Document KGK35j3mqwoZZQ67yEp2xz2QQ

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 32:s -65 (1997) Proportionate Mortality Among Unionized construction Operating Engineers Frank Stern, MS,* and Marie Haring-Sweeney, PhD This report presents the results of proportioriate mortalig ratios (PMR) and proportionate cancer mortality ratios (PC.MR) among 15.843 members of the International Union of Operating Engineers who had died between 1988-1993. Operating engineers represent one of rhe 15 unions it1 the Bici!ditrg m d Cwistritciion Traclcs Depcir?t,i<nt and are responsiblefor the operation and muintenmice of heavy earrhtiioving equiptnent used in the construction of buildings, bridges. rouds, and other facilities. Usitig L7.S. proportionate cancer monaliq as the referent, statistically significant eler>atedmortulin was observed for cancers of the lung (PCMR = 1.14. 9 5 5 cotlfidaiie in:en?alrCI) = 1.09-1.19) and bone (PC.WR = 2.14, CI = 1.19-3.52). Using L'.S. proportiotiate mortalir: as the referent. statistically significant elevated mortalin. was observed for other benign and unspec@d neoplasms (PMR = 1.54, CI = 1.09-2.13), emphysema (PMR = 1.37. CI = 1.20-1.55). other injuries (PMR = 1.43, CI = 1.20-1.70) (buhich included crushing under/in machinery tractor rollover: run over bv crane), and suicide (PMR = 1.22. CI = 1.06-1.40). The P.MR for leukemia and aleukemia (PMR = 1.19. CI = 1.01-1.37), but not the PCMR (1.07, CI = 0.92-1.23). was also significantly elevated, Some of the occuputional exposures that may have contributed to these excesses include diesel e.rhuust. asphalt and luelding fumes,silica dust. ionizing radiation, und coal tar pitch. The present stud? iiriderscores the need to control airborne e.rposiires to these sirhstances and for inj:cr? prc*iwition rfons aimed at operating engineers in the construction indilts:r;. Am. J . Ind. Med. - 7 3 1-63. 1997. G 1947 \tile!-Liss. hi.. KEY WORDS: operating engineer; construction; proportionate mortality; lung cancer; bone cancer; leukemia; injuries; mesothelioma INTRODUCTION The purpose of this proportionate mortality ratio (PMR) study is to identify those causes of death in excess among Operating Engineers as a starting point for possible prevention and intervention activities. The International L'nion of Operating Engineers (IUOE) was founded in 1896and. from its relatively small beginning, the IUOE has grown to approximately 375,000 members with more than 200 local unions within nine regions throughout the United States (Appendix A). The IUOE is composed of members who National IWtitutefor OccupationalSafelty and Health, Cincinnati, Ohio. `Conespondence to:Frank Stem, NationalInstitute for OccupationalSafety and Health,4676 Columbia Parkway, Cincinnati, OH 45226. Aceepted 17 December 1996 work as heavy equipment operators and mechanics in construction and related industries, as well as operators and maintainers of physical plant systems in factories, office buildings, hospitals. schools. and other facilities. The former are called "hoisting and portable engineers" (also known as "Operating Enpeen." the name used in this study): the latter are called "Stationary Engineers." Operating Engineers comprise more than 70% of the union membership (approximately 370,000 members) and are the focus of this investigation. Operating engineers are those members who, in general. operate and maintain heavy earthmoving equipment such as cranes, bulldozers. graders, and backhoes (Appendix B). This equipment is used in four main activities: (1) the building of roads, bridges, tunnels, and dams (Heavy and Highway, 408 of membership): (2) the construction of buildings and power plants (Building Trades, 30% of membership); (3)the removal of earth materials and grading 0 1997Wiley-Lis, Inc. +Thisarticle is a US Government work and, as such. is in the public domain in the United States of America. 52 Stern and Haring-Sweeney earth surfaces and in the replacement of concrete, blacktop, and other paving materials (Grading and Paving, 20% of membership); and (4) the constructing of drainage systems, pipelines, and other related activities, such as blasting (Pipeline. 10% of membership). (For a more detailed description of the Operating Engineers' duties, see Appendix C.) Because Operating Engineers perform many varied duties, Operating Engineers have potential for exposure to numerous chemical. physical, and biological agents. Often these exposures can be episodic in nature. A survey conducted during 1981-1983 among a representative sample of 4.500 U.S. industrial facilities with eight or more employees (employing nearly 1.8 million workers) recorded potential worker exposure to chemical. physical. or biological agents [NIOSH 1988, 1990a.b; Sieber et al., 19911. The results of the survey by the percentages of Operating Engineers exposed to various agents are available upon request from the author. Some of the potential toxic exposures included diesel exhaust. asphalt and welding fumes. cutting fluids. solvents. carbon monoxide. silica. and various other type<of dusts. Based on these exposures. C ~ U S Z Sof deach h! p c h - esized to be elevated in the cohort included luns caner" dnd nonmalignant respiratory diseases.A potential excess ri& of deaths from skin cancer was also hypothesized due to the 3perating Engineers' exposure to both asphalt and to the sun. Furthermore. excess death from occupational injury was predicted due to the heavy earthmoving equipment used and its potential for rollover. Because Operating Engineers work side by side with other construction trade craftspersons and laborers, whose tasks and work practices vary widely. Operating Engineers may also be exposed to other hazardous materials. Therefore. other causes of death were also examined. METHODS AND MATERIALS work history files were purged; and (2) the number of deaths for which a claim had been filed for 198851993 was estimated at approximately 16,000, which would give us adequate statistical power to examine even relatively rare causes-of-death. The study population was identified from the computerized demographic file maintained at the international headquarters of the Operating Engineers in Washington, D.C. Information used from this file included the member's name, Social Security number, membership number, date of birth, and date of initiation into the union. The information obtained from the work history file included the local unions where each member worked, the time period for which dues were paid in each local, and the regional office of the local. Unfortunately. specific type of work activity for each member was only available, in most cases, from the individual locals and there were more than 3-00 locals representing Operating Engineers included in this study. Obtaining work activity information for each member would have been a very arduous and time-consuming task. Therdore. specific work history information from each local was not obtaincd. From thc death claim file *%e obtained the member's date of death. death clam number, and whether the claimant was actively working immediately prior to his death. The study group included all eligible members for whom a death benefit claim had been filed as well as a few members known to be deceased by the Operating Engineer's local and placed on the death beneficiary file, but for whom a death benefit claim had not been filed by the beneficiary (N = 161). As death certificates were obtained. the underlying and contributory causes of death were coded according to the Ninth Revision of the International Classification of Diseases [WHO, 19771 by an experienced and qualified nosologist. Study Populatiloti Statistical Analyses Our study population consisted of all deceased Operating Engineers who (1) had been active paying dues Three types of PMR analysis were conducted using the members of the IUOE for at least one continuous year: ( 2 ) National Institute for Occupational Safety and Health's were actively paying into the death benefit fund at the time (NIOSH) Life-Table Analysis System (LTAS): one that of their death whether they were currently employed, evaluated the overall proportionate mortality, a second that unemployed or retired; and (3) had died in the United evaluated the proportionate cancer mortality [Steenland et States between January 1, 1988 and December 31. 1993. al., 19901. both using underlying causes of death, and a third Because there were only 13 female members in the file. that evaluated the proportionate mortality using all causes of they were eliminated from analysis. death (multiple causes) as listed on the death certificate The Operating Engineers' death claim file has been [Steenland et al., 19931.The PMR methodology was used in computerized since October 1980 and consists of all lieu of the Standardized Mortality Ratio (SMR), which gives member deaths since 1975-more than 55.000 deaths. The an approximation of the relative risk of disease. because we - Operating Engineers also maintains a computerized demo- did not have information on the entire population at risk. The graphic file and a separate computerized work history file number of deaths in the study population. by cause, was of all its members since 1960.We chose to study only those compared with the number of deaths expected. Expected deaths occurring between January 1. 1988 and December rates were based upon the race and cause-specific proportion- 31, 1993 for the following two reasons: ( I ) prior to 1988, ate mortality experience of the U.S. male population for the all records of deceased members from the demographic and 5-year calendar time periods 1984-1989 and 1990-1994, Mortality Among Operating Engineers 53 c The general characteristics of the study population and lung and cancers of the bone. Leukemia and aleukemia show that of the 15,843 male deaths, only 233 (approximately and cancer of "other sites," which were also statistically Sig1 . 5 8 ) were among nonwhites. Included in the category of nificantly elevated in the PMR analysis, were still elevated white males were 57 of Hispanic origin and 56 of American in the PCMR analysis but were not statistically significant. . 54 W Stern and Haring-Sweeney TABLE I. Observed Number of Deaths, hoportionate Mortality Ratios, and 95%ConfidenceIntervalsAmong Male Unionized Operating Engineers who Died 1988-1993 Causes of death (ICDA-9) ~rvedno.Ofde8thp PMR All causes(ooo-999) Tuberculosis (010418) All malignant neoplasms(140-208) Buccalcavity and pharynx (140-1 49) Cancer of the stomach (151) Cancer of larynx (161) Cancer of trachea, bronchus, and lung (162) Cancer of bone (170) Cancer of kidney (189.0-189.2) Cancer of other and unspecifiedsites (194-1991 Leukemia and aleukemia (204-208) Benignand unspecifiedneoplasms(210-240) Diabetes mellitus (250) Diseasesof the blood (280-289) Mental, psychoneurotic, and personalitydisorders (290-31 9) AlCOhGliSn (303) Diseases of the nervous sys:eni (320-389) Diseasesof the heart ( W 2 9 ) Ischemic heart disease (410-414) Cerebrovascular disease (430-438) Diseases of the respiratw system (460-519) Pneumonia(except newborn) (480-486) Bronchitis( 4 W 9 1 ) Emphysema (492) AsMma (493) Pneumoconiosesand other respiratory diseases (470-478,494-519) Asbestosis (501) Silicosis (502) Diseases of the digestive system (520-579) Liver cirrhosis (571) Diseasesof the genitourinarysystem (580-629) Diseasesof Me skin (680-686) Diseasesof the musculoskeletalsystem (710-739) Injuries (800-949) Transportation injuries (E800-848) Poisoning (E850-869) Falls (E880-888) Other injuries (E890-928) Suicide (E950-959) Homicide (E-978) 15,843 0 4,816 68 124 59 1,915 15 121 339 182 65 272 46 115 25 223 5.6G3 4,580 838 1,700 427 43 240 20 958 1 3 480 179 223 14 39 355 142 12 58 133 206 18 1.00 0.00 1.11' 0.86 1.01 1.24 1.26" 2.39" 1.18 1.151.19' 1.43" 0.90 0.74' 0.79" 0.73 0 8C" 0.W 0.960.95 1.04 0.821.28 1.37" 0.96 1.11" 0.84 1.49 0.91' 0.88 087' 0.87 1.24 1.04 1.05 0.87 0.71" 1.431.n. 0.61' 0.98-1.02 o.OO-o.M1 1.08-1.14 0.66-1.08 0.84-1.20 0.95-1.61 1.20-1.31 1.33-3.94 0.98-1.41 1.03-1.28 1.02-1.37 1.10-1.82 0.80-1.02 0.544.99 0.65-0.95 0.4?-1.07 0.70-0.fZ 0.944.99 0.934.99 0.89-1.01 0.99-1.09 0.74-0.90 0.93-1.73 1.2C-1.55 0.59-1.48 1.04-1.19 0 23-2.16 0.30-4.34 0.83-0.99 0.76-1.02 0.76-0 99 0.47-1.45 0.88-1.69 0.93-1.1 5 0.88-1.24 0.45-1.52 0 534.91 1.20-1.70 1.06-1.40 0.360.96 CI, awrftdence interval; PMA. proportionate mOrtalitV ram. 'P < 0.05. "P < 0.01 v The PMRs in the multiple cause-of-death analysis were Years of Union Membership found to be have similar results to those in the underlying ause-of-death analysis and therefore, are not tabulated.HOW- PMRs by years of union membership, a surrogate for ever, theseresults are available from the author upon request. duration of exposure, examining diseases of specific interest ~ I Mortality Among Operating Engineers 55 TABLE II. Observed Number of Deaths, Proportionate Cancer Mortalii Ratios, and 95% Confidence Intervals Among Male Unionized Operating EngineersWho Died 1988-1993 Causes of death (ICDA-9) All malignant neoplasms (140-208) Buccal and p h m Lip (140) Tongue (141) Other parts of buccalcavQ (142-145) Pharjnx (146149) Digestive organs and peritoneum (150-1 59) Esophagus (150) Stomach (151) Intestineexcept rectum (152-153) Rectum (154) 811iarypiissages, !iver,gallbladder (155.0, 155.1) Liver not specified (156-155.2) Pancreas (157) Peritoneum and other digestive (158-1 59) Resprratory system Larynx (161) Trachea. bronchus, and lung (162) Others respiratoty (160,163-165) Male genital organs Prostate 1185) Testes i186) Urinary organs Kidney (189.Cb189.2) Bladder and other urinary (188, 189.3-189.9) Other and mpecified Skin melanoma (172) Skin (173) Eye (190) Brain and nervous system (191,192) Thyroid gland (193) Bone (170) Connectivetissue (171) Other sites (187.194-199) Lymphatic and hematopoceljc Non-Hodgkin's lymphoma(200-202) Hodgkin's disease (201) Leukemia and aleukemia (204-208) L-eloma (203) a. confidence interval:PCMR, pmportionatecancamwtalii rate. ' f < 0.05. --f c 0.01. clbfvedno.of- 4,816 68 2 17 16 33 1,025 102 124 395 86 67 28 211 12 1,983 59 1,915 9 536 535 1 244 121 123 527 53 22 2 77 1 15 18 339 430 163 12 182 73 PCMR 1.00 0.77 1.47 0.87 0.65 0.76 0.90- 0.83 0.90 0.88' 1.10 0.79' 0.90 0.94 0.71 1.13" 1.12 1.140.62 0.91 0.91 0.56 0.97 1.06 0.89 0.96 0.34 0.85 0.83 0.80 0.15' 2.14' 0.82 1.03 1.oo 0.96 1.17 1.07 0.90 95% CI 0.97-1.03 0.60-0.97 0.18-5.32 0.50-1.39 0.37-1.06 0.53-1.07 0.84-0.95 0.68-1.01 0.75-1.08 0.80-0.97 0.88-1.36 0.61-0.99 0.60-1.29 0.82-1.08 0.36-1.23 1.08-1.18 0.85-1.45 1.04-1.19 0.28-1.18 0.83-0.99 0.83-0.99 0.12-3.12 0.85-1.10 0.88-1.27 0.74-1.06 0.88-1.04 0.63-1.1 0 0.53-1.29 0.10-3.00 0.63-1.W O.o(M.81 1.19-3.52 0.49-1.30 0.93-1.15 0.90-1.10 0.82-1.12 0.60-2.04 0.92-1.24 - among the Operating Engineers are presented in Table 111. category of union membership and were significant-,r elePMRs for lung cancer declined slightly with increasing vated after 20 years. Significant elevations after 30 years as a years of union membership. while PMRs for leukemia and union member were observed for laryngeal cancer, benign aleukemia peaked in the categories 10-20 and 20-30 years. neoplasms, and suicide. With regard to injuries, there were PMRs for emphysema were elevated in each IO-year deficits in risk of fatal falls but increased risks for "all other ! 56 Stern and Haring-Sweeney TABLE Ill. ObservedNumber of Deaths and Proportionate Mortality Ratios for Selected Causes by Years of Union MembershipAmong Male Operating EngineersWho Died, 1988-1993 Causes of death Years of union membership e10 10-20 20-30 OBS PMR OBS PMR OBS PMR 30+ OBS PMR Total O S PYR All cancers 103 1.20 378 1.13 1,357 1.10' Lung 39 1.36 155 1.36- 576 1.28- laryngeal 2 2.30 4 0.80 13 0.97 Bone 0- 2 4.08 6 3.17 Leukemiaand aleukemia 3 0.97 16 1.33 58 1.37- Benign neoplasms 2 2.18 7 1.91 9 0.72 Heart disease 107 0.86 443 0.94 1,543 0.99 Bronchitis 0- 1 0.39 12 1.46 Emphysema 7 1.87 17 1.25 60 1.32' Transportationinjuries 0- 12 0.98 59 1.18 Falls 2 1.08 5 0.69 15 0.71 Other injuries 1 0.59 i 2 1.48 55 1.80' Suicide 5 1.79 14 0.97 60 t.09 2.978 1,145 40 7 105 47 3,510 30 156 7i 36 68 127 1.11" 1.231.40" 1.85 1.10 1.65" 0.96' 1.41 1.39" 1.01 0.69' 1.24 1.413" 4,816 1,915 59 15 182 65 5,603 43 240 142 58 133 206 1.111.26" 1.24 2.39" 1.19' 1.43" 0.96" 1.31 1.37" 1.05 0.71" 1.43" ?.22" O K . observed (number of dealits):PMR. proporbonale mortality ratio. ' P < 0.05. "P c 0.01. types of injuries" after 10 years as a union member. No significant trend with years of union membership was observed for heart disease or any other cause of death using the chi-square test for trend [Breslow et al.. 19831. Age at Death PMRs for selected causes by 10-year. age-at-dearh categories after age 40 are presented in Table IV (prior to age 40 there were only five deaths). For all cancers combined and for cancers of the lung there were statisticallysignificant elevated risks of death for each category after age 50. Deaths due to bone cancer and leukemia and aleukemia were elevated for each 10-year age category. Deaths from emphysema and suicide were significantly elevated after age 60. With regard to fatal injuries, the category "other injuries" showed statistically significant increased risks in age groups 4 W 9 and 50-59, whereas deaths due to falls were well below expectation for each 10-year age period except for age 4 0 4 9 , in which only 2 deaths occurred. For all fatal injuries combined. the average age at death among Operating Engineers was 67.8 (standard deviation = 12.6) as compared to 73.8 (standard deviation = 9.5) for all other causes of death, a difference that was not found to be statistically significant using the z-test. Ceographic Region Geographic regional analysis of mortality was conducted to examine any unusual patterns (Table V). The one striking feature of this analysis was the statistically signifi- cant elevated risks (P< 0.01! for cancers of the bone, and for leukemia and aleukemia in Region 2. In fact. 9 of the 15 deaths due to bone cancer in the entire study were observed in Region 7. an almost sixfold exce~sR. egion 2 comprises the midwestern states (AppendixA). Race Among the 233 deaths for nonwhite males. PMRs were significantly elevated for only two causes: all cancers combined (N = 85, PMR = 1.25, CI = 1.00-1.54) and kidney cancer (N = 6, PMR = 5.48, CI = 2.00-11.92). Causes that were elevated included lung cancer (N = 30, PMR = 1.29, CI = 0.87-1.85), stomach cancer (N = 7, PMR = 2.24. CI = 0.90461). and rectal cancer (N= 3. PMR = 3.21. CI = 0.66-9.40). DISCUSSION Statistically significant elevated PMRs among the Operating Engineers were observed for cancer of the trachea, MortalityA m o n g Operating Engineers 57 TABLE IV. Observed Number of Deaths and ProportionateMortality Ratios for Selected Causes by Age at Death Among Unionized Male Operating Engineers Who Died, 1988-1993 cwsatofdsrth(lCOA-9) O S PMR OBS PMR OM PMR OBS PW ~~ ~~ All cancels 61 1.27 428 1.19- 1.437 1.or 1,980 1.12- Lung 18 1.18 178 1.23' 609 1.11' 849 1.38" Larynpear 1 2.00 5 0.94 17 0.98 21 1.20 Bone 1 5.88 1 1.43 4 2.35 5 2.00 Leukemia and aleukemia Benign neoplasms 5 2.35 0- 11 1.05 0- 55 1.32 20 1.79 71 1.10 26 1.40 Heart disease BKNlChitis 66 1.10 379 0.99 0- 1 0.83 1,399 9 1.02 1.32 2,149 0.93' 15 1.oo Emphysema 1 2.13 7 1.00 58 1.31' 118 1.42. Transportationinjuries 21 1.48 36 136 31 0.82 38 0.99 Falls 2 1.25 3 0.57 9 0.64 19 0.72 Other injuries 11 2.08' 30 2.22" 33 1.33 34 1.20 Swide 12 0.92 25 0.83 57 1.17 69 1.31' OB,observed (numberof deaths); PMR. proportionate mortali raw. 'P < 0.05. .-P < 0.01. OW ~ 1,908 261 15 4 39 19 1,610 18 56 16 25 24 43 PMR 1.13" 1.312.34' 3.45 1.16 1.59 0.95' 1.32 1.41' 0.83 0.73 1.23 1.74' OES PMR 4.816 1,915 59 15 182 65 5,603 43 240 142 58 133 206 1.111.261.24 2.39" 1.19. 1.430.961.31 1.37" 1.05 0.71" 1.431.22" TABLE V. Observed Number of Deaths and Proportionate Mortality Ratios for Selected Causes by Geographic Regiona Among Unionized Male OperatingEngineersWho Died 1988-1993 Cause of death Region 1 OBS PMR Region 2 OBS PMR --Region 3 Region 4 Region6 Region9 Region 10 Region 97 Region 98 OBS PMR OBS PMR OBS PMR OBS PMR OBS PMR OBS PUR OBS PMR Cancers Larvnx 17 1.89' 16 1.34 Lung 344 1.20- 475 1.25" Bone 2 1.69 9 5.64" Leukemiaandaleukemia 25 0.92 55 1.50- Benign neoplasms 4 0.95 6 1.05 Heart disease 1,045 1.01 1,402 1.00 Bronchitis 3 0.51 14 1.75 Emphysama 32 1.02 51 1.21 Transportation injuries 16 0.61' 34 0.95 Falls 15 1.07 12 0.62 Other injuries 20 1.14 32 1.35 Suicide 23 0.70 44 0.99 All cancers 893 1.12- 1,206 1.13" 5 3.29' 56 1.15 0- 4 0.87 1 1.41 181 1.04 2 2.03 2 0.37 7 1.63 0- 3 1.03 10 1.90 130 0.96 2 0.47 3 0.85 201 1.45" 115 1.00 0- 2 4.12 16 1.16 15 1.26 5 2.25 4 2.02 546 1.02 461 0.97 2 0.64 4 1.43 23 1.42 23 1.61' 15 1.18 7 0.70 1 0.13- 8 1.16 18 2.09" 11 1.56 17 1.08 16 1.27 437 1.11. 369 1.10' 5 1.30 176 1.40" 1 1.90 19 1.44 5 2.28 477 0.91' 3 0.96 25 1.57' 14 1.35 4 0.53 13 1.73 18 1.36 418 1.13 -9 0.79 0 1 1.37 469 1.28 35 1.25 40 1.71- -1 0.65 0 0- 38 1.03 5 1.81 3 1.33 8 1.32 2 4.56 2 5.67 1,298 0.89 86 0.81 81 0.94 15 1.75 0 - 0 - 76 1.72 4 1.22 4 1.52 40 1.28 4 1.78 6 2.76' 14 0.68 2 1.39 1 0.84 -30 1.35 0 4 2.79 66 1.68 3 1.04 4 1.45 -1,164 1.10 1 1.16 :1 ' 24 +k@Oll,setIlogadiA OB.obsennd (number ot deaths); PMR, proportionata mortality ratio. 'PC 0.05. " P e 0.01. I 58 Stern and Haring-Sweeney I 1 -- bronchus and lung, for bone cancer, for leukemia and [19891 conducted a prospective study of over 476,000 men I aleukemia, and for deaths due to "other and unspecified exposed to diesel exhaust in various occupations. The results I cancers." These categories were all elevated in the PCMR showed a positive trend by duration of exposure between analysis with the former two remaining statistically signifi- diesel exhaust and lung cancer for those men with 16 or cant. For noncancer deaths. significantly elevated risks were more years of exposure (relative risk (RR)= 1.21) and a observed for benign and unspecified neoplasms. pneumoco- significantlyelevated risk of lung cancer specifically among niosis and other respiratory diseases. emphysema, suicide, heavy equipment operators (RR = 2.60, 95% CI = 1.12- and all other injuries. 6.06). Carstensen et al. [ 19891 examined data from the Swedish Cancer Registry for the incidence of lung cancer Lung Cancer among 97 specific occupations from 1961-1979. Data regarding smoking habits in different occupational groups The study found a significantly elevated PMR for malignant neoplasms of the lung; however. this result was not found to be related to duration of union membership. The small decrease in risk of lung cancer by duration of union membership may. however, have at least been partially related to the slight increase of heart disease risk with duration of union membership. Possible contributors to the overall increase in lung cancer may include diesel engine tshaust. asphalt fumes, si!ica. welding fumes. t l s t r ~ ~ i o sa.nd smokirg. Operating Engineers may be exposed to diesel engine eshzust emitted from the heavy-duty trucks and equipment they operate. were obtained from a random sample of 1% of the survey group. After adjustments for smoking, only 3 of the 97 occupations showed a significantly increased relative risk of lung cancer with time worked: foundry workers ( P = 0.02): stationary engineers ( P = 0.04):and construction operating engineers ( P = 0.02). The authors suggested that the increased risk in lung cancer incidence among operating engineers was most likely due to diesel exhaust exposure. In a case-control study of lung cancer in which oczupations and smoking hi,,tor?eswere evaluated. Hayes et al. [1999] fGUlld a srnoking-adjusted odds ratio of 2.1 (CI = 0.6-7.1 ) amoi:g heavy equipment operators who had worked 10 years or Diesel exhaust is a highly complex mixture of gases. vapors. longer. and of particles (soot1 that has been shown to be carcino- Two previous studies conducted specifically among genic. The particles are of most importance in considering Operatins Engineers reported elevated mortality from lung the toxicity of diesel exhaust because (1) they are small and cancer. Wong et al. [ 19851conducted a retrospective cohort readily inhalable and can therefore reach the lower respira- study of more than 34.000 men with at least 1 year of tory system where they are retained: (2) several thousand membership in the Operating Engineers' union of Locals 3 organic compounds can be absorbed on the surface of the and 3A. which included northern California. Utah. Nevada. carbon particle aggregates. many of which are cytogenic, Hawaii. and Guam. The overall standardized mortality ratio carcinogenic, or mutagenic: and 3 ) the!. tend to be retained (SXIR) among the cohort \ias statisrically significanlly for long periods of time in the lower respiratory tract where below expectation at 0.8 1. However, the authors reported a they accumulate. favoring induction of chronic pulmonary significant trend toward increasing lung cancer risk with effects such as respiratory impairment and carcinogenesis duration of union membership as well as a statistically [Health Effects Institute. 19951. significmt elevated risk of lung czncer aliujng all rerired The National Institute for Occupational Safety and members (SMR = 1.64)and among those retiring at or after Health (NIOSH) has recommended that "whole diesel age 65 (SMR = 1.30). Decoufle et al. (1977J conducted a exhaust be regarded as a potential occupational carcinogen PMR study of Operating Engineers selecting those members in conformance with the Occupational Health and Safety Act where a death benefit had been paid in 1967.The overall risk (OSHA) Cancer Policy (29 CFR 1990)." although currently from cancer of all sites was significantly elcvatrd. at 1.12 there is no OSHA standard specifically for diesel eshaust. ( P < 0.01): this result was similar to the P3,lR of I . 1 I ( P C The NIOSH recommendation was based on the results of 0.01) observed in our analysis. For lung cancer, the risk in both animal studies [Ishinishi et al.. 19S6] and studies of the Decoufle study was 1.30 ( P < 0.01):our study observed occupational groups exposed to diesel exhaust. The IARC a PMR of 1.26 ( P < 0.01). [ I9891 states that there is sufficient animal data but limited Approximately 90% of Operating Engineers are in- human evidence for the carcinogenicity of diesel engine volved on a full-time basis in grading, paving. resurfacing, exhaust. Most epidemiologic studies have suggested an and repaving highways. roads. and streets. Asphalt, which is association between occupational exposure to whole diesel a mixture of paraflinic. naphthenic. cyclic. and aromatic exhaust and lung cancer: several studies [Boffetta et al.. hydrocarbons as well as heteroatoniic compounds contain- 1988; Carstensen et al., 1989; Garshick et al.. 1987; Edling ing sulfur. nitrogen. and oxygen. is the major paving et al., 1987; Hayes et al., 1989: Wong et al.. 1985; Decoufle application on these surfaces [Asphalt Institute. 19901. et al.. 1977) have observed excess lung cancer risk specifi- Asphalt has also been shown to contain relatively small cally among heavy equipment operators. Boffetta et al. amounts of carcinogenic benzo(a)pyrene [Craft. 19831. Mortality Among Operating Engineers 59 Dermal and airborne exposures to asphalt fumes have been shown to pose a carcinogenic risk in experimental animals and asphalt fumes have been classified as a possible human carcinogen by the IXRC (IXRC group 2B). N O S H presently recommends that asphalt fumes be considered a potential occupational carcinogen [NOSH, 19881 and that the airborne exposure limit be kept below 5 mg/m3. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a threshold limit value (TLV)for asphalt fumes of 9 mg/m3as an 8-hr time-weighied average (TWA) [ACGIH. 19951 to "reduce the risk of possible carcinogenicity" [ACGIH. 19921. OSHA has has not established a permissible exposure limit (PEL)for asphalt fumes. Laboratory studies have shown chemical extracts of asphalt fume to have cancer-causing and mutagenic properties. Painting of asphalt extracts c n niouze skin produces tumors that increase with dose [NIOSH. 19891. Other laboratory studies show DNA changes in mouse lung and skin cells [Schoket et al.. 1988aI and in human fetal ce!ls exposed to asphalt fumes [Schoket et ai.. 198ShI. The human epidemiological studies. however. have been less definitive than the animal data in suggesting an association between occupational exposure to asphalt and lung cancer. The IXRC monograph on asphalt [IXRC. 19851 stated that there was "inadequate evidence that bitumens alone are carcinogenic to humans." A 1991 review by Chiazze et al. of studies regarding the carcinogenicity of asphalt in humans since the IARC monograph. also sug- gested that "epidemiological data . . . do not fulfill the criteria for showing a causal association between e s p s u r e ro asphall md de\ ?lopnient o i canctr." Yever.helt.s?;.studies by two investigarors [Hansen. 1589. 199I ; Engholm et al.. 19911 have reported elevated lung cancer incidence and mortality among workers exposed to asphalt. Hansen [ 19891 examined the cancer incidence of asphalt workers who had been involved in road paving between 1959 and 1984. Among those workers with a minimum latency period of 15-20 years. the standardized incidence ratio for lung cancer was 3.4 (95BCI = 2.3-5.0). The excess incidence persisted after correction for smoking habits. In a later study. Hansen et al. [ 199I] reported on the mortality of the same cohort: the results showed a significant excess risk of lung cancer mortality (SMR = 2.9, CI = 1.94.3). Engholm et al. [1991] has also reported slightly elevated mortality (SMR = 1.10) and incidence (SIR = 1.24) of cancer of the lung among road pavers using asphalt. although the numbers. 7 and 8 cases. respectively. were small and the results not statistically significant. A further analysis was reported in the paper regarding a case-control study of lung cancer within the cohort that showed a relative risk estimate among asphalt pavers to be in the order of 3 when adjustments were made for smoking and population density. However it should be pointed out that the Hansen and Engf.olm studies were based on European data. which may be a different exposure than received by U.S.workers. Other agents to which Operating Engineers may be exposed that are also considered possible or confirmed human lung carcinogens, include silica dust [Steenland et al.. 1996; Kurppa, 1986: Westerholm, 1986; Goldsmith, 19821. coal tar pitch [Steenland et al., 1996: Chang et aL.1992: Partanen et al.. 1994;Silverstein, 19851, which had been prebiously used in asphalt in the United States. welding fumes [Beaumont et al., 1981; Stem. 1987: Singleton et al.. 1986: Siinoriato et al.. 19911 and asbestos [Steenland et al., 1996; Selikoff, 1969; Selikoff et al., 19651. The possible relationship between smoking and increased lung cancer mortality is Jiscussed in the section Smoking-Related Deaths. B ~ i i Ce ancer The elevated PMR for bone cancer among this population was statistically significant ( N = 15, PCMR = 2.14. C1 = 1.19-3.52). Furthermore. 9 of the 15 bone cancer deaths occurred in Region 2 where an almost sixfold excess risk of bone cancer was observed. Bone cancer has been induced in animals by various chemicals. although internal exposures to bone seeking radium isotopes is the only occupational exposure that has been associated with bone cancer [Kessler et al., 19871. However. at least two previous epidemiologic studies have associated bone cancer with silica exposure. Forastiere et al. [ 19891 found a statistically significant excess risk of bone cancer mortality (odds ratic = 4.1. CI = 1.3-9.5 ) among workers exposed to silica d:ist a'; did c t e c n l d t t 31. [1986] in a cohort of granite cut!L?:S (FMR = 3.14.CI = 1.15-6.55). Leukemia and Aleukemia Leukemia and aleukemia were statistically significantly elevated in the PMR analysis but were only elevated in the PCMR analysis. One previous study examining the incidence of leukemia by occupation over a 15-year period in more than one million U.S. residents observed a statistically significant elevated risk ( P < 0.0I ) among heavy equipment operators, the result being the highest risk among all occupations evaluated [Morton et al., 19841. Potential exposures among Operating Engineers that may be associated with leukemia include ionizing radiation exposures from X-ray testing of pipeline welds, electromagnetic field exposure associated with welding, and asphalt fume exposure. A small percentage of Operating Engineers perform X-ray testing of pipeline welds (welding two joints together and X-raying the weld [radiography])and. therefore, may be exposed to ionizing radiation. It has been shown that radiographers, on average. have an annual dose equivalent of approximately 430 mrem (4.3 mSv) and that 22% have I 1: ! 60 Stern and Haring-Sweeney annual dose equivalents of 500 mrem (5.0 mSv) or more [NCRP,19891. The current standard for radiation exposure is an annual total effective dose equivalent not to exceed 5,000 mrem (50.0 mSv) [CFR, 19911. According to the union. all the Operating Engineers who perform X-ray testing of pipeline welds in the United States are from Region 2 (Appendix A). which had the highest PMR for leukemia of all the regions examined. These Operating Engineers are required to wear badges to record their radiation exposure. Being considered is a plan to investigate this potential association further with a nested case-control study that will allow a better assessment of actual job duties and exposures. Elevated leukemia mortality has also been observed among workers with electromagnetic fieldexposures. including welders [Savitz et al., 1995; London et al.. 1994;Guenel et al.. 1993: Ciccone et al.. 1993: Preston-Martin. 1988: Juutilainen et a].. 1990: Stern. 19861. In addition to welding on pipelines. Operating Engineers may also weld equipment when necessary for repair. In a least one epidsrniologic <cud>.asphalt fumes wcrr associated with leukemia. Bender et al. [ 1989j analyzl cancer mortality during 1945-1983 in a cohort of 4.849 highway maintenance workers exposed to various substances including asphalt. The SMR for leukemia for those workers with 30-39 years of work experience was 1.3 (CI = 1.7-8.8). Skin Cancer with both smoking and occupational exposure to heavy airborne concentrations of fumes, dusts, and gases [Wong et al., 1985: Sullivan et al., 19951.The first authors had found a statistically significant elevated risk of emphysema (SMR = 1.65. P < 0.01) among members of Local 3 and 3a of the Operating Engineers union, two of the many local unions included in our analysis. The emphysema risk increased with duration of union membership and was especially high among retirees where the SMR reached 2.77. Since a random sample of union members in Locals 3 and 3A did not indicate any difference in smoking habits between the union members and the general U.S.population, Wong concluded that smoking was considered "not a likely significant confounding factor'' for this result. Sullivan et al. [1995] calculated prevalence rates and rate ratios of respiratory conditions among construction workers based on data from the 1988 National Health Interview Survey.For emphysema. Sullivan observed a prevalence rate of 25.8 per 1 .OOO male construction workers and a rate ratio of 1.34 when comparing construction workers u i t h other workers in the survey. Thc iolc of dua: exposure its it ;elates to emphysema in this peplation is unciear. Hov.ever. it hac been reported that members of this union historically have heen exposed to concentrations of respirable dust, especially silica. substantially in excess of permissible levels from bridge. road. and tunnel construction: concrete and granite cutting: and blasting operations. among others [NIOSH. 19921.The PMR for deaths from silicosis was elevated but not statistically significant 1.49 ( P > 0.05). No excess risks of death from melanoma or other skin cancers were observed in the current stud!. Elevated skin cancer mortality was of concern because operating engineers spend a great deal of their time outdoors exposed to the sun [Kricker et al., 1995: Armstronp et al., 1995: Vitasa et al., 19901 'tnd because the! are exposed to a.pha:: [Sicmeier et al., 1988; Bull et al.. 1985; Robinson et al., 19841.Niemeier et al. [1988] showed that exposure to asphalt fume condensates causes skin tumors in two strains of mice. Bull et al. [1985] and Robinson et al. [I9841 showed similar results using an asphalt-based paint solution. Howeker. both Bull and Robinson concluded in their studies that the asphaltbased paints used contained insufficientPAHs to produce the tumorigenic responses noted and that some other component may have initiated the tumors. The epidemiologic study of mastic asphalt workers by Hansen [I9891 did not show an excess risk of skin cancers despite the fact that the workers had been primarily employed outdoors. Nonmalignant Respiratory Diseases The PMR for emphysema was statistically significantly elevated for deaths occurring after 20 years membership within the union. Higher risks of emphysema are associated Fatal Injuries We observed a statistically significant elevated risk of 43% over expected for the death category "other injuries." From examination of the death certificates.we observed that mr]ii> ,ai [he J c a t h were &IC to crushing unddin nuchineq.. tractor rollover. run over by crane. thermal burns due to gas explosion. and struck by object while operating a bulldozer. The injury mortality rate in the construction industry, in general [Toscano et al.. 19951, and among Operating Engineers. specifically. is one of the highest among all major industries and occupations in the United Statcs. .4 previous NIOSH analysis of cause-of-death from death certificates for the years 1985-1986 from 19 U.S. states has shown that Operating Engineers have a statistically significantly ele- vated risk from "other types of injuries" ( P < 0.05) [Robinson et al.. 19931. Parsons [I9891 examined the risk of nonfatal and fatal injuries among all occupations within the construction industry and numerically ranked the occupations by risk factor. accident type with related costs. and employment. Operating Engineers were ranked third among all high-risk occupations. behind only laborers and carpenters. Other studies which examined disability and/or monality results by occupation have also shown that Operating Mortality Among Operating Engineers 61 Engineers have an increased risk of death from fatal injuries [Decoufle, 1977; Guralnick. 1963; USDHHS. 1967; Registrar General, 1958, 1971; Buskin, and Paulozzi 19871. Decoufle [I9771 observed a threefold excess risk of fatal accidents occurring at places other than home among Operating Engineers. In a 1950 study of mortality by occupation [Guralnick, 19631, a significantly high rate of death from injuries occurred "while at work" for men categorized as "cranemen, hoistmen. and construction machinery operators"; relative mortality was 173% greater than the national average. A 1961 ReSistrar General's report on occupational mortality for England and Wales sholced a fourfold risk of dying from nontransportation injuries among "operators of earth moving and other construction machinery" [Registrar General, 19711. Buskin and Paulozzi [ 19871 in a study of fztal injury in Washington State between 1973-1333 iound that construction operating engineers had one of the highest PMR of all construction jobs evaluated (PMR = 2.36: CI = 1.54-3.46). It was interesting to note that Pollack et al. [1996]. in an analycis of various construction trades. noted that only 5 % of r'atd injuries among operating engineers were due to falls. while transportation injuries and "contact with objects and equipment'' comprised 48.3% and 33.3%.respectively. of all fatal injuries. In this study, a similar result was observed: the death category due to falls was significantly lower than expected. whereas the "other injury" category was significantly elevated. Smoking-Related Deaths IVorkxs in :hc constructisn industry mzy h;wc a grcater ksk of snioking-rel,i[ed Jiseases because of thcir excessive smoking experiznce [Walrath et al.. 1985; Hrubec et SI.. 19921 and the potential synergistic effects between smoking and various exposures. Information regarding smoking status or amount of cigarette smoking among members of this group of Operating Engineers was not available. PMR results for those diseases that have been most associated with smoking were. for the most part. elevated. The PMRs for lung cancer and emphysema were significantly higher than expected. and the PMR for bronchitis was higher (but not significantly) than expected, while the PMR for diseases of the heart was significantly below expected. PMR = 0.96 but higher than expected for a working population. Since lung cancer and nonmalignant respiratory disease may be associated with smoking and also with some of the agents present in the operating engineers'environment. the relative contributions of smoking and occupational exposure cannot be accurately evaluated. Strengths and Limitations Like all epidemiologic studies, this study has some potential limitations and strengths that should be cunsidered. The representativeness of the group studied relative to all operating engineers in general is an important strength. We chose all deaths for the years 1988-1993 for those members of the IUOE as our study group for the following reasons. First. the IUOE is the largest single group of operating engineers in the world. Second, the number of deaths in the study, 15,843.had sufficient power for examining the results from even the rarest causes of death. Third. the deaths from 1988-1993 were the most recent and. therefore, the most representative of both current and past work practices and exposures of Operating Engineers. Fourth. all membership data had been computerized since 1988 making the study more accurate. as well as more efficient to complete. Finally, and probably most importantly, the local dues that an operating engineer was required to contribute went to the International Union to pay into the death beneficiary fund. Even when a worker retired. he still was required to pay into the fund although at a reduced amount. Therefore. we believe that our study of deceased operating engineers who received death benefits was reasonably representative of all operating engineers who had worked long enough to be vested ( 1 year). A second strength of this PMR study is derived from the existence of the death benefit fund in the Internationalunion. Studies comparing PMRs with SMRs have shown that PMRs are useful indicators of disease risk. showing a high correlation, in most cases. with SMRs and especially when there is a financial interest for survivors to report deaths [Roman. 1984; Beaumont. 1981;St. Claire. 19811. Beneficiaries of deceased active and retired Operating En,o' ineers recei\,en dea:h benefit. the amount of uhich varies depending Oti :ht men~ber'syears of senice. upon notitication of a mcniber'.s death. A potential limitation in the PMR methodology is that the magnitude of each cause of death is dependent upon the magnitude of the PMRs for other causes of death. This can be especially important if a specific common cause has a relatively high or low mortality. If the PMR for the common cause of death is high. the PMRs for other causes are artificially deflated and vice versa. Typically in a working population, the risk of heart disease is lower than expected due to the so called "healthy worker effect" and, therefore, in a PMR study the other causes would be artificially elevated. In this study, the risk of heart diseases had a borderline statistically significant low PMR of 0.96 (CI = 0.95-0.99). with 5.603 observed deaths and 5.810 expected deaths. The difference of the 207 deaths would have been spread over the remaining 99 causes but would have been differentially distributed, mostly to lung cancer. and. therefore. only would have slightly increased the PMRs for the other remaining causes of death. Another possible limitation of this study. as in most PMR studies, is the fact that members who terminate their employment prior to retirement or death are not included in 62 Stern and Haring-Sweeney the analyses. It has been shown [Fox and Collier, 1976; Redmond and Breslin. 19751 that these individuals tend to have different mortality patterns than individuals who remain employed until retirement. In current employees. relatively fewer cancer deaths are found as compared with terminated employees because cancer deaths are not sudden nd. therefore. use existing records as the basis for analysis. Specific exposures to which individual operating engineers would be exposed are sometimes difficult to evaluate, since many local unions do not track sites, specific job tasks performed. or exposures. when an operating engineer is dispatched to a particular construction job. A nested case-control study would be more suited to evaluate the types. intensity. and length of esposures of the members. A nested cs?-con:rol study is being considered to esainine the exess bone < m < z r~ n Iaeuktmia and aleukemia deaths from Region 7 . which w m found to be statistically significant. There are several additional limitations. First. PMR study results are based on death certificate data. which have little information on potential confounding factors such as tobacco. alcohol use, and socioeconomic status. Second, some causes of death (Le.. skin cancer) are normally not fatal and. therefore, a mortality study would not necessarily observe an increase in risk. An incidence study would be better suited to evaluate the risks for these types of diseases. Finally multiple significance testing may result in associations that arise from chance alone. Since PMR studies are exploratory in nature, the significant results found should be confirmed in additional studies. SUMMARY AND RECOMMENDATIONS Our results among 15,533 members of the IUOE in this study seem to confirm earlier findings of increased risk of death from lung cancer among operating engineers. Some of the excess lung cancer risk may have beeti due to occupational exposures to diesel exhaust, asphalt andor welding fumes. silica dust, or possibly coal tar pitch or some other toxic agent. Excess cigarette smoking. however. cannot be ruled out as a possible contributing factor. The reasons for the excess deaths from bone cancer and from leukemia and aleukemia are unknown; however, at least one of the potential exposures in the operating engineers' environment. ionizing radiation, has been associated with these diseases in other studies. The increased risk of death from injuries is believed to be related to the heavy-duty equipmentlmachinery being used by Operating Engineers. PMRs for heart disease were slightly, but significantly,lower than expected. Based on the results of this study, the following recommendations may help reduce morbidity and mortality from job-related causes. First. study the causes of injuries among operating engineers. Such studies are necessary to identify risk factors and to assist in the development and targeting of injury prevention and intervention strategies. (Routinely collecting data on the makes and models of heavy equipment involved in fatal accidents will help safety engineers redesign equipment with reduced crushing, rollover. and electrocution hazards.) Second. reduce exposures to diesel fumes to the lowest feasible concentration using state-of-the-art engineering controls and work practices. Third. use engineering control. containment measures, and improved work practices to reduce workers' exposure to silica. welding. and asphalt fumes. asbestos. and other hazardous materials during renovation. demolition, and maintenance work. Fourth. conduct a case-control analysis for bone cancer and for leukemia and aleukemia. both di><L:.;zsfer nkich ionizing radiaticn can be considered a potential c3c:.;c.by obtaining work histog. data and radialion badge readings that may render some clue as to why the results in Region 2 were significantly elevated. Fifth. provide periodic medical examinations to those workers who have exposure to known hazardous agents. Finally, deVd0p health promotion programs to include efforts aimed at smoking cessation because of the well known harmful effects from smoking and the potential interaction between smoking and other exposures in the workplace of operating engineers. ACKNOWLEDGMENTS The a!.:thor acknowledges the International Union of Operating Engineers. especially Mr. William Smith and Mr. Ed Trejo from the Health and Safety Department and Mr. George Huguenin from the Data Processing Department; Mr. Pete Stafford and Dr. b u t Ringen from the Centers to Protect Workers' Rights; M s . Sue Palu and Ms. Lih Chang from the Computer Science Corporation: and Ms. Betty Walpole, hls. Chns Gersic. Ms. Jean Geiman, Ms. Kim Jenkins. M r . L a q Wetzel, and MS.Denise Giglio from the National Institute for Occupational Safety and Health. REFERENCES Asphalt Institute i19901: "Repon to OSHA and NIOSH:Status of Asphalt Insutute lnduzrry Steenng Committee Research Rognrn on the H e d t h Effects of .4spha11 Fumes and Recommendation for a Worker Health Standard."Lesington. K Y Asphalt Institute. ACGIH (1992): "Documentation of the Threshold Limit Values and Biological Exposure Indices." 6th Ed. Vol 1. Cincinnati. OH: American Conference of Governmental Industrial Hygienists. Mortality Among Operating Engineers 63 -' ACGlH f 1995): "Threshold Limit Values and Biolonical Exwsure Indices Goldsmith D. Guidotti T,Johnston D I1981,): Does occupational exposure for 1995-1996." Cincinnati. OH: American Conference of Governmental to silica cause lung cancer? Am J Ind Med 3:423--1.(0. Industrial Hygienists. Guenel P. Raskrnark P.Andersen 1. Lynge E ( 1993): Incidence of cancers Armsuong B. English D. Heenan P ( 1995):A dose-response curve for sun with occupational exposure to electromagnetic fields in Denmark. Br J Ind exposure and bL.1 cell carcinoma. Int J Cancer 60:481,188. Med 50:75&76.1. Bofetta P. Stellman D. Garfinkel L ( 1988): Diesel exhaust exposure and mortality among males in the American Cancer Society prospective study. Am J Ind bled l4:403415. Hansen E ( 1989): Cancer incidence in an occupational cohort exposed to bitumen fumes. Scand J Work Environ Health 15:101-105. Beaumont J. Weiss N (1981): Lung cancer among welders. J Occup ,Med 233839444. Hansen E (1991): Mortality of mastic asphalt workers. Scand J Work Environ Health 17:20-14. Beaumont 1. TL. Okun AH ( 19SI): Occupational data sets appropriate for proportionate mortality ratio analysis. Banbury Report 9 "Quantitication of Occupational Cancer." pp 391 1 1I. Hayes R. Thomas T. Silverman D. Vineis P. Blot W. Mason T. Pickle L. Correa P. Fontham T. Schwnberg J (1989): Lung cancer in motor exhaust-related occupations. Am J Ind Med 16:685-695. Bender A. Parker D. Johnson R. Scharber W. Williams A. Marbury M. Health Effects Institute (1995): "Diesel Exhaust: A Critical Analysis of Mandel J i 1989): Minnesota highway maintenance worker study: Cancer Emissions. Exposure. and Health ERects." Cambridge, MA: Health Effects mortality. Am J Ind hied 15:545-556. Institute. Breslow ?;. Lubin J. Muck P. et al. (19831: blultiplicative xodcls and cohort analysis. J Am Stat Assoc 78: 1-1 2. Bull R. Robinson $1. Munch J ( 1985I: Letters to the editors. J Appl Toxicol 5:42347_4. BusLn S . i'x!ozzi L (1987): Fxal injury in rhe ionstruction industp in Washington State. .AmJ Ind Med I 1 :453-460. Carstensen J. Pershagen G. Eklund G ( 1989): Time trends in occupational risks of lung cancer among Swedish men from 1961-1979. Am J Ind .Med l5:44I-u8. Centers for Disease Control (1986): Premature mortality due to uninrentional injuries-United States. 1983. MMWR 35:353-356. Chiazze L. Watkins D. Amsel J ( 1991): Asphalt and risk of cancer in man. Br J Ind Med -18538-542. Ciccone G.Minbelli D. Levis .A. Gavarotti P. Regc-Cambrin G. Davico L. Vineis P 1993): Mye!oid leukemias and myelodysplasic s>ndromes chcinic31 exposure. histalcgic ~uh!! pe and c>toge!!et:cs in a iase-control >udy.Cancer Gene! Cylogenet 68: 135-13. Code of Federal Regulations ( 1991): Title IO. Part 20. Federal Register 50:2339 1. Craft B (1983): Solvents and related compounds. In Rom W (edl: "Environmental and Occupational Medicine." Boston: Little. Brown. p 515. Hrube: Z. HiJir B. Rogot E. Vaught J (1992): "Mortality Risks by Occupation Among U.S. Veterans of Known Smoking Status 19561980.'' NIH Pub1 No. 92-3407. Bethesda. MD: DHHS (PHS). IARC i 1973I: "IARC Monographs on the Evaluation of Carcinogenic Risk of Chcmizais to Humans. Vol 13: Certain Polycyclic Aromatic Hydrocarbons .mi Heterocyclic Compounds." Lyon: International Agency for Research on Cancer. IARC ( I985I: "IARC Monographs on the Evaluation of Carcinogenic Risk of Chemicals to Humans. Vol35: Polynuclear Aromatic Hydrocarbons. Part 4: Bitumens. Tars and Derived Products. Shale-oils and Soots." Lyon: International Agency for Research on Cancer. IARC ( 1987): "IARC Monographs on the Evaluation of Carcinogenic Risk of Chemicals to Humans. Vol 42: Silica and Some Silicates." Lyon: International Agency for Research on Cancer. IXRC ( 1980): "IARC Slonographs on the Evaluation of Carcinogenic Risk of Chemiscil., tt? Humans. Vol16: Diesel and Gasoline Engine Exhausts md Some N i t r r x s v s . " L!on: International Xpcncy for Research on Cmcrr. Ishinrshi N. Koizummi A. .\.lcClellan R. Stober W (eds)( 1986): "Carcinogenic and MuugeNc Effectsof Diesel Engine Exhaust." New York:Elsevier. Juutilainen J. Laara E. Pukkala E ( 1990):Incidence of leukemia and brain tumors in Finnish workers exposed to EMF magnetic fields. Int Arch Occup Environ Health 62:289-294. Decoufle P. Lloyd W. Salvin. L ( 1977):Causes of death among construction Kessler E. Brandt-Rauf P (1987): Occupational cancers of the brain and machinery operators. J Occup hled 19:123-128. bone. STAR. Occupational Medicine. 2: 155-163. Edling C. Anjou G. Axelson 0. Kling H ( 1987): Mortality among personnel exposed to diesel exhaust. Int Arch Occup Environ health 59:559-65. Enghoirn G. England A. Linder B f 1991): Mortality and cancer incidence in Swedish road paving asphalt workers and roofers. Health Environ 1:6?-68. Everett G. Blair A. Cantor R. Gibson R. Van Lier S (1985): Environmental chemical exposures as risk factors for leukemia and non-Hodgkin's lymphoma. Am J Epidemiol I27:535-536. Forastiere F. lagorio S . Michelozzi P. Perucci C. Axelson 0 (1989): Mortality pattern of silic.otic subjects in the Latium region. Italy. Br J Ind Med -16:877-880. Fox A. Collier P ( 1976): Low mortality rates in industrial cohort studies due to selection for work and survival in the industry. Br J R e v Soc Med 30:2?5-230. Kricker A, Armstrong B, English D. Heenan P (1995): Does intermittent skin exposure cause basal cell carcinoma? A case-control study in Western Ausualia. Int J Cancer 60:489-!94. Kurppa K. Gudbergsson H. Hannunkari 1, et al. ( 1986):Lung cancer among silicotics in Finland. In Goldsmith D. Winn D. Shy C (eds): "Silica. Silicosis. and Cancer: Controversy in Occupational Medicine." Cancer Research Monographs. Vol. 1.New York: Praeger. pp 3 11-320. London S. Bowman I. Sobel E. Thomas D. Gmbrant D. Pearce N. Bernsrein L. Peters J ( 1994): Exposures to magnetic iields among electrical aorkers in relation to leukemia risk in Los Angeles County. Am J Ind bled 26:47-60. Morton W. Marjanovic D (1984):Leukemia incidence by occupation in the Portland-Vancouver Metropolitan area. Am J Ind Med 6: 185-205. Garshick E. Schenker M. Munoz A. Segal M. Smith T.Woskie S.Hammond K. Speizer F (1987): A case-control study of lung and diesel exhaust exposure in railroad workers. Am Rev Respir Dis 135:1242-1248. National Council on Radiation Protection and Measurements ( 1989): "Exposure of the U.S.Population from Occupational Radiation." NCRP re.wt No. 101. 64 Stern and Haring-Sweeney 4 Niemeyer R. Thayer P. Menzies K, von Thuna. Moss C. Burg J (1988):A Selikoff IJ, Chug J, Hammond EC (1965): Relation between exposure to comparison of the skm carcinogenicity of condensed roofing asphalt and asbestos and mesothelioma. N Engl J Med 272:560-565. coal tar pitch fumes. In Cooke M. Dennis A (eds): "Polynuclear Aromatic Hydrocarbons: A Decade of Progress." Tenth International Symposium. Selikoff U (1969):Asbestos. Environment 113-7. Columbus. Ohio: Battelle Press. pp 609-647. Sieber K. Sundin D. Frazier T,Robinson C (1991 I: Development. use. and NIOSH ( 19773): "Criteria for a Recommended Standard: Occupational availability of a job exposure matrix based on National Occupational Exposure to Asphalt Fumes." Cincinnati, OH: U.S.DHEW. Publ. No. Exposure Survey data. Am J Ind Med 20: 163-174. PB-277-333. Washington. DC: National Institute for Occupational Safety and Health. Silverstein M. Maizlish N. Park R. Mirer F (1985): Mortality among workers exposed to coal tar pitch volatiles and welding emissions: An NIOSH ( 1988): "NIOSH Testimony to the Department of Labor: Statement exercise in epidemiologictriage. Am J Public Health 75: 1283-1287. of MOSH. the Public Hearing on Occupational Exposure to Asphalt Fumes."Cincinnati. OH: US. DHHS. Simonato L, Fletcher A. Anderson A. et al. ( 199I ): A historical prospective study of European stainless steel. mild steel and shipyard welders. Br J Ind NOSH ( 1988. 1990a.b): "National Occupational Exposure Survey." Med 18:145- 154. DHHS (NIOSH) Puhl. Nos. 88-106. 89-103. Washington, DC: National Institute for Occupational Safety and Health. Singleton J. Beaumont J ( 198I ): "COMS 11. California Occupational Mortality 1979-1981. Adjusted for Smoking. Alcohol. and Socioeconomic NlOSH ( 1989):"Assessmentof the CocarcinogeniclPromotingActivity of Status."California Depanment of Health. Asphalt Fumes." US. DHHS. Contract No. DO-83-261 2. Washington. DC:National Institute for Occupational Safety and Health. St. Claire P. Butler W ( 19s1): " A Review of Proportionate Mortality Design in Occupational Epidemiology." Presented at the American Public Health National Institute for Occupational Safet} and Health. ( 1992, "ALERT- Association annual meeting. Los .\ngeles. November 5 . 1981. Request for Assistance in Preventing Silicosis and Deaths in Rock Drillers." Cincinnati. NIOSH Publ. No. 92- IO?. Parson>T . 19891:Esiablishment of a construction safe!!. research plan for NIOSWDSR. 3TIS PBX9 I65 197. Steenland K. Beaumont J I 1986,:A proponionate mortality study of granite cutlers. Am J Ind Med 9:: '39-201. Stctniand K. Resumon; J . Spsc!h S. E r i ~ D~ .oOkun 3.. Jurienko L. Ryan B. k i i i i p S. Rmcw R. SIJ?IWL-. bl.lorrir J I 104(~1S.?.. de\eiopments in Partanen T. Boffetta P ( 1904):Cancer nsk in asphalt workers and roofers: the life :able analysis sysrcn c!f the Narional I ~ s t i t ~ fto-r Occupational Review and meta-analysis of epidemiologic studies. Am J Ind Med Safer) and Health. J Occup Med 32:l09l-1098. 26:71,1-i40. Steenland K. Nowlin S. Ryan B. Adam S (1992): Use of multiplecause Pollack E. Griffin M. Ringen K. Weeks J (19961: Fatalities in the monality data in epidemiologic analyses: US rate and proportion files I construction industry in the United States. 1992 and 1993. Am J Ind Med developed by the National Institute for 0c;upatronal Safety and Health and 30325-30. the National Cancer Institute. Am J Epideniiol 136:855-862. Preston-Manin S. Peters J ( 1988):Prior employment as a welder associated Steenland K. Loomis D. Shy C. Simonsen N (1996): Review of occupa- with thedevelopment of chronic myeloid leukemia Br J Cancer 58:105-108. tional lung carcinogens.Am J Ind Med 29:475190. Public Health Service (1967): "Public Health Service and Social Security Stern F. Waxweiler R. Beaumont J. et al. (1986,: A case conuol study of Administration: Occupational Characteristics of Disabled Workers by leukemia at a Naval nuclear shipyard. Am J Epideniiol 123:980-991. Disabilit) Condition. Washington. D. C. US Government Writing Oflice. PHS publication no. 153I . Stem R r198Tj: Cance: incidence among welders: Possible effects of exposure to exuemei) low frequency electromagnetic radiation (ELF) and Redmond C. Breslin P (1975): Comparison of methods for assessing to welding fumes. Environ Health Perspect 76:221-229. occupational hazards. J Occup Med 17:313-3 17. Sullivan P. Bang K. Hear1 F. Wagner G I 1995): Respiratory disease risks in Robinson C. Stern E Halperin W. Venerahle H. P-terzen \f. Frazicr T. the co:lstrJctinn inkstry. &CUF .Med 10:313-?31. Burnett C. Lalich N. Sestito J. Fingerhut M ( 1995):Assessment of excess mortality in the construction industry the United States. 1984-1986. Am J Ind Med 28:19-70. Toscano G,Windau J (1995): "The Changing Ch,mcter of Fatal Work Injuries. Fatal Workplace Injuries in 1993: A Collection of Data and Analysis." U.S. Department of Labor. Bureau of Labor Staristics. Robinson M. Bull R. Munch J. Meier J ( 198-1): Comparison of carcinogenic and mutagenic activity of coal tar and petroleum asphalt paints used in portable water supply systems.J Appl Toxicol 1:49-56. kitasa B. Taylor H. Strickland P. Rosenthal F. West S. Abbey H. Ng S. Muncz B. Emmett E ( 1090):Association of nonmelanonia skin cancer and actinic keratosis uirh cumulative solar ultraviolet exposure in .Maryland Roman E. Beral V. Inskip H. McDowell M. Adelstein .A (1984,: .4 watcrnien. Cancer 6 5 : X l I - X l i . comparison of standardized and proportional mortality ratios. Stat Med 3~7-14. Walrxh J. Rogot E. Murray 1. Blair A 1985): "Mortality Patterns Among U.S. Veterans by Industry and Smoking Status." NIH Publ. No. 85-27-17. Rothman K. Boice J (1979): "Epidemiologic Analysis With a Prognm- Bethesda. MD: DHHS rPHS). mable Calculator." Washington. DC: Department of Health and Human Services. 30-3 I . NIH Publ. No. 79-1649. Westerholm P. Ahlmark A. Massing R. Segelberg I (1986): sihcosis and lung cancer -.4 cohort study. In Goldsmith D. Wiitn D. Shy C (eds): Saviu D. Loomis D ( 1995): Magnetic field exposure in relation to leukemia "Silica. Silicosis. and Cancer: Controversy in Occupational 'Medicine." and brain cancer mortality among electrical utility workers. Am J Epde- Cancer Research Monographs. Vol. 2. New York Pneger. pp 327-333. miol 111: 13-124. Wong 0. Morgan L. Kheifecs L. Larson R. H'honon M (1985): Mortality -' Schoket B. Hewer A. Grover P. Phillips D (1988a):Covalent bibding of coal among members of a heavy construction operators union with potential tar. creosote and bitumen to the DNA of the skin and lungs of mice exposure to diesel exhaust emissions. Br J Ind bled 1 2 : 1 3 5 4 8 . following topical application.Carcinogenesis 9: 1253-1 258. WHO (19771: "International Classification of Diseases. Manual of Ihe Schoket B. Hewer A. Grover P, Phillips D (1988b): Formation of DNA International Statistical Classificationof Diseases. Injuries, and causes Of adducts in human skin maintained in short term organ culture and treated Death. Based on the recommendations of the Ninth Revision Conference. With coal tar. creosote and bitumen. Cancer 42:621-626. 1975."Geneva: World Health Organization. Mortality Among Operating Engineers 65 APPENDIX A. Regional Areas Region States included 1 Connecticut, Delaware, Maine, New Hampshire. New Jersey, New York, Pennsylvznia. Rhode Island, Vermont 2 Indiana. Illinois, Kentucky, Kansas, Michigan. Missouri, Ohio. Oklahoma 3 District of Calumbia, Maryland, North Carolina, South Carolina, Virginia, West Virginia 4 Arkansas, Alabama, Florida, Georgia, Louisiana, Mississippi.Tennessee 6 kwa, Minmta, Ne- Nerol Oak& "UIO&ota. 'iVtsccls~l 9 Montana, Oregon, Washington, Wyoming 10 Arizona Wiomia cdorado.Hawari. Nevada, New FAexm.Utah 97 Arkansas.' Louisiana.aTexasa 98 Texas 'Pebcieum-relakd nsrk only. APPENDIX B. Description of Operating Engineers' Equipment The following power equipment and machinery is recognized as sith the jurisdiction of the International Union of Operating Engineers. The Intemational Union of Operating Engineers claims jurisdiction of all equipment as granted by the AFL Convention, November 11-23. 1907, ResolutionNo. 124, and also claims jurisdiction of any new equipment Introduced to the indusby. This listing is not to be considered exclusive. Air Compressor Associated Monitoring Instruments Back?oe Barrel :iraocler %vices Btctipiant Boom Truck Concrete Breaker Concrete Pump Concrete Saw Crane Crusher Dozer Grader Endloader F m Tractor Forklift Generator Gradall Grader Heater Incinerators Pugmill Pump 3 Treat Sys:ems PlJmCC:e!e bbcme Zwer S>ovel Power Machine Robotic EquipmentClamshell Scraper (Self-propelled) Side Boom Tractor Skid Steer Loader Slip Form Paver Sloper Paver Sweeper Tractor Trencher Vibratmg Compactor Welder Welding Machine Well DnllingRig APPENDIX C. Description of Operating Engineers' Duties 1. Highway, road, street andsewer construction, andgrading andpavingWork. Defined as all phases of work pertaining thereto, including overpasses, underPasses. bridges, except pile driving, bridge alterations, sewer and water pipelines, OT any other pipeline work, oilostatic high-voltage underground cable lines and transportation mainline pipelines, duct lines, street grading, drainage, curb Setting. sidewalks. grade separations, land improvement, site clearing, grading and paving, resurfacing and repaving (excepting bistate pipelines, water crossings, bridges, and tunnels). Excavation. embankment, grading, paving, and drainage around and adjacent to bridge structures are included in this category. 2. Heavy constructionwfk:Heavy construction is defined as construction and alteration of Oil Refineries, Power Plants, Chemical Plants, Sewage Disposal Plants. FilteringPlants, Incinerators. Atomic Energy Plants, Missile Bases. all work performed under compressed air, airports. foundations. pile driving, piers. abutments. re!aininy .Nails. viaducts, water crossings pertainingto pipe line Work, shafts. tunnels. subways. track elevations, elevated highways, resurfacing Work on brstate bridges and tunnels, reclamahon projects. sanitation PrOJeCfs, aqceducts, irrigation projects, water power development, hydroelectric development, transmission lines, locks, dams. dikes, docks, levees, revetments, channels. channel cutoffs, intakes. dredging projects, jetties, breakwaters. harbors. ofishare terin;nais, 2ower piants and other installations, excavation and disposal of earth. garbage and rock projects in connectionwith the above. and any other bridges and drainage structures, including the assembly, Operation and maintenance and repair of all equipment. vehicles and other facilities used in coiinec;holi :with. and sewing, the a!ormentioned work and Serdices. 3. Buildingconstruction work: Building Construction is defined as construction of building structures, including modifications thereof, or additions or repair thereto. intendedfor use for shelter, protection, comfort or convenience. Building construction includes the demolition of, and excavation and foundations for, building construc!ion. 4. Oilostatic cables and transportation mainline pipelines (including testing): Oilostatic high-voltzigeundergroundcables and transportation mainline pipelines are 2eficed as all ;bases of wcrk ;ertan!ng to oilostatichigh-voltage urderground c23:e Wes and trar,spo$atlcn mair,:ine 3ipeiines. the ccnstriction. CsdkJtiOn. treating. reconditioning.tes:;ng, taking-@$relaying or relocation of cross-counw pipelines or any segments thereof transporting coal, gas, oil, water, or other transportable materials. vapors or liquids. including portions of such pipelines Within private property boundaries, up to the first metering Station or ConnectiOn, as well as gathering lines that connect directly from the wells to the mainline Pipe lines and gathering lines to or from gasoline extractionand gas dehydrationplants and water flood lines up to the first metering station or connection are likewise included. The phase. "first metering station or connection" means that point that divides mainline transmission lines or higher pressure lateral and branch linesfrom lowel pressure distribution systems. If a metering station or connection is located on a mainline transmission line, the work covered includes the Construction Of all pipelines up to the point at which lower pressure distribution systems take Off from higher pressure lateral and branch lines. 5. Sewer construction work: Sewer Conshction is defined as construction, repair. and alteration of storm sewers; sanitary sewers: combined storm sewers and sanitary sewers; telephone, gas and electnc, fiberoptics, (excludingdrainage systems and telephone, gas and electric and fiber optics lines that are part Of overall road. street and highway construction. or heavy construction or building work); and pump stations with a cost not in excess of $4,000,000.00S.ewer agreement manning applies to all projects with a cost of $3,000,000.00 or less. Outfalls are considered beavy constructionwork. i !I i,