C\J study of steelworkers. I Methodology "'<3cup Med 11 229-310. 1969 .O 10. Tibervhi* tCooper Asvociati- published /*% 11. Redmond CK. Ciocco A. llovd Jc HW: long-term mortality steelworkers (V. Mortality om neoplasms among coke oven worker* ju* cup Med 18 621-629. 1972 Mortality Study of Workers in Manufacture of Vinyl Chloride/Tabershaw. Gi