Document KR9bnbaBkX0nVVZKGBVeNbEeo

SA1-068-82-531 STUDY OF CANCER MORTALITY IN CHRYSOTILE ASBESTOS MINING COUNTIES Final Report By Richard Ziskind Daniel Smith Daniel Baxter Gary Spivey Energy-Environment Systems Division SCIENCE APPLICATIONS, INC Los Angeles, California 90067 EPA Contract Number 68-02-3443 Project Officer John Acquavella Epidemiology Branch HERL, US EPA ' Research Triangle Park, N.C. 27711 7 April 1982 Health Effects Research Laboratory Office of Research and Development U.S. Environmental Protection Agency Research Triangle Park, N.C. 27711 TABLE OF CONTENTS 1.0 INTRODUCTION-HISTORY-SUMMARY 2.0 BACKGROUND REVIEW PROTOCOL ELEMENTS AND DATA GATHERING 2.0.1 Health Risks 2.0.2 Determination of Air and Water Ambient Asbestos Levels 2.0.3 Case and Control Selection 2.0.4 Case and Control Matching System 2.0.5 Quality Assurance of Death Certificate Abstraction and Coding 2.1 DETERMINATION OF STANDARDIZED MORTALITY RATIOS (SMR'S) PAGE 1 5 5 6 19 29 29 32 REFERENCES APPENDIX A APPENDIX B APPENDIX C Description of Electron Microscopy Abstracting Forms and Codes SMR Data Bases for Calaveras and Tuolumne Counties ABSTRACT The purpose of this study was to implement key data gathering tasks of an epidemiological study protocol formulated as part of the intial program phase. These activities included the asbestos analysis of air and water samples and the identification and development of a study subject data base. Initially, the ultimate objective of this program was formulated as the evaluation of the hypothesis: Deaths due to respiratory traot cancer, mesothelioma, and cardiovascular disease are associated with the length of residence proximal to asbestos mining activities after controlling for the effects of cigarette smoking, occupation, and genetic susceptibility. California death record tapes were secured for the period 1969 through 1978 for the two counties with the most extensive deposits of asbestos bearing serpentine mineral formations. County residents were subdivided according to cause of death as given by the three and four digit ICDA codes. Case and control groups were defined in order to investigate whether the geographical distribution of residence associated with particular categories (case group) differed from that of the control causes. Three case groups were developed for males and females with two controls for each case. Causes of death known to be associated with occupational asbestos exposure were generally taken as case categories whereas controls were selected with precisely the opposing criterion. Case groups were digestive tract cancer, respiratory tract cancer and heart disease with hypertension. Control groups were reproductive cancers, heart disease without hypertension and general categories. In order to asssociate an inhalation and ingestion exposure index with each individual's residential history, ambient concentrations of asbestos were determined for airborne and waterborne pathways. The California Air Resources Board made available their archive of cellulose high volume air sampler filters from the early 1970 time period. Twenty two filters were selected for electron microscopic analysis. These encompassed the DISCLAIMER This report has been reviewed by the Health Effects Research Laboratory, U.S. Environmental Protection Agency, and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the U.S. Environmental Protection Agency, nor does mention of trade names or commercial products constitute endorsement or recommendation for use. geographical area of importance including the adjacent counties with areas outside the serpentine mineral formations. All samples were analyzed for chrysotile content by scanning electron microscope and several by transmission electron microscope as a quality assurance measure. In the serpentine area (TO fi ? fiber counts all exceeded 1.0x10 /m and ranged to 3.7x10 /m (12 samples 5 6.7x10 average). In the non-serpentine areas all fiber counts were less 53 43 than 1.0x10 /m and averaged 4.9x10 /m . Water samples were gathered throughout the area and analyzed for chrysotile concentration. Eight samples contained chrysotile concentrations above the detectable limit of approximately 0.4x10^ fibers/liter. The highest concentration measured was approximately 20xl06 fibers/liter. Examination of air and water asbestos concentration findings permitted the assignment of an air exposure index-high, medium, low- to each residence community. Water asbestos were insufficiently elevated and geographically coherent to support the definition of an exposure index. Acknowledgements The authors wish to expressly acknowledge the cooperation of a number of individuals and agencies who provided us key support during the study. Dr. Gregg Wilkinson and Mr. John Acquavella, formerly of the Epidemiology Branch EPA/RTP, provided technical guidance and resources which were critical to the conduct of the program. Ms. Susan Twiss of the State of California Air Industrial Hygiene Laboratory and Ms. Judy Hodgkins, California Air Resources Board, researched and obtained the archived air sampler filters which were analyzed for asbestos. Mr. Roger Smith of the California Department of Health Services coordinated and expedited our obtaining computer tapes containing death records. Dr. James Mlllette of the Exposure Evaluation Branch, Epidemiology Division, EPA/CINC supervised the turbidity and asbestos analysis of water samples. Discussions with technical staff at Union Carbide Corporation (Dr. H.B. Rhodes and Mr. John Meyers) and Calaveras Asbestos (Mr. Michael Dell'Orto and Mr. Robert Hoylman) were quite helpful. We further acknowledge the assistance of the local water districts throught out Calaveras and Tuolumne counties as well as the regional air quality managment district. Staff was provided quality assistance from the following individuals - Mr. Alan Miller and Richard Miller for data abstracting and coding, Mr. David Barsky for data base management and programming, Ms. Melanie Nelson for manuscript word processing. Finally we extend our thanks to Dr. Carl Hayes for his assistance in project oversight during its final stages. 1.0 INTRODUCTION-HISTORY-SUMMARY This report documents the second phase of a research effort concerning the association between ambient asbestos and cancer mortality. This segment was primarily a data gathering activity and consisted of air and water sampling for asbestos in the Calaveras and Tuolumne counties of California; collection and coding of certain categories of mortality data for the period 1969-1978; and asssignment of asbestos exposure indices to the study subjects. In addition standardized mortality ratios (SMR's) were calculated for somewhat broader mortality categories in the two counties for three years 1969-1971. These SMR values were compared with the expected number of deaths for each cause based upon three-year California rates. In 1978 the U.S. Environmental Protection Agency performed an in-house study of age adjusted mortality rates in asbestos mining counties across the United States. The results showed increased mortality ratios for buccal and pharyngeal cancer, respiratory cancer, urinary tract cancer and deaths from hypertensive heart disease. Relative risks for these causes of death ranged from 1.2 and 5.6. One of the limitations of this study was that the exposure to asbestos was defined not on the basis of environmental measurements in the communities, but by census information on mining. The investigators concluded that further investigation was needed and EPA decided to contract (competitively) to fund a case/control study that would include measurements of ambient asbestos exposures. SAI was awarded the procurement in September 1979. The first steps of the program included selecting the most suitable counties for study (resulting in Calaveras and Tuolumne), designing the epidemiological protocol, and developing an air and water sampling and analysis plan. Calaveras and Tuolumne counties were selected for several reasons: A rich and extensive asbestos bearing serpentine formation traverses the western portion of both counties. These counties are rural and individuals tend to be exposed to fewer confounding hazardous emissions. The exposure of this population to asbestos was hypothesized to be significantly elevated in localized portions of the counties while at low background levels in other parts of the counties. 1 Computer tapes of mortality data were obtained from the office of the State Registrar of Vital Statistics for the two counties for the time period 1969-1978. The data were sorted into computer files according to cause of death (ICDA code), sex, age, and county of residence.** The epidemiologic protocol design was to identify three case groups each of males and females. Each case group consisted of a selected set of causes of death known or suspected of being associated with occupationally related exposure to asbestos. Two control groups were identified for each case group with their selected causes of death categories known to be unrelated to asbestos exposure. The overall approach thus for each case subject is to identify by age and sex matching, two control group members and associate with each an asbestos exposure index based upon their residence location. In order to investigate whether air and water ambient levels of asbestos were elevated and to determine their gradients across the county a sampling and analysis approach was designed based upon knowledge of the water distribution systems, populations, and air quality monitoring stations. It was predicted that roughly half the population in these two counties might have been exposed to elevated concentrations of asbestos in the air and/or water. In September 1980 EPA approved the study protocol and SAI was issued a new contract to collect the mortality and exposure data. This report documents that contract. The California Air Resources Board provided assistance to SAI in this study phase by making available their archives of high volume air sampler filters for the earliest time period still retained i.e. 1972 through 1974.* Twenty-two cellulose filters were selected for electron microscopic analysis. These encompassed all geographical areas of importance. Results were clear- 3 cut. In the serpentine area fiber counts all exceeded 100,000 fibers/m , ranged to 3,700,000 and averaged 675,000 for 12 samples. In the non-serpentine areas all samples (10) had fiber counts less than 100,000 * As opposed to county of death. * It is most desirable to obtain past asbestos concentration information since this more closely reflects the exposure the subject popuation recieved 2 3 fibers/m and averaged 49,000. Blanks and duplicates were run as quality assurance measures. Since no archived water samples were available, twenty four were gathered from throughout the two counties in order to comprehensively characterize the asbestos content in each distinct water distribution system. Eight samples contained chrysotile concentrations above the detectable limit of approximately 400,000 fibers/liter. The highest concentration value measured was approximately 20 x 10^ fibers/liter which may have been a local phenomenon associated with cement asbestos pipe transport. Unlike the airborne case, waterborne levels were neither significantly elevated nor geographically coherent to support the development of an exposure index. In summary the airborne levels of asbestos found in communities in the serpentine formation areas are significantly elevated over non-serpentine areas and are more illustrative of occupational environments although the fiber sizes distribution is biased toward the fines. Importantly, of course, those exposed is a non-occupational population which is typically less hardy. The following case and control groups with identifying cause of death codes (ICD, 8th revision) are being utilized for males and females: Case Groups Corresponding Control Groups 1. Trachea .Bronchus and Lung Cancer (ICD 162.0-162.9) General Causes (various ICO numbers) Reproductive Cancers (ICO 174, 185-187.9) 2. Digestive Tract Cancer (ICD 150.0-159.9) General Causes Reproductive Cancers 3. Hypertensive Heart General Causes Disease (ICD 400.0 404.9, 410.0, 411.0, 412.1-412.2) Non-Hypertensive Heart Disease (ICD 410.9, 411.9, 412.3-412.4) The total study population is 1382 individuals. 3 The study group was developed from the State computer tapes discussed above. In order to obtain the information necessary to support the mortality analysis, the death certificate hard copy was located, information abstracted, coded and placed on tape. The death certificate abstract form is shown as Figure 2.1-2. All necessary information has been coded to initiate the tracing of the surviving spouse or informant if that is ever needed. Subsequent effort for this research would begin at this point. It would be appropriate to perform the analysis of this data base and test for associations between cause of death and the area of residence within the counties. Specifically the correlation between a case group, e.g. the 85 males deceased from the categories of hypertensive heart disease, and their airborne asbestos exposure based on residence history would be statistically contrasted with the 85 age matched males deceased from general causes and finally the 85 who died of non-hypertensive heart disease. This approach was formulated as the most cost-effective procedure to determine if any categories of mortality correlated with asbestos exposure and to prioritize them. The master plan for completion of the study, as envisioned by EPA, would be to perform a next of kin survey to Improve upon the Information base coded from the death certificate. A questionnaire was developed in the initial EPA sponsored contract which primarily obtains or verifies information on smoking, drinking and residence and occupational history. Next of kin Interviews would only be considered later for specific case group categories where a convincing association with exposure was found. 4 2.0 BACKGROUND REVIEW 2.0.1 Health Risks Health effects due to the occupational exposure to asbestos has been studied particularly in the mining, milling, textile, and construction industries. In their review of findings, EPA researchers (Acquavella, et al. 1979) cited studies* of human cohorts implicating asbestos as a factor in increased mortality from several types of malignancy: mesothelioma, lung and laryngeal cancer (especially for smokers), and possibly GI cancer. Mortality from non-cancerous conditions of the respiratory and possibly cardiovascular system has also been related to chronic occupational exposure (Mancuso, 1967; McDonald, 1971). Studies have examined the risk of increased mortality among residents in neighborhoods proximal to asbestos processing faciltiies, in areas with natural asbestos deposits, and in communities having identifiable asbestos fibers in public drinking water. Historically such studies have been equivocal. However, recently with the emergence of two key factors (electron mierosopy and cancer incidence registries) several studies undertaken have identified and quantified a risk factor among communities with elevated asbestos exposure to airborne and/or waterborne concentrations. Specifically Graham (1977) demonstrated, through use of tumor registry data, residents in several Quebec communities had risks from 1.5 to 8.1 times higher than control communities for 10 different cancer sites among males and for seven sites among females. The most prominent excesses were found for cancer of pleura, small intestine, salivary gland, peritoneum, lip and tongue for males; and lip and pleura, salivary gland, kidney and melanoma for females. * Kleinfield, 1967; Mancuso, 1967; McDonald, 1971; McDonald, 1974; Miller, 1978. 5 Kanarek et al. 1980, analyzed the asbestos content in the water distribution systems supplying the San Francisco-Oakland Standard Metropolitan Statistical Area (SMSA). The dependent variable of interest was cancer incidence adjusted for age, sex and race. The major Independent variable was chrysotlle asbestos fiber content. Kanarek showed elevated mortality from cancers of the esophagus, stomach, gall bladder, and pancreas. Acquavella et al., 1979 investigated the hypothesis that cancer as well as respiratory and cardiovascular disease mortality would be in excess In chrysotile asbestos mining counties across the country. Although national In scope, California figured large in this study since it accounts for over 70% of total U.S. asbestos production. Mortality data from the years 1969-1971 were obtained from the POPATRISK data base. Unfortunately this data base coarsely groups respiratory and digestive tract cancers and does not allow their subdivision into sub-groupings of more specific occupationally asbestos-related sites. Two critical features of the study protocol were that the county level was the smallest population breakdown and In a related limitation a localized source of emissions such as a plant or region of natural asbestos deposits could not be expected to affect the ambient air of an entire county. Thus the study would overestimate the population at risk and therefore dilute potential associations. The study protocol had no mechanism for considering occupational exposure. Control counties were matched according to population density. The results showed increased mortality ratios for buccal and pharyngeal cancer, respiratory cancer, urinary tract cancer, and deaths from hypertensive heart disease. Relative risk for these causes of death ranged from 1.2 to 5.5. 2.0.2 Determination of Air and Water Ambient Asbestos Levels SAI undertook research to follow-up on the EPA effort discussed above. The purpose of the work was to design and execute an epidemiologic study protocol to further evaluate the hypothesis that asbestos related health effects have been observed among populations without occupational exposure. Two distinct California areas with extensive asbestos bearing serpentine formations were researched. One is associated with a deposit running through the junction of Fresno and San Benito counties (New Idria Deposit). The second is located throughout the western sections of Calaveras and Tuolumne 6 counties (herein referred to as the Calaveras Deposit). The preferable study area was determined to be that associated with the Calaveras Deposit. Selection criteria were three-fold: greater population base, evidence of elevated airborne and waterborne concentrations of asbestos, and the existence of archives (CARB) of useful ambient air sampler filters dating back over seven years. Figure 2.0-1 illustrates the asbestos deposits in California. The New Idria and Calaveras Deposits are among the richest and most extensive in the state and contain the only active commercial sities. Figure 2.0-1 depicts the general area of Calaveras and Tuolumne counties. The oldest measured ambient levels of airborne asbestos taken in the western county area was reported by the California Department of Health in 1965-1967 (California Department of Public Health, 1967). Ambient (upwind) asbestos concentration was measured by dust sample collection through impingers. Quantification was by optical microscopy. Ambient levels on two separate occasions were made and ranged between 0.1 and 2 million particles per cubic foot of air (mppcf). A federal study at about the same time of the area "Environmental Survey of Asbestos Mining and Milling in California " (December 1966, Public Health Service Division of Occupational Health) suggests the equivalence 10 total fibers/cc = 1 mppcf by impinger. In the cited ambient concentrations (from the NIOSH Recommended Asbestos Standards) 3 the levels across the country are summarized as generally <10ng/m with 3 occasional peaks as high as 100 ng/m (by electron microscopy). Using optical microscopy, ambient levels are generally less than 0.01 fibers > 5 ym/cc with peak values as high as 0.03 fibers >y5 m/cc. Using the Public Health Service equivalence 6 fibers > 5 ym/cc, 1 mppcf by impinger yields the mine area ambient (upwind) concentration range 0.6 - 12 fibers/cc.* Further using the NIOSH suggested equivalent 20 fibers > y5 m in length (as determined by optical microscopy) per nanogram of asbestos yields the mine ambient range 12 3 - 140 ng/m . Thus the ambient levels detected at upwind locations in the vicinity of a Calaveras mine/mill are at the extreme high end of surveyed range. A number of subsequent studies of the general area have confirmed that quite elevated concentrations of airborne asbestos exist. The most recent, of course, being the comprehensive analysis done of the area performed by SAI for EPA in 1980. * Note the current NIOSH recommended standard is 0.1 fiber/cc for an 8 hour time-weighted average (as detected by optical microscopy). 7 Figure 2.0-1 Asbestos Deposits of California. 8 t>VU"\ jt StTZ[ c,,.'j !*"NLY-l'Wv1*l/tlOH wp^ l /-< UHC nnocH .. a LuIN"*ptCt*giOLJLLLA1\NOVCV..isv, ^tBbMw<o3H_ii ed_aUCj':f4o4tjJFtCfarjgj{'`^-)i.tvCrw'CtrwlVttN..".,,7\fi^(.^,si-a* i.. k -STOCKTONtW ClMTCfl, Krf^W v- MtlbMkS*-' PAKOA! .^gR: - ^fli/-\rSI *' tv-" ^ WltXftAt J**'*1 ' Figure 2.0-2 Serpentine Areas of Calaveras and Tuolumne Counties. 9 The California Air Resources board provided hi-vol sampler filters from geographical areas of interest. Available samples went back to 1972. Analysis of these filters provided an important basis for the determination of airborne asbestos exposure to the study population. Filter selection procedure was to obtain 22 filters accounting for seasonal variation at significant single locations, coverage of the entire geographical region, and representation of suspected high and low suspended particulate values. In addition, all hi-vol filter flow traces were Inspected to confirm that regular flow rates occurred throughout the collection period and that no data tampering was evidenced. Table 2.0-1 summarizes the results of the scanning electron microscope analyses. Fiber counts and other data should be read as follows for SAI number 81-1101 there were 3,251,00 fibers/m in the fiber size range of less than 5 microns length. Figure 2.0-3 and Table 2.0-2 can be used to explicitly interpret all sample locations. As can be readily seen from Table 2.0-1 the first twelve readings (sites 55922, 55921 and 22741) are significantly elevated over the remainder, i.e. serpentine deposit sites compared to non-serpentine. Furthermore the serpentine area concentrations must be assessed as extremely high by any measure and would be of note even in an occupational environment. In addition to analysis by scannning electron microscopy several analyses were performed by TEH (transmission electron microscope) as a quality assurance procedure. TEH Analysis was' conducted using a Hitachi Hodel H-500 Scanning Transmission Electron Hlcrosope equipped with both SAED and Dispersive X-ray capabilities. Two grids for each sample were counted at a magnification of 10,000X and the diameter measurements were made at magnifications of 100,000X or 200,000X. The magnifications were calibrated using a carbon grating replica. Chrysotile fibers were identified according to morphology and/or selected area electron diffraction. Comparison of TEH and SEH analysis for 81-1116-2 (Sonora 55922 9/20/74) and 81-1235 (Van401ELD 09001 8/14/73) are summarized in Table 2.0-3. The fiber counts for the TEH analysis are slightly higher due to the higher resolving power of the TEH. 10 Table 2.1-1 SUMMARY ASBESTOS ANALYSIS BY ELECTRON MICROSCOPY OF STUDY AREA HI-VOL FILTERS $A| Humber Location Site Collection Date flbers/m? <5|im(l0*' ) 81-110! 81-1097 Sonora Sonora 55922 55922 08-08-73 10-25-73 81-1116 *31 -1094 81-1120 Sonora Sonora Sonora 55922 55922 55922 09-20-74 12-30-73 06-28-74 81-1099 Sonora 55922 09-25-73 81-1121 81-1118 81-1102 Sonora Sonora Sonora 55922 55922 55921 04-05-74 07-22-74 07-15-73 *81-1106 81-1110 81-1092 Sonora Sonora Mariposa 55921 55921 22741 05-24-73 03-23-73 07-11-72 81-1231 81-1232 Cam!no 09663 Placervllle 09664 04-10-73 04-10-73 81-1235 Van 401 ELD 09001 08-14-73 81-1199 Modesto 50557 07-26-72 B1-1204 Stockton 39252 07-25-72 81-1213 Leevlning 26772 09-20-72 81-121712 Madera 20001 11-20-72 81-1218 81-1197 81-1196 Madera Bridgeport Van 201 ELD 20002 26773 09301 03-13-73 04-07-73 06-15-73 Sample blank 129 (same ashed blank dilution as sample filters) Sample blank 12 (10 fold ashed blank dilution as sample filters) Sample blank 12 (10 fold aerosol O.T. and filtered water blank) 3251 232 704 247+145 106 388 231 153 378 1031+253 86 417 7.5 29 14 66 29 46 79 10 18 0.0 7.0 0.0 denotes filter variation within one sample filtration ^denotes sample variation between twn separately filtered samples flhers/m3, >5i.m (10'J) 448 24 12 44+23 8.4 38 26 9.5 73 79+60 14 31 0.0 13 0.0 16 0.0 1.9 8.3 3.4 0.0 0.0 0.8 0.0 mass/m3 , mass/m3 5nm (10*3) >5i.m (10'3) 221 118 46 37+21 13 43 31 86 73 268+130 3.8 44 0.4 1.6 0.5 10 5.1 147 15 18 24237+33748 380 16 27 1461 202 435+214 103 7.2 0.0 7.5 0.0 160 0.0 1.3 3.1 0.1 11 0.0 0.3 0.0 11 2.8 39 0.0 0.0 3.4 0.0 Surface area/m3 Surface area/m' <5iiiii (10'd 5gm (10*3) 2513 379 456 234+130 89 332 201 204 401 1305+106 45 360 4.5 15 6.3 59 40 1578 127 105 5205+6243 333 185 122 752 526 2100+183 216 104 0.0 61 0.0 232 0.0 21 38 2.0 33 0.0 4.4 0.0 37 23 74 0.0 0.0 9.6 0.0 Figure 2.0-3 Site Locations of Samples Analyzed for Asbestos 12 Table 2.0-2 Ambient Asbestos Samples-Site Designations Site isiqnation 1 2A 28 3 4 5 6 7 8 9 10 ' 11A 11B Site Location Mariposa Sonora Location #1 Sonora Location #2 Bridgeport Camino Placerville Van 201 Van 401 Modesto Stockton Lee Vining Madera #1 Madera #2 Sample Date 7/11/72 3/23/73, 5/24/73, 7/15/73 8/8/73, 9/25/73, 10/25/73, 12/30/73, 4/15/74, 6/28/74. 9/20/74 4/7/73 4/10/73 4/10/73 6/15/73 8/14/73 7/26/72 7/25/72 9/20/72 11/20/72 3/13/73 13 The surface area and mass values are slightly higher in the SEM analysis which is probably due to the apparently larger fiber diameters which result either from gold coating the filters or problems with resolution above magnifications of 50,000X. Appendix A contains information on the procedures used for the preparation and analysis of the electron microscopy effort. The microscope facilities are described and additional remarks are made pertaining to the results and conclusions. Analysis of the turbidity and asbestos content of water samples was conducted by the Exposure Evaluation Branch of the Epidemiology Division, Health Effects Research Laboratory, EPA Cincinnati: Twenty three water samples were gathered by SAI staff encompassing the population centers and water distribution systems. Table 2.0-4 delineates the sampling sites and Table 2.0-5 summarizes the analysis results. The water distribution system location and types - both historic and current were discussed in the final report from the initial contract (Ziskind, 1980). Ten samples contained statistically significant amounts of chrysotile asbestos with three samples over 1 million fibers per liter. The highest concentration measured was at Groveland (20 x 106 fibers/1 iter) and appears to be due to aggressive water transport through asbestos cement pipe (Personal Communication B. Beaudreau, General Manager, Groveland Commercial Services District). The pH In the Groveland system decreases to approximately 6.0 after gas chlorination. Lime treatment is planned to raise pH to greater than 9 which should reduce the asbestos content in the water. In any event the system is localized and fairly recent ( 16 years). It was concluded that asbestos concentration in water was neither particularly elevated nor distributed with a sufficient gradient to warrant creating an exposure index for use in the epidemiologic protocol. It was decided, on the other hand, that airborne concentration of asbesto fulfilled both criteria (sufficiently elevated levels and geographic gradient) and exposure indices were formulated. Categories of asbestos concentration areas in the two counties were defined as either high, medium and low according to whether they were less than 5 miles from deposits, between 6 and 10 miles, or greater than 10 miles. Deposits were readily located on the area geological maps and each community was labeled and coded for incorporation into the 14 57303 57304 57305 57306 57307 57308 57309 57310 57311 57312 57313 57314 57315 Table 2.0-4 ASBESTOS WATER SAMPLING SITES Residency 270 High School Street San Andreas (Utility Sink) Residency 151 Chestnut Street Valley Springs (Garden) Residency 8288 West Main Mukelumne Hill (Garages) Residency Main Street West Point (Garden) Haags Store (Also Residency) R.R. Flats Rd. (Well Water) R.R. Flats (Bathroom Sink) (No Filter) Residency 429 Church Murphys (Kitchen Sink - No Filter) Murphy's Hotel Murphy's (Bathroom Sink - No Filter) Jackpot Gas Main Street Angels Camp (Bathroom Sink - No Filter) Residency 1280 Bush Angels Camp (Garden) Gold Rush Mobile Homes Parrott's Ferry Road Columbia (Bathroom) Old Tuolumne County Court House Yaney Street Sonora (Bathroom) Residency 33 Bradford W. Sonora (Garden) Residency 514 Stewart Sonora (Garden) 16 57316 57317 - 57318 - 57319 - 57320 - 57321 - 57322 57323 57324 57325 - Samples Samples Residency 18415 Gardner Ave. Tuolumne (Garden) (A little murky brown) Residency (Apt. Bldg.) 22771 Twain Harte Drive Twain Harte (Garden) Strawberry Store (Gen. Store and residency) Hwy 108 Strawberry (Garden) The Square Nail Restaurant 18376 Bay Ave. Tuolumne (Bathroom) Yosemite Bank Hwy 120 Grovel and (Bathroom) Residency 121 (The Main Street) Copperopolis (Garden) Same as 57321 Same location as 57320 Same location as 57306 Black Bart Inn - Garden Faucet 55 St. Charles Street (Hwy 49) San Andreas 57303 - 57322 were taken in October 1980 57323 - 57325 were taken in March 1981 17 Table 2.0-5 Turbidity and Asbestos Results for California Samples Chrysotile Concentration Millions of Fibers/liter Sample No. Description Turbidity (JTU) Cone. 95%Confidence Limits Upper Lower 57303 57304 57305 57306 57307 57308 57309 57310 57311 57312 57313 57314 57315 57316 57317 57318 57319 57320 57321 57322 57323 57324 57325 2551A 2551E 2552E 2562E 2561E 2581A 2601A San Andreas Valley Springs McKellumme Hill West point Railroad Flats Murphys Murphys . Angels Camp Angels Camp Columbia Sonora Sonora Sonora Tuolumne Twain Harre Strawberry Tuotumne Grovel and Copperopolis Copperopolis Grovel and West Point San Andreas Blank Blank Blank Blank Blank Blank Blank 0.6 2.1 3.3 1.6 2.5 1.4 2.5 0.3 0.7 0.6 0.3 0.2 0.5 10.0 0.3 0.9 0.7 0.5 1.3 5.5 - - - 0.2 0.2 0.2 0.2 0.2 0.2 - NSS (0.3)* BDL (0.1)** 0.4 5.5 NSS 0.1) 0.6 0.6 NSS (0.1) 0.7 BDL (0.05) 0.5 NSS (0.2) BDL (0.06) NSS (0.4) NSS (0.3) NSS (0.06) BDL (0.07 3.2 BDL (0.3) BDL (0.3) 20.1 0.4 0.5 NSS (0.05) BDL (0.05) NSS (0.15) BDL (0.05) BDL (0.05) NSS (0.05) BDL (0.05) 0.5 - 0.8 6.9 0.4 1.1 0.9 0.3 1.0 - 0.8 0.4 - 1.0 0.5 0.2 - 4.2 - - - - 0.2 0.4 - - 0.2 - 0.05 - 0.05 4.0 0.09 0.1 0.3 0.02 0.4 0.2 0.01 0.3 0.05 0.05 - 2.3 - -' - - - 0.05 - 0.09 - - 0.05 - * NSS - Non-significant. While concentrations based on less than five fibers may show the presence of asbestos in the water, the actual val ue is not considered very reliable. ** BDL - Below the detectable limit shown . No fibers were seen in the analysis. 18 coding of the mortality data base. The flexibility was retained to assign numerical values of fiber concentration to each area. In the serpentine areas 3 fiber counts exceeded 100,000 fibers/m , ranged to 3,700,000 and averaged 675.000. In the non-serpentine area (all greater than 10 miles distance) all 3 samples had fiber counts less than 100,000 fibers/m and averaged 49,000. In addition to the residence of the deceased individual being recorded on the death certificate their length of stay in the county and in the state are recorded as denoted in Figure 2.0-3. Although without further investigation it would not be possible to verify their residence history in the county during that period, it does facilitate the elimination from the study of individuals with less than a minimal period of residence in the county. Furthermore it is thus possible to define an exposure index equal to the product of length of stay in the county and average fiber concentration in the area of residence. 2.0. 3 Case and Control Selection The study group was defined as those individuals who died in Calaveras and Tuolumne Counties during the ten year period 1969 and 1978. Approximately 4300 individuals, nearly all white, were found to be in that population. It was predicted that approximately one half of the population would have resided in the serpentine formation areas and therefore the counties would provide a useful distribution of residence (exposure index) for contrast among ICDA categories. Both cases and controls were identified from the California state death tapes. The tapes are compiled monthly alphabetically by county of death. Thus it was necessary to obtain the complete tapes from Calaveras and Tuolumne counties and those entries from throughout the state of residents of Calaveras and Tuolumne counties who died elsewhere. These tapes have coded the basic information from the death certificate including the full name, date of death, sex, race, birthplace, date of birth, age, county of death and residence cause of death (4 digit) and local (county) file number. The listings were sorted into groups according to the International Classification of Diseases (ICD) code for the underlying cause of death. A ten year time interval (1969-1978) was selected in order to gain a sufficient statistical base while not proceeding into the more distant past thereby complicating the study by introducing earlier revisions of the ICD codes. 19 Causes of death hypothesized as linked to asbestos exposure (primarily based upon the occupational literature) were delineated and case groups formed as follows: 20 c e r t Figure if ic a t e o DECEDENT PERSONAL DATA CERTIFICATE OF DEATH Tfnniic numbft STATE OF CALIFORNIA--DEPARTMENT OF PUBLIC HEALTH NAME OF DECEASED--FIRST NAME j 1. MIDDLE NAME |lC LAST NAMC I ____ I I SEX 4 COLOR OR RACE 5 BIRTHPLACE iSSIw? 6. DATE OF BIRTH LOCAL BLCISTBaIION diSIRtCT ANO~CtWftriCMC~~Nui<litR 2a DATE OF DEATH--hohih ox. it J2 HOUR _____ I I 7. AGE Aiut ** ir UHQtA I <C*A \t UWOH ?4 HOUH NAME AND BIRTHPLACE OF fATHER ______________YEARS 9 MAIDEN NAMC AND BIRTHPLACE OF MOTHER 10 CITIZEN OF WHAT COUNTRY 14. LAST OCCUPATION II. SOCIAL SECURITY NUMBER 12- NARRlEO. NEVER NARRlEO WIOOWEO OIVORCIO i SPECIFY! ID RUMItt OF l|U| IR ** OCCW'AftOh 16 NAME OF LAST EMPLOYING COMPANY OR FIRM IF UtF lPLOi|0 10 Main 13 NAME OF SURVIVING SPOUSE <ir oiu. intib nbioin nbnii 17 KINO OF INDUSTRY OR BUSINESS PLACE OF DEATH I8. PLACE OF DEATH--NAMC OF HOSPITAL OR OTHER IN PATIENT FACILITY ___________________________________ I8o CITY OR TOWN [18*. STREET ADDRESS--IITH1T AND nuubia. OA IOCA1IONI JlBC INSIOC cut CORPORAll UN:IS I .SPECIFY *CS CR NO1 - ! ______________________ II_____________________ [18c. COUNTY I I_________ [ I8f l(tM or ll IN [Mall Of HIN 1180 tlMCIM Of l. i* I| IYEARS IY`ARS USUAL RESIDENCE |T9a USUAL RESIDENCE--STREET ADDRESS I STREET AND NUUIEA OA LOCATION I . (IF DEATH OCCURRED IN INSTITUTION INTER RESIDENCE BEFORE ADNISSIONI I9c. CITY OR TOWN --------IT!9o. COUNTY I I I 19 INSIOE CITY CORPORATE LIMITS I ISPICIFf TES OR HOI I I [I9E STATE I I_______________ 20. NAME AND MAILING ADDRESS OF INFORMANT PHYSICIANS OR CORONER S CERTIFICATION Ova DAM ISO PlCC >111(0 MCiYI FROM IM( autlt SUMO (LOW ANO IMAI I t*A( H((D OR (A.NS OF 0(CI*S(0 as tlOUiRlD ft LAV 21a PHYSICIAN: I MIRIM CIRUFf IMAI OlAtH OCCV'MI A (MI HOUR OAK AND P14CI ftlAMD 4*0V| ROM INI CAUStft SUIID mo* ANO FliAl I AHIMDIO INI aici*ico rOM TO CNKR RORlM OAF l|lfl I IASI SAM tMf 21c PHYSICIAN OR CORONER--iicraiur* ard DitRii c imi 21c. ADDRESS 12lo. DATE SIGNED II ''Rlffi'AlVJS`&R*INiultfl " FUNERAL DIRECTOR AND LOCAL REGISTRAR 22a SPECIFY lUftlAl. ENTOMBMENT OR CREMATION 22a. DATE 23. NAME OF CEMETERY OR CREMATORY 24. EMBALMER--SIGNATURE ur loot kmralncoi LICENSE NUMBER 25. NAME OF FUNERAL DIRECTOR 10* PERSON ACTING At SUCH I Sf *- IF ROt CIRIIFIIO *f CORORIR MAS IMIS DIAIM RirOAHO 10 CORORIR* 27. LOCAL REGISTRAR--SIGNATURE SMOFI t$ OR ROI 28. CAUSE OF DEATH 29. PART I. OCATH WAS CAUSED BY: IMMEDIATE CAUSE (A) ENTER ONLY ONE CAUSE PER LINE FOR A. 8. ANO C CONDITIONS. IE ANY. WHICH GAVE RISE TO THE IMMEDI ATE CAUSE 4 A . STATING THE UNDERLYING CAUSE LAST DUE TO. OR AS A CONSEOUCNCE OF (B) DUE TO OR AS A CONSEQUENCE OE (C) APPROXI MATE INTERVAL BETWEEN ONSET AND OEATH 30. PART II: OTHER SIGNIFICANT CONDITIONS-- <ririi*ro io mr*m ro *o riiaiir id imi fmriduk crwu omir m mr u OTIRAHTR k CfR *M*Vy 4). attic*** | aa. * lt ti"->>:t'0* Jfc *. #((< | Jt* f.ciaiP it n 'iR-*ih6 It CR MO* j Af* *' Dial-' * ." Mt CR NO 33 SPECIFY accioent sutciot oa homicide 34 rPilatCrcl oOFr iINhJiUuRitY f'VB|*t|cAnA(OMMitai afnar*tl*ial|cIi 0*FW| lUUDFRO lie t INJURY 37a. PLACE OF INJURY istrect and nunser oh location ano ciit or town* INFORMATION 35 INJURY AT WORK 1*1 C IF f t|t( kOt h7i F'UU'*0 FIV10I J#R. MMI (Olltvtl . | RI V*PIMil illM ID _____________ |_______________________________ 36> DAIE OF injury--t j 36i HOUR *a am (IMFIMI l|Mt ROM FOR MF(I J- OR Ipill (N|<ll|i|F|(tf| |t OR NO* I .I I -NQ *1*1 I** *(.>! I|l| I Vtl FOR *>tCOl' WKD* ill OR tOt I MIUS 40. DESCRIBE HOW INJURY OCCURRCO iimm ittwud o> iln *)( titwm m nmii ! or rmr tHnuto ti imirio umiir if f 2.0-3 DEAT H -C al if o r n ia STATE REGISTRAR A 0 c. 0. E ' F Ml V I t AM ICM> VJ II A. Case Groups (hypothesized associations with asbestos exposure) 1. Malignant Neoplasms of Digestive Organs and Peritoneum ICD 150.0 to 159.9 2. Malignant Neoplasm of Trachea, Bronchus and Lung ICD 162,0 to 162.9 3. Hypertensive Heart Disease ICD 400,0 to 404.9, 410.0, 411.0,412.1 to 2.2 B. Control Groups (no hypothesized association with asbestos exposure) 1. Reproductive Neoplasms (matched to digestive and respiratory cancer case groups) Males: ICD 185.0 to 187.9 (Prostate, Testes, Other and Unspecified) Females: ICD 174.0 to 174.9 (Breast) 2. Non-Hypertensive Heart Disease (matched to hypertensive heart disease case group) ICD 410.9, 411.9, 412.3 to 412.4 . 3. General Causes of Death (Matched to digestive, respiratory and hypertensive heart disease case groups). Includes all causes of Death, except: a) Tuberculosis ICD 10.0 to 19.9 b) Malignant Neoplasms of Digestive Organs and Peritoneum ICD 150.0 to 159.9 c) Malignant Neoplasms of Trachea, Bronchus and Lung ICD 162.0 to 162.9 d) Malignant Neoplasms of Breast ICD 174.0 to 174.9 e) Malignant Neoplasms of Prostate, Testes, Other and Unspecified Male Genital Organs ICD 185.0 to 187.9 f) Malignant Neoplasms Without Specification of Site ICD 199.0 to 199.9 g) Mental Disorders ICD 290.0 to 315.9 h) Hypertensive Disease ICD 400.0 to 404.9 i) Ischaemic Heart Disease ICD 410.0 to 412.9 j) Cerebrovascular Disease ICD 430.0 to 438.9 k) Diseases of the Respiratory System ICD 460.0 to 519.9 l) Diseases of the Digestive System ICD 520.0 to 577.9 m) Complications of Pregnancy, Childbirth and the Puerperium ICD 630.0 to 678.9 n) Congenital Anomalies ICD 740.0 to 759.9 o) Causes of Perinatal Morbidity and Mortality ICD 760.0 to 779.9 p) Water Transport Accidents ICD 830.0 to 833.9 q) Other and Unspecified Accidental Falls ICD 887.0 to 887.9 r) Accidental Drowning and Submersion ICD 910.0 to 910.9 s) Accident Caused by Firearm Missiles ICD 922.0 to 922.9 t) Suicide and Self-Inflicted Injury ICD 950,0 to 959.9 u) Homicide ICD 960.0 to 969.0 v) Legal Intervention ICD 970.0 to 978.9 w) Injury Undetermined Whether Accidentally or Purposely Inflicted ICD 980.0 to 989.9 x) Injury Resulting from Operations of War ICD 990.0 to 999.9 22 These categories were eliminated from the general control causes of death because they included: 1. Other case or control categories (b, c, d, e, h, i) 2. Categories which could be associated with asbestos exposure and/or the three case categories (a, f, j, k, 1) 3. Categories unlikely to contain records that would be age-matchable to case records Cm, n, o) 4. Categories containing deaths due to recreational activities, which could be related to length of stay in the county, or place of residence within the county (p, q, r, s) 5. Categories containing deaths likely to present difficulties in ob taining information from survivors due to their sensitive nature (g, t, u, v, w, x) All case and control subjects chosen were white, recorded as residents of either Calaveras or Tuolumne Counties, and died in years 1969 through 1978. 23 In summary, three case groups were selected which have been cited in the occupational or general epidemiologic literature as suspected of being asbestos related. We have selected specific concomitant cancer or heart disease control groups and a general control group. Table 2.0-6 provides the breakdown on the case and control group sizes. The general control group included all categories except 1) those which could possibly be associated with asbestos exposure, e.g. digestive and respiratory diseases, 2) those likely to present difficulties in obtaining information from surviviors, e.g., suicides, 3) those likely to be poorly age matched with case groups, and 4) those heavily locale specific, e.g., drowning. Table 2.0-7 illustrates the age and year of death breakdown of male case group 11*. Each case subject was then age and year of death matched with two controls- one from control group VI and one from the appropriate designated analog control group which in this case is group IV. After all case and control subjects were identified, each Certificate of Death was located, reviewed, abstracted, coded and placed on tape. Figure 2.0-3 shows the California Certificate of Death. Additional information abstracted from the Certificate includes material vital to assigning asbestos exposure, e.g. residence and length of stay In the county; assisting in identifying confounding exposures, e.g. last occupation; useful in locating surviving kin; and verifying critical data such as the ICD number. Residence information was recorded and also coded according to the distance from high asbestos deposit areas. Coding of occupation was performed and occupations classified into asbestos exposure potential as: definite, probable, possible and probably no exposure. Subsequent analysis of these data will focus on residence in the area so the primary measure of exposure and will treat occupational category as a covariate which will be stratified or adjusted for. It is readily acknowledged that death certificate listing of occupation is a poor measure. These other such confounding factors such as * Numbers disagree with those above since a slightly different analysis was being performed which utilized somewhat different ICD categories. 24 Table 2.0-7 Male Deaths from Malignant Neoplasms of Respiratory System (ICD 160-163), by Year and Age at Death, Calaveras and Tuolumne Counties 1969 LT 10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65--69 70-74 75-79 80-84 GE 85 TOTAL I I I 1 I 1 I ! 1 I 1 I 1 0 0 0 0 0 0 1 0 0 0 3 1 2 2 4 2 l 16 1970 1971 1972 0 00 0 00 0 .. 0 0 0 ' . 1 v - ; 0 000 0 00 000 1 00 010 30 1 221 1 20 `2 d 2 1i1 220 1 1* 1 001 13 . 7 1973 - .i 1974 * Ct 00 00 00 00 "0 u 00 00 00 u1 02 02 5 5 53 30 14 0 0 . .. 22 14 21 1975 -- 0 0 0 0 0 0 0 0 i 5 2 4 4 4 0 4 1 25 1976 . 'i " ..........O' 0 0 ........ 0 0 0 1 0 0 1 3 4 3 5 1 2 2 22 1977 .1 1978 00 00 o 7 t/7 . o "''.-7 0 0 . 0" u 00 00 00 01 21 : 3 .v i '2 i 62 i3 22 01 J0 19 12 smoking and drinking could be accounted for at some future time by means of next-of-kin interviews if the proposed analyses identified specific case groups with a significant elevated risk and there was sufficient interest to minimize additional possible confounding factors. Figure 2.0-4 shows (in photo-reduced size) the computer generated form developed to record the abstracted information. For each subject decedent, data from the death tapes are filled in when the form is generated. These data are: o Social security number o Name o Data of death o Birthplace and birthdate o Age at death o Marital status o Counties of death and of residence o Cause of Death o Whether or not an autopsy was performed o The qualifications of the certifier. The data recorded by our abstractors from the hard copy death certificate were entered in the appropriate blanks. These are: o Identification Number o Father's name and birthplace o Mother's name and birthplace o Name of surviving spouse o Last occupation and years worked o Name and address of hospital The format for the death certificate abstract corresponding to Figure 2.0-4 is described in Appendix B. Coding for birthplace, occupational classification, occupational asbestos exposure, city codes (for exposure indices), and county codes are all provided in Appendix B. 27 m iimi tJ.'Ki if a;,iit iuiHiK.it;i CARD NO 0 1 ID NO 01 02 03 04 05 06 STATE FILE NO . LOCAL REG (III SOCIAL SECURITY NO 07 08 09 10 It 12 13 ll iS NAME DATE (IF DEATH 16 17 18 IV 20 21 22 23 24 25 2A 27 28 29 30 31 32 33 34 35 3A 37 38 39 40 11 42 43 44 45 4A 47 <3 49 50 51 SEX RACE BIRTHPLACE BIRTHRATE AGE 52 53 54 55 56 57 58 59 60 61 62 63 64 CARD NO 0 2 ID NO FATHERS NAME BIRTHPLACE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 MOTHERS MAI DEW NAME BIRTHPLACE 27 28 29 30 31 32 33 34 35 36,37 38 39 40 41 42 43 44 45 46 47 48 4V 50 MARITAL STATUS NAME OF SURVIVING SPOUSE 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 CARD NO 0 3 ID NO LAST OCC YRS COMPANY KIND 01 02 03 04 05 06 . 07 08 09 1011 12 NAME AND ADDRESS OF HOSPITAL CO OF DEATH LENGTH OF STAY IN CO IN CA USUAL RES CITY CO 13 14 15 16 17 IB- 19 20 21 22 NAME OF INF ADDRESS 23 24 25 26 27 28 2V 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 S3 54 55 56 57 58 59 CITY 60 61 62 63 64 65 66* 67 6B STATE 69 70 CAUSE OF DEATH CODE . AUTOPSY 71 72 73 74 75 CERTIFIER 76 PHYSICIAN/COKQNER NAME ADDRESS PHYSICIAN LICENSE NUMBER IMMEDIATE CAUSE(A) DUE TO(B) DUE TO(C> OTHER SIGNIFICANT CONDITIONS AIR ASBESTOS X 10 77 78 79 UATER ASBESTOS 80 .. 1 Figure 2.0-4 Death Certificate Abstract 2.0.4 Case and Control Matching System The system for matching control records to case records was established as follows: o Controls were matched to cases of the same sex. o Cases were categorized into 5 year age groups (<5, 5-9, 10-14, 15-19...,80-84, <85), and listed by year of death (1969 through 1978) o For each case of given sex, 5 year age group, and year of death a control was chosen randomly from among all controls of the same sex, age group, and year of death. If there were no controls with the same year of death (or if the number of cases out-numbered the controls for a given year of death), a control was sought from the year of death nearest the case. All controls were chosen from the same age group as the case. o An effort was made to choose unused controls for each successive case group. But if all controls in a given age range and year (e.g. digestive cancer), controls were used again for another case group (e.g. lung cancer). For the Reproductive Neoplasms control group, the pool of subjects was so small (only 115 decedents), nearly all had to be used twice to provide matches for the Digestive and Respiratory cancer case groups. Among controls taken from the General Causes pool, approximately 12% of the male controls and 9% of the female controls had to be used for matches twice. The Non-Hypertensive Heart Disease pool was large enough that no controls had to be used twice. 2.0.5 Quality Assurance of Death Certificate Abstraction and Coding As each death certificate was abstracted, the certificate was quickly check for (1) internal consistency, and (2) consistency with the information as coded by the California Office of Vital Statistics on the computerized records. Because of time limitations, this check could not be exhaustive, but nevertheless several errors were detected. 1. Errors in the State Vital Statistics Coding of Residence. We discovered several instances where the county of residence coded on the state death tape was incorrect. One type of error was to assign either the Calaveras code or the Tuolumne code to the county of residence when the 29 city of residence actually lies in a different county. This error occurred fifteen times in our series. Number 3 2 1 1 1 1 1 1 1 1 1 City of Residence Stockton Coulterville Knight's Ferry Oakdale Berkeley Oakland Acampo Linden Sutter Creek Santa Clara San Francisco Actual County San Joaquin Mariposa Stanislaus Stanislaus A1 ameda A1 ameda San Joaquin San Joaquin Amador Santa Clara San Francisco Since only decedents who were residents of Calaveras or Tuolumne Counties were to be used in this study, all of the aabove out of county residents were deleted. Another error we discovered was the assignment of the Calaveras County code to five decedents who were actually residents of Tuolumne County. Number City Residence 3 Sonora 1 Columbia 1 Tuolumne City We corrected the county of residence codes for these decedents, and kept them in the study. We should not one feature of this miscoding in the state records. The decendents in our series were selected from the state tapes on the basis of their residence being coded as Calaveras or Tuolumne. However, any actual residents of Calaveras or Tuolumne who were miscoded as residents of other counties would not have been included. In view of the coding errors displayed above, this last type of misclassification probably did occur, although there were probably few of these since only 20 total errors were detected in roughly 1000 records. 30 We also found one instance where a coded age at death differed from the death certified age at death by one year, and so this correction was made. 2. Errors in Death Certificate Entries There were only two errors detected on the death certificates themselves. One was an incorrect year of birth (inconsistent with the year of death), and the other was an inconsistency of the length of stay in the county with the length of stay in California. These erros could not be corrected, since we do not know what the actual entries should be. 3. Errors in Vital Statistics Coding of the Cause of Death The information abstracted from the death certificate included the complete causes of death as well as the "other significant conditions". We checked the causes of death on the certificate against the Office of Vital Statistics 4 digit ICD code on a 10% sample. In a few Instances, the death certificates themselves were vague, and so the given ICD codes were necessarily somewhat arbitrary. But no incorrect ICD codes were found, so we feel confident accepting the codes as given. 4. Errors in Coding the Abstracted Data For quality control of our own effort--namely the coding of the death certificate data we abstracted--we recoded a 10% systemtatic sample of the certificates. One hundred and two records were checked, and 14 coding errors were found. Since each certificate contains 6 variables to be coded*, this translates into a rate of 2 coding errors per 100 variables. This was judged to be acceptable, and the records were sent to be keypunched. * The birthplace of the decedent, the birthplaces of the parents, the occupation, the likelihood of occupational exposure, and the city of residence. 31 2.1 Determination of Standardized Mortality Ratios (SHR's) Standardized mortality ratios were calculated as part of this study utilizing the California State mortality tapes. The purpose of this effort was to examine if the total observed number of deaths in the counties for particular categories of ICD codes were at variance with the expected numbers based on State of California rates. It should be noted that the exact residence of each individual within the counties was not factored Into the analysis. Therefore the analysis does not bear directly upon the key study question of whether individuals living in the vicinity of serpentine deposits, i.e. experiencing elevated ambient airborne asbestos concentrations, have different mortality patterns. Rather it examines the gross Incidence across the counties in comparison to the State of California. Since the counties are relatively rural in comparison to the significant state population centers many factors differ and remain uncontrolled in this analysis. In order to compare the mortality of Calaveras and Tuolumne Counties to the experience of the State of California as a whole it is necessary to take into account the potentially confounding effects of age, race, and sex differences. We have calculated standardized mortality ratios (SMR's), adjusting for age, for whites only, separately for males and females. The causes of death to be examined were grouped into six categories as follows: A. Three categories of death from causes possibly associated with asbestos exposure: -Malignant neoplasms of digestive organs and peritoneum (ICD 150-159*) -Malignant neoplasms of the respiratory system (ICD 160-163) -Hypertensive heart disease and hypertensive heart and renal disease (ICD 402-404) ' B. In addition, two comparison groups of deaths were looked at. 32 composed of deaths from causes that have no reported association with asbestos exposure: -Malignant neoplasms of the breast (used for females only) (ICD 174) -Malignant neoplasms of the genital organs (ICD 180-187) C. Finally, we examined the total number of deaths from all causes. The ICD codes included in these categories are broader than the ICD codes used to delineate the case and control groups. These categories had to be. used because the only published source of age, sex, and race specific numbers of deaths for California is the United States Vital Statistics,** and the causes of death were tabulated in these broader categories. Ischaemic heart disease deaths (ICD 410 to 412) were not included in the SMR calculations because the published deaths were not separated into hypertensive and nonhypertensive. The SMR is a ratio of an observed number of deaths to an expected number. The observed number of deaths for each cause is the sum of the deaths for that cause in Calaveras and Tuolumne Counties for three years, 1969, 1970, and 1971. The expected numbers of deaths for each cause were calculated by multiplying cause-specific three-year California rates (for whites, for each sex, and for each 5 year age group) by the corresponding 1970 subpopulation of Calaveras and Tuolumne Counties. The three year California rates used in the calculations were derived by summing the State deaths in 1969, 1970, 1971, and dividing by the 1970 population given by the U.S. Census. The expected number of deaths in each 5 year age group were then summed over all ages to give the total number of expected deaths in Calaveras and Tuolumne counties for the three years in question.* * * International Classification of Disease, 8th Revision * Table 7-6 "Deaths from 69 Selected Causes, By Age, Color, and Sex, Each State" 33 The 95% confidence limits of the SMR's were calculated as outlined in Rothman and Boice (1979), assuming the occurrence of events to be Poisson distributed. For observed numbers less than 30, the upper and lower limits were found from the table in Remington and Schork (1970) (p. 394). For SMR's with observed values greater than 30, Byar's approximation given in Rothman and Boice (1979) was used. For males, all SMR's were less than 1.00, l.e., there were fewer observed deaths than expected, based upon the experience of white males In California. Even the mortality from all causes was depressed (686 deaths observed vs. 728 expected). Indicating that (adjusting for age) white males in Calaveras and Tuolumne had a lower overall mortality than males in California for the years 1969 through 1971. The category of death that mosts nearly approached the expected figure was malignant neoplasms of the respiratory system. None of the male SMR's was statistically significant at the &*0.05 level, since all confidence limits span the null value, 1.00. For females, the picture is somewhat different. The all causes mortality was increased to 1.05 timesthe expected. Among the conditions suggested to be related to asbestos exposure, the SMR's were elevated above unity for cancers of the digestive system (SMR*1.07) and hypertensive heart disase (SMR*1.75). However, the number of observed deaths for respiratory cancer was less than expected (6 to 10.18). Among the "dummy" conditions not known to be related to asbestos exposure, the malignant neoplasms of the genital organs among women showed an elevated SMR of 1.34. This result was unexpected. However, the recent study by Kanarek et al (1980) of asbestos in drinking water and cancer incidence in the San Francisco-Oakland area found an elevated number of deaths from uterine cancer. Although none of the female death ratios reached statistical significance at the <*=0.05 level, the hypertensive heart disease SMR (1.75) had the largest excess of observed over expected. One difficulty with a community study of an environmental exposure such as this one is that an observed excess mortality might not be caused by ambient environmental exposures, but by occupational exposures. Examining 34 deaths among males and females separately is one way to check for this possibility. If asbestos related mortality were higher among men than among women, exposure in the workplace might be the cause. In our data, however, males have lower mortality ratios than females for most causes, including total mortality. The lower than expected overall mortality for males deserves some comment. In studies of males in an occupational setting, this observation has been called the "healthy worker effect." Occupational groups tend to be selected for the healthier, more vigorous individuals in the population. Consequently, even when adjusting for age, the overall mortality of a specific industrial group may be less than expected, if the expected mortality is based on the experience of all males in the general population. It may be that the occupational and recreational activities prevalent in these two rural counties (where timber and mining are dominant industries) exert a small selective pressure on males, which accounts for a male population with a lower than expected mortality. The fact that the observed mortality was not lowered for females indicates that an occupational selection might be involved. On the other hand, it may indicate the presence of a factor which puts females at a higher risk. One method to "adjust" for a possible healthy worker effect in occupational studies has been suggested by Tabershaw and Gaffey (1974) , Kupper et al(1978), and others. This involves the calculation of a "relative" standardized mortality ratio (RSMR) by dividing the cause-specific SMR by the all causes SMR. This results in a measure of risk that takes into account the lower underlying mortality of the study popuation.. Since for males the all causes SMR was 0.94, the calculation of an RSMR increases all of the observed to expected ratios. All cause spcific RSMR's tend to be closer to 1 than the SMR's, except respiratory system cancers, where the RSMR=1.04. However, this adjusted SMR is not statistically significant. One reason for the general lack of statistical significance in this analysis is that many of these SMR's are based upon small numbers. These two counties combined had a 1970 white population of only 17,000 males and 16,000 females. Consequently, the number of deaths accruing in just three years is 35 not large. Our data set contains all deaths from 1969 through 1978. However, we have elected to use only deaths from 1969 to 1971, spanning the censal year, in order to use the 1970 census population as a denominator. The lack of age, sex, and race specific population figures during the middle and late part of the decade prevents us from making full use of our mortality data. In order to use all of the observed county deaths during the 1970's, it would be necessary to get population estimates for these years. This would be possible by using the forthcoming 1980 census data. Intercensal populations can be estimated using the 1970 annd 1980 figures and estimation procedures, such as those given by Shryock, Siegel, et al (1976). Finally, we must discuss the choice of a comparison population. The indirect standardization technique measures the experience.of the two counties against the experience of the entire state of California. We have restricted the analysis to whites, compared males and females separately, and adjusted for differences in age distribution between the counties and the state by standardization. But there may be other factors that confound the mortality comparisons. The expected values were derived from the death rates of the state of California as a whole. The state death rates Include deaths from urban areas such as Los Angeles and San Francisco. These urban areas may have increased cancer mortality over rural areas by virtue of greater air polluation, pollution of drinking water, occupational exposures, and smoking levels in the population. In short, asbestos related mortality in Calaveras and Tuolumne Counties may have been masked by comparing these counties to the state population, which is composed of subpopulations exposed to several other environmental insults that can produce the same effects. A better comparison would be to use rural California counties near Calaveras and Tuolumne, with similar population densities and industries, but without serpentine deposits. This is not possible at this point in our study, however. Such a comparison would require mortality data from the comparison counties that are age, sex, race and cause specific. Data this detailed are not available from the published California vital statistics. We would have to identify selected comparison counties and access Calfornia death tapes the same way the Calaveras and Tuolumne data were acquired. 36 Tabl e 2.1-1 and 2.1-2 present the SMR results for males and females respectively. Appendix C provides the age specific mortality data for Calaveras and Tuolumne counties from which the three year study interval, 1969-1971 was taken. 37 Table 2.1-1 STANDARDIZED MORTALITY RATIOS - MALES Obseryed deaths reflect Calaveras and Tuolumne County experience (1969-71) Expected deaths are Based upon rates for California 0969.-71) Malignant Neoplasms of Digestive Organs and Peritoneum (ICD 150-159) ' 'Males Observed Deaths Expected Deaths 33 36.53 SMR IMI 0.90 SMR 95% Conf. Limits (0.62, 1.27) Malignant Neoplasms of Respiratory System (ICD 160-163) Hypertensive Heart and Renal Disease (ICD 402,404) Malignant Neoplasms of the Genital Organs (ICD 180-187) Mortality from All Causes 42 1 11 68S - 42.98 0.98 (0.70, 1.32) 3.06 0.33 (0.01, 1.82) 13.12 0.84 (0.42, 1.50) 723.03 0.94 (0.87; 1.02) 38 Table 2.1-2 STANDARDIZED MORTALITY RATIOS - FEMALES Malignant Neoplasms of Digestive Organs and Peritoneum (ICD 150-159) Malignant Neoplasms of Respiratory System (ICD 160-163) Hypertensive Heart and Renal Disease (ICD 402, 404) Malignant Neoplasms of the-Breast (ICD 174) Malignant Neoplasms of the Genital Organs (ICD 180-187) Mortality from All Causes Observed Deaths 27 6 6 13 18 488 Expected Deaths 25.32 SMR (O/E) 1.07 10.18 0.59 3.42 1.75 18.18 0.72 13.43 1.34 464.04 1.05 SMR 95% . Conf. Limits (0.70, 1.55) (0.22, 1.28) (0.64, 3.82) (0.38, 1.22) (0.79, 2.12) (0.96, 1.15) 39 REFERENCES Acquavella, J., Wilkinson, 6., et al. (1979) "Pilot study of cancer and cardiovascular disease mortality in asbestos mining counties." Paper presented at the 107th annual meeting of the American Public Health Association, Nov. 4th, 1979, New York, New York. California Department of Public Health, (1967), Industrial Health Study Wells Cargo, Inc,, Pacific Asbestos Corporation Mine Copperopolis, California, A.E. Lowe, California Department of Public Health, Study 2963, August 1967. Environmental Protection Agency (1980) support document for Proposed Rule on Friable Asbestos - Containing Material in School Buildings. EPA 560/12-80-003. Fleiss, J.L. (1973) "Statistical Methods for Rates and Proportions." J. Wiley and Soncs, New York. Graham, S., Blanchet, M., Rohrer, T. (1977) Cancer in Asbestos Mining and Other AReas of Quebec. JNCI 59, 1139-1145. Kanarek, M.S., Connforti, P.M., Jackson, L.A., Cooper, R.C., and Murchio, J.C., (1980) Asbestos in drinking water and cancer incidence in the San Francisco Bay area. American Journ. Epidemiol. 112(1): 54-72. Klelnfield, M., Messite, J., Kooyman, 0. (1967) Mortality Experience in a Group of Asbestos Workers. Archives of Environmental Health 15, 177-180. Kupper, L.L., McMichael, A.J., Symons, M.J., and Most, B.M., (1978) On the Utility of Proportionate Mortality Analysis. Journ. Chron. Diseases 31:15-22. Mancuso, T., Al-Attar, (1967) A Mortality Pattern in a Cohort of Asbestos Workers. Journal of Occupational Medicine 9, 4, 147-162. McDonald, J., McDonald, A., Gibbs, G. (1971) Mortality in the Chrysotile Asbestos Mines and Mills of Quebec. Archives of Environmental Health 22, 667-686. McDonald J., Becklake, M., Gibbs, G., et al. (1974) The Health of Chrysotile Mine and Mill Workers of Quebec. Archives of Environmental Health 28, 61-68. Miler, A. Asbestos Fiber Oust and Gastrointestinal Malignancies Review of the Literature with Regard to a Cause/Effect Relationship. (1978) J. Chronic Dis. 31, 23-33. National Center for Health Statistics, "Vital Statistics of the United States." Vol. II Mortality, Part B, 1969, 1970, 1971. Remington, R.D., and Schork, M.A., (1970) "Epidemiologic Analysis with a Programmable Calculator." National Institutes of Health Publication No. 79-1649, Washington. 40 Rothman, K.J., and Boice, J.D. (1979) "Epidemiologic Analysis with a Programmable Calculator" National Institutes of Health Publication No. 79-1649, Washington. Tabershaw, R., and Gaffey, W.R., (1974) Mortality STudy of Workers in the Manufacture of Vinyl Chloride and its Polymers. Journ. Occupat. Med. 16:509-18, 1974. U.S. Public Health Service, 1966. An Environmental Survey of Asbestos Mining and Milling in California, Principal Authors, J.R. Eynch and O.L. Johnson, U.S. Department of Health, Education, and Welfare, Public Health Service, Division of Occupational Health, Report SR-17, December. Ziskind, R.A., D.F. Smith, J.L. Hahn and G. Spivey, (1980), Determinants of Cancer and Cardiovascular Disease Mortality in Asbestos Mining Counties of California, SAI Report 068-81-514 1 May. 41 Appendix A Description of Electron Microscopy A-l Description of Whatman #41 Cellulose Filters The filters shipped to Science Applications, for analysis by Scanning Electron Microscope were contained individually in glassine negative storage envelopes and appeared to be in good condition. Some filters appeared to have lost some material or were unevenly dispersed. These filters were excluded from the analysis. The filter dimensions were 8" x 10" with an effective filter surface of 7" x 9" or 63in2 (406.5 cm2). A-l A-2 Laboratory Procedures for Asbestos Measurement of Air Samples Collected Collected on High Volume Whatman 41 Cellulose Filters t Cleaning of glassware and utensils All utensils and glassware are cleaned in a sonic bath (Bransonic model 220) using 2 rinses of Mi11i-Q water (.2 urn filtered) and a final sonicated rinse of reagent grade acetone. After cleaning, the glassware and utensils are stored in sealed plastic bags. All water is prescreened using, the Scanning Electron Microscope to avoid any asbestos contamination. Procedure for ashing the filter samples: Sections of filters no greater than 2" x 2" (1" x 2" is optimum) are excised from the original 8" x 10" Whatman 41 high volume filter using precleaned scissors and transferred into engraved precleaned glass vials (70 mm x 30 mm). For almost ail samples a 1" x 2" sample is excised. Each filter is placed in the vial with the top surface of the filter against the inner surface of the glass vial. No more than 2 sample vials are ashed at the same time. The vials are placed into the Low Temperature Asher (International Plasma Corp. Model PM 104C) side by side and lying down with the top of the vial facing the door of the ashing chamber. This will minimize any effect of sample cross-contamination. After the samples are placed in the Low Temperature Asher, the power is turned on and the chamber is placed in the slow evacuation mode. In approximately 5 minutes the vacuum will reach 1 torr; at this time the chamber is switched into the fast vacuum mode and will pump down to less than .1 torr in a matter of minutes. At this point, the RF generator and oxygen flow are turned on and the ashing of the filter begins. The filters are ashed for 4 hours at a vacuum of 1 torr, oxygen meter flow of 200, and an RF forward power of 20 watts. The reflecting power is kept below 1 watt by the fine tuning on the instrument console. Once ashing is complete the RF power and oxygen are turned off and the vacuum value on the instrument is turned to the off position. The purge for the sample chamber is opened to allow the chamber to return to atmospheric pressure over a period of 30 minutes (any shorter time could result in sample loss or contamination). Before the samples are removed from the chamber, the power to the entire instru ment must be turned off to avoid turbulence caused by the instrument cooling fans. The samples are removed carefully and capped. Sample dilution procedures: All filter handling and filtration were performed in a laminar flow bench with a particle concentration at >_.5ym of less than 100 particles/cu. ft. A Climet Model 208 particle counter was used to monitor particle levels. The capped samples containing the ashed filter are transferred to the laminar flow bench and the initial dilution is performed with the air fan turned off so that the dry ashed sample is not blown out of the vial during the first addition of aerosol O.T. dispersant. Exactly 20 ml. of .2ym millipore filtered .1% Aerosol O.T. is carefully pipetted into the sample vial. The vial is capped, shaken gently and then placed in a ultrasonic bath (Bransonic Model 220) for 5 minutes. The sample is removed from the sonic bath and exactly 2.00 ml of the solution is withdrawn 1 cm from the bottom of the vial and transferred to a clean plastic 15 ml. test tube with a screw top cap. Approximately 5 ml. of .2ym filtered deionized water is added to the test tube and gently shaken for approximately 1 minute before pouring into the filter assembly. The 25 ran filter assembly (Nuclepore stock #410200) is made of borosilicate glass with a sintered glass support and has a funnel volume of 20 ml. and an 2 effective filtered area of 2.14 cm . The asbestos samples are collected on a .2ym pore size nuclepore filter which is backed by a .45ym pore size millipore filter which aids in a more even dispersal of particles. The sample contained in the plastic test tube is poured into the filter assembly after 1 ml. of deionized water has been filtered through the funnel to saturate the filter media. The test tube and cap are rinsed twice with 5 ml of deionized water into the filter funnel and a light vacuum is applied to the filter to allow complete filtration within 30 seconds. When the sample solution approaches approx. 1 cm in depth, the walls of the filter funnel are carefully rinsed with 2-3 ml of filtered deionized water and allowed to totally filter. 15 seconds after the sample solution has finished filtering the pump is turned off and the filter is allowed to air dry for 30 minutes before removal from the funnel assembly. The sample filter and the backing filter are removed together with clean polyethylene forceps and transferred to a clean plastic petri dish with a depth no less than 1 cm and taped in place. The filter is ready for sectioning for the Scanning Electron Microscope or the Transmission Electron Microscope analysis. - FILTER PREPARATION FOR THE SCANNING ELECTRON MICROSCOPE Using a clean razor blade, excise a portion of the taped filter section from the filter by pressing evenly downward on the filter and backing filter (it is not advisable to pull the blade across the filter as this may result in particle loss and filter distortion). Carefully remove the cut section and transfer to a clean sheet of 2" x 2" leucite or plexiglass (keeping the backing filter in place aids in transferring the filter section without warping). The backing filter is removed by carefully sliding the nuclepore sample filter laternally off the backing filter using a sharp needle. 4 mm x 4 mm sections are cut using a new razor and pressing with a downward motion only. The softness of leucite or plexiglass provides for a very even undisturbed cut. The razor blade and the 2" x 2" plastic are discarded after each filter is cut. The filter sections are transferred to aluminum specimen mounts backed with #465 scotch transfer tape and only the edges of the filter are gently pressed down and evened out using a sharp needle. The samples are coated with gold using an ISI P-SI Sputter Coater Set at 40 ma, 2.5 kV, a vacuum of .1 torr, and coated for 2.5 minutes. A-4 FILTER PREPARATION FOR THE SCANNING TRANSMISSION ELECTRON MICROSCOPE The filters sections remaining in the petri dishes after SEM sample preparation are transferred to a vacuum evaporator and coated with 40 to 50 mm of carbon in bursts on the order of 5 seconds to avoid polymerization of the nuclepore filter. 3 mm x 3 mm sections are excised from the filter pad as described in the SEM filter preparation procedure and placed carbon side down over a carbon stabilized formvar coated copper grid (200-300 mesh). The copper grids to be extracted by the Jaffe wick method (EPA 600/2-77-178) are placed on top of a section of Whatman #42 ashless filter paper that is over a square of polyethylene foam that has been triple washed and ultrasonicated in acetone. The entire extraction arrangement is contained in a precleaned 100 mm x 15 mm precleaned glass petri dish. Four grids for each sample are pre pared in the following manner. Approximately 10 me. of reagent grade chloroform is pipetted onto each 3 mm x 3 mm filter section using a syringe and the petri dish is carefully filled with chloroform to a level approaching the top of the foam support. The petri dishes are covered and placed inside a bell jar to maintain a high chloroform atmosphere and reduce evaporation. Each filter grid is allowed 48 hours for dissolution of the nuclepore filter. The grids are then transferred to a clean covered petri dish to dry before analysis by the Transmission Electron Microscope. FILTER ANALYSIS BY SCANNING ELECTRON MICROSCOPY The total counts of two separate filter areas of each sample are analyzed at a magnification of 10,000X in the slow scan rate mode with a beam current of 15 kV. The resolution of the ISI Super III-A Scanning Electron Microscope is checked prior to each sample analysis using an asbestos standard sample con taining many fibrils with diameters of .02 to .03ym. Actual sample analysis proceed only when fibrils of .03ym in diameter can be clearly resolved using the slow scan rate at a magnification of 20.000X. Each sample filter section (two for each sample) is analyzed for a minimum total of 50 fields or 50 fibers (100 total) and the results are combined and totaled in the computer analysis. Chrysotile asbestos fibers are confirmed by morphology and the presence of magnesium and silicon using a Kevex 5100c dispersive X-ray system. Fiber analysis for the purpose of this survey were placed into four categories; chrysotile, amphibole, ambiguous, and non-asbestos. Confirmation for chrysotile required both morphology and X-ray identification. Very small fibers (<.l urn diameter) which do not readily yield strong X-ray peaks were confirmed when their fiber diameters and length were very well defined or when they were found in the same field as another larger fiber confirmed to be Chrysotile by both morphology and X-ray spectra. Amphiboles when present were confirmed by morphology and X-ray spectra. X-ray spectra typical of an amphibole must be well defined otherwise the particle will be listed as ambiguous. The ambiguous classification contains all the fibers which have a questionable morphology or an ambiguous X-ray spectrum. The most common example in this category is a fiber which exhibits a silicon peak but no magnesium peak. The non asbestos fiber category includes all fibers defined as having an aspect ratio of 3:1 but not having an asbestiform morphology. The second criterion includes all fibers greater than .lym in diameter that exhibit no X-ray spectrum or no silicon peak. The final reporting of data includes fibers/meter3 , mass/meter3 (nanograms) and surface area/meter3 (ym2 ) expressed as total fibers, fibers <5ym, and fibers >5ym. A-6 It is very important to emphasize the instrument parameters used in the analysis. The accelerating voltage on the SEM was set at 15 kV for a number of reasons. Beam penetration at a higher kV range is much greater and decrease the ability to resolve individual fibers with diameters below .1 m. 15 kV is also the optimum energy range for X-ray analysis. The peak to background ratio for Magnesium Aluminum and Silcon is much higher at 15 kV than 20 kV or 25 KV also due to beam penetration (less area below the fiber is being excited). The working distance of the SEM was calibrated and maintained at a working distance of 8 mm and a stage tilt of 15. This provided for maximum resolution without compromising X-ray yield. The samples were prepared on .2 m pore size Nuclepore filters (particles on the shiny side) primarily because of their smooth background as compared to .1 m pore size or even the .45 m pore size filters. A-3 Microscopy Facilities SAI's electron microscopy lab contains a scanning electron micro scope equipped with a dispersive X-ray spectrometer and a dedicated micro computer for rapid and tailored data reduction of particle field counts, parti cle density and size distributions, and elemental abundances. The microscope is equipped with both a high angle back-scatter detector for atomic number contrast and a low angle back scatter detector for high resolution surface detail. Adjacent to the SEM laboratory is a trace particle clean room which has been tailored for the handling and preparation of ambient air samples for asbestos and trace metals (see Figure A-l). The room is equip ped with a HEPA filtered air system producing a variable laminar flow inside the room as well as a positive pressure throughout both the main lab and the anteroom. This eliminates any possible outside contamination for trace metal or asbestos samples. In addition to the ceiling HEPA filter system, the room is equipped with a laminar flow bench. Through a formal agreement with Scripps Institution of Oceano graphy, SAI utilizes the scanning transmission electron miscroscope facility located less than 2 miles away. This instrument is an Hitachi Model H-500 with a magnification range of 500,000x and a resolution of 1.4 A0, and is equipped with both Selected Area Electron Diffraction and computerized dis persive X-ray capabilities. Instrumentation SAI: Model ISI Super IIIA Scanning Electron Microscope 70A resolution magnification range 12-200,OOOx A-8 1. Semi-clean transfer room (positive pressure to the outside exit). 2. Ceiling Hepa filter. 3. Floor exhaust with dampered control for variation in laminar flow over bench #4 and the posi tive pressure of the room. 4. Clean work table. 5. Bench for Jaffe-Wick prepara tion of filters. 6. Vented clean box for chloroform extraction of filters. 7. Laminar flow bench for filter sectioning and filtration. 8.. Polyethylene sink. 9. Particle tac mat. W\ scale 1" * 4* FIGURE A-l TRACE PARTICULATE CLEAN ROOM. 7-4 - Standard secondary electron detector - High backscatter detector for atomic number contrast - Low angle backscatter detector (low loss) for high resolution surface imaging and elevation measurement with a resolution of 500A. (Detector is used for measuring particle volume and photographing biological and low atomic number surfaces.) PS-I Sputter Coater AuPd and Au target Kevex 5100 c Dispersive X-ray System 2 30mm detector area 1.49 ev/channel resolution Motorola 6800 Computer System with dual floppy disc Scripps Institute of Oceanography: Model Hitachi H-500 Scanning Transmission Electron Microscope Transmission Mode - resolution 1.4A0, magnification range to 500,000x equipped for Selected Area Electron Diffraction Scanning Mode - resolution of 30A; magnification range of 1000 300,000 equipped with a Model 6230 Ortec dispersive X-ray system which includes the computer and dual floppy disc. Denton Carbon Evaporator A-10 A-4 Results & Conclusions Viewing the concentration summaries for Sonora and Mariposa sites (Table 2.0 - 1) reveals a minimum of at least one order of magnitude differental in concentration for fibers/m3, mass/m3, and surface area/m3 in contrast to other sites assumed to be very low in concentration (Van 201 ELD, Van 401 ELD, Camino). Depending upon which parameter is viewed, large differentials can occur in concentration when comparing two samples. For example, comparison of Sonora sample 12-30-73 (SAI #81-1094) with Camino sample 04-10-73 (SAI #81-1231) yields the following conentration effects: Total fibers/m3 Chrysotile Total mass/m3 81-1094 Sonora 291 24200 81-1231 Camino 7^5_______________________ _____________ (K44^5 Total surface area/m3 5450 Ratio: Sonora Camino 39 60500 1200 The fiber concentration in Sonora (81-1094) is 39 times higher, the mass concentration is 60500 times higher and the surface area is 5450 times higher This wide variation in concentration data should be considered carefully when relating to any epidemiological data. The usual reporting of data includes fiber and mass concentration without reporting surface area. Theoretically mass and surface area do not differ in ratio only when the size distribution of the asbestos population does not change. In the real world situation the size distribution changes greatly in chrysotile source rock areas with changes in meteorologic conditions. The percent of chrysotile fibers >5ym in the Sonora County samples varied from ' `\ 1 to 19 percent (Table A-l) . This variation in the size distribution is responsible for poor correlation between fibers/m3 and mass/m3. In actuality, the correlation between fibers/m3 and surface area/m3 i is a much better correlation (Table A-2). The correlation of all parameters <5ym is fairly consistent with the correlation between fibers/m3 and surface area/m3 (.98) being extremely good. Above 5ym none of the parameters correlate and it is important to note how poor the correlation is between fibers/m3 and mass/m3. It is recommended that some further investigation of surface area/m3 as an included parameter in the reporting of asbestos data be considered. A-12 SAI Sample # 81-1101 81-1097 81-1116 81-1094 81-1120 81-1099 81-1121 81-1118 81-1102 81-1106 81-1110 TABLE A-l Sample Variation in the Percentage of "Occupational" Chrysotile Fibers (<5ym) in Eleven Sonora County Samples Collection Date %Chrysotile fibers .5um %Chrysotile fibers >5ym 08-08-73 10-25-73 09-20-74 12-30-72 06-28-74 09-25-73 04-05-74 07-22-74 07-15-73 05-24-73 03-23-73 86 71 74 49 39 56 79 61 57 82 54 12 7 1 9 3 5 9 4 11 6 9 %Ratio of Chrysotile fibers >5um 14% . 10% 1% 18% 8% 9% 11% 6% 19% 7% 17% A-13 TABLE A-2 Correlation of Fibers/m3, mass/m3 and Surface Area/m3 for Sonora sites Compared parameters Fibers/m3 (excluding 11-1094) mass(ng)/m3 mass(ng)/m3 (excluding 81-1094) surface area (ym2)/m3 Fibers/m3 (excluding 81-1094) surface area ym2/m3 Coefficient of Correlation <5um >5ym total distribution O1o ro .70 -.13 .83 .30 .98 .59 .22 .96 A-14 Variable Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Appendix B DEATH CERTIFICATE ABSTRACT FORMAT Col umn Location 01-02 03-06 07-15 16-45 46-47 48-49 50-51 52 53-54 55-57 58-59 60-61 62 63-64 Field 1m. F2.0 F4.0 F9.0 7A4.A2 F2.0 F2.0 F2.0 FI .0 F2.0 F3.0 F2.0 F2.0 FI .0 F2.0 Description Card Number, 01 Identification Number Social Security Number:999-99-9999-blan Decedent (Last, First, Middle) Date of Death, Year (last two digits) Date of Death, Month Date of Death, Day Sex: 1-Male , 2-Female Birthplace (see State and Country Codes Date of Birth, Year (last three digits) Date of Birth, Month ' Date of Birth, Day Age Code: 0-100 years or over,1-years Age, years B-l Variable Number 15 16 17 18 19 20 21 22 DEATH CERTIFICATE ABSTRACT Column Location 01-02 03-06 07-26 27-28 29-48 49-50 51 52-80 Field 1m. F2.0 F4.0 5A4 F2.0 5A4 F2.0 FI .0 7A4.A1 Description Card Number, 02 Identification Number Father's Name (First, Middle, Last if different from decedent) Father's Birthplace (see State and Country Codes) Mother's Maiden Name (First, Middle, La Mother's Birthplace (see State and Country Codes) Marital Status: 1-Married; 2-Single, Never Married; 4-Divorced; 5-Widowed; 9-Unknown/Not Stated Name of Surviving Spouse(First, Middle, Last) B-2 DEATH CERTIFICATE ABSTRACT Column Location Field Type Description 01-02 F2.0 Card Number, 03 24 03-04 F4.0 Identification Number 25 07-09 F3.0 Last Occupation (see Occupational Codes): 999-blank 26 10-11 F2.0 Number of Years in Last Occupation: 99-blank 27 12 FI .0 Kind of Occupation: 1-Definite Asbestos Exposure; 2-Probable Exposure; 3-Possible Exposure;4-Probably No Exposure; 9-No Occupation (see exposure codes) 28 13-14 F2.0 County of Death (see County Codes) 29 15-16 F2.0 Length of Stay in County, years: 99-blank 30 17-18 F2.0 Length of Stay in California, years: 99-blank 31 19-20 F2.0 Usual Residence, City (see City Codes) 32 21-22 F2.0 Usual Residence, County (see County Codes) 33 23-40 4A4.A2 Name of Informant (First, Last, Middle) 34 41-59 4A4,A3 Address of Informant 35 60-68 2A4.A1 City of Informant 36 69-70 A2 State of Informant 37 71-74 F4.1 Cause of Death, ICD 8th Revision Code 38 75 FI .0 Autopsy: 1-No Autopsy; 2-Autopsy, results used; 3-Autopsy, results not used; 4-Autopsy, unknown if results used; 5-Unknown if an autopsy 39 76 FI .0 Certifier: 1-Coroner; 2-M.D. or D.O.; 3-D.C.; 4-Unknown before 1975, Military after 1975; 5-Unknown B-3 01 - Alabama 02 - Alaska 03 - Arizona 04 - Arkansas 05 - California 06 - Colorado 07 - Connecticut 08 - Delaware 09 - District of Columbia 10 - Florida 11 - Georgia 12 - Hawaii 13 - Idaho 14 - Illinois 15 - Indiana 16 - Iowa 17 - Kansas 18 - Kentucky 19 - Louisiana 20 - Maine 21 - Maryland 22 - Massachusetts 23 - Michigan 24 - Minnesota 25 - Mississippi 26 - Missouri 27 - Montana 28 - Nebraska 29 - Nevada 30 - New Hampshire 31 - New Jersey 32 - New Mexico 33 - New York 34 - North Carolina BIRTHPLACE STATE CODES 35 - North Dakota 36 - Ohio 37 - Oklahoma 38 - Oregon 39 - Pennsylvania 40 - Rhode Island 41 - South Carolina 42 - South Dakota 43 - Tennessee 44 - Texas 45 - Utah 46 - Vermont 47 - Virginia 48 - Washington 49 West Virginia 50 - Wisconsin 51 - Wyoming 52 - Virgin Island 54 - Outlying Possessions 55 - United States, Place Unknown B-4 BIRTHPLACE FOREIGN COUNTRY CODES 56 - Asia (inc. India, Israel, Korea, Lebanon, Pakistan other Asia) 57 - Austria 58 - Belgium 59 - Central America (inc. British Honduras, Costa Rica, El Salvedor, Guatemala, Honduras, Nicaragua, Panama) 60 - Canada 61 - China 62 - Czechoslavakia 63 - Denmark 64 - Eire (inc. Ireland, Northern Ireland) 65 - England 66 - Finland 67 - France . 68 - Germany 69 - Greece 70 - Hungary 71 - Italy 72 - Japan 73 - Mexico 74 - Netherlands 75 - Philippine Islands 76 - Poland 77 - Portugal 78 - Rumania 79 - South America (inc.Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uraguay, Venequela, other South American) 80 - Scotland 81 - Spain . 82 - Norway, Sweden 83 - Switzerland 84 - USSR (inc. Russia, Ukrania) 85 - Wales ` 86 - West Indies (inc. Cuba, Dominican Republic, Haiti, Jamaica, West Indies Federated, other West Indies) B-5 Page 2 Birthplace FOREIGN COUNTRY CODES 87 - Yugoslavia 88 - All others (inc. Africa, Australia, Azores Islands, New Zealand, other Pacific Islands 89 - Unknown Nativity B-6 OCCUPATIONAL CLASSIFICATION SYSTEM Occupation Code: Professional^ Technical, and Kindred Workers Occupations Code: Professional, Technical, and Kindred Workers - continued 001 002 003 004 005 006 007 010 011 012 013 014 015 020 021 022 023 024 025 026 030 031 032 033 X 034 035 036 042 043 044 045 051 052 053 054 055 056 061 062 Accountants Architects Computer specialists Computer programmers Computer systems analysts 063 064 065 071 072 Computer specialists, n.e.c. 073 Engineer Aeronautical astroiiautical eng. 074 Eng. not specified (4 yxs.college)075 Chemical engineers 076 . Civil Engineers Electrical 6 electronic engineers 080 Industrial engineers(incl: gas plant engineers) 081 Mechanical engineers 082 Metallurgical 6 materials eng. Mining engineers 083 Petroleum engineers . Sales engineers . 084 Engineers, n.e.c 085 Farm management'advisors Foresters and conservationists Home management advisors 086 Lawyers and judges 090 Judges Lawyers . 091 Librarians,archivists,and curators 092 Librarians . 093 Archivists and curators . 094 Mathematical specialists . 095 Actuaries _ 096 Mathematicians Statisticians 100 Life and physical scientists Agricultural scientists 101 Atmospheric and space scientists Biological scientists 102 Chemists 103 Geologists Marine scientists 104 Physicists and astronomers 105 Life and physical scientists,nec 110 Operations 6 systems researchers 111 and analysts 112 Personnel labor relations workers 113 Physicians, dentists, 6 related Practitioners 114 115 Chiropractors 116 Dentists 120 Optometrists Pharmacists Physicians, medical and osteopathit Podiatrists Veterinarians Health Practitioners, n.e.c. Nurses, dieticians, $ therapists Dieticians Registered nurses Therapists Health technologists $ technicians Clinical laboratory technologists : technicians Dental hygienists Health record technologists $ technicians Radiological technologists 8 technicians, n.e.c. Therapy assistants * Health technologists g technicians ' 71 C C ' Religious workers. Clergymen . Religious workers, n.e.c. Social Scientists Economists Political scientists Psychologists Sociologists Urban regional planners Social Scientists, n.e.c. Social 5 recreation workers Social workers (incl. juvenile counseling) .. Recreation workers Teachers, college university Agriculture teachers Atmospheric, earth, marine 6 spac teachers Biology teachers Chemistry teachers Physics teachers Engineering teachers Mathematics teachers Health specialities teachers Psychology teachers Business 6 commerce teachers Ecomonics teachers History teachers B-7 ( Occupation Code: Professional, Technical, and Kindred Workers - continued 121 Sociology teachers 122 Social science teachers, n.e.c. 123 Art, drama, 8 music teachers . 124 Coaches 8 physical ed. teachers 125 Education teachers 191 . 192 193 194 Photographers Public relations men publicity writers . ' Radio 8 television announcers ^ Writers, artists, 8 entertainers, 126 English teachers . n.e.c. 130 Foreign language teachers 195 Research workers, not specified 131 Home economics teachers (incl. research director) . 132 Law teachers - 133 Theology teachers 134 Trade, industrial technical Management and Administrators, Except Farm 135 Miscellaneous teachers, college 201 Assessors, controllers 8 treasurers; university local public administration 140 Teachers, college 8 university, 202 Bank officers financial managers subject not specified (incl. grad. 203 Buyers 8 shippers, farm products assistant) 205 Buyers, wholesale 8 retail trade Teachers, except college 8 university 210 Credit men . 141 Adult education teachers 211 Funeral directors 142 Elementary school teachers. 212 Health administrators 143 Prekindergarten teachers . 213 Construction inspectors, public 144 Secondary school teachers administration 145 Teachers, except college 8 univer 215 Inspectors, except construction, sity, n.e.c. public administration . 146 Teachers, not specified 220 Office managers, n.e.c. - Engineering and science technicians 221 Officers, pilots pursers; ship 3 50 Agriculture 8 biological tech 222 Officials 8 administrators; public nicians, except health administration, n.e.c. <' 151 Chemical technicians 152 Draftsmen . 223 224 Officials of lodges, societies 5--\ Postmasters 8 mail superintends. 153 Electrical 8 electronic engineering 225 Purchasing agents 8 buyers, n.e.c. technicians 226 Railroad conductors . 154 Industrial engineering technicians 230 Restaurant, cafeteria 8 bar manager 153 Mechanical engineering technicians 231 Sales managers 8 department heads, 156 Mathematical technicians retail trade . 161 Surveyors 233 Sales managers, except retail trade 162 . Engineering 8 science technicians. 235 School administrators, college \ n.e.c. (includes trainee) 240 Technicians, except health 8 engineer School administrators, elementary 8 secondary . ing science 163 Airplane pilots 164 Air traffic controllers . 245 Managers 8 administrators, n.e.c. ( film producer, self employed) 246 Management trainee ; . ..... ... 165 Embalmers 1/0 Flight engineers .' Sales Workers 171 Radio operators 172 Tool programmers.numerical control 260 Advertising agents 8 salesmen 173 Technicians, n.e.c. 261 Auctioneers 174 Vocational 8 educational counselors 262 Demonstrators Writers, artists, 8 entertainers 264 Hucksters 8 peddlers 175 Actors 180 Athletes 6 kindred workers 181 Authors 182 Dancers 133 Designers 184 Editors 8 reporters 185 Musicians 8 composers 190 Painters 8 sculptors 265 Insurance agents, brokers 8 under- ` writers (incl. insurance coordina' 270 Real Estate agents 8 brokers 271 Stock 8 bond salesmen __ 280 Salesmen 8 sales clerks, n.e.c. (i: medical distributer, drugstor'^tl 281 Sales associate ' Clerical and Kindred Workers 301 Bank tellers (incl. banking,proofer) 384 Telegraph operators 302 Budgetary control 385 Telephone operators 303 Billing clerks 390 Ticket, station 8 express agents 305 Bookeepers (incl. accounting, auditing (incl. railroad station clerk) clerk) 391 Typists 310 Cashiers . 392 ' / Weighers - 311 Clerical assistants, social welfare 394 Miscellaneous clerical workers (incl 312 Clerical supervisors, n.e.c. (incl. service rep; general office worker) det. head - office work, office 395 Not specified clerical workers (incl manager) Volt, Kelly) 313 Collectors, bill 8 account 396 Other clerical 314 Counter clerks, except food . 315 Dispatcher 8 starters, vehicle Craftsmen and Kindred Workers 320 ' Enumerators 8 interviewers 321 Estimators 8 investigators, n.e.c. 401 Automobile accessories installers (incl. costomer's representative) 402 Bakers 323 Expediters 8 production controllers 403 Blacksmiths 325 File clerks (incl. filers, book 404 Boilermakers store sorting) 405 Bookbinders 330 Library attendants 8 assistants 410 Brickmasons 8 stonemasons (incl. library clerk) 411 Brickmasons 8 stonemasons, apprentic 331 Mail carriers, post office 412 . ^Bulldozer operators (incl. tractor 332 Mail handlers, except post office driver) (incl. mail clerk) 413 Cabinetmakers - 333 Messengers 8 office boys 415 Carpenters 334 Meter readers, utilities . 416 Carpenter apprentices Office machine operators ' 420 Carpet installers 341 Bookeeping 8 billing machine oper- 421 Cement 8 concrete finishers ators " 422 Compositors 8 typesetters 342 . Calculating machine operators 423 Printing trades apprentices, exc. 343 Computer 8 peripheral equipment pressmen (incl. print shop helper) operators .. 424 Cranemen, derrickmen, hoistmen 344 Duplicating machine operators 425 Decorators 8 window dressers 345 Key punch operators . 426 Dental laboratory technicians 350 Tabulating machine operators 430 Electricians 355 Office machine operators, n.e.c. 431 Electricians apprentices 360 Payroll 8 timekeeping clerks 433 Electric power linemen 8 cablemen 361 Postal clerks (incl. postal service) 434 Electrotypers 8 stereotypers 362 Proofreaders . 435 . Engravers, exc. photoengravers .. 363 Real estate appraisers 436 Excavating, grading 6 road machine 364 Receptionists operators, exc. bulldozer Secretaries 440 Floor layers, exc. tile setters 370 Secretaries, legal 441 Foremen 8 hammermen 371 Secretaries, medical 442 Forgemen and hammermen 372 Secretaries, n.e.c. 443 Furniture 8 wood finishers 374 Shipping 8 receiving clerks 444 Furriers 375 Statistical clerks 445 Glaziers . 376 ' Stenographers 446 Heat treaters, annealers, 6 tempers 379 Administrative assistant 450 Inspectors, scalers, 8 graders; 381 Stock clerks 8 storekeepers (incl. log and lumber inventory) 452 Inspectors, n.e.c. (incl. telephone 382 Teacher aides, exc. school monitors investigation) (incl. school aide) 453 Jewelers 8 watchmakers (incl. jewe 383 Telegraph messengers work) B-9 Operatives, Except Transport - cont'd Laborers, Except Farm - continued 656 Punch stamping press operatives ` 762 Stock handlers (incl. box boy, g-^Wgj 660 Riveters 6 fasteners clerk, stock girl) 661 Sailors 5 deckhands 763 Teamsters 662 Sawyers . 764 Vehicle washers 5 equipment cleaners 663 Sewers 6 stichers 770 Warehousemen, n.e.c. 664 Shoemaking machine operatives 780 Miscellaneous laborers 665 Stationary firemen 785 Not specified laborers (incl. factoti Textile operatives 786 Sanitation man, sanitizer 670 Carding, lapping g combing operatives 787 Maintenance man, n.s. . 671 Knitters, loopers 5 toppers 672 Spinners, twisters $ winders Farmers and Farm Managers .- 673 Weavers 674 Textile operatives, n.e.c. (incl. 801 Farmers (owners and tenants) miller) 802 Farm managers . . 680 Welders 6 flame-cutters 681 Winding operatives, n.e.c. ' Farm Laborers and Farm Foremen ' 690 Machine operatives, miscellaneous specified (incl. pottery worker) . 821 Farm foremen .- 692 Machine operatives, not specified 822 Farm laborers, wage workers (incl. 694 Miscellaneous operatives (incl. farm hand, farm work) miscellaneous handywork) 823 Farm laborers, unpaid family workers 695 Not specified operatives (incl. 824 ..Farm service laborers, self-employed baker's assistant, paper miller, pie 825 Civilian Conservation Corp . factory, auto factory, jewelry factory, box assembler, aluminum Service Workers, Exc. Private Household window plant, factory worker, made barricades) Cleaning service workers 701 Boatmen canalmen 901 Chambermaids maids, except privi 703 Busdrivers household 704 Conductors motormen, urban rail 902 Cleaners charwomen . transit 903 Janitors sextons (incl. custodi 705 Deliverymen 8 routemen Food service workers . 706 Fork lift 8 tow motor operatives 910 Bartenders 710 . Motormen; mine, factory, logging 911 Busboys . ' - camp, etc. 912 Cooks, except private household (:| 711 Parking attendants . cook, director, chef) 712 Railroadbrakemen 913 Dishwashers 713 Railroad switchmen 914 Food counter fountain workers 714 Taxicab drivers chauffeurs 915 Waiters (incl. barmaid) 715 Truck drivers 916 Food service workers, n.e.c., exc private household . Laborers, Except Farm 917 Restaurants, n.s. 918 Hostess 740 Animal caretakers, exc. farm Health service workers 750 Carpenters' helpers 921 Dental assistants 751 Construction laborers, exc. carpenteri 922 Health aides, exc. nursing (incl helpers asst., nuclear research lab work 752 Fishermen 8 oystermen 923 Health trainees ( 753 Freight g. material handlers (incl. 924 Lay midwives fumiturs mover) 925 Nursing aides, orderlies attend 754 Garbage collectors . 926 Practical nurses 755 Gardeners 8 groundskeepers, exc. farm 927 Health spa worker 760 Longshoremen stevedores 761 Lumbermen, raftsmen 5 woodchoppers (incl. lumber) B-ll Craftsmen and Kindred Workers - cont'd. Craftsmen and Kindred Workers - cont'd 454 455 456 461 462 470 471 472 473 474 475 480 481 482 483 484 485 486 491 492 495 501 502 503 504 505 506 510 511 512 514 515 516 520 521 522 523 525 530 531 533 534 535 536 540 542 543 545 546 Job die setters, metal Locomotive engineers . Locomotive firement Machinists Machinist apprentices Mechanics 5 repairmen Air conditioning, heating 8 refrig. Aircraft Automobile body repairmen Automobile mechanics Automobile mechanic apprentices Data processing machine repairmen 550 551 552 554 560 561 562 571 572 575 580 Structural metal craftsmen (incl. ire worker) Tailors Telephone installers 8 repairmen Telephone linemen 8 splicers . Tile setters . . Tool 8 die makers Upholsterers Specified craft apprentices, n.e.c. Not specified apprentices Craftsmen 8 kindred workers, n.e.c. Former members of the Armed Forces Farm implement ' Heavy equipment mechanics (incl. Operatives, Except Transport > diesel, factory mech, meter) Household appliance 8 accessory installers mechanics (incl. re . pairmen) Loom fixers Office-machine . Radio and television Railroad car shop . Mechanic, exc. auto, apprentices Miscellaneous mechanics repairmen Not specified mechanics 8 repairmen 601 602 603 604 605 610 . 611 612 613 Millers; grain, flour 8 feed Millwrights 614 Molders, metal . 615 Molder apprentices . 620 Motion picture projectionists 621 Opticians, 8 lens grinders 8 polishers 622 Painters, construction 8 maintenence 623 (incl. contract) . 624 Painter apprentices 625 Paperhangers Pattern 8 model makers, exc. paper Photoengravers 8 lithographers Piano 8 organ tuners 8 repairmen Plasterers Plasterer apprentices Plumbers 8 pipe fitters Plumber 8 pipe fitter apprentices Power station operators Pressmen 8 plate printers, printing Pressmen apprentices Rollers 8 finishers, metal Roofers 8 slaters 626 . 630 631 . 633 634 635 636 640 641 642 643 Sheetmetal workers 8 tinsmiths Sheetnetal apprentices Shipfitters . 644 645 Shoe repairmen Sign painters 8 letterers Stationary engineers Stone cutters 8 stone carvers 650 651 652 653 Asbestos 8 insulation workers Assemblers Blasters 8 powdermen Bottling 8 canning operatives Chainmen, rodmen, 8 axmen; surveyini ' Checkers, examiners 8. inspectors; manufacturers . Clothing ironers 8 pressers ' Cutting operatives, n.e.c. Dressmakers 8 seamstresses, except factory .. Drillers, earth Dry wall installers 8 lathers Dyers Filers, polishers, sanders 8 bugger: Fumacemen, -smeltermen 8 pourers Garageworkers 8 gas station attenda- .Graders 8 sorters, manufacturing Produce graders 8 packers, except factory 8 farm Heaters, metal - Laundry -8 dry cleaning operatives,n. Meat cutters 8 butchers, exc. manuf- turing ' : Meat cutters 8 butchers, manufactur Meat wrappers, retail trade Metal platers Milliners Mine operatives, n.e.c. Mixing operatives Oilers 8 greasers, exc. auto Packers 8 wrappers, except meat 8 produce Painters, manufactured articles Photographic process workers Precision machine operators . Drill press operatives Grinding maching operatives Lathe 8 milling machine operative Precision machine operatives,n.e. B-10 Service Workers, Exc. Private Household, cont'd Personal service workers 931 932 933 934 935 940 941 942 943 944 945 950 952 953 954 960 961 962 963 964 965 966 980 981 982 983 984 Airline stewardesses Attendants, recreation amusement Attendants, personal service, n.e.c. Baggage porters 5 bellhops Barbers Boarding $ lodging house keepers Bootblacks Child care workers, exc. private household (incl. n.s., juvenile detention) Elevator operators Hairdressers $ cosmetologists .Personal service apprentices Housekeepers, exc. private household School monitors Ushers, recreation 5 amusement Welfare service aides Protective service workers Crossing guards bridge tenders Firemen, fire protection Guards 5 watchmen Marshals constables Policemen 5 detectives (incl. rail road traffic officer) Sheriffs bailiffs Military Child care workers, private household (incl. baby sitter) Cooks, private household Housekeepers, private household Laundresses, private household Maids 6 servants, private household 996 Occupation not specific enough to code 998 DX $40 - R.eTuc.cE> Z(oO - U.NJSMfLC/cD 0 - l-toaeMAu^A- > 1- , HfSS/AH- } AJCT d&Ofl-T^T^ B-12 Occupational Asbestos Exposure Codes Category Definite asbestos exposure - decedent employed by asbestos company Probable exposure - including building, house construction, plasterer, automobile mechanic, cement worker Possible exposure - including steel or metal worker railroad workers, house painter, longshoreman, PG & E laborer Probably No exposure - including Farmer, Rancher, lumber worker, office or clerical, food service, health services. Calaveras and Tuolumne Counties City Codes I High Asbestos Areas: less than 5 miles from deposits Calaveras County Tuolumne County 11 - San Andreas 12 - Altaville 13 - Angels Camp, Carson Hill 14 - Melones 15 - Valley Springs, Double Springs 16 - Copperopolis, Salt Spring Valley 17 - Burson 18 - Calaveritas 19 - Campo Seco 20 - Sonora 21 - Chinese Camp 22 - Jamestown 23 - Grovel and 24 - Jacksonville 25 - Tuttletown 26 - Big Oak Flat, Moccasin II Medium Asbestos Areas: 6 to 10 miles from deposits Calaveras County Tuolumne County 31 - Milton 32 - Jenny Lind 33 - Telegraph City 35 - Mokelumne Hill 36 - Mountain Ranch 37 - Murphys 38 - Douglas Flat 39 - Vallecito 40 - Columbia Ill Low Asbestos Area: More than 10 miles from deposits Calaveras County Tuolumne County 51 - West Point 52 - Railroad Flat 53 - Arnold, WhitePines 54 - Camp Connell 55 - Avery, HathawayPines 56 - Sheep Ranch 57 - Glencoe 58 - Wilseyville 60 Twain Harte 61 Tuolumne, Bodenhamer 62 Strawberry 63 Long Barn, Sierra Village 64 Soulsbyvilie 65 Standard 66 Mi-Wuk Village, Sugar Pine B-15 01 - A1 ameda 02 - Alpine 03 - Amador 04 - Butte 05 - Calaveras 06 - Colusa 07 - Contra Costa 08 - Del Norte 09 - El Dorado 10 - Fresno 11 - 61 enn 12 - Humboldt 13 - Imperial 14 - Inyo 15 - Kern 16 - Kings 17 - Lake 18 - Lassen 19 - Los Angeles 20 - Madera 21 - Marin 22 - Mariposa 23 - Mendocino 24 - Merced 25 - Modoc 26 - Mono 27 - Monterey 28 - Napa 29 - Nevada 30 - Orange 31 - Placer 32 - Plumas 33 - Riverside 34 - Sacramento 35 - San Benito 36 _ San Bernardino CALIFORNIA COUNTY CODES 37 - San Diego 38 - San Francisco 39 - San Joaquin 40 - San Luis Obispo 41 - San Mateo 42 - Santa Barbara 43 - Santa Clara 44 - Santa Cruz 45 - Shasta 46 - Sierra 47 - Siskiyou 48 - Solano 49 - Sonoma 50 - Stanislaus 51 - Sutter 52 - Tehama 53 - Trinity 54 - Tulare 55 - Tuolumne 56 - Ventura 57 - Yolo 58 - Yuba 98 - Out of State, Out of Country B-16 Appendix C SMR Data Base for Calaveras and Tuolumne Counties C-l Male Deaths from Malignant Neoplasms of the Digestive Organs and Peritoneum (ICD 150-159), by Year and Age at Death, Calaveras and Tuolumne Counties YEAR LT 1C 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45--4 9 50-54 55-59 60-64 65--69 70-74 75-79 80-84 GE 85 TOTAL 1969 1970 1971 1Q72 1973 1974 19 75 __ T ' o---------------o--------- --------- o.... - ------------o -....------------o---------- ....0" ------ ------ Q I0 0 0 0 0 0 0 I0 0 0 0 0 0 0 I0 10 0 0 ......" 0 0" 0 0 0 0 0 0 " - 0 - -Q - 10 0 0 0 0 0 1 I0 0 0 0 1 0 0 I0 I' 0 0 o 10 o- 0 0 3 ... - o0 0 0 10 0 1 0 2 i 0 I1 1 0 0 1 2 1 I1 11 00 21 42 5 ........... 2 ----- 2 0. .... - o2 I3 2 4 i 2 2 1 I3 2 2 i 0 1 0 (1 1 3 i 0 2 2 I1 1 1 0 *" 0 - 1 1 l 11 9 13 12 13 11 8 1976 -0 0 0 0 0 0 0 0 1 3 0 4 3 2 0 4 ... 0 17 1977 --0 0 0 0 0 0 0 0 1 0 0 0 3 3 1 1 2. 11 1978 -U 0 0 0 0 0 0 0 1 0 2 3 6 4 2 2 "0 20 Male Deaths from Malignant Neoplasms of Respiratory System (ICD 160-163), by Year and Age at Death, Calaveras and Tuolumne Counties 1969 LT 10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65--69 70-74 75-79 80-84 GE 85 TOTAL I I I I 1 I I 1 I 1 1 0 0 0 0 0 0 1 0 0 0 3 1 2 2 4 2 1 16 1970 0 0 0 0 0 0 0 1 0 3 2 1 2 1 2 1 0 13 1971 0 0 0 . 1 0 0 0 0 1 0 2 2 3 i 2 1 0 '13, , 1972 1973 1974 1975 0 0 0 0 0 0 0 0 0 l l 0 2 1 0 1 1..... 7 _____ 0 0 0 0 00 0 0 0 0 0 5 5 3 1 0 0 . ... . 14 00 00 00 00 00 00 00 00 11 25 22 54 3 ' ........ ` " 4 04 40 22 4 1~ 21 25 1976 ' ,r) 1977 1978 00 00 00 o0 0 .0 00 10 00 00 12 3 : 3 42 36 51 12 20 2...... 3 rv. . 0 0 o o 0 0 0 0 :1 - '1 1 1 2 3 2 1 0 22 19 12 Male Deaths from Hypertensive Heart and Renal Disease (ICD 402, 404), by Year and Age at Death, Calaveras and Tuolumne Counties AGE 01 .V 1969 YEAR 1970 LT 10 I 1 0-- I 4 I 15-19 I 2 0-2* I 25-29 I 30-3* I 35-39 1 40-4* I 45--4 9 " I 50-54 I 55-59 I 60-64 I 65--69 I 70-74 1 75-79 I 80-84 I GE 85 "I ....... TOTAL I O 0 0 0 0 0 0 0 0 0 0 0 0 O 0 o 0 O 0 0 O 0 0 0 O 0 0 0 0 0 1 0 0 0 ........0 1 1971 1972 1973 i. " 0 0 0 00 0 000 000 oo 0 000 000 00 0 o0 o 000 00 0 00 0 00o 00 1 000 0 ..............0 - ----------- 0 0 --------------- 00 .... 01 0 1 1974 1975 0 ~o 00 00 0 -0 - 0 0 00 00 00 00 00 00 00 00 00 00 00 ...... 2... ' ...........1 '2 1 1976 1977 1978 0 U ..... 0 00 0 00 0 000 0u 0 00 0 000 000 " 0 ... ---------------o~ 000 000 00 0 0~ 0 0 00 0 000 0 -o - 0 0 --,------- 00- 000 Male Deaths from Malignant Neoplasms of the Genital Organs (ICD 180-187), by Year and Age at Death, Calaveras and Tuolumne Counties LT 10 10-14 15-19 20--? 4 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 GE 85 TOTAL 1969 . I0 I0 10 I0 I0 I0 I0 I0 I' 0 I0 10 I0 I0 10 I1 I0 Ii I2 YEAR 1970 i. 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 3 1971 1972 ........... 0 0 00 00 00 00 01 00 00 o ' '"0" 10 00 00 0 ... " 1 10 10 21 " 1...... 0 6 .3 1973 : .. 1974 . .. 1975 VC 1976 ., 1977 >. 0 0 ..... o............ 0 0000 000 0 000 0 0U0 0 0000 000 0 0000 0 0 o ---- 0 000 0 000 0 0 4 0 0.... - 01 - 0 1 020 1 3l30 " 1. l..........' 3 0 -----..... 1 2 ..... . ----------00 --- 0 0 0 0 0 0 0 0 0 0 0 2 1 2 1 2 0 9 ____ ____ 6 7 2 8 1978 .' tr 0 0 0 0" 0 0 0 0 0 0 2 4 1 0 .2 2 11 Male Deaths from All Causes, by Year and Age at Death, Calaveras and Tuolumne Counties "AGE ?l cr> , ___J -- YEAR 1969 .<% ' 1970 r TM" " ' LT " TO"" 10- 14 I 15- 19 1 20- 24 I 25- 29 I 30- 34 1 6_ ............. 0 4 3 0 l 3 0 3 5 4 3 35- 39 40- 44 45- 49 50- 54 55- 59 60- 64 65- 69 70- 74 75- 79 80- 84 GO 85 I I I I I I 1 I 1 I 1 2 6 4 9 22 23 28 43 42 22 22 0 1 4 11 16 16 34 29 29 22 28 TOTAL I 237 206 1971 1972 0 1973 -------8 - - --------3-------- 01 35 5 1 _ 5t -- ' 23 53 54 12 .......... 8 9 10 . 13 22 25 27 38 33 31 . 42 26 32. 32 26 26 " 22 ` 6 1 1 7 3 3 .2 3 lb 10 12 29 42 39 21 24 26 241 247 245 1974 1975 1.... ------ 1 2 5 2 0 2 7 '7 10 16 27 28 , 25 30 37 24 7- 0 1 5 4 4 4 2 a 12 15 24 45 40 23 22 20 224 236 1976 Z 1 4 a 7 4 3 1 8 16 16 37 42 46 31 25 16 267 1977 1978 4 ------------8 22 27 64 42 27 71 63 56 7 13 l 7 12 26 34 33 45 36 40 30 30 28 34 -- 38 " ----------29 253 274 Female Deaths from Malignant Neoplasms of the Digestive Organs and Peritoneum (ICD 150-159), by Year and Age at Death, Calaveras and Tuolumne Counties dooodoood AGE 9! i .. ..J 1969 i YEAR 1970 LT 10 10-14 15-19 20-24 25-29 3 0--3* 35-39 40-44 45 -- 49 50-54 55-59 60-64 65--69 70-74 7 5-79 80-84 GE 85 TOTAL I I I I I I I I I I 1 I I I I I. I I 0 0 0 0 0 0 0 0 1 0 1 2 0 3 2 l' 3 13 0 0 0 0 0 0 0 0 2 0 0 1 0 2 2 0 1 8 1971 1972 -o 0 0 0 0 0 0 0 "'O' 0 1 0 0 1 1 3 -0 6, O' 0 0 0 0 0 0 0 o 0 1 1 0 0 1 0 2 5 1973 *0 0 0 0 0 0 0 o 0 0 1 1 2 4 1 02....... 11 1974 1975 1976 .... o------- -- ..... O' 00 00 00 .... o 0 00 00 00 o0 10 02 02 14 25 14 10 "1 ....... 0 7 17 -a 0 0 0 0 0 0 0 -------- 0 1 2 3 r 1 1 l "2 12 1977 TT 0 0 0 O O 0 0 0 2 0 1 a 1 o 2 r 7 1978 1 0 1 1 0 1 3 T 8 Female Deaths from Malignant Neoplasms, of Respiratory System (ICD 160-163), by Year and Age at Death, Calaveras and Tuolumne Counties AGE 01 CO 1969 YEAR______________________________________________________________ s_________ __ 1970 1971 1972 1973 1974 1975 1976 1977 1978 LT 10 I 0------------------- O'-----------------0---------------------- 0------------------0--------------------0-------------------- 0------------------0---------------------- 0-------------------0~ 10-141 0 01 00 0 O0 00 15-191 0 00 00 0 00 00 20-24 10 00 00 0 00 00 25-29 I-----------------0--------------------0-----------------0--------------`--0--------------------0---------------------0------------------- 0------------------0--------------------- O-------------------0" 30-34 10 00 00 0 00 00 35-39 100000000 0 0 40-44 1000000 1 0 1 0 45-49 I-----------------0--------------------0-----------------0 0------------------0--------------------1--------------------1------------------O--------------------1-------------------0" 50-54 10001 0000 0 1 55-59 10 21 l0 0 20 22 60-64 10 00 02 0 00 15 65-69 I----------------0--------------------0----------------- 1---------------------0------------------3------------------0--------------------0------------------0----------------------1-------------------1 70-74 II 0 0 0 10 2 2 l 1 75-79 10001012002 80-84 10 0 0. O0 0 11 01 GE 85 "I-------------- 0 0-----------------0---------------------- 0------------------0------------- 0 0 " --------------1--------------------- 0--------------------0 TOTAL 1_______ 1 2 3______3___________ 6 2 ________ 9 4 ________7_________ _13 Female Deaths from Malignant Neoplasms of the Breast (ICD 174), by Year and Age at Death, Calaveras and Tuolumne Counties 1969 _YE A R 1970 LT 10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 00-84 GE 85 I I I I I~ I I I 1 I 1 I I I I 1 1 TOTAL I 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 3 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 1 4 1971 1972 - -0 0 0 0 0 0 0 1 0 0 0 3 "" 0 1 0 0 1 ----------------0 0 0 (0j . ............ 0 1 0 0 0 l 0 9 1 0 1 0 .6 4 1973 1974 1975 1976 0 0 0 0 0 0 1 0 1 1 0 1 0 0 1 0 1 6' 0 ........... 0 00 00 00 0 ............ 0 00 0 .0 00 1 11 1 1 1 02 00 10 01 68 . 0 0 0 0 0 0 0 0 0 0 l 1 1 0 0 0 0 3 1977 1978 00 00 0 v. 0 00 O' " 0 00 00 00 1l 13 . 2 . 1 00 ' 1' 1 32 00 00 11 99 Female Deaths from Malignant Neoplasms of the Genital Organs (ICD 180-187), by Year and Age at Death, ' Calaveras and Tuolumne Counties 1969 YEAR_________________________________________________________________________________ 1970 1971 1972 1973 1974 1975 1976 1977 1978 LT 10 I 0 0 0-------------------- 0------------------0--------- 0.......... 0---- 0---------------------- 0------------------0" 10-141 0 00 00 0 0 0 00 15-191 0 00 0O O 0 0 00 20-24 100000000 0 0 25-29 I------------0------------------ 0------------------ 0--------------------- 0------------------0--------------------0 '............... 0---------------------0-------------------- O------------------- XS~ 30-34 10 00 00 0 0 0 00 35-39 10 00 00 0 0 0 00 40-44 10001 01 00 1 0 45-4 9 I-------------0------------------ 0------------------ 1 ------------------ 0------------------- 0........ 0 0---------------------0-------------------- O--------------------1~ 50-54 11000 1 1200 1 55-59 I I 1 0 00 10 2 00 60-64 10222021 0 0 0 65-69 I------:--1--------------------- 1-------------------0----------------------1------------------0--------------------- O------------------0--------------------2---------------------1-------------------2" 70-74 10 l 10 0 0 0 0 10 75-79 11 022 000 0 0 0 80-84 II 1 10000 1 1O GE 85 1---------- 0------------------ 0------------------ 0---------------- 0-------------------0-------- 1.......... 0 0--------------------- O------------------- 0~ TOTAL I 5 6 7____ ___ 6_______ _1_^ _____6___ 3 5 4 4 Female Deaths from Hypertensive Heart and Renal Disease (ICD 402, 404), by Year and Age at Death, Calaveras and Tuolumne Counties 1969 LT 10 I 10-14 I 15-19 I 20-24 1 25-29 ' 1 30-34 I 35-39 I 40-44 I 4 5--4 9 I 50-54 I 55-59 I 6 0-64 1 65-69 I 70-74 I 75-79 l 80-04 I GE 85 " I TOTAL I 0 0 0 0 U 0 0 0 0 0 0 0 2 0 0 0 i~ 3 YEAR 1970 1971 1972 1973 1974 1975 1976 o ... 0 ........... O' ........... ... 0 ............... 0 .............. 0 .... o 000 000 0 000 0000 000 0000 0 o 0 0" 0 0 0~ 0000000 000 000 0 000 000 1 0 0 0 0 ..........0... 0 0 01 00000 01 0 0000 0 0 0 o 0 0 0 0 . ... ... 00 - .' 0 0 " 0 0 000 0 1 00 00 0 000 0 010 0 ..................O' ----------------0 - 0 t -' --------------l0 .0 0 .............. 0......................0 030 1 20 1 197.7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -- o 0 1978 0" 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 Female Deaths from All Causes, by Year and Age at Death, Calaveras and Tuolumne Counties AGE o -- PO / 1969 LT 10 10-1A 15-19 2 0 -- 2* 25-29 30-34 35-39 A 0 -- 44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 60-84 GE 85 TOTAL I ............4 13 I1 I1 I0 I0 I0 I0 I3 I5 I 11 I 10 I 18 1 18 1 22 I 24 1 35 1 155 YEAR 1970 ? 0 2 1 0 0 2 1 6 5 11 13 18 19 19 28 34 166 ......... . 1971 "..........5 1 0 1 3 0 1 6 5 10 12 15 10 20 22 21 35 167 ............. . . ,, . ___ ________ ... ............. ..... . ...... .. _ 1972 1973 1974 1975 1976 1977 1978 o...... .......... 6 ...... 5....... ...........2 ' ........ 3"' 2 001 000 201 21 4 51 02 1 2 ~2 ' 3 0 0 o 1 001 020 22 1 1 1 4 4 4' 1 6 '' 3 4 465 5 -----------------5 " .......... . " 6 - 6 e 89 9 5 8 7 12 1 1 10 1 0 14 17 15 18 16 9 9 18 19 , 23 ....... 20 14 10 23 21 25 15 21 20 . 21 24 23 20- 20 11 25 27 36 ~ ...... '38....... ........33- 26 22 29 41 ---------- ` 31 ............ 37 133 176 175 192 162 169 186 Female Deaths from All Causes, by Year and Age at Death, Calaveras and Tuolumne Counties 1969 LT 10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 GE 85 TOTAL 1 1 I I I 1 1 I 1 I 1 I I 1 i I I 1 ~1 ...... ' 4' 3 1 1 0 0 0 0 3 5 11 10 18 18 22 24 35 155 YEAR 1970 ..... 7 0 2 1 0 0 2 1 6 5 11 13 18 19 19 28 34 166 1971 1972 1973 ""...........5" ........ 1 0 1 3 0 1 6 5 10 12 15 10 ' ' 20 22 21 35 " ' o........ 0 2 5 2 0 2 4 4 6 8 194'". ` 10 20 . 11 36 167 133 6 0 0 1 3 0 2 1 6 8 7 17 18 23 21 25 " 38 176 1974 19 75 1976 1977 5' .............. 2 10 12 02 00 10 11 3 4 45 89 12 1 1 . 15 18 ..... ... 19 / 23 21 25 24 23 27 26 33 -- - 41 ' 175 192 ...... 3 2 00 14 12 01 20 14 65 -------5 ....... ---------- 6 " 95 10 10 16 9 ....... 20 14 15 21 20- 20 22 29 ......." 31 ' " ...... 37 162 169