Document YrQYNJ23G91Gp38kwqeMmmJ3k

DEPARTMENT OF HEALTH ____________________________________________________________________________ Pathology Division Report: Demographic Data and Disease Rates for January - December 1999 Dr Jill Murray Lizet Coetzee NATIONAL CENTRE FOR OCCUPATIONAL HEALTH NCOH Report P O Box 4788 JOHANNESBURG 2000 TABLE OF CONTENTS Executive Summary Section 1: Introduction Section 2: Data Description Distribution of autopsies by year & ethnic group (1975-1999) Number of autopsies by age & ethnic group (1999) Number of autopsies by type & ethnic group (1999) Number of autopsies by industry & ethnic group (1999) Number of autopsies by years of service & ethnic group (1999) Mean duration of service and mean age by type of mine & ethnic group (1999) Section 3: Active Tuberculosis Distribution of active tuberculosis by anatomical site (1999) Number and prevalence of pulmonary tuberculosis by age& ethnic group (1999) Number and prevalence of pulmonary tuberculosis by industry& ethnicgroup (1999) Section 4: Silicosis Number and prevalence of silicosis by industry & ethnic group (1999) Number and prevalence of silicosis in gold miners by age & ethnic group (1999) Section 5: Massive Fibrosis, Coal Workers' Pneumoconiosis, Mixed dust Fibrosis & Asbestosis Number and prevalence of asbestosis by age & ethnic group (1999) Section 6: Emphysema Number and prevalence of emphysema by age & ethnic group (1999) Number and prevalence of emphysema by industry & ethnic group (1999) Number and prevalence of emphysema by years of service & ethnic group (1999) Section 7: Mesothelioma Number of mesothelioma cases by age & ethnic group (1999) Number of mesothelioma cases by industry & ethnic group (1999) Section 8: Primary Lung Cancer Number and prevalence of primary lung cancer by age & ethnic group (1999) Number and prevalence of primary lung cancer by industry & ethnic group (1999) Section 9: Causes of death Causes of death by ethnic group (1999) Appendix: Distribution of autopsies according to the last mine the deceased worked at 3 4 5 6 7 7 8 9 10 11 11 12 13 14 15 16 17 17 18 18 19 20 21 22 2 EXECUTIVE SUMMARY South African law requires the examination of the cardiorespiratory organs of deceased miners and ex-miners for compensation purposes, provided the next of kin agrees. These examinations are performed at the National Centre for Occupational Health (NCOH) and the findings are recorded on a computerized database (PATHAUT). This database provides an important resource for surveillance and research. During 1999, 2529 cases came to autopsy at the NCOH. Of these, 65.5% were black men, 32.9% whites, 1.1% coloureds and 0.5% were submitted without information on the ethnic group. Overall disease rates (per 1000 cases) for 1999 are as follows: Emphysema (201/1000) n Silicosis (133/1000) Tuberculosis (123/1000) Primary lung cancer (25/1000) Asbestosis (13/1000) Mesothelioma (9/1000) B Massive fibrosis (8/1000) Coal Workers' pneumoconiosis (4/1000) Mixed dust pneumoconiosis (2/1000) 3 SECTION 1 - INTRODUCTION The Pathology Department of the National Centre for Occupational Health (NCOH) provides an autopsy service for miners and ex-miners to determine the presence of occupational lung disease. Under the Occupational Diseases in Mines and Works Act (ODMWA, 1973) it is obligatory for the last attending doctor to remove the cardiorespiratory organs and send them for examination provided the next of kin agrees. A detailed report of each case is sent to the Medical Bureau for Occupational Diseases (MBOD). Cases certified as having a compensatable disease are then referred to the Compensation Commissioner's office, where payment of compensation is managed. Since 1975 the pathological findings have been recorded on the PATHAUT database which is a unique computerized source of information for research. PATHAUT combines data from autopsy summary sheets and clinical files (including occupational histories) onto a single database. The structure of this database was changed in 1995/1996 and new programs were written, upgrading and enhancing the existing database by improving the quality of the system and making better use of existing data (SIMRAC Project GEN509). This is the third of the new format reports and describes autopsy cases examined during 1999. Data from PATHAUT are exported into the Statistical Analysis System (SAS System) where programs have been written using the Structured Query Language (SQL) permitting the user to analyze data on the SAS System related to any aspect of the PATHAUT database. During 1998 this was done for the 1975-1995 database, converting these data to a similar format as the current PATHAUT database. 4 SECTION 2 - DATA DESCRIPTION The number of autopsies performed since 1975 is presented in Table 2-1. TABLE 2-1 DISTRIBUTION OF AUTOPSIES BY YEAR & ETHNIC GROUP (1975-1999) Year of Black White Coloured Indian autopsy N % N %N %N % 1975 2190 71 854 28 32 1 1976 2335 68 1072 31 27 1 1977 2351 69 1039 30 33 1 1978 2245 67 1090 32 32 1 1979 2118 66 1026 33 45 1 1980 2338 64 1274 35 46 1 1981 2209 66 1117 33 33 1 1982 2312 63 1302 36 44 1 1983 2096 65 1109 34 41 1 1984 1966 64 1098 35 28 1 1985 2275 64 1200 34 66 2 1986 2456 68 1125 31 45 1 1987 2594 68 1168 30 78 2 1988 2518 67 1165 31 77 2 1989 2138 65 1090 33 60 2 1990 2172 64 1155 34 51 2 1991 2143 65 1080 33 66 2 1992 2144 66 1049 32 70 2 1993 1863 65 956 33 65 2 1994 1737 61 1021 36 94 3 1995 2830 71 1059 27 99 2 1996* 766 68 329 29 19 2 1997 2223 69 897 28 70 2 1998 1977 68 836 29 49 2 1 0.03 1999 1656 65 832 32 29 2 TOTAL 53652 66 25 943 32 1 299 2 1 0.001 * Computerized data for only 6 months are available for this year Unknown N% 14 1 18 1 17 1 12 1 61 0.1 Total N 3076 3434 3423 3367 3189 3658 3359 3658 3246 3092 3541 3626 3840 3760 3288 3378 3289 3263 2884 2852 3988 1128 3208 2880 2529 80 956 5 It is important to note that there is a referral bias in that black men are infrequently autopsied after leaving employment in the mines, whereas the majority of whites come to autopsy after retirement. The age distribution of autopsies for 1999 is shown in Table 2-2 and Fig 2-1. In 1999 the mean age for black miners was 40.1 years (37.9 in 1998) and for white miners 61.8 years (61.3 in 1998) TABLE 2-2 NUMBERS OF AUTOPSIES BY AGE & ETHNIC GROUP (1999) Age group Black White Coloured Unknown All races N %N %N %N % N % 0-19 1 0.1 0 0.0 0 0.0 0 0.0 1 0.04 20-29 98 5.9 17 2.0 0 0.0 1 8.3 116 4.6 30-39 553 33.4 53 6.4 0 0.0 0 0.0 606 24.0 40-49 647 39.1 78 9.4 4 13.8 0 0.0 729 28.8 50-59 250 15.1 158 19.0 9 31.0 0 0.0 417 16.5 60-69 23 1.4 247 29.7 8 27.6 0 0.0 278 11.0 70-79 7 0.4 191 23.0 5 17.3 0 0.0 203 8.0 80-89 0 0.0 78 9.4 3 10.3 0 0.0 81 3.2 90+ 1 0.1 4 0.4 0 0.0 0 0.0 5 0.2 Unknown 76 4.5 6 0.7 0 0.0 11 91.7 93 3.7 Total 1656 100 832 100 29 100 12 100 2529 100 FIG 2-1 DISTRIBUTION OF AUTOPSIES BY AGE & ETHNIC GROUP(1999) 700 600 It) Q) 500 It) m u 400 CL> _Q 300 E 200 100 0 0-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Agegroup Black IHWhite Coloured 6 The pathologists at the NCOH perform 2 types of examinations. For men dying distant from Johannesburg, the cardiorespiratory organs are removed locally, preserved in formalin and sent to the NCOH. Full autopsies are undertaken on men who die close to Johannesburg. Table 2-3 presents the distribution of autopsies by ethnic group for 1999. Autopsies of cardiorespiratory organs only comprised 92.9% of examinations. TABLE 2-3 NUMBER OF AUTOPSIES BY TYPE & ETHNIC GROUP (1999) Cardiorespiratory organs only Full autopsy TOTAL Black N% 1653 99.8 3 0.2 1656 100 White N% 655 78.7 177 21.3 832 100 Coloured N% 29 100 00 29 100 Unknown N% 12 100 00 12 100 TOTAL N% 2349 92.9 180 7.1 2529 100 Table 2-4 and Figure 2-4 show the distribution of autopsies by industry and ethnic group for 1999. The majority of miners were from the gold mining industry (75.8%). 86.2% of coloured miners came from asbestos mines. TABLE 2-4 NUMBER OF AUTOPSIES BY INDUSTRY & ETHNIC GROUP (1999) Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown Total Black N% 1312 79.2 83 5.0 173 10.4 23 1.4 11 0.7 1 0.06 1 0.06 34 2.1 18 1.1 1656 100 White N% 603 72.5 58 6.9 38 4.6 29 3.5 6 0.7 10 1.2 18 2.2 46 5.5 24 2.9 832 100 Coloured N% 0 0.0 0 0.0 0 0.0 25 86.2 0 0.0 4 13.8 0 0.0 0 0.0 0 0.0 29 100 Unknown N% 2 16.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 10 83.3 12 100 TOTAL N% 1917 75.8 141 5.5 211 8.3 77 3.0 17 0.7 15 0.6 19 0.8 80 3.2 52 2.1 2529 100 7 FIG 2-4 DISTRIBUTION OF AUTOPSIES BY INDUSTRY & ETHNIC GROUP (1999) Black White Coloured m Gold Coal Platinum Asbestos Other* * Includes copper, diamond, quarry, silica (silicon smelters), manganese, tin, zinc, minerals, chrome and iron as well as cases where information about type of mining is missing Detailed information about the years in mining service by ethnic group is given in Table 2-5. This is also presented in Fig 2-5. Cases are categorized according to the industry in which most years of service occurred. The percentage of cases with missing information on the duration of service is 22.7%, down from 43% in 1998. TABLE 2-5 NUMBER OF AUTOPSIES BY YEARS OF SERVICE & ETHNIC <1 1-5 6-10 11-15 16-20 21-25 26-30 31 + Missing Total GROUP( 999) Black White N% N% 10 0.6 7 0.8 219 13.2 64 7.7 236 14.3 67 8.0 349 21.1 69 8.3 263 15.9 86 10.3 126 7.6 86 10.3 38 2.3 100 12.0 19 1.1 192 23.2 396 23.9 161 19.4 1656 100 832 100 Coloured N% 0 0.0 6 20.8 5 17.2 2 6.9 6 20.7 3 10.3 0 0.0 3 10.3 4 13.8 29 100 Unknown N% 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 12 100 12 100 TOTAL N% 17 0.7 289 11.4 308 12.2 420 16.5 355 14.0 215 8.5 138 5.5 214 8.5 573 22.7 2529 100 8 FIG 2-5 DISTRIBUTION OF AUTOPSIES BY YEARS OF SERVICE & ETHNIC GROUP (1999) Black White <1 m-5 D6-10 D11-15 16-20 D21-25 D26-30 D31 + The mean duration of service & age by mining type and ethnic group is shown in Table 2-6. TABLE 2-6: MEAN DURATION OF SERVICE AND MEAN AGE BY MINE TYPE & ETHNIC GROUP (1999) Minetype N Black Age Service Mean SD Mean SD Gold 1312 39 11.7 Coal 83 45 35.6 Platinum 173 43 8.1 Asbestos 23 51 13.4 Diamond 11 44 9.5 Copper 1 28 - Iscor 1 53 - Other 34 46 14.5 Unknown 18 29 25.5 Total 1656 *Duration of service not known 10.6 5.2 11 7.9 9.2 0 14 5.5 0 8.3 7.8 8.4 10.6 12.1 - 7.1 0.0 N 603 58 38 29 6 10 18 46 24 832 White Age Service Mean SD Mean SD 63 15.2 20.2 14.0 60 16.2 17.0 12.7 58 11.7 14.1 11.3 63 10.7 14.2 14.3 67 17.2 24.3 18.0 65 10.5 13.5 11.7 69 8.7 19.5 12.7 56 14 11.4 11.1 55 21.5 0 - 9 SECTION 3 - ACTIVE TUBERCULOSIS Active tuberculosis was diagnosed in 15% (387) of all the cases autopsied in 1999 (Fig 3-1), in comparison with the 510 (18%) cases of the previous year. The distribution of tuberculosis (TB) by anatomical site is presented in Fig 3-1. 80% of TB cases had active pulmonary tuberculosis (PTB). Of the PTB cases, 88% involved the lungs extensively. 92.9% (288 cases) of PTB cases were black, 5% (16 cases) white, 2% (5 cases) coloured miners and in 0.3% (1 case) the ethnic group was unknown. 75% of all PTB cases came from the gold mines and most of the PTB cases were in the age group 40-49. Fig 3-1 Distribution of active TB by site (1999) Glands & lungs (43%) Glands, pericardium & lungs (2%) Lungs only (34%) Pericardium & lungs (1%) ^ Glands only (19%) Pericardium only (1%) In 65% of cases of pulmonary tuberculosis found at autopsy, the disease was not mentioned in the clinical notes which were submitted with the organs. 10 The age distribution of cases with active pulmonary TB is shown in Table 3-1. The difference in age distribution between ethnic groups might be explained by different referral patterns (page 3). The rate of PTB in 1999 (122.6/1000) is lower than in 1998 (149.0/1000). TABLE 3-1 NUMBER & PREVALENCE OF ACTIVE PTB BY AGE & ETHNIC GROUP (1999) Age group Black White Coloured Unknown Total N Rate N N Rate N Rate N Rate Rate 20-29 30-39 40-49 50-59 60-69 70-79 16 163.3 0 92 166.4 1 124 191.7 3 38 152.0 3 1 43.5 4 2 285.7* 4 -0 18.9 0 38.5 1 19.0 2 16.2 0 20.9 1 250.0* 222.2* - 200.0* 0 0 0 0 0 0 - 16 137.9 - 93 153.5 - 128 175.6 - 43 103.1 - 5 18.0 - 7 34.5 80-89 Missing 015 197.4 1 0 12.8 1 -0 333.3* 0 -1 90.9 2 24.7 16 172.0 TOTAL 288 173.9 16 19.2 5 172.4 1 83.3 310 122.6 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific age group for specific ethnic group The distribution of active PTB cases by industry is shown in Table 3-2. 75.2% of active PTB cases came from the gold mining industry (75.8% of all autopsy cases came from that industry). The rate of PTB in the gold mining industry of 121.5/1000 is lower than in 1998 (172.0/1000), whereas the rates in all other commodities have increased. TABLE 3-2 NUMBER & PREVALENCE OF ACTIVE PTB BY INDUSTRY & ETHNIC GROUP (1999) Industry Black White Coloured Unknown Total N Rate N Rate N Rate N Rate N Rate Gold Coal 225 171.5 21 253.0 8 2 13.3 0 34.5 0 -0 -0 - 233 121.5 - 23 163.1 Platinum Asbestos Diamond Other Unknown 31 179.2 2 87.0 3 272.7* 5 147.1 1 55.6 0 2 1 1 2 69.0 166.7* 21.7 83.3 0 5 0 0 0 - 200.0 - 0 0 0 0 1 - 31 146.9 - 9 116.9 - 4 235.3 - 6 75.0 100 4 76.9 TOTAL 288 173.9 16 19.2 5 172.4 1 83.3 310 122.6 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in a specific industry for specific ethnic group 11 SECTION 4 - SILICOSIS Silicotic nodules were found in the lungs in 336 cases, 13.3% of all autopsies, compared with 16.0% in 1998. 93.6% of these cases came from the gold mining industry. Of all cases of silicosis, occasional silicotic nodules were found in 39.8%, a few in 17.6%, a moderate number in 26.2% and a large number in 16.4%. The distribution of cases with silicosis by industry and ethnic group is presented in Table 4-1. As indicated previously, cases are categorized according to the industry in which the most years of service occurred. Cases from the platinum mining industry with silicosis might be explained by unstated previous service in gold mines. TABLE 4-1 NUMBER & PREVALENCE OF SILICOSIS BY INDUSTRY & ETHNIC GROUP (1999) Industry Black White Coloured Unknown Total N Rate N Rate N Rate N Rate N Rate Gold 199 151.7 116 192.4 0 - 0 - 315 164.3 Platinum 3 17.3 3 78.9 0 -0 - 6 28.4 Coal Asbestos 2 24.1 0 2 87.0 0 - 0 1 -0 40.0 0 - 2 14.2 3 39.0 Diamond 0- 1 166.7* 0 -0 - 1 58.8 Iscor 0- 1 55.6 0 -0 - 1 52.6 Other 3 88.2 0 - 0 -0 - 6 75.0 Unknown 2 111.1 2 83.3 0 - 1 100.0* 5 96.2 TOTAL 211 127.4 123 147.8 1 34.5 1 83.3 336 132.9 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in a specific industry and ethnic group 12 The age distribution of cases from the gold mining industry with silicosis (Table 4-2) differed between ethnic groups. TABLE 4-2 NUMBER & PREVALENCE OF SILICOSIS IN GOLD MINERS BY AGE & ETHNIC GROUP (1999) Age group Black White Total N Rate N Rate N Rate 0-19 1 1000* 0 - 1 1000* 20-29 1 12.8 0 - 1 11.4 30-39 27 57.1 2 57.1 29 57.1 40-49 105 202.7 3 49.2 108 186.5 50-59 54 323.4 17 149.1 71 252.7 60-69 2 200 32 197.5 34 197.7 70-79 1 500* 30 205.5 31 209.5 80-89 0 - 29 432.8 29 432.8 90+ 0 -1 250* 1 250* Missing 8 127.0 2 500* 10 144.9 TOTAL 199 151.7 116 192.4 315 164.3 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific age group for specific ethnic group 13 SECTION 5 - MASSIVE FIBROSIS, COALWORKER'S PNEUMOCONIOSIS, MIXED DUST FIBROSIS & ASBESTOSIS MASSIVE FIBROSIS There were 20 (0.8%) cases of massive fibrosis (12 black, 8 white) and the majority of them (80%) came from the gold mining industry. COAL WORKERS' PNEUMOCONIOSIS There were 11 cases of coal workers' pneumoconiosis most in the age group 60-69 (36%). MIXED DUST FIBROSIS There were 5 (0.2%) cases of mixed dust fibrosis of whom 60% came from the gold mining industry. ASBESTOSIS There were 34 (1.3%) cases of asbestosis of which 35% had slight interstitial fibrosis, 53% moderate and 12% marked. Amongst all cases with a history of asbestos exposure, there were only 8 in whom asbestos plaques were found. However, the parietal pleura which is usually the site affected by plaque formation is hardly ever submitted with the lungs. All of the coloured miners with asbestosis came from asbestos mines as did the majority of blacks and whites with this disease. 14 The distribution of asbestosis by age and ethnic group is shown in Table 5-1. TABLE 5-1 NUMBER & PREVALENCE OF ASBESTOSIS BY AGE AND ETHNIC GROUP (1999) Age group Black White Coloured Total N Rate N Rate N Rate N Rate 30-39 1 1.8 0 - 0 - 1 1.7 40-49 3 4.6 0 - 0 - 3 4.1 50-59 7 28.0 1 6.3 2 222.2* 10 24.0 60-69 3 130.4 4 16.2 3 375.0 10 36.0 70-79 0 - 3 15.7 5 1000* 8 39.4 80-89 0 -1 12.8 1 333.3* 2 24.7 TOTAL 14 8.5 9 10.8 11 379.3 34 13.4 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific age group for specific ethnic group 15 SECTION 6 - EMPHYSEMA There were 508 cases of emphysema, the extent of which was mild in 63.4%, moderate in 30.9% and marked in 5.7%. The distribution of emphysema by age and ethnic group is presented in Table 6-1 and Fig 6-1. TABLE 6-1 NUMBER & PREVALENCE OF EMPHYSEMA BY AGE & ETHNIC GROUP (1999) Age group Black White Coloured Unknown TOTAL N Rate N Rate N Rate N Rate N Rate 0-19 20-29 1 1000 1 10.2 00- 0 0 -0 -0 - 1 1000 - 1 8.6 30-39 40-49 50-59 60-69 70-79 80-89 26 47.0 2 88 136.0 11 46 184.0 41 8 347.8 123 3 428.6* 90 0- 47 37.7 141.0 259.5 498.0 471.2 602.6 0 2 2 2 2 1 500.0* 222.2* 250.0* 400.0* 333.3* 0 0 0 0 0 0 - 28 46.2 - 101 138.5 - 89 213.4 - 133 478.4 - 95 468.0 - 48 592.6 Missing 10 131.6 1 166.7 0 -1 90.9 12 129.0 TOTAL 183 110.5 315 378.6 9 310.3 1 83.3 508 200.9 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific age group for specific ethnic group FIG 6-1 DISTRIBUTION OF EMPHYSEMA BY AGE & ETHNIC GROUP (1999) 140 120 100 80 60 40 20 0 0-19 20-29 30-39 40-49 50-59 ---- 60-69 Black White 70-79 Ethnic group 80-89 16 For black and white miners with emphysema, the majority were from the gold mining industry (68%) (Table 6-2), whereas most coloureds came from asbestos mines (most autopsies on coloureds were referred from these mines) TABLE 6-2 NUMBER & PREVALENCE OF EMPHYSEMA BY INDUSTRY & ETHNIC GROUP (1999) Industry Black White Coloured Unknown TOTAL N Rate N Rate N Rate N Rate N Rate Gold Platinum Coal 125 95.3 222 368.2 0 22 127.2 15 394.7 0 21 253.0 23 396.6 0 - 0 0 0 - 347 181.0 - 37 175.4 - 44 312.1 Asbestos Iscor Copper Diamond Other Unknown 4 173.9 9 310.3 8 320.0 0 0- 14 777.8 0 - 0 0- 5 500.0 1 250.0* 0 2 181.8 2 333.3* 0 - 0 3 88.2 18 391.3 0 - 0 6 333.3 7 291.7 0 - 1 - 100.0 21 14 6 4 21 14 272.7 736.8 400.0 235.3 262.5 269.2 TOTAL 183 110.5 315 378.6 9 310.3 1 83.3 508 200.9 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in a specific industry and ethnic group TABLE 6-3 NUMBER OF EMPHYSEMA BY YEARS OF SERVICE & ETHNIC GROUP (1999) Years of Black White Coloured Unknown Total service N Rate N Rate N Rate N Rate N Rate <1 1 100.0 1 142.9 0 - 0 - 2 117.6 1-5 12 54.8 15 234.4 0 - 0 - 27 93.4 6-10 18 76.3 14 209.0 1 200.0* 0 - 33 107.1 11-15 32 91.7 28 405.8 1 500.0* 0 - 61 145.2 16-20 31 117.9 34 395.3 2 333.3* 0 - 67 188.7 21-25 21 166.7 41 476.7 1 333.3* 0 - 63 293.0 26-30 5 131.6 45 450.0 0 - 0 - 50 362.3 31 + 5 263.2 79 411.5 2 666.7* 0 - 86 401.9 Missing 58 146.5 58 360.2 2 500.0* 1 83.3 119 207.7 Total 183 110.5 315 378.6 9 310.3 1 83.3 508 200.9 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in a specific industry for specific ethnic group 17 SECTION 7 - MESOTHELIOMA In comparison with the 19 cases of 1998, there were 24 cases of mesothelioma in 1999. The distribution of mesothelioma by age and ethnic group is presented in Table 7-1. TABLE 7-1 NUMBER OF MESOTHELIOMA CASES BY AGE & ETHNIC GROUP (1999) Age Group 30-39 50-59 60-69 70-79 80-89 TOTAL Black N% 2 25.0 5 62.5 1 12.5 00- 8 White N% 04 26.7 7 46.7 3 20.0 1 6.7 15 Coloured N% 001 100 00- 1 TOTAL N% 2 8.3 9 37.5 9 37.5 3 12.5 1 4.2 24 The distribution of mesothelioma by industry and ethnic group is presented in Table 7-2. Cases are categorized according to the industry in which the most years of service occurred. The highest proportion of mesothelioma cases was found in white miners. TABLE 7-2 NUMBER OF MESOTHELIOMA CASES BY INDUSTRY & ETHNIC GROUP (1999) Industry Asbestos Coal Copper Gold Iscor Platinum Other Unknown TOTAL Black N% 5 62.5 1 12.5 00002 25.0 0- 8 White N% 2 13.3 01 6.7 3 20.0 2 13.3 1 6.7 3 20.0 3 20.0 15 Coloured N% 1 100 0000000- 1 TOTAL N% 8 33.3 1 4.2 1 4.2 3 12.5 2 8.3 1 4.2 5 20.8 3 12.5 24 *2 February 2006. In an earlier print run of this report, the total number of mesothelioma cases was given as 22. Changes have been made to the text and tables. 18 SECTION 8 - PRIMARY LUNG CANCER 63 cases of primary lung cancer were found at autopsy (84 in 1998) of which 17.5% were in black miners, 76.2% in whites and 6.3% in coloured miners. Most of the cases were of the squamous cell type (27%), followed by lung adenocarcinoma (24%), large cell type (22%), small cell type (21%) and bronchoalveolar carcinoma (6%). The distribution of primary lung cancer by age and ethnic group is presented in Table 8-1 and Fig 8-1. Black miners were in the age group 40-59 whereas the highest proportion of whites and coloureds were 60-79 years old. TABLE 8-1 NUMBER AND PREVALENCE OF PRIMARY LUNG CANCER BY AGE & ETHNIC GROUP (1999) Age group Black White Coloured TOTAL N Rate N Rate N Rate N Rate 40-49 50-59 60-69 70-79 5 7.7 1 5 20.0 3 0 - 23 0 - 15 12.8 19.0 93.1 78.5 0 0 3 1 375.0* 200.0* 6 8 26 16 8.2 19.2 93.5 78.8 80-89 Missing 0 - 5 64.1 0 1 13.2 1 166.7 0 - 5 61.7 2 21.5 TOTAL 11 6.6 48 57.7 4 137.9 63 24.9 Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific age group for specific ethnic group The distribution of primary lung cancer by industry and ethnic group is presented in Table 8-2. For black and white miners, the majority of cases came from the gold mining. For coloured miners, most cases were from the asbestos industry where most of the coloured miners were referred from. 19 TABLE 8-2 NUMBER AND PREVALENCE PRIMARY LUNG CANCER BY INDUSTRY & ETHNIC GROUP (1999) Industry Black White Coloured TOTAL N Rate N Rate N Rate N Rate Asbestos Coal 1 43.5 2 69.0 4 2 24.1 1 17.2 0 160.0 7 -3 90.9 21.3 Copper 0 - 2 200.0* 0 - 2 133.3 Gold Iscor Other Platinum Unknown 6 4.6 33 54.7 0 0 - 5 8.3 0 1 29.4 2 43.5 0 1 5.8 1 26.3 0 0 - 2 83.3 0 - 39 20.3 - 5 263.2 - 3 37.5 -2 9.5 - 2 38.5 TOTAL 11 6.6 48 57.7 4 137.9 63 24.9 Rate per 1000; `because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific industry and ethnic group The prevalence of lung cancer by age (a) and industry (b) is shown in Figure 8-2. FIG 8-2 PREVALENCE (PER 1000) OF LUNG CANCER BY AGE (a) & INDUSTRY (b) FOR BLACK AND WHITE MINERS (1999) (a) QCD. <1> "So O CO > CD 40-49 50-59 60-69 Age category 70-79 80-89 (b) 300 250 200 150 100 50 0 Gold Plat Coal Asbestos Iscor Copper Industry Black White 20 SECTION 9 - CLINICAL CAUSES OF DEATH Table 9-1 & Figure 9-1 shows the clinical cause of death which accompanied the cardiorespiratory organs by ethnic group. Diseases of the respiratory system were the most frequent (48.4%). Black miners had the highest proportion of unnatural causes of death (20.2%). In 17.4% the cause of death was not stated. TABLE 9-1 CAUSES OF DEATH BY ETHNIC GROUP (1999) Respiratory Unnatural Not stated Cardiovascular Miscellaneous Nervous system GI tract Genito urinary Haematological Metabolic Endocrine system TOTAL Black N% 954 57.6 335 20.2 157 9.5 37 2.2 68 4.1 50 3.0 31 1.9 19 1.2 4 0.2 01 0.06 1656 White N% 249 29.9 87 10.5 268 32.2 132 15.8 56 6.7 9 1.1 18 2.2 9 1.1 3 0.4 1 0.1 0- 832 Coloured N% 22 75.9 2 6.9 3 10.3 02 6.9 000000- 29 Unknown N% 01 8.3 11 91.7 0000000-- 12 TOTAL N% 1225 48.4 425 16.8 439 17.4 169 6.7 126 5.0 59 2.3 49 1.9 28 1.1 7 0.3 1 0.05 1 0.05 2529 FIG 9-1 CAUSE OF DEATH AS GIVEN BY THE CLINICIANS WHO SUBMIT THE ORGANS TO THE NCOH AS SHOWN IN TABLE 9-1 Black White Respiratory Not stated Cardio vascular Unnatural Nervous system Gastro intestinal Genito urinary Haematological Miscellaneous 21 DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE THE DECEASED WORKED AT MINETYPE LAST MINE WORKED AT Asbestos African Chrysotile Asb Asbestos Mine Cape Blue Danielskuil Asb Mine Everite Gef co Kliphuis Koegas Penge Asbestos Pomfret Asb Mine Shabanie Asb Mine Stofbakkies Wandrag Asbestos Mine Total from asbestos mines Cementation Cementation Total from cementation Chrome Chrome Mine Dilokong chrome Mine Marico Chrome Mine Tweefontein Waterkloof Chrome Mine Winterveld Chrome Total from chrome mines Coal Amcoal Colliery Arnot Colliery Bank Colliery Bleskop Colliery Blinkpan Colliery Bosjesspruit Colliery Brandspruit Colliery Delmas Colliery Dorsfontein Colliery Douglas Colliery Duiker Colliery Durban Navigation Coal Durnacol Mine Ermelo Coal Forzando Colliery Goedehoop Colliery Greenside Colliery Grootgeluk Hlobane Colliery Kilbarahan Coal Koornfontein Coal Landau Colliery Longridge Collieries Matla Coal Middelbult Coal Mine Natal Anthracite Coll BLACK 4 1 3 0 1 3 0 2 2 0 0 0 0 1 6 3 0 4 0 0 2 3 5 0 1 2 8 1 0 1 1 0 0 0 1 5 0 1 0 0 2 2 0 2 3 0 WHITE 5 5 3 1 2 4 0 1 5 2 1 0 1 1 1 0 1 2 1 1 2 0 2 1 1 0 1 3 1 4 0 1 1 1 0 0 1 0 5 1 0 0 1 5 1 3 COLOURED 0 0 5 3 0 2 2 8 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 UNKNOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 9 6 11 4 3 9 2 11 7 2 1 1 1 66 2 3 7 3 1 6 1 1 19 4 3 7 1 2 2 9 4 1 5 1 1 1 1 1 5 1 1 5 1 2 2 1 7 4 3 22 New Denmark New Largo Colliery Rietspruit Colliery S A Coal Estates Sasol Coal Mine Savemore Colliery Secunda Colliery Shaft sinkers Spingfield Colliery Spitzkop Springbok Colliery Tavistok Colliery Twistdraai Union Coal Mine Van Dyk's Drift Welgedacht Witbank Collieries Total from coal mines Copper Messina Copper Mine O'Kiep Copper Phalaborwa Prieska Shabani Copper Mine Tsumeb Copper Mine Total from copper mines Diamond Bellsbank Diamond Mine Cullinan Diamond Mine De Beers Consolidated Diamond Mine Du Plessis Diamond Mine Good Hope Diamond Mine Premier Diamond Sonneberg Diamond Mine Total from diamond mines Emeralds Gravelotte 8 0 0 0 19 1 7 0 0 2 0 0 4 0 0 0 2 0 1 0 0 0 0 4 3 3 0 0 0 3 0 0 0 3 1 1 0 0 2 1 2 2 1 1 1 1 2 1 6 2 3 1 1 1 1 0 1 2 1 0 1 3 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 2 0 0 0 0 0 0 1 0 0 0 0 Gold Barberton GM 010 Beatrix Gold 27 3 0 Blyvoorquizicht 1 18 0 Bradlock Gold Mine 1 0 0 Brakpan Gold Mine 110 Buffelsfontein Gold 13 19 0 City Deep 02 0 Consolidated Main Reef 0 3 0 Consolidated 110 Modderfontein Consolidated Murchison 0 1 0 Consort GM 210 Crown Mines 06 0 Daggasfontein 150 Deelkraal 13 2 0 Doornfontein 090 Durban Roodepoort Deep 12 17 0 08 03 01 01 0 19 01 09 01 02 04 01 01 05 01 02 01 08 143 02 07 01 03 01 01 15 04 04 05 01 01 01 06 01 23 01 01 0 30 0 19 01 02 0 32 02 03 02 01 03 06 06 0 15 09 0 29 23 East Driefontein East Geduld East Rand Prop Elandsrand Elsburg GM Evander GM Freddies Gold Free State Geduld Free State Saaiplaas Future Gold mining Geldenhuys Gold Mine Grootvlei Prop Harmony Hartebeesfontein J.I.C. Gold Mine Joel Kinross Klipval GM Kloof Leeudoorn Leslie Libanon Loraine Luipaardsvlei Estate Marievale Masimong Gold Mine Modderfontein Murfun Gold Mine Naledi GM New Consort Nigel GM Oryx President Brand President Steyn Primrose GM Rand Leases Randfontein S A Land Saaiplaas GM Sallies Sheba South Roodepoort Springs GM St Helena State GM Stilfontein Sub Nigel Target Gold Mine Unisel GM Vaal Reefs Ventersport Village Main Reef Virginia GM Vlakfontein 74 1 35 30 0 29 104 4 1 1 0 2 123 78 2 17 22 0 57 21 2 39 7 0 0 10 0 0 6 3 0 18 7 72 0 0 29 0 0 0 2 0 0 34 0 3 0 1 0 125 0 0 0 0 15 1 15 8 2 2 6 15 5 0 1 10 21 22 0 2 10 1 22 5 0 17 6 1 5 1 1 1 0 3 1 2 16 8 2 5 19 1 6 2 0 5 2 3 1 14 1 0 1 49 5 1 4 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 89 02 0 50 0 38 02 0 31 0 110 0 19 06 01 01 0 12 0 144 0 100 02 2 21 0 32 01 0 79 0 26 02 0 56 0 13 01 05 0 11 01 01 06 06 01 0 20 0 23 0 80 02 05 0 48 01 06 02 02 05 02 0 37 01 0 17 01 01 01 0 174 05 01 04 05 24 Vogelstruisbult Welkom GM West Driefontein West Rand Cons West Witwatersrand Western Areas Western Deep Levels Western Holdings Western Reef GM Winkelhaak Wit Nigel GM Total from gold mines Platinum Amadelbult Platinum (Rustenburg) Atok Platinum Bafokeng Eastern Platinum Mine Impala Platinum Karee Platinum Northam Platinum Rustenburg Platinum Swartklip Platinum Western Platinum Wildebeestfontein Zondereinde Plat Mine Total from platinum mines Iron Sishen Iron Mine Iron & Associated Manganese Mangenese Lead & Minerals Blackmountain Lime Union Lime Manganese S A Manganese Minerals African Rainbow Minerals & Expl Non Miner Industry Non Miner Phosphate Foskor Beperk Quarry Quarry Silica Silicon Smelters Steel Highveld Steel and Vanadium Steel & Iron Iscor Tin Rooiberg Mineral Division Transvaal Tin Tin mine Union Tin Unknown Unknown Zinc Maranda Mine TOTAL 0 2 54 0 4 18 110 48 0 3 0 10 5 1 4 4 1 5 158 3 2 1 2 1 4 0 1 2 22 1 2 1 1 4 1 1 0 0 0 0 21 0 1656 1 11 28 6 1 14 37 13 3 8 7 0 0 0 0 23 1 2 25 0 3 0 1 1 2 1 0 1 0 1 9 1 0 0 4 40 2 1 1 1 26 1 832 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 29 01 0 13 0 82 06 05 0 32 0 147 0 61 03 0 11 07 1841 0 10 05 01 04 0 27 02 07 0 183 03 05 01 03 251 02 07 01 01 03 0 22 02 0 11 02 01 04 05 0 42 02 01 01 01 10 57 01 12 2529 25 26