Document Lp28RepZM78aXoqoxoN3em04X

DEPARTMENT OF HEALTH Pathology Division Report: Demographic Data and Disease Rates for January - December 2000 Dr Jill Murray Dr Geoff Candy NATIONAL CENTRE FOR OCCUPATIONAL HEALTH NCOH Report 3/2001 P O Box 4788 JOHANNESBURG 2000 TABLE OF CONTENTS Executive Summary Section 1: Introduction Section 2: Data Description Distribution of autopsies by year & ethnic group (1975-2000) Number of autopsies by age & ethnic group Number of autopsies by type & ethnic group Number of autopsies by industry & ethnic group Number of autopsies by years of service & ethnic group Mean duration of service and mean age by type of mine & ethnic group (2000) Section 3: Active Tuberculosis Distribution of active tuberculosis by anatomical site Number and prevalence of pulmonary tuberculosis by age& ethnic group Number and prevalence of pulmonary tuberculosis by industry& ethnicgroup Number and prevalence of pulmonary tuberculosis by years of service & ethnic group Section 4: Silicosis Number and prevalence of silicosis by age & ethnic group Number and prevalence of silicosis by industry & ethnic group Number and prevalence of silicosis by years of service & ethnic group Section 5: Massive Fibrosis, Coal Workers' Pneumoconiosis, Mixed dust Fibrosis & Asbestosis Number and prevalence of asbestosis by age & ethnic group Section 6: Emphysema Number and prevalence of emphysema by age & ethnic group Number and prevalence of emphysema by industry & ethnic group Number and prevalence of emphysema by years of service & ethnic group Section 7: Mesothelioma Number of mesothelioma cases by age & ethnic group Number of mesothelioma cases by industry & ethnic group Section 8: Primary Lung Cancer Number and prevalence of primary lung cancer by age & ethnic group 4 5 6 7 8 8 9 10 11 12 12 13 14 15 15 17 18 18 19 20 20 21 2 Number and prevalence of primary lung cancer by industry & ethnic group22 Section 9: Causes of death Causes of death by ethnic group (2000) Appendix: Distribution of autopsies according to the last mine where the deceased worked 23 24 3 EXECUTIVE SUMMARY South African law requires the examination of the cardiorespiratory organs of deceased miners and ex-miners for compensation purposes, provided the next of kin agrees. These examinations are performed at the National Centre for Occupational Health (NCOH) and the findings are recorded on a computerized database (PATHAUT). This database is unique and provides an important resource for surveillance and research. During 2000, 2608 cases came to autopsy at the NCOH. Of these, 68.9% were black men, 29.2% whites, 1.6% coloureds and 0.3% were submitted without information on the ethnic group. No Asians (Indians) were autopsied. Overall disease rates (per 1000 cases) for 2000 are as follows: Emphysema (146/1000) n Silicosis (145/1000) Tuberculosis (160/1000) Primary lung cancer (26/1000) Asbestosis (19/1000) Massive fibrosis (9/1000) Mesothelioma (7/1000) Coal Workers' pneumoconiosis (4/1000) Mixed dust pneumoconiosis (4/1000) 4 SECTION 1 - INTRODUCTION The Pathology Department of the National Centre for Occupational Health (NCOH) provides an autopsy service for miners and ex-miners to determine the presence of occupational lung disease. Under the Occupational Diseases in Mines and Works Act (ODMWA, 1973) it is obligatory for the last attending doctor to remove the cardiorespiratory organs and submit them for examination provided the next of kin agrees. A detailed report of each case is sent to the Medical Bureau for Occupational Diseases (MBOD). Cases certified as having a compensatable disease are then referred to the Compensation Commissioner's office, where payment of compensation is managed. Since 1975 the pathological findings have been recorded on the PATHAUT database which is a unique computerized source of information for research. PATHAUT combines data from autopsy summary sheets and clinical files (including occupational histories) onto a single database. The structure of this database was changed in 1995/1996 and new programs were written, upgrading and enhancing the existing database by improving the quality of the system and making better use of existing data (SIMRAC Project GEN509). This is the fourth of the new format reports and describes autopsy cases examined during the year 2000. Data from PATHAUT are exported into the Statistical Analysis System (SAS System) where programs have been written using the Structured Query Language (SQL) which allows the user to analyze data on the SAS System on any aspect of the PATHAUT database. 5 SECTION 2 - DATA DESCRIPTION The number of autopsies performed since 1975 is presented in Table 2-1. TABLE 2-1 DISTRIBUTION OF AUTOPSIES BY YEAR & ETHNIC GROUP (1975-2000) Year of Black White Coloured autopsy N %N %N % 1975 2190 71 854 28 32 1 1976 2335 68 1072 31 27 1 1977 2351 69 1039 30 33 1 1978 2245 67 1090 32 32 1 1979 2118 66 1026 33 45 1 1980 2338 64 1274 35 46 1 1981 2209 66 1117 33 33 1 1982 2312 63 1302 36 44 1 1983 2096 65 1109 34 41 1 1984 1966 64 1098 35 28 1 1985 2275 64 1200 34 66 2 1986 2456 68 1125 31 45 1 1987 2594 68 1168 30 78 2 1988 2518 67 1165 31 77 2 1989 2138 65 1090 33 60 2 1990 2172 64 1155 34 51 2 1991 2143 65 1080 33 66 2 1992 2144 66 1049 32 70 2 1993 1863 65 956 33 65 2 1994 1737 61 1021 36 94 3 1995 2830 71 1059 27 99 2 1996* 766 68 329 29 19 2 1997 2223 69 897 28 70 2 1998 1977 68 836 29 49 2 1999 1656 65 832 32 29 2 2000 1798 69 761 29 41 2 TOTAL 55 450 66 26 704 32 1 340 2 * Data for only 6 months are availab e for this year Indian N% 1 0.03 1 0.001 Unknown N% 14 1 18 1 17 1 12 1 8 0.3 69 0.1 Total N 3076 3434 3423 3367 3189 3658 3359 3658 3246 3092 3541 3626 3840 3760 3288 3378 3289 3263 2884 2852 3988 1128 3208 2880 2529 2608 83 564 6 It is important to note that there is a referral bias in that black men are infrequently autopsied after leaving employment in the mines, whereas the majority of whites come to autopsy after retirement. The age distribution of autopsies for 2000 is shown in Table 2-2 and Fig 2-1. The mean age for autopsy from black miners has increased from 37.9 years in 1998, 40.1 years in 1999 to 40.8 years in 2000. The age of white miner autopsies has also increased to 63.3 years in 2000 compared to 61.8 years in 1999. TABLE 2-2 NUMBERS OF AUTOPSIES BY AGE & ETHNIC GROUP (2000) Age group Black White Coloured Unknown All races N %N %N %N %N % 20-29 92 5.1 9 1.1 0 0.0 0 0.0 101 3.9 30-39 591 32.9 31 4.1 1 2.4 0 0.0 623 23.9 40-49 719 40.0 89 11.7 5 12.2 0 0.0 813 31.2 50-59 278 15.5 140 18.4 9 22.0 0 0.0 427 16.4 60-69 40 2.2 219 28.8 10 24.4 0 0.0 269 10.3 70-79 7 0.4 180 23.7 9 22.0 0 0.0 196 7.5 80-89 6 0.3 87 11.4 5 2.0 0 0.0 98 3.8 90+ 1 0.1 5 0.7 2 4.9 0 0.0 8 0.3 Unknown 64 3.6 1 0.1 0 0.0 8 100.0 73 2.8 Total 1798 100 761 100 41 100 8 100 2608 100 FIG 2-1 DISTRIBUTION OF AUTOPSIES BY AGE & ETHNIC GROUP(2000) 20-29 30-39 40-49 50-59 60-69 70-79 80-89 Age group 90+ Black White Coloured 7 The pathologists at the NCOH perform 2 types of examinations. For men dying distant from Johannesburg, the cardiorespiratory organs are removed locally, preserved in formalin and sent to the NCOH. Full autopsies are undertaken on men who die close to Johannesburg. Table 2-3 presents the distribution of autopsies by ethnic group for 2000. Autopsies of only the cardio-respiratory organs comprised 93.9% of examinations. TABLE 2-3 NUMBER OF AUTOPSIES BY TYPE & ETHNIC GROUP (2000) Cardiorespiratory organs only Full autopsy TOTAL Black N% 1792 99.7 6 0.3 1798 100 White N% 609 80.0 152 20.0 761 100 Coloured N% 41 100 00 41 100 Unknown N% 8 100 00 8 100 TOTAL N% 2450 93.9 158 6.1 2608 100 Table 2-4 and Figure 2-4 show the distribution of autopsies by industry and ethnic group for 2000. The majority of miners were from the gold mining industry (70.7%) compared to 75.8% in 1999. The number of autopsies from platinum miners has increased from 173 (10.4% of autopsies of blacks) in 1999 to 343 (19.1%) in 2000. As in 1999 the majority of autopsies from coloured miners came from asbestos mines (68.3%). TABLE 2-4 NUMBER OF AUTOPSIES BY INDUSTRY & ETHNIC GROUP (2000) Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown Total Black N% 1289 71.7 75 4.2 343 19.1 19 1.1 16 0.9 5 0.3 1 0.1 19 1.1 31 1.7 1798 100 White N% 551 72.6 39 5.1 30 4.0 28 3.7 13 1.7 17 2.2 15 2.0 35 4.6 31 4.1 759 100 Coloured N% 2 4.9 0 0.0 0 0.0 28 68.3 1 2.4 8 19.5 0 0.0 1 2.4 1 2.4 41 100 Unknown N% 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 8 100.0 8 100 TOTAL N% 1842 70.7 114 4.4 373 14.3 75 2.9 30 1.2 30 1.2 16 0.6 55 2.1 71 2.7 2606 100 8 FIG 2-4 DISTRIBUTION OF AUTOPSIES BY INDUSTRY & ETHNIC GROUP (1999) Black White Coloured Gold Coal Platinum Asbestos Other* * Includes copper, diamond, quarry, silica (silicon smelters), manganese, tin, zinc, minerals, chrome and iron as well as cases where information about type of mining is missing Detailed information duration of mining service by ethnic group is given in Table 2-5. This is also presented in Fig 2-5. Cases are categorized according to the industry in which most years of service occurred. It is important to note the large percentage of cases with missing information on the duration of service (22.6%), which is a reflection of the poor quality of the data provided by the mines. This is similar to 1999 (22.7%) but lower than the figure for 1998 (43%). TABLE 2-5 NUMBER OF AUTOPSIES BY YEARS OF SERVICE & ETHNIC <1 1-5 6-10 11-15 16-20 21-25 26-30 31 + Missing Total GROUP (2000) Black White N% N% 10 0.6 3 0.4 205 11.4 47 6.2 294 16.4 50 6.6 426 23.7 92 12.1 275 15.3 79 10.4 127 7.1 78 10.3 35 2.0 93 12.2 18 1.0 157 20.6 408 22.7 162 21.3 1798 100 761 100 Coloured N% 0 0.0 4 9.8 10 24.4 2 4.9 5 12.2 1 2.4 2 4.9 5 12.2 12 29.3 41 100 Unknown N% 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 8 100 8 100 TOTAL N% 13 0.5 256 9.8 354 13.6 520 19.9 359 13.8 206 7.9 130 5.0 180 6.9 590 22.6 2608 100 9 </> 500 Q) 400 FIG 2-5 DISTRIBUTION OF AUTOPSIES BY YEARS OF SERVICE & ETHNIC GROUP (2000) 300 200 -Q | 100 Z 0 i--i,i i--n i n 11 Black White <1 m-5 D6-10 D11-15 16-20 D21-25 026-30 031 + The mean duration of service & age by mining type and ethnic group is shown in Table 2-6. Cases where age and type of mine service were not given are excluded. TABLE 2-6: MEAN DURATION OF SERVICE AND MEAN AGE BY MINE TYPE & ETHNIC GROUP (2000) Minetype Gold Coal Platinum Asbestos Diamond Copper Iscor Other N 1085 55 199 14 9 5 1 14 Black Age Mean SD 42 8 41 9 43 8 62 11 49 8 53 7 47 50 8 Service Mean SD 13 7 15 8 12 7 12 9 15 10 16 5 24 14 8 N 463 31 24 18 8 14 14 24 White Age Service Mean SD Mean SD 65 14 24 58 15 16 59 15 18 59 11 14 62 11 22 67 12 16 61 11 22 64 10 20 11 12 11 9 8 8 13 10 Total 1382 596 10 SECTION 3 - ACTIVE TUBERCULOSIS Active tuberculosis was diagnosed in 16.4% (416) of all the cases autopsied in 20001, in comparison with the 387 (15%) cases of the previous year. The distribution of tuberculosis (TB) by anatomical site is presented in Fig 3-1. 81% of TB cases had active pulmonary tuberculosis (PTB). Of the PTB cases, 81.3% involved the lungs extensively. 94.0% (391 cases) of PTB cases were black, 4.3% (18 cases) white, 1.2% (5 cases) coloured miners and in 0.5% (2 cases) the ethnic group was unknown. 80% of all TB cases came from the gold mines and most (43%) of the PTB cases were in the age group 40-49. The overall rate of TB (159/1000) is higher than in previous years: 123/1000 (1999) and 149/1000 (1998). This is attributed to the increase in the PTB rate in black miners from 206/1000 in 1998; 174 (1999) to 218/1000 in 2000. The rate in PTB has increased markedly in the platinum miners. Fig 3-1 Distribution of active TB by site (2000) Glands & lungs (46.5%) Glands, pericardium & lungs (3.1%) Lungs only (30.1) Pericardium & lungs (1.6%) Glands only (18.6%) Pericardium only (0.2%) 1 earlier printings of this report incorrectly gave the figure for 1999. 11 The age distribution of cases with active pulmonary TB is shown in Table 3-1. The difference in age distribution between ethnic groups might be explained by different referral patterns (page 3). TABLE 3-1 NUMBER & PREVALENCE OF ACTIVE PTB BY AGE & ETHNIC GROUP (2000) Age group Black White Coloured Unknown Total N Rate N Rate N Rate N Rate N Rate 20-29 17 185 0 0 0 -0 - 16 158 30-39 123 208 1 32 0 0 0 - 124 197 40-49 171 238 6 67 2 400 0 - 179 220 50-59 56 201 4 29 2 222 0 - 62 145 60-69 7 175 3 10 0 0 0 - 10 37 70-79 0 0 2 11 1 111 0 - 3 15 80-89 2 333 2 23 0 0 0 - 4 40 Missing 15 234 0 0 0 - 2 250 17 233 TOTAL 391 218 18 22 5 122 2 250 416 159 Rate per 1000. Denominator: All autopsies in specific age group for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. The distribution of active PTB cases by industry is shown in Table 3-2. TABLE 3-2 NUMBER & PREVALENCE OF ACTIVE PTB BY INDUSTRY & ETHNIC GROUP (2000) Industry Black White Coloured Unknown Total N Rate N Rate N Rate N Rate N Rate Gold 282 218.8 8 15 0 00 0 290 157 Coal 10 139 0 0 0 00 0 10 88 Platinum 86 251 000 00 0 86 231 Asbestos 1 53 2 71 3 107 0 0 6 80 Diamond 4 250 0 0 0 0 0 0 4 133 Other 2 105 7 200 2 222 0 0 11 200 Unknown 6 194 1 32 0 0 2 250 9 127 TOTAL 391 218 18 25 5 122 2 250 416 163 Rate per 1000. Denominator: All autopsies in a specific industry for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 12 TABLE 3-3 NUMBER OF ACTIVE PTB BY YEARS OF SERVICE & ETHNIC GROUP (2000) Industry Black White Coloured Unknown Total N Rate N Rate N Rate N Rate N Rate <1 1 100 0 0 0 - 0 0 1 77 1-5 41 200 1 21 1 250 0 0 43 168 6-10 56 191 4 80 0 00 0 60 170 11-15 94 221 1 11 0 00 0 95 183 16-20 58 211 2 25 1 200 0 0 61 170 21-25 34 268 2 26 1 1000 0 0 37 18 26-30 4 114 2 22 0 0 0 0 6 46 31 + 0 0 3 19 1 200 0 0 4 22 Missing 103 253 3 19 1 83.3 2 250 109 185 Total 391 218 18 24 5 122 2 250 416 160 Rate per 1000. Denominator: All autopsies in a specific industry for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 13 SECTION 4 - SILICOSIS Silicotic nodules were found in the lungs in 378 cases (14.5% of all autopsies). 92.9% of these cases came from the gold mining industry. Of all cases of silicosis, occasional silicotic nodules were found in 66.7%, a few in 21.2%, a moderate number in 10.6% and a large number in 1.5%. The age distribution of cases with silicosis (Table 4-1) differed between ethnic groups. No clear trend was evident for increasing age and increasing rates of silicosis in black miners. One explanation is that relatively few older black miners who have retired came to autopsy. TABLE 4-1 NUMBER & PREVALENCE OF SILICOSIS BY AGE & ETHNIC GROUP (2000) Age group 30-39 40-49 50-59 60-69 70-79 80-89 Missing TOTAL Black N Rate 39 66 124 172 71 255 13 325 1 143 2 333 16 250 266 148 White N Rate 00 00 3 34 14 100 36 124 35 194 24 276 112 134 Colo ured N Rate 00 00 00 00 00 00 00 00 Unknown N Rate 00 00 00 00 00 00 00 00 Total N 39 127 85 49 36 26 16 378 Rate 62 156 199 182 184 265 219 145 Rate per 1000. Denominator: All autopsies in specific age group for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 14 The distribution of cases with silicosis by industry and ethnic group is presented in Table 4-2. As indicated previously, cases are categorized according to the industry in which the most years of service occurred. Cases from the platinum mining industry with silicosis might be explained by unstated previous service in gold mines. TABLE 4-2 NUMBER & PREVALENCE OF SILICOSIS BY INDUSTRY & ETHNIC GROUP (2000) Industry Gold Platinum Coal Asbestos Diamond Iscor Other Unknown TOTAL Black N Rate 250 194 7 20 3 40 1 53 00 00 2 83 3 97 266 148 White N Rate 101 183 3 100 2 51 00 00 00 4 77 2 65 112 148 Coloured N Rate 00 00 00 00 00 00 00 00 00 Unknown N Rate 00 00 00 00 00 00 00 00 00 Total N Rate 351 191 10 27 5 44 1 13 00 00 6 71 5 70 378 1451 Rate per 1000. Denominator: All autopsies in a specific industry and ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. TABLE 4-3 NUMBER AND PREVALENCE OF SILICOSIS BY YEARS OF SERVICE & ETHNIC GROUP (2000) Industry Black White Coloured Unknown Total N Rate N Rate N Rate N Rate N Rate <1 1 100 0 0 0 - 0 - 1 77 1-5 6-10 11-15 16-20 16 78 23 78 65 153 61 222 1 21 2 40 7 76 7 89 0 0 0 0 00 00 00 00 - 17 66 - 25 71 - 72 138 - 68 189 21-25 26-30 41 323 12 343 12 154 27 290 0 0 00 00 - 53 257 - 39 300 31 + 7 389 40 255 0 00 - 47 261 Missing 40 98 16 99 0 00 0 56 95 Total 266 148 112 147 0 00 0 378 145 Rate per 1000. Denominator: All autopsies in a specific industry for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 15 SECTION 5 - MASSIVE FIBROSIS, COALWORKER'S PNEUMOCONIOSIS, MIXED DUST FIBROSIS & ASBESTOSIS MASSIVE FIBROSIS There were 15 (0.6%) cases of massive fibrosis (8 black, 7 white) and all were from the gold mining industry and 14 were miners with less than 11 years experience. COAL WORKERS' PNEUMOCONIOSIS There were 9 cases of coal workers' pneumoconiosis with 6/9 in the age group 40-49, younger than those reported in the 1999 survey. MIXED DUST FIBROSIS There were 7 (0.3%) cases of mixed dust fibrosis of whom 5/7 came from the gold mining industry. ASBESTOSIS There were 50 (2.8%) cases of asbestosis of which 66% (n=33) had slight interstitial fibrosis, 28%moderate and 3% marked. Amongst all cases with a history of asbestos exposure, there were only 8 in whom were asbestos plaques found. However the parietal pleura, which is usually the site affected by plaque formation, is hardly ever submitted with the lungs. All of the coloured miners with asbestosis came from asbestos mines as did the majority of blacks and whites with this disease. 16 The distribution of asbestosis by age and ethnic group is shown in Table 5-1. TABLE 5-1 NUMBER & PREVALENCE OF ASBESTOSIS BY AGE AND ETHNIC GROUP (2000) Age group Black White Coloured Total N Rate N Rate N Rate N Rate 40-49 7 10 2 23 0 0 9 11 50-59 6 22 4 29 2 222 12 28 60-69 3 75 9 41 4 400 16 60 70-79 2 286 4 22 2 222 8 41 80-89 2 333 0 0 3 600 5 51 TOTAL 20 11 19 25 11 268 50 19 Rate per 1000. All autopsies in specific age group for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 17 SECTION 6 - EMPHYSEMA There were 429 cases of emphysema, the extent of which was mild in 62.0%, moderate in 32.6% and marked in 5.4%. The distribution of emphysema by age and ethnic group is presented in Table 6-1 and Fig 6-1. TABLE 6-1 NUMBER & PREVALENCE OF EMPHYSEMA BY AGE & ETHNIC GROUP (2000) Age group Black White Coloured Unknown TOTAL N Rate N Rate N Rate N Rate N Rate 20-29 30-39 1 11 16 27 01 32 0 0 -0 -0 - 1 11 - 17 27 40-49 50-59 60-69 70-79 61 85 49 176 12 300 2 286 11 124 43 307 84 384 85 472 02 222 5 500 6 667 0 0 0 0 - 72 89 - 94 220 - 101 376 - 93 475 80-89 90+ 3 500 1 1000 35 402 0- 4 800 1 500 0 0 - 42 429 - 1 125 Missing 8 125 0 -0 -0 - 8 123 TOTAL 152 85 259 340 18 439 0 - 429 165 Rate per 1000. Denominator: All autopsies in specific age group for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. For black and white miners with emphysema, the majority were from the gold mining industry (71.7%) (Table 6-2), whereas most coloureds came from asbestos mines (most autopsies on coloureds were referred from these mines). TABLE 6-2 NUMBER & PREVALENCE OF EMPHYSEMA BY INDUSTRY & ETHNIC GROUP (2000) Industry Black White Coloured TOTAL N Rate N Rate N Rate N Rate Gold Platinum 111 87 196 355.7 14 41 7 233.3 0 0.0 307 166.7 0 - 21 56.3 Coal 13 173 10 256.4 0 - 23 201.8 Asbestos 4 211 7 250.0 15 535.7 26 346.7 Iscor 0 0 6 400.0 0 - 6 375.0 Copper 1 200 6 352.9 3 375.0 10 333.3 Diamond 1 63 6 461.5 0 0.0 7 233.3 Other 4 211 10 285.7 0 0.0 14 254.5 Unknown 4 129 10 322.6 0 0.0 14 197.2 TOTAL 152 85 258 339.9 18 439.0 428 164.2 Rate per 1000. Denominator: All autopsies in a specific industry and ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 18 TABLE 6-3 NUMBER OF EMPHYSEMA BY YEARS OF SERVICE & ETHNIC GROUP (2000) Industry <1 1-5 6-10 11-15 16-20 21-25 26-30 31 + Missing Black N Rate 0 0.0 11 54 16 54 31 73 35 127 15 118 5 143 3 167 36 88 White N Rate 0 0.0 9 192 16 320 33 359 27 342 25 321 28 301 67 427 54 333 Coloured N Rate 000 6 600 1 500 3 600 00 00 3 600 5 417 Unknown N Rate 00000000- 00 Total N Rate 00 20 78 38 107 65 125 65 181 40 194 33 254 73 406 95 161 TOTAL 152 85 259 340 18 439 0 0 429 165 Rate per 1000. Denominator: All autopsies in a specific industry for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 19 SECTION 7 - MESOTHELIOMA The number of cases of mesothelioma in 2000 was 17 compared to 24 in 1999 and 19 in 1998. The majority of cases were whites (n=15; 88.2%) (Table 7-1). TABLE 7-1 NUMBER OF MESOTHELIOMA CASES BY AGE & ETHNIC GROUP (2000) Age Group 30-39 40-49 50-59 60-69 70-79 80-89 TOTAL Black N% 1 100 00 00 00 00 00 1 White N% 00 00 6 40 7 47 17 17 15 Coloured N% 00 1 100 00 00 00 00 1 TOTAL N% 16 16 6 35 7 41 16 16 17 The distribution of mesothelioma by industry and ethnic group is presented in Table 7-2. Cases are categorized according to the industry in which the most years of service occurred. TABLE 7-2 NUMBER OF MESOTHELIOMA CASES BY INDUSTRY & ETHNIC GROUP (2000) Industry Asbestos Coal Copper Gold Other Unknown TOTAL Black N% 00 00 00 1 100 00 00 1 White N% 6 40 17 00 4 27 17 3 20 15 Coloured N% 00 00 1 100 00 00 00 1 TOTAL N% 6 35 16 16 5 29 16 3 18 17 *2 February 2006. In an earlier print run of this report, the total number of mesothelioma cases was given as 14. Changes have been made to the text and tables. 20 SECTION 8 - PRIMARY LUNG CANCER 69 cases of primary lung cancer were found at autopsy of which 18.8% were in black miners, 73.9% in whites and 7.3% in coloured miners. Most of the cases were of the squamous cell type (28%), followed by large cell type (23%), adenocarcinoma (22%), small cell type (22%), and bronchoalveolar carcinoma (6%). The distribution of primary lung cancer by age and ethnic group is presented in Table 8-1 and Fig 8-1. Black miners were in the age group 40-49 whereas the highest proportion of whites were 60-69 years old. TABLE 8-1 Age group 40-49 50-59 60-69 70-79 80-89 Missing NUMBER AND PREVALENCE OF PRIMARY LUNG CANCER BY AGE & ETHNIC GROUP (2000) Black White Coloured N Rate N Rate N Rate 7 10 1 11 0 0 2 7 6 43 1 111 2 50 27 93 2 200 1 43 10 56 1 111 00 1 16 7 81 00 1 200 0- TOTAL N Rate 8 10 9 21 31 115 12 61 8 82 1 14 TOTAL 13 7 51 7 5 122 69 26 Rate per 1000. Denominator: all autopsies in specific age group for specific ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. The distribution of primary lung cancer by industry and ethnic group is presented in Table 8 2. For black and white miners, the majority of cases came from the gold mining. For coloured miners, most cases were from the asbestos industry, which referred the majority of autopsies of coloured miners (68.3%; Table 2.4). 21 TABLE 8-2 NUMBER AND PREVALENCE PRIMARY LUNG CANCER BY INDUSTRY & ETHNIC GROUP (2000) Industry Black White Coloured TOTAL N Rate N Rate N Rate N Rate Gold 5 4 38 69 0 0 43 23 Coal 1 13 1 26 0 - 2 18 Asbestos 0 0 3 107 4 142.9 7 93 Platinum 3 9 1 33 0 - 4 11 Copper 0 0 1 59 1 125 2 67 Diamond 1 63 0 0 0 0 1 33 Iscor 0 0 1 67 0 - 1 63 Other 1 53 5 143 0 0 6 109 Unknown 2 65 1 32 0 0 3 42 TOTAL 13 7 51 67 5 122 69 27 Rate per 1000. Denominator: all autopsies in specific industry and ethnic group. Where there are a small number of cases in the denominator these rates may not be reliable. 22 SECTION 9 - CLINICAL CAUSES OF DEATH Table 9-1 & Figure 9-1 shows the clinical cause of death submitted by the doctors, which accompanied the cardiorespiratory organs by ethnic group. Diseases of the respiratory system were the most frequent (54.7%) which has increased from 50.9% (1998) to 57.6% (1999) to 63.5% (2000) in black miners. Black miners had the highest proportion of unnatural causes of death (16.5%). In 16.9% the cause of death was not stated. TABLE 9-1 CLINICALCAUSES OF DEATH BY ETHNIC GROUP (2000) Respiratory Unnatural Not stated Cardiovascular Miscellaneous Nervous system GI tract Genito urinary Haematological Metabolic TOTAL Black N% 1141 64.5 297 16.5 137 7.6 38 2.1 47 2.6 64 3.6 48 2.7 12 0.7 11 0.6 2 0.1 1797 100.0 White N% 254 33.4 48 6.3 291 38.2 92 12.1 40 5.3 5 0.7 21 2.8 8 1.1 1 0.1 1 0.1 761 100.1 Coloured N% 29 70.7 2 4.9 6 14.6 3 7.3 0 0.0 1 2.4 0 0.0 0 0.0 0 0.0 0 0.0 41 99.9 Unknown N% 1 12.5 0 0.0 7 87.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 8 100.0 TOTAL N% 1425 54.7 347 13.3 441 16.9 133 5.1 87 3.3 70 2.7 69 2.7 20 0.8 12 0.5 3 0.1 2607 100.1 FIG 9-1 CAUSE OF DEATH AS GIVEN BY THE CLINICIANS WHO SUBMIT THE ORGANS TO THE NCOH AS SHOWN IN TABLE 9-1 Black 23 DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE WHERE THE DECEASED WORKED MINETYPE LAST MINE WORKED AT Asbestos African Chrysotile Asbestos Asbestos Mine Aucampsrus Asbestos Mine Cape Blue Danielskuil Asb Mine Dublin Asbestos Mine Elandsfontein Asbestos Mine Enkellewiller Asbestos Mine Everite Gefco Glen Allen Asbestos Mine Kliphuis Koegas Noupoort Asbestos Mine Penge Asbestos Pomfret Asb Mine Stella Asbestos Mine Total from asbestos mines Cementation Cementation Ulco Cement Chrome Chrome Mine Montrose Chrome Mine Rustenburg Chrome Swartkop Chrome Tweefontein Western Chrome Mine Winterveld Chrome Total from chrome mines Coal Alpha Anthracite Colliery Arnot Colliery Bank Colliery Black Wattle Colliery Blesbok Colliery Blinkpan Colliery Bosjesspruit Colliery Brandspruit Colliery Delmas Colliery Dorstfontein colliery Douglas Colliery Driehoek Collieries Duiker Colliery Durban Navigation Colliery Goedehoop Colliery Greenside Colliery Grootgeluk Khutala Colliery Kleinkopje Colliery Kriel Colliery Landau Colliery Matla Coal New Denmark New Vaal Colliery BLACK 0 3 0 1 0 0 0 0 0 8 0 0 3 0 1 2 0 0 1 0 2 0 0 0 0 0 0 2 5 0 0 0 4 3 0 1 0 0 2 1 7 2 1 1 1 6 1 4 1 1 WHITE 1 2 0 2 2 1 0 0 2 0 0 1 3 0 4 1 1 2 0 1 2 1 1 1 1 1 1 0 2 1 1 2 1 1 2 0 1 1 0 0 2 2 0 0 0 0 0 3 3 0 COLOURED 0 0 1 4 1 0 1 1 0 3 1 2 9 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 UN KNOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 1 5 1 7 3 1 1 1 2 11 1 3 15 2 5 3 1 63 2 1 1 4 1 1 1 1 1 10 1 2 7 1 1 2 5 4 2 1 1 1 2 1 9 4 1 1 1 6 1 7 4 1 24 Newcastle Coal Mine Richardsbay Coal Mine Rietspruit Colliery S A Coal Estates Sasol Coal Mine Savemore Colliery Secunda Colliery Sigma Colliery Spingfield Colliery Strathrae Collieries Tavistok Colliery Transvaal Navigation Colliery Twistdraai Usutu Colliery Van Dyk's Drift Vlaklaagte coal mine Vryheid Coronation Welgedacht Witbank Collieries Total from coal mines Copper Bamangwato Copper Mine Copper Mine Messina Copper Mine O'Kiep Copper Phalaborwa Prieska Tsumeb Copper Mine Total from copper mines Diamond Bellsbank Diamond Mine Bobbejaan Diamond Mine Cullinan Diamond Mine Dancarl Diamond Mine Diamond Mine Loraine Messina Diamond Mine Premier Diamond Sonneberg Diamond Mine Total from diamond mines Gold Anglogold Health Serv (Free State) Ardo Holdings Gold Mine Balmoral Gold Mine Bambanani GM Beatrix Gold Beisa GM Blyvoorquizicht Bracken Mines Brakpan Gold Mine Buffelsfontein Gold Carletonville GM City Deep Consolidated Main Reef Crown Mines Daggasfontein Deelkraal Doornfontein Durban Roodepoort Deep 02 01 01 12 11 4 60 11 0 03 12 11 11 01 31 01 01 01 02 01 11 10 00 01 06 42 03 02 21 01 12 20 20 23 10 76 01 11 01 01 30 43 3 10 1 15 03 22 24 19 01 05 01 16 02 17 3 0 13 58 0 02 0 01 0 01 0 03 0 0 15 0 06 0 0 11 0 03 0 03 0 02 0 02 0 01 0 04 0 01 0 01 0 01 0 02 0 01 0 02 128 0 01 1 01 0 01 6 0 12 0 06 2 05 0 02 28 0 03 0 01 0 03 0 02 0 02 0 05 0 01 1 0 14 0 01 32 0 02 0 01 0 01 0 03 0 0 46 0 01 0 0 16 0 03 0 04 0 0 43 0 01 0 05 0 01 0 07 0 02 0 0 20 0 0 13 0 0 13 25 East Driefontein East Geduld East Rand Prop Elandsrand Ellaton GM Elsburq GM Evander GM Freddies Gold Free State Geduld Free State Saaiplaas Future Gold Mine Gold mine Goldfields Grootvlei Prop Harmony Hartebeesfontein Heidelberg Gold Mine J.I.C. Gold Mine Joel Kalahari Goldridge mine Kinross Kloof Kopanang Gold Mine Leeudoorn Leslie Libanon Loraine Luipaardsvlei Estate GM Mali Gold Mine Marievale Masimong Gold Mine Matjabeng GM Modderfontein Motlhobeng GM New Consort New Kleinfontein GM Oryx Placerdome GM President Brand President Steyn Primrose GM Rand Leases Randfontein Rand Refinery Robinson Gold Mine S A Land Saaiplaas GM SAMAT GM Sheba Skeat Gold Mine Springs GM St Helena State GM Steelpoort Stilfontein Sub Nigel Tshepone GM Unisel GM 52 12 02 2 14 30 5 01 01 53 4 35 5 7 15 85 01 10 21 2 10 110 22 56 23 01 14 0 10 3 10 84 55 20 10 29 6 03 46 11 59 01 01 03 11 0 90 01 01 01 01 31 0 10 4 11 42 16 01 03 20 18 01 01 01 12 01 02 01 02 33 8 01 01 0 18 01 20 21 0 0 64 0 02 0 0 16 0 0 35 0 01 0 01 0 0 57 0 0 40 0 0 22 0 0 13 0 01 0 01 0 03 0 0 12 0 0 132 0 0 79 0 01 0 0 14 0 0 13 0 01 0 0 12 0 0 75 0 01 0 0 35 0 03 0 0 57 0 0 14 0 01 0 01 0 03 0 0 11 0 09 0 01 0 01 0 01 0 01 0 0 31 0 01 0 0 15 0 0 58 0 01 0 03 1 0 39 0 01 0 01 0 01 0 03 0 01 0 02 0 01 0 02 0 0 41 0 01 0 01 0 0 18 0 01 0 02 0 03 26 Vaal Reefs Ventersport Villaqe Main Reef Virqinia GM Vlakfontein Welkom GM West Driefontein West Rand Consolidation West Witwatersrand Western Areas Western Deep Levels Western Holdings Western Smelters Winkelhaak Total from gold mines Platinum Amadelbult Platinum (Rustenburg) Atok Platinum Eastern Platinum Mine Helam Platinum mine Impala Platinum Lebowa Platinum Mine Messina Platinum Mine Northam Platinum Rustenburg Platinum Swartklip Platinum Western Platinum Wildebeestfontein Zondereinde Platinum Mine Total from platinum mines Iron Sishen Iron Mine Thabazimbi Iron Mine Total from iron mines Iron & Associated Manganese Manganese Lead & Blackmountain Minerals Lime Union Lime Manganese S A Manganese Manganese mine Minerals Non Mineral African Rainbow Minerals & Expl Anglo power Industry Non Miner Spoornet Total from non-mineral Quarries Hippo Quarries Marikana Granite Petsa Quarries Van Dyk Total from quarries Shaft Shaft Sinkers Sinkers Silica Silicon Smelters Steel Highveld Steel and Vanadium 267 0 0 2 0 6 47 0 4 12 70 47 0 2 21 12 5 0 102 3 0 7 192 1 3 1 11 0 0 3 0 0 2 2 25 0 2 1 0 0 1 0 0 2 4 1 41 9 1 2 3 5 24 6 1 24 27 10 1 2 0 2 0 1 15 1 1 1 23 0 4 0 0 2 3 5 1 1 5 0 0 1 2 3 2 1 0 1 1 0 2 0 0 0 308 0 09 1 02 0 04 0 03 0 0 11 0 0 71 0 06 0 05 0 0 36 0 0 97 0 0 57 0 01 0 04 1757 0 0 21 0 0 14 0 05 0 01 0 0 117 0 04 0 01 0 08 0 0 215 0 01 0 07 0 01 0 0 11 406 0 02 0 03 5 0 08 0 01 0 01 0 07 0 02 0 0 25 0 01 0 04 0 04 0 02 11 0 01 0 01 0 01 0 01 4 0 02 0 06 0 01 27 Steel & Iron Vanadium Vanadium Zinc Unknown TOTALS Middelburg Steel and Alloys Iscor 01 3 25 Rand Carbide Vanadium Mine Zinc Corporation Unknown 0 1 32 1798 1 0 28 761 0 01 1 0 29 0 01 0 01 2 8 70 41 8 2608 28