Document R543b9jdQv4XwyGna5a2KpMv

g*feiojrs o Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos Mount Sinai School of Medicine, New York Prepared for National Inst, for Occupational Safety and Health/ Cincinnati, OH 1982 PB83-220it7 / HWBUI0008390 PB3-2 2Ca'f 7 r Investigation of Health Hazards in ltrafce Lining Repair .-.ud Maintenance Workers Occupationally Exposed to Asbestos ~ NIOSH Contract 210-77-01 l'j Principal 1 nvesti jv i or William J. :aohoIson, Ph.D. V _________ __________ 7 r - ^ ~^\ ENVIRONMENTAL SCIENCES LABORATORY MOUNT Kl tC<l(K or uU'iOxl u< **. i . u'iki . ul K( to-- OO00 if national technical INFORMATION SERVICE 7 HWBUI0008391 ,-MPatf maimmmm * Jy - ** `.Investigation of Health Hazards In Brake Lining Repair and |Kafhtenance Workers Occupationally Exposed to Asbestos W.j. Nicholson Sinai School of Medicine of the City '^University, of New York -- ^ . V* = : .. * '' Parkway ^ ClneihnaciOhio "43226 prr r 220897 4a HA m. rm,.rrr... * 210-77-0119 m 5X Tj* W toM 4 WwW M. HA Hk- -r * -- W--* , mam/mmm, &&* trnmmrn are several sources of asbestos exposure to garage nechanicsand automobile repairmen. that the asbestos exposure from the debris of brake or clutch lining -wear,' particularly when the brake or clutch housing are cleaned using a high pressure air hose. Second, garage mechanics may be at risk from exposures during the use of autobody ~ fnietr and, finally, asbestos dust can be disseminated during mixing and application of ` undercoating materials each of which has contained the fi*:or in previous years. ) Jit order to determine-'the extent of the asbestos-real ted risk from garage maintenance work, . . ftlQSH has contracted with the Environmental Sciences Laboratory to conduct a clinical ^^exiirtnation of garage mechanics. The examination was to focus specifically upon those .^manifestations of'asbestos disease, such as. x-ray abnormalities and pulmonary function .^deficits,, that,would elucidate the possible.effects from exposure to asbestcs in ^garage employments - v - C.'<rs' asbestos, brakes, automotive-repair, respiratory-disorders V k7AHMUt TO TfflE POTLIC nacLAsnrra wLM$mm Up imtMt HWBUI0008392 r Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos Authors William J. Nicholson, Ph.D. Susan M. Daum, M.D. William V. Lorimer, M.D. Haary Velez, M.D. Ruth Lilia, K.Oi Irving J. Selikoff, M.D. Albert Miller, M.D. Henry A. Anderson, M.D. S. Alf Fischbein, M.D. Edwin C. Holstein, M.D. William N. Rom, M.D., M.P.H. Kanneth D. Rosenman, M.D. James D. Todaro, M.D. Wei-nan Cheng, M.D. Vestal Li; S.S. Diane Tarr, B.A. ENVIBONMENTAL SCIENCES LABORATORY Q0 M% OtCiNI O# tf Ct V WAMVCM( o M .y * vha Vi... .... J................................................................................ HWBUI0008393 TABLE OF CONTENTS Introduction...................................................................................................................... I Materials and Methods................. .. ....................... .'............................... ................. 2 Study population......................................................................................................... 2 Examination locations and protocols......... .................................. 5 Results............................. .................................................................................................... 12 , Occupational histories.................................................................................. 12 . X-ray abnormalities. ....................................................................................... 17 Age standardization of X-ray readings........................................ 26 Smoking standardization of X-ray abnormalities................... 28 Standardized X-ray abnormalities by cork activity............ 29 . Autobody repair and undcrcoating work................................. .. 36 Effect of previous shipyard employment.................................... 38 Evidence of malignancy................................................... Pulmonary function tests............. ....................................................... Principal, sp iconic trie tests............................................. Measures of small airway flow......................... ............... 46 Possible effects fro* non-acchanic garage equipment.... 52 Autobody repair............................................................... Correlations between X-ray abnormalities and pulseaary function tests.......................................................... .. 60 Comparison with other populal ions............. .................................. 60 Physical examination results......... ................................................. 65 laboratory findings...................................................................... Nickel concentration inveldcrs............. ............................................... 74 Asbestos, exposure data.......................................................................... .... 86 Review of published results........................................................ 86 Measurements in Mew York City facilities...................... 90 Estimates of study population exposure.................................... _ 93 Summary...................... ........................................................ ........... ............................. 93 References................................................................ ........................................ ............. 97 Appendix 1............................... ................................... ...................................................... 1 41 41 41 59 74 HWBUI0008394 1 INTRODUCTION Several investigation! have indicated that significant asbestos expo sure say occur during brake maintenance and repair work (Nicholson, 1979; Rohl, et al. 1976; Hickiih and Knight, 1970). Lisited studies J` It have. suggested that.exposure say be associated with the risk of asbes tos-induced disease including both pulmonary asbestos!* and asbes tos-associated cancer (Lorimer ct al, 1976; Greenberg and Lloyd-Davies, 1974). These limited reports do not, however, indicate whether the risk of .asbestos-associated disease is common or uacmeaa. The question is of 'importance because over one million workers are regularly or interaiittently engaged in vehicle maintenance work in the United States at this time (Bureau of Labor Statistics, 1979). Additionally, a large number of other workers were formally engaged in such work in the past and now are either retired or employed otherwise. It is estimated that 4,940,000 individuals are currently alive with such current or past employment (Nicholson ct al., 1982). There are several sources of asbestos exposure to garage mechanics and > JeW**9f automobile repairmen. First, of course, is that the asbestos exposure from the debris of brake or clutch lining wear, particularly when the ckKK^7 brake or clutch housing are cleaned using a high pressure air hose. Second, garage mechanics may be at risk from exposures during the use of autobody filler and, finally, asbestos dust can be disseminated 2>- rrru\'-**-' during mixing and application of undercoatlng materials each of which has contained the fiber in previous years. la order to determine the extent of the asbestos-related risk from garage maintenance work, N10S1I has contracted with the Environmental Sciences Laboratory to^conduct a clinical examination of garage acchaics. The examination was to focus specifically upon those manifesta tions of asbestos disease, such as X-rny abnomai ities- and pulmonary function deficits, that would elucidate the possible effects from exposure to asbestos in garage employment. ) HWBUI0008395 2 STUDY POPULATION MATERIALS AMD METHODS The study population for this project consisted of Bombers of the following union group* who routinely performed brake maintenance repair work: *5 1. Local 259 of. the United Automobile Workers (UAW) whose members - were employed in comaicrcial garages in New York, New Jersey and Connnecticut, Also included were all pensioners maintaining vested rights in a program administered by the Local. 2. Local 246 of the Service Employees International Union (SEIU) employed in New York City municipal garages. The unexposed control population for the above brake workers consisted of: ' . ' ' ^l$m^:^relecud prior-tif tW;.be*iiuan*; o5?SS*Bc*iSfcfe'^u!^ w ` -?g. 353T:'*:- - f,l;` ' . * *-.'** v dS*. ,, . -detet^sing-JSSus- effect*'o-osiilid tto<.;.expe^usre ^<w ..workers cneageiT'tn `brake maintenance sad repair : t?--worlr. The. control groups, vere chosen because of memberatiipt in the tamer .iJs-idS--1 ';-'s ~ * ' * . r^miaa and similar employment circumstances but without brake auiintcn- ^'Vsnce work... .A* the Study progressed it was found that many of the control pagnlatlow had had exposure to asbestos in.other circumstances | such as shipyard work, and that fewer 1>C 37 members were particip.it ir.j* in the examination than was initially expected. Titus,, in consul La Li on HWBUI0008396 3 with the project officer, it was decided to add to the control group* the X-ray* to be taken la examinations of Local 595, UAW members earployed in production (aoa-maineermnee) job* ta an automobile body construction facility in Linden, Hew jersey. These workers were to be examined for effects of lead exposure associated with their work in an examination AprIT 7-10, 198(1. An analysis of their work activities had indicated that their current employment provided only limited opportu nity for asbestos exposure. The decision to include this group was made prior to the April examination. -A3 r> . In border to reflect the effects of asbestos exposure, only those in dividuals with tea years of employment in a particular trade were oA : considered for examination.. In the case of the UAU members this con sisted of sll individuals, with ten years'of union membership. For SE1U members who were classified as mechanics in the New York City Civil Service Employees categorization, five years of prior automobile main $tro *. ^ tenance work were required in order ta obtain such a status. Thus, the criteria of five years of union membership identified individuals, who had at least tea year* of employment la garage work as a mechanic or apprentice. Table I list* the distribution by seniority date and union: affiliation: of alt individuals Whn were invited and who; participated in thm examination*,. The response was limited by several circumstance*- One was the dis*> tease:' sany individual*.had; to- travel, in Order: to; react! ah examination, i&bj^' Joitexaeipl> both, local 259 and DC 37 Headquarters at which, most gifeg.a? t* examinations were Meld are located la lower Manhattan, whereas most = : I .. mswiy-j^riicipdat* lived; in- Brooklyn- or Qweensv- Many lived at even : ' V;*.*-* . . . - * .. . -s..' ' ' - 'i^!^tep4i#tittce* in Ue*tche*ter or Jfissia County, If.T. or .in' Ifew -'- ; - ' Jersey...'Exswinstiss sites vere arranged to accomodate as many of. the - . 1^,4. SS*-tudy pop;t*it`aat.,iom - as ^possible, but many Individuals still livre'od- " at`',***.11 . jjffliiidewliie-totMce 'from* d Another factor, wi* that, most shop* Jr^amiaed..'byiithe.se unions are relatively small'(79%-of the population Stockers/ in^ shop*, employI n fewer than 30 Members, only ane-aixttk*-o'f whom vouJ<J/Juvc beer* eplye3 for longer than ten .fear*/. sj*-- . . - < HWBUI0008397 4 ? a 4W<03 *co oC? 44s Su0 *4430> O e 3 > s -9 "4* a 3 & PI u c M *8 *3 <? u <*; n 6 sa *u* V) w w uc V . e o 40 u -eH j41 ua w tc 4o0 QW 6O c .. 44*0 3 V OV-:4 iA. O NC U 2. O :* ja *\ w HO .3 -3< a .,*3 dj w. II 0- ^C0-u*, s- e~* * o<5 3 oS <-S vn in %An- oH ex . <wf: ffi *"*- H Ox H- 8 O o OX Ox i O o *N i 41 Ue xmu 2e O3 Ua 3U <1 Hx U 40 ' e < <n it U >* 41 40 U H >% U . <* O 4J Oe* &< ; u da, . C O oC4:-uHU (f1*- HCo .M4UJ ' O U >v C. (-fel 43'-9>o-*4-' o<3 a OH 40 3 40 34t0i- * to3 uoM , *8H. -OC4 'Uv 4o1 -< . ac-.4*i e .:.mo- 6 4 0 3i 40 >* ' ...: - **< >* 5; .J*,-. 4*. -*: Ov +4' U.-7-. G; . c Vc - jC? 40 - 4* E S3UvvJ*K->4, UW9 *C-.M* ' 40 4r-. o,- O . : c o - m ofi =e eo-'- C5* P4 . m ' 40 **4 4. JO 3 --I m; 'w-s. oH- 0 ::: t .. ' : w ' 40-:*- W<T 40-;-'' i '- . ^ox ii 8 1 I; - * 3 -3 e e. ^ ' '. 8 40. *s.:.'.. u 8 U 41 w 40.*.* t OC - -<0n; . V-1' r-. -' ^ -- 8 w- o . e 1 ...,. ` 4* . -W - o 1 . o o o. <n - - i ;.: 40'-^,V-s-....... - f-- - C-' Of' I: 40 C ' '1. OO w i 3 ' ^- '40'- o 40. 1 -3 O 4> - Ox ic e. 44 8 : * ** C v C o 1 c e O4 40 40 | . 3> 4* ^ C^U g 0-J c C1 U -3 f 4. *4 a w f <1 C WK o s. 1 03 4 C U oo *4 u o 40 o UI 1 *3f H f- fe. 1 -< HWBUI0008398 s The contact with individuals in these shops was. by mail with letters fro* the Union President sad Or. Irvins J, Seliku/f of Mount Sinai School of Medicine, followed by a phone call from- Mount Sinai person nel. In the larger shops wh*.te' the: program w*.s also described by the Union health and: safety .representative and attendance encouraged, greater: participation resulted'. Finally, only one examination was held at each of the sites outside off Manhattan and those unable to attend on a given day .could only be accomodated: at a clinic in New York City. These factors led to a particularly low response of the 264 individuals invited to the examination site in Long Island where only 23.SX parti- a- - cipated versus 33.4% at the large shops of Condec. 3 Information was obtained by phone, and fro* the return: nailer, of the reasons for nan-participation. These are tabulated in Table 2. It also wan found that, of those sent invitations, 2.3-5.3% were undeliverable by the post office. EXAMINATION LOCATIONS AND PROTOCOL Examination*, were held at approxima tcly monthly Intervals? froin May 1978 through:. Jehrunry 1980 at a . variety- of sites chosen foc.fheir conVca-' icoe* to the residence .or employment location : tbe; participants. Theseincluded the. unionheadquarters. of Local 259,, MAMv in New; York City Vaad^ .Schenectady, Mew York;: the; Community Cen'ervi:SLa*fbrd, Con- nectieuCj;: the headquarters .of DC 37, State, County and Municipal Em ploys**. ttolon 1 - Hi;' YoMr' City;' the Paterson Clinic, .Paterson, Mew Jerseyi. the: Multiphesle flcdical. Center, Hempstead;, Long. Island^ and : Mount. Sihiei School of Medicine, New York City. For: those location* -.... :. : withont- If-ray facilities, portable units were obtained. In each lo- cation spirometry nations verir established using field survey equip ment of the- Pulmonary Function: Laboratory of Mount Sinai School off Medicine. Laboratory, cxaslntng. and. interview stations- were easily established Jo the:available space in all facilities. : Appendix 1 Is the form used for all t-xaieina lions. The cr.aai nations consisted off a complete* occupation*I history with detailed descriptions i. ! HWBUI0008399 6 Table 2 Reasons given for non-part tclp.nt Ion in examinations- Do not wish to partic.ipcte Noe interested Too. busy at this tine Inconvenient tir-c Recent examination Current illness. Injviry or incapacitation Illness or death In fnr.ily Too Car. to cq~c or coved away Miscellaneous non-hen]th .'reasons Telephone. response 20 20 20 7 5 3 A.- . s. Mail-in response 175 5 3 '5. .1 HWBUI0008400 of. work activities that could affect the health of the individual, 'iCfi Ascriptions of work practices during brake maintenance and repair g workr and. the use of- personal protect lot* devices. Special care was ~T takes to elicit information on previous qwire*f to asbestos sod otherj that might' be.paeuuoconiotic. The clinical examination, tests, and procedures consisted of: 1. complete medical history; 2. current: and- past uses o_f medications; 3. . current and past symptoms; c 4. physical examination; 5. complete blood count, including a differential count on individ uals with an abnorma] white cell count; 6. 20 channel blood chemistry analysis; 7. pulmonary function tests, Including determination of complete flow-voluae characteristics; S 14 x 17 inch, full size postcro/anterior chest X-ray. AJa Alleftest X-rayxy laboratory results, and examination findings were reviewed^ immediately for conditions that might require; urgent attrn? tiotti; If such condition* were found, the patient was not! fled and. If bt;wished, hia peraooal : physician was called. The radiocraph* were sabii^uentty interpreted; using the 110 U/C 'International Claatalfleaf low of Psjeuswcohioseav' Parenchymal changes of J/0^ or- greater were conaidered abnormal as were pleural thickening, pleural plaque* sod pleu ral calcification;.; Additionally other abnormal disease conditions'were noted. (S Appendix 2. ) Predicted-values for spirometry were based upon the revised analysis by Hiller fit al. (1980) of data of Morris, Koski, and Johnson (1971). The criteria; for individual spirooetcic abnormalities ace listed in Table 3. After interpretation of. the X-rays and review of all laboratory and clinical findings, a report and letter were prepared and sent to each participant. The two most isportaut parameters for the aesrsrsent of health effects from asbestos exposure are the manifestation of tail 1 irregular opacifies on an interprctahlc X-ray anJ restrictive pulmonary HWBUI0008401 8 TabU- 3 Criteria for normality of spirometry FVC FEV 1 FEV,/FVC > 801 of predicted > 751 of predicted <29, >.75 age 30-59, >.70 age- >60, >.65 FVC predicted = 0.147 r Height (in.) - 0.025 x Age (yr.) - 4.241 FEV^ predicted = 0.094 x Height (in. ) - 0.032 x Age (yr.) - 1.426 (For Blacks,, the predicted value* were 891 of the above.) MMT predicted 0.044 x lleight (ia.) -0.046 x Age (yr.) +2.806 (For flack*, the., same values were observed.); From: Miller, Thornton, S:ith *r.l Mori is. Am. J. Ind. Med. 1:55-68, (1980). HWBUI0008402 9 function deficits. Of the 916 individuals froot the four groups listed above who participated in the examinations, readable X-rays were avail able on 860 individual s and interpret;'!*! e pulmonary function testa on 883. The 6. IX unsatisfactory X-rays stemmed from, the use of portable X-ray facilities that did not have processing facilities immediately available. In one examination, a light leak developed in the X-ray cassette holder that rendered 30 X-rays unreadable (24 froa SEIU mem bers and 6 from DC 37 members). Because of the extensive travel in volved, lev with unreadable X-rays from the examination Look advantage of 4 the availability of another X-ray at a later examination. The distributions by union affiliation and vork. activity of participants with valid X-rays and pulmonary function tests are shown below in Tables 6 and 7. X-ray developing facilities were not available for films taken by the portable units and by two of the fixed installations used in this sur vey. The unavailability of a film for review at the tiae it was taken led to a less than desired quality for the readable X-rays. Both over- sad under-penetrated films present difficulties in the interpretation of th* minima 1 changes seen with low. level asbestos exposure. Thus-, a greater degree of inter-- and intra-observer variability exists with the interpretation of Use films of this survey by the physicians reading . thei Xrrays. then with films taken by the nac technician, with the same equipment, and continuously monitored for quality. & Following the completion of the examinations, all X-rays from all examinations were intermixed, masked, and identified with a. coded number. If multiple films of the same individual were taken; these were labeled with a single number and designated as A, 8, C, etc. These films were read asa group individually by three experienced readers who were free to utilise the best P-A file for the determi nation of an X-ray reading. Results for the three readers and that of the individual who read the X-rays following each examination were catered on a code sheet fpr each participant. The results of the four readings were then averaged using the following criteria: ) HWBUI0008403 10 1 - All parenchymal readings vithin given categories (rounded, irreg ular and combined) were averaged utilizing the ILO 0/C twelve point: scale. If the average came exactly half-way between two value*-, as is possible, with an- even number of readers, the values of the three1 readers vho read' the entire group of Xrtiyi at one time determined whether one averaged up or down. 2, If the reading of one individual differed by three units froa that of the average of the others, all readers re-read that particular fil*- The readers were told that a disagreement existed on par enchymal readings, .but no other information was provided. If the subsequent reading brought the outlying interpretation into closer agreement, the average of the second readings was utilized. If a disagreement of the same magnitude still persisted, the X-ray was interpreted by the entire group of readers and a consensus ob tained'. (This occurred for fewer than five X-rays.)' 3. If a disagreement existed among the readers - as ..to whether or not pleural changes existed such- film* were: also- re-read with the specifleatienthat: a, disagreement existed: with, respect: to in terpretation of .the pleura-. Following. a:- second interpretation;, it determination was based upon the average of the second reading. If * aX-r*yvwa* latecpeeted;: as normal by two- individuals and abnormal by two others, the interpretatioos. of the same three readers- a* before determined tlte overall classification. Approximately 110 X-rays read early in the sequence were reintroduced into the group at a later time to provide information on reproducibil ity of the Individual readers. For this analyais no "second" readings am- described above were used. Table 4 shows the distribution of dif ferences of parenchytp 1 and pleural readings of each of the four read ers: along with the average score of the parenchymal readings foe each individual (based on . 12 point scale). As can be seen both the inter observer reproducibility and intra-observer comparability of readers is trail within similar variations determined by other Interpretation groupa (Rossiter, 1972; Clover, Sevan, Cotes, et ol., 1980). (See Table 12 for the results of individual and averaged readings by job category.) ; HWBUI0008404 11 Table 4 The variability and reproducibility of three Reader 1. : -3 Subcategory difference (Second reading * first reading) -2 -1 0, 1 2 / .3 /' 0 4 13 93 1 1 0 (82) Staadard deviation: 0.77 Average score: First reading 2.40, Second reading. 2.241 2. ; 3. 05 20 66 10 (56) 4 0 Standard deviationi. 0.83 Average score: First reading, 2.67; Second reading. 2.55 ':V..V 8 ' " 12 ' 63" - 14 /. .. V S (57): 0 ' Standard deviationr :i:..0t;Average aeore: First reading,, 2.51j Second reading, 2,38 . ( ) ~ Humber of films read *i 0/0 both times. * 0/- = 1; 0/0=2; etc. /yoTV ci. S*0*r>A. "at I ) HWBUI0008405 12 RESULTS OCCURATIORAL HISTORIES A careful review, of. all jobs each person held revealed that many exam- iastioas-participanta bad previously been employed in a job with poten tial foe significant asbestos exposure. This is ahovn in Table 5 for *cfe union grossp that participated in the examination or whose X-rays wte utilized for analysis. Overall 21.5X', of the study participants h*d ia identified or highly probable exposure to asbestos in previous i ... ... . employment or. willtary^service. The percentages were particularly high, in the group* that included men with skills as welders (vehicle con- straction and city Maintenance Mechanics). Here, asbestos exposure in shipyards or during the welding and cutting of high teerperature equip ment insulated with asbestos was identified. Of the 234 with identi fied or possible asbestos exposure and readable X-rays, 87 (8.9X of all 5 3 7 S'* X-rays) were of sen previously employed in shipyards. In order to eliminate any confounding exposure in the analysis of brake vork, the health effect*, of individuals with identified and;possible exposures to asbestos aodi other dusts were analyzed separately, according to the fbor bread expooure: categories of Table S,*;direct ocCupationaI asbestos exposure, shipyard sad heatings trades,, possible asbestos exposure, and; exposure to other dusts. In the direct occupational category were . those individual*: that . insulated pipes ,, worked;in: asbcstqs' Mahufact ur- ii operationd: oc had sitailac exposure*.. Among..-.those classified: in. shipyard or heating trade* were those with' any shipyard employment or work that Involved the repair, installation;, or. maintenance of bull or rod*; equipment or equivalent exposures. Also included in this cate gory: were a group of wen (12) that insulated mufflers with asbestos or Installed brake. linings on a continuous basis during the construction of., amphibious vehicles. Aa individual w**> classified-in tlie category with the highest potential 'asbestos exposure- (a# ordered above), irrespective of the total. e*floyment time iu that category. It should be noted that while every core was utilized la attempting to elicit a past asbestos exposure, this may HWBUI0008406 13 Table 5 The distribution- by union affiIiation and type-=of- work activity* of study participants Type of work activity Kb identified asbestos exposure o r garage wo rk Uaion affi1iation UAW 259 Maine. Coast. UAW 595 DC 37 14 70 85 : (3. n (55.6), (69.1) 28 (28.9) SEIU 246 Total: 8 (2.4) 205 Garage employacst but so brake work (23V0) 2 0.6) 18 (18.6) 22 (6.5) 124 Brake work 217 (61.0) 2 (1.6) - . 18 (18.6) 213 (63.2) 450 Other dust exposure 7 (2.0) 3 18 (2.4) (14.6) 1 (1.0) 1 (2.1) 36 Possible asbestos exposure Ik 23 (3.9) (18.3) 11 (8.9) 13 (13.4) 22 (6.5) 83 Shipyard,, heating trades it-. \ 26s;; 5" . iir: (.6.2) (20:. 6);. f.(4.Tr ; (1.7,5):. 6.1 Direct, asbestos exposure; (insulation, factory, work) - 4k ' ' (3.3) " Z: ^ " i (2.1): (1.2) 131 - 10 Total*;- . :: 356- 126: '123:- ' 92 ;io3!r Totals with; biber pos sible asbestos exposure 36 , 37* 20; (10.1) (29.4) ;(l6v3) 32 (33.0) 7 ' 224 (25-8) (21.5) (. ) *'-'Percentage'-;'o.- unlon.-aenbe-rs in job category. 1 Four en had nissiagr occupational histories: and. Thesewere excluded froa further analysis. * Ten of these 26 individual* insulated mufflers and 2 continuously installed brakes .during ampliibiousvehicle construction. Their "other asbestos, exposure"' occurred, as part, of the: job under study . - These were- not included it* to tals with ether possible .asbestos : csjewre. : In subsequent analysis, however, they vert- included in the category of shipyard, heating trades. HWBUI0008407 14 not have been successful in every instance, due to aadequate recall of the worker or because an asbestos exposure may have occurred without his knowledge. The large number of workers with identified exposures suggests the possible scope of the problem. Such, unidentifird expo sures would, however, contribute proportionately to the abnormalities found in both iKe exposed (brake workers) and unexpused groups under study. In.the analysis that follows workers will he classified accordin* to their asbestos exposure irrespective of their union affiliation or job classification at: recruitment. It is striking that 8.9%of all participants had previous eoiployment in the shipbuilding and ship repair industry. As approximately 45% of the study participants were over age 55, many had opportunity for employ ment in one of the several Hew York area shipyards that operated during sad after World War II (Brooklyn Kavy Yard, the Hoboken yards of Todd slid- Bethlehem .-Steel)'... I Approximately 4,500,000 men (and women) were es^loyed, in. ship construction add' repair during. World Vac II: (Hicholsoii, Perkety and; Seli|;o, 1982}:. This, constituted 9 .% of the. non--a-gri.culf tural- national male.work force in 1943y but a mucitswalTer percentage was employed after World War II (ff.2X-0.SX) (Bureau of Labor Statistics, . 1919) i;;,..;.Thu*y.:,:the- find!ng of" sucM jk- large number with; shipyard: : employment;:. in; thi.sy study is; understandable and; .prowldes- an. opportunity t* evaluate the effects; of past short-term shipyard work as- well: as. ' that garage employment. Tables . 6 and 7 dieptay the distributions, by work activity, of: those fox whom Interpretable X-rays are available and for whom valid pulnonary function tests wejre obtained. As can be seen, lower percentages of- readable X-rays were available for DC: 37 and SEIU 246 members be cause;; of the previously, nentiohed loss of 30: X-rays. The individual# involved, however, were randomly scattered amoug the different exposure categories. The .percentage of individuals with valid pulmon.-.ry func tion tests (96.4%) compares favorably with other surveys. Again, those With missing tests are randomly distributed among all ar-cpal. joual categories. HWBUI0008408 IS Table 6 The distributions and percentages of readable X-rays by uai.cn affiliations and type of work activity1 t Type of work activity Union affiliation UAW 259 Kaint. Const. UAW 595 . DC 37 SEIU 246 Totals Ko identified asbestos 14 67 85 exposure or garage work (100.0) (95.7) (100.0) 25 (100.0) 8 (100.0) 202 (93-5) Garage employment but no brake work 81 2 (98.8) (100.0) - 14 19 116 (77.8) (86.4) (93.5) Brake work 214 2 (98.6) (100.0) 18 (100.0) 187 87.8) ym) (93T5) Other dust exposure. '7 3 18 (100.0) (100.0) (100.0) 0 (0.0) 7 (100.0) 35 . (97.2) : Possible asbestos. ;; exposure ' 2T (10040) (91; 3) (100.0) , 9 ,: 77 (81.8) ; (90.9) :-.:(92.,8):-;- : *y . V; m Shipyard, beating trades - 22 (10040) 5 CJQO..0)' 13 ' ' 57 (75,5): (93.4), 123 (94.0); Diteefr asbestos exposure -- (insulation, factory work) ` - 4 ' ; : I-'- i :; 9~ (100.0): V (50.0) (100.0) (90.0) Totals--.'. 352 121 123 (98.8) (96.0) : (V00.0) 80 . 302 ' '. 9 83; v (87.0) (89.6) (94.6) ( 3 - Percentage of category with readable X-ray. j 1 HWBUI0008409 16 Table 7 The distrilmtion of va1pu1monarv function teats by uni cm af f iliaiior. and type of work activity* 2 Type of work activity Union .affiliation UAU 259 Maint. Const. DC 37 5E1U 246 Totals No identified-asbestos 13 exposure or garage work 02.9) 69 (98.6) 15 (89.2) 8 (100.0) 115 (95.8) Garage employment but no brake work 80 2 (ioo!o) 07.6) (100.0) 22 (100.0) 122 (98.4) Brake work 211 07.2) 2 (00.0) 17 (94.4) 206 (96.7) 436 (96.9) Other dust exposure 7 2 1 (100.0) (67.7) (100.0) 7 (100.0) 17 (94.4) Possible asbestos exposure-.. 14.- 'V 23: ' 11 (100.0) ; Cl 00.0) (100.0) -..20- 6$ (90.9) (97.1) Shipyard, heating trades - ' ' '21 26* '17; 05.5) (100.0) (100.0) 56 (91.8) 120 (95.2) Direct asbestos- exposure - - . (insulation, factory work) .:: i::.. (S0.C) 4; (100.0) l".y(83.3); .Totals- 346. -." 124 r (97.2) (98.4) (96.7} 323 (95.8) 883 (96.4) ( j -Percentage of category wi th valid fielmonary function test- 1 Two men with valid pulmonary function tests had mi ssing . occupational histories. * Ho pulmonary function tests were performed at the Linden, Ncv Jersey cxaination o UAV 595 mers-her s.. HWBUI0008410 17 X-RAY ABNORMALITIES Tables 8a and 81; list the averaged readings for the parenchymal X-ray abnormalities according to the 110 U/C International Classification of Pneumoconioses for th> various asbestos-exposed groups established in this survey. Seven hundred and ninety-nine- of 983 readable X-rays were classified as having 0/0 or 0/1 readings for parenchymal, fibrosis. One h'uodretl and' sevenLy-seveu were classified in category 1 (1/0-1/2) aad: seven were classified as having 2/1 -2/3 .ibaoi-w.lities. Of those with normal pleura, 735 of 871 (84,5*) vrre also norinal for parenchyma 1 changes. For those with abitona.il jilcuva, the percentage with normal parenchyma was much less. Only 64 of 113 (56.65) of the readings were categorized as 0/0 or 0/1. r\ 7 <7T o/o o//. / 77 ffc3 = -- C'jjo //z.) Tables 9a sud 9b list the pleural abnormal itics according to the se verity (exteut and thickness) of pleural thickening a ad whether or not calcification, or pleural plaques were seen. The greatest proportion of pleural sbnorj8alities; consisted of pleural , tltickcning; (89 of 113). ;'vPieurail\ Calcification^ was seen only infr.equeatly, being identified on, ottly -12 X-rays`r. including eight for which pleural thickening was also noted; Pleural plaques were seen on 3 X-rays, including 16 for which pleural thiekeoing wa* also idcutiii*d and ooe with plt-urnT caicifixation, > ' The degree of plcursT abnormal itics was relativelyminor. 0f> those: with pleural thlckeniag, 42: Uad the lowest, cstef-.vty of extent and thickness (A/l). Twenty-nine were categorized as either A/2 or 1/1. The more severe examples of pleural thickening were largely -.epofined' td individuals who had either direct asbestos exposure or had previously been employed in shipyards. , Table* 10 and 11 list the percentages in the different occupational categories according to the type (a) of X-ray abno reality. As cad be seen from Table IT, the: percentage with any abnormality among those with garage employment is 24.21 ctmparcd to 18-85 among individuals with no stated asbestos exposure or garage employment. Corresponding percentages for parenchyma I ahnomml i ties are 19.OX vs. 15.3X and for r pleural abnormalities 8.45 vs. 8.9%, respectively for those with gara.c ! ): i HWBUI0008411 ________ p o ru re to Asbestos in cflte se irle n , h tf.h e r in the t n b lc , such os brake w ork. Irre g u la r opacities '-yV ' ' -; : P ro fu s io n o f f a l l ' , Normal p le u ra The number eod c a t e t o r r o f P a re n c h y w a l X -ray a b n o r a * H tie a c c o rd in g to work a c tiv ity 18 tS ooooo o o - o - o <n *-< o O *4 O ^ O <- - O "O ^ m ^ O^ A s fS ?* ?N*: o**-. C' <T" tn M . a <cN&J n ,Ctn4\. - 'nO- m- 449 u ****>: > Uu Xu-< S' V - Xw--: . * S- Xvtt-;*- a*: WMfll- W; .-.XUe - w9s "X6 * Cu & o4 aa U#*?4 a*S .' .Xw > - Xbl *3 VS ... Mw - .3* Xow ess , ..-..9GCy.V '. - ` "*W3J - X4i**4 o '.3' M .. ' - U*U. >'.-.3uV; XUUo,:;- ' . oL-- X4a1. 1*4 A 4 fc(OA* - +&t* .' ?* -xtf.: *W3 n>* "K . XCG -.'. 4umJ..?*uu-*:r.. Xa- aO' . mu m MoOfc- ^--a34 - 5*44' ' U4Ho HWBUI0008412 i T a b ic 8b The nueber and ca te g o ry o f p ik b c Iiy m I X r n a b n o rm a litie s according to work a c t iv it y as .a 'brake w o rk e r 'y p u id 'n p t have e th e r exposure to asbestos o r o th e r d u s ts . On th e o th e r hand, ca te g o rie s low in the ta b le , shipyard w orkers, e .g ,, could a lso have ex positre to agbestop in c a te g o rie s h ig h e r in the ta b le , such aa brake .work. 19 o o o o o o .o "* o -y - ex -* U8 y- n *o>I*I*a *a u ayQ 0a Cal * *0 <** *# *" O ?*4* ***<94 4# S3 ^.9 aa y 9V C O 3 fi .A'Oc: > - *U :6 & I? >e4-. * U r n v no 9W-: o - - Oa*k t-sWe 0. .-.** 3- 41 *#49 .U9 X4S4 Xy3S.' *4 y0 3o- 44. &494 >0 XyS .9" 0V : 4H4>; *.14 'jUy#;,. - U' W e* S0r w 3w0; & O - O 3- eO" - 0fie VmMWo > 0 O & * r* *9*l yte*.- . f4&0yM4l-u OWS0.*- '. 0 Ss f<ir* 0: p0* ` &. 0 4y4a1*. yo. ^ ' -'MX'y0mI- 0 . y0- 0 y0 sfi - XO0/rV > 0v-4oma4- y . .: . . X*0909*. H0 X<*34 Xa0I O . ' fOwie :-~: 'X4*0S4*;- .'..'' . Nyfiy4e.' 4O4'..'-\** 00ya 40oe4 - *4. VUu O3' VI Q w - *H4000-44' . , 4N49 y U e0 00 04 >y- oa' !-9 . J0S 3O- H3 >: i HWBUI0008413 v` Or. th e o th e r hand, c a te g o rie s low In th e ta b le , s h ip y a rd w o rk e rs ,e . g . , co u ld a ls o have exposure to asbestos in c a te g o rie s lo w e r In th e ta b le * i . e . , a person c la s s ifie d ..'e-bt'akcw orker would n o t have o th e r exposure to asbestos o r o th e r d u sts. The c t ` fj;o r{? tl< ia o f work a c t iv it y is such t h * t m In d iv id u a: l in a given ca te g o ry would have no exposure o f a category The number and catenory o f p le u ra l X -rsy s b a o n n a litic s according to vork a c tiv ity mu 9a a <r 0 H0 $w ao aW O . 0 20 W O f"*< o o o m *i > &s H 0*4 H 0e a * w u c M 43 ct 0 *4 H '0 - 0 ww a3 4 H o a Sftri O e--s 0 ( 0 ,c 4* o -H ~ JSL .m & -e 6 &4 0 & I sa -' <5 8 -C 0 .4-4 * ; (a *< < <C H* I9-4- w.-' a- S0B9- 44 x w W > 4 4 M u o 3 **4 o o p. > H f>4 *- O O O O O F4 C4 9-* a a 4* <*1 hi * * e< *4 < wH94I wO H* H^4* %rt <"V <N w0V ' 94 ^ f'94 H f* cm hv vsn* 4* 0 Sri * 0 a 4^ 0 -0 a 4 w 9 be 0G *0 9 O W o H , 9 ** o q4 0 w - u a 9 a <i *V 0 # H o *4 P* U a Si 0 41 a o Mu m 0 w o -3 3 3 Qe 0 H -U 0 ' X 0 0 *A Oe.W U K O. u 0 0 -o m a 0* * 0 4 * p. 0 u a 34 It W 9 0 .. 00 a. 0 0 ja. a c U *4 0 eW 0 U "at 48 H (1 3 0 a 0 *ft 3 H 14 0 fi eft 0 94 U n W H 00 >e u U0 f0t -a 0 H w c 0 o 04 01 a w 0. 9-4 0 44 O H a 04 01 4We34 ' ' &: 4J ` -" a;-. *4 mv aH-- a a a* <441* -9-^..; . .-.-*e4*./*a*-w'a.. 9*.4^i4i O0* 0w e -e4 a H0I- fi A- W0 41 e jsi c H O H4- -s s a -4 h 41 ^4 (wi ua *gh ' Ps 0 00U a0 O W H *H ftv 0 *4 .- bri >% 3 . g 0; 0 H W 9--1 M 0 . >ri W S* <0 1W 0 0 S*4 a4 0 ftssft 888 ts--a Mt 4 n la th e ta b le , such as brake work. HWBUI0008414 c a te to ria s in asbestos to exposure have a ls o could c.r., w o rke rs, S 41 r o* &, & a a y3 Xu P4 9 ^ ** y m My o 3 494 . HX4k4 'Mma ' 0fci 9e *44 o 3 y4 X X0 X44 -ye < y9 0 M u0 ym H3y *39*4 ' X9 &a *4 X X n*>#*, 9 0 0 c wt 9o y 0cS c Am X - My X >9y i X - *"4 -V ' m S' Xy> -c pu. y0 , ^3 e ;. 0 44 . 4Vc4 3 '. - m y '-v M U y,,\ 1 af.<r JO V *2 a v 0 X A. .4IK4.-. ->4 44 M 0"` i4 os- w o eJHP% %4 21 w#* w<S N N O "* **? w0* wn <N *4 <M X O X o oo o o o o O O O P O O H --1 a o * x* X * o o cn xx f4 XsV| w *-- ** ..H c n3 x n x c4 o o o >9 <n rs x f^4 o *: < <s >wv e<m0fr . W-* 49 *" X 0; X f* n 9. o<Sj waen. x Wi 4 0 Jwtt- 49* 0 - 41 A ( 0y a ey. jys *9 9 9 X 3 0 *4 4 W 0 44 49* <1*,f 9 x- e 9> X yU i0- A ;* ry k* V 0 % 2Z 49 yo 0 9 r*. U o yy 03: y 9y ya -. My. 9 3: u A 9 4Cj pH. 1` 3n-v 99.. Ky - 0 494 vr 4* X0 4* * TU3* ?3- *3 0w. y 4 e4 44 0 X9 "3y y3 U 9 K: cKy yO C uy 00 4C4 M .Cr9 9O rt 4> if yo en W C X44 o X 0 0 9 sy n X cw. X W3 4 x y3 y %* y c. w 0 W 494 9 s~* Om -30 u4 u um xo 09 m W OO 9 0. W30. .O04 ou S"2 90 0s 94- 41 <1 > to X9 3a0. x*0 Kc, 3 41 9 3 W0 XU X4* 049 9 O9 a y y *4U49 X>9 e 4 X v> oe -4 8 53 y 93 3O H9 Xa 3 9* U X-' X<9 X 3W 3 9 3 -4 3 44 * x> O *- m - yc:v.;-.-` 0.: 0 '...Xy Mi y<7 - X 4f U - C.-X a c, . 0 O'- 494: *4- m ym ao *><' S: X .9- 9 - X4.4-..:-3 . '*.+: .-4*4*-' 1c3*` -. . 0 U O' ^3 x 3 -y u c c. o . - 3- '9- 0" y- y. -o ,- v-.c '0*. n cu y4*. 0 jXs4- x440. XOe u x44-- CO: > ' U u A 44 yS X4u4 U4p** C X * 48 C0j X` J9 : 4y4 4e4- xU yo o, e aO (0Ui y H x 9, 0 39 4f 9 . 44 W 0^2 <y4. k0>4 Hy.. . d9 xo x4 Xe x-* y3 0 Xy y0* x44 XM0 4< 43 VX 0X9 O 4 u 49 n *hi 94 xC M| ^ 0 uw m W *e 9 9 : X9 * M f) H r s h ip y a rd ta b le , in . the c a lc e o ric a low as brake work. other hand, ta b le , such th e the iOnn HWBUI0008415 22 u om v <1 ^3 y 04 o m3 n 0^ . on 43S S 5 o on s y 04 *n a 04 <? on r* 04 ar e > ** uo oU o A *UUo3 d 04' u 3 O H <" fll a a Q e C & <o "3dtf *-* Wi _O ot O1 a O* O8 - 03 O Ot 04 <4 *4 OO (W "S X# o* <rj H O* 04 w on 0"* <3 04 X > 04 wn X w-s on *r *-4 -* #- . 04 5* on C4 n O1 x 04 o* n >4 * d* X 03 4 04 49 44 o $4 ,, 4MI s *-* - t~* n O* o* ^ s**on4 W 04 3 Ueyy ed* y & "4. 3 R W. 4 O' %,- ' Oi X d 1*. o x * o on 0s* o C1 O1 4 G& o. O4 nro ** O dv '. 4' & r ( <c * n . H o f*-. # . ' *? S" x* <r 04 o. - - . ^ x * ?< d* . 04 cd 4- - , . .. '.: o*- -- . Ot 04- 04 .; 04 0-04 .or r.- *4 j:> R5 M-< -W 'O'- 1 Xi.-; X . M y DwOs *>yu*. X H . ^ 04'' ^*'d ,. 'O '--- * - . +mr v-r K O. o c * , <n- o* S=i S* JS. 4 O o- 4* <9 h V @ 4# m <r u d *o * o 44 y - 3 A^1' , - O' ^A d^ Xy x y o 2r y ec 44' u 49. 3. . #*< < u d 3 y a4 < y.' 40- dX IH* ' '' *4? O-'-.Cfc:- . ' o~ X*.' n 04 * 04 '*- . 4rt* rr*o0** *4 3v. . O- - . -'V> o* 3V 04 0^'- ,. . *Q ' n SR: OV n u - s"V 3 m - y- j4 -' a - y w- d *3 ' 3: d ' Or - - -. U-- . X . y-. . d . tf . 44. a 3y u Xw 3' - 0 y0 d C ' w. O 44 p4 .. . u 0 * 44 0 d *4 X- y 4 Sy y y ^3 y W c -S ' ye Xa m d ^0 a *y y3y 4 *4 *3. . *"i - .y Tf o d u y u - . *y - >s U"3 0 V e- & y h J& . 69 y y- e u d X s<4 ** o ey *3 O w VOtl' H40 - 8 y. d. h* HWBUI0008416 129 13.1% 24S 25.2% Number and percentage o f X -ra y b n o ra lltle a . a c c o rd in g to yorfc a c t iv it y and X -ra y c r it e r ia -2 & U OOft ** . Xi <UU 13 n n 23 nA 091 W * U o c 0e e^ S UioA S 9 &W -< *U04 .<U4 Ouft s<e9 4*3* *** o U . * a u u ^* Wy aU W <a9 ^cw O ** h> ** 00 #4 o\ . m * p% M-9 ** 04 tn . ^o a* <$ * < a* pi <n *4 a* * or*- 04 a* 04 04 * 04 04 wa y g o^* y&6 u&u8USa .9SGducm3 , *4 oo S n os. # a* 04 <n " 04 * PV 04 n 04 ?* ,,, O O -- 04 a* pi 04 eo . -4s 08 04 * 04 . <T5 ** 00 * m 0% <r p yw wo ^O-< **a ay V .CofTt:. CV; * s"5 i'r 0 mSf* ft*. tfl <rrs- $` . are n i1n-4 o .- K 04 'e-n m 08 fr* 04 ST 04 04 w 49 ft* JQ ft* b,, au ae * p * yb ua o * >* Cb S *9 4 > n-4 4J & m M u o * <n 04 sn o m tf 8*ft , -- *3? .m o Or y . a. M yM Mo up e > *9 P y^g e<a* pb 4J 4 9 04 OU XP 4a w p 2 V oa %4 y o 4 -4 < t0*-- ST NO N ^m QO 0* 90 M U o 2r 44 W yP <9 <3 JUsg <9 re*l U 3 K K3k' >o M043 --* 04, y w 3 P a, y -- Xy. w a ` ' - p o o. Xy 0S c J3 9 4 y vs 3y 9 W .* y -a M VS <a c O IU 8 . U f .U . . aft e f5 y o %3 lo. <9 s U| -fl P3 fS yu wo 33 CO. >u* Xo y w. w0 wn 4/ V5 -- oa &e oj * 4J --<*8 U3 y u z --< H Ow 113 114* 18<* 18.7* T o t-ilr. HWBUI0008417 24 nployacnl compared to thowe with no ouch nuploynent or no iUtc4 ubfftdt exposure*. The Minimai overall differences brtwern these two groups are store Hni feiit in parenchyma l abnormal i ties, there being little difference in the percentages of pleural abiiarst.il {tics. On the ^ other hand, significant di f ferrace* exist in the percentsget. of pleural abnormal{ties among those employed in work having, direct asbestos exposure or shipyard employment and those only c<ploycd in garage work or having no asbestos exposure. We will thus utilize both parenchymal ad pleural abnormal iticn to charatlrri < the various exposed group.*:. * Other criteria could have been utilized for the determination of an abnormal X-ray. For exanplc, ve could have required that all four readers read an X-ray as ahuorual before .it would In. so cats>;i.i i/cd, or that, an averaged .reading of 1/1 be required for the cstabrisleicnl of parenchymal fibrosis, or that pleural plaques not ei-oat i lute an ahum Ballty.. To investigate whether aoru stringent criteria for! ubnontaJitie*-.would have-altered'-l l.e- analy*5 r, the. oveiull results were cal culated With the criteria for abnormality, being'-an Xrray categorized as 1/1 or. greater aid/oc: the preseth-r? of pleural thickening: of c;. 1 c i f i c.i-tdon- (pliquee were not cons id* red abnoriiiJ ). These data are shown in the list -coluui of- Table 11 and demonstrate tin identical trends that were present in the data with less stringent criteria for aluu rsmltgies. '.V Table 12 thews the distribution of abuortu 1 X* rays t*r ca h reader according to work, eategoty. Whi le dill err tit pvtcehlages. <*f abneiv.*! X-ray* were obtained by tie* various readers, the trends according to work activity were Hi ghly conaiatetit . Thowc engaged in brake work had a higher percentage of abnormalities cerpn red tu those who did nor and those with other asbestos exposures !u*l the greatest percentage of abnormalities according to al l four riu4-rr.. Thus, the overall X-ray results are relatively independent of the individual readers and inde pendent of the criteria for -ibuoraai i (y r.itild ish*d. HWBUI0008418 o 25 3^ aiut it ' u a H w^ UW 3 3 *4 -O a /* * pv 3" id pi as >* SO w * ^ VI . M-n pi ^ * w MS vs *- C\` PI 0S * "S pi- N n 4 P* PTCH N, . VI - s - n w 'O vs *s n pi ^ a. O0 w Af sf vs wv *-*ps vs ^ '- 00 (N W V* vs H SO 0O PI % "ly. o vft p w- s VS t 4 a PI OR PI w 4 w vs p* <m $a M3 Sqc*? p /p ' irt %n w pi ^ a w 41 *S -< O <A.*i ol R 99 JBt O s Os 8 . PI P* * P* VS ^ P4 w s? vs * PI p P4 ^ P* rt W 03 '-v *^ 'C* P <n ^ co pi w 08 vs P* P P PS ^ s PI w vs * P> PS P* n% MS PI w -O W -* > >% y o e* a ^ 'j y JS ys u& <o y Vt n s 3 >M 0 y 3 W Ky <30 ^ O PI PI - '-y ^ pi mp' pi n ^ . pi - ^ ww ei O PI ^ #< irt wn w Pl:^. >y ^-s pi 03 PI . p* pi n +* f\ - p m ww * OS ^ >0 w *** * os w >a p- - Cs *rpti ^ tfi. w 'sO * (? 'O. `mt w PI /"S * as t*% fH n w *o .ym.-4m*-. <wr w0 Q<9 s . ^ *? s3 <*~v o ; rv 'O/;' PV*- - ." x .;- --<<n** . . .W vr ** pi *< ' >o%.. . y ou wo 03 3 O ps . ** >4 * S'** ' PV'*"s '- " * .CT4.' Pl-P-S': '" * OS PI O PI. P- PI Vs *- PI < PI ^ pi >r N, r\:<9- P# 'S, PI ^ fr*' Vi- -S0-- '.,>. trt : - '.- .o ? --o ,WA-- .. f*->- - 9*4 . ^o -- w - - .' - -. . V'-w. o *"s 4-^ -PS-^s PI ** y pi PI ..'. n - '.PI PI . u 9 O Mi o '< o mo as Q . 3 - PI "* pi n pi ** pi 9*> PI 91 '. . :^ 'V ."- . Qm <? . as P Ok P'S vs. S0 :-. PS .- n A w - W-; W - W; SB**- it yM o cl y *<Quo3 pi ps *& ) i\ s w i HWBUI0008419 26 kg* atandarlxstion of X-ray readinr. Inasmuch as th prevalence of X-ray abnormalities reflects various assaults to the lung (separate from that under study) that accrue mrtlaa, it is necessary to cuaalder age In comparisons of groups exposed to asbestos, la different circumstances. Any age effect can. In part, be due: to unknown exposures to various duals, including asbestos, tha opportunities for which increase with time. Additionally, any dust-related change a progress with t ise and the auoi festation of rela tively aioor exposures early in life can be rignificant in later years. As discussed previously, * selection criteria for the exposed, and control groups resulted in study populations that had slnilar age distributions. However, La store accurately take into account any age effect, the overall percentages of X-ray abnormalities were standard ized to the age distribution of all 983 individuals for vhow readable X-rays were available. A standardized percentage, P , was calculated using equation (I). lL 'F1, hJ/93'. std. (D WherePj is the percentage of abnormal X-rays in the ith age category' of; the group of interest sad K^, the number of all 583 individuals ..in the:ith age group; . For a group haviug: an age cell with no- data : (iasulatioh/factory, other) ..standard!'*#t iaa vu 'based on those ceils with data using equation (2) Patd " 1 Ft Hj/W.'ll avail I all i Mpavail i (2) Where again equals the pcresetsgo of abnormal X-i ays in the ith age category tha group of interest and xT, the nwchrr of all 983 indi- viduala 1st the ith age category; ii the percentage of .abnormal X^rays aawog all tIS indivldoala in the ith age category. These over all age-standardfred percentages are shwii In Table 13. The difference between the individual^'performing brake work ami thowe with no identi fied asbestos exposure remains, while the percentage of abnormalities ia those employed fa a garage but not engaged In brake repair work HWBUI0008420 -T o b io 13 Percentage o f X raf a tm o m a fitlia i according to work a c tiv ity . by & tf (14/134) .a f/? i3 ) . it0 */3 ? 2 ) (12/235) (12/29) (2 4 # /fi3 ) ^3 an <0 H n m o-4 &4 a*n ja m >41 ^rv ^r n *-e rx** wfn rn-** *ws**. sSo3 <i O ^1 <n ^n r% *** o e---a o* --n* n oo < <n* * eo< *\<&-v **-* xan nn <^n s * o ^ *n*& an m<r-*m-n* - m<n . * ** nan- **>-3%* . vo-* *^e** fc*rt^a* *<n*% <n * 41* *^n o<nt ^a*n-* *- * an P-* cv N ^*- n",laa 4"0:e^*"**<' *S4O>***-- -a-nV mC4-:*^*. O* '.a- t* fi < ""*a^Xn -'1 W r w4 *S O >OV** w I 0Xoo3 i%9. f >+4*** . -.<w-*OXJ* & 2<o1-v . 1*3t34* W XT' .- m . .*4bo- - O' . - . j&4-~-- --O': -: V3! . V@--O34- Oa*bO '" - 4J*e*oB4*"0.:',.-''.- t4Xumdj*o xs - 99f4 OOaOw9KOO.' XoXbuOu4*' v 4e0* o +UA *3m** wO *^*L ^ 4^ O#4 9 o d O 1VM3 1oG3 HWBUI0008421 11 kttum to iatvlut below tha lcl of thae- unexposed otherwise. Vm fwreentai** of abnormalities among those with other <tbi(a exponit will ti(fli(ic4oUy different from these unexposed; consider the percentage of X-rsy abnormalities a manifestation of n normal distribution with a variance reflected by the number of abuor- it. - e. . , *1; X-rays, the respective standard deviations in the final column of Tlits. 13 ar calculated. Vhlln the percentage- of abnormal X-rays In aseh of the Job categories of Tattle 13 has a large uncertainty associ ated" With it because of the limited number of individuals in a work activity (other thaa brake work), the pattern of observed percentages yields a rowrkable consistency. The two groups with no identified asbestos exposure, noa-garage controls and garage workers with no brake or body work have the lowest percentages of abnormalities, the various activities with probable asbestos exposure have the highest percent ages, and brake workers are intenaediate. Individual* with other dust exposure appear to be unaffected by such materials. This is probably tlar'result of the relatively short exposure tlates or the warfinal expor . smsm. circuastaneesv The: other dusts included coal (23 won)./silica (9 .%Sa*r ).,; *fld Other dusts (3 men).; five of. the1 other dust' exposures were foe .longer thsa- tea yearsv (One of tle five had an-ahoormal X-ray. ) ..Hat; average exposure of the other 30 was.. ;3yiyears. In subsequent Muilysi*~ those 3S individua 1*: will be characterised by their garage (or owjjfrage}!-:;|lbyisftit.\On#' notable . feature- of Table 13 is the high parentage of abnormal X-rays among the 32 individuals who worked for sow time ia awte badly repair. (Sec subsequent acctiaos^ ua auto body .repair ahd uadereeating work.) standardisation of X-ray abnormalitlcs Smoking has been identified as exaccrbatlug, the.nob-malignant effects ef asbestos. Heath rates from asbestosis among 20+ cigarette/day smoken are 2.8 tlmrs greater than: ** nou*a>ker.v (Maaswnd, Scliknff, and. Seldom, It7f) and both parenchymal and plcur.vl X-ray abnormalities : have been reported as more common among current and ex-smokers thaw MStaokcra (Weiss, 197T; Rosa iter and Karrins, 1979} Weiss, levin, and HWBUI0008422 29 CoodHA, 1941). An effect of snaking oa the prevalence of X-ray abnor malities vaa also found la- this study with both parenchymal and pleural *abnormalities found More aawnti* ex-smokers- than Oonsstohers and more frequently asong current taskers than cx-snokera. The age standardized data for the overall X-ray readings are' ahovn in Table 14a. Table 14b lists the percentage distrihutloo of seeking histories iceerdtog-.to job category. As the uaexposed group contain* 251 current smokers than the other exposure groups, the X-ray results, where possible, should be standardized for cigarette smoking aa well at j for age. .This, can be dose foe ssajer work categories, but is unreliable for sost subcategoeies because of the absence of data in some smokiogage cells. The standardization procedure follows that of age standard isation and utilizes the overall smoking histories of the study group (31.6% were smokers; 42.4%, cx-aookcrs; and 26.0% nonsmokers). Standardized X-ray abnormalities by work activity Table IS lists the age and smoking standardized percentages of X-ray beotcauiiities aswa^ those. wittv ae idenkifled asbestos exposure, those engaged to brake alntenance snd 'repair,. sndi those wito prbbatoi'e aaW*^ tea exposure, including auto body repair work. The overall percentage of atmoraiel. X-rays a*oa| indivi4uala with, probable asbestos exposure' differs'/nignMicaatlyjfrom' those unexposei: CF<.QdSr two sided). The difference* i* particularly significant (P<0.0002) for pleural abnor malities.. - This occura because pleural aboorealities often appear from relatively low asbestos . exposures and can exceed parenchymal? aboarwalities la prevalence at long times free onset of exposure. (See Anderson, st: si. If76,; o.g.)' An many of the individuals in this "probably exposed" category- worked during' World Wat II ia shipyards, we are observing effects in this group after 35 years from onset of exposure. Table Id lists the age and smoking standardized percentages of abnor malities according to garage activity and union:. There is relatively little difference between the percentages dr abnormal X-ray for the auto workers of UAW Local 25P while a large and aiguificant (p < 0.05) HWBUI0008423 30 Table 14a .fEL ** ndardisrd percentage of Xrray abaorw.ilities according to sookiiy. history (all exposure categories) Smak ins Hitory Abnormalitv Stackers Kx-smokcrs Nonsaokcrs Satoklng standard!red Pleural Parenchymal Any 14.0 26.3 32.6 11.2 16.0 22.9 9.1 13.9 20.4 11.5 18.8 25.3 : Table- I4b Percentages of distribution r_sifcluji .hir.toric# according to job category Smokers F.x-smoke r a Konswokers Ho exposure including. Ma'Mchani c garage Work 39.1. 39.1 21.7 Stake wrk 29.1 . 43.1 27.8 Probable asbestos exposure . 31.8 42.0 26.1 HWBUI0008424 Table IS The age and saakinjj standardized percentages of X-ray abnormalities according to exposure'catesagr Exposure category Pleural Ko identified asbestos exposure 8.4 t 1.6 Hon-farate work 10.4 2.3 Garage work but no brake 'work.' 2.2 Brake work - -p;Z- 1.3 probable asbestos exposure laeludia- body work If.8 2.7 Parenchymal_________ Any 15.8 2.1 20.1 2.5 17.0 t 2.8 21.9 3.2 14.4 1 3.5 17.8 3.9 If. 1 2-2 19.9 2.7 24.4 2.5 32.5 t 3.5 HWBUI0008425 32 Table 16 Ate and maklnn standardized percentages1 of X-rav abnormalitlea far different group* of garage workers according to work activity Work activity UAW 259 Brake. work2 19.8 t 3.0 Xb brake work* 17.3 t 3.3 Percentage of participants with other asbestos exposure 15.13 Group UAW DC 37 595 SE1U 28.9 4.0 21.7 4.6 18.7 4.7 16.3 25.8 Oversl1 24.4 t 2.5 20.1 2.5 21.5 -*-iSta'adnrdized' towage a^; itttokiag- diatribution of .a 13 - -963 aen for. who, readable Xr rays;, werei evtilabfei *^lib identif ied asbestos exposure . *.Doea eat. include 12, individuals with; asbestos .exposure: during eapbibioos feMtlricwitiiiitttoai HWBUI0008426 33 4tffmc exist.x between those employed in city garages and all other : groups- cosblaed; This can be attributed to the greater grinding sad finishing of brake lining Material that the city workers do. The work Pla: commercial garages is virtually exclusively oa automobiles in which I brale* ahoea are simply removed and replaced. Asbestos exposures large- $* ty occur through; the sir blowing of residual dust in the drum housing. .Many of the city workers, on. the other, hand, repair truck brakes and, here* Machining of the lining stay be required to obtain a proper-fit. This additonal exposure can be significant. Kohl, Langer, Volff, and VeisaMn (1976) found short -term asbestos concentrations during the machining: of new brake linings to range from 24 f/nl to 72 f/al. r,^ Tables 17a and 17b show the percentages of individuals with X-ray abnonMlitles according to years of garage employment and yearn since must of garage work.- As can be seen, there is an increasing percent age of X-rays according to either variable. However, to some extent. thin would be a reflection of the previously discussed age effect seen ia both the exposed and uacxpoaed populations analysed in this study. 7a: order; to;., taker laid account age, the age-standardised, percentages.-of.. abnormal X*rays -ware calculated for the age decades; 40 through 69 years, foie;those employed more than or less than 30 years, aud store than or lens than 30 yearn- frost onset of eeploymeat. (Individual* ia each of these- three age decades wars included.1 ia both the 30* years end 30-year group* no difficulties with empty cells, was avoided.) However, the assail numbers ia each, age cell prevented any .smoking standardizat ion. Ike results show that/those, employed: foe so re than 30 years or with 30 or more years from onset of exposure have the greater percentage of aboonaal X-rays* The differences between the age standardised ahnor'mallties in the group with 30 or more years of eaploywent and those with so asbestos or garage exposure or those with lest than 30 years ef garage aaplopMOt achieve a one-sided level of significance of P<0.0S. An analysis by the estimated number of brake jobs per week, however, C " does not indicate any trend (Table IS). The rmtlmatcs are necessarily uncertain because of poor recall and the analysis did not-'Couaider either duration of work or ti*:c frou onset of employment. HWBUI0008427 34 Table 17a Percentage of individuala1 with X-ray abnormalities according to years of garage work ____________ Year* of garage, ctnploymcTit Garage track <20 20-29 30-39 40+ Totals Braka work 13.8 (13/94) Ko brake work 27.0 (3/43) Total 18.3 (26/142) 20.0 (34/170) 16.7 (6/36) 19.4 (40/206) 28.8 (34/18) 16.7 (2/12) 27.7 , (36/130) 45.2' (14/31) 23.0 (95/413) 0.0 (0/3) 21.2 (21/99) 41.2 24.2 (14/34) . (116/512) Age standardized <30 30+ Brake work 19.4 + 3.0 28.7 4.2 - 'Table 17b,: Percentage- of individuala with X-ray alntonwal tiles according to' yea re: since onact of p.arant* work Years- since onset Garage work <20 20-29 - 30-39 40+ " Totals Brake vork 13.2 (10/76) Ko brake work 22.5 (9/40) Totals 16.4 (19/116) 20.3 (30/148) 21.2 (7/33) 20.4 (37/181) Age standardised > 30 Brake work 21.2 3.6 24.4 (33/135) 11.1 (2/18) 22.9 (35/153) 40.7 (22/54) 37.5 (3/8) 40.3 (25/62) 30* 25 .3 2 3.5 23.0 (95/413) 21.2 (21/99) 24.2 (116/512) HWBUI0008428 72 ^h O<" N# ^n .. O *4 *4 *S 44 4 44 44 44 *4 O <*4 P* O N** f43^^-*3^ /H* **-0** OH NH #f**J o *** . * f* NA <*"* (&<> &k Q-O4 oo <9 o sQs u eu u s4 * m t 3m ** ft 8 ^ S3 N P4 P4 P4 -*?1 P4 ** w wwww 3 O *A n N Q * 4 <4 **% n n n ^ <>e 1* & 4HJ -M W i 4 Q 483 'f.*r *V <*4 0 *4 $* * 0 f** m fl nT V> 4 . 44 '" . * 8 * ' `f* 3-v#** *f*i**$*****$*>* ^ p* pt H v> W N H H ,W*^W W W ^ < < ^ a 4 H !S5 M U fN f*< N >| N *< 3 W. W iWr *W w o a 'O m *A O f*- ps a * *4 u &\ P*4 44 44*A Ob u 4J 44 44 44 44 *1 P4 * <w>4 - 4 *4 44 44 *A P4 o $ 'U 1 ri 4<v H. a r*- o a c* . . _. . <W| ..... a <* ^ A A O A <"Y *** ^ 03 f* P'1 s~4-sO HNM *t W w w w s> # f* *3 * . `-fV'4.*4 H *3 - .44 44 4* 44^4# 44 ^3 O S 3% -* 0. 0 ' 0.0 & 3..*3;-.** p* 44. w n 41 H:H H K H.*4'; M '*> W 44 H 00-0 3 *3 03 w-l 0 0 ' t **i **4 O O O 44 44 44- 44-44 f4 *B4 ^4 0. - * 4 f=4 t4 O* <* 3 0 43. 03 CO <*H 0-4 4 o 03 4P- o 44 %3 -& 3 ff* O' flV O' SIIII <i *a r4 Of*t O*4 OA O pC* m< -u.. 4o1 OtDO'^O' N f*i A vS 9 i i $ii o f3i a&T * %l' ia O r*s < r. m i s 44 HWBUI0008429 n TahU___*5 ataadaxdizad systolic and diastolic Slood prcnr-urcr accordInr to race. aswkinfi hist orv, and 1ob caeef.orv Race Ssaokios? history Saekm Ex-taiokers Koosaaokers Saokcra Ex-**ek*r Kansnokcrs White - Slack Systolic 131.3 l 1.3 140.8 3.3 137.3 i 1.0 143.4 i 2.2 135.6 1 1.4 141.7 i. 3.8 Olastolic 82.9 l 0.8 88.S 2.1 85.3 1 0.6 90.0 1.6 84.8 a 0.7 86.3 2.3 Job eatexory White Slack Systolic Ho-Identified!exposure. 140.1 * 2.3 . 'JL30.4vi 5.2: Car* work; but; ao brake*. -v. Brake. Work 136.1 1 2.7 ' 139.4-1 4.6?" 134.5 1 1.0 V 140.5.1 2.*7. Asbestos exposure 135.5. 1.4 14f. 6 1 5.2 .. ; So ldendlled exposure Wastolie. 83.1 t 1.2 89.9 1 3.6 Carafe work out m brakes 85.5 t 1.3 87.8 1 1.3 Brake work Aabeacoa exposure 84.4 0.6 84.4 0.6 87.0 1 1.9 $4.9 1 2.4 HWBUI0008430 74 LABORATORY FIMOfXGS thm data aft t>e blood analyses (CSC and Stth) nrr showa in Table** 44 find 47* 1* aausual findings irt present for any parafactcr. THm mmsam of feb*- parameters according Co Job category arc Hated in Table 44 jod.do not >hv anything remarkable. Table* 49 tad id ahov the result* f ti, analysis of sputum specimen* far abnormal cytology sad the blo-od analysis for carcinogenic embryonic antigen (CZA). They show no find- - -i. : . . ; . --------------------------------------------------------- iaga' M|gestive ofneoplaaia, Boat value* arc within the aormat range. 7rtiefi them ia no difference in the distribution of either parameter * ` - foe the different jolr categories. MRC RESPIRATORY SYMPTOMS The principal result* of the respiratory fiye.ptosis questi f-nu.t ire are ihoan in Tables SI, 52 and S3. Tablcs 51 and 52 show the expected correlation with, cigarette rooking. In Table S3, the scokiug stand ardized percentage* of: chronic bronchitis and shortness-' of . breath ` *5 ` - ' ' ;. ' _ . -_ .. e*te|tie* re listed for different job categorier. inC3X COKCXHTRATIOHS IH WELDERS As'-'p&xt of s- study ta assess effects on welders, plasms nickel coacen- trstloaa sere seasad: In, twelve velder* in the control group engaged is . amphibious:* whicle constructiou. The results are shown in Table 54 nf~ indlcste thafc'tho particular group within this study had higher " .-O'** -. nickel concentration* than a gsslip of 62 welders in a large shipyard *o4 tea tis* Ui cpacentration of hor.pi tai.. controls. While no p^ia? logical' effects can be associated with such concentration::, the toxic and- potentially carcinogen!c effects of nickel would anggent identifi cation of the exposure source sad iwplraent.-tion of abatement measures. HWBUI0008431 75 Tabl 46 The distribution of blood count valuta TtbC AnalyciSJ Haag* (8ec heading* . for concentration unit) Ihd ivl dn1 r. within ran?* Number Percentage - _ White blond cell count (theu*n:idr. > 13.9-11.3] . < 3.00 3.00 - 4.99 3.00 - 6.99 7.00 - 8.99 9.00 -10.99 . >11.00 1 70 342 303 124 39 0.1 7.9 38.7 34.9 14.0 3.1 Red blood cell count (cifllions) < 4.25 4.25 - 4.74 4.75 - 5.24 5.25 - 5.74 5.75- 6.24 >6.25 . 5 130 462 228 34 12. I4.3-6.3J 2.0 14.7 52.3 25. S '3.5' 1.4 . <13:. 0 13,0 - 13,. 9 14.0 - 14.9 15.0-15.9 2.6.0, - 16.9 1?1 - 17.9 ; 18,0 <37.5 37.5 -39.9 40.0 M2,4 42.5 -44.9 43.0 -47.4 47*5-49.9 50.0 -52.4 >52.5 Hemoglobin (^n/dl) 112,9-IS.2] . 12-V 54 237 ' 335 ... . .184 ; 54 .' ' .: 6.- 1'v4 6.1 26.8 37.9 21.0 6.1 . 0.7 Hematocrit (percent) . ' 4 . ' 13- . 92 245 308 154 53 15 f.38.9-54,91 . 0.5 1.4 10.4 27.7 34.3 17.4 6.0 1.7 13" Lahoratorv r.-rnal rnncc \ ! HWBUI0008432 76 Table 47 The dlscrlbut1on of fonrcriracion; of various blood cotr.nonents f-SMA Ari.ilvr.l?V Rang* (See headings for : Within range l concemracion unit) Kusvaer Percentage Glucose (-e/dl) (65-1251 < 80 80 - 99 100 119 120 - 139 140 159 > 160 46 , 5.0 415 ; 46.8 294 ' 33.2 61 6.9 25 2.8 47 3.5 Urea-nitrop.en (nr/dl) [8-251 < 10 10 - 14 15 - 19 20 - 24 > 25 44 250 4 20 J 50 22 5.0 28.2 47.4 16.9 . 2.5 Crnarinlnc (mr/dl) (0 ,7-1.5 ] <. 0.80 0. so 0.29 1,00 - 1.19 1.20 - 1.39 1.40 - 1.59 - 1,60 ^ -5-. 113 339 315 89 22 ` :: 0.6 12.8 38.4 ; 35.6 10.0 2.5 Sodium (men/I) (135-WSJ < 138 138 -- 139 140 -- 141 142 - 143 - 144 - 145 . 146 - 147- > 148 14 1.6 i02 11.5 234 26.4 237 . 26,7 125 14.1 76 6.6 98 11.1 Poea-.nit-T: (r:cr/I.) [3.5-5.01 < 3.00 3.00 - 3.49 3.50 - 3.99 4.00 - 4.49 4.50 - 4.99 > 5.00 5 0.6 38 4.3 2?: 25.2 451 39.8 209 23.7 56 6.2 HWBUI0008433 77 Table 47 (cone limed --2) Rang* (S headings for concentration unit) Within range Nujnber. Percentage Chloride Cceq /I) [95-107] < 100 100.0 - 102.4 102.3 - 104.9 103.0 - 107.4 107.5 - 109.9 1 110.0 50 215 212 229 . 88 92 5.6 24.3 23.9 25.8 9.9 10.4 Carbon dioxide { raeq/L) [24-32] < 25.0 23.0 - 27.4 27.5 - 29.9 30.0 - 32.4 i 32.5 39 238 310 244 55 Uric ncid (tev/d 1) [3.5-9.0] 4; 4 26.9 35.0 27.5 6.2 <4.0 4.0 - 5.9 6.0 - 7.9 8.0 - 9.9 I 10.0 24 376 392 88 6 . - Calciua (tar/dl ) f8 .5-10.51 2.7 - 42.4 44.2 9.9 0.8 - < 9 .0 9.0 -- 9.9 10.0 10.9 I 11.0 16 510 340 17 r 1.8 57. a 38.5 1.9 Inorganic phosphate (str/dl) [2.0-4.51 < 2.00 2.00-2.49 2.50-2.99 3.00 - 3.49 3.50 - 3.99 > 4.00 16 1.8 134 15.1 331 37.4 230 31.6 92 10.4 33 3.8 Total protclu (r (6.0-8.5] < 6.50 6.50 - 6.90 7.00 - 7.49 7.50 - 7-99 8.00 - 8.49 > 8.50 26 2.9 197 22.3 401 45.4 197 22.3 55 6.2' 7 0.3 i ) HWBUI0008434 78 Table 47 (contlnned-33 Range (See headings far concent rat ion unie) Within range Humber' Percentage- Albumin O/dl) (3.0-5.5) 1.50 - 3.99 4..00'"- 4.494.SO - 4.99 S.00 - 3,49- 18 2.0 439 49.7 398 45.0 29 3.3 Cholesterol {nn/dl) (140-330] l : < 150 13 1.5 1 150 - 174 66 7.4 175 - 199 .162 18.3 ! 200 - 249 443 50.0 250 - 299 178 20.1 | i 300 24 2.7 Creatine ^hosphoklnnsc (U/L) (0-2251 <50 50- 74 . 75 - 99 100 - 14 9 150 - 199 200 - 249 250 - 299 300 52 .`162-:..' ' ,196 258 104 49 ".-43- - 5.9 18.3 22.1 29.0 11.7 5.6 2.5 4.9 HWBUI0008435 u4 * *4 fi(^u | t)4 f tff^ u ti4 ,`$ee9f4U$rt Job T9 1o 5& tOM tiMfkr*t*oM^ aMM^ Qo^ooo^oo^^o j 0000^00909000000^ O M Q O MM4<M*4MMM4(MMMM(4*I444(44 coo Q M I1 4b Is w 4V <* ^>- *- O | *- n w *bf 4b <n 4 M A ^ <** *9 M ^ f*S M r ^ MM n <( *4 M 4 4 * g? e-c a 4 O f 4 * Q i** Q O * "* #4 < * *4 f4 #*<"* O tS*' doo * oooo *- d *4 4b _ 4 <4 4 O 0* 4 M 4 | 4 4,* M 4 M O4 O4 *O4 m n-4 4 O N) 4i 3*> * Ob. b 4 O It !-- o a *9A4 MtS iiO4 <a(Ma4iAxO'40'4n4M4O4Cb 40b 0^004<*b NO40 d 4 000000000^0 4# 4 4 M f^ ^ * 4 <t *t Orbi 44 < MTS 4 W O ^ ^ ^ ^ I I W-. -* 9 <* Ob "* NO.OA^N*4.0. AQ4 ^f(fxO(rOt)rQt4aOQ O *4 09 <4 < *4b - M * ( 44. O'' O 4 f**- 0O9.4OW90^*` 4*<<494' 0* 0*4 0T 44b *S * 4*4? 4 cb O 4 P4 4 K o ^ .mi b n m .4 . 4 i*b 4 b o b <>< ^ O <* t m M 9B 4 O o S0i *"3 1 3 & S 9 WI ^ 1 s t9o .0 b --9i OU * ** uo M ~2SS *~*'.u-*^* U**&-*.* %*30J- tl%--*-^V*a* O 4tOo9 V^ ^.CS ^Xis 03 >J U --ori '3 <~ .e. c F 4Q j3 &L.< voV w% U r, 4* --b3a ** 2 j? e. n4 <9 C 9 4S O' - @ -3 1 O. a *$ S VI -O1 uv. ft T t'a* HWBUI0008436 c o n c e n tra tio/n * rc a u lta aod CIA category 1 .' & - 80 o e* a. 9"*' | 8 n G*1 2 sOm o* U Wc 0 > wn so *TM ..pi PS *" P<O*n*' <**-*-1 tOn' O' rt vgj - a} %0 ** O' O' 3 ps p<ni pe*i 'O m o' fH vp ^ - pi 5onf a o w P* Pc**$l 00 ^<f. on Po*vS O' <n & r *4 9a N N PS * CO wi M n3 n n p* O .*? V0 . a 9^ 0% e* pv O' w*i mn NT*: * o 6 Oe *woo9 : weoS u it 9 be 9 <M W uo a n* >K (1 il 4 SO O be W f- 0 oo i J3 O SO ^m a 9 a Jrf W O4 90 o O ft $, U -m u ft o o& W 0 - ti M^ a w 3<0. a u M <*' f-8 O X <0 & ^3 p % 3U be tl --e M ^0 <w. w 3 w- * #3 JO V e|. na x. S W . S' J3 *" <0- 9 w >*o *-* a . mow^ w xi cUv o * uOS be e Oe9 e. w e o- 8 5? WW N P, d litrib u tto a ' o f putua cytology '"''" a c c o rd ia .t'ia ^ job K ild n ly p la o r dyaptnala Moderate a ly p la o r dysplaata The * HWBUI0008437 81 fi O :a 3 . & o s ws i* ; O3 <Q1 e <o> as `St m W"& 4 wHa si J9I*r4i . -o uO V > o * I ua sa <IPi ifiS* s v J > - ' o v M9. / ^ v$ e# e4*f <*! c^1v< f*4 lor?tt* ?c***> * -# N *- V.S tfV4' ^* sr e* e* * 'S 09. P** ** *4P **? '. <f?l V) . , W #*-. . v'f ^ *s vs <? cwi- *$ ^ *c d t? # *(4I m U fc* im a. 4# c a ** MU 1 m a <3 & o n <<0sv9* v3** V m* *---4* <f^n- < * e - <a *o U141* *^3 U & C fl : 4frm H <9 * *"<**<*<, V N u * *-< % a **J4 %>s M * >k 4 <9 --oaT#4o t>v, * W 4 W ^ 4 ** > C 3. C4$ U i* >J* 4* W 4 W #-* 4 4 4 y s 3 Ob 0w *0*-^ 0*3 it S4.fi5 x: S2 HWBUI0008438 82 Tnblo SI The number and percentage of individuala with reported shortness at bs&atk I.^RO AC cording io aoi;iuv "caTTIJETy MRC shortness of breath caeeeory Smoking catcfarv Sabkars Exsmokers Konsookars Hen Walking fast dr ~up a slight hill Walking with others at ovu age Walking at ovn pace Total 199 (72.6) 51 (18.6) 10 (3.6) 14 (5.1) 274 274 ` (76.3) 55 (15.3) 19 (5.3) 11 0*1) 359 181 (82.6) 28 (12.8) 6 (2.7) 4 (1.8) 219 percentage HWBU10008439 83 Table 32 The.number end percentage of individuals repoetins symptom of chronic bronchi c ls (HRC) aceardins to smoking catcjtorv Chronic bronchitis Tee No To cals Smoking, cntecorv Smokers Ex-smokcri lljn-staktrr. 80 (29.1) 34 (9.5) 21 (9.5) 195 (70.9) 325 (90.5) 199 (90.5) ' 275 359 220 ) I ) HWBUI0008440 34 Mu 0 ^aG* -W3*..- 4aG4s js e 9S1 'G 9U a > u "uOm wCo - Sg JS a W 0 3 Ov* ^O P* <" 1 *A O -4 *y g S& os *vOn & Oor <o .0*o-34, ^09 0<3o /^|. -4 O I o o O r-4 <-l o 2 Mwr m8 ^0o33 o* 0^?c*3**i W0fHV. *v4O-Oo-0<0 .wP*- ~-*ns*i noQ feoe ^ o w <o %*n 4pw**"Hy*** H wo o w9 MWmO ss- wUG0* OSwC U <33 * wOusU oJfw0*l x- *4* 3cWM WO* 3o W0e. <41G O S.S 3 3W *C<33O0GM a Ss o --** W* w 5 *o3s O d O .<A3 3w3 o 0 nWC MOw c"OOoJA 3 K 3 O C O *& 8- s < awacuj* HWBUI0008441 83 Tab I 54 -Wlckel concentrations In the plasma of amphibious vehicle, cousttuctIon welders compared co ariicr groups Croup ' Vehicle welders Shipyard welders Hospital controls no* Individual's- 12 Plasma nickel couccntration* Jug/1 icer) Median Range Keen i SO 11.8 5.4 - 14.3 10.8 2 '3.2 62 2.5 <0.5 - 15.3 3.1 1 3.3 15 0.7 <0.5 - 2.6 1.0 i 0.7 HWBUI0008442 86- AS8F-ST0SIEXPOSIJRK DATA iTOTW Of PUBLISHES RESULTS Xeview of fiber concentration data for brake week ^writy at aeuuRMati have been made of. asbestos air concentrations dtcbi:' brik* lining ^.repair sad Maintenance activities inC the United (Citas:tad Great Britain. These include both long-term sampling over a- wridai day to obtain lnfonutioa on time-weighted average exposures to Mtisn,. sad short-term sampling to document the concentrations during ynctoan work practice*." ` Tho.- largest set of auunples of brake Maintenance work is that obtained ,. bjT VIOSH during the years 1975 through 1976 where 283 samples were 1 takas* la lw brake repair facilities, including 152 over a one week paritad In one facility, documenting both long-tana, time--weighted awmrape- (TWA) "exposures and asbestos concentrations in specific brake Xepeir .ietivltiarT'QQGS8, 1972-1976}., Unfortunately, no doexuaeutstion jBSiats- aa-- tm the-namber of- brake jobs performed in a facility or by *ogtte:: during' sampling periods ok on the work practices* utilised darjat^fclie"-repair amf maintenance vork. Table 55 summarise* the data ....... ", 1 ..r 'ir. oat tlma-veightcd espoaana, ore* a sampling period, for'Mem:-changing lixiax itriaA,' :pwdiias out rivets, riveting linings' to shoes, and : nmcMag la^ thgr piste'department. Table 56 list* general: area sample* -ta'fciM-." during coiorM.-of a day. These data demonstrate that, in .- - --------------------------------------------------- ---- ------------------------------------------- *gtaatal, thmloag-term asbestos exposure* of tarsee wolaytta ace below. O.SM/al. However, daring the air bloving of drums, punching out of. rivets and riveting asbestos concentration* can be considerably higher. Further, area samples taken distant from the location of brake repair show widespread dissemination of airborne asbestos with concentrations op to 1.3 (/ml fouisd to be present. . Bora limited date are available from industry sources. In-Great Rrl- txiaV Oickish and .Knight (1970)* of the.Ford Motor Company have provid- 1%: -ITT.-'- * . . - *` ed., information on both long and. short-tern sampling, during different HWBUI0008443 87 eo 4 4*1 u <a tn oc. 8>s *s-." um#O-.rWn'H ,tI"2 Mio-i aaS. 4--n3< > '' * -5 AJ *k*33 r* 'jj. * I '1.-f4t1 s4 p4 I II. w H mm rt o oo o c% X y0O ^ X 2 -4 o ftS *9 a v%! H1 H Oa. O o o ei* co-4 O U Hf . Oo >n * *% m8IA : .1. . f* f*4 f* "4 H n f* . *<*O*r - *** w4 3*41 S**4**' wnp3*-f*c* ' A*0*` ' ,mHW -oumm - o a W wo< X 9X O `'QH O 0* T t m i M108M (1973-1976, u n p u b lis h e d d a ta ) \ HWBUI0008444 I ) ! 88 I s I jggk 9m I1 00u 1 uo u# ^0mnP-4 5 3U^4a 0aw .**^0f2ec* l-v U40 3S0* s I 4f4t 0 %8 & Q 9* U J si K KO Ow u-) 11 ift w0 o0 <* fN *0 f v** o S3 * * o o o o oo ) HWBUI0008445 I 41 *5 Sf G S <3 U M o Hu a C U o<y un o eoja o c u^ 4* ^ G SU Ua>.*<V-<1 43 U <3 a m o o* o 4I3* g- 3 -Ob nt4f. OC : a3 i: *h c* u G Q W J P* o a 8 t 3 Oo A* Cf433 a > 4Q3 O 3 a u n SI 60 x 9 U O g < Mdd 5 34 31 e <3 42 &s J 5 -.a- 4S 41 4* U n ' Hu rot' <6 w rw n u ti <- a wA- 13 u t* l \ \I HWBUI0008446 90 brak* repair activities. These are shown in Table 57. The vock prac tices saaplcd by Hickish aiui Knight appeared typical of those of past year* with the drua dust being removed by air blowing- During the full coarsa of brake service air concentrations of frets 0.4 to 3.6 f/k were found. More recent information has been supplied l<y Raybcscos-Manhattan 7k / .Oofaafe Ola rah, 1979/ Theme show that during the course "of. well controlled brake-repair work with exhaust ventilation utilized asbestos exposures o-*J of 0.02 to 0.3 f/tal may occur during- the course of a brake job. Short-term aabeatos concentrations during r.peci fi-. work activities have been; measured by several groups in both aul oisot i ve and truck servicing. Tbeae are shown iu Table- 58. They dcQanatrate that short-term asbestos concentvarious during brake maintenance work can be high. However, because lcomprise only a portion of the- work involved in brake r.iuir.tenance, tiic TWA concentra tions are generally much lower. Clearly, reduction of these peak expo sures by.engineering controls or by work practices can significantly reduce TWA exposures. '. Two sets of data on the time course of asbestos conccntr.it iou exist. The measurements of total dust by I.cc* indituie that after air blowing; short-term dust concentrations arc high but fall within on'mites to lower value*. The data-on f iber counts by Kohl4 indicate that censur able concentrations, of asbestos persists iu' the /workplace for as long /as- 15 minutes after air blowing a* far .is. 75 feet away. These data, coupled with, the previous information on asbestos concenti .it Ions in. general gnrage areas, indicate that a gen:-va 1 , low-level background contamination - of nrbejtos can exist . throughout a garage where brake repair is'conducted. MEASURE! iKKTS IK KKW Y6RK CITY FACIMTKS (1979) 2" During 1979,. NlOSIi made measurement at three New York City focilitic* employing worker* who attended rxaminal iom iu tl in survey. Tli-w vrrr the veptir shops of the 'DrpacLoviils of S.uii taticn, .Trar.sp.-i al ion wad Police. The result.* ar shown in Table 52. Tiny arc isimil.n la 'Ui* HWBUI0008447 ft . ^n d .tru c k ,b fa k g i'g a ln c m flfi fta tl ltlg i w , Ih o ri-te rw samples d u rin g s p e c ific brk re p a ir a c ttv lc lc a MJ . i C <** Qtt'*M+* iiW <v4 X . O * ' m <A f* .t* ia. 3 <B 4HHOJN O *** <* 4 n o sr v't e^ ae c^ O *m a <W *Q oa M o3 &3 m G S . * ma . *. .. K4 *0 434 <4 44 4 > M4g4. 8 <* %0 e* W4 Q@ pn r<e * *-* * ! 1 I 9 ^ b0 W* * <*r -4 oO . <*-. & X a* HM X p* u <* p* <* o s U-r . U 44 22 X p4 <A 66 X -- O * C s X V0 r* ov H 0b *- P* 61 Ob -* 'U 0 - x- -4 '-fS` X i* OC XX 0- . - ^C- 8 *0 wC ` X 44 r U 0 *3 ^3W < %J -0 Mt ' 0 MS o2 . e un> Xb 44 3 It W. 3 P K s- X -3 v *5? ""* fl~4 N I8f P*4 f*' <& < H mc o P4 P 1 P* r% P4 *4 8 a H o n i *Nt P* 0b H X 0% 4 p* 0b m b 6 4rf Xx ' <& * wX w 0 ac X ss >: 44. 44 ' 33 - a-'-: XX XK 0^ c( "S c. 4 x --5< *C3 6c4 U-i c 4. oH >0 - %0 0b '0* _a '^4- 4< 6 * ' X o & "* 0 U 0 oo$ - X c -X C u a s>. > c. <4 > aaam r? et 0b *4 0 44 0 oo4 X 0 X -O 0 XU e* x4 % <j U -* . %r. k* i HWBUI0008448 n Table 59 LflflR- and shorr-tr ret .lampllnr of b rako lining repair and uia i jir i'n.ineo vork in .S'ev York Ciry *ararc faci1it lev Activity. Sampling time fiber consent ration (f/-l) Sanp] <t tva Brake change After iinishing Job Wet brushing of dust Area sacpla Area sample D<*parr?aciiC of 3anitatian 136 190 10 . 395 390 6.33 0.12 0.54 0.06 0.05 0.21 - Department of Tra- Brake mechanic 1 Brake mechanic 2 Brake tw-chenle 3 Vet brusMi'C of dune (mechanics 1,2,3) 150 396 175 194 135 3 3 9 t! on 0.15 0.30 0.31 0.26 0.24 2.62 2.22 0.87 0.23 0.28 Police rvpA.-Ttivar.; Brake mechanic! . : 129 0.20 /-6a..'.'- - 0.21 Broke mechanic 2 - ` 124- . - , - ' .: o. 34 - . 177 0,06 Brake mechanic 3 " -47 0.03 Dry brushing of dust 12 0.81 21 0.61 ' 0.20 Q . 2.3 . HWBUI0008449 93 discussed previously. TWA exposures during a full brake Job averaged bout 0.20 f/sl. During either vcl. or dry brushing of brake dust concentration* could exceed 2 f/atl. E3T1HATE3 Of STUUT PQPMLATIOB SXP0SUK2 TWA exposures during automobile brake Maintenance rouged generally Hetines 0.2 to: 0.7 i/al if beuahiag or air blowing of brake dust, occurred. Prior to 1930, .riveted brake linings were used and aoaevhat higher concentrations stay hav- occurred. Table 60 Hots the distribution of brak*-Jobs pee week dene by U.A.V. Local' 239 brsbers. The average is about ose every tvo days far those, who do brake work. If the exposure daring the 1-2 hours required for a job ia 1 f/ul , aa approximate TVA exposure would be 1 f/al (1.5/16) or about 0.1 I/ml. General garage exposure from other- Jobs would add slightly to this, but the upper . lialt of the average exposure for the cowaercial garage Mechanics satstained ia this' study would be 0.2 f/ml. for tlu- S.K.I.U. Local 246, nrfi rales eaployed by the City, higher averagv exposures would have .occurred from the rivetlag, drilling aod grinding that was done on :lat|a tritrk brake a*scablie#. Howererthese high exposure wort actiJtjLtiiek would -only: require a few Minute*of work'. As with comerrial S***#* workers, few 'City.'.b^loiM, worked on a brake job as often, as ...U*** evea with: the ibtereittcntly higher exposures- experienced hjP'-SwK.I.II. aeaberm, the- average exposure for the group over time is unlikely to, exceed: 0.3 f/al SttttARY The clinical exatiination of garage employees engaged in.the repair ana maintenance of vehicles indicate the ftllu%ag results 1. A greater prevalence of X-ray ahnocmalitter is found .wnn^ garage acctualc; vho repsired brakes than among M>u- cottar control* a.*' ) HWBUI0008450 . Muaber o t PorcentaBa 'iif c ~ f r M o o a & C**4 # *4 f4 0 4Ud4 . S3*- X4( W a : 05i: H w x44r * *T .o K4- *5#"-; ' e 1 ; , ^ac *Ha8 . &i% H X44. o :' * ' - - ^4.- -" X C* O44 M-X. s r. . - m- - X c O x d ta cO Oc .wOc aw* -Hw 4Ui O H vo m ka fra n ' ofbr hopa wa r g m u l a tia < te a i r c l lun'e2n3 tcaso M l* M of i ;o f 'biralta I n Ov HWBUI0008451 compared to amskata with lesser service. The increased prevalence in commercial garage workers exposod, on average, to less than 0.2 i/ml warn not statistically significant while a ilpltlcsot excess la aea la workers who had occasion to triad aad natch lac brake, lining* prior to installation aa larger vehicles. The prevalence of X-ray abnormalities is io. accord with estimates of asbestos exposure in the different circusuitaacea. 2J? Hie prevalence of X-ray abnormalities asoag workers la auto body shops was psrticalarly high isdj' although the number of such in dividuals wsa Halted, also achieved a level of significance at <0.05* ^ The higher percentage of abnormalities in this group can be attributed to the past sanding of auto body-fillers containing asbestos. 3. Individuals who had previous employment in shipyards, averaging five years in duration, also had a greater percentage of abnormal X-rays. The percentage age standardized percentage was signifi cantly greater in those whose shipyard employment began 34 or store years previously. The. pnlawoary function results of garage mechanic* engaged in brake work are no different from noq^garsgc,: worker*: and other 'tbeeil;'fOpitUtioa controls. Am the major ;apt cometric tests are less-.sesnitiw nenaurea of .asbestos exposure than X-rays, this finding is in accord with the lew exposures of the groups under stady. ' 3. Car Jockeys, new vehicle preparation men sod auto body shop vmkers hav# signlflcsatly reduced pulaonary fhartion tests (FVCj, FEVj,- and HMF) compared to other garaRe worker* and getters 1 popu lation controls. Tho auto body' shop employees had exposure to asbestos and a var iety of solvents.. The causal exposure among the ear joekcy-vchicle preparation men is uncertain. .The role of automobile rduuM should be investigated. / j HWBUI0008452 94 4.. Pnlawriry functloa deficit* correlated with X-ray abooraMlitle*. Creator percentage* of X^ry boo mail tie* and pelootury function deficit* were sees moitg current and (ontr Batcher* than mm| BOAMMlcail. 7. Vo unusual physical examination of laboratory finding* were iden tified. Ae in other studies, a high prevalence of hypertea*ion we*'observed7 aaaoog black*. which was not correlated with any job '"category. S. A avail group of welder* In awphibiou* vehicle coaetructioa shoved aigulficantly elevated plasma concentration* of nickel. HWBUI0008453 17 larmsos Aadertoh, B.I., lilis, X., Uaue, fl.M., Flacbbein, A.J. and Sellkoff, I.J. Household-contact asbestos neoplastic risk. fan. I.T. Acad Scl. 271:311-323, 1976. Aytu, S.H., Cviiu, X., Licht, 0., Criesbach, J., Rrimold, T., Ferrsad I. ud Crisdtlcllo, A. Health elfttti a< expsoura to high concentra tion*? of aatoswtive. emission*.; Arch. Envir. Health 27:168-178, 1973. Baas, X. The flow voiimie loop: ahnral standards sad abnormalities la >ehseaie, ehstnetive^jwlaMary disas.. Chest 63:171-176> 1973. iHUih. Occupational' Hygiene Society: Hygiene staodard for chrysotile asbestos dust. Aha. Oceup. Hyg. 11:47-69 Bureau of Labor Statistics. Employment and earnings. United States, 1909-197'ii., SIS Bulletin 1312-11. Government Printing Office, UasUiagtom, D.C., 1979. Cherniak, S.H. and Riber, H.F. Normal standards for ventilatory func tion using an antossted wedge spirometer. An. Rev. Respir. Dis. 106:38-66, 1972. Ferris, 1.0., Andersen, 0.0. and Zickmantcl, R. Prediction values for scneaittg tests of pulmonary function. Amer. Rev. Resp. Dis. 91:232-261, 1963V/. /?;. loye,'J.S.^ levsn^ C., Cotes, J.Elwood, P., Hodges, I., ICell, R., Lowe,.; C., McDermott* H. and Oldham, P.. Effects of exposure to slate dssC: la. Horth tfsles.. - firit, J. Indus. Hed. 37:132-162, 1980. Qreeaberg, H. and Llayd-Davies, T.A. Hesothcliosui. Register 1967-1968. leifcv- J.; Indus*. Med*. 31:91-104, 1974. /-/ -SeUieff, 1.7. - soul..' Ssidosa, . HV':- Asbestos exposure, ~ jrtgsrefctm smoking and dcatJi cates.. Ana. NvX. Acad. Sci. 330:473-490, ' . 4," " ~ - Ucfclsb, D.X. . and Kaight, X.L. Exposure to asbestos daring? brake Bsiateasae*. Ana. Octwp.Hyg. 13:17-21, 1970. Higgins, H.V; end Keller, J.3. Seven measures of ventilatory lung function. Population values and a comparison of their ability to discriminate between 'persons with and vithqnt chronic respiratory tymptoos- and disease, Tcruauet, Hicbigan. An. Rev. Respir. Dis. 10i25-272, 1973. . \ Knight, H.L. and Hickiab, D.E. Investigations into alternative forms of .control for dust generated during the cleaning of brake assemblies and: drums. Asa,.Occ. Hyg. 13:37-39, 1970. \ HWBUI0008454 98 %'fa qu, R. J. , Slatla, R.C., Lcbovitx, H.D. and Burrows, I. Thm naxi- a*i expiratory flow--volume curve. latatl standards, variability and iffacta of i(i< Am. Rev. Respir. Dla. 113:587-600, 1976. Xacy, *.C., Callahan, I., Bores, H.C. and Snyer, J.fl. The Voters* A^nlalntratioa-Arwy Cooperative Study of Pulmonary FuoctiM, 1, Clinical SpinMMty in Mo owl Man. Am. J. Wed. 30:243-258, 1961. lntV G.L., Removing dust from brake aaaeMblIc* during servicing iWnutire cleaning Methods. Asa. Occ. Kyg. 13:33-36, 1970. R. fiauM, S.,. Andersoa, K., Andrew* , 6. and Selikoff, I.J. Ab*tn*is aatoag maintenance worker* la the chcnicsl industry and in inery wckan. la: J.C. Vsganr and W. Savin (ed*.), Biological of Mineral Fibrsa. IARC Scientific Pub. Mo. 30, Lyon, pp. :190. ; jSoa**6..m..*.-.., i-. - 'V.T.,V*nia,' AJC* Miller, A. * Micfcelaon, V.J, and Selikoff, Aaboato* exposure of brake repair verkees in the United States. MtU final J. Med. 43:207-218, 1976. Marafc, J. Unpublished data of Kaybostoa-Kanhattaa Corporation. CPwanoal Communication), 1979. Ml leg. A., Thornton, J.C., Saith, H. and Morris, J.F. Spirometric "ahmnrnality'* in a normal sale reference population: further analysis .* tfea 1971 Orege study. An. J, Indus. Med.. 1:55-68, 1980. *- * - J.Jt., JCoeki, A and Johnson, L.D, Spirometrlc standards for bnaitl^ aonsMakiag adult*. An. Rev.' Respr. Si*. 103:57-67, 1971. ^ - **' " latandni.: Institute, for Occupational Safety and Health,' 1972-1976. fvcanaal GanmuniestJea, Jblpfc Zuowalde. for - Occupation* 1 Safety and Health. Industrial Bggjamn- .'^ixvgy Report of the Key York City Sanitation, Traffic. and tuilce-. Brake Servicing Facilities, Queen*, Mew York. Cincinnati, Ohio =. , ' - . YicSMlseg* ,X Ferhei9: .S, , and Sollkoff, I.J. Occupational exposure tm^tofcwinei popwlatlo at.riak and projected mortality - 1980-2030. Ati^X/lad. IWd.. 3:259-511, 1982. jakA.*., laager, A.M i Volff, M.S. and Veisaan, II Asbestos expo- WW"i4srifflg brake lining maintenance and repair. Euvir. Res. 123.110-128, 1976. 7 rl^rTvj"'-- * ' * ~- IsMiteri' C.Xk- and Marries, P.C. U.K. Mava 1 Dock-yard* Arbeotaaia Stwfys |my of the sample population aged 50-59 years. Brit J. lda*. Med. 36:281-291, 1979. Rossiter, C.E. Initial repeal ability trial* of tic L'TCt/CIui.innal i Clanaification .of. the.. radiographic appearances of pncusarccnloses. Indnstr.- Med. 29:407-419, 1972. HWBUI0008455 100 appendix I 'V. ) HWBUI0008456 ____ . _. M&xz ix?aii ass HkurrwscE urnsjis svaror ^SEriESsS'': r jfcMtmaat- fUa9HIr StrMt 4ea&% fSlligt ~ '^mr- . SMSaSiVi*rv.r--.-'i :-- * ' ofPhyaician (optional) ' u r' - 8.&xmmi'im&imz-y-- ; . Otui - - City f.. . Data of Births Onion Local Si Seats ____*Af* '>?%* _ "-wp TM 233? Stas, > ..- '}:. -r*'; V" U3UKE: UlnmiH Protein i EMVlitONr/EBNTAX) SCIENCES LABOBATCB;: SC.}",0*-C?f MEDICINE OF THE CITY UNIVERSITY OF NEW YORK HWBUI0008457 HWBUI0008458 fa--z;jg&---.-: -T. r3* v S. :*r ' ? - ft:( &f' , 7 < -i-35r ' --; -; */* - v-.. :n <y a 1 T- ;* .-^.- .**......-Sc-A\ 2 ' : v.` - 2, * ,.r. - re M . -f~ | )* < t 1 1- *P$T * Il y? - K Sts* i>r _J yy r r-t-. ^T. v > ^ : * ..- r > X HWBUI0008459 iTv-ri- m it ?g-.-s~pSbi`.f-=.c. Ivm.t': ` first' 5'T.:^J. .vc=act I i 1 1 js i rj -.;r;?Tw-Toar- first xacaed ee istaseaa (oecptlaiullf) last axjoa^d to asheatoa: (occtraarioKxllj ) tattl~~ ee.!ntr of years arut seatia exp. os ersft ta saO&eestaa /pxc4~ & tsifS. C&JiiMJJ- pcn&$ A&t Ljtf- ****{. 5^^'j ;* * 3Q<* fate* essplayed- Cat Carafe tort*; ^^53r*'.'hu'. -.- ' .." . . I1 1 K,T.VW.-------'" ` ' "/}:'Dates perfarriac braie liA&a-g I '! 1 prfsrstsc irfutesrcosttns jfirSjt-v .t>~- t-r* - rv`/w< 1 i lipa<|i' to a tier Cssfa - 2-res ' r- f I l iTtq .. __L i ii r`i2s?trv*.V*h. to I i 1 N* tso .1- ! m r. to T te to 1 l I hs to 1 1 i 1 21 to r 1 i 1 !> to r 1 .1: 1 C? L_ i--J* -JLI -J4.--i )n S':T^a-^ - 1111 ex. p/^ssx-rr------SKa^a^jl.. Tear, first *xpoa<t . - ' '.v-T** last exygaerf- RU=br of j*wa and rentes cnpoad : t i r-' 1 :!' I. v' .! rit ..... f*r first exyasod . I'yfi.Sia^.Tfig last rSss *<2 ---------Sr.-...----... ... total stabler of jean nd ssaniha exposed Tanl years Badorjreesd Otter taar tint txpaaodl . tear last exposed Total'aurar of yetya -=i cont.bs exp-jjad ;./ -k.- t:M: I-' | = i1 ; I:- s< I.-- i f - l xs 1 ' 1 rr ll4 r i 1 2t t*rto? to beesrioj t pnit wby did lay acaber of jc-^r itsadiat* lastly ecr'e 11Jv satestea? l-a 2-T*s /. If ;*,_ *Sa, J ) r^'*' Hi <T^i 1 to /.{///I / ri7/zrr tc /.-I" ; ^v/i i -V / t 13 /- < / i l 2S^--.b>* teprodeexj trow gffj| bt yraiUbW COOT1, - l<s| 1 -Uf !3 1 1 1 HWBUI0008460 ) ^sx 1C5 XISPIJUTCSY QVT3Tiex:aOE jrcJeo 1 ! ( ! "TIT t SM sow feinc ta ask you ioa questions, sslnly about your chest. I *ou l d Ilka; you to int*fr: "*TES'* or "M0* whenever possible. COCCT li: :> D jwt usually cough first tMo* In the eoraise (on ftttuj p*)y : ;?.:.v". Count- a cough vttfit first moke- or on first going.'out of doors; /-:* '*"*'" Xacelud* clearing throat: or single cough. 1 - So 2 - To* 'J.vJ.'Do- you usually cough during .the day (or at atgfccVj? Ipon aa occasional couch. r ~Jvv.-r; r';- 1 - So 2 - To* 3. If ye*j Do you couch like this oa cost days (or niches) for as ouch as three conths ee.ch year? .1 - So 2 - Tea Sara you been coughing like this* Cli - less than ro years y <21 - ears than r*o years phuzx Ba you usually ferine tr?i any phlccs frees your ekest first thing; i% the *. r.-tNwrai'ac. .(bn- -gutting up.*-):?.- '' '/: '"r-\ -- Count' phlcj^ sltli: first sooko w on first eolntt, out of doors.. '.ip..;*&cla4*- ehlscff-.-fraii-the'-no**-. Count swallouad phl#sa. 1 - So 2 - Ye* S. . So you usually ferine up any phlega. fro your chwa t during the day . Co* at night*)? " ;:V;--Si: 2 - Yes ` * If y*n*. Da you bring up phlags like this on aost days Car sights*) far as each as three oonths eh year? . i - so x tvs Karo you done *o for: V. (1)'. - less than ro years (2) soru than ro years . .' -- That color fa your s-putusi or phlcgn? (1) - - win fish (2J,:. - yello* and/or eretn (2) -grey and/or black, (4) - brn Catos KusSor ) <* Tor sight shift employees HWBUI0008461 Is your cough seA/ar phlcga production related 10 soy season? Cl) - iprinc (2V - .mower 1 - f* (4) -- n-sttr - (3) - *11 year ' Don The puts jcxax tkxxk thxs the- pattest fulfi ljus the crvzvaia ros CSWKTC ttOSaOTIi? - m s- (3):ipktiy 1, .la. t?. put tir year* have you had * period of (i:icre3*4hd). out* 9 4 t. '|Mp listing tor tlirae seek* or ere? 1 - So 2 - Tea ' Have you had ware than on* such period? 1 - So ; 2 - T ee .'" lave you tr coughed up blood? 1 - So 2 - Yes If tw: (1) <3) (3) 14) C3) bow often? . only occasionally oaly occasionally with a sever* cold rputssi streaked wits blood (frequently) hemorrhage other (specify other) . { 30 ,/ 1 I it ... *7 -------1 321 ! sif ._ 24 1 10. W* this tatthw:past year? 1 - So 2 -" Ye* ' HITHU3SyES3 - ` /. 'li."'dkr ywi= troubled fey htsr?ss.sr of breath when/hurrying `oof iaivoV-erdasid^. . . 1. - So X - Tea lie/' . Do yoa (ft sbar% 4t fereoiA walking *4th other people b ywy.eee i{t?. . '"Szh'r.:. r.- : l - So 2 - Tea 13. Do you* have to stop for breath whes-ea Iki ag it your om puce : oa level fTouad? l - So 3 - Ys WKEEZI2C 14. < Does) you chest ever sound ehcexlag or *Sls w`1 1 I - Sn 2 - Tvs 15. Ifjree: De* you grt this costly dv.r tie dry or acr-tly v Bight, cr both? 1 - Day* - SIgtrs 3 - Doth is. Save you ever had stracks of skorrasas of brer: i it etuecsir.g? 1 - So 2 - Yea 1 / HWBUI0008462 tiCdlPATIOMAf. lltflT W IY COHT|NURD- Use at air hoso* to blow owe brake sheas: Wslch years, doom 1C7 Oo/dld you. bevel or aachtn* shoes? Which years done ' . What current dust rerovml practice is: used during brake or dutch Jobe at your garage? Whan did this basis? Vhac was doo before? Old you do undercoatinj .work or wars you near such work? Describe: t cs 66 ID S3iXRAX0R3: ETClZhT: ' 1,.-.. :-pd- y^*.iwe*-r;.*vte*jira-c.br? 1 " -/l-V-.Te*.' ... 2. What type is it,, asialy ? 1 - Filter 2 - Carsridgs 3 - MrShpply _ 3. ''Oo-:'''yow/w*e.;-it'usual!'f;:\ I.Usually 1 - Occasionally 3 - lofrequenxly 1. Do you eat at your work site: . " 1 - Ep '2' -. Tas 2. Do you sneka at your vork site? , 1 - Ho , 2 - Tcs 3 - Hcnssska? 3. Do you ehnoge your eloehec before going her.-1? l.yfe.'- 2 Tcs 4. Does your c=?layer furnish work clothes, ard launder choc? . 1 - .'Id 2 - Tea 5. Do you have separate lockers for street ar.i votk clothes! 1 -Xo. 2 - Wi 6. Do you ihoucr before joins hoc*? 1 - 'Jo , 2 - Tcs 77 73 mi 1........ lff.1 CZI5E LmJ 'ID rrwi HWBU10008463 ICS if.. If yw: Is An a your breatkinf Absolutely aorral berea attacks? 1 - 2 - T m rtVTXnt IV... 0oa. ttt: vestber affect your chest? : Oaiy: mord "`YES'* If tdvtrte mtlwr'deflaltrly and regularly . . cans** chest tycptcat. It. If yes; Does th* seather oak* you abort of breath? Type of weather (1) - beat (3) - cold (3) - daapness . , !; (4) -- dry ross (3) - toy extrw* i; 2 3T 3il r- 40 msxL cmfwH 3Wkt.Dw.Joaa usually have a stuffy nose or catarrsh at the tack of your . f. ' la the winter? 1 - So 2 - Tea 21. r Da you hsvs this la the susaer? " ./i' POTSIC1AK COStEfT; Kasai catarrh; .. 1. <1) has no relation to chert eoc.di doe (2) acsrsTat es cough and phlegr: yroAuc tion frea chest, as described shore. (3) 4# a cause of cough and phi tpr (4) 1* a. asperate entity - no easeh and phlec* re produced by patient. (5) caaaot be specified CaSfXVLSZSSTS ^ 22^ DurlB4: the past three years have you had any chest 1 linen which has kept you froa your usual activities for as such as a week? i I i I 42 .| _ lE 23. - C ` If yes; Bid you bring up sere phiesa than usual in any . of " theaw illnesses? - ..... Ewe away Illnesses ilk** thttav> you had la the past ttm years? COD rnn If.' Diysa have a heart condition for tfhi.ch you arr under a d.-vefor'* eir? 1 - '. 1 - So 2 - Yes iU . If. mTXSm specify conditions and drug therapy ): HWBUI0008464 TQ8&CC0 BSOiasg 103 3/ Ob' you a* raok* cic*rct*a? _ tt "HD**:. Saw yea vr *oak*a cigsrattaa? 1 - So 2 - Tr* 2S^ Be* bU rt yo. ihM yo 1 tarted. tookloc r*clariy? 2*i Be* old-*r*; you-fea-you hit pr a? rwkinf i [t ftt*.4i? jraars. list l&at stopped iseking 30 Wdli you nk oa th tvrt(*? ' <f * ." ' ` -' ai'i^Da/eie 7i 1 nival* tb dfaratta iaake? I - So 2 -'tea 32,'-; BUat do/dld yo costly asok? Typ* Cl) - filter (2) aoo-Sllter Sis* Cl) rular ( ) - Q<2 - kins *ts 3 10 ailiiseter 33. .e yott ook a pip*? 1 - Ha 2 - Yes .14*. . ~ _ lif "So**; Kav* j&i aver laokad a pipe? 1 - So 2. - Ta* 38y:-C.-lBrMUf-.jipaiBl* * ij- Wtfii- you lteoke? 2*#i 0ywa- saak* cifar*? * 1 Ha 2: - tea . If ~H0": Ha** 70a rvar saokad cl jars? i - Ha 2 ~ T*i 3fr ;* ;* ; \ Be* may dc*x * d*y/do/<S14 you *aok? ' jW0*T.Coiyo &** tetr*a? 1 -So- 2 - TJ 3 QT; T 1 50 L. i 51 1 54 L1 L_LaJ HWBU10008465 mst msratr ---------------------------------- i" C' no Aiaz ) .LUL J 4 first m BATE or BIRTH razzes. i ito si ACT i is 1 tni .,>1 \msx aain4 bf i physician? (Month & year). i it I !bt .*ste illness (&rt hospitalized, other than. trauma) (- f ai-I scuta Illness (heapitiUitd, other than traces) 3,, trauma (not hospitalized) irmuom- (hospitalized) 3,. "follce-up, acutei Illness * .folio*-up, chromic Illness 1* . routine ehek-up *'.' occupatlona 1 surveillance propraa (exam, supplied by employer) 3,, pra-=playsnt physical ' . - ----- ea< your last chest xnayt month year ti } ' KmsU: 1 aarsal 3 Jterul 1> dMta't know PBTSTCIAS; Code 0001 ; . . if never bed chest x-r*y ' 25 ':r'"Bar* jffit; mr.hwa hoepltmlixmtf? mix "l, Km CH 3^ tern Describe belov HOSPITAL REASCCf T0-?1 PM"3IClASf Have release or=-i been stgr-ed? So ret \ / HWBUI0008466 *v 2*--**** tal<s Ill factor :s: you !-{ au / the foUc/vir.g renditions'1 Ctrti 1. _ Jta rt mi r=u r 82, ~ Ax%in& 23.R**rt Attack i " * {Me'Aay\ tii? hea rt eondi ;ia: lor rfcici> you Sjsly&g***- twl*r. the ear* of. s doctor? (specify) blood pressure, aid. . W.-_ .-Ct*d2 e*ti oa ^'ta :- Of-i^Ai-daea lOvy Srw&eMtti uJ'Xlapitji*** \v. - y.;. ----- 12-iy Brooietd etaal * .IS.rt-filsoaayy tuberculosis 14.-31lieo*lt S5,:.vAjlNr*X<M!i3 ;14l,, y Other M&eu.*r (specify) 6trotate*t<al alc*T - told try St.8. " . - Seaor-rbaKt . SSiy.IHsiode*!, sleer - tald by H.B. r-' JT.- , S2*4Safr fro* aider 34, Other Cl.bleediac 23.'* U2at&* berni* f*,, - ._ KepacTtla Jf.` Jatradle# .s` 2$. "' Call bladder disease 23, Liver disease -"rr- v-*-` 30, ' 2al*rx*d liver " 21^y^Ciarhoaia .'- alcoholic 32.^>yV"'.- Other , .* 33. Clceraii re colitis 34. Divert: cul 1 tl * 33. Other Cl (specify) Cent tour: na rv 36. Xcpftrl tl* 37. Kidney (laziest* type) .34. Urinary infection U. Kidney stones 40. Prostata esl&.rs,e=*at 41. Blood is urine (not caused by above) 42. Protein in uriae (cot caured by a to re eondi sic*s) 43. Other jeni tourlrary 3hin 44. Psoriasis 43. Ecxroa , 46, Other skin (rp-ecl iy) Bicod 47., Acute Aaureia 46. Chronic Afic-al* 4-S, toe whito- blood count' so, Problcea etth blood clatticy, or bleedinc 51. St efcle cell , 3.2, Thelesseai* 33, Other-Blood (specify) Bye - 54. le^uire glasses 55;; Claacoca 36. Cataracts: 57. *eak or lary eye . 38. Optic neuritis 30. Other tye (?clfy) tar. Xo?c and Threat 60, Chronic Sinusitis 61- Impaired feesris?- 62. Xasal allergies . tetjaLfCr. ^ HWBU10008467 4`: liffa(al polyp* (5< Toastlectooy CiT Other IXT (specify) :.'#1TOU Svttw iT* Set213re disorder ; Sixolse JPerlrl asan * t Dt * jbi^lhrfehlatrte Hines* .Tli.'t" Other* Serroes (spec!fy) mt.Zx ;* SX^It&muitoid arthritis :.. . TX*r Other arthritis ^4^ Injury- .?Sr;' Dejjenera11 ve disc disease 1*$fs'-".Tans Keurelo*ic Invoiveaent? T7*_ Son* lesions 1#,; Other Musculoskeletal (specify) 1*2 Cer.arat are c 79. Thyroid 41 tease or potter #0. Diabetes . #1. Coot 11. Sight mstr S3.. Fever 4. Other (spec4. ?r) Cancer Si. Skin 84. Throat 87. tucg .. Stccsch 89. Boel 90. Ractus 91. P ros ta t e 97. Breast 93. Cervix 94. Uterise 93. Other CA (spec: ';) I JEfrg-fC-1 P I ;A'3 condition aaber C,D a 'V'C / "'= ' .V-'. . -^ic ' * * Carretrely taactl ve e ' Active-* not: under physictan't care ye*r, diagnosed Active, tr.det of h.Vvsl ci >a ca re i.ySjT --:.** h*4 j,,r.. - -in i 13 rl : If- ' ,1-'/ f- r 23 . i'- ! \*T 'l t-: hi i f 1 35 It! ba fit - - 43 .Cal. 1-5 .ji afcove; punch E In col 8 Other . - t7 ' 1 31 is*1 59 63 1st hi 73 7| I 11 \'* f1__ v ! ' 1:V1-S 19 . ' I!- ! 23 ' V.! T7>- ! ri ! jli . 1i - _ ' 25 ' 39 1 -ha J - i r. 47 T I i 31 ! Col. 1-5 -3 stove; punch K m eol. 6 HWBUI0008468 bvaztmx, .Xi'J iM 3V iVhixkf Quaatltr 13 ^OLUJ/Sftl j'wrca/'vaele fiat* Ar**k approx. 10 abotj 1 plat 1. aa alcafvol intake 2. < # can*; < 1 ; < 1/2 pint 3. -24 eaaa: 1-4 quart* 1/2-2 pints/voe'e 4. > 24 on* ; > 4 quart*; > 2 ?ia:a/k. 5. ex-alcoholic < 1 jt I. ax-alcoholic 1-3 years 7. cx-alcoholic > lit* year* _L anjicancerr am: too cctp.rsTi,T tascjc am- or tkz tou-c-ing msdicvtisvs? 1 Kot taking any replication 2 Currently tak: rj sedica i;m f 54 OX -.Waratlc* C*tr pi lie ) 03 :'21(b rt =#<1* ( other) t33 .-rirtroilynertai -V;- ~ cardtM - A CfcaffBHSay;ci,t>lliaC (bl<x><l thinner) t^^gtjqrtx^a^ittilXIttotlca fitara l<Q^S^pwt<fe awte'^-:.X2^;r^s^eSited ~ IS Trtsqatlixr 19vx ABtl^dvprvsMata .' 3i; ~;SXi^j^:plix* daily CVyijtttT, jrwo-.wwr'ktiO-- radiotherapy? . 23 Asti yQBfflralaaatJ -,s -. -, ' 24 .- Aail-'lrilaKStsrl* 25 - Uxatlvt* ` ;... 26 - Aatibfitlnlne* 1 27'_f DocoJbfektamtar .* * * 23 29 - AL6T^r^sk'0;`- 341 - Other (srf?iiy1 ' Li *t scdlc* riar-s currently b*i&3 taken, by ensber t 3 to : 1 47 ; 1 M 1 71 f 73 1-'' l> 75- '1 1 77 79 HWBUI0008469 :a mSlCU. SXMrtSATlflM t&M-T f f 1 12 3* ^cr 11 (in.} ^ltta v r aiir Hiddl* Initial 13 117 9umbmr . ' 1 ~ sl 5** 2 - fal Mm: rxc* !6 23 Xoptlnrlry IFI 1 soraal, 27 2 " irrejalar S~~- . tesri'a. i* * tAmcs.......................................... ;^r v " '-a ? X 'ihzJi developed, v*U (KHirtiirad Ht*:. t '* '"'-i. - - *' ;/'% 2'- OU4 3 octet rza * " appear* chronically ill 3 " pel# w -3 f* Mad ~ii ' ctwasxs--.. -6 " other % ..................... ..X.......................... *^<*#e '"2 lip* toogu* -'4:' * ' - ' Secants ... *-*^o'5 - r - * " ' .t* 1 # 2; - To* .. 3 . fJjogr* too* -' ~ s~.. - ' ' "v'V vStaail* - *1 .*-* (boomE' 1, oeher *X}j ehoraetorisn. J; \5 302i; V *Rkl*s odxss* 1 JS* 2 -T* 32 JOISTS '^rt * aoraal. '. 11 aheariml If'afcaocMl.:. ` Joint cad*: 1 tlP .; . ff'*f Kao* rl - BET' . f ? Aaile : 3 Write 4 Ilfeev 3 *'Shoulder f- ' "Vdoccxipti^c ccdc:^ ` f Haro than 3 _.^3 *.!. otter `f- ___ 7 2'iieda3ai host: Aj^^&nSxy:lMS; 33 Joint doacrl ptii. ill I lM; um 0 ) HWBUI0008470 -3 - 115 1 m- StfrMX 1. m afessarmi&H ty tlV&tMMrnalt 1 m satarrta ' t axsM wmlgMrtM 3 m priMl _4 > other {deacribe) - ETCS (laoorul, ltbtomU (ioxllr folardlctarlc Cl=3a 2*.Ya) * * ................ fre -i'- *'.^n Coiojaactlra (laeoxsal, 2--*t ejected, 3-pale, 4-other Beooriba "ether" s is-i ...: .-a.v - 44 4 47 44 iSOQta (leoortsal, ahooraality another)* * ....................... ......... j Peocrlbe "other" ;- ____________ : j '3 ^twrpiim _* *. > ;S- ol*rfW 3 m nodalar I2S^gfATKf CItsV lesatleas) .. ' - - 4 ,, V``` .. .rv - ;lr.e70*uX - !=-: - 5 'iacolaal . ... " .Xj-cervical.. . * m.-marm than 3 *ite# ?* ;nprMlaflUr 7 other 4'm axillary V-' ' S . i r-`? - ; sr '* raamrnca 1; e'.ao'raal. . l^dMllaeaa,, riche 3/-dallaesa, let* 4 *. Jacreaaed. A? diameter `5 W flarinc of eeastal oareiaa; SV CM HWBUI0008471 116 yjipg rzjoaxsiott..,.... % - owrul % ftallruraa, ri*hc 1 jtailnean, left ft- * bypar-^rasoeaat, right ... Oualba "other*: ra S - hr^r-riMuac, left 4 - hyp4r-rMOM(, bilateral.bases 7 other >-*r- .. . 4CS9JLTAXKW......--------------- ---------- 57 J. ft jMxvnJL breath sounds 2 * ftacrnased - ritht J - ltie -4 " Aeeraaaed bilaterally ft uhfstlnt and/or rhoochi^-dil f U* 8 . aoitt rales f * ocher > wfcaeriaa and/or rboochl In a localised area: Jteaerlba aehr"m SALES. 1 * mm 2 ** SLAL 2 SfAL 4 wax 5 S-Raaa 4- UAL *4*aaa 7 - LTAL't8 - L-Baaei 0 - Allfume (ncrc than 1) M oapfAC f&UATtm. km footssioh ............... |Ia*aL. 1 lft^ fwdrittl hs f : 2.;-|wnsx palpable la *p is*aentt i: *' tlsht heave 2 jhear* aniarsaA by percuaaioa ft - displace* F.M. I ., T5" JEWHE S0C8B*. f. iaacmsl. "J pnur } * itszans heart seuada Daacribe "ether"; ft - pH >ft II 5 - S3- .. 6 - other ASpOMQf - laarxctloai____________________ _______________________ - ' KiMM 5 *________ ________._______________ _______________________ AMowlnal tenderness to palpsdon. .- 1 non* 2 SOC J * *LQ ft * PpdgMMtrtc 5 * fcri-uabllleal ft UK* 1 * UA | atuar Peacrftba- -father"_______ ' - . .*..... . J HWBUI0008472 nUJPASLZ LIVES a>ao palpable, 2-palpatoleJ.................. IS (Mlptbl*, *ps nld--elarlcaLar line - 1b cm LSwr ZMn&&nttr$M (lo, M<t) ......................... J4w*V .................................... l-tmr--1 ' 3alin(Ur nodular MacrMd. ttnsH' 4*tlr 7*U*BtZ >712X3 Cl-ao* palpable, 2-paJpabl*..........--11 ptlp>M( two, dlantlou by percussion <e=a) MLMSLE nDKCW (1-oot palpable, 2-pal pabl'e, right_ 3-palpablo, left)'****........................... iasaaSAL MASSES BY PALPATIOX {l*aoo, 2-prasent) - * Laatloa, size- and consistency * 70 . 7X 73 -74 '**? *^ * jis? Jiff . Aa 3 SCmOLOClOU. EXW1IKATI0M Smp ioadea nflaxts . laamrsal J1-'y.* S-toypasactivw ' 3-decreased 4-absen* ' ipeei fy; obaoraali tyt aide kse : 11; i- bleeps wrist 12 ^14 a 4 # ,# *. i aaa * r < . tmmawwaS' - ' SU4#er***wf *trwac*& ladleatetcssele. croup Involved;_______________ 3wri*i drop 4twl*ky sign. S*#ztKr "ftkasii d-g&biasfci f-etlwr v TXBCQiK* * ......... -. l-ooa J--outstretehed hands 3-iateatioa 4-fae*, . 5*otJw* JJeocxilW "other": I I 1*1 i I 18 Cpi.^ 1-9 **-_ a* >wo; punch K la col. 10 HWBUI0008473 sasosst pin Arts* Cl, abseac, y.. - . - - Lag* (1 - absent-. 2 present) 2 present) cxbee^ranoiLocic V-." 1: OOQ 2 present (destrlbc)____________ IXIH1S13.` S CCOE., 1- Selikoll 2 * tedarsea 1 toss JTv? FUcfabeia -5:- Ealsc&ir. *.T Larl.acr , It *, tea . JUj*a=aais; lflr ; T6&ax! re CS EE 5 "l HWBUI0008474 exa^r^ys HTOttJt tXS zst roct -^ 'IfITOlirr DESCXt?TIOa 1* Investigation of Health Haxards lit Stake Lining tapair and Kaiataeeiie* Uorkara Occupationally Exposed to Asbestos Ciaosa. 11Q-T7-O1IS-QQQ0) ' - 1; Xivstg*tdr*-s Irving J. Selikoff; K.D< and VlllLaa J. MieboLsoe, Fb,0. * - .-g; ' .. . .3.-Purpoaet .' To identify any huaaa health hazards Associated. vl ch - ^'^Vrak* repair aa*i sa&nsaatie. s^cmsax to pAsxicrPATE S S- T. ______________, age , , hereby voluntarily c~re to cooperate la the: above naeod stvidy sad to undergo the tests listed in Aftaci-ant Th* study bo* been discussed with as and I have been given a. copy cf thi s deosseat. -I understand that: ' 1. The procedures and testa to be followed are an stated is Attachwent Aj no procedures arc cxpecloenLal. 2, Attendant discooforts and risks are as ootrd in Attachment A >r,d, except as noted, are ninioal and provision loss been cade for spy necessary medical eare, and: I have, been Cold t>-aat to do if 1 have any reaction. .. .:j"- ]' 'r' 3--; Benefits era & ind lea ted the Purposeataceacat above ONtt . I, Itea; 3) .. . - . - ; ' .. 4v' V Utralternative procedure adraategeoua-t: me are available, they `atm? specified- in Attachment. A; and if they'bccosr available during: the prsjcfe,. tha procedure seat , adyaatageioos. for ae will be indicated and used otr an crplaaxcion vill be given to ns as to as*-pf aaayMother procedure,. - ' -~t\' - My: inquiries; vUl be-answered by the project directors or other perxooani inyovled in the project, (Telephone 2I7-630-3S23) . Z: aa free to terviasce sy consent and to discoarlhae participation in the project at any Cine viHxJut prejudice to nyself, 7v My identity and ay reJationthip to any iri/oraation (!) disclosad by wm in conpleting any prpjaeL; quessioonaire cad (2) reported by a-or derivedvfrtse1 ae during ny participation ta the above nened project shall be kept eonfidenti.il and wilt be disclosed to others vlthout ny vqlctea consent except as required by law and except that such information vtU bo used for aeatJstiral and research purposes la such a manner that no Individual can be identified. I understand that if any. iafovcatioa is found out concerning o that caa endanger the health and safety of others, this infor mation trill be given to the proper authority, - I. If any of ny oedical records it re required for purposes of this .project*.* taperata written content for release..of the records will be requested Croa sc. HWBUI0008475 H30 f. Thera will ^Mitlaai that 1 will W ulmd ter ituwcr, end *f inquiries coneseeing the queacieaa will, im yt.: ~ . ..~r ` ' ' Or. Selikoff or Dr. Sicholson 212-450-52T 10. A- report of any significant. iaforaatloa froa the study that ' specifically concerns aa<: including pedicel lafbrstatioov will . be fwaishad by. the. project of fleer or his designated representative to aa or to nydesignated physic isn(s) upon completion of the study or earlier if appropriate. ... iiQuantf - = u. . Subject's Naas* Data .xxx.-vcosisErr for iuotxkamce of records hereby (Its consent for Mount.Sinai School of Medicine..to- uaintain all Wittrfi/ei. this examination. They will be completely confidential as above and i^tforati<ttj<ill . bareleased to any physician 1 designate upon ny .written-''.reeaesVI.ead' hothoriratioa *tr any tine in the future. giaygstz' Subject* Keae. ,: ..Hetm ' ` X T* inffiST ASH IDIHOSIZATIOT FOR RELEASE OF XKFORKAIXOIf JX*.,, -- - - - - hereby requeue and authorise tlUfc^PrdJ,ct. Dixpetor to Xaibra the following physicians whose ooocs and `'addressee X haw`entered below of any significant findings froa the'above named study concerning e*. (130 HOT LEAVE BLAKE: WRITE "HO" WHERE TOO ^00 3WT HUSH TO erVE.A IUJCE AHD ADDRESS). i . " , ';* '. t. Mf personal; physician: 2. Other physicia'aV Dr. Dr. StrMKr ; ; - . - Streat: ** -:Vs?.-v-*v~*N-, Cltrt *- -V.-. *7.f4-- A>~ *r -''isr--4 v:\ * . -v City: *- > -nL V'.; Scata/Zipjl. - . .. : iC ,'->*** " J. ** - :Ifl ATTACHHlfTT A A. / lavesslgasion of Health Hazard* lit Irak* -Lisin* Repair* and XalnCBAanca. Worker* Occupationally Expwerf. to Asbestos onosa 210-77-QU3-<3000} " . ... l':feT7s procedures and tests which involve husaa subjects la conduct ^of; this project are a* follow; - flood casts ITria* anhlytis Sputua cytblogy Chest x-ray Pulmonary function cases Physical examination Eaeh.ef the above provides important Infcmatler. far the;' evaisiaticn o health statu*. There is einct' disceihforc associated siti; the ,ir4v-isj o f-blood froa. Che am. The spucua eye a logy involves coughing c? pfcieyjfws tht throat tner a container which is provided. The palneciry fuser lea. test.--involves a maxima breaching-. afford C.dl&ghe* under the Privacy Act of 1974 Title S Caitcd States Cede. "''" JTIctloa 532(a) (e) (3) " !&z- - :- --/dd . . XSss;. iafsrsatiea required t1 h*. iva to a* under to* Privacy Act Off.-ltlA.i* aa follow:. - r 15: Authority for collecting information is die 0ccup.it local, idety fei-had Health Act of 1970, "23 -The principal purpose of. this 'stud* is as stated la Section t* d':. I'ltm 3. : - ' Ww-ji. CT. - v... : - 3) Koecine use of this lnforaation is in developing criteria and programs for a safe and healthy place of enployarcc. ~ 4)"-'I-do bo.c have to furnish any info reactor* I do not wish to. Clothing happens to Be as a result of'oy not providing infcrracioa, whether all or in part of that requested, except chat I =cy he terminated from the project. . HWBUI0008477 m2 Brakevorkers Occupational History Asbestos Exposure Cod# Berk Practice (Prisarv Code) U Brake work: (Greater chan 1 Job p.v.r. 6 souths) or garag procedures vhlcK" vouid r etuit in- heavy direct exposure, e.g. lwakr work.. clutch work,. or front end, work which involves the air blowing o asbestos containing debris.: 2.:- Caxatavork sot directly involving brake* but where ocher exposure to- asbestos could occur la the facility (i.e. brake 'work dooe elsewhere at the work site). 2A. Body repair work involving aa asbestos filler. 23. Undercoattag work on a regular basis.. 3-.- Heavy occupational exposure (activity vculd normally raise visible dust)j t,g. factories, Insulation work. 4. -Indirect asbestos exposure, e.g. in shipyard work, taping -by painters, construction work near spraying of. ast-f-scos or Insulation work, work la plushlag and heating traces vita asbestos exposure. S.\ Low indirect exposures, possible Indirect,, or very, occasional direct. Brake Work Codes - Secondary Cede (For e Primary Code of 1, only) "`"Frecwener .jr. r in " 1 . A ! job/day or greater '3: : J;r.-4; jroba'per-week C 1 - 4 Jobs per ssonth 9 1 - S Jobs/6 tsonths . Tertiary Code 0 Ito grinding, or beveling 1 . Seats grinding or beveling Sample Entry: 1 B1 ICO . 2 0 0 ) \ | HWBUI0008478 B IT U/C Classification Inf m u f tatafe d<3 Radiograph)** is HWBUI0008479 I, lWtiuWiWfift'<: ."'. . ires iisSsSsSr *' imiu ii il;! !! ""' r*\;i ~ *. a ...w-- ..* -.r.w. 23 -!5 f *it ` H. If <i*k J . 1, 1 ' *? sQJ&sr'-. -- -..v-r - iPSetfc&A'jirt '*>1 41 Iv * IP i`aSiS'flr.iJ'J ?y**.... ln*Mfllfc iTtZ'iSg&T*'- l^ig 111? I iij ft li: .&**.< T-<,,'J*. ** *-4rr.' HWBUI0008480 1 au >mut 2 2 *'li g <89 -. 5S J8MMw 4r 8*4e8888T*949 .4O4U8s84*r < 8 a *r *a cn* Ww* aOs ei 'os w r9i4* /*f*%4 e< *e-*s* S4 a") *3 n ssr w ** OP<* O* **-ns we* nnn* .<*S*4sn*- - *"4 *s W ' O' -9O'-"*M w s*o89a *v ^ s a sH wn . pnn w*s<Mg*"f5 <m8* 4<oSr n .**s W js A 83 wso** 81 8* ft f* - . ^4mi9- . *Ve 9#U. . K6a39> fS 98- 99 9k** n - * 8 n 94"' s* .. . 9.v - '*' - *-v w- 9f9s4* nsso94*'99 * W' 9-v so 8 s* 9* . .-.W-7 94: nn wK m m s Ct-S' m -9. - w:: <9ft4.4W4994^44. ' n -s 94 S n r* s* . . S9. 4 -9A4 9* . w 999444--4S<#*). <w6- - .. .n44->n-Ss 9 'W8 A k9. 5. * 9*4S4' 9*4 ' *944' ' VSe19/,:' 8H > 4914f 8X8X 94 * w` 4*f88O48 r-.9J83Q4s A t ne% f4*&<s*\ Q<n %r? e<'s, w*8 . *v wsr$* w 4f*->s ' wS* <-<n*n\ ^s*8-* w 88*<<ws4*ans ` .* n8n w*nc-s** I J35 Wt x<3s4 >*>844 - msn* w94 9 *a4 s 9S *N "* **8 *4 'S m . w. .4-9s94s4r* i 9S M W* )&8 8 u 8 X es! P4 9 *S #4, .. w- '94-. 9S 9 4994t W^9AS4 ' - A 9-' e9*-%-SeS ' ' 94 8 H 8 w4 4j . a--- <& 4 - -44--8. -. U'4 *X8a898L***.9k8>3<844. X44tO8N888S44*^ X9"M8X8888W8814 es * <M , ) HWBUI0008481 34 taoa| thoit Mabtn of Local 239 of the UAV who wore examined, 2? had Imncs uiaiaed previously (Lorimer, 1974). Table It shows Che compari* of the tso seta of reading* /or these Individual*. Of the 27 pairs of Z*nya read, tea received i dead cal readings. The 1979/1980 reading was one subcategory higher than chat of 1974 la acveu; la six it wo* erne- tubestogory lex*. One reading was two suhcategorles higher la H79-8Q- and three were two subcatrgorios lower. Thu* the overall read ying* wore vory similar between the two periods of tine and there wax as evidence for any progression of fibrosis among the snail group of individuala examined in two"periods of tine. Auto body repair and undercoat*nn work Hut highest percentage of X-ray abnormalitics in any group observed Id thin study wan among men employed in auto body shops foe varying pe riods of tine (38.6% versus 24.ST for brake workers and 18.6X for g*jr*ge worker* who did no brake work). While relatively few wen were ia the category, tlie percentage oif abnormalities was significantly higher, than: garage workers who did no brake repair (P<Q,Q5, oce-sided). Hm average .tins of sssploywent "of the group in body shops was 13.3 years. Of those employed more than 20 years, 3 of 7 (7IT) had abnorsal X-rays, . In post years asbestos was coaaooly used as > reinforcing. agent in plastic auto body fillers used for dent patching. Extensive dust exposure was eosarae as the material was sanded smooth. The. extent of asbestos exposore is unknown because no fiber counts are available from aoch operations. Fortunately, with the increased awareness of ulicstos hazards sad with the introduction of the occupational asbestos stand ard, most manufacturer* removed asbestos iroci their formulations. In a carrent (1981) analysis of six compounds used in shops employing _UAW 259 mca&crs,' no asbestos wo* identified. However, while current atbesta risk* no longer exist in these shops (it least to our knowledge), persona exposed previously should W wade aware of the? r asbestos exposure, the risk associated with It, the fyn-i-p.ietic effect of ci(..<rttc smoking, aud the desirability of appropriate noli cal survei1 lane-. taS O HWBUI0008482 37 Table 19 Cawpariacn of X-r^ , readings of taraf.e eaployrcs 1974-1979/fiO 1974 reading 0/0 0/1 1/0 i/t ; 1/2 0/1 6 5 0 0 0 1979/1980 Reading 0/1 1/0 1/1 4 0 3 ' 0 0 4 . . 0. o"': 0 0 1 0 1. 1/2 0 0 :0 r 0 HWBUI0008483 s Aatonobila uodercoating utrritl s also coot a lni asbestos as a rein** facctut fiber sad dlMaaa had been suggested la individuals engaged pels*ipally la uodercoating work. Thirteen sen wore identified la this *dy with liinifieiat period*: of uodercostiag work. Of Um group tfcm had abnormal Stray*., bat two of the three *lu work la body ahsps. Uma, wo haw Insufficient data to evaluate a risk Cron this activity la this population. Parenthetically, numerous other men re- Jttetod? having occasionally (one to. two times per year) applied under- (Mtiat materials. These, individuals, were not segregated in aay aonly * i*' *;, . - sC#*-' In all caif vtert uudercoaiiog 4t 4oof# r*i<hf*fiixetl conogisds v - - ' .. warn utilised. It woold.be expected that the spraying of such material i. -- would' not . lead to the release of high concent ntloat oi resirablu ssbnstos fibers. However,, the griddle.j indcrf*<*l of dry, over-sprayed \h * . * material oo shop floors-could release the encapsulated fibers. Effect of previous shipyard cnplovncnt 0f the SC3 individuals with readable - X-rays, 87 had been previously `sppleyed for* sosws. poriod of tine in a shipyard, generally during World Vsc`~12'. Overall , M. IX of the; X-rayn of. this group were abnormal . On ;M*St*- standardised basis, 28.4i were- abnormal ccopared to 20.51- .foe `>1X groups', aacxpciscd to asbestos (control group, garage workers with so b*sbr: sc_ body work exposure, sad those expescii only to other dusts). Ssesvaa.' of thn - fulatdvely small tmaher of cases, Ute difierencs between tiunM. fescsmMg^. ia- ttsC signifiesat. at P<O.OS level. , Table* 26:sad 21 bsw tie tsmhmr aad percentages: of abnormal X-rays according, to years of shipyard employment and: limn since onset of shipyard: warfcv To the steot possible, age standardised prrcrnUgci Uvr been calculated for tack capsouc category although, with Uto small ouabers la a given time call* the procedure has large statistical uncertainties. The average tins sf esflojfMflt of all 11 individuals in rhip/ard wr.rk was five fears. As few CIS) worked longer than ten years, the data in.Table 20 aur the' trend according to shipyard employment are unstable lec3tse of tfcc: mil nusbars in longer term cnployv eat categoric*'. In Table 21: kowvct, a sigttfiicact trend with yesta since onoet a* shipyard employ ment: Is seen.' On an age litahi-dlsH basis, 3/.11 of llow1 with sore HWBUI0008484 39 Table 20 l>--her and percentage of X-ry abaatiialitlfta ceorttn to year* of ahtpyard nagloyeftt FareaebynaL madia* -- 0 1 .2 Itifg af ahlpyard itlavwne ' 0-4.9 S-f.fi 10-14.9 IS-If, 9 - Mot*al nlear* 31 14 4 340 100 4 2 0 Totala S3 f l a .7 1 " . i . " - - -1: z. ; 1 Hl 1 pleura .4 0 0' 1 .0 ', 0 " 13 .10 -i *: **T 20 baanaslitir 39421 'A*p ctaadacdlscid: pecemtaft@ stmllfcy 27,21 T-- 4 ' 33i3X ; so.ot : 24.71 45 .SI; - .3 42. fX, 37.11. 34 3f.il 21. HWBUI0008485 W: Table 21 The aueher taJ p<reraU(e of 3C-ray ahaoroialltles aceortliag to Years from onset of ikipyict caalyrflt' ' tmcsAchymat StNMOMlity < 10 Team since enact of nvloyseat 10-1. 20-2#. 30-30.# *' - .. . *' - : l -3 0 0 Hanoi pit era 3 . 12 02 0' 0 33 7 I tt. . ' .fl. ' ' .0 f.V ,V,,v.y. . 0, -' Abnormal plrur.t . 0 r? f. . 2f .o'.', y , ;-.y W .... t' - 40e : Tatala 2 53 0* 01 2 13 " .t "..ty. ahnAcmllty ' .;> o. 4 . 27 : . - 3 34 o.ox..; . /2S.e%V-;v / 45. OX 60.02 If. IX V,V;:::A' t WiiitTillsed fees****** ei shiiiiiniiiiillfcf .. " '.Hiir ; 34.6X 47.6X 2I.6X 32.#!*: * Ac* sta4r<IJ**4 percentage of those 30 or km re years- Ire VMt f sMpyacd eaployweat. HWBUI0008486 41 than3 years free ooset of shipyard cwploywent- had abnormal X*y. This fiirctflUti la different Croat. that of uocxpoaed individual* at a ^01 (two-sided) lcrel of il|sii(lcMce. Xk. 1*; feasible te eesparr the result.* of tha prevalenceof aboeraal Jrfsy* iiwig 4(tfenit- ahipyard populations, 30 years or abro fro* MMt'ef aeplayswac. The finding hers of ITT sore X*roy aboarsalities '(kospor^ t~ central*.-latent fotwert ahipyard trorkera^ impleyeb foc^as 78t*s*e_ OlT fin* jnars, It is agreeseat with studies* of . the effects of Jong-tarm shipyard eaployweot. la a study of ship repair workers, aapXoyed for sore than 20 years, ITT of the X-rays of those 30 or autre jmxw'tmm onset of. eoploynent were abaorsal (Sellkoff, Micbolson, and XiUt^ lltO). The percentages of abaomal X-rays la the two troops are approzinately la the ratio of the periods of evployucnt. Evidence of aallgatmer Im f.,T"ray creefflist of a population of this aixe, ' it would not be joftcrgectcd that.a cheat aaligaaacy weald lie identified. dach wee the f**e..witk- oaM^liMtivtdiial. lit this study. Be: was referred to the chest Ittevte^ThC; Mnant.% Mnot; Bospital. for follow-up diagnosis,Its hroochejMdtiK?csrctaamw- was not operable,* and while alive two years later, woo CMfltiatt; yimUhtlcaU^,. at ezaaihat ion. hts Cfit level wo* :fi3.-aoa*'KTfti/l : oadhls gpntti*-.analysis* chewedmoderate atypta, but ae /L frnS^f )' wmoifAiY iwcnow- nans Principal sairawetrlc tests Tablas 22, 23, 24- and 23 show the peso vs lues of forced vital capacity Vsjii'. aT perceufc of that predicted (100 z FVC/PFVC), the forced espirstocy ysltatrisl second as- * percent of farced vital capacity; (100 a UVj/ jW),! the foreed* smpirstory volune-ia 1 second as a percent of that 'predicted' (100 x^TEf^ffFa^, aad-Jthe- atazinai nidcxplratory flow btvan . 231: ind\73t of. forced vitalVcapacity as a percent' of that pre- HWBUI0008487 42 SJ o m m Oft 8 Oft Oft o *w o 0% * 0* 4* 49 44 44 tM 08 * ftO ftO *rt Oft o * o 8 9 *8 9 t 8 0 X8 *X- 2Nm a 9 f' X4* wO44ft 4m4 X* <0 m 3 4444 -4O09f*t <fi0ft 4O8ft 0O4ft wO*4ft 8* w W00"f1rt- r 04 4m444 oo f44449 OOfftt 0041f4nt *O* w0.4 O*4*04ft 48 ' 4m90 X8OU * - * . :*S''-M*O* <8** %-raCXy9-'-xiJi9r**1Oyfe* ;XXf4X4t4r y11 c* >8fm mX98` yu9O948'm-4yO<* 9 <94P-4- 9< 499* . M S ^ ft W 0, <4 M 9 04 48 0ft * w w 0ft ftO X m r 0ft w <w^ W W 3 ^X 8 8 - 8 o w 04 04 0 Oft 04 O *. * 04 04 3 80 9 w8 49 4 X O i4 *' 44 44 8 > 08 44 44 44 44 44 44 01 8| 0* 0 0ft Oft 46 04. 48 04 Oft Oft Oft X X ; *0 Oft Oft Oft - * X 4 <# ->34 04 * .8 O -O 9 O X 8 8X m ft* 0 9 X- 0*8 .o - 44 9>v^s-O. ** 04 *m8 040Tv 00*ftW ' . W; W m-. MW9 ! 8. <* 4- ft* : xx '*m*;-m#*-`0s--- 8 ? X- 9 8b Ur- V 8 t f Ii yo O'-' X8oI 3 xy Po X9y X Ss o X4 y <1 3 9 8* o rir *** -,. 04 oft 44 44 & ;..%* 00 49 o*~ *#8 a e. & Xy 49 4yC4 p3 SP"^8 55 8* . 89 *y*M* ~yW3oMQ8Ob '- .12 E *9Vwt--9y84?** * .. . ^<H** ox4V84-. y 38-8 y- t* O 93 S* y9' Ifr O mo *O4 , X9y9-' . BXC* X9y- r ' .. 9 u9: . : xo8o84.y<oaM**i- *y* . fty 9 *4 X8* -1--8X ' . MQWyy w^3c . 2 -o4- 8o 3a-#*'. y O *2 * -X-' - xmjos >a * .X0i-*'-.<448O9M9*#*9*.:-XXfOO9l"- ,X*t*w68o48!*-X*08^9o4*r -3 & li - 8%*Oy1y..*a*'O8>W0w*.-**we9**4*-. 9y9 4y#y3I* " 8 0 4 o 84My9 9 a H n at 4m84 i&g HOo &98 f9t* XeI Xo- xo9s X **X fe O:' ** 44 8 9 4>XUm4 ^o8 y 49a# r-;.- 49 xu IIx0o-3w o * . . *> %M W 4^ o 8O : m4o4ftft m. 9 a Xft* x* oy e ft o Ot o *wo0o*!8*oa9- xM0y* Xooyy39 xxoyO o- ;y *> * 48*' * W X Oa>9O.Xw 44 * XP 8y xo Xo 3 HWBUI0008488 43 rt 1 m& xm 21 31 X0 8* <N # umu Maimi * 3aoft , 4XBrt> O t9o Oi9t ina o* 9** w 444 X?* art ft' ** . *X4 ( XX* ?** P** x art* * ' art . W <W .' f<tn ' \4 X * *ft O a**w m XX* xft* a** * ' Xas ` w xart X ft Xft* X X fX** ft* Xft* X** o X* XX 4X* XX Prt Xw-l (* ft a**-' a* a**- a* X w n X 'XW wX as a Xart X> XX- XX X ft* XXa X 4* fft*i XX a* a* -- ^ - <Xw XX ar X wv ask <w art rtrt XX X. Waar*t a> ' . 9 .ft 9 1 a* O'** w - art* wft'-' -; *4- X Xarts- w. ' *x- ` aa*)* W wXX: OrtV - VX>n- ,'ax , >X<a ft X ad '- *c U3 ' X -f.t-- 44- - ,u. v?*r* -' A44 Wft*l , mi #X**'* f** 44<'. -' f**" .* . Jrf ' aa*a ma# .Xa4*.. 4X1-- XX'r-- . fXrt*. - x#-**--. X -' ^- X- -. -* a fwt - 'x - 3- , * 9 ft . X xv. .X -' ' f**-' art*. 44 ft fwt * .Mto . S : 4ff4tt 3ftS ft ft ' ft UlaS $s - ufft)t: m fftt r %* xft fftt a -' fftt- 9: - >Q41 9 ft O fr H . w .* tfot-9 *d4 -a>ufffttt*4 41 ft X5pfQt>, Mfftott Fcfftt <414 a ft Uf to X ft --3* ' 391-' ft VOft 3 o . - Xaft*.w-.WS a ft ft 3 ft * to u l-2. 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' X f3t. 0ft- 9 ; x9 ft 9#- U X U*S "9 4>f9at>* .x-Odm9 XaXa3ft fot X X399.-.-Hf-9w>t*-Xf9t- OW3 rt X9 -9ft- XW *9 >s X0 ftot- -dfftt.' 41- 'ft:"-; xXft-axfti-r;~xx>-;-:.-..0f.t-'-9Sft-- -. ft*. -- l x . . - . x- . -db-' - ft : x x - a r * ft,,xa x c-w0 aa ft ft wft to X .-9< >S X ft ft to aft ft X-.43ft-.ftto.- Ufttf9t MX.--. t3o--UfSt tfot 3 tf0otv3X>- Xf4t:' . mft ft M0 . 3ft X . aa99*.Xfftt r"3t3o at0ffott ttoo Xd-. ft UXS Cfr! ft ft d >-8 -2 ft X<drt ft $*4 aftfet u ^&as 4ft ft X to 3 0 tfot xft ft rtrt d9af0t 0"--9 * 0 d3ftot t0o .0t4o* tt * e x a art*. 0 ft rt x ut X ft ft i 90 >9 C *3U xtoU S-a--90 dfxt --a 3aU^ax0 --ft- x 0 io to ft us 0 U ft u; x x= 0 X >k-0 X-. w W ft to to ft art Px a 3a c rtrt -s to \) > HWBUI0008489 44 m am %. S! AM *^TS S :S S 0 I *a O r r t 5 feibr vi vi *0 9 o 8 mi aft O 8 8 M *1 . <f*V b<Hd s o^ VI *ft n rr *V0I vp <* e* f*4 cv O p p*f -3* ahf*t 9* p S f S' IS 40 V 3b 8- ** M & aa Oas t4o u4. * a4 <0 . * P 0 v St: 4 1* a m 4 jbpm >m P th-4 >W* ***w* X&3. 0 4 W *a ; C 4 O P --5 44 aas ahi 3 * *4* 4 fi* t* 4 3 8 Sr. -* P\ Q >H O X5 * *4 >0 >W 0 --O> &.* 4 --s 4s x po a4 hs <4 4 <1 4 f la IS 52 4'.0, as :: t 19ft. 4 a- 4 t* PI : Ssb- P- p aft em 4 ^ft. u o s* P4 t'S ; 0 4 ** aB p .P * C m 4 as 3 a 4 a O3 p& aft G <*& - U *3 tft a . 4 t# wu 4'. P o w aVI ft Pi w a o e p H 3b' PP M # ua p^ ua -4 % 4: C O'a- <w* ' b **'' . 9 PI W. - ' 3 4' O w. rs *. *** 4 ' PI ' ' P . . . O o ' ' 4T ' fl O o # . 4 -' 4 4O P-. 3-- 3 , 4 o e 4 O U u 3 p 4 PP ** 0. X '*- p A - 4 ' 4 P C4 <1 o fi '-a as . - m <. 0 4 P t 0 a a a-. 4 4 0 4- - -X;_ '. 0 f .: A9 0 *- - P 4 * w . - 4 . . 4 . * ** ; ftb w a n. p f we b -QWf <4 ' 9 Q 44 W Mfi O ft a*S* O --a as ** oh< go u ar a o 4 P - ' 9b 4 . SS - . s esar VP 3 k. P S j. - a p m ^r-p- VA- 3 PP * ,,A s s p: a . p 4' . .- : .'V*.-P*-' ' W-.-J4 dwa ^ 3 PP4 4 S ^9 -w 4 hi 4ft W 5 - -5* w* a d w^ u 3o P U a w 4 O b 3 4 S 4 U wp3 **r O W ->** 4 <4 <a--Oft ap9c - es .. a<s1 la08 * Msp3l' *9M WaUpap-f*;t>-.UCSpftr. XP<Kwf4ib. x0a4-. wo pe as* e u4-- ahs ad-- W * P H P v X o e V p - 4 . P P 4 < <0 4 ** a pp * w a*- ^ 0 3 S-a'JS' s 0 w 0.<4 . 84 P 3, if ft-<a . a aX h U A <+ e i 4ep *a 0 . 0 w 0 v t OS 3 : a s s 3 Q *1 . p 3 4 Q 4 <wt * H ft 8 If -3 aft i o c gl 4- eb e w la 5ft- P P- - as 4ft ',, o w P |2 P P 3Q O3 w 3 -a as ) HWBUI0008490 1% m 3 2S o 3 M to* 44 O O *3 ltSm ** J2--5 *w | 5 ,-S *.-3: 9 9 mm w-s st Mi Mi 44 * 53 n *0 i t -.. 0 at - o O O M St Cl s*o<04asSC 0R40 Og0 to !E >0 . *msin0r *g t .m 044 40*%4 *w*% w*Mn 44 re*g* *Wm*0> s w ^<0 *404# 4t%8 mg *wNa**0n .^ ^<M eg eg MCM 44 m0 eMg ?4 '*M0* f** 0"! 4e8g Cetl ' s3 f tS m 0 mi fc 5 2; u m 0sc . -- /x<0g* X9i?r ** *e . '**->erX8~*&/x#?-*W*- *ff to 4* g- * oms m .<* McS *3 b* X & MMSatt >0 JS88 ^ <*OM0 3 0- X<t X mu m x*-~* js a -*>e4 .4Ct`ea.#. a0 ^e 0X <w to ^ 0 0@* 'e.. o w ox 0 XT4. * 13 3 % *>% *rrt. -g>0i . 20eg4- Seg *0* .i^:-. - 44 ggfe e4eg4en *A M rM . 0T-; ' '9P0^*'- . ..tn ;-' M<444i 44-,. eg* 4e8g9 px -04p4oM44*r' : -.. 0a- a8 CS: f 90e0wg4ig-.-4.e9eIe0gg;-r,--. --**^*X9e03#**:-,<*e*ao&4*:' .-.**<^>4wX>899w*%^*.*X*X*&-04.r4-**f-.*.'.-*h-.0OCt03A3X0oSL-'v-m9O0X>00f*000i--:,- $ u Xsfu . 8oM H>0d Ir. .4..001 J00- `1-4&0'04*sOs 00ew0eg>g' u a 03M0OUs to I UgXgC8f*.iL-M4X0WO0W00*-; 0gt8ueee-X"2oc4 xO- - XLfs: XI Cf6fL o00L0ec XX0U 0--a30ae*g -%Xa005OcCeW0p00eyg3: *XmX0u29oXeV*se9x?**r. . # X 9a. 0M0c<*e0ee0-M--994S<------.JW9o903O009000nm?4b:.'j' ' tS0ov f0t m0 - 0||i-. X00' . 8 <& .. `.s0a0 ''" ,.-' . -aw09 x*'a804-- -. nwX90s..' toS-' -"'. U30 -*9to.. 0008-,mXf0o0cb-.. X0m00 ' 0e8M-'. g0l* s0e~ OW ISX0t; cX eg 0&* r- a MS? O:U ?a m-.. V*88W0M0Xt09o4-C:>ttwXe^ow3C08>4t*-MtH403o00a.<0eb3**. -. .X*0*. 0* MX*8Ue4Mn4S*f 8KX.-. Mi*t*i ^ot84o - S'. t0e0* wtUo 44 w# 4 u_ .to.:*_*_' _ '.. |XMXB"t0t0g0*990MX9teeetobo*od*V:---W*MtoSK0:>*W3X988uOoB*-L*&l*-.--'.:a;XXXe0.t>.S90t9a00990000..o.4oS*-.*.O--X^*-tO3txe000t00S.9S4oo.o*t-0u.-.9:9^xtxt3930t*oo0o1'C. )= HWBUI0008491 44 (100 x KHF/FfSHT') according to Job category and ajwokisg history. TW prediction equations used vers those o Hiller et si. (I9S4J (See Tablar-3). ' Hi* dixtrlbutioci of those parameters Is shown ia Tobies 24, IS. With the exception of auto, body wethers sad garage workers wh d not week with brakes, there ore no dlffereacea betn-eea the messas c i the .distributions of the three principal tplcometrie teat respite CWC/WW* jFlVj/FflVj ,, TEVj/TTC foe all other groups of workers-. ieelBdiwfc, those with possible past exposure to asbestos. While there Uc sene /differences between the various Job categories la tatofcing esteatocy^ sehtroops, these ore largely the result of statistical varia tions., The mere stable, awokins etaud.irdir.cd data, ahoy virtually Idwtlcii results for the mtcxposi-d control populationbrake workers 4*4.tSrilvi4iil: exposed, or possibly exposed, to asbestos. These data are:-,shows ..la Tabic 30. This night he ooticipated as only Marginal difference*; were Been in the percentage of X-ray ahnonaa 1 ities among ladiwidmal* in different work categories. As forced vital capacity is liatliy 4 less sensitive detenaioation of asbestos-related changes than pnMoh of X-ray abnormalities and forced expiratory volume, is one sndsad csjotr* . to exposures other than ashes ins, the absence of a ;4s7t^tni tread name the groups with varying ashestbs-., exposure is sot Haeapnctedt.. Ckee* sectioa bn: nessures of. ^eail airway disease, far a 44sca**ioa of fWF/BfHT) . ftrssnres of aaaall airway disease . . f.. seen- la- Tables' 22-24, with: they, excepting f.'.iiaa!nKthflfe'-ga.mr wochgrs;. and those non engaged la anto body work, no differences existed * It-- th#'. aeam* of the spireactrieC test results- between- the three -alor occupational groups studied, those uwexposed ta asbestos or to garage <W>Cic; tltes^ engaged la brake work, and those with a prwbablc asbestos aatposnig. However8 is the case of WlK/nttlF' (Table 25) individuals with 'W-l IfvaUIld';asbestos expatunt had a lover-. smoking.'. ausihriiaed seas .honored ta. those ta the othor two cstegwrieu al though net it i M.Oi . lewsi ;C" significance;, The uaexposed control group had. the highest aswk vciaes* followed closely by .occhaaits engaged in brake vorfcv. Those; with- idcaCf fled and possible exposure to asbestos had interme- HWBUI0008492 *7 Table 26 The dlstrlbutIon of forced vital capacity as a perreatage of that predict HI (100 a FVC/PFVC) by tot category and suaklriif histary 3b category <40; . 100 % FVt/FVCP 60-79.9: SO-99,9 100V- iNkldeatified aabesen* exposure or garage work Garage eatployaieot hue ao brake workBeak* work Body work Suokcrs ,0 (0*0? 5 : (11.1) 2 (5.6) 7 (13.4) 1 (O.t) 20 (15.6) 0 (0.0) '0 (0.0) 29 (64.4) 23 (63.9.) 67 (52.3) .11 (91.7J 11 (24.4) 4(11.1) 40 (31.3) 1 (8.3) Ex-smokers ... Jttt-Identified' asbestos 0 exposure or gakage work. (0.0) : VV : 27 16 "'';(8.S).7 7 (st.s) V".(34:0)-;, .Garage efeplayacnt' but. no brake work 2 (6*7) . f: (20.9) 16 : ' 16- (37.2) (37,2) Inhewtk , :: . 2. ` . Cl.-11 . ' 21 " ;''7S: C1T.5) (41.2): 84 (44.2) * Body* work- ^ .7:VS7'.'V 'l77; r.:0.7-..-i;;> 10 7:7 7>:' 37V '7' . (6.n ; (66.7); (20.0); . . - : 7 7' Ws idgatHticd asbestos - exposure or garage work r* Garage euployuent hot brake work Brafee.work Body work `C'Vjs^fercenlage Menssrskerx ; ;:77 ^77/ X -..7r77 0 (0,0) 7-.V: (12.0) (44.0) 7 (46.0) 0 6:. (0.0) . (I*. 8* . *2 (1.7) (5.0) . (53.2) 7.'59V' (50.0); 9 (31.-0) 50 (4274)7 0 (0.0) 0 (0.0) `4 ` 1 (60.0) (20.0) \ ) HWBUI0008493 48 Table 27 The distribution of. forced expiratory vnl lime in one second as x percentage ol torced vit_a1 ca.nocity (JOO ]c_FEV^/FVC) according tu job category an<i smoking history Job category Ho identified asbestos exposure or garage work. Garage employment but no brake work Brake work Body work ' Mo identified-asbestos exposure or garage.work Garage coployaent but no brake work Brake work Body work Ko idealifled asbestos exposure or garage- work Garage employment but no brake work , Drake work. Bddv work ( ) ~ percent age. 100 x FF.V./i'VC <55 55-64.9 65-74.9 75-64.9 85+ foke rs 0 :7 (0.0) (15.6) 12 17 . - 9 (26.7) ' (37.3) (20.0) 0 (0.0) 4 10 (11.1) - (27.8) IS (50.0) 4 (11.1) 4 (3.1) 11 (S.6) 42 (32.0) 53 (41.4) 18 (14.1) 1 (8.3) 0 (0.0) 3 (25.0) 8 (66.7) 0 (0.0) F-r.-S;sokers . 3- (6.4) 3-. ` 8 23. (6.4) ,(17.0). , y (48.9.); -. 3 (7, C) 2 (4 - 7) 1.4 (32,6); 18 (41.5) ' : 1(0.6) 9 (5.0) 35 (29.2) 99 (54.4) 1 (6.7) T'- 0 (0.0) 6: (40.0) 6 (40.0) 10 (21.3) 6 (14.0) . 38 (20.9) 2 (13.3) Monsmokern. 0 (0.0) 1 (4.0) 2 (6.<n 2. (6.9) 0 (O.p) 0 (0,0) b (0.0) 1 (20.U) 2(8.0) 19 (76.0) 3 (12.0) ' .5: (17.2) . 15 (31,7)' 5 07.2) 26 (22.0) 64 (54.2) 28 (23.7) 0 (0.0) 3 (60.0) -1 ' (20.0) HWBUI0008494 49 Table 28 TRc distribution*- erf farced' expiratory volumc- tit, One* second to- that predicted (100 x FEV ^7HFKV^) bv job category : and smoking history 100 x FEV1/PFV1 Job. category <60: ` 60-79.9 80-99if 1Q0+ Mb identified asbestos exposure or garage work Smokers 0 (0.0) 5 (11-1) Garage eieploywent. but no brake work 1' (2.8) 6 (16.7) Brake work 2 0.6) 14 (8.6) Body work 1 (8.3) 0 (0.0) 19 (42.2) 20 (55.6) 57 (44.5) 7 (58.3) 21 (46.7) 9 (25.0) 58 (45.3) 4 (33.3) Mo .identified asbestos exposure or garagevork E.<-smokers -2 (4.3) -2 ' (4.3) Garage employment but no brake vork A (9.3)- 3 (7.0) Brake work 2 (1-1) 9 (5.0) Bodywork, . -1 -1 (6-7) (6-7) 15 (31.9) 28 (59.6) ' 17 : is (9.5) .(44.2): 41 (22.5) 130 (71.4) 6 :(40.0) 7 (46.7) Moo smokers Ko identified: asbestos 0 exposure or garage work (0.0) 0 (0.0) Garage employment but no brake woit Brake; work I (3.5) 1 (0.9) \1 ( 3.5> 4 (3-4) Body work 0 (0.0) 0 (0.0) ( )'' perrrntape r r (28.0) 9 DUO) .23 (24.6) 3 (f'O.C) 18 (72.0) IS (62.1) 84 (71.2) 2 (4oro) HWBUI0008495 so . Table 29 The distribution of forced expiratory flow between 25% am1 75% of forced: vital capacity a* a percent of that' predicted (100 * MHF/PMMFT a ccordin*to i oh- category and' sattkinar history - ' - too x MMK/PHMT -- * Job- atetory r - .- ,Me identified asbestos !xoucc.or garage work <60 60-74.9 75-89.9. 90-104.91 105 -. Smokers . 10 9 - ' -3 r.. 5 (25.6) (23.1) ; (7.7) ... (12.8) ->.-12 - ' (30.8). Ooratps employment but.no brake work 9 (30.0) 9* 4 (30.0) (13.3) 3 (10.0) 5 (16.7) Brake work. Body work r 37 * (33.6) 2 (18.2): 16 (14.6) 3 (27.3) 19 . (17.3) 2(18.2) 14 (12.7) 1 (9.1) 24 (21.8) 3 (27.2) * Ex-Smokers Kb identified asbestos exposure or garage work 7 (16.7) 5 (Vl.9) 7. 06.7) 5 : - 18 (11 - 9) (42.9) Garage employment JmfciB# brake work - 12 06.4) = S. - . - . S> - . ; 3 (15.2) 05.2) (9.1) ' (24.2) Brake work (9.3) It-- 03 . 31 -51 (ll-J) (22.0) (20.7) . (36.7) Bodywork ... . (36.-4): 1 "* / (S.i) 0 (0.0) "l(9.1) le identified'asbestos .repaint**''**; 'faira**, work Garage ocploywent but wr brake work Brake work < ' V- . ' Body work : ( ) = percentage. Monsmokerit -0 (0.0) 3 (15.8) l (5.3): . 1 (5.3) 14 (73.?) '' 3 (12.5) . 1 (1.1) , .I.' (25.0) 5 (20.8) - s. (20.8) ' 11 (12.2) : -' 10 (17.3) l . . ., j - (25.0) (25.0) 6 (25.0) 5 (20.8) 21 41 (23.3) - (45.6) 0 (0.0) -1' (25.0) HWBUI0008496 51 Table M aboarmal puleaoarr function tests by job: cc*rr , "3o eatetorr Kean va1ue a' IflMI x FVC/PFVC ifc'ideatift'ed asbestos ili[inm$iire- or gsrag* Mrit 7-'t 1.2; PairH-riocrmsat,l** 10.2 2.9 Garage enplofaest but; ea brake. work 91.311.3 23.2 4.7 'mkm'kmtk 98.9 0.7 - 10.9 1.6 WSf: work .. ' 92.9 2.4 5.7 4.0 fteflaita and possible asbestos exposure 94.1 1.1 13.1 2.6 (widestifled asbestos exposure or garage work 100 x FEVj/PFEVj. 102.6 1.6 ' .time**'asp laywat kmtymm- bmkm work fcTMt.iork; . * . 97.6 1.9 105,2 10.8 '^7.4. 3.4 ,.. . Ifcflttlte sod possible asbestos exposure 102.8 1.3 7.2 3.2 14.9 4.9 7.111.3 1.3 4.8 8i7 1 2.1 . . fed asbestos rgi iMr or gars go work 100= x MMF/PW1F` ' 13.1 2 3.3 .. *rm*-easplofo,t hot M* brake; work ' $0.5 : 3.4 :V, -. 31.6 13.4 ^:4.3-l-7.3 Iraki work; 93,6 1.6 27-.S-t 2.8 ' Bodywork > ', H.O i'M 46.6 1 13.3 jPefiaite end possible gibestoe, exposure IS,Q i 2.8 43.f 5.2 i ;Standardized to 1W isokini distribution of all with valid pul** pMMcj function test. (Ssaken, 31.6X; Ex-sookers, 42.41; JCoa-;. ~*'#St*;*-.26.0X). - -iV " * JMowsllima 10- for" 1043 x FVC/PJVC and 100 x FCT^PTTV *#.=tlwa>75-. focJOO^xrJWF/PfdF. I HWBUI0008497 52 *Cft-.WltM* umI thaw neo-mechanic |ici(< MtUn the lewett v(!m*. Itift itUfimic* bttvwa'ih# oechaolc and aea-nechante (irit mfccri is #1 tgffle'niat. it tlf f<@.QQt` (Cvxt^id<d) kvel. (See section oo. pMJb]e ktt&k. ( soomechsaic ^riya employment.) The lac difference dtjf**** body repair worker*bat,. because of Um nutlet iiuiliiliiii,* Individuals, it did sot. achieve sifaifieaace at the 0.05 i .**"'. '- Wwlble *ffKt free non-occhaalc taraitc <-*pteyurni Fofc^thocpctacipal three ,apl roost ric testa, aa well a* for hHT/ PfWF, ..fsritiyfctlMls' With garage eapta^wai, hot who- did not engage ia brake Wrt, had significantly lover ncaaa sad a greater percent cMj*rofaboorma 1 polaaqaty function results than either controls, brake .wriini r. thse with possible exposure to asbestos otherwise. Ve #*V*i*lt*d Whether this nay be the result of the (rester percentage IT.hiLsckr sad';liipaala enployed ia this category compared to other job CtiTitle*5 tmipied with improper pulmonary function- standards for 'iv--.'--V i-v - - "'i.. " 'r' > ckroepe*'.-TsMy':H;; show* the-' percentage of . Individuals In the joh . cat**ories ;according to their -race. As Can be seen, soon* friniffghitlT. gprsfe, eafioy*eat, but im brake work, more than 141 wre * 'lilicCjac.M^pentcjc'eyitsd'-;te 'Ift'.ef those vitb no identified asbestos JHS^osartr-'ssd 14X of these who worked in brake maintenance and repair. ponsible;. * we-.- took into account the known.', diffetence* sad -'whits . populations ia. the: predicted standards for So. ftMhtwft-vital eapscitf sad- forced expiratory: volume in one second (black In wore ffX. of these of whites}. for HMT the isee prediction tjJnj** . gursaukt^cT wem hsed; for blacks and white* as there appears littl 'racial.-differenc* ia flow rates (Schoenberg et il., 1978). However, 4ata: tbsso standards. are relatively linited and they may bet be fully scenesto. Fpr Hispanic* ve used the same criteria is for white*. .t , * ,, .. .. ... Fabler JHf shews the overall spirnmotric data according to rce._ As can bs~eeaii.the nee** far FVC/PfYC and FEVj/PFEVj for the black population sre- generally lower than the white population in all soaking categoric*. [7&.ranking standardised difference is- significant at the P<0.0l level (twmeldH) for rVC/TTVC.I On the other hand,, the data for the Hispanic HWBUI0008498 53 Table 31 The- distribution and percentage* by race segordth* to the work activity of study participants ..who had valid pulooaacy function tests . > . Race Type of work activity White Black Hispaaic He. identified asbestos or garage work a- Garage eeploysent Vit no brake work m (76-1) 63 (33.9) 19 (16.2) 40 (37.6) 9 (7.7) 4 (3.7) Irak** work 354 (83.6) 56 03.1) IS (3.5) Body work eldest!fled tod possible asbestos exposure 24 6 (73.0) . 08.1) Ill: " (88.9) . - 19 (9.5) 2 (6.3) 3 O'. 5) Totals . - 709 _ . ; im - 33-- - (86.3); .07.0) (4,0) HWBUI0008499 54 The mcxnn of *r 1 roart r I tests Hv race *a Vhlta'. ; * *' Mack1ri * ', 2- ' lispaale Current ranker* 93.010.9 (222) 91.212.3 (53) 94.513.4 (5) Saoklrift h i ** lory Ex-kookcr* 100 x FVC/PKYC Mnasauker* - 97.410.9 (.100) . 99.611.0 (187) S9.911.5 (51) 96.5+3.0 (36) 94.412.8 (17) 11,6+5.6 (7) * Smaklat 9tan4rdi2H* = 94.610.5 '92.011.4 91.912.2 Ci' ' - Vbfto Black1 Hispanic 54.211.1 (220) 98.412.1 (53) 105.015.3 (2) 100 x reVj/l'FT.Vj 104.911.1 (300) 110.011,2 (186) 100.4+2.2 (51) 106.813.6 (36) 101.7+4.7 (17) 95.3+5.9 (7) v '.*+ ''* / 100 x I'tJF/l'MHF JAit* Widk : v HtspsttiC: ; 77.512,2 CIf?) . .92.712,3 (248) 102.912.5 (144) 83.514.9 (44) 89.814.7 (40) f5>516.1 (24) " 55,3114.1(7) : .94.115-3(1:1) . 113.316.4 (5) .103.510.7 101.4+1.6 101.113.0 50.6+1.4 89.313.0 ,59.716.2 apd PIWj for black* vere 0.If that f&r whites. , *' Stiaihtdittf'to-'. tke tacking dlsfrlbutlaa of all vith valid- pulwiurif- fitnct'lwrtosts. (Satokec*, 31.6I; Ex-atrakcri, 42.4X; MonsaKskers, 26.0X.) ) HWBUI0008500 55 population is similar Co that of whites with the exceptias of the ooonoklag croup, which is coapriaed of only six individual a. Thus, tbs us ( tho tiw prediction function for Hiap*lc so for white* would: appear to he. a correct procedure but the prcdlctiqa correction `V f Coe blacks rroaiss In question. ^s -*'** - r.,,. . ss STdeplete 'the Mist of tVC/PFVC and FEVI./PFIEV, for blacks ard wbitoo- bp Banking history and job category sod Table 54, the tanking standard lead seaos by race and Job category. (Too few Hispanici were miliMa farthi* analysis.) As can be seen, the deficits for thoee .tatafoclsed so garage. eoployeea, but who do no brake repair or aaintenr*. ipeor-worfc, easfc foe both racial groups. However, it is particularly hotohle foe':.tho blacks where the swans ef rvC/PFVC and FETj/Vm'j for aott-brakai.^ garage workers are 101 lower than for blacks cu?loved in sthst. Jobs. The pnlnonary function deficits la this group largely iccsoat. for the lower values seen for blocks overall in Table 32 and --lissr that proper no real spirometry parstaters wre v?-?4. Hus origin of these deficits Is not clear. The group is Jarpely cow prised of "car Jockeys," auto polishers, and new car preparative wea. wo. considerable nwesent of individuals among these- jobs. ad eftaaJ a. gersee would do ell three.) They are eeployed ia the &*mm facilities:*'a* the brake workers. Also included arc small group of ikiUti eehaaie* vh would gerfene.difficult mechanical or electric*! *ef^4rs,.part4epaetaeat personnel, and * few oen la DC 37 who were- .1 rftf. . * ... . diffetchecs working out of the' repair area. Table 33 lists the spifo* Sr*-., .-.r-. . - 4v; \-w ' - adMftk^deto; ` Coer, tbe- three' group* in cooawrcial,-garages, co^*red t*" -tfciiw"damaged' iat brake work,: .those exposed to asbestos otberai'sc, or :tSh; fcmexpoaed control group. At can be seen, the d.*f icilu are associ ate^ with the group working as ear jockeys or rsr |>toperation eu and in suto body shops. The differences in Use auskinjj Itmiatdixad Mans for FVC/1TVC and FEV^/PJTVj , betweu the car jockoy- vehielo. preparation srn and wcchenics (iucJnding those who do brake J'"r- '-'"T?V -. work).ate significant at P<0.01 (tv*-aided). ) ) HWBUI0008501 lS jftfa ljU if jfeai&r ^ . `ggiy y ir le - t<i t t *.ft, ...J - '*0* -0. js fT -** . 4U* 0 -.. :*i Af n mm mftt*~' 4e# Mw ' v5.05 * <n* t fet O * * tas V H>&i * w <*<* 4* & O <00 f3t* -2. ' a0t, *?. 0 O- . 0 U. C -0 uficC- 06 a* 0 -a t6S 0 * 0* t0o m . Jt4o 0A 3*. SO03 48 to 4O* 00 0g m0 m *6 w0 9 a 4 <0* to <J O l> . <o4 to *Ow J0S *o4*i, cu O w0" (1 to 0 e. 0X $& 0 e t9o & ,0 us sc to tot . 0 -0 0 Atot: At 0u ^" 0 0* Mto9 ' '*0* ss & HWBUI0008502 37 Table 3* Mawrr fraction reaulta of parade workers vfw do not repair brake* according to work activity and caottlnt history hlaburf .function pa ramter . Current - Saokeg . Ex-tnokers Koo-snokers Mechanical Vork/Parta Department rvc/PTvc ; aa.a 3.4(6) IWj/PIBfj'..;- -4.3(6) -Mff/fWE '166.1114.7(6) 105.31 1.4(4) 110.71 6.5(4) 80.71- 7.5(4) 95.214.4(7) 100.116.2(7) 89.0112.1(7) Aato bo<Sy repair work yrvp/wvc Wi^i Ttff/JtMP ; fS.Ot 2.8(12) fS.lt 5.5(12) M.3t 1.8(11) 92.814.6(15) 16.915.5(15) 71.419i4(11) 92.91 4.5(5) 100.61 6.5(5) 91.3127.5(4) Mew eeMcle. preparatlea-car jockey-car polisher ;jfC/FFVC mgsmt WF/PlttP -*.$* 4.7(15) ;'t?.e*.$.2cm V76^2*10.6(12) S8.S1 3.1(21) .92.71' 4.0(21) 81.01. 8.2(16) 96.91 6.6(8) TOt. 31 6.9(8): 94.2115.2(3 ) 1 ) HWBUI0008503 Tahla 35 tankltm tandardltc*^ puloon* o' .fraction mtilf* cf tssmsm iwpkY vho do not repair brak** " . < cowrtd tar other ribor* . - -a, \ *- _ m/mc fit1/pfv1 HKF/PJStr 1*#'. tdaatlfi d' aiWs tea gywttt'- taraj work f teJ^'awret -- - - - 102.Stl';4 96;9tO.? . 102.6si,6. 105.210,8: ` ^ 95.11.3.: 93.6*1.6 Parta J^partam 97.511.7 104.2*3.5 90.9t6;4 92.912.4 97.613.4 80.018.8 VmkisSJL.prepara tloo car. Jodwya * car frallshen v 89.112,6 95.4*3.0 82.9*6.3 OcflMtafaad pdaslbla CXpOTOT*-- 96.H1.1 102.8H.3 89;012.8 to tha- cooking distributiotj of aJ't vtth valid jmluot*ary *tocti<m t*t- (Sookars* 3L6X{- 'ExHeoLfra^ 42,42; Noo- 2*.0Z.) HWBUI0008504 Sf MtMt that ccupUoiUil factors may be associated will* Umm deficits, tho possibility exists that greater exposure to maa>h<la <ad>aMfc. aw| individuals la tfaia a roup ham contributed U> these flad- .A tn*Ut exposure could arlao if the meefaaaics. generally worked * cars with. Mtlaat off or* if oat with exhaust hosci. attached. That exhaust.may b* contributory ia suggested by the data of Ayers ct (1S?3) who how' observed aignificaat. pulpou^ deficits among hridgs^aad tia>iwl workers vim are heavily exposed to automobile exhaust dairiag tbo coorsa #< their work in the bridges and tunnels ia o4 ra4 RewXork City.'- There, deficits in forced vital capacity of 9% fin? Mxihra atj; IT., for aamkers, compared to a ooimal poprlatiao '(amoking-met. apod 4*4lD: were. ;fea. Greater deficits were sees for intiski-iHUiiatti af'atowy'flow. The association of autooobile exhaust xijtlttho deficit* ta pulxmoacy function among a limited group of garage vorSirm ft^ sf eomrto, only- suggestive. For a definitive association t*lte -:4--jwtwtiid^: lit"i accessary that a detailed study be made. of tto.wscit'activities ml. the exposures of this group of workers in order : tar if ..ifcgy: do have significantly core exposure to auto ex- kra't thaa do garage mechanics. -Cvpo tot* body repair `Mocfctrs who wore engsged ia auto tmdy repair had wan value* for the "tahrioua spieometri tests' that were considerably lower than those. of jpsssgsmrckaales,;,. usexpeaed central* and even the groups exposed to shtttto otherwise. Ibessso of the few individuals in this group, the dfJ^zsosa*totiraem:.^M|. suta body workers and garage mechanics only sM*vs statistical significance for IXVj/TFtVj. In addition to aabastM and other dusts, which could primarily affect FVC, the auto body shop worker* arc exposed to solvents from paints and fillers, and wldiat. foams. The naalfeatations of di* ec seen in both the X-rays mtA the pulmonary function tests in the liailed populations observed in tbit study warrant further definiation. Similarly, iu*hstri.il |V ' " -- hygiene survey of the materials to which auto body repairum are ex- posod is also necessary. J ) HWBUI0008505 60 Correlations iwtWfa X-ray abnormalities <n<l pulmonary function tc*t* Table: 3& list* three pulmonary function result S' according to* the X-ray reading of the iadtvldiuli. TW- criteria were utilized. for X-ray ibMtuUty, a 1/0 or (inter jareocliywa 1 reading and/or any ploural ewa** Including Um presence* of dlapbragtsatlc plaques, rad a 1/1 or ftMtar parcocttyMl re ad las and/or pleural thickening or cal cl ficacioa. 'Cn. presence only of a dlaphrra* t Lc plsque was not considered abnormal ii tha' lattar criterion.) The results show that in general those with * T. ' * * . abnormal X-rays hare lower pulmaaary function than those with: normal This .if tvidaat for smokers and ex*" seekers. .Tie .* pulsusnary .ftaaeftion means for the noosmokers, however, am the same for those with sbsaemsi X-rays as: for those, with normal X-rays. this is to be ex- .* t - V -- peet*d: a* mlahnai asbestos effects can be seen on X-ray before signi ficant .deficits in JVC occur; However, even minimal asbestos effects .cam be exacerbated by smoking, leading to the deficits seen in Table 36. The data of. Table 36 are consistent with the previous discussed data fswfjgestiag a.... greater, percentage of X-ray abnonsaliticc aeaoag asrrvnt 'aed previous: sraokers coapared: to noasaokers. Also,.' as ex* Ipctnd*.tb<r p^monary deficits in those vid*. abnormal X-rays are-great* esT Whea'the. criteria for aboomality is ore stringent. ~CaMnegiso>n with other bepnlatiqim .Xsbler 37 provide*..* obrapariaon between pulmonary functiorr result* --weed- i* thl. study sad those determined In a study af the general: jepsiatiee of ttlehlgan (MlHer et al., 1980). For this comparison, the *<* mis dUnic garage workers are excluded because' of factors that nay be wf<|Bt>.U that. group, the studies overlapped considerably ia time and hm Seme, technical permacmel were used is eidt. (The field dotes for the- HicMgnm survey were February 1978 through December 1975 aud for dds. studyr Hay If78 through February 1980.) The purpose of the Hichi* gash Mrrcy vra'-to measure levels of polyhroelnatcd biphenyls la blood sad' adipose tissue- and to evaluate other health indicators. . The gruup a* choaen by a szxn&tm selection process using Michigan phone numbers. Predicted values utilixed the regression equation* for the data of HWBUI0008506 61 Table M Spirometric parameter. t* i<w) The mesas- q( tplromelric values. according to X-ray reading and sawkiughistory ualeg two criteria for X-ray abnormality X-ray reading . Hemal Abnormal \ 0/0, Pl.Th. or Pqs.) {formal Abnormal (1/1 or Pl.Th) ikpe/mc ' ' ` . 92.711.1 (176)' -Smokers 91.611.6^(84) ' (ns) 94.011.ST (S3) itff/i'Mtff IQ.312.6 (152) J6.113.8 (73) Ex-smokers FSC/PFVC: JSVPFEVj 97;210.9 (264) .05.21ill (264) 92.411.9 (81) 98.712.5 (81) tMT/RMT . 92.412.3 (216) 89.414.8 (62) WonsawJcers. imcimc:^r * ^rr;* 5sf^^rarf :9^5tii (173) * : *,"* ' t ;i0#.8i.4-(172) ft.SIT. 6-(48) ^ ._ ll0.m.t(48) Dar/Rtar-. ; 11,0&>3 (127) 105.314.9.(37) 94.011.0 (213) - ..se. .-W * . ... 96.811.2 (212) 80.712.3 (190) 19.212.2. (43) 89.012.S-. (42) 69.515.2 (35' 98.110.9 (299) 90.112.7 (43) 104.111.0 (299) 96.113.3 (43) 91.612.3 (243) . 91.316 . O '(34 ) 99.811.I (151) . . - J. - * I0S.511.2 (190) 99 i 22i3' (24)' .1 108.612*. S(24) 101.912.4 (144) 107.617.1" Q?) HWBUI0008507 i > ^ 62 Table 37 . A comparison of snlrnraetrlc result? In this cohort th those observed in the general population of iHchiga Observation <?roup This stvdy (excluding . -Michigan non-echanic garage general workers) population Smoking hiacocy Blacks Whites Whites Seekers Ex-seokcrs Kaosookers Smokers Eab-sookers JSanaaakers 100 x FVC/PFVC 96.322.4 93.722.3 98.223.7 94.321.0 98.620.9 101.121.1 94.7 97.3 99.2 100 x FEV^/PFT?! 104;122,7 102.422.6 206.724.3 95,521.1; 96.1 104.821.1 3,01.6 110.221.2 ,105.8 .... Smokers Ix-smokora Nmunokats 1CH5 x KiF/PMMT 9Q;223,2 76.522;4 80.5 90.825.5' 95.322.3 88.2 98.926.0 : 106.622.6 ^r.97vt : Predicted values were obtained from the data of Jtetrij' et el.' HWBUI0008508 63 Morris et si., 1971) . As can be seen, the data foe the whites la this study coopsre very favorably with Michigan white sales. (Had the non-mechanic garage workers been included, mean values from IX to 2X lower would have been obtained (c.f. Table 30). A; variety of: different research groups have produced regression equa tions for pulmonary function.parameters on the basis of.measurements on "normal" populations. The equations of Kory et al,,. 1961; Cherniak and Rsber, 1972; and Morris, Koski, and Johnson, 1971, particularly, have gained widespread acceptance for comparative purposes. The populations Utilized and the criteria for acceptable data are shown in Table 33 for these 'three studies along with five others that have also established regression equations for normal populations and this study. As can be seen, only two of these research groups included only nousmokers in the study-group. A third included individuals who saoked for less than sis month* and one included individuals who were ex-smokers of less than five-pack years of cigarettes. In some cases averages of best efforts were utilized; in others, values for all parameters were taken from the flaw volume curve of the best effort as date ruined by forced vital capacity. 'Of most Importance* a considerable diversity exists in the age^iistributioas o the. study populations, selected. Values for- FVC andiRfj. increase" until: about -age 23, then regain relatively unchanged .'until'---, about age 35, and, thereafter declining steadily with, age. Be cause of this complexity, regression equations,, based upon a wide range oi ages- and .utilizing- only-. ; single linear term to account for age, caa - be algnlficsafely in. errori The errors are such as to; produce overesti mates of pulmonary functions for young and older groups and underesti- '*at*. foe those in the middle years (see, e.g., Schoenberg et ali, 1973). As the population la this study is largely between the ages of 40 sad 70, most regression equations are likely to understate the values foe these parameters. Additionally, lower predicted values will clearly be obtained from papulations that include smokers or from studies' that include averages of several expiratory ef forts rather than the maximal ones. The use of standards from such population." cao^lcad to underestimates of effect Jfrom agents in the workplace that can .. . , ' affect pulmonary function. : I HWBUI0008509 i*i *i!la -aJ6a " jjo jja jf t 64 ) tto 21 \i < tst XRy 2 .>** u *mg Z*to 3g' I ti z fe e--e* .aa SI 5( M2 Ut 3i i *s*'. . i sH M S * fae tyao s to< to M* <" uaa 41u*4 aCyT JS:* g** 6tOo4 IN 3 M aaa& 6ea3 age aa g|w < xl t ) ic H l Ms ws oe.3 33 I** ,,.l:. '. &* - 5 *T- 1 - I i: to X a. to .0- . __ ia a teo* to 4 if fj* ?:i r? ?ee4 fc v - i*.tmar o;. iIs 5 : s e 2 OI 8** e to* s # r to* jnwruH i t i o i- l *p*n* ini' HWBUI0008510 65 la this study valid pulmonary function tests exist for 163 noasatokors la aUar than tint non-mechanic garage group. The previous discussion has .indicated their pulmonary function parameters. (FVC, FEV^ sud MW), Mf<n favorsbly with the group studied by Morris, Koski'sad Johnson. It; is instructive to utilize the regress ion equation* from the above stddiee of normal populations to obtain other cmrparative data. The Various regressiou equations utilized are shown la Table 35 and the percent.: ratios .-of observed to predicted: spirometry parameter* are listad iar Table. A3. As can be seen, the values, obtained for FVC/PFYC sm rWj/PFEVj are in excess of 1.00 far all regression equations. This is the result of the inclusion of s>okcrs asiong comparative groups, the use of averages of several efforts, or the underpredirtion result- the broad age distributions utilized for the regression cqua- tlbo*.'. High values of FEVj/rFEVj result, in part, from an extrapolated origin of expiration (c.f. Table 35). The values* for MrfF/PJMF", FKF^g/- frarso, and are less than 1.00 for the prediction equa tion* of Cherniak ami Knitdson. This is the result, of their use oi the MxisMMi flow value obtained in any effort rather than the flow in the offqrfe with ear.issues FVC, It is general Vy found that lower flow rates agtt-;obCoined during, the jchimecat of a oazisal ,F.'C. The Morrisq .-Konfct-, and: Jetmso: equations would appear':tt::gti; comparison forj EVC^ andi MNP because * large, proportionv of their populat ion -.Vi* -alv age 30, raly nousaokers were studied, aod the best effort was . atHired. The very complicated rquatioa of Schoenberg, which was . 4evIiped.t.properly take account, of age,, is limited by the relatively few individual* over-age 30 and: the use of averages of efforts. Eogsusaion- equations lor the various apitnactcic. parameter* obtained few* data: on the 163 white, iwasaolrr* tested- in .thi uurvey are I iated la Table 11. Because only three individual* Wete under age 30, only the linear dependence on age could he cal.iM ished. .. MmiCAi, EXAMiy.vnos r.zsvus - Table 42 list* the number and percentage oi abnormal i tie:, feun.l ou phy sical .examination according to Job category and or;.n nvr.tff!. The only ) ) HWBUI0008511 u Table 39 Hi* paraaatara In rmt>*s*loa equation* for the ptatlietioa of apirotaatrie functiona la nlti* scudlea Study * x Ut. (ia.) x Arc Cyra.) Gotta tent Morris t al. Millar at al. CStarhlak t-JUbar Xmidaoa at al. f%XXiM { 4l. Kory c al. &aaa Hi*jetta i Seller - JZ 0.144 0.147 0.12102 0.1431 0.11654 0.13208 0.159 0.15744 -0.023 -0.026 -0.01337 -0.029 -0.027 -0.022 -0.023 -0.024 -4.241 -4.053 -3.18373 -5.459 -2.79 ' -3.60 -5.72 -5.38 Hotzlf c al. Millar at al. Qtradak h Saber Knudaoti 6 Kellar Tmxxim at al. l&ssf. et ali:7 Mssms S Kallar Iferri* aril. Killac at elV Cheratak fc-labar %mdm<n al. SifSm* 4 'biles ** * Qiecniak 4 Rabar Kaudsem ae el. lSiass. 4 Bellas Miekigaa 6 Cherniak 4 Rabat Knudson et al. Hlchlcaa TCTi 0.092 0.094 0.09107 0.13204 0.07364 0.09398 0.11644 ' ' -r-'MMg ' . 0.047 0.0440.0594# 0U143 O.OSSSS 1250. 0.06326. 0.069 0.0435 0.102SS 1273 0.0903 0.W4 0.049.7 -0.032 -0.032 -0.0232 -0.027 '-0.028 -OiOlS -0,028; -1.260 -1.426 -1.50723 . -4.203 -0.70:7 -1.59?V .. -3.14:A;>; 7:7;: ` /77V.-; -0.045' .v +2.313 ^ -0.046 7;+2.806= -0.037- . +2.61287 ^1.03t :7 -2.864 -0.044=..-;7'" +1.837 ; -0.03049 -0.015 0,037 -0.0232 +2.40337 ' -5.4 +2.577 . -1.1121 ~ -0.01987 -0.012 -0.02833 42.72354 -4.143 0.03562 HWBUI0008512 o ^ WW4 *7 l M ' - a4 - ' 44- 44 44 M *. . HI'- 'h4:v:. 44 44 ' O '- *>4 j, 0 > n 4 O ' *+' m m.- m +* -.O p* *** . - _ HT 44 if - *4-- 44 A 4*4 iZ-'rJi' *4 #4 *4: *# -. * *& f*- jM- P4 0, PI r .- -- a- - . *.. _ (N H 4 '**: m* w # 44V-:''44'- 44*-; 44-. ** '' . :** QO H * ' 4 m $ ^;' ' P*-- *V'. P* . * P4 m O* F4 - 4- - ***4 : P<" ho-;- ` ' W' sw >4 - a . 'c- 0; * pa4 9. &* 44 4 hM 44 % fa 9 *H ' VoM*' fca '. 0 e 0aa 3 I d 5 a- Ha 44 a ffaaaa- tf9c hm4` a fKa. m 5 si fa HI' a*- a -Ma- . '4a4 4 4aa a 4eat4? 44as0aa35- ee0H8 4u5 4 ) ? HWBUI0008513 m Table 41 Predict log equations detgnsln*4 for varlou* apira>serlc parameters from 163 nona<&uk,in;f whites^ In chi* scuJy ParssMters FVC mi WF m3* nrn Regression equation________________ - %2 0.0136 x Htv- 0.0267 x Age - 3.29 0.0856 x Ht. - 0.0270 x Age - 0.792 0.0159 x He. - 0.0269 x Age + 4.017 - 0.0033 x He. - 0.0259 x Age + 6.124 0.0060 x HC. - 0.0196 x Age* + 2.093 0.43 0.43 0.C9 0.04 0.12 Mo nottrwechanical carage workers arc included:. However, there* wara;no other exclusions based on health lit formation ,ar job. HWBUI0008514 69 m3 -3 > ^e9 ) i 5 * H ao ,ae<a* g0 . 4*. s* 3 -3 .* 3 g3 51 *O*. 4: <M *S a., t. *2 a 19 "3 a 5* 3~ HWBUI0008515 70 circuastsacu la which a lUtiittMlly ti gnif leant greater percentage of la (oob<I la foe * Imams l lynph glaada aatong the popu- Utlot a* aa uaespeaed control. With the tuMaber of rubcatc- goriars established itt Tabls 42, inch * finding; would bo- xpctl ms tbm boot* of dbuKe alone. Sic attribute, no aigulfieanca to It. Talk!* 41' iham- the number and percents.c of individuals. with rales or ;flhtar: dabbing'according to their'X-ray readings A greater percentsgo %& individuals with abnormal. X-ray* have dry rale* thaw da individual s with aornl X-ray, The nuathera, however, arc no small that the data 4 aot' achieve significance. There was no correlation of finger club bing with. X-ray findings. Overall, rales were observe d in 4.S% of the entire *ta*4y group and clubbing iu;2.6X compared to 23.2X with abcomal X-rays fee 13.11 if wore stringent X-ray reading criteria vere utilized (e.f. Table 11)1.. Thus, ia contrast to earlier data from Great Britain * (British Occupational Hygiene Coeaaittee, 1943), it would appear that the pre--aeg of X-ray abnormalities ia a considerably more sensitive parsbotsr, than, galas (or restrictive paLnonary functioa deficits) for the-* catogorixation of asbestos discs me. This has. also been eeu ia , soyeral. othsr ifbatUa^cxpaaei groups, including shipyard. vpriirs;- .(to. : tid: publisha^). sod cbemlcaL or oil refinery; saiatenancc. employees (Lilia /ZjxJgS *. alC ll : Oats foe tiwr blood pressures are ahown in Table 44 according to age, Ibh categwef, and race. As con be sera, the systolic ' apd diastolic: blood pressures of the blocks are a f gnl fi eaatly above thoac. of the whites. Systolic pressures increase from 5 to 7 percent per decade and. diastolic fro*- 2 to 3 percent each decade- with the rates of iacrr*se beig. ggcoCer for blacks than whites. The analyses of. the age a toad ardised blood pressure* accordiug to ssvtking history or job category arc shown in Table 43. White cigscettc nunkera appear to have somewhat lower blood pressures, but this ,could be artifactual as it is aot reflected in blacks. Va significant differences are seen in the analy sis of blood pressures according to work activity. HWBUI0008516 71 Table 41 The noaber end percentage of Individual* with rales', and'/of f ingur clubbing, according to X-ray reading* Hales present dubbins present Both rales sad clubbing present* X-ray reading Normal Abnorna1 30 (4.3) 17 (6.9) 16 (2.6) 6 (2.7) 3 (0.5) 1 (0.5) The eases^with both rales and clubbing arc Included; ia tb separate categories as yell. ' ... ... - 1 I '1 i ; I HWBUI0008517