Document VjYqoJBpZ4Qgwe5dqywVj861K

ii>7Cn\ FiLE Copy EPIDEMIOLOGICAL STUDY OF VINYL CHLORIDE WORKERS Final Report Kay 3, 1974 Submitted to ' The Manufacturing Chemists Association 1825 Connecticut Avenue N- W. Washington, D. C. 20009 by * Taberchavr/Cooper Associates, Inc. 2180 Milvia Street Berkeley, California 94704 'spj 1051 ACKNOWLEDGMENT The research which forms the basis for this report was supported by the voluntary contributions of the following naoed chemical companies engaged in the synthesis and/or the polymerization of vinyl chloride, and administered In their behalf by the Manufacturing Chemists Association . . Air Products and Chemicals, Inc. . .` Allied Chemical Corporation Borden Chemical Division of Borden, Inc. Continental Oil Company Diamond Shamrock Company The Dow Chemical Company Ethyl Corporation Exxon Chemical Company Firestone Plastics Company B. F. Goodrich Chemical Company * The Goodyear Tire and Rubber Company Monsanto Company OLin Corporation . ' PPG Industries, Inc. Shell Chemical Company Stauffer Chmolcal Company t - Tenneeo Chemicals, Inc. Onion Carbide Corporation ONIROYAL, Inc, ' - -- - \v>V 1052 TABLE OF CONTENTS SECTION I. 5umraary IX. Introduction ' III. Selection of Study Plants ' _ - IV. Data Collection ' V. The Measurement of Exposure VI. Follow-up of Study Population VII. Description of Study Population VIII. Calculation of Risk of Death xs. Analysis X. Discussion XI. Possible Biases in the Calculation of Risk Page 1 2 ' 3 A 5 6 7 9 11 13 15 REFERENCES 17 LIST OF TABLES 1. Follow-up Status of 8384 Vinyl Chloride Workers 2. Distribution of Months in Exposed Employment by Birth Year t for 712S Vinyl Chloride Workers with Completed Follow-tip - 3. Distribution of'Months in Exposed Employment by Year in Which .. Exposure Began, for 7128 Vinyl Chloride Workers with Completed Follow-up 4. Distribution by Months of Exposed Employment end Time Weighted Average Exposure Score, for 7128 Vinyl Chloride Workers with Complete Follow-up 5 Person Years of Observation by Year of Birth and Age for Vinyl Chloride Workers 6. Observed Deaths/Expected Deaths and Standardized Mortality Ratios in Vinyl Chloride Workers vW 1^53 7. Observed Deaths/Expected Deaths and Standardised Mortality Ratios in Vinyl Chloride Workers, by Estimated Level of Exposure 8. Observed Deaehs/Expecced Deaths and Standardized Mortality Ratios in. Vinyl Chloride Workers by Duration of Exposed Employment 9. Observed Deaths/Expected Deaths and Standardized- Mortality Ratios in Vinyl Chloride Workers vich Exposure Indices below 1.5, by Duration of Exposed Employment * '. 10. Observed Deaths/Expected Deaths and Standardized Mortality Ratios in Vinyl Chloride Workers with Exposure Indices of 1.5 or Greater, by Duration of Exposed Employment __ 11. Distribution, of Deaths by Exposure Category and by Whether Cause of Death Was Determined, and Correction Factors Used for SKR Calculations 12. Results of Follow-up in Several Occupational Groups 13. Angiosarcoma Deaths in VCK Epidemiology Study Population 14. Ocher Malignancies (190-199, l.C.D.) in VCM Epidemiology Study Population 15. Malignant Neoplasms of Buccal Cavity and Pharynx (140-148, l.C.D.) in VCM Epidemiology Study Population FIGURE 1. Flow Chart of Follow-up Procedure ATTACHMENTS A. Plant Contact Form B. . Plant Background Form C. Job History Form D. Follow-up Letter VjCW 1054 ^r EPIDEMIOLOGICAL STUDY OF VINYL ClILOimm WORKERS Final Report: - May 2, 1974 X. SUMMARY _ Eight thousand, three hundred and eighty four men who had had at least one year of occupational exposure to vinyl chloride before December 31, - 1972, were followed in a historical prospective mortality study. The major findings of the study are: 1. The overall mortality of the study population was approximately 75 percent of what would be expected in a comparable population of II. 5. males. 2. No cause of death showed a statistically significant excess over what would be expected in a comparable U. S. male population. `' 3. No new deaths identified as angiosarcoma of the liver were found. 4. All previously known Angiosarcoma deaths in the study population during the study period were found as part of the routine study procedure. . 5. Cancers of the liver (primarily angiosarcoma), respiratory system, brain, and cancers of unknown primary site, as . veil as lymphosarcoma, occurred more often than expected In those members of the study population with the greatest exposure. Even though the excesses were not statistically significant, the findings warrant further study. 6. Other cancers occurred at lower level's than in the general male population, with the exception of cancers of the buccal cavity and pharynx. There was an excess of these 1055 2- - cancers, which however vas inversely related to exposure. The explanation for this finding is not apparent. II. INTRODUCTION _ The study vas begun by Tabershaw/Cooper, Associates, Inc* on . June 15, 1973, under contract from the Manufacturing Chemists Association. The original eight month period of the contract vas later extended by two months, in consideration of logistical problems arising from the number of plants which participated in the study. The objectives of the study are: (1) To compare the mortality Of individuals vho have worked in vinyl chloride plants with that of the general population; f2) To compare mortality patterns within the population of vinyl chloride workers, based upon estimated occupational exposure; and (3) To compare mortality among vinyl chloride workers with the mor tality of other groups which TCA, Inc. has studied* The study took the form of a historical prospective mortality study. The study population consisted of individuals who had worked for at least one year in a job involving exposure to vinyl chloride before December 31, 1972, and Included retired and terminated as well as active workers. For each such worker the date of birth and an employment history were obtained, and the . vital status of the worker as of December 31, 1972, was ascertained. For those found to have died, those death certificates that were available were obtained and the cause nf death determined. The observed mortality was compared with that of the United States male papulation. "ooV 1056 III. SELECTION OF STUDY PLANTS The Manufacturing Chemists Association Identified 43 United States -plants belonging to 19 companies, which, either produced vinyl chloride or *. * used it In the production of polyvinyl chloride. The name and address . of a responsible liaison person at each' company and plant was provided to TCA, Inc. (Attachment A). A brief questionnaire was sent to each plant to obtain an estimate of the exposed population and to find out how far back in time personnel records could be obtained, and to determine whether Job histories were available for retired and terminated workers (Attachment B) - - All the plants responded. On the basis of the replies, four plants were dropped from the study because they had. begun operation after 1968. It was felt that exposures in such plants would be too recent and too. brief to provide useful data. Study of one other plant was deferred be cause It had stopped production of vinyl chloride seven years ago, and appeared to present difficulties In identifying.an exposed population. In addition, three more plants were excluded from analysis because, when data analysis began, it va? found that Information from these plants was defective in o-ne of'several respects (e.g., no exposure data, no job histories available for terminated employees, etc.). The present report therefore deals with 35 domestic plants involved in either VCM or FVC production, which provided a study population of 8384 individuals. ` \ Tzars* --4 -- ri iT ^wS*^-'-'1-- V-^T~J IV. DATA COLLECTIOM In each plant, data vere collected for each worker stated by the -plant management to have been employed for'at least one year In a job involving exposure to vinyl chloride. In some plants, particularly those producing the monomer, this determination could be made on the basis of job titles. Usually, however, exposure was a function of both job title and the location of the Job in the plant, so that the assessment of exposurehad to be made on a case-by-case basis by plant officials. Data vere collected for as far back in time as complete records vere kept. In most cases this covered the entire history of the plant. In otL'.ra, records vere kept for a fixed period such as a decade. In a few, records were kept for different periods, depending on whether the worker had died on the-job or bad left employment. la Che latter case it was necessary to exercise care in defining the period for which study data were to be collected. Tor example, if a plant kept records for five years on those who left employment, but kept them * indefinitely for those who died on the Job, no termination could be in cluded in the study unless it occurred within the last five years. Data from Che earlier period would be biased for the purpose of this study, since a worker had to die to be In the records for the earlier period. The policy therefore was to determine how long each kind of record was kept (quit, discharged, retired end alive, retired and deceased, died while employed) and to define the study period as the shortest of these. One problem which arose in the PVC plants resulted from the fact that a worker could transfer within the plant from exposed to non--exposed jobs. Therefore, even though the number of workers in exposed jobs at a given 105S * ^wvr-a..- ^ i -j - v ?***"*y*r -J -J-'~-' ' ^ ' 1-^ '~- time may have been a small proportion of the total work force. It was necessary to search every worker's record to find those who might in the past have had over B year's experience In exposed jobs. Several of the PVC plants undertook to conduct this search themselves. ` As a result, plant data were collected in two ways. In some plants, a TCA, Inc., team visited the establishment, copied the records designated by management as representing exposed workers, and obtained sufficiently detailed exposure estimates to produce a job history. In others, the plants were provided by TCA, Inc. with standard forms which they filled out for workers whom they identified as exposed. Three basic forms were used, depending on whether the worker was known to be alive, known to be dead, or was of unknown status. In all three cases a work history with estimated exposure was recorded, the differences being in the ancillary data required. . Attachment C shows such a form for workers known to be dead. Approximately 5000 of the study population, came from plants visited by TCA, Inc., while the remainder came from plants which had filled out the forms themselves. * V. TEE MEASUREMENT OF EXPOSURE - The job history forms (Attachment C) were originally designed in the expectation that vinyl chloride exposure on each Job could he quantified in parts per million* This proved generally to be impassible. However, Industrial hygiene and safety personnel In each plant -were able to identity certain jobs and-locations as Involving the highest exposures in the plant, and to classify ocher exposures as medium or low relative to Che ''high" represented by the jobs with the greatest exposure. Therefore, the attempt 1059 L r.r- --,ir jf~ 6- - to obtain objective exposure data vas abandoned, and each exposed job in the vorkerTs history was scored I, 2, or 3 to indicate low, medium or high estimated exposure. . This gross classification has two major failings, as a result of the subjective nature of the estimates. The first is that the scores represent estimated relative exposure within a given plant. It is therefore possible that, in objective terms, a "high" score in one plant corresponds to a "medium" or even "low" score in another. The second is that exposures in most plants have tended to decrease over time, so that a worker with long service may have "had jobs in the remote past which involved "low" exposure relative to other jobs at that time, but which might be "high" in comparison with current exposures in the same job. This subjective classification is therefore of questionable validity In characterising the exposure of a given worker. For epidemiological purposes, however, those who have high scores can reasonably be expected, on the average, to have had the greatest exposure, while those with low scores will have had the least, even though the true exposure in each group may vary considerably from person to person. The estimated exposure history of each worker was summarized by calculat ing An Exposure Index (El), This was done by multiplying the number of months on each job by the exposure score, totalling these overall exposed jobs, and dividing by the total number of months of exposure. VI. FOLLOW-UP QF STUDY POPULATION . A follow-up procedure was instituted for those who had left employment and whose vital status could not he determined at the local plant. A portion of the terminations was traced by mall, using a fora letter sent to the last 1060 -7- known address. Attachment D shows such a letter. If the letter was re turned as undeliverable, the procedure shown in Figure 1 was used to obtain a current address. - __ The remainder of the terminations was traced through a retail credit bureau. The latter was also done for a portion of those who could not he found by the mail follow-up. ' Approximately 5500 of the study population came from plants In which direct mall follow up was employed. In the remainder of the population follow-ups was by retail credit bureau. There was no significant difference between the success rates of the two methodologies. Table 1 shows the vital status of the study population as of December 31 1972. Follow-up Is 85 percent complete, although follow-up data were still being received at the time the files were closed for this report. Of the 352 workers known to he dead, death certificates have been received for all but 24. The mortality calculations in the succeeding sections of this report are based only on those workers who were successfully -traced, which is equivalent to assuming chat mortality among chase noc found is the same as among those who were found. In order to examine the reasonableness of this assumption, the differences between those found and noc found are examined briefly as part of the following section. VII. DESCRIPTION OF STUDY POPULATION . Table 2 shows the distribution of those successfully traced, by year of birth and number of months of exposure. The median birth year was 1931 {compared wlch 1920 for those not found) and the median durati'in of employ ment in an exposed Job was 80 months *144 months in those not found). The -8- shortest exposures occur In both the oldest men, most of vhoseworking life was over when vinyl chloride came into general use, and Che youngest men, whose date of hire was closer to the closing date of the study. Although nearly half of the study population had less than 60 nonth? of exposed employment, there were nevertheless 855 workers with 20 years or more exposure, and 1641 with 15 years or more. Table 3 shov3 the distribution by duration of exposure and the year in which exposure began. The median year in which exposure began was 1962 Cversus 1953 for those not found). Notice that almost half the study population first entered exposed employment in the decade 1960-69. This reflects the fact that a great many plants first began vinyl chloride operations in Chat decade and means that these workers have not been . followed for an substantial length of' time after their exposure occurred. Table 4 shows the relationship between duration of exposure and Exposure Index CEI) . The median El is 1.44 Cl.75 for those not found). There does not appear to be a close relationship between the El and the duration of exposure, that is, workers with a higher El do no: differ substantially in duration of exposure from those with a lower El, One Implication is that in assessing the relationship between mortality and exposure, both duration and level of exposure should be examined separate ly, as well as in combination The data shown above for those not found indicates that they were born (and began their exposure) about 10 years before the group on which follow-up was complete, and had about half the duration of employment with a slightly higher El. Typically, their employment in an exposed job ended before 1960. The bulk of these workers came from older plants from -9- which data were collected late In the study. Although there appear :o be nothing very unusual about this group In terms of work history an- exposure, it is nevertheless true that their exposures took place further back in time than that of the group success fully traced. It Is therefore possible that their mortality, after a substantial latent period, might show a somewhat different pattern .of mortality from the traced group, _. 7111 CALCULATION OF RISK OF DEATH The usual method of describing the risk of death in a study of this kind is to express the number of deaths which actually occurred as a percentage of the number which would have been expected in a comparable male population observed over the same age and time intervals. This statistic is called the Standardized Mortality Ratio (SMR). In order to calculate the number of expected deaths it is first necessary to calculate the number of years for which each worker was observed, and to classify chese years of observation by the age intervals into which they fell and the birth date of the worker. Table 5 shows such a calculation for the 7128 vinyl chloride workers on whom follow-up was complete. This group represents 77,846 person-years of observation. Tor example, the table shows that for workers born in the years 1925-29, there were 2725 person-years of observation in the age interval 30-34, and an easy calculation shows that these person-years were lived in a period whose midpoint was ahout 1960. Therefore, the number of deaths to be expected in this cell of the table is the number of deaths occurring in 1960 among 2725 males aged 30-34 in a comparable non--exposed population. 1063 -10- In the present study the U. S, male population vas used as the standard of comparison, and the age-specific U. S. male death rates for the appropriate ages and years wore applied to-the corresponding cells of Tabic 5 to obtain the expected deaths.* This was done for all causes of death together, and lor each of the 35 causes for which detailed mortality rates are published on a national basis (omitting such causes as breast cancer, congenital malformations, and diseases of Infancy). Table 6 shows observed and expected deaths, and the SMR, for each of these causes for the total study group. In calculating the SHR's fot specific causes, the 24 deaths for which no certificates were found were assumed to have the same cause distribution as those for which certificates were available. In the standard population, each SMR would be equal to 100. Therefore, the statistical significance of the deviation of each SMR in the study population from the expected value of 100 was tested. A single asterisk Indicates chose SMR's which differed significantly from 100 at the 5 percent level, that is, which had a probability of .05' or less of occurring by chance. A double asterisk indicates those which were significant at the 1 percent level. SMR's based on fewer than 5 observed 2 cases were not tested for significance. The practical interpretation of these statistical statements will be examined below. Each diagonal in Table 5 corresponds to experience centered around a giten year. For the first three diagonals (from left to right) 1950 rates were used; for the next three, 1955, 1959 and 1965 rates were used; for the last two, 2967 rates were used. 2 Large-sample tests of significance were derived from: CMang, C. L., `'Standard error of the age-adjusted death rate," Vital Statistics Special Reports. 47 (1961) pp 275-235. 'OtW -11- Tafale 7 shows the seme SJIR'e for workers with an Exposure Index below 1.5 versus those at 1.5 or above. The dividing point of 1.5 represents a level halfway between "low" and, "medium.. " ' Table S shows similar resulta for workers with less than 5 years exposure versus those with' 5 years or more. In order to examine .the possible interaction between duration and level of exposure, the study population was divided into 4 groups on the basis of both El Clow vs high) and duration of exposure Cshorc vs long; using the same dichotomizatioxi as Tables 7 and 8. Table 9 shows the results for short versus long exposure in the low El group, and Table 10 shows the same comparison in the high El group. In each of the above tables, deaths for which certificates had not been received were assumed to be distributed as a uniform percentage of all causes. The cause specific SMR's were therefore adjusted upward by a percentage which varied in each subgroup. Table II shows the distri bution of uncertified deaths in each group, and .the resulting percentage by which the cause specific SHR's were Increased. ' IX. ANALYSIS The overall mortality of the study population is statistically significantly lower than that of the U. S. male population. There were 352 observed deaths compared with 467 expected, for an SMR of 75. _ Table 6 shows that no specific cause of death was statistically signi ficantly greater than expected. Several, particularly heart disease, accidents and "other diseases" not detailed In the tables, were significantly below their expected values. ocW 1055 -12 - When the study population is divided according to length and duration of exposure (Tables 7 and 0) and combinations of these measurements (Tables 9 and 10) three major patterns emerge. . Tor malignant neoplasms as a whole, the SKR increases with increasing exposure, whether measured by level, duration, or both. In the high ex posure group with 5 years `or more exposure (Table 10) there are 26 observed cases and 26.11 expected. . '' , For cardiovascular - renal diseases as a group, there are also increases in the SHR with increasing exposure, but the number of observed cases restain less than expected, the differences being statistically significant In all groups except the high exposure, long duration group In Table 11. For all other causes, there are no consistent relationships with exposure. Within the malignant neoplasms, the largest (although not statistically) significant SMK is in cancers of the buccal cavity and pharynx, with 5 observed, 2.84 expected, and an SMR of 189. However, Tables 7 to 10 show that all these cases have Exposure Indexes below 1.5, and 4 out of the 5 have less than 5 years exposure. ' Cancer of the digestive system shows no excess In the study population as a whole. However, in those workers with Exposure Indexes of 1.5 or higher, there are 12 observed cases where 9.14 are expected (table 7), In the subgroup of the above workers with 5 years or more exposure, there are 11 observed cases and 7.47 expected. Respiratory cancer shows a slight excess in the total group, and a similar pattern for different exposure categories, with 13 observed versus 10.28 expected when the Exposure Index is 1,5 or higher, and 12 observed versus 8.50 expected when, in addition, the duration of exposure Is 5 years VSCN/ 1056 -13- or more. Malignant neoplasms of other and unspecified sites show an excess in the total group, and an increase with both level and duration of exposure (Tables 7 and 8) . The relationship with exposure is more pronounced, since those with exposures of less than 5 years have fewer cases than expected. The lymphosarcomas, 'although occurring at about the expected rate when the whole group is considered, are concentrated almost entirely in the high exposure long duration group. .In that category there are 4 cases observed and 1.84 expected. Cancers of the-genital and urinary organs, and leukemia, have fewer cases than expected. The number of cases is too small to examine any trends, X. DISCUSSION The favorable overall mortality of the study population is a phenomenon commonly observed In working populations. Studies of several occupational groups have shown that, even if there Is an occupational hazard which greatly Increases the risk of death from a particular cause, the overall mortality may well he favorable. Table 12 shows the SMB.*s obtained in a number of recent studies of other occupational groups. Although for technical reasons these SMR*g are not strictly comparable, the overall mortality In the present study is clearly favorable. SMR'e which are higher than expected may be worthy of attention oven if they are not statistically significant. This Is especially true in the present study since the number of deaths from many causes is quite small, and even a relatively high SMR may not reach statistical significance. If, In addition, a particular cause shows a consistent pattern of increase with exposure or estimated exposure, the findings are particularly 1067 -W- inceresting. By these criteria, mortality from digestive cancer, respiratory cancer, cancer of other and unspecified sites, and lymphosarcoma, appear to be related 'to exposure as estimated in this study. In view of the.association between vinyl chloride exposure and angio sarcoma of the liver, the digestive cancers were examined further to see what contribution angiosarcoma made to the observed mortality pattern. Of the 19 digestive cancers, 7 were liver cancers, of which two were angiosarcomas according to the death certificate. However, among angiosarcoma deaths in vinyl chloride workers identified by other investigators, there were 6 which occurred in the present study population during the study period. They were all found in the course of the study, but 4 were listed on the death certificate as due to causes other than angiosarcoma. Table 13 shows these deaths with the death certificate cause. If there had been no angiosarcomas, Table 13 shows that the total number of digestive cancers in the high exposure group .would have dropped to 6, and the number with high exposure and 5 years or more exposure would have dropped to 2, so that the mortality pattern in this cause group is due entirely to angiosarcoma. ` The other cause group worth further investigation is cancer of other and unspecified sites, both because it is a heterogeneous category and because It seems, unlike Che other cancers, Co be more related to duration than to level of exposures. Table 24 shows a list of the specific causes included in this category, which is essentially brain cancer and generalised cancer with primary site -15- unknown. About 40 percent of the observed deaths were due to brain cancer. In the general male population, about 22 percent of this category is due to brain cancer> so that not only is the mortality from this cause excessive, but brain cancer is overrepresented. The possibility exists based on the lack of specificity of some of the listed causes that some of the brain cancers vere not primary, but-met ascases: from another unidentified site such as the lung. The cancers of the buccal cavity and pharynx are difficult to explain because of their occurrence in the low exposure -- short exposure group. It Is possible that this is a chance occurrence, or that exposures to other substances were involved. XI. POSSIBLE BIASES IN TT1E CALCULATION OF RISK There are three areas la which bias could have entered the calculation of the above SMR's. The first Is the choice of the U. 5. male papulation as a standard. The second is the absence of 15 percent of the population who were not found. The third is the discovery, as-the study ended, of a group of LSOO workers whose exposures occurred up to 55 years ago, and who are not Included -in the study group. The choice of the U. S. male population was not entirely appropriate. The study population was concentrated almost entirely In the Eastern half of the United States, whose normal mortality is slightly higher than that of the whole country. This implies that the correct expected values should have been slightly higher than the ones which were used, and Che corresponding SMR's slightly lower. This has no practical significance except for those malignancies in which the SMR's were above 100. However, regional differences in mortality from those causes is such that these SMR's would have been at most 1.5 to 3 percent lower, with no substantive difference In the results. -jrr.T -1 r. The workers who could not be traced -may conceivably contain a dispropor tionate number of deaths, which could Increase the overall SMR. It appears un likely that the distribution of causes would be substantially different. How ever, without actual data in hand, the possibility cannot be ruled out that either some new causes of death might become significant, or that some of the relationships found In this study might be diluted. The same comments epply even more to the group of 1500 workers discovered too late to be included in the study group, since they would provide data in precisely the area (very long exposure and long latency) in which the present study is relatively weak. W 1070 References: Archer, VE, Wagoner, JSC, Lundin, FE, Jr: Cancer mortality among uranium mill workers. J Occup Ked 15:11-14, 1973. Enterline, PE, DeCoufle, F, Henderson, V: Mortality in relation to occupational exposure in the asbestos industry. J Occup Med 14:897-901,-1972.. Encerline, PE, Kendrick, MA: Asbestos-dust exposures at various levels and mortality. Arch Environ Health 15:181-186, 1967. Hammond, EC, Selikoff, IJ: Relation of cigarette smoking to risk of death of asbestos-associated disease among insulation workers in the United States, Symposium on Biological effects of Asbestos, Lyon, October 2-5, 1972, paper ?46. ' Lloyd, JW, Ciocco, A:- Long-term mortality study of steelworkers; methodology, J Occup Med 11:229--310, 1969. Lundin, FE, Jr-, Lloyd, JV, Smith, EM, Archer, VE, Holaday, DE: Mortality of uranium miners in relation to radiation exposure, hard-rock mining and cigarette smoking--1950 through September 1967. Health Physics 16:571-578, 1969. ' Redmond, CK, Ciocco, A, Lloyd, JV, Rush, HW: Long-term mortality study of Steelworkers--VI. Mortality from Malignant Neoplasms among coke oven workers. J Occup Med 14:621-629, 1972. Tabershaw, IR, Cooper, VC, Balze'r, JL: A Labor-management occupational health service in a construction Industry. . Arch Environ Health 21:784-783, 1970. muAJunm r imiijunimMsnagp --ri-" IUi . Table l Follow-up Status of 8384 VinyL Chloride Workers Humber Percent Total 8384 100.0 Alive 6 770 80.3 Dead 352 4.2 Ur. known 1256 15.0 Death Certificates Rec'd. Not Rec'd. 328 24 92.7 7.3 April 15, 197* ahjiwti m 'Od^ 1072 t O <! CO I Table 2 Distribution of Months In Exposed Employment by birth Year, for 7128 Vinyl Chloride Workers with Completed Follow-up Year of birth Total <60 1875-79 1880-84 1885-89 1890-94 1895-99 1900-04 1905-09 1910-14 1915-19 1920-24 1925-29 1930-34 1935-39 1940-44 1945-49 1950-54 1 5 7 21 3B 89 214 404 648 897 940 B77 986 1169 700 132 1 1 3 10 9 33 79 145 . 229 276 287 ' 454 664 632 132 Total 712B 1 2955 Months of exposure 60-119 120-179 180-239 240-299 300-359 360-419 Unknoun 22 1 33 792 4 9 12 13 21 22 27 35 62 58 96 . 80 37 72 120 191 98 143 214 118 ' 169 252 12B 181 378 120 27 481 16 66 2 17 43 73 105 160 139 26 6 34 43 84 64 20 ' . 3 15 13 B l l 2 2 '5 4 4 3 7 8 2 1796' 697 786 565 25 39 39 April 15, 1974 Table 3 Distribution of Months In Exposed Employment by Year ' In Which Exposure Began, for 712B VinyL Chloride Workers with Completed Follow-up Year Exp. Started Total 1930-39 1940-49 1950-59 1960-69 1970-71 35 1048 1967 3368 715 Total 7128 <60 2 135 389 1714 715 2955 60-119 4 93 257 1442 1796 120-179 1 119 383 195 698 Months of Exposure 180-239 240-299 300-359 ----------------- 360-419 Unknown 4 6 13 151 277 237 5 34 2 631 282 20 17 ,b 786 565 250 39 ' 39 vW 10 April 15, 1974 <! Exposure Index Total 1,0-1.4 1.5 + Unknown 4032 3057 39 Total 7129 Table 4 Distribution by Months of Exposed Employment and Exposure Index for 7120 Vinyl Chloride Workers with Complete Follow-up Months of exposure <60 60-119 120-179 180-239 240-299 300-359 360-419. Unknown 1715 1125 402 406 274 92 LB 1240 671 295 300 291 159 21 39 2955 1796 697 786 565 2.51 ' 39 ' 39 May 2, 1974 i t o i ui Person Years o f Observation by Year o f B irth .a n d Age fo r V in y l C hloride Workers A p r il 13, 1974 uc.C1--na* must --4 o--vn3ss1 --<Oo^N> Casi\ -^<Jri -- "' Cnl On'- --on* orOs'^- -cO--anH1 --<OuNs* a<OMsN ONON -WO3N -uUC VS as ON --oni o ----Oc<' 4<O----N <a ioOP-sdl OoOss --OC=S-"* *o<o"sr* ^OuC-OSvi oOC--ONhc OaCDs sCojOs- Hi=Gn5O CaOOsS <CCZO) 0CO3 vIC^NsO #^(CS4O HurOc <tKt r~ n C"> (or1--Ns1Jj (M crs? C -r-a. tC mvs OcfNSJ orvsTrr oCOO' c*fONsn' vs rtsO. fO .--i CM CpHO rs cOCnO CcsafOsf r*->44 --Of*f sN'dOa- r<N0On2i iCrOs n m TH, O R*-4 cgP-mSH (00<--N03T* iCCf/SMM. sQ0nO0O rl vO CO vs s* _4 CCO OoCS CnO CM <Cr-MssM.j CoIcAMn r% <C-Os csCo-- rCQs OrsS tnrOs tOrs v0s0 +<--3t h? oCM MCcmn3 irCPOMOj CCMMOf o r-* * CCMO hCDM *rO-o.' CCopMMO tCCOMM fV^H--S1 nt--OJ vCrssM Ctmf\ Mt 4CC--MM MCmMT c p--e CctCM- tGSOO3 CC0MM3 Mv24l sMspOO4 n rOv CM Ccnl mcrs2n n.T rM--. c* mO un \tQn rmi~sj vtos --* CHMt nCOM r-H u1-S4 f-^ -*! VrsS CCZO3 fPnH. C\0M c<nt C-M4 <Ce--MP< CCMM vcns m COM ICS NO' CvMs CcMn vs O4 m <TS CM vs vs <*C3oD r-* 1^-41 ofos C<MrO--M--Sj vn0p4D3 Ovirnss Oc-4> CM O*onrl %MnCO3o nMnCM3 SvCOOf CotOM CoCMM ouSo o trS t1o-4 Ot--ots '* MCoCM4t* CO0ViM4SN M<OC1ntl Omr<Nt -T hO3- O' Mvis* V-IcTaSrS uS vs SNoHOOJ tovsDOjss POrH-r. rvO-tsN. -T OCtO iCa0diOOi \>W 1076 TABLE 6 OBSIEVED DEATHS/EX PSCTED DEATHS <W STAMDidlDlZED MORTALITY RATIOS IK VINYL CHLORIDE WORKERS Cause of death with I.C.B. number 1 obs/eap shu1 AIL cauaaa 352/467.28 75** Tuberculosis (001-019) Tubrct>loils of raaplratory system (001-0(18) Matignant neoplasms (140-205) Hillgnant neoplasms, buccal cavity and pharynx (140-Ua) Hallgnant nsoplasms, digestive organa and peritoneum (1)0-159) HalLgnant neoplasms, raaplratory lyatara (160-164) HalLgnant neoplasms, genital organa (170-179) Haligninfc neoplasms, urinary organa (100-181) Malignant neoplaiai, other end unspecified site* (190-199) . Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tlaauea (200-103, 205) Diabetes mallicus (260) Mtjor cardiovascular and renal dleeaaee (330-334, 400-468, 592-594) Vascular leelone affecting CHS (330-334) . Rheumatic fever 6 chronic rheumatic heart dia. (400-602, 610-416) Arterloielerotic heart disease (420) Honrheumatlc endocarditis (421, 422) Vlyptrtemiva heart dlaeaae (440-44]) Other hypertensive diieaea (444-447) Chronic & unspecified nephritis & renal sclerosis (592-594) Influence and pneumonia (480*493) Ulcer of stomach and duodenum (540,541) eppendicitla (550*353) Hernia and Inteetlnal obstruction (560, 361, 570) Gastritis, duodenitis, entntltit end colitis (543, 571, 572) Clrrhoili of Uvar (581) Kyperplaele of proatato (610) Symptomi, senility and Ul-deflned conditions (780*795) All other dinettes (raelduel) (fetor vehicle aecidenta (810-835) Other accidents (800-802, 840-962) Suicide (963, 970*979) Hemicids (964, 980-985) 1/5.71 19 1/5.34 20 79/77.16 no 5/2.64 189 19/21.67 94 . 25/23.93 1.12 3/3.55 9l 1/3.60 30 17/11.75 155 3/3.77 85 6/6,06 106 7/6,11 . 120 155/207.46 SO** 13/24.48 57** 5/6.87 . 78 121/137.)] 95 1/6.58 16 3/9.33 35 3/2.60 124 0/4.-2 7 0 r/9.96 54* 2/3.83 56 0/0,66 0 t/l.Sl 71 1/1.31 82 3/15.60 21 0/0,39 0 1/7.34 15 21/43.78 49** 17/32.70 56** 18/30.64 6]** 16/16,83 102 1/11,98 9 Humber of workers Feraon-yaari 7120 77846 lSMt*s adjusted for deaths with cam* unknown. See Table 11, *Slgniricsnt at SI lavel. ^Significant at IX Laval, Hay 1, 1974 CD TABLE 7 OBSERVED fl'EATKS/EXFBCTBU DE.tTHS AND STAHD'JtOIZED HDRIAL ITT RATIOS IH Vm CHLORIDE WGHXESS, BY ESTIMATED LEVEL OF EXPOSURE Causa of death wirh I,C,D. number All eauae* Tuberculosis (001-019) Tuberculosis of respiratory syieum (Oai-DOS) Malignant neoplasms (140-205) Hellgnant neoplasm, buccal cavity and pharynx (140-146) Malignant neoplasms, digestive organ* and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organ* (170-179) Ma'lgnant neoplasms, urinary organa (100-181) Malignant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) lymphosarcoma, lymphatic and hematopoietic tlasuaa (200-203, 205) Diabetes asLUtua (260) ' Majar cardiovascular and renal dlaeasas (330-334, 400-468, 592-594) Vaicular Lesions affecting CMS (330-336) Rheumatic fevar A chronic rheumatic heart din, (400-402, 410-416) Arteriosclerotic heart disease (420) Monrheumatic endocarditis (421, 422) Hypertensive heart disease (440-443) Other hypertensive disease (444-447) . Chronic & unspecified nephritis & renal sclerosis (542-594) Influents and pneumonia (480-493) Ulcer of stomach and duodenum (540, 541) Appendicitis (350-93)) Hernia and Intestinal obstructten (560, 561, 570) . Csetrltls, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (561) Kyparplaata of prostata (610) Symptoms, senility and ill-defined conditions (760-795) All other diseases (realduel) . Hater vehicle accidents (610-833) Other accldanta (000-802, 840-962) Suicide (96), 970-979) Homicide <964, 980-985) Hufd>*r of vottara Penan-years lSKR't adjusted Tor death* vlth cim unknown. *Si*nl .`leant at }% Uvl. **Signl(leant at IX level. Saa Table U. Hay f, 1974 El <1,5 obs/exp SHR* El i I, 5 ohs/exp SKpl 186/270.33 70** 157/195.68 BO** 0/3,38 0/3.16 37/44.28 5/1,62 7/12.50 11/13.56 2/2,30 1/2.07 9/6,57 1/2.18 1/3.43 5/3.65 84/120.11 7/14.42 3/3.99 68/78.94 0/4,20 1/5,48 i/1.52 0/2.50 5/5.80 1/2.21 0/0.39 0/0.88 0/0.76 2/8.90 0/0,25 0/4.22 14/21.90 8/19.08 31/17.83 9/9.73 0/6.98 (1 0 90 330 60* 86 93 51 166 69 31 166 75** 52** 80 92 0 19 70 0 92 48 0. 0 0- 23 0 0 68* 45** 66* 93 0 0/2.33 -0/2.18 41/12.67 0/1. H 12/9.14 13/10.28 1/1.43 0/1.52 8/4.52 2/1.57 5/2.54 2/2.65 49/86.99 6/10.06 2/2.85 51/58.05 1/2.89 2/3,66 2/1.07 0/1.77 0/4.13 1/1.60 0/0,27 1/0.63 1/0.55 1/6.64 0/0.14 1/3.09 6/15.89 9/13.46 6/12.67 7/7.02 1/4.94 0 0 114 0 U1 135 75 0 190 136 212 at 05* 6*r 75 95 38 56 201 0 0 68 0 m. 196 16 0 36 41** 72,, 50** 107 21 4032 45354 ' 2057 32108 TADI'S 6 OBSKIVED DEATIB/EXTECTED DEATHS AND ST.iND.iHDIZE& MORTALITY- RATIOS IN VINYL CHLORIDE NORMAS BY WRATION 0* EXPOSED EMPLOYMENT . Caute of death with I.C,D, nunber <60 month* obi/exp 3HR1 60 month* obi/exp ' SKt* AIL cauree >4/140.33 67** 251/329.30 76** Tubirculfltle (001-019) Tuberculoale of reeplratory aye ten (001-008) Mtlignant neoptaiaa (140-205) Malignant n.optiim, buccal cavity end pharynx (140-14B) .lallgnanc neoplaint, dtgeatlve organa and peritoneum (*30-139) Malignant neap lima, reeplratory ayacen (160-164) Hellgnant ncoplaina, genital organa (170-179) Hellgnant ncoplaint, urinary organa (LflO-161) Malignant natiplama, other and unspecified altea (190-199) Laukanle and alaukeaita (204) Lynphoaarcona, lymphatic and henatopoletlc tlaauea (200-203, 203) D1abate* allitui (260) Major cardioyatcular and renal dlaeaae* (330-334, 400-468, 392-396) Vaacular lealoni affecting CMS (330-334) Rheumatic fever & chronic rheumatic heart dla. (400-401, 410-616) Arterloaelerotic heart dtaaaae (420) Monrheumatic endocerdltla (421, A22) Kypertenalve heart dtaaaie (440-463) Other hypertenalve dtieaae (444-467) dironlo & unapaetfled nephritis & renal icleroala (592-594) Influence and pneumonia (480-A93) Ulear of etmach end duodenum (360,541) Appandlcltla (530-333) Narnia and lnteattnal obatruetIon (360, 561, 370) Caatrltle, duodenltla, enterltla and colltli (343, 371, 572) Ctrrhoala of liver (361) - HyparpleeU nf proatat* (610) - Symptom*, eenlllty and tli-deElned condition* (780-795) All other dlieaaea (realdual) Itotor vehicle accident* (610-633) Other aeeldenta (600-802, 840-962) Sulclda (963, 970-979) Homicide (964, 960-963) 0/2,23 0/2.07 13/19.96 4/0.70 2/3,26 3/3,52 0/0.99 0/0,63 2/3.40 1/1,25 1/7,01 2/' .80 28M.4S 4/5.97 2/2.39 21/32.54 0/1.79 1/2.42 0/0.79 0/1.53 3/2.93 1/1.07 0/0,24 0/0,42 1/0,40 1/4,49 0/0.07 1/2.28 4/11,'1? 10/16.14 7/12,94 6/6,34 1/5.80 0 0 78 688 46 65 0 0 71 96 60 134 65** . Bt 101 78* 0 49 0 0 n? 112 0 0 301 26 0 51 40 75 AS* 114 20 0/3.55 0/3,33 65/57.61. 1/2.16 17/16,56 21/18.51 3/2.76 1/2.79 15/8.23 2/2.53 ' 5/4.07` 5/4.54 125/157.39 9/18.71 3/4.53 99/D5.39 1/5.35 2/7.01 3/1.a: 0/2.76 2/7.01 1/2.78 0/0.43 1/1.10 0/0.92 2/11.18 0/0.33 0/5.09 16/26.34 7/16.65 10/17.82 10/10.28 0/f,20 0 0 116 47 106 116 112 37 167 ai 126 113 81** 49** 68 96 20 30 170 0 29 37 0 93 0 18 0 o. 63* 43*\ 58* 100 0 ttmiber of worker* Feraon-yeari 7953 . 34201 4134 ' 43240 adjuated Eat deatht with came unknown, See Ttbla 11, te* significant at 51 level. O ^Significant at U level. CD Kty 1, 1974 TiJt-E 9 OBSERVED DEATHS/EXfEClEl DEATHS JND STANDARDISED MORTAL ITT RATIOS IN VINYL CHLORIDE WORKERS WITH EXNSURS INDICES BELOW US, BY DURATION Or EXPOSED EMPLOYMENT . Causa of daath with t.C.D. number All causes Tuberculosis (001*0(9) Tuberculosis of respiratory aystem (OOl-OOB) KaUgnent neoplasms (190*201) Millgnant neoplasms, buccal cavity and pharynx (140-146) Hallgnint neoplasms, digestive organs and peritoneum (130-159) H*llgn*nt neoplasms, respiratory system (160-164) HallgnenC neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-MI) Hallgnant neoplasms, other end unspecified sire* (190-199) Leukemia and aleukemia (206) Lymphosarcoma, lymphatic and hematopoietic tlaaucs (200-203,203) Dlabetee tael Li tut (260) Major cardiovascular ant1 rannl disease* (330-336, 400-468, 592-596) Vascular lesions effecting CHS (330-336) Rheumatic fever 4 chronic rheumatic heart dti. (400-602, AlQ-416) Arteriosclerotic heart disease (629) Konrhaunatlc cndoeardltls (621, 622) Hypertensive heart disease (440-461) Other hypertensive disease (664-667) Gironto & unspecified nephritis A renal sclerosis (392-596) Influenza and pneumonia (480-493) ' Ulcer of atonech and duodenum (340, 541) Appendicitis (550-553) Hernia and Intestinal obstruction f561, 561, 570) Caitrltle, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hyperplasia of prostata (610) Symptoms, senility and Ill-defined conditions (7B0-795) All other diseases (residual) Ms tor vehicle accidents (810-835) Other accidents <800-802, 840-962) Suicide <963, 970-979) Homicide (964, 980-9B3) . Hlunber of worker* Person-year* . *SNR'e adjusted Tor death) with causa unknown. See table 11. ^Significant ut 3X laval, "significant at IX Isvsl, Miy I. 1974 *60 month* exposure *60 month* exposure obs/exp SKA obs/exp SHrI 56/89,23 (3** 132/161,20 73** 0/1,41 0/1,31 0/12.86 (t 0 73 4/0,65 1016 1/3.43 2/1.58 34 6r. 0/0.iC 0 0/0,55 0 1/0.97 120 0/0.79 0 0/1,26 0 2/1.15 203 21/33,38 73" 2/3.93 59 2/1.30 155 16/21,14 88 0/1.10 0 1/l.Sfl 74 0/0,50 0/0.97 0 3/1.06 0/0,60 n/0.15 0/0.27 0/0.26 180 0 0 0 0 1/2.00 0/0.05 0/1,43 42. 0 0 4/7.45 63 3/9.67 35 3/7.90 44 3/4.00 06 0/3,35 0 0/1.97 6/1.65 29/31,46 1/1.17 `6/9.08 9/10.00 2/1.62 1/1.53 8/4.43 1/1.40 02.23 3/2,50 53/86,62 5/10.51 1/2,1J 32/5'.87 O/J.OI 0/3.Vd 1/1.02 (1/1.53 2/3.95 1/1.53 0/0.24 0/0.61 0/0.51 1/6,09 0/0.20 0/2.79 10/12.92 5/9.22 8/9.63 6/5,66 0/3.43 0 0 95 83 60 93 127 67 187 73 46 124 55" 49* 41 93 0 0 101 0 S3 6? 0 0 0 16 Q 0 79 56 63 109 0 1715 2l4lS 2317 ' 23920 1081 (y C* ^ TABLE 10 OBSERVED DZATIIS/HPECTEO DEATHS aHD STAI1DARDI2ED HDKTAUtY RATIOS IN VINYL CHLORIDE WORKERS WITH EXPOSURE INDICES D1` L.S OR GREATER, BY DU.IAT ION OF EXPOSED EMPLOYMENT Cauae of death with t.O.D, nucbtr All ceuaea Tuberculosis <001-019) Tuberculosis of reaporotory system (001-003) Malignant neoplasms (140-205) Malignant neeplatms, buccal cavity and pharynx (140-140) Malignant neoplasms, dlgeetive organa and peritoneum (150-159) Malignant neoplssns, respiratory system (160-164) Malignant neoplasm, genital organs (170-179) Malignant neoplesme, urinary organa (L3Q-18L) Hallgnant neoplasms, other and unspecified sites (190-199) Leukemia and eleukcmla (204) Lymphosarcoma, Lymphatic and hematopoietic tissues (200-203, 205) Diabetes taellltua (2bD) Hsjor cerdlovascuter end tenel diseeses (330-334, 400-463, 592-594) vascular lesion* affecting CMS (330-334) Rheumstic fever & chronic rheumatic heart dls, (400-402, 410-416) ArterLoaclerotlc haart disease (420) Nonrheum*tic endocarditis (421, 422) Hypertensive heart dlaaase (440-443) Other hypertenslva disease (444-647) Chronic A unspecified nephrltl* & renal sclerosis (592-594) Influenza and pneumonia (430-693) , 'Jlcar of it coach and duodenum (540, 541) Appendicitis (550-553) Hernia and intestinal obstruction (561, 561, 570) Gastritis, duodenitis, enteritis and colitis (563, 571, 572) Cirrhosis of liver (531) Hyperpleale of prostata (610) Symptoms, senility and Ill-defined condition! (7BO-795) All other dieeeeee (reelduel) Motor vehicle accident* (B10-B3S) Other eccldentl (30Q-602, 840-962) Suicide (963, 970-979) Homicide (964, 980-935) Humber of worker* Pi non-year* lSKR's adjusted Cor deaths with cause unknown. Sea Table 11. Significant At 5T Level. **SIgnlflant At 1% level, a* ,i * ,. -- <60 month* exposure 160 month* exposure oba/exp 5HR1 ots/exp . SHH* 38/47,93 79 119/147.81 81* 0/0,76 0/0.71 5/6.57 0/0.23 1/1.67 1/1,79 0/0,29 0/0,26 1/1.18 1/0.44 1/0.71 0/0.61 7/16.54 2/1.87 0/0.82 5/10.41 0/0.57 0/0.76 0/0.27 0/0.54 0/0.99 L/0.35 0/0.08 0/0.14 1/0.14 0/1.56 0/0.01 1/0.80 0/4.02 7/6.05 4/4.73 3/2,40 1/2,18 0 0 96 a 76 71 0 0 107 269 178 0 54** 135 0 61* D 0 0 0 a 362 0 0 904 D 0 153 0 146 107 158 38 0/1.57 0/1.48 36/26.11 .0/0.99 ll/7;47 12/8.59 1/.1.41 0/1 26 7/3.51 1/1.13 4/1,34 ` 2/2.04 62/70.46 4/B.19 ' 2/2.04 46/47.65 1/2.32 2/3.10 2/0.81 0/1.23 0/3.13 0/1.25 0/0.19 1/0.49 n/o.41 1/5.08 0/0.13 0/2.30 6/11.88 2/7.43 2/7.96 4/4.52 0/2,76 .0 0 141 0 151 144 73 0 204 90 222 100 90 50 100 98 44 66. 253 '0 0 0! 0 209 0 20 0 0 51* 28 26 88 0 1240 12828 1317 19305 Hiy I, IS74 Table 11 Distribution of Deaths by Exposure category and by Whether Cause of Death Was Determined, and Correctton Factors Used far SMR Calculations Total* Exposure Index <1.5 21.5 Exposure CattRorl es Total Exposure Exposure Index and Total Exposure Time In Months in Honths <60 k60 <1.5 <1.5 *1.5- .*1.5 4 <60 E> 60 & <60 6 560 All causes 352 iaa 157 94 251 56 U2 38' 119 Cause known 328 176 146 78 244 ' 46 126 30 116 Cause.unknown 24 12 U 16 7 8 4 8 '' 3 Percent increase 7.3 In SHR's . 6.a 7.5 20.5 2.8 16.6 3.1 26,6 2.5 ^Deaths In exposure categories do not add up to deaths in total category because 7 deaths had unknown exposure data, and one of those was of unknown cause. Hay 2, 1974 V jO * / I C S c  M-ir.iLri-r.--**** iii'.Tr---- Table 12 Results of Follow-up in Several Occupational Groups Studv Population Number YaarS Of SMR Observed Observation All causes Reference Asbestos building product workers . . 12,402 1951-1963 Entcrlinc * 89 Kendrick, 1967 Asbestos friction material workers 7,510 -N Enterline 89 Kendrick, 1967 Asbestos textile plant workers 1,843 m Enterlihe 121 Kendrick, 1967 Cotton textile ' workers ' 6,281 m Enterline 88 Kendrick, 1967 White underground uranium miners 3,414 1950-1967 159 Lundin et al, 1969 Steelworkers 59,072 1953--IS61' 82 Lloyd S Ciocco, 1969 Asbestos insulation workers > 20 years 250 1946-1965 140 Tabershaw et al, 1970 Coke oven workers 4,661 1951-1966 98 Richmond et al, 1972 Asbestos maintenance service, etc. 43B 1941-1969 124 Enterline et al, 1972 Asbestos Insulation workers > 20 years. 370 1963-1971 19B Hammond Selikoff, 1972 Asbestos insulation workers 17,800 1967-1971 136 Hammond Selikoff, 1972 Cranium mill workers 662 1950-1967 99 Archer et al, 1973 Lead smelter workers 2,352 1946-1970 107 TCA, Inc , unpublished Lead battery plant workers 4,680 1946-1970 99 TCA, Inc., unpublished Petroleum refinery workers 18,916 1962-1971 68 TCA, Inc., unpublished May 3, 1974 ~otW 10 S3 Table 13 Angiosarcoma Deaths in VCM Epidemiology Study Population Study Ho. 4250 4255 5765 7303 737$ 7385 Age at Death 54 $0 45 36 52 43 Mos. Exposed 203 281 167 L74 236 214 Cause as Given Cirrhosis o liver (seV. weeks) Autopsy yes _ Bleeding from hepatoma (3 days) (Laeunecs clrrhosla) 'yes Angiosarcoma rc. lobe of liver f10 mos.) yes Liver failure (l mo.) Cancer of Uver, primary (15 mos.) - Cardiac tawparade and nasalve left hemothorax (mini.) Wtduly metastatic angiosarcoma of liver (4 mos*) ` . Hepatic failure Primary carcinoma liver yes April 15, WK a> oo s >*: Table ill Other Malignancies (190-19'-', I.C.D.) In VCM Epidemiology Study Population Study Ho. Age at Death Moa. Expose'! Cause as Clven Autopsy- 2744 38 186 Widespread metastatic melanoma yes (l yr.) Malignant melanoma of back 3700 48 50 Malignant melanoma with widespread no macastuses . 2096 67 69 Brain tumor (carcinoma) (8 mos.) ` - 3946 43 64 Meningitis and pneumonitis (5 wks.) no Ependymoma, fourth ventrlcle-braln , (2 moa, post-op cranlotomyl- 4433 54 81 Astrocytoma, malignant-left cerebral .yes hemisphere (l yr.) . 4800 61 51 Carcinoma of the brain Arteriosclerosis no Pneumonia-due to static congestion 7279 57 271 Brain tumor, glioblastoma multiforme - (18 mos.) . 7300 7371 4 4 58 211 Brain tumor, malignant (2 mos.) - 249 Brain tumor, malignant no 7306 53 216 Thyroid carcinoma with metarrases no 5769 52 239 Carcinomatosis ' Carcinoma vertebral body yes table 14 Other Malignancies (coni,) Study Ho.' Age at Death Mos. Exposed Cause as Given Autopsy 5246 67 201 Lipoaarcoma with metastasis (3 mos.) yes 2850 64 193 Carcinomatosis, primary region not - no known _ (Past history, rheumatoid arthritis, , myocardial infarction) 4778 54 300 Card Lac arrest (l hr.) . . Respiratory arrest and cerebral hypokla (2 days) Widespread metastatic carcinoma ' (2 mos,) 4786 61 313 Generallied metBstasls undiffer- ' yes entlated (7 mos.) ' Squamous cell carcinoma, primary site undetermined 5783 69 166 Metastatic carcinoma of abdomen - Critical site undetermined . (Pulmonary emphysema) 7301 55 ' 133 Carcinomatosis (4 mos.) Primary site undetermined no April 15, 1974 O 00 rrs r' t * i I !< L: vi* ? ?i i \ i i, ; is Table. 15 Malignant Neoplasms of Buccal Cavity and rharynx (140-148, I.C.D.) In VCM Epidemiology Study Population Study No. 3003 3431, 3001 7365 3334 Age at Death 31 36 37 54 63 Kos. Exposed Cause as Given Autop: 49 Carcinoma of Up with metastasis no to lung and neck (5 yrs.) 30 pulmonary edema (50'mtn,) no Pulmonary metaatases (Carcinoma, epidermoid, tongue and . mandible) 71 Hetustatlc squamous cell ca. - 1 yes primary lesion palate 4(1 , ` Atelectasis due to metastasis to `yes mediastinum (4 mos.) - Hultlple malignant metastases to brain, ILver 6 mediastinum (1 yr.) Adeno-carctnoma of nasal pharynx (2 yrs.) 26 Kasstve hemorrhage Into trachea- tree Statue post laryngo-pharyngectomy, left radial neck dissect ton Well-differentiated keratin It. leg squamous cell carcinoma of left pyriform alnus (mo*,) April IS, 1974 tW 1087 Manufacturing Chemists Association VCM Epidemiology Study Parent Corporation Plant Designation Address Telephone _J_______)zext. TABERSHAW-COOPER ASSOCIATES ' CONTACT FOR SUBJECT STUDY: Name t___________________ Title ______________________________________________________________ Mailing Address Street Address (please identify with sufficient precision to serve as a taxi-driver's instruction) Telephone (_______) Signed _ Name _ Title _ Company ^ Address Telephone __(_______)______________________________ext. *088 I Tabershaw-Cocper Associates, Inc. 2180 Hilvlo St., Suite 104 Berkeley, California 94704 Manufacturing Chemises Association VCM Epidemiological Study Plant No. 1. When did this plant begin work involving vinyl chloride? 2. What Is the approximate size of the current work force, exclusive of secretarial and office personnel? 3. Approximately how many of these are employed in jobs in volving some exposure to vinyl chloride* . 4. Please answer the appropriate one of Che following questions about your retirement plan. a. No retirement plan Voluntary plan, begun in c. Required of all employees, begun In d. Now required, formerly voluntary. Voluntary plan begun in Required plan begun In Remarks: 5. Please answer the applicable questions below about retention cf records. How long are personnel records kept . a. for those who retired but were not covered by a retirement plan? b. for these who retired under a retirement plan and * have dl.'d? e. for those who quit or were discharged? d. for Chose who died while employed? 'CsW' 1090 - ~ ~ - -1- ^ .^a=fj.- :.-&sr^.-.".~ Taberahaw-Cooper Associates, Inc. pag 2 6. Do the personnel records which ere retained contain a record of job titles and dates uf job title changes for the Individual concerned? 7. Please list the job cities in the current work force which involve some exposure to vinyl chloride. ATTACHMENT B (coot.) VCK p idem to Logical Study - Individual Work History torm S - Workers known ta have died (please attach copy of death certificate) 1. Date of birth 2. Date hired 3. Date of death 4. Place of death Status at time of death: 5. Employed ______ ' 6. Retired (give date) 7. Terminated (give dute) . 8. If death certificate is not available, please give oae of worker so that death certificate can be obtained, Ko contact will be made with relatives or attending physician. Job no 1 2 3` 4 5 6 7 Job history with estimated exposure Title Check estimated exposure In ppm <50 50-199 200-500 ?50Q _ from ' to _______ from ____________________________ to ________ ' _ from _____ to '______ -- ____from to ______ _from _______________________________ to - _____ from , to _____ ;______________________ from to______ __ CyW 3 092-