Document N2Q8JrekO20G8qJmOLgDD2G28

NATIONAL INSTITUTE FOR OCCUPATIONAL HEALTH Pathology Division Surveillance Report: Demographic Data and Disease Rates for January to December 2003 Dr Jill Murray Dr Geoff Candy Gill Nelson Zodwa Ndlovu NATIONAL HEALTH LABORATORY SERVICE NIOH Report 15/2004 PO Box 4788 JOHANNESBURG 2000 e-mail: jill.murray@nioh.nhls.ac.za ACKNOWLEDGEMENTS We thank the following staff members of the NIOH Pathology Department, without whose contribution this annual surveillance report could not be published: Phyllis Back Jemima Cantrell Juliet Buthelezi Anna Khumalo Joseph Mukhovi May Humby Martha Rikhotso Natisha Khoosal Johanna Dibedi Rosinah Soko Nora Ngutshane Jay Vallabh Julienne Mkhize Goodman Rani Patrick Mbhontsi Wilson Mashele Johannes Mathetha Johannes Makoena Thanks also to Michelle Kotze (IT Directorate, National Department of Health) for upgrading and maintaining the PATHAUT system. Notes: The following terminology has changed since the annual report of the 2002 data was produced: "Ethnic group" is now referred to as "population group" "Industry" is now referred to as "commodity" (e.g. gold, coal, etc.) National Institute for Occupational Health, PO Box 4788, Johannesburg, 2000, South Africa ISSN 1812-7681 EXECUTIVE SUMMARY During 2003, 2 318 cases came to autopsy at the NIOH. Of these, 66.3% were black men, 32.1% were white,1.0% were coloured and 0.6% were submitted without information on population group. Overall disease rates (per 1000 autopsies) for 2003 are shown in Figure 1. 250 223 200 oo 150 0Q). 100 (0 O' 190 189 50 31 19 16 95 2 0 Pulmonary tuberculosis Emphysema Silicosis Primary lung cancer Asbestosis Mesothelioma Massive fibrosis Coal workers' pneumoconiosis Mixed dust pneumoconiosis FIG. 1 OVERALL DISEASE RATES FOR 2003 In 2003 the prevalence of silicosis was similar to that in previous years. However, the prevalence of pulmonary tuberculosis (PTB) increased, following the trend of the last several years. The rise in PTB was particularly evident in black gold miners where the rate increased from 274 per 1000 in 2002 to 328 per thousand in 2003. During 2003 six reports were written, utilising the PATHAUT data (see appendix 2). Research projects for which the data were used were presented at a number of forums. Two post graduate students from the University of the Witwatersrand also utilised the data. i TABLE OF CONTENTS EXECUTIVE SUMMARY GLOSSARY SECTION 1: BACKGROUND SECTION 2: DEMOGRAPHIC DATA SECTION 3: ACTIVE TUBERCULOSIS SECTION 4: SILICOSIS SECTION 5: OTHER PNEUMOCONIOSES Massive Fibrosis Coal Workers' Pneumoconiosis Mixed Dust Pneumoconiosis Asbestosis and pleural plaques SECTION 6: EMPHYSEMA i iv 1 2 8 10 12 12 12 11 13 SECTION 7: MESOTHELIOMA 15 SECTION 8: PRIMARY LUNG CANCER 16 SECTION 9: CLINICAL CAUSES OF DEATH 17 LIST OF TABLES Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 3.1 Table 3.2 Table 4.1 Table 4.2 Table 4.3 Distribution of autopsies by year and population group (1975-2003) Number and proportion of autopsies by age and population group (2003) Number and proportion of autopsies by type and population group (2003) Number and proportion of autopsies by commodity and population group (2003) Number and proportion of autopsies by years of service and population group (2003) Mean age by commodity and population group (2003) Mean duration of service by commodity and population group (2003) Number of cases and prevalence of active PTB by commodity and population group (2003) Number of cases and prevalence of active PTB by age and population group (2003) Number of cases and prevalence of silicosis by commodity and population group (2003) Number of cases and prevalence of silicosis in the gold mining industry, by age and population group (2003) Number of cases and prevalence of silicosis in the gold mining industry, by years of service and population group (2003) 2 3 3 5 6 7 7 9 9 10 11 11 ii Table 5.1 Table 6.1 Table 6.2 Table 6.3 Table 7.1 Table 7.2 Table 8.1 Table 8.2 Table 9.1 Number of cases and prevalence of asbestosis by age and population group (2003) Number of cases and prevalence of emphysema by age and population group (2003) Number of cases and prevalence of emphysema by commodity and population group (2003) Number of cases and prevalence of emphysema by years of service and population group (2003) Number and proportion of mesothelioma cases by age and population group (2003) Number and proportion of mesothelioma cases by commodity and population group (2003) Number of cases and prevalence of primary lung cancer by age and population group (2003) Number of cases and prevalence of primary lung cancer by commodity and population group (2003) Clinical causes of death by population group (2003) 12 13 13 14 15 15 16 16 17 LIST OF FIGURES Figure 1 Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 9.1 Overall disease rates for 2003 Distribution of autopsies by age and population group (2003) Distribution of autopsies by commodity and population group (2003) Distribution of autopsies by years of service and population group (2003) Distribution of active TB by site (2003) Clinical cause of death as given by the clinicians who submit the organs to the NIOH (2003) 4 5 6 8 17 APPENDICES Appendix 1: Distribution of autopsies according to the last mine where the deceased worked (2003) Appendix 2: PATHaUt publications and activities (2003) 18 23 iii GLOSSARY Asbestosis Coal workers' pneumoconiosis Emphysema Massive fibrosis Mesothelioma Miner Mixed exposures Prevalence Silicosis Surveillance Lung fibrosis caused by asbestos fibres Lung fibrosis caused by exposure to coal dust Lung disease caused by the destruction of the alveolar walls Lung fibrosis caused by exposure to dust and measuring more than 1cm in diameter A malignant tumour of the pleural cavity of the lungs A person who has worked in a controlled mine or works The multiple dust types to which a miner may be exposed, having worked in several mining commodities in his lifetime The number of cases in a defined population at a given time Lung fibrosis caused by inhalation of silica dust; detected by the presence of silicotic nodules in the lung tissue The ongoing and systematic collection, analysis and interpretation of data related to either occupational exposure or adverse health outcomes iv SECTION 1 - BACKGROUND The Occupational Diseases in Mines and Works Act, 1973 (Act 78 of 1973) requires that the cardio-respiratory organs of a deceased person who has worked at a controlled mine or a controlled works be examined for the presence of occupational disease, regardless of the clinical cause of death and provided that the next of kin agrees. These examinations are performed by pathologists at the National Institute for Occupational Health (NIOH). A detailed report on each case examined 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 for compensation is managed. Since 1975, the pathological findings from the autopsy examinations have been recorded on the computerized PATHAUT database. PATHAUT comprises data from autopsy examinations and clinical files which include occupational histories. The database is unique and provides an important resource for both surveillance and research. These data are the only comprehensive surveillance data on occupational lung disease in the South African mining industry. The data presented in this report summarise the PATHAUT system surveillance results, i.e. the results of the systematic collection, collation, and analysis of the pathology findings in the cardio-respiratory organs of mine workers. Data from PATHAUT are exported into, and analysed, using SAS v8.8. This is the seventh consecutive annual report and describes autopsy cases examined during the year 2003. Many of the cases had "mixed" exposures in that they had been employed in more than one commodity. For simplicity, cases are categorized according to the commodity in which most years of service were recorded, i.e. the commodity in which they had worked for the longest period. In Appendix 1, however, the cases are listed according to the most recent (last) mine at which the miners worked. All disease rates reported in this document are expressed per 1000. In all calculations, the denominators used are the total numbers of autopsies in specific commodities, age groups or population groups. Some of these rates must be viewed with caution, as the denominators are very small. This applies, for example, to those commodities where few workers are employed (such as tin mining), and to the older age groups in some instances. 1 SECTION 2 - DEMOGRAPHIC DATA The number of autopsies performed since 1975 is presented in Table 2-1. TABLE 2-1 DISTRIBUTION OF AUTOPSIES BY YEAR AND POPULATION GROUP (1975 - 2003) Year of autopsy 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996* 1997 1998 1999 2000 2001 2002 2003 Total Black N% 2 190 71 2 335 68 2 351 69 2 245 67 2 118 66 2 338 64 2 209 66 2 312 63 2 096 65 1 966 64 2 275 64 2 456 68 2 594 68 2 518 67 2 138 65 2 172 64 2 143 65 2 144 66 1 863 65 1 737 61 2 830 71 766 68 2 223 69 1 977 69 1 656 65 1 798 69 1 690 67 1 677 67 1 536 66 60 353 66 White N% 854 28 1 072 31 1 039 30 1 090 32 1 026 33 1 274 35 1 117 33 1 302 36 1 109 34 1 098 36 1 200 34 1 125 31 1 168 30 1 165 31 1 090 33 1 155 34 1 080 33 1 049 32 956 33 1 021 36 1 059 27 329 29 897 28 836 29 832 33 761 29 813 32 763 30 745 32 29 025 32 Coloured N% 32 1 27 1 33 1 32 1 45 1 46 1 33 1 44 1 41 1 28 1 66 2 45 1 78 2 77 2 60 2 51 2 66 2 70 2 65 2 94 3 99 2 19 2 70 2 49 2 29 1 41 2 13 1 50 2 23 1 1 426 2 Indian N% 1 1 20 * Data for only 6 months are available for 1996 Unknown N% 14 1.2 18 0.6 17 0.6 12 0.5 8 0.3 13 0.5 28 1.1 13 0.6 123 0.1 Total N 3 076 3 434 3 423 3 367 3 189 3 658 3 359 3 658 3 246 3 092 3 541 3 626 3 840 3 760 3 288 3 378 3 289 3 263 2 884 2 852 3 988 1 128 3 208 2 880 2 529 2 608 2 529 2 518 2 318 90 929 It is important to note that a referral bias exists: black men are infrequently autopsied after leaving employment in the mines, whereas the majority of whites come to autopsy after retirement. The numbers of miners coming to autopsy has decreased steadily over the years, probably reflecting the concomitant decrease in the number of miners. In 1994 there were around 344 000 people employed in the gold mining industry compared to 183 000 in 2003. 2 The pathologists at the NIOH perform two types of autopsy examinations. For men dying distant from Johannesburg, the cardio-respiratory organs are removed locally, preserved in formalin and sent to the NIOH. Full autopsies are undertaken on men who die close to Johannesburg. Table 2-2 shows the distribution of autopsies by population group for 2003. Autopsies of only cardio-respiratory organs comprised 94.8% of all examinations. TABLE 2-2 NUMBER AND PROPORTION OF AUTOPSIES BY TYPE AND POPULATION GROUP (2003) Autopsy type Cardiorespiratory organs only Full autopsy Total Black N% 1531 99.7 5 0.3 1536 White N% 630 84.6 115 15.4 745 Coloured N% 23 100 0- 23 Unknown N% 13 100 0- 13 Total N% 2198 94.8 120 5.2 2318 The age distribution of autopsies for 2003 is shown in Table 2-3 and Figure 2-1. The mean age at autopsy for black men has increased from 37.9 years in 1998 to 43.4 years in 2003. The mean age of white men at autopsy has remained essentially unchanged (63.5 in 2003). TABLE 2-3 NUMBER AND PROPORTION OF AUTOPSIES BY AGE AND POPULATION GROUP (2003) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N% 67 386 686 287 22 7 5 76 1 536 4.4 25.1 44.7 18.7 1.4 0.5 0.3 4.9 White N% 5 0.7 20 2.7 84 11.3 151 20.3 228 30.6 173 23.2 79 10.6 5 0.7 745 Coloured N% 01 4.3 2 8.7 6 26.1 6 26.1 5 21.7 2 8.7 1 4.3 23 Unknown N% Total N% 0 - 72 3.1 0 - 407 17.6 1 7.7 773 33.3 0 - 444 19.2 0 - 257 11.1 0 - 185 8.0 0 - 86 3.7 12 92.3 94 4.1 13 2 318 3 TABLE 2-4 NUMBER AND PROPORTION OF AUTOPSIES BY COMMODITY AND POPULATION GROUP (2003) Commodity Gold Platinum Coal Asbestos Iscor Diamond Copper Iron Manganese Other Unknown Total Black N% 1 100 71.6 315 20.5 44 2.9 35 2.3 011 0.7 2 0.1 2 0.1 9 0.6 7 0.5 11 0.7 1 536 White N% 498 66.8 38 5.1 64 8.6 35 4.7 27 3.6 10 1.3 13 1.7 11 1.5 2 0.3 19 2.6 28 3.8 745 Coloured N% 1 4.3 2 8.7 1 4.3 16 69.6 0000003 13.0 23 Unknown N% 1 7.7 00000000012 92.3 13 Total N% 1 600 69.0 355 15.3 110 4.7 86 3.7 27 1.2 21 0.9 15 0.6 13 0.6 11 0.5 26 1.1 54 2.3 2 318 Note: this table reports only those commodities where a total of 10 or more autopsies were received Black 71.6 20.5 White Coloured l~~l Gold EH Coal EH Platinum EH Asbestos EH Other* FIG 2-2 DISTRIBUTION OF AUTOPSIES BY COMMODITY AND POPULATION GROUP (2003) * Includes Iscor, copper, diamond, quarry, silica (silicon smelters), manganese, tin, zinc, minerals, steel and chrome, iron, manganese, fluorspar, lime, railways and other industries, as well as cases where information about type of mining is missing 5 Detailed information about the years in mining service by population group is presented in Table 2-5 and Figure 2-3. It is important to note the large proportion of cases with missing information about the duration of service (21.8%). This proportion is similar to that found in 2002 (21.6), 2001 (24.4%), 2000 (22.6%) and 1999 (22.7%) but considerably lower than that for 1998 (43%). TABLE 2-5 NUMBER AND PROPORTION OF AUTOPSIES BY YEARS OF SERVICE AND POPULATION GROUP (2003) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41 + Unknown Total Black N% 26 1.7 129 8.4 248 16.1 292 19.0 300 19.5 151 9.8 53 3.5 9 0.6 3 0.2 1 0.1 324 21.1 1 536 White N% 2 0.3 56 7.5 42 5.6 66 8.9 86 11.5 92 12.3 79 10.6 79 10.6 58 7.8 28 3.8 157 21.1 745 Coloured N% 04 17.4 2 8.7 1 4.3 3 13.0 2 8.7 000110 43.5 23 Unknown N% 001 7.7 000000012 92.3 13 Total N% 28 1.2 189 8.2 293 12.6 359 15.5 389 16.8 245 10.6 132 5.7 88 3.8 61 2.6 31 1.3 503 21.7 2 318 Years of service: < 1 1 - 5 6 - 10 11 - 15 Q16 - 20 21 - 25 26 - 30 31 - 35 36 - 40Q 41 + FIG 2-3 DISTRIBUTION OF AUTOPSIES BY YEARS OF SERVICE AND POPULATION GROUP (2003) 6 The mean age and duration of service by commodity type and population group for those cases for which information was available are shown in Tables 2-6 and 2-7. TABLE 2-6: MEAN AGE BY COMMODITY AND POPULATION GROUP (2003) Black White Commodity N Mean SD* N Mean SD* (years) (years) Gold 1028 42 7 496 64 13 Coal 44 46 9 64 62 14 Platinum 313 44 8 38 59 11 Asbestos 35 57 14 35 65 8 Diamond 11 48 8 10 61 12 Copper 2 46 8 13 67 10 Iscor 0- - 27 64 11 Other 18 54 13 32 63 11 Unknown 9 51 16 25 60 14 Total 1460 43 8 740 64 13 * Standard deviation TABLE 2-7: MEAN DURATION OF SERVICE BY COMMODITY AND POPULATION GROUP (2003) Black Commodity N Mean SD* (years) Gold 920 14 7 Coal 37 19 9 Platinum 208 14 6 Asbestos 26 9 11 Diamond 10 23 6 Copper 0- - Iscor 0- - Other Unknown 11 16 0- 10 - Total 1212 14 7 * Standard deviation White N Mean SD* (years) 421 24 11 49 23 11 24 17 8 28 12 9 7 18 8 8 15 14 25 22 11 26 20 0- 9 - 588 23 11 7 SECTION 3 - ACTIVE TUBERCULOSIS The distribution of active tuberculosis (TB) by anatomical site is presented in Figure 3-1 (n=639). Active pulmonary TB (PTB) was diagnosed in 22.3% (518) of all cases autopsied in 2003, in comparison to 20.7% (521) in 2002, 19.2% (486) in 2001, and 16.0% (416) in 2000. Most of the men with PTB were black (92.9%; 481 cases), 5.4% (28 cases) were white, 1.2% (6 cases) were coloured, and in 0.6% (3 cases) the population group was unknown 3.6 4.2 1.4 23.5 50.9 16.4 Lungs & nodes (325; 50.9%) Lungs, nodes & pleura (23; 3.6%) Lungs only (150; 23.5%) Lungs, nodes & pericardium (9; 1.4%) Nodes only (105; 16.4%) Other combinations (36; 4.2%) FIG 3-1 DISTRIBUTION OF ACTIVE TB BY SITE (2003) The overall rate of PTB (223/1000) has increased from 207/1000 in 2002, 192/1000 in 2001, 160/1000 in 2000 and 123/1000 in 1999. This is attributed to the increase in the PTB rate in black men to 313/1000, from 287/1000 in 2002, 267/1000 in 2001, 217/1000 in 2000, and 174/1000 in 1999. In black gold miners, the rate of PTB has increased annually from 171/1000 in 1999 to 328 in 2003. Rates in black platinum miners increased steadily from 1999 (179/1000) to 2002 (383/1000). However, in 2003 the rate decreased to 305/1000. The distribution of active PTB cases by commodity is shown in Table 3-1. Rates in this and the following tables are expressed per 1000. The majority of active PTB cases (73.6%) came from the gold mining industry (69.0% of all autopsy cases came from that commodity). 8 TABLE 3-1 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY COMMODITY AND POPULATION GROUP (2003) Commodity Black White N Rate N Rate Coloured N Rate Unknown N Rate Gold 361 328 20 40 0 -0 - Platinum 96 305 3 79 1 500 0 - Coal 6 136 1 16 0 -0 - Asbestos 8 229 1 29 5 313 0 - Diamond 4 2 0 0 Copper 0 1 0 0 Other 3 0 0 0 Unknown 3 0 0 3 Total 481 313 28 38 6 261 3 231 Note: rates have not been ca culated where numbers are small Total N Rate 381 238 100 282 7 64 14 163 6 1 3 6 518 223 The age distribution of cases with active PTB is shown in Table 3-2. Most (68.3%; 354 cases) were in the age group 30-49 years. TABLE 3-2 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY AGE AND POPULATION GROUP (2003) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 16 239 117 303 232 338 81 282 7 318 1 143 0- 27 355 481 313 White N Rate 01 50 3 36 8 53 11 48 3 17 2 25 -- 28 38 Coloured N Rate 001 500 03 500 2 400 00- 6 261 Unknown N Rate 00000003 250 3 231 Total N Rate 16 222 118 290 236 305 89 200 21 82 6 32 2 23 30 319 518 223 9 SECTION 4 - SILICOSIS Silicotic nodules were found in the lungs of 437 cases (18.9% of all autopsies), 91.5% of which came from the gold mining industry. Of all cases of silicosis, occasional silicotic nodules were found in 57.9% of cases, a few in 19.5%, a moderate number in 19.9% and a large number in 2.8%. The distribution of cases with silicosis by commodity and population group is presented in Table 4-1. As indicated previously, cases are categorized according to the commodity in which the most years of service occurred. The rate of silicosis in gold miners has remained fairly constant over the last three years, viz. 228/1000 in 2001, 252/1000 in 2002, and 250/1000 in 2003. Cases of silicosis from the platinum mining industry might be explained by unstated previous service in gold mines. Rates are expressed per 1 000 autopsies. TABLE 4-1 NUMBER OF CASES AND PREVALENCE OF SILICOSIS BY COMMODITY AND POPULATION GROUP (2003) Commodity Black N Rate White N Rate Coloured N Rate Unknown N Rate Gold 290 264 109 219 1 1000 0 - Asbestos 2 57 2 57 0 -0 - Coal 1 23 4 63 0 -0 - Platinum 13 41 0 - 0 - 0 - Diamond 2 2 0 0 Copper 0 1 0 0 Other 2 3 0 0 Unknown Total 03 310 202 124 166 0 1 43 2 2 154 Note: rates have not been ca culated where numbers are small Total N Rate 400 250 4 47 5 45 13 37 4 1 5 5 437 189 Although the silicosis rates increased with increasing age in both black and white men, the age distribution of cases with silicosis (Table 4-2) differed between the two population groups. Higher rates of silicosis were found in blacks at younger ages. Nevertheless, silicosis was diagnosed in young men (< 30 years old) in both population groups, as well as in those with few years (< 5 years) of silica exposure (Table 4.3). 10 TABLE 4-2 NUMBER OF CASES AND PREVALENCE OF SILICOSIS IN THE GOLD MINING INDUSTRY, BY AGE AND POPULATION GROUP (2003) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 1 19 30 99 159 317 79 485 5 625 0016 222 290 264 White N Rate 01 71 5 96 19 188 37 253 34 286 12 200 1 500 109 219 Colo ured N Rate -------1 1 000 1 1 000 Unknown N Rate 00000000- 0- Total N 1 31 164 98 42 34 12 18 400 Rate 18 98 295 371 273 283 200 240 250 TABLE 4-3 NUMBER OF CASES AND PREVALENCE OF SILICOSIS IN THE GOLD MINING INDUSTRY, BY YEARS OF SERVICE AND POPULATION GROUP (2003) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41+ Unknown Total Black N Rate 3 176 17 181 26 127 51 222 83 379 50 459 16 432 4 500 1 500 -39 217 290 264 White N Rate 1 500 3 88 2 80 7 167 12 207 11 175 17 298 23 343 17 354 4 160 12 156 109 219 Coloured N Rate ----------1 1 000 1 1 000 Unknown N Rate 00000000000- 0- Total N Rate 4 211 20 156 28 122 58 213 95 343 61 355 33 351 27 360 18 360 4 160 52 202 400 250 11 SECTION 5 - OTHER PNEUMOCONIOSES MASSIVE FIBROSIS There were 20 (0.9%) cases of massive fibrosis (11 black, 8 white). Eighteen were from the gold mining industry. COAL WORKERS' PNEUMOCONIOSIS There were 11 (0.5%) cases of coal workers' pneumoconiosis. MIXED DUST PNEUMOCONIOSIS There were 4 (0.2%) cases of mixed dust pneumoconiosis. ASBESTOSIS AND PLEURAL PLAQUES There were 44 cases of asbestosis of which 61.4% (n=27) had slight, 31.8% (n=14) moderate and 6.8% (n=3) marked fibrosis. 32 cases had worked in the asbestos mining industry at some time in their lives. Only three of the cases submitted with a history of asbestos exposure had asbestos plaques. However, the parietal pleura (the site where plaque formation usually occurs) is seldom submitted with the lungs. The distribution of asbestosis by age and population group is shown in Table 5-1. No asbestosis was diagnosed in cases under 40 years of age. TABLE 5-1 NUMBER OF CASES AND PREVALENCE OF ASBESTOSIS BY AGE AND POPULATION GROUP (2003) Age group (years) 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 46 7 24 3 136 3 429 3 600 020 13 White N Rate 04 26 6 26 6 35 3 38 0- 19 26 Coloured N Rate 02 333 2 333 1 200 00- 5 217 Unknown N Rate 000000- 0- Total N Rate 45 13 29 11 43 10 54 6 70 044 19 12 SECTION 6 - EMPHYSEMA There were 440 cases of emphysema, the extent of which was mild in 78.6% (n=346), moderate in 18.6% (n=82) and marked in 2.7% (n=12). The distribution of emphysema by age and population group is presented in Table 6-1. TABLE 6-1 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY AGE AND POPULATION GROUP (2003) Age group (years) 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 9 23 63 92 56 195 2 91 2 286 4 800 6 79 142 92 White N Rate 08 95 43 285 103 452 91 526 42 532 1 200 288 387 Coloured N Rate 001 167 4 667 2 400 01 1000 8 348 Unknown N Rate 0000002 167 10 154 Total N Rate 9 22 71 92 100 225 109 424 95 514 46 535 10 106 440 190 The majority of black and white men with emphysema 62.0% (n=273) were from the gold mining industry (Table 6-2). TABLE 6-2 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY COMMODITY AND POPULATION GROUP (2003) Commodity Gold Platinum Coal Asbestos Iscor Copper Diamond Other Unknown Black N Rate 81 74 30 95 15 341 8 29 0- 0 3 4 1 White N Rate 191 384 15 395 26 406 11 314 12 444 3 3 15 12 Coloured Unknown N Rate N Rate 1 1000 0 0- 01 1000 0 6 375 0 0- 0- 00 00 00 02 Total N Rate 273 171 45 127 42 382 25 291 12 444 8 6 19 15 Total 142 92 288 387 8 348 2 154 440 190 Note: rates have not been ca culated where numbers are small 13 TABLE 6-3 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY YEARS OF SERVICE AND POPULATION GROUP (2003) Years of service 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41 + Unknown Total Black N Rate 7 54 16 65 27 92 32 107 27 179 7 132 2 222 1 333 1 1000 22 68 142 92 White N Rate 13 232 17 405 18 273 25 291 37 402 36 456 34 430 31 534 13 464 64 408 288 387 Coloured N Rate 2 500 1 500 1 1000 1 333 00001 1000 2 200 8 348 Unknown N Rate 0000000002 167 2 154 Total N Rate 22 116 34 116 46 128 58 149 64 261 43 326 36 409 32 525 15 484 90 179 440 190 14 SECTION 7 - MESOTHELIOMA The number of cases of mesothelioma in 2003 (n=37) was higher than in previous years (19 in 1998, 24 in 1999, 17 in 2000, 18 in 2001 and 27 in 2002). Sixteen cases (43.2%) had previously worked in the asbestos mining industry (not necessarily for the longest period). TABLE 7-1 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY AGE AND POPULATION GROUP (2003) Age group (years) 40-49 50-59 60-69 70-79 80+ Total Black N% 5 33.3 4 26.7 3 20.0 3 20.0 0 0.0 15 White N% 3 13.6 3 13.6 12 54.5 4 18.2 0 0.0 22 Coloured N% 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 Total N% 8 21.6 7 18.9 15 40.5 7 18.9 0 0.0 37 The distribution of mesothelioma by commodity and population group is presented in Table 7-2. The highest proportion of mesothelioma cases was found in asbestos miners (35.1%). TABLE 7-2 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY COMMODITY AND POPULATION GROUP (2003) Commodity Asbestos Gold Platinum Copper Iscor Other Unknown Total Black N% 9 60.0 3 20.0 1 6.7 0 0.0 0 0.0 1 6.7 1 6.7 15 White N% 4 18.2 8 36.4 0 0.0 1 4.5 1 4.5 4 18.2 4 18.2 22 Coloured N% 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 Total N% 13 35.1 11 29.7 1 2.7 1 2.7 1 2.7 5 13.5 5 13.5 37 *2 February 2006. In an earlier print run of this report, the total number of mesothelioma cases was given as 36. Changes have been made to the text and tables. 15 SECTION 8 - PRIMARY LUNG CANCER Seventy two cases of primary lung cancer were found at autopsy, 19.4% of which were in black, 76.4% in white, and 4.2% in coloured men. Most of the cases were adenocarcinomas (30.6%; n = 22), followed by squamous cell type (27.8%; n = 20), small cell type (22.2%; n = 16), and large cell type (18.1%; n = 13). One case of bronchoalveolar carcinoma was diagnosed. The distribution of primary lung cancer by age and population group is presented in Table 8-1. TABLE 8-1 NUMBER OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY AGE AND POPULATION GROUP (2003) Age group (years) 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 13 69 5 17 1 45 01 200 014 9 White N Rate 01 12 10 66 25 110 11 64 8 101 055 74 Coloured N Rate 001 167 1 167 1 200 003 130 Total N Rate 12 79 16 36 27 105 12 65 9 105 00 72 31 The distribution of primary lung cancer by commodity and population group is presented in Table 8-2. For white men, the majority of cases came from the gold mining industry. TABLE 8-2 NUMBER OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY COMMODITY AND POPULATION GROUP (2003) Commodity Gold Coal Asbestos Platinum Copper Iscor Other Unknown Total Black N Rate 44 3 68 3 86 26 002 286 014 9 White N Rate 34 68 1 16 6 171 6 158 1 77 2 74 4 211 1 36 55 74 Coloured N Rate 002 125 00001 333 3 130 Total N Rate 38 24 4 36 11 128 8 23 1 67 2 74 6 231 2 37 72 31 16 APPENDIX 1: DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE WHERE THE DECEASED WORKED (2003) Commodity Antimony Asbestos Total from asbestos mines Chrome Total from chrome mines Coal Last mine worked Helam Antimony Mine African Chrysolite Asbestos Asbestos Mine Bandag Asbestos Mine Bewaarkloof Asbestos Mine Black Rock Asbestos Mine Blackrich Asbestos Cape Blue Danielskuil Asbestos mine Everite Gefco Kliphuis Koegas Mashaba Asbestos Mine Noupoort Asbestos Mine Penge Asbestos Pomfret Asbestos Mine Turnall Asbestos Black 1 1 1 1 30 1 35 Chrome Mine Mooinooi Palmiet Chrome Arnot Colliery Atcom Opencast Coal Mine Amcoal Colliery Bank Colliery Brandspruit Colliery Coalbrook Colliery Coalfield Mine Cornelia Colliery Delmas Colliery Douglas Colliery Duiker Colliery Durban Navigation Colliery Durnacol Mine Duvha Opencast Ermelo Coal Goedehoop Colliery Greenside Colliery Grootgeluk Hlobane Colliery Kleinkopje Colliery Koornfontein Coal Kriel Colliery Landau Colliery Longridge Collieries Matla Coal Middelburg Colliery 6 1 4 1 1 4 2 6 7 1 White 1 1 4 Coloured Unknown 1 3 1 31 11 2 10 5 1 47 1 1 1 3 1 37 15 4 1 1 6 2 1 1 1 1 3 1 2 1 1 1 1 1 1 1 1 1 2 3 2 1 1 5 1 Total 1 2 5 1 4 1 4 2 2 45 1 11 1 1 2 3 1 87 4 1 1 6 8 1 1 4 2 1 1 3 1 3 1 1 2 1 1 5 1 1 1 4 3 8 1 1 12 2 18 Commodity Gold (continued) Last mine worked Chavani GM City Deep Consolidated Murchison Crown Mines Daggasfontein Deelkraal Doornfontein Doringkop GM Durban Roodepoort Deep East Driefontein East Rand Prop Elandsrand Evander GM Freddies Gold Free State Geduld Free State Saaiplaas Goldfields Grinaker GM Grootvlei Prop Harmony Hartebeesfontein J.I.C. Gold Mine Joel Kinross Kloof Kopanang GM Loraine Leeudoorn Leslie Libanon Luipaardsvlei Estate GM Marievale Masimong Gold Mine Matjabeng Gold Mine Merriespruit GM Middelburg GM Minroc GM New Kleinfontein GM Nigel GM Oryx Placer Dome GM Poortjie GM President Brand President Steyn Rand Leases Rand Mines Randfontein S A Land Saaiplaas GM South Deep GM South Roodepoort Spaarwater GM Springs GM St Helena State GM Stilfontein Black 74 5 43 3 5 1 100 74 4 6 13 88 1 13 1 13 16 13 1 37 27 1 26 1 25 1 White 1 1 1 2 4 5 6 1 9 14 21 3 4 Coloured Unknown 14 1 10 27 16 3 1 2 11 3 6 8 1 3 1 1 2 1 1 1 18 1 12 2 1 17 1 1 1 1 1 6 11 Total 1 1 1 2 4 5 6 1 9 88 26 3 47 3 14 1 5 1 10 127 90 7 7 15 99 1 3 19 1 21 1 3 16 13 1 1 1 2 1 37 28 1 20 12 2 1 43 1 1 1 1 1 1 31 1 11 20 Commodity Gold (continued) Total from gold mines Platinum Total from platinum mines Iron Total from iron mines Manganese Total from manganese mines Tin Total from tin Last mine worked Sub Nigel Transvaal GM Tshepone GM Ubuntu Small Scale GM Unisel GM Vaal Reefs Ventersport Virginia GM Vlakfontein Vogelstruisbult Welkom GM West Driefontein West Rand Consolidation West Witwatersrand Western Areas Western Deep Levels Western Holdings Winkelhaak Wit Nigel GM Atok Platinum Bafokeng Eastern Platinum Impala Platinum Karee Platinum Lebowa Platinum Modikwa Platinum Messina Platinum Northam Platinum Paardekraal Anglo Plats Rustenburg Platinum Swartklip Platinum Townlands Platinum Mine Western Platinum Wildebeestfontein Zondereinde Platinum Unknown Platinum Iron Ore Mine Sishen Iron Mine Thabazimbi Iron Mine Hotazel Manganese Mine National Manganese S A Manganese Rooiberg Mineral Division Rooiberg Tin Mine Zaaiplaats Tin Mine Black 22 2 1 179 1 54 1 54 1080 1 4 90 14 2 2 2 13 188 2 5 13 336 1 1 2 2 1 3 6 White 1 1 2 Coloured Unknown 1 44 8 2 3 1 5 21 7 2 13 16 13 1 3 457 2 1 1 2 19 2 1 1 1 2 1 24 1 8 1 62 2 1 1 2 3 1 4 1 1 1 3 Total 1 1 24 2 2 223 8 2 3 1 6 75 8 2 13 70 13 1 3 1540 1 5 2 111 15 3 3 2 15 1 212 2 1 8 5 13 1 400 1 2 1 4 2 3 1 4 10 1 1 1 3 21 Commodity mines Fluorspar Iron & Manganese Lead & Minerals Quarries Silica Sinkers Steel Steel & Iron Zinc Non-Miner Unknown TOTAL Last mine worked Witkp Fluorspar Mine Associated Manganese Blackmountain Stone Allied Crushers Silicon Smelters Shaft Sinkers Highveld Steel and Vanadium Iscor Zinc Corporation Industry Rhodesia Railways Transnet Unknown Black White Coloured Unknown 1 22 2 1 21 1 4 1 38 1 2 10 1 1 11 25 3 12 1536 745 23 13 Total 1 4 2 1 3 1 39 1 12 1 1 51 2 318 22 APPENDIX 2: PATHAUT PUBLICATIONS AND ACTIVITIES (2003) Journal articles Published: 1. Murray J, Rees D. Tuberculosis and silicosis in South African gold mining. OSH and Development 2003; 5: 2-10. In press: 1. Gerston KF, Blumberg L, Tshabalala VA, Murray J. Viability of mycobacteria in formalinfixed lungs. (In press: Human Pathology). 2. Murray J, Nelson G. Demographic data and disease rates in deceased South African miners. (In press: Occupational Health Southern Africa). 3. Ross MH, Murray J. Occupational respiratory disease in mining. (In press: Occupational Medicine). 4. Murray J, Back P, Nelson G. Pulmonary nocardiosis in autopsies of South African miners. (In press: South African Journal of Epidemiology and Infectious Diseases). Submitted: 1. Naidoo RN, Robins TG, Murray J, Green FHY, Vallyathan V. Validation of autopsy data for epidemiologic studies of coal miners. (Submitted: American Journal of Industrial Medicine). Congresses 1. Candy G, Murray J. Trends in atheroma diagnosed at autopsy in SA miners 1975 - 2001. 13th congress of South African Hypertension Society. March 2003, Sandton City Conference Centre, Johannesburg. 2. Phillips J, Murray J, Nelson G. Asbestos, Simian Virus 40 and Mesothelioma. Mine Medical Officers Association, Sixth Annual congress. May 2003, Sparkling Waters Hotel, Rustenburg. 3. Calverley A, Murray J. South Africa's treasure chest: Pandora's box for health? 9th International Inhalation Symposium. June 2003, Hannover, Germany. 4. Candy G, Murray J. Increasing prevalence of coronary artery atherosclerosis in South African black and white miners: NCOH PATHAUT mining autopsy data. 43rd Conference of the federation of South African Society of Pathology. June 2003, Johannesburg. 5. Honma K, Murray J. Intrapulmonary lymph nodes in South African miners - An autopsy survey. 19th European Congress of Pathology. September 2003, Ljubljana, Slovenia. Higher degrees 1. Sartorius B. MSc in Epidemiology and Biostatics : Prevalence, trends and risk factors of arteriosclerosis in autopsied SA miners from 1975 - 2001. Completed 2003. School of Public Health, University of the Witwatersrand 2. Chaudry S. MSc in Epidemiology and Biostatics: Attribution of lung cancer to asbestos exposure in miners in South Africa. Ongoing, started 2003. School of Public Health, University of the Witwatersrand. 23 Material from the autopsy service was presented to a wide range of audiences, e.g. health care workers on the mines, occupational health nurses, members of the National Union of Mineworkers, Department of Labour employees; and at various forums, such as University of the Witwatersrand Research Days and local workshops. 24 DISTRIBUTION LIST Individuals Dr John Robinson Prof David Rees Prof Mary Ross Ms May Hermanus Mr Doug Rowe Dr Molly Ohaju Ms Michelle Kotze National Health Laboratory Services (NHLS) National Institute for Occupational Health (NIOH) Safety in mines Research Advisory Committee (SIMRAC) Department of Minerals and Energy (DME) Department of Minerals and Energy (DME) Department of Minerals and Energy (DME) Department of Health (DoH) Institutions Medical Bureau of Occupational Diseases (MBOD) Compensation Commissioner for Occupational Diseases (CCOD) Department of Labour (DoL) National Institute for Occupational Safety and Health (NIOSH) Department of Health (DoH) Libraries National Institute for Occupational Health National Health Laboratory Services University of the Witwatersrand Medical School Mine Occupational Health Services