Document LgG2jwarL1MdroyVRmOLbpnjd

FILE NAME: Pennsylvania (PA) DATE: 1962 Dec DOC#: PA023 DOCUMENT DESCRIPTION: PA Medical Journal Article - Pneumoconiosis Mortality in PA Pneumoconiosis Mortality in Pennsylvania Jan Lieben, M.D., and Philip C. Hill, B S. Harrisburg, Pennsylvania T H I S report is a continuation in time of the article which appeared in the J o u r n a l in August, 1960, and described pneumoconiosis mor tality tor the period from March 1, 1957, to Feb. 28, 1959, in Pennsylvania. The present paper depicts mortality for the period from Jan. 1, 1959, through Dec. 31, 1960. Mortality figures for occupational diseases of the chest continue high and there has been no startling change. The cost of occupational dis ease compensation for the illness has risen from $21,000,000 for the 1957-1959 biennium to $23,350,000 for the 1959-1961 biennium. These pay ments are made under the Pennsylvania Occupa tional Disease Act of 1939 which provides for procedures that are separate and distinct from the Workmen's Compensation Act in connection with cases of silicosis, anthracosilicosis, and asbcstosis. This act was amended in 1953 and fur ther provides that " in those cases where disability or death is not conclusively proved to be the re sult of the last occupational exposure, all compen sation shall be paid by the Commonwealth." Since occupational pneumoconiosis is a chronic disease and most workmen do not stay on the same job throughout their working lives, most of the claims are paid in full by the Common wealth rather than by an insurance carrier or the industry responsible for the dust hazard. The State assumed 100 per cent financial responsibility for 92 per cent of the claims paid during 1959 and 1960, and shared responsibility with employers in the remaining cases. The first steps of the preventive program pro posed in the 1960 paper have been initiated and over 16,000 coal miners have been x-rayed and studied in central and western Pennsylvania. Part of the findings have been reported elsewhere. The Department of Mines and Mineral Industries is conducting a vigorous dust: control program throughout bituminous and anthracite mines in Pennsylvania and has accomplished the correction From the Division oi Occupational Health, Pennsylvania D<? pa it m e n t of Health. Pneumoconiosis is a disease to be reckoned with; the mortality figures are high and are not dropping. This paper shows the disease to be im portant as a primary cause of death, but also emphasizes its secondary role. 1 of many dust hazards. Results of these accom plishments will not show up for several years since pneumoconiosis is a slowly progressive and cumulative condition. According to the most recent figures compiled by the National Vital Statistics Division of the National Center for Health Statistics, 55.3 per cent of the pneumoconiosis mortality in the United States occurs in Pennsylvania. Approxi mately 93.8 per cent of all deaths from anthra cosilicosis are reported from Pennsylvania (Table I). The number of Pennsylvanians dying annually with occupational lung disease as the underlying cause of death has increased since 1950 as shown in Table II. It is also of interest to note that since 1950 the number of deaths attributed to tuberculosis com plicated by occupational lung disease (code num ber 001 of the International Statistical Classifica tion of Diseases, W H O ) has remained fairly constant (1950, 152 deaths; 1954, 116; 1955, 135; 1956, 148; 1957, 144; 1958, 344; 1959, 139; and 1960, 138), although mortality from all forms of tuberculosis during the same period has been reduced 63.5 per cent (2474 deaths in 1950 to 902 deaths in 1960). When the age of decedents is examined, it is found that occupational lung disease is the eighth most frequent cause of death among males aged 65 years arid older, and is 1.3 per cent of the total male mortality in this age group for the year 1960. Among males aged 45 to 64 years, pneu moconiosis is the seventh most frequent underly ing cause and is 1.8 per cent of the total male mortality in this age group. L ess than 1 per cent: of the males dying from this disease were under 45 years of age. DECEMBER, 1962 1475 IKS<*lfiC8HtrK*il31 In the five Pennsylvania counties where most of the occupational lung disease is concentrated, mortality from this cause among males over 44 years of age is far more frequent Pneumoconiosis is the second most frequent cause of death in Lu zerne and Schuylkill counties, exceeded in fre quency only by heart disease. These lung diseases ranked fourth in frequency as cause of death among males in this age group in Carbon, Lacka wanna, and Northumberland counties, being ex ceeded only by heart disease, cancer, and vascular lesions affecting the central nervous system. The figures indicated in the foregoing do not tell the whole story since they are based only on tabulation of the primary causes of death. An examination of 240,273 death certificates filed during the two-year period Jan. 1, 1959, through Dec. 31, 1960, was made to determine how fre quently pneumoconiosis was reported as a com plication or contributory cause in addition to the number of times this condition was indicated to be the primary cause of death. During the period there were 2772 male deaths reported with men tion of occupational lung disease in the certifica tion of cause of death. Sixty-two and seven-tenths per cent of these reports (1739) stated that the occupational lung disease was the primary cause of death, while for the other 1033 deaths pneumo coniosis was specified to be an associated morbid condition existing at the time of death. The 2772 deaths involving pneumoconiosis were 2.1 per cent of the 133,939 males who died from all causes during the two-year period. In 11 of the 67 counties in Pennsylvania the propor- TABLET Mortality from Occupational P neumoconiosis in U nited S tates and P ennsylvania (1959) Underlying Cause of Death Code * N uvaber of Deaths Pcnnsyl- Per U S . Vnia Cent i Silicosis 523.0 541 67 12.4 Anthracosilicosis 523.1 743 697 93.8 Asbestosis 523.2 18 6 33.3 Pneumoconiosis s m 179 60 33.5 Other specified ( unqualified) Pneumoconiosis $24.0 60 22 367 (not due to silie;a ) Total 1541 852 55.3 In te rn a tio n a l S ta tistica l C la ssifica tio n c<f D iseases. In ju r ie s , and Causes of D eath. W H O , 195$ Tie v isio n , t P e n n sylv a n ia /U S. x 100. S ol' r c r : F o r all tables, U n ite d Suites data from N a tio n a l Office ol V ita l Statistics. H E W . am! Pen n sylvan ia data irum Pennsylvania Department of Health. 1476 TA BLE II N umber of Deaths from P neumoconiosis in P ennsylvania, 1950, 1954*1960 Year Number of Deaths 1960 887 1959 852 1958 793 1957 795 1956 740 1955 695 1954 627 1950 728 (Figures for 1951-53 not available) tion of males dying with pneumoconiosis exceeded 2.1 per cent. Of the total deaths involving pneu moconiosis in the State, 81.7 per cent occurred in these same 11 counties, and 76.3 per cent of the total were concentrated in five counties (Luzerne, Schuylkill, Lackawanna, Carbon, and Northum berland). Fig. 1 indicates the 11 counties in which the proportion of male mortality involving pneumoconiosis exceeded 2.1 per cent. These counties include eight hard coal and two bitumi nous coal producing areas. The underlying causes of death for the 1033 men where occupational lung disease was indi cated to be only an associated morbid condition are shown in Table III. The distribution of these causes is quite different from that found for male decedents over 44 years of age in the State as a TABLE HI P rimary Causes of D eath R eported on Certificates M entioning P neumoconiosis as an A ssociated M orbid C ondition in P ennsylvania J a n . 1, 1959, to D ec. 31. I960 Primary Cause of Death Number of Per Cent Deaths of Total Ail causes . .................. ............ . .. 1033 Heart disease . . . . . . . . . 509 Malignant neoplasms .............. 155 Pneumonia and influenza .......... 74 Vascular lesions of central nervous system ........................ 68 Pulmonary edema ...................... 30 Pulmonary insufficiency .......... 15 General arteriosclerosis ............ 12 AnlhracosHicosis* ...................... 0 Pulmonary emphysema .. 5 Tuberculosis ................................. 3 Lung hemorrhage ...................... 3 Bronchitis ..................................... 1 Pulmonary fibrosis .................... l All other causes .......................... 148 * As rc]*rii-i| on iteiiih certificate 100.0 49.1 15.1 7.2 6.6 2.9 1.4 1.2 0.9 0.5 0.3 0.3 0.1 0.1 14.3 T H E PENNSYLVANIA MEDICAL JO U R N A L whole. 1 cent of ti nge or ole as in this occupatio only 0.3 j 2.8 per ce in Penns influenza, per cent causes, pneumoci over-all c sus 16.5 ] The th males in cancer, ai nervous 74.3 per with assc three can because o and influt diseases. When this grou it was fo total iiid1 with an ii reported pation en the latest t-2r<! o: I "7,5 i r* K--! , r L... I DF.CEMB1 whole. For example, in Pennsylvania 1.1 per cent of the deaths of m ales who are -15 years of aye or older are attributed to tuberculosis, where as in this group of males known to have had an occupational lung condition at the time ot death only 0.3 per cent died from tuberculosis. About 2.8 per cent of the males dying in tins age group iii Pennsylvania are victims of pneumonia and influenza, while in the pneumoconiosis group 7.2 per cent of the deaths are attributed to these causes. The proportion dying from cancer in the pneumoconiosis group is slightly lower than the over-all cancer death rate in the State (15.1 ver sus 16.5 per cent i. The three most frequent causes of death for males in this broad age group (heart disease, cancer, and vascular lesions affecting the central nervous system \ generally account for at least 74.3 per cent of the total deaths. In the group with associated occupational lung disease, these three causes claim only 70.9 per cent of the total because of the number of deaths from pneumonia and influenza and from other chronic respiratory diseases. When the occupations which are reported on this group of death certificates were examined, it was found that 1655 or 59.7 per cent of the totnl indicated work which may be associated with an inhalant hazard. Occupations which were reported are shown in Table IV. Since the occu pation entered on the death certificate is usually the latest employment of the decedent, it is very TABLE IV O ccupation? R eported ox D eath C ertificates I d u e F*ir M ales D y in g with S ome M ention of O c a rational L u x e D isease in Pennsylvania J a n . 1, 1959. to D ec. 31, 1960 (.)< cnpalion Xumber ol Deaths All occupation Mine worker ............. Laborer . Railroad worker ............................................. Steel mill w o r k e r ............... Carpenter .............................................. Farmer Bricklayer ........................................... M ach in ist...................................... Stone worker.................................................. B la c k s m ith .......................................... . Other, specified . . . Retired and unspecified....................................... 2772 1591 215 51 31 29 29 H 19 7 5 399 A14 possible that those reported as retired or as farm ers and hotel workers may have been miners, steel workers, and brickyard workers earlier in their lives, f t is possible that die railroad worker* had worked in the railway yard foundry, and the laborers could be exposed to many different in halant hazards. Summary 1. Mortality statistics indicate that the number of deaths tti Pennsylvania from pneumoconiosis (primarily aruhracosilicosis ) has increased since FIGURE 1. C O U N T I E S WI TH M A L E M O R T A L I T Y F R O M P N E U M O C O N I O S I S IN E X C E S S G F 2.1% O F T O T A L M A L E M O R T A L I T Y : Pennsylvania, Jan u ary l, 1959 - December 31, 1960 DHCP.MBKR. 1962 OVER 20% H 8 TO 20% | ; 1 2.1 TO 8% 14 7 "* 1950, even though coal mining operations in the State have been curtailed and there are iewer mines in operation. 2. Occupational lung disease is the seventh most frequent cause of death among Pennsylvania males aged 45 to 64 years, and is ranked eighth among males who are over 64 years of age. 3. In Luzerne and Schuylkill counties pneu moconiosis is the second most frequent cause of death among males over 44 years of age, and in Carbon, Lackawanna, and Northumberland coun ties this disease is the fourth most frequent cause in that sex and age group. 4. When death certificates filed during a twoyear period were examined, it was found that 1033 records indicated occupational lung disease to be a morbid condition existing at the time of death (but not the primary cause) in addition to 1739 certificates which stated pneumoconiosis to be the underlying cause of death. 5. The total of 2772 deaths involving occupa tional lung disease was 2.1 per cent of the 133,939 males who died during the same two-year period, and 81.7 per cent of these deaths were reported from 11 counties that comprise the larger part of Pennsylvania's coal mining areas. 6. Where pneumoconiosis was a morbid con dition mentioned on the death certificate but not the primary cause, it was found that the primary causes were distributed differently in frequency than causes of death in the general population of males over 44 years of age. There was a distinct ly higher than average death rate attributed to pneumonia, influenza, and other respiratory dis eases. 7. Fifty-nine per cent of the occupations indi cated on the death certificates of persons dying from or with pneumoconiosis could be associated with an inhalant hazard. World Experts View Thalidomide The tragedy of thalidomide, the drug responsible tor the birth of thousands of malformed children, could not have been avoided. Such was the consensus ot physicians from the world over, gathered at the 10th Internationa! Congress of Pediatrics in Lisbon, Portugal. Most participants agreed that the tragedy was un avoidable because the thalidomide case was without precedent. It was not possible, even if the most thorough experimentation on animals had been carried out, to predict the effect which the synthetic drug turned out to have on the human embryo. Unpredictable as it was, the phocomelia " epidemic" could nevertheless have been limited, according to several physicians at the congress. Among them was Widukind Lenz, M.D., professor of human genetics at Hamburg University, who first showed that thalidomide could be a teratogenic agent. The thalidomide catastrophe revealed how poor the existing warning system was, Dr, Lcnz told congress participants. He had revealed the teratogenicity of thal idomide early last November " it took ten days to alert Germany to its dangers, mainly through the lay press, which turned out to be the most efficient warning sys tem," he recalled. Ten days was long enough, but elsewhere it took even longer, Dr. Lenz added. Health authorities of most countries reacted with surprising slowness. In at least five countries, according to Dr Lenz, thalidomide was actually not efficiently withdrawn from the market be fore March this year, even though evidence against the 1478 drug as a teratogenic agent was stronger than that against German measles. Sidney Q. Cohlan, M.D., of New York, chairman of a round-table discussion on teratogenic agents, noted that as a result of the thalidomide panic the public has been clamoring for legislation that would require thor ough animal testing of a drug before it is administered to human patients. But. he asked, how much can the. most thorough animal tests predict? 11 wc arc to ban all drugs which are teratogenic to animals, irrespective of dosage, answered Dr. Cohlan, " we would have to discontinue the use in pregnancy of penicillin, streptomycin, tetracycline, nicotine, caffeine-- to name only a few." As a matter of fact, one could conclude from animal experimentation that aspirin is more dangerous than thalidomide, he commented. S ix times the maximum permissible dose of salicylates produces serious malformations in rat fetuses. In con trast, administration of 75 times a comparable thalido mide dose to pregnant rabbits produces only minor fetal defects. According to Dr. Cohlan, at least thalidomide may awaken medicine to the possibility of similar dangers elsewhere. Up to now, he pointed out. there has been ititle interest in the possible teratogenic effects of drugs or other agents, and only three years ago was the World Teratology Society founded under the presidency of Josef Warkanv, M.D., of Cincinnati. Even now the society lias only 150 members--mostly anatomists, em bryologists. and geneticists--including only 12 pedia tricians and three obstetricians.--Reprinted from Medi cid World News. THE PENNSYLVANIA MEDICAL JOURNAL Alt I N mid-1 all Unit i Of these, \ schools in extinct (w A nevvl; 5 Health vSei on the local ical schools previously Health Set tracted aiu data as reft medical sc! the United and other s I Location oi There v located in 1 this minibe U. S. schoo twenty-four for most of with only r f; cent of thei j schools. Pennsvlv; !; states m. pr< f medical schi , Slightly mo i! of the 14,25 | sylvarua gn schools. Ill i with 73.7 pe percent. H states which medicine.) The rema physicians \\ viflecl into 9. Dr Allman is uale School of I DECEMBER,