Document MMBMoLEO7nxem9k6x67266zgj

EPIDEMIOLOCICAL STUDY OF VINYL CHLORIDE WORKERS Final Report Hay 3, 1974 *4- , . tv,, . . 7;>-' ,Submitted to jrf^s, , ^ V' ~ The Manufacturing Chemists Association 1825 Connecticut Avenue N. W. Washington, D. C. 20009 1fegv by Tabershaw/Coopcr Associates, Inc. 2180 Mllvia Street Berkeley, California 94704 R&S 020730 jy The research which fern*; the hauls for this ri-p'irt ***:; siij>]ior; (, '! hy tlic voluntary cent r 1 hut I on;; of the f nJ Jowl named rhcvi! i a1 t erip.in i < S enj'.if*,,,,J in ihe Gynthesls and/or the pot yir.er I /.at Ion of vinyl rhlnrld , mv! administered in their lx li.-iI i hy the tiainif net ur 1 Cl.ir.lsLs in! lest Air Products Chemicals, Into: porn''.J All Jed Chemical Corporation Borden Chemical Division Continental Oil Company Di amond Shamrock Company The1 Dow Chemical Company Ktliyl Corporation Fxxon Chemical Company Firestone Plastics Company B. F. Goodr ich Chemical Company The Goodyear Tire and Rubber Corpora* Monsanto Company Olin Corporation ` `Shell Chemical Company I I 1 *t - ` Stauffer Chemical Company Tenneco Chemicals, Incorporated Union Carbide Corporation * UHIROYAh, Incorporated '---tlT-*- table or c:o::ii-:;ir, SECTION I. Summary II. Introduce ion III. Selection of Study Plants IV. Data Collection V. The Measurement of Exposure VI. Follow-up of Study Population VII. Description of Study Population VIII. Calculation of Risk of Death IX. Analysis X. Discussion XI. Possible Biases in the Calculation of P i sk Pape 1 2 3 4 5 6 7 * 11 13 13 REFERENCES 17 LIST OF TABLES 1. Follow-up Status of 8384 Vinyl Chloride Workers 2. Distribution of Months in Exposed Fn.pl nyrv-nt by Birth Year, for 7128 Vinyl Chloride Workers with Completed Folio v-up 3. Distribution of Months In Exposed Employment by Year in Which Exposure Iicpnn, for 7128 Vinyl Chloride Workers with. Completed Follow-up 4. Distribution by Monties of Exposed Employment and T ime We i j;ht ed Avernpe Exposure Score, for 7128 Vinyl Chloride Workers with. Complete Follow-up 5. Person Years of Observation by Year of Birth and Ape for Vinyl Chloride Workers 6. Observed Peat lis/Expeetod Deaths and Standardired Mortality Patios in Vinyl Chloride Workers R&S 020732 R&S 020733 7. Ohset'"/(I I>. at I.s /1 .per1 < d D> .i' Is ,and St andai d :.M d Vert a] 1 ! V Ratio;; i n Vinyl Chloride L'ur; rs . by hr.: ii;.. * ia! L.-vel of oso:r<* 8. ObsiTv* d n. at hs /I':;-- f d !)i at .-.is! Stasd.M dire ' :wi al ! t v D.at 1 O' in Vinyl Cbiui 1 (!.' '..'ol'J'ef s by Dor.at it. :1 o! : ,..;.os< d I 9. Observed Deal !.. /Dope, ted D.at .and St an !.;: !!.'. d "ori.-il! ty D.at 1 o Vinyl Chloride '..'orl'ers w ith I V sum Indices he If; 1 .a. 1-y Dur ;i: of Expos ed Jh `.;i 1 cyr t nt 10. Observed Peaths /Iw-peetcd Deaths at.! Standard! ;s ! Mar' a3 i ty D.at i c Vinyl Ch 1 or!de V'orht r s w ith I y.po su re Indites of 1 .3 or CGreater * by Duration of K.'tposed I":r.plc-. L 11. D1 Kt r i hr. L i o n o f la aths b v i;::* L O !' 11 r afi r,.irand ;... y. . . ..r Cat! of Dent,h '.'as Do temined , and Cor ;`es t icn has tor- ; I'sed for. Calculi'll. Ions 12. Results of Follow -up in Several Ot eupat i ona I Croups 13. Angiosarcoma Dent hs i n VCM lip i .de:;;i o 1 vyy a t ud y Population 14. Other Ha] 1 f;nanc i e s (190-199, T .C .D.) in VCM Dp ! P.er. i ol cp.y ft udy Dopulntion 15. Malip.nnr, t St'op] a as of Buccal Cnvitv and Dharynr. (1 0 -1 'p , I.C.D.J in VCM Dp ideriolo yy Study 1`optil.'it!on. FIGURE 1, Flow Chart of Follow-up Procedure ATTACH.ML.MTS A. Flant Contact Form B. riant BncLp.round Form C. Job History Form D. Follow-up l.etttr l > -It. } , < l ' yas;-r ': : ;r >'< w Ki'inuiioU'Mr.M. r.iir.v or vi:;vi. Pinal deport - May 2, I9/4 I. NUMMAHV K1 iU thousand throe I undr'-d and * iti.y four '-h'. had ad at i' -i' t one year of occupat Jonal exposure to vinyl chloride tef/>je I>*-c. r !I, 197?., wore followed In a hisLor 1 cal prosper Live mortal ! ty study. The major findings, of the study are: 1. The overall mortality of the study population warapproximately 79 percent of what we'.Id he expectt d in a comparable population of N . K. male-,, 2. No cause of death, s,bowed a statisti/al1y x; ;;r I f i ear.t excess over what would be expecte! i:'. a eorp sra1 o U. N. male population. 3. No new deaths identified as an;; iosa rror a of tin. liver were found. 4. All previously known Aiujicrarccrvi iii.itin: in two teey population durlnj; the study period were found as part of the routine study procedure. 5. Cancers of the liver (primarily ar.p.iosarcora) , respiratory system, brain, and cancers of unknown prir.aty rite, as well as lymphosarcoma, occurred more often than expected in those members of the study population with the greatest exposure. liven thoup.h the excesses were not xtat:si 1 si 1 y significant, the findings warrant forth.-r -'indy. 0. Other cancers occurred at lower leve ls ts.iu in the p.< otai male population, with the exception ot cancers cf the buccal cavity and pharynx. There wax an of the:;*' R&S 020734 1 *1>- . ' R&S 020735 cancers, wbi<!> r was i nvir-.'l y !< Ial`d ! <' e/ju:,ure. The explanation for L111 r: I 1nd J up. Is not ippui'Ui . IJt* INTI'OMT.TIn;: The study was bep.uu by Tala rshnwAloopir , i.im l.ii In.e. or, June 15, 1 `J 7 3 , unde i* ecu', rat 1 from th>- liantiiai t ur iC: :. i: L: < la: Ion. The original ei;;ht month period of Lho contract war. Kuc: extended. !,y two months, In consideration of lop.i sLlcal problin.:; ar 1 u i a;; Iron the number of plants which, pr.rlici] ..ted In the study. The objective', of the study are: (1) To compare the mortality cf individuals vh'i have worked. in vinyl chloride plants with that of the p.cuer.il ;epu1 at 3 on; (2) To compare nertaifty patterns within the population oi vinyl chloride workers, based upon estimated occupm i o:w. 1 exposure; an: (3) To compare mortality ar.onp, vinyl cliloride v or hers with, the mor tality of othci groups wb.ich T(`A, Inc. liar stud.ied. The study tool', ike form of a historical prospect 5v.- mortality study. The study population consisted of individuals who had '.orbed for at least one year in a joh involving exposure to vinyl chloride before Decim.ker 31, I'*'h and included retired and terminated as well as active workers, lor each, such worker the date of birth and an employment histleovryy vweirret cohbitna;ined, and. the vital status of the worker as of December 31, 11997722, was aassecnertained. Per those found to have died, those death certifica.'itLesli thaatt wceere available were obtained and the cause of death determinerdj .. The cc;lba:..<, rvvei d mortal 1 ty was compared with that of the United States rale population. >&aa.*wiSv " ' &: in. si:n;cTin:: r irn iiv n,vnj^ The llanuf art u: Ifiber: 1 st s Assoc 1 at. Ion ld--r.: II 1. d Unite! .t *:; plant:; belong 1 np to 19 conpan 1os, which either ptedu' vinyl thlwrlde or lined It In the production of polyvinyl chloride. 'Ib*1 .n:d ,<dd:i-.',-. of a responsible liaises person nt cadi cor.pany and pi.on was provided to TCA, Tnc. (At toolin' nt A). A brief questionnaire wa.'; sent to each plan: Lo oltuin nr. <-:;t inat<: of the exposed population and to find out ho., far in t w.e ; run"'.''! records could be obtained, and to determine ..hetl.ir job i s 11 r i es '-a :u available for ret. ired a nd 'e r.v.inat.( d vorh (. !`S (At tac: ".i n*. b). All the plants res ponds d . On tils ha >:i r, ot the vepl ies, four plan. were dropped f rcrt the s te.dv lecaus c they had te;;un cps lion after 19( It was felt that expose. res i n such plants: v;c uld hi toe r r> nt and t oo brief to prov1 it:c useful d a t a . f.u: dy of c'iio other plant was deferred b cause It had KtOJiped pr oduc t ion of vinyl chloride ,:ev`r. years. njpo, and appeared to present d i f f icul t i m; in ident lfyinp. as-exposed population. In addition, three r.oro plants were excluded fro:.: analysis because, when data analysis bep.an, It- was found that 1 r.fc:: .at: m f rev. these plas.ts was defective i:i one of several respects no exposure data, no job histories available for tenr.Innti d employees, etc.). The present report therefore deals with 35 dcr.estic plants involved In either VC" or I'VC produel ion, which provided a stud;. ;opulntion o: 838** individuals. 9e*O do S'.'.riSf " 1 :-: * IV . DA I A COI .ITlVI Di:: In each p];mt , data w.-i collected lor * .t *: 11 '.;ui D:' Mat'd by 1 ! i * planL wnuaper.enL to have }>*` :i e.uployet! for at 3*i:L ou> voar in a job involving exposure Lo vinyl chloride, In none plants, p.'. r t i i u 1 nr 1 y those producln;; the munor.ei , this detcrminat. I on could hi <>n the basis oi Job titles. Usually, hovc/cr , exposure was a fund ion of both Job title and Lilt location of the job in the plant, no that t bo assessment of exposure bad to ho made on a ca.sr-hy-casc ban!:: by plant officials. Data were collected for ns far back in t Ir" ns u'l-.j.lftc record:. were kept. In iiio.SC cases this covered tl'.e entire history of t l.c plant:, in others, records wore kept for a fixed period such ns n decade. In a few, records were kept for different periods., depend inp, on wi.ether the worker had died on the* job or had left employment . In the latter case it v.'ns necessary to exercise care in defininp Lite period for which study data were to be collected. I" or example, if a plant kept records for five years or. those who left employs,er.t , hut kept them, indefinitely for those who died on the job, no terw.ir.nt ion could be in cluded in the study unless it occurred within the last five years. Data from th.e earlier period would be biased for the purpose of Lhis study, since a worker had to die to be in the records for the earlier period. The policy therefore was to determine how Ion;: each, kind of record was kept (cpiit, discharged, retired and alive, retired and deceased, died while employed) and to define the study period as [): shortest of those. One problem which arose in the l'Vli plants result .-d free: the fact that a worker could, transfer within the plant from exposed to non-* xposed jobs. Therefore, even tiiouph the number of work* rs in expots d jobs at a piven * O Z q* fib CO iSto;-- hX. '*'&* >' ttetm***' -? L\:m . '' - v" <>, ' * j&f-. ;a1! i is opor L ion of l be to 1 .1 1` V'M *i 1 (It ( e , it was ry worker's re<r.ord to ! J t:d t bos* who I'll till I in t ho sir ' i; expel' i enci- in e>: ;*,f: ed Jobs. ;'.i vi r.i 1 ol the ( coir [net this :!.(. irch Lit* e 1 V< ' . : datei were col. 1 ectt-d in two v.iy In so:,i pi acts. cd tl ic estahl i simient. ('O p i * d i records i! V * i i* I - '"l * :ont i: exposed workir and obi. list.'1 sufficiently eit es to produce a job hi st cry. in others,( L h vi TCA,, Inc. wit b star.-! el I t] fotv.r, i..hJch they f iiJi-a out for workers '..'her they identiiisd as exposed. Three basic forms were used, depending or. whether the worker was known to be alive, know;', to be dead, or was of unknown status. In all three cases a wcr.- hi story with estimated exposure was recorded, the dii ferencer. Kir,'. it' the ancillary data required . Attachment C shows .such a form for workers known to he dead. Approximately 5000 of the study population can?- from plants visited by TCA, Inc., while the remainder came from, plants which has filleu out the forms themselves. v. thk Mr.Asrnr:'.r.::T ok ri.posi'Ki: The job history forms (Attachment C) were oripir.nl ly designed in the expectation that vinyl chloride exposure on each job could be quantified in parts per million. This proved generally to be impossible. However, industrial hycio.no and safety personnel in each plant were able to identity certain Jobs and locations as involvir-c the hi chest exposure:; in the plant, and to classify other exposures as medium or lew relative to the "jiip.h" represent'd by the Jobe. with, the preatest exposure. Therefore, the attempt R&S 020738 ywuu g^.iwsB 'A .Z%Zr mjn wr u y ~ riim Tt^MliiT R&S 020739 Lu obtain objective fxpfieui e data '..'.if. nbandoif-d , .if! .e h exjiisf! ]>>h In the worker's history vas ncorn! 1, 2, or 'i t'j led lent'- I red Iw*. or high cot lw.itft! CXpOMII <. Til 1 ir gror::. class i Meat Ion ha.1, two major ! a 1 1 ! i:;,-. , a-; a result of the subjective nature of the est fnates. The firr.t is that tin 'ft ore;; represent estimated relative exposure within a given plant. It is therefore ; os s!h! e that, in objective terr.is, a "high" score in one plantcer re-ponds to a "medium" or oven "!ov" score in another. The secon ! i *. that exposure-: in most plants; have tended to decrease over time, so that a worker with lor.;-, service way have had jobs in the remote pant which involved "lo;.1" exposure relative to other jobs at chat time, but whLch ir.in'nt b>- "hirh" in c os-par i so:. wiLh current exposures in the same job. This subjective classification Sr. therefore of questionable validity in character i:: ing the ixjosure of a given worker. For epidemiological purposes, however, these- who rave high scores can reasonably he expected, on the average, to have had the j;rent*-r.t exposure, while those with low scores will have linJ the lear-t , even thong:: the true exposure in each group way vary considerably from person to person. The estimated exposure'hi story of each worker was summarired ly calculat ing An Exposure Index (111). This was done by mil t iplyinj-, the number o: month: on each job by the exposure score, totalling these overall exposed Jons, and dividing by the tota' number of months of exposure. VI Fui.i.oiMip of s'ithy rni'ui.ATio:: A follow-up procedure was instituted for there who h.i ! left er.:j>!oya.i nt and whose vital status could not he determined at the local plant. A portion of tile terminal Jons was traced by mail, using a foi::. litter sent to the last R&S 020740 I - 'M . - - , ohm*?. fa ' 1 -7- 1' -diov; :m h a 1 < : t > : . I f :f ! * !i : f - r v\ \ t bi' prooi-.biro r>!.< './n ! ii !ire,. ] V,. M 1! '.It! I 1* obtain ;i current -mi!*ii ess. 11 : ! r. i t I s:e ./1 " L r.i' 1 d 'hr - ., ' i r * : .1: i Hi- so done ( or a pa: t ! a. of : >.o * f M-lH iU-t be found by ilir fci1oe.-.-eupp. Approx lr"..li !y 'jV ' o ti.i: Study po; ul at n !.. : * . j t.. direct tr.a i 1 folio1./ up vm; ilr.y> d . In t !.' : < r i , J follor.'-ups './as ly retail i ld i t b11re.ie , :a : apul a 1. ; ,, 4, t c : . . . s- ,1 f ffiif.Mlri! hi n ! !n' *: IT rets rati1: of the f. > al status cf i :.* Mu!;y i: m ` ' i of '*. c- cent complete, altheu, :h fol 1 . -up d.i still beinp, iidivi-u at le Line the files vifi rli's.d Mr Li. i ,o be dead, di .it h isrl ; f i i ...t! ha a 1 for all but 24. it ions In tb.e si/.u.;!; up St!* t foil: <`1 ll.is r. \ >rl;orti who '-/ere succo.. sfu!1v i:vr* t; , \:h\i-h ii equivalent to assuninp, tlaiL mortality .ur.t>::those not four.-! is the sore ns anon;' those i.i-.o t/cro found. In order to examine thi1 ro. or.ahl./at : r, cl this assur.-.ption, tlic d i f f orences bet'./eur. those found and cm. found art examined briefly ns part of the fol 1 ot/i r.;; section. vi1. PKScuii'Tiu:: nr r.i i:i-v iT.pn.ATm:: Table 2 shovs the distribution of those men u 1 ! y trased, by y>. ar of birth and tuirber i' months of exposure. Th. Median birth yeat `-/is !`01 (conpared with. l'.'dO for those not four.J) an.! the t-sian deration of erploy- ir.ent in an exposed job vae months mouths in those r -t fo'-r. !,>. '1 he 1 *NT*t**-'*-i' ; v, " ' >V ' \a: *r*^' * -- R&S 020741 shortest exposure;; orcir !n both the oldest :-,i a, no:.* o' .! os. voi i.! r.g life was over when vinyl chloride cane Into ;/r.era! .i:i'I the youngest non, whose date of hire was closer to the closing dale of the study. Although nearly half of the study population lad !>-:; than f.O costas of exposed e"iployi.;<-nt , there were nevorthel ess 5J55 vori r:: ,..,ith ?f) yeas:, or core exposure, and 16M with 15 years or more. Table 3 shows the distribution by dur In which exposure began. The medlar. year (versus 1953 for those not found) . Notice r f o and tie.- ye;ir i.i <omi: c began vnr. IW ;;L .i It;cw l ,.i! f the si u ,*u/. population first entered exposed employment inV. 1thhee <d.<! cca id<:** '' 1' '9)<*'0f--0999., " i. 1 s reflects the fact that a great many plants first began vinyl chloride operations in thaL decade and wear.:; Lb.at tb.ee,e verbere haw- net been ollowed for any substantial length of tine after their :.p''surs- occurred. Table 4 shows the* relationship between dur.it ion of exposure and Exposure Index (El). The median El is 1.4- (1.75 for thti.se not four.u) . There does not appear to be a close relationship betas on the El and the duration of exposure, that is, workers with a higher it do not differ substantially in duration of exposure from those with a lover El. One implication is that in assessing the relationship between mortality and exposure, both duration and level of exposure should he examined separate ly, as well a in combination. The data shown above for those not found indicates that they were born (and began their exposure) about 10 years beiore the group on which follow-up was complete, and had about half the duration of (nployrs-nt with a slightly higher El. Typically, their mploys:... nt in an expo s : job ended before 1900. The bulb, of those workers earn- from elder plants fro:: -9 R&S 020742 vhich data ViTi collected late In the stmly. Althouph ll,. re ;ij ; < ns to be nuthl up vi ry *11: 11 .do st this ; l oep In terms of work history mil! o/.po:.tnc, it Is iiivci ' i l.-.-. t i n.- th.it t!,.-! r exposures Lock plan < further back In t I:, i: than tbs: o! ! in s-.n e e..s- fill ly traced. It is therefore pc slide that th'ir i.oii.j].'.,t y , a f t < r a subs tnnti.-:1 latent period, mipht show a sor.-vhil dlff-rert patttin of mortality from the traced proup. vni. cai.cit.at;o:: or ;:i;:r or miAiii The usual method of d.eserihi::;; t he risk of death in a study of this kind is to express the number of deaths vhich actually c-'erred as a perc.oncape of the nurdier whi'-h would have K i:: ev-pt-ts in a compar.il-l e male population observed over the su::.o ape and time 1 r.t. rva 1 s . This statistic is called tb.c Standard i ted Tonality !'at to O'!"). In order to calculate the number of exp-emd dea: h-; it is first necessary to calculate the number of years for vhich each v.-orkcr vs: observed, and tc classify those years of cb: vr-at i on ly the ape ir.lt rva! s into which they fell and the birth tint* of the vork.er , Table 5 shows such a calculation fer the 7128 vinyl chloride workers on whom follow-up was complete. Tit it: proup represent;. 77, f:-'.6 pi rsor.-yc ars of observation. For example, the table shows that for worker:, her:'. In the years 1925-29, there were 2725 person-years of observation in the ape interval '10-34, ant! an easy calculation shows that th.-se pi.rson-ye.irs were lived in a period whose midpoint was about 19A0. Therefore, the number of deaths to be expected in this cell o! the table is the nr.:,her of deatht occtirrir.p in 1940 ,r-'or.p 272.') males aped 30-.i4 in a eor.p.irehlc r.c r.-et.po-. d population. ; -r sirjjttar*- -10- 111 tlw pre.'.'-nt study the l'. S. ri.i 1 popu! .11 I on -.n-: <r id .1:. lImStandard of comparison, ;m<! the age-spec i f it I', V.. rmli- *!*-** ii r-'i t :t for the appropriate ages and years were applied to t!:- cor1 <-:,j!:t;r.olls of Table 5 to obtain the expected death:..' 'Ibi:: was done for .ill Causes of dentil together, and for each of Lh'- 35 cause;: f"r which detailed mortality rates are published 0:1 a national basis (emitting mk-!i causes as breast cancer, congenital malformation:;, and disease--. o! Infancy). Table 6 shove observed and expected deaths, and the i`"K , for each of these causer, for the total study group. In cal cul at in;; the fil'K's for specific causer, the 24 deaths for which, no certificates '..-ere found were assumed to have the same cause distribution as those for which certificates were available. In the standard population, each SMit would be ecjual to 100, Therefore, the statistical significance of the deviation of each SiiR in the study population from, the expected value of 100 '..as tested. A single ar.L.-r indicates those SMR's which differed significantly frer: 100 at the 5 percent level, that is, which had a probability of .05 or less of occurring by chance. A double asterisk indicates those which were significant at the 1 percent level. EMU's based on fewer than 5 observed 2 cases were not tested for significance. The practical interpretation cf these statistical statements will be examined below. R&S 020743 Mach diagonal in Table 5 corresponds to experience cent*rid around a given year. For the first throe diagonals (fro: left to ricb.f) 193'M rates were used.; for the next three, 1955, 1 959 and 1905 rate-; -.vie used; for the last two, 1967 rates were used. 2 Largo-sample tests of significance were derived fret.: Chinn:-,, C. I.., "Standard, error of the ago-ndjusted death, rate," Vital S! at i -t i ( :. Special Kororts. 47 (10M) ,,p 275-283. -] J Table 7 .':Iiov:. the same SMS's fui vor! i r;; will, an i : p-isere Indix below 1.5 versus those -at. 1.5 or above. The ! iv Id I:;,; point o! 1.5 represents a level halfway between "low" a a-! "r-<! i u: . " Table 8 shows similar results for vorlerr with h-,:, than 5 years exposure versus those with 5 years or more. In order to examine the possible interaction between duration and level of exposure, the study population was divided into 4 groups on Lite basis of both hi. (low vs hlph) and (juration of exposure (short vs long) usinp the same d ichotoir.iration as Tables 7 and 8. Table 9 shows the results for short versa;: lor.;-, exposure in the low El group, and Table 10 shows the same comparison in the high hi proa;;. In each of the above tables, deaths for which certificates had r.uL been received were assumed to he distributed as a uni for;; perrent apt- cf all causes. The cause specific SMR's were therefore adjusted upward by n percentage which varied in each subgroup. Table II shows the distri bution of uncertified deaths in each proup, and the resulting percentage by which the cause specific SMR's were increased. IX. ANALYSIS The overall mortality of the study population is statistically significantly lower than that of the. U. S. male population. There were 352 observed deaths compared with 467 expected, for an SMR of 75. Table 6 show;; that no specific cause of death was statistically signi ficantly preater than expected. Several, particularly heart disease, accidents and "other diseases" not detailed in the tables, were sip:; ifleant!; below their expected values. R&S 020744 ft# ** ' \; \3% (. - niit*n /' -12- wi.cn the study {.oj-tj 1 at Inn !;; <! I v !!*! ,i> ' it.! !liepih and ilm.ii hn. of exposure (Tables 7 and 8) and comb J n:i 11 os'. of these r ensure: (Tables 9 and 10) tbtee major pattern;: emerge. For malignant mo;-! as a whole, the S"!1 inci * .w* : w!ih increasing exposure, whether measured by level, duration, or Loll.. In the hi;;h ex posure group with 5 year:; or more exposure (Table 10) tin re are V> observed cases and 26.11 expected. For cardiovascular - renal, disease;; as a group, there are also incron: t-, In the SI IK with, i no rear, in;; exposure, but the number of c:served can:, ic'.ain less than expected, the differences being statistically sip.r.ifleant in. all groups except the high exposure, long duration group in Table 11. For all Ollier causes, there are no consist* nt relationships with, exposer*-. Within the nnlign.ir.L neoplasms, the largest (although n.^t statistically) significant SI IF. Is in cancers of the buccal cavity and pharynx, with 5 observed, 2.86 expected, and an Sliil of 139. However, Tables 7 to 10 show that all these cases have Fxposurc Indexes below 1.5, and 4 out of the 5 have less than 5 years exposure. Cancer of the digestive system shows no excess in the study population ns n whole. However, in those workers with. F.xposure Indexes of 1.5 or higher, there arc 12 observed cases where 9.14 are expected (table 7). In the subgroup of the. above workers with 5 years cr more exposure, there are 11 observed cases and 7.47 expected. Respiratory cancer shows a slight excess in the toial group, and a similar pattern for different exposure categories, with 13 observed versus 10.28 expected when the Fxposurc Index is 1.5 or hip,her, and 12 observed versus 8.50 expected '..`hen, in addition, the dur.it ion cf expo.-use is 5 years H&S 020745 or more. Malignant neoplasms o! other and unspecified sites shuv: an vxcf.s in the totnl {jrouji, mill an increase with both lev< 1 and dm .it Inn of i/.jicMii'i! (Tablet; 7 and 8). Tin- relat ios.ship with < y. pose r< in t r pronounr i d , t.lme those with exposures ol less than 5 years have fever r.than expected. The lymphosarcomas , a 1 thour.h ocoirr in;- at al-wul. tin' I'Sjiftlo! rate wlii-n the whole p.roup Is conr. idered , are concentrated almost entirely in the hip exposure Ion;;, duration proup. In that ;atepory there aj 4 r.-itc:, obsirvod and 1.84 expected. Cancers of the genital and urinary organs, ar.d 1 eu'r.eu.ia, h.ave fewer cases than expected. Tin- nur.ber of cases 1:; too snail to examine any trends. X. DISCUSS to:: The favorable overall iroitality of t hr study population Is a phi nnr.-.et or. corur.only observed in v.-orh I np populat ten::. Studies of several eccupat ioral groups have shown that, even If there is an orcup it tonal har.nrd wh i c ! preatly increases the risk of death frori a particular cause, the overall tonality any well be favorable. Table 12 shows the Saa's obtained in a number of recent studies of other occupational groups. Alchoup,!' for technical reason:, these SMR's are not strictly comparable, the overall mortality in the present study is clearly favorable. SMK's which are higher titan expected may be worthy of attention even If they are not statistically significant. Tills it; especially t:ue in the present study since the nur.ber of deaths from, ratty causer, is <;elte rt.nl 1, and even a relatively hij;h fillR tray not reach statistical r i j;n: f i car.ce . If, in addition, a particular cause shows a consistent pattern of increase with exposure or estimated exposure, the find!::;-*; are part icul ar 1 v R&S 020746 >o /wwe",1' -I/,. R&S 020747 interesting. By the.se criteria, mortality fro::; d i l ! ve r;ii:o-r , resp 1 ratory rancor, cancer of other and unsprr ! f Ini filter., a: id 1 /;p!co an appear to be r 1 ai id to exposure as est lrn.it ed In tills study. I;> vK'W of the jsr.oc 1 .at I on between vinyl chloric!* i or tire* and aaglo- sarcowa of Lite livir, the d igest J ve c.iiaarr; '..'ere < sar.i ned further to see whaL contribution angiosarcoma made to tire observed mortality pattern. Of the 19 digestive cancer?;, 7 wore liver cancer:;, of which two were angiosarcomas accordirg to the death certificate. !!o'..v,vr , among .angles.arrow.; deaths in vinyl chloride workers identit itd by otl.es is.vi at I r.-ator:., there were 6 which occurred In the present study population during the study period. They ,.,c:e all found in the course of the study, rut were listed on the death certificate as due to caur.es otlsr than an;- io'v.rccw.a . Table !'J shows llu-se deaths with, the death certificate cause. If there had been no ar.g i osarcorr.ar;, Table 13 show;-, that the Total number of digcsti"e cancers in the high exposure group wwiifd ha.v - dropped to R, and the nuit.ber with hig.h exposure and 5 years or wore exposure would have drepp. d to 3, so that the mortality pattern in. this cause group is cine entirely tc angiosarcoma. The other cause group worth further investigation is cancer of Other and unspecified .silos, both because it is a heterogeneous category and because it seenu;, unlike the other cancers, to be store related to duration than to level of exposures. Table 14 shows a list of the specific caus.es Incited., d in this category, which is essentially brain cancer and, general i d cancer with primary site -15 unknown. About 40 pero-nt of the observed !<-.if_ 1.vs !* du< to. brain cancer . In the jjonorn] male population, about 2.2. peteent of this eatepory It. due to bruin cancer , no that. not only J:i t. In* wirtii] !ty f i on th!'. ru excess J '.v, but bruin cancer It; overrept <*:; uted. The* pout: lb 1] 1 ty exist,:; bused on tin* lack of .'peril !< fly of sene of tie 1 in Led causes rli.it some of the bruin cancers vert- not pi h.iiy, but retastasi from nnorlier unidentified site such as the lun;;. The- cancers of the burcul i:,iv i > y and pharynx are difficult to explain because of their occurrence in the Ir1.' exposure - short, exposure y.rou;;. It is possible that tills is a chance occurrence, or that exposures to other substances were* involved. XI Possihi.i: Hi/.hi-:; i:: ;cai.cvi.a'; in:: d- r.i:d: There are three area:; in which biat; could have ent<-i . d tb.c calculation of Lb.c above f.f ill's. The first Is the choice of the l'. 5. male pnpulal :cu. ..* a standard. Tb.e second Is the absence of 15 percent of the population -.ho were not found. The third is the discovery, as tb.e study ended, of a prsup of 1500 workers whose exposures occurred up to 35 year; ap.o, and who are not included in the study p,roup. The choice of the U, S. male population was not entirely appropriate. The study population w.iS concentrated almost entirely in. the has tern half ef the United States, whose normal mortality is slightly hij-.her than that of the whole country. This implies that the correct. exj.i"ted values should have been sliphtly lup.her Lhan the oner, which were used, and the corre: ; and i m SMR's slightly lower. This ha:; no practical significance exc< ; t for those mail;*,nancies in which the IhhU's were above 100. However, rrp.im.ul difference', in mortality from those muses is such that theM V2vvuM have li<n at most 1.5 to 3 per ci nt levs r , will: no substantive .! i f f,i . in tb.e result:.. R&S 020748 i ''I }f l" r` The voider:: who it'uld t jn r lie tr.ie.d :-iv < om < I v.il. I y lin ;i ! f .;*! - LlotinLc u;..her of do:ilhs, which could 3 netc.nu: the oyer. ill . 1 L appe.trs tit>- JJVcly that the d I st r 1 hut f r.n of c would he suhstaiit !;i 1 1 y d!il*:ent. how ever, without actual data J u hand, the possibility eannft he rulii! out that either some new causes of d'alh nij'.ht honors.- s 1i f 1 cant , or th.it tore oi the relationships found In thin study i::i;;ht he diluted. The sane consentr, apply even Bore to the proup of 11/)h workers discovtred too late to he Included in the study proup, sliire they would provide data in precisely t ho area (very lor./, exposure an I lent- lntoney) in whir h the ; :w : r.t study Is relatively v.vnk. 33 Qo CO 020748 References: Archer, Vi', V.'np.ni.er , .1", Lumlin, IT, ,!r: Car.* <v :* rial ity sir o uraniun i:;i 13 vorN'r-.. J Ooeup M**d 1 : I 1-14, 1W). Put erline, IT, .T-Omf I , I', Hi'iklirM-n , V: Mortality !r: r* 1. s t. I : occupational y/pcsurc in tin- asbestos i r.du:-t ry . .! *v* u;. M*d 14:897-902, 1972 . *o PntcrlJne, IT, Pendr i ck, MA: As.be ;;t os-dust < xpe'.u: *; a! rious level.*? ami r.ortalfty. Arch Cnviron health 19:!H1-J 1997. llamnoml, PC, Pel {'. off , T.J: Me 1 at ion of < ip.rrr: t( : of death of a:: ho si os - as re i at ** -1 d Is.-.:, i?1 i i:* r | in the Unite d ft a!. i* * S_y:-.po- 1 us: on !:. to I up.: ca 1 e f!. Lyon, Octoho r 2-9 . 19 72, paper PAL. flap !o r i :,k ii.n ..orl'crs Lloyd, ,UJ, C iocco., A *. I one to r::i tort a ! ' ' v study of * i cl- orerrs; met hodolopy. .1 P, tii;i Mi d 11:;' 29-210, 19A9. I.ur.J in, IT, .Jr., Lloyd, .IV.', T.ith, I.?!. Archer. V!:, Pal Mortality of uran I ts.i r: : i *? in rela! ior. to rad I if1:; ^ hard-rock r.in I up. am! c i pn ret t a i::..o'r 92 3 i rom-.h r- ; t .: Health Physics 1 (<: S 71 - 5 7 --1, 1999. Pi;: Redr.omi, CP, CJoci'0, A, l.ioyl, Pur::, i!V.': Li!::::- i of r.t ('! workers--VI, Mortality fro r. Ma 1 i main Mcep 1 oven workers . J Occup Mod 1 *'.: 921 -62 9, 1972. :orta! ity studmorn toko Taker alia vt. Hi, Cooper, l.'C, Halter, .11.: A Labor*n.ir..*.:* * ::t tu cupa: ion,* I health service in a construction im'.ur-t v. Arch Jlnviror. Ileal ti. 21:784-788, 1970. R&S 020750 1 ! Follow up ;,t.itu\ of 8 IfU* Viuy! Chlotfi!,- Woi Nuiiitif-r I'crrfttl Tot .i 1 8 io'. 100. ft Al i Vc f'O.H U*kul ij,; /,.? U; l iW/Vii \: ,u 15.0 > .i ii , V. `. ; t ' : f i c-it i". . ,* /. i 3 * r 1- R&S 020751 Apri1 15, 19 74 Table 2 Distribution of Months in Exposed Employment by Birth Year, for 712S Vinyl Chloride Workers with Completed Follow-up Year of birth Total IS 75-79 IS30-84 1355-59 04 195-9 19-n-ni liOj-09 '910-1-', 1915-19 i-*:o 1925-29 1951-39 1935-39 1 `'*4 0-44 [9-5 5-91 1151-5** l 5 7 21 3S S9 214 494 6**5 59 7 9-'*0 877 9 So ll? 700 132 r-'t il 7128 <60 l l 3 10 9 33 79 195 229 276 25 7 4 54 66-* 032 132 2155 60-119 120-179 Months of exposure 150-239 2**0-299 300-359 360-419 Unknown 22l 33 7 9 *> 4 9 12 2 13 21 22 17 6 27 35 37 43 34 3 62 53 72 73 43 15 96 80 120 105 5- 13 191 95 14 3 160 214 llS 169 13 9 *34 20 S 252 125 151 3 75 120 27 45 1 It) 66 1 1 2 7 5 4 3 7 8 1706 O'# 7 736 5<j 5 25 39 April 15, 1974 ZSLOZO S9U Table 3 Distribution of Months in Exposed Er.ployrnent by Year in Which Exposure Began, for 7128 Vinyl Chloride Workers with Ccr.pleted Follow-up Year Exp. Start ed Total 1939-39 I^AO-An 1959-59 1969-69 1970-71 35 lO-'.S 1962 3368 715 Tct J1 7123 <60 2 135 389 1714 715 2955 60-119 u 93 257 1442 120-179 1 119 38 3 195 Months of Exposure ISO-239 240-299 300-359 4 6 13 151 277 237 631 232 360-419 5 34 V rknown *> 20 17 1794 693 786 565 250 39 39 i April 15, 1974 ESZ020 SSU Exposure Index Total 1.0-1.4 1.5 + Unknown 4032 3057 39 Total 712S Table 4 Distribution by Months of Exposed Employment and Exposure Index for 7128 Vinyl Chloride Workers with Complete Follow-up <60 60-119 120-179 Months of exposure ISO-239 240-299 300-359 360-41? Ur.kncvT! 1715 1125 402 406 2 74 92 1240 671 295 360 291 15= 2955 1796 697 7S6 565 251 IS 21 1 39 39 39 Miv 2 , 19 74 "IT *$iozo ssa Table 5 Person Years o Observation by Year of Birth and A?c for Vinyl Chloride Workers ,\?c Tot i 1 L5-L- : 3-3.. v> A1 .. ^ 5 ;-555-55 `5--9 ` 3 ' " - TotaIs 1375 IE 79 77SA6 It- - 70 12'7 76 L -I l 3' 5 0 IJTJi -1" n 3'j32 l 'V- -.`2 .-v n 3 5 1 _______LJ ______ ISS1 1385 ISSA ItS? 92 12 A ! 1 1 I 22 K. 15 '25 31 . : 2 1 i 11 1`; 5 5 Year of Birth 1890 1895 19r)1) i1'05 19i> L915 19 JO 19:5 19 30 19 j5 j19-0 i 19-5 1?5T 159- l S 99 : looo 19 '4 l ni n L9J4 to 2 Q * 9 j-* ^ c >L i. --ill--L, 317 705 1 -'A 2 -'155 ' > J i. -1 11 1 5F :3335 fr 1; '3 io ill!; v : 12 5t 57! 21 t '- ;' 1 35 l lb-; 5 3 J -HI 92 L- 1 ! :2 33 5 1 n i.. 1 .. 1 7 l i-331 ! 7 ' I !' 2-- 1 >5- 3 12 * 37.11 ' 1 -s'! i 1 ; 221 1-.H5 3 7- ' ; - - , , ' -t 11 i5 i v* 35 13: 155 53- i - -5 5 5 '2 : It 7-'- 5 1 1i ?] :.. . - 1 . , - 1- t t1 13'- 7-2U'- I'll7: 7 1 ! ______ ... -3 3 ! ______i______ !______!______ 77 I'-.. --i - i `1 *,, 3 i U l 1J _J______ i______!______ it ` 91 1 - > ` 13 I s L !_ . !J l 1l i 11:1 i1 i1 _i___ 1_ ____ i1 1 Ap t 15, I9 7i ssiozo S9fc| TABLE 6 OBSERVED DEATHS/EXPECTED DEATHS nND STAND.-JtDIZED MORTALITY RATIOS IN VINYL CHLORIDE VORKERS Cause of death with I.C.D. number All causes Tuberculosis (001-019) Tuberculosis of respiratory system (001-008) Mai ignant neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Kill gn.tn t neoplasms , respiratory system (160- 164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Milii'.nanl neoplasns, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203, 205) Diabetes met Ileus (260) Major cardiovascular and renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting 12/S (330-334) Rheume11 c lever A chronic rheumat ic heart dis, (400-402, 410-416) Arter lose torot 1c heart disease (420) Nonrheumatic endocarditis (421, 422) Hvpert ons i vc heart disease (440-443) Other hypertensive disease (444-447) Chronic 6 unspecified nephritis A1renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of stomach and duodenum (340,541) ..ppend icilis (550-553) Hernia and intestinal obstruction (560, 561, 570) Gastritis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hvperplnsia of prostaLe (610) Svnplom.s, senility and ill-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (610-835) Olher accidents (800-802, 840-962) Suicide (9u3, 970-979) Hcmiclde (9b4 , 980-985) Number of workers Person-years .id jutted lor deaths with cause unknown. Signi ! icanl at 5\ level. **>ignificant it l % level. See Table 11. iy 2, 1974 9SZ0Z0 S9U ob s/ex p SMR1 352/467.28 7 5*"* 1/5.71 1/5.34 79/77.16 5/2.84 19/21.67 23/23.91 3/3.55 1/.1.&0 17/11.75 3/3.77 6/6.0e 7/6.31 155/207.46 13/24.48 5/0.87 121/137.33 1/6.58 3/9.33 3/2.b0 0/4.27 5/9.96 2/3.83 0/0 * uu 1/1.51 1/1.51 .3/15.1-0 0/0.39 1/7.34 21/45.78 17/32.70 13/30.64 16/16.83 1/11.96 19 20 no 169 112 91 30 155 85 no 120 80** 57** 7$ 95 lu 35 124 0 54* 5n 0 71 62 21 0 15 c J 102 4 7123 77S46 s'* jf- I TABLE 7 OBSERVED DEATHS/EXPECTED DE.itHS AND STANDARDIZED MORTALITY RATIOS IN VINYL CHLORIDE WORKERS, BY ESTIMATED LEVEL OF EXPOSURE Cause of death with I.C.D. number All causes Tuberculosis (001-019) Tuberculosis of respiratory system (001-008) Malignant neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Malignant neoplasns, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Miltgnant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203, 205) Dlubctrs mcllitus (260) Mi jor cardiovascular and renal dis cases (330-334, 400-468, 592-594) Vascular lesions affecting CMS (330-334) Rheumatic (ever 6 chronic rheumatic heart dis. (400-402, 410-416) Arteriosclerotic heart disease (420) Sonrhcumatic endocarditis (421, 422) Hypertensive heart disease (440-443) Other hypertensive disease (444-447) ' Gtronic 6 unspecified nephritis A rcn.il sclerosis (592-594) Influen.M and pneumonia (480-493) Ulrer of stomach and duodenum (540, 541) Appendicitis (550-553) Hernia and intestinal obstruction (560, 561, 570) Gastritis, duodenit is, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Kyrcrplasia of prostate (610) Symptoms, senility and ill-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (610-835) Other .'cc idents (800-E02, 840-962) Suicide (9t>3, 970-979) Homicide (964, 980-9S5) Number of workers Pcrson-vears *a..i.g..n..si..I.aledajunst te.dit for deaths 52 1 eve 1. **Jigniticant it 17. level. with cause unknown. tsiozo Se< Table svu n. Miv 2, 1974 El <1. 5 obs/exp SKR1 El SI. 5 obs/exp SMR1 188/270.33 70** 157/195.68 80** 0/3.38 0/3.16 37/44.28 5/1.62 7/12.50 11/13.56 2/2.30 1/2.07 9/6.57 1/2.18 1/3.48 5/3.65 84/120.11 7/14.42 7/3.9S 68/78.94 0/4.20 1/5.48 1/1.52 0/2.50 5/5.SO 1/2.21 0/.1.30 0/0.tiS 0/0.76 2/8.90 0/0.25 0/4.22 14/21.00 8/19.''S 11/17.83 9/4.73 0/n.9S 0 0 90 330 60* 86 93 51 146 49 31 146 75** >** SO 92 fl 14 70 O 9; 48 0 0 0 23 0 0 68* 45** 66* 93 .0 9/2.33 0/2.18 41/32.67 0/1.21 12/9.14 13/10.28 1/1.43 0/1.52 8/4.52 2/1.57 5/2.54 2/2.65 69/86.49 6/10.06 2/2.85 51/5S.05 1/2,S9 2/3.86 2/1.07 9/1.77 o/4 . 1 3 l/l.'O 0/0.2 7 1/1.6 3 t/0.55 1/6.04 0/0. 14 1/3.09 6/15.89 9/13.46 6/12.67 7/7.02 1/4.94 0 0 134 0 141 135 75 0 190 136 212 61 85* 64 73 95 38 56 201 0 t>8 0 171 196 lo 0 34 41** 72 53** 107 21 4032 4 5354 3057 321 OS .S' ' d. ft ,r i. i 3& ! j 'fe > OBSERVED DEATHS/EXPECTED DEATHS .iND ST.tND.iRDIZED MORTALITY RATIOS IN VINYL CHLORIDE WORKERS BY DURATION OF EXPOSED EMPLOYMENT Cause of death with I.C.D. number All causes Tuberculosis (001-019) Tuberculosis of respiratory system (001-008) Mailt',nant neoplasms (140-205) MilIgnunt neoplasms, buccal cavity and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Malignant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lvm.phor.arcom.n, lymphatic and hematopoietic tissues (200-203, 205) Diabetes mellitus (260) Major cardiovascular and renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting CNS (330-334) Rheumatic fever ( chronic rheumatic heart dis. (400-402, 410-416) Arteriosclcrotic heart disease (420) Konrheumatic endocarditis (421, 422) K>pertensivc heart disease (440-443) Other liypcrt ens ivc disease (444-44 7) Ctronic & unspecified nephritis 6 renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of sioRMch -Mid duodenum (540,541) Appendicitis (550-553) Hernia and intestinal obstruction (560, 561, 570) CustriLis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Itvpcrplasin of prostate (610) Svn.pt oms, senility and ill-defined conditions (780-795) .ill other diseases (residual) Motor vehicle accidents (810-835) Other accidents (800-802, 840-962) Suicide (963. 9JO-979) ilunf cido (964, 980-985) Humber ot workers Person-years 'sMR'-i adjusted (or deaths with cause unknown. Significant at 57. level. **Jignifleant at IT level. See Table 11. M.iy 2, 1974 8SZ020 S'? a <60 months obs/exp SMR* 4/140.53 67** 0/2.2J 0/2 .,'7 13/19.96 4/0.70 2/5.26 3/5.52 0/0.99 0/0.83 2/3.40 1/1.25 1/2.01 2/1.SO 28/51.45 4/5.0? 2/2.39 21/32.54 0/1.79 1/2.42 0/0.7O 0/1.55 3/2.93 1/1.07 0/0.24 0/0 mSu2 1/0.40 1/4.49 0/0.07 1/2.28 4/11.97 10/16.14 7/12.94 b/6.34 1/5.SO 0 0 78 688 46 65 0 71 96 60 134 65** 81 101 7S* 0 49 0 n 121 112 0 0 301 26 O 51 40 75 *0 ^ ir. 10 2 9 55 14201 60 months obs/exp SMS* 251/329.30 76** 0/3.55 0/3.33 65/57.61 1/2.16 17/16.56 21/13.51 3/2.76 1/2.79 15/6.23 2/2.53 5/4.07 5/4.5'. 125/157.3? 9/ IS.71 3/4.53 98/105.39 1/5.35 2/7.01 3/1.82 0/2.76 2/7.09 1/2.73 o' 0.4 3 1 /1. n 0/0.92 2/11.18 0/0.33 0/5.09 16/26.34 7/16.65 10/17.82 10/10.28 O/t.,20 0 0 116 47 106 116 112 37 1S7 SI 126 113 81** 49** 68 96 20 33 170 0 29 17 0 93 0 18 0 0 63* 43** 5S* mo 0 4 \ >4 43240 9 OBSERVED DEATHS/EXPECTE9 DE.tTHS /.ND STANDARDIZED MORTALITY R..T10S IN VINYL CHLORIDE WORKERS WITH EXPOSURE INDICES BELOW 1.5, BY DURATION OF EXPOSED EMPLOYMENT Cause of death with I.C.D. number All causes Tuberculosis ('101 -019) Tuberculosis of respiratory system (001-008) Matii'iunt neoplasm (140-205) Malipnant neoplasms, buccal cavity and pharynx (140-148) Mil tenant neoplasms, digestive organs and peritoneum (150-159) Milipnant neoplasms, respiratory system (160-164) Malipnant neoplasms , peni t a 1 or pa ns (170-179) Malir.nant neoplasms, urinary orpans (180-181) Milipnant neoplasms, other and unspecified sites (190-199) Leukemia and aleukonia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203,205) DirjSrtes rellitus (260) Mijor cardiovascular and tonal diseases (330-334, **00-468, 592-594) Vascular lesions atfectinp CNs (330-334) Rheu-t.it ic fever 6 chronic rheumaric heart dis. (400-402, 410-416) Arteriosclerotic heart disease (421) Nnnrheunatic endocarditis (421, 422) Hypertensive heart disease (440-44J) Other hypertensive disease (444-447) CJtrnnic 6 unspecified nephritis 6 renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of stomach and duodenum (540, 541) i Appendicitis (550-553) Hernia and intestinal obstruction (56 ), 561 , 570) Cas t ri11s, dundenttis, enteritis and colitis (543, 571, 572) Cirrhos l s of liver (581) dvperp las la o f pros tat e (610) Symptoms, senility and ill-defined conditions (780-795) nil other diseases (residual) M.otor vehicle accidents (810-835) Other accidents (800-802, 840-962) suicide (9ul, 970-979) Homicide (964, 980-985) Number ot workers Person-years 'jMR's adjusted lor deaths with cause unknown. *5ipnificant at 57. level, Si pni1 icant it 17. level. See table 11. Miv .'. 1 <60 months exposure i60 months exposure obs/exp 6MS* obs/exp SMrI 56/89.23 63** 132/181.28 73** 0/1.41 0/1.31 8/12.86 4/0.45 1/3,43 2/3.58 0/0.68 O/0.55 1/0.97 0/0.79 0/1.26 2/1.15 21/33.33 2/3.93 2/1.50 16/21.14 0/1. IS 1/1.53 0/0.50 0/0.97 3/ 1.86 0/0.63 0/0.15 0/0.27 0/0.26 1/2.80 0/0.05 0/1.43 4/7.45 3/9.87 1/7.98 3/4.08 0/3.55 0 0 73 1016 .14 65 0 123 0 0 203 7 3** 59 155 8 0 74 n 0 183 0 3 0 0 42 1 0 63 35 44 86 0 0/1.97 0/1.3 5 29/31.46 1/1.17 6/9.03 9,10.00 2/1.62 1/1.53 8/4.43 1/1.40 1/2.23 3/2.50 63/36.32 5/10.51 1/2.49 52/57.87 0/3.02 0/3.9 0 1/1.02 0,1.5 3 2/3. 9> W1.53 f\t 0. 24 0,0.61 0/ 1.51 ' 1/6.09 0/0.20 0/2.79 10/12.92 5/9.22 8/9.35 b,' 5.66 0/3.43 0 0 95 83 63 93 127 67 137 73 46 124 75** 4 9* 41 93 0 0 101 0 53 67 1 0 0 16 0 0 79 56 S3 109 0 1715 21418 2317 23920 6SZ0Z0 SSU TABLE 10 OBSERVED deaths/EXPECTED DEATHS rND standardized mortality RATIOS IN VINYL CHLORIDE WORKERS WITH EXPOSURE INDICES 01 1.5 OR GREATER, BY DURATION OF EXPOSED EMPLOYMENT Cause of death with ICD. nunber Al 1 causes Tuberculosis (001-019) Tuberculosis of resporatory system (001-008) Malign mt neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) Milign.mt neoplasms, digestive organs and peritoneum (150-159) Mi l i,;nint neoplasns, respiratory system (160-164) Malignant neoplasms, genital org ins (170-179) Malignant neoplasms, urinary organs (180-181) Milignant neoplasms, other and unspecified sites (190-199) J.rut.eni.i inti aleukemia (20m) Lvmphosarcom.i, lymphatic and hematopoietic tissues (200-203, 205) Diabetes mollitus (260) Kijor cardiovascu lar and renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting CNS (333-334) Rheumatic fever ft chrunic rheumatic heart dis. (400-402, 410-416) r teriosc lorot i c heart disease (423) Konrheuratic endocarditis ('*21, ^*22) Hvpertensive heart disease (440-44)) Other hypertensive disease (444-447) t Chronic f, unspecified nephritis 6 renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of stomach mil duodenum (540, 541 ) Appendicitis (550-553) Hernia and intestinil obstruction (560, 561, 570) Gistritis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hvpri pl.t;. 1 a o! prostate (6lfl) Svmptoms, senility and ill-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (810-8)5) Other accidents (flOfl-802, 8'*0-9t>2) Suicide (9i,3, 970-979) tWicide (9>>4, 930-985) Number of workers Person-years l.iMH' ; adjusted for deaths, with cause unknown. *:> i grit : icunt at 5" level. **:.i r.ni ! ir.int at 1?. level. See Table 11. May 2, 19 7'. <60 months exposure 60 tronths exposure obs/exp SMR* obs/exp 33/47.93 79 119/147.81 81* 0/0.76 0/0.71 5/6.57 0/0.23 1/1.67 1/1.79 >1/0.29 0/0.26 1/1. IS 1/0.44 I/O.71 0/0.61 7/ 16.54 2/1.37 0/0.32 5/10.41 0/0.57 0/O.76 1/0.2 7 0/0.54 O/O.99 1/0.35 0/0.08 0/0.14 1/0.14 0/1.56 0/0.01 1/0.33 0/4.03 7/6.05 4/4.73 3/2.40 1/2.18 0 0 91> 0 76 71 0 o 107 288 1 78 0 54^ 135 0 61* 0 0 0 0 0 362 0 0 904 0 0 158 o 14 6 107 153 5S 0/1.57 0/1.48 30/26.11 0/0.99 11/7.47 12/3.53 1/1.41 0/1.2r> 7/3.5t 1/1.13 4/1.64 2/2.04 b2/70.46 4/8.19 2 / 2.04 46/47.65 1/2.32 2/J. 10 3, ).S1 0/1.2 3 0/3.13 0/ 1.25 0/ 1. 19 1/0.49 0/ 1.41 1/5.08 0/o.t 3 0/2.30 ti/11.88 2/7.43 2/ 7.1]o 4/4.02 0/2.7o 0 0 141 0 151 144 73 0 204 S3 222 MO 90 50 100 t>6 25) 0 r> 0 0 209 0 20 0 Cl 51* 28 2*3 ss 0 1740 12628 1817 19 305 09Z0Z0 S9U Tabic 11 Distribution of Deaths by Exposure Category and by whether Cause of Death Was Determined, and Correction Factors Used for SMR Calculations Tot a l* Exposure Index <1.5 >1.5 h .<rosurc Total Lx posurc Ti--e in Months <60 >60 Cate .'or i Exposi: re <1.5 6, <60 Index and Tot : 1 in Mont hs <1.5 -71.5 f. 760 5 <60 Exposure -1.5 e* 7 60 All causes 352 IS8 157 94 251 5t> 132 3S 113 Cause known Ciu.s e unknown Forcent increase : n > MM ' s 32S 24 7.3 17 146 12 11 78 244 16 7 6.8 7. 5 20.3 2 .S t 48 S U>. > 125 30 i* S 3.1 26.6 116 7 2.5 *Deatks in exro;ure categories do not add up to deaths in total category because 7 do ichs had unknown exposure data, and one of those was ounknown cause. 197** 1.9A020 S*U R&S 020762 Tab)- 12 }"-:;i:lt:; of Jitudv j* '?; * !;p in w**`.'i'l'-il ' j* j ! 1 J!ur h**r Oi r.' fV* V*.Mxof : :-.i> f -1,* * i v *1 i * ; /.I! r Asb'e.t.os bci 1 rji r-.'T product voik'-rs Asbestos frid ir`.s tnn ter i n1 vo i ke rs 12,402 i'j'ji-i 7, 510 it 09 89 Asbestos textile plant workers 1, 84 3 i 121 Cotton Lisxt i 1 o workor 0,281 i 88 White ur.de: orotitvl uranium minors 3,411 1950-1007 : ''> Stcclworkorr. 00,072 1953-1961 n2 Asbestos is: elation worker.1; > 20 year:; Coke oven worker;: 2 ISO 4, C01 1946-1905 1951-12OC 140 90 Asbestos r.a i n tenance service, etc. 438 1941-1909 124 Asbestos inr.nl.it;ion workers > 20 yearn 370 19G3-1971 198 Asbestos i nsul ati on workers 17,800 Uranium mill workers G62 Lead smelter workers 2,352 19G7-1971 1950-1907 1940-1970 136 99 107 lead battery plant worker:: 4, G80 194G-1970 99 Petroleum refinery workers 18,916 19C2-1971 G8 i < !' ' Int'M'1 i n* / Kendrick, 19 ('7 Inter! i:.*.- f. Kendrick, 1907 Kntejlino >. Kendrick, 1907 Ik.tcr 1 ir, Kendrick, l'T,7 Lund::, et al , I960 Llcr/d r. Cicero, 1909 Till '*" v nl'. -1 v <jt til 4 I'JIO Hicd,::;o:.d et a 1, 1972 llnterl ir.v al, 1972 l!ar.-:'.';:`.d r, Sclikoff, 1972 Harmond t Sclikoff, 1972 Archer et al, 1973 TCA, Ir.c. , unpublished TCA, Inc., unpublished TCA, Inc., unpublished May 3, 1974 'r* -r? *l >? V - 1 ;3 U'JAJ j ^Lgtf-g. > ll *v* R&S 020763 M1 **V*!*-W**;W-T**H+ XWM>I<pMM)K r.T'rt^ ;'-4 Table 13 Angiosarcoma Deaths in VCM Epidemiology Study Population Study No. 4259 4255 57t5 7393 7376 7385 Age at Death 54 69 Mos. Exposed 293 281 45 167 38 174 52 238 4 3 214 Cause as Given Cirrhosis of liver (sev, weeks) Bleeding from hepatoma (3 days) (Laennccs c ir rho ' is ) Autopsv ves ves Angiosarcon i rc. Icho of liver (19 mo.;. ) VC.1 Liver failure (l no.) Cancer of liver, urinary {13 nos.) Cardiac tanpanade u:u! massive toft homothorax (n:ns.) Widely no tastat i c c.::t ; arc on * of liver (A res.) iiepat i e : i i 1 ure pr ini r v care i nor. i liver , v? April 15, 197A d'k \J ; It#' Tab Cther Malignancies (193-199, l.C.D.) in VCM Epidemiology Study Population udy ;;o. 2 74 4 3700 209 6 394 6 44 33 4S00 72 79 7330 73 71 7 i '7 ' 5 7 '? Age at Death 3S 4S 67 43 54 61 57 ` i >4 3S j> ij 52 Mos. Exposed 1S6 50 69 6^* St 51 2 31 211 24 9 2 In 2 39 Cause as Given 7ea topsy Widespread metastatic melanoma (l yr.) M11 igr.ant melanoma ci back yes Malignant melanoma with widespread me t at as es no Brain tumor (carcinoma) (S mos.) - Men ingi t i s and pr.oumoni t i s (5 Vr:s . ) Epend vm.oma , tov.i'lh vent r ic 1 e - ar a m (2 mo;, post-op cranictemv) no t roevtema , r:a I i gr.artt - le .' t cerebral yes hemisphere (1 vr.) Cr.c in.c-a of t!;e brim or tot io 1 er r' i I'inir.r.M due to static congestion .. w Briir. tumor, e. t; eb '.a--1 ora mul:t:or""o (IS mos.) Brain tumor, ma l i .tnaut (2 mos.) Brain tumor , ml io,nant - no Ttivroid care iron w;t:i meta; tases Care i nrmatO' i ' Circinomi ve::e^ra 1 hodv r. o> ves t9Z0Z0 SSH Tabic I:* Other Malignancies (cone.) Stuev ;,'o. Ago at Death Mos. Exposed 5 2-'* 6 28 50 67 64 201 193 2 773 54 300 A 785 5 783 7301 61 69 55 318 16/ 6 13.1 Cansc as Given Aut ops Li nosarcoma with mo t as t as is (3 mos . ) yes Careinom.atosis, primary renicn not known (Pas t history, rheum, it c id arthritis, myreurdi a l infarct i on) no Cardiac arrest (1 hr.) Respiratory arrest and cerebral hypoxia (2 day;) Widespread metastatic curcinomi (2 -os.) Generalised metastasis and if tercr.tinted (7 nos.) Sq-.i.inocs cell carcinoma, primary site undetermined yes Metastatic carcinoma ot abdomen Critical site untiet erm;net! (Paimonary emphysema) Carcinomatosis ( mo a .) Primarv aitc undetermined r.e \ rs r iili 15, 1974 99Z030 S'Sd Tab ie 15 Malignant Neoplasms of Buccal Cavity and Pharvnx (140-148, I.C.D.) in VCM Epidemiology Stud Popula:ion Study No. 3003 3431 3001 7355 335-* Age at Death 31 55 57 54 63 Mos. Exposed 49 30 71 40 / 26 Cause as Given Autopsy Carcinoma of lip vith metastasis to lung and neck (5 yrs.) no Pulmonary edema (50 min.) Fu Inonarv not os Z ascs (Carcinoma, epidermoid, tongue and m.and ib le) no Net astatic squamous cell ca. prim.iry lesion palate yes Atelectasis cue to metastasis to red ia i c i tram (4 r.os.) Multiple malignant metastasos to brain, liver A mediastinum. (1 yr. ) Atfeno-carcincma of r.asut pharynx (2 yrs.) yes M.as ;:ve iiemcrrh i.'.e into trachea- yes Statu1 post larvo.-.p-pharyngectemy. left radial nook dissection Wo 11 - d i: ferer.t i ated kcr.it in icing squamous cell care ir.om i of left pvriform sinus (nos.) April 15, 19 7A 99Z0Z0 S9U v. ' 7* vital STATUS UNKNOWN r0LL0WUP /ITAL STATUS ,<MOV'/N 1 Z9Z030 ssa ^* f-*.<tnl !)'< i: r i :i | Chr-m i s t ; As:;ryi.at ! r,i,_ I ~.i.is < ", i_r ! fiey N * ndy Parent Cornornti s:. Plant lies i gnat icn Address _________ To lephone (______) * TAIiEKSJ.'AW-COOPNK ASSOCIATES' CONTACT i'OH OUiid ECT ST'dD' Name Title Mai linn Add re: Street Address (please identify z t li si: f f ; t f fn` pr*-r:s'.n: to serve as a taxi-driver's instreet ion) Telephone Signed Name Title Company Address Telephone __(_______ j_ ext . 3J ft CO o IO O o> 00 R&S 020769 Tnbershaw-Cooprr A'soclates, Inc. 2180 Milvl.i Sf . , Suite 10.'. Berkeley, Cnliiotnlu 94 704 Manufacturing Oirml:. tr: Ar.s nc 1 .it i tin VC?4. Kp 1 deml o 1 <>gi c 1 lit * = y Plant No. 1. When did this plant. begin work Jnvolvin;; vinyl chloride? 2. Wli.il Ik the appro:-: im.ic < sire of the current work force, exc Ins i vc of secretarial and office personnel? 3. Approximate1y haw many of tlier.u are cr,ployed in Job-; in volving .some exposure to vinyl chloride? 4. Please answer the appropriate one of the following, questions about your retirement plan. a. No retirement plan b. Voluntary plan, begun in c. Required of all employees, begun in d. Now required, formerly voluntary. Voluntary plan begun in Required plan begun in Remarks: 5. Please answer the applicable questions below about retention of records. How long arc personnel records kept a. for those who retired but were not covered by a retirement plan? b. for those who retired under a retirement plan and hove died? c. for chose who quit or were discharged? d. for those who died while employed? ATTACHMI.NT T/ibcnh.iv-Cooper A-inociiKe*:, Inc p.ifjc 2 6. Do tle per *:otiiii' I records wSi i c ii .ire ret- 1 cnnt.ijn > record of Job titles and dates of Job title changes lor the Jndfvltlu.il concerned? 7. Please IJst the job titles in the current work force which Involve some exposure to vinyl chloride. r R&S 020770 E^^~ VCM Kp 1 I ii I <>; 1 c ji 1 btudy I 1.(1 1 V 1 (!*1 '! ! n'lt V Hi Korin li - Workers known to have died (;> l ntt.'ich <<>py << f *J *-/ 11 > t cr t 1 1 I cnl c ) 1. Date of til riti 2. Date hired ____ 3. Dale of death h. Place of denth :;t .it o-. nt time of de.tth : 3. Deployed _________________ 6. Retired (;.lvo date) __ 7, Terini Mated 0;ive dnte) 8. If death certificate is not available, please ;;ive name of worker no that denth certificate enn be obtnlned. Jin con; net will be made with relative;, or attending physician. Job no. Job history with estimated exposure Title 1 f rom to 2 from to 3 from to U from to 5 from to 6 f rom to 7 f rom to Cheek os tlrr. Jtcd exposure in ppm -50 50-199 200-500 '500 R&S 020771 4 2W0 J f-:, i>.r..,i I . ;j.) 1. '. ``l .S' I ir ic Do a r Wo ;ir < .1 rric.'ir* h 1 i rm t (im'ornc'i with the health of workers in indusliy in l !: < United itates, V.'e ti ivi1 been isked to study cert ain occupitions in order to determine the health nl men who hive .'it one line or .mother worked in these ocrnji.it ion-.. To accompli sh this we need to know ii tlice-i* men we are interested in wort: alive cm December 31, 1072. rr any of the r',!i who died on or before th.it date, we need to know the place and date of deatli. With these teeth, we can compare the health statistics of our men with the general population. To assist us, can yon provide information regardin;- the person whose name appears below? A stamped, addressed return envelope is enclosed tor your replv. Needless to say, any intormat ion you r.ive us is strictly con fidentia 1. Thanks for your cooperation and assistance with this project. Sincerely, '-X ^{"^2: Jj'C^C'0 t ' W. Clark Cooper, fi.D. Name: Date of birth: Was above named man alive as of 12/31/72? If deceased prior to 12/31/72: Date of death place of death (city and state) R&S 020772 ATTACHf.r.NT 1)