Document e7OXyD8RqnQmbELxe1a4967EG

CATE OF REQUEST: 4/3/87' NOT NEEDED AFTER: INTERLIBRARY LOAN SCHOOL OF VETERINARY MEDICINE LIBRARY LOUISIANA STATE UNIVERSITY BATON ROUCE, LOUISIANA 70803-8414 ~/i/o i/3 XX3QPOC Mail request Fax request DATE SENT DATE DUE PANAFAX NO. (504) 346-3295 FOR USE OF: Leila Hopewell STATUS: DEPT: PERIODICAL TITLE, VOL. AND DATE OR (BOOK AUTHOR) JOURNAL OF OCCUPATIONAL MEDICINE. Vol. 16, 1974. /QpPj PERIODICAL ARTICLE AUTHOR, TITLE, PAGES OR (BOOK TITLE, EDITION, PIACE, Tabershaw, I.R.;Gaffey, W.R. : Mortality study of workers in the manufacture of vinyl chloride & ita polymers. Pg. 509-18. NOT SENT BECAUSE: ( ) IN USE ( ) NOT OWNED VERIFIED: LM Vol. 15, 1974, Pg. 2967. ( ) OTHER LENDING: LIBRARY LU-M DATE RECEIVED DATE RETURNED Request complies with 108(g)(2) Guidelines (CCG) other provision of copyright law (CCL) AUTHORIZED BY: TITLE FROM LU-U 04/'01/8S 09:18 P. 3 TuHv ILL TOTAL P. 3 X.-tf.* 25000001 Gr 002 BFG37192 r i MATERaL-fMY BE PTECTED 8t COPT RIGHT OW Journal of Occupational Medicine vA^IVl I August 1974 Vol. 16 No. 8 Mortality Study of Workers in the Manufacture of Vinyl Chloride and its Polymers* Irving R. Tabershaw, M.O. and William R. Gaffey, Ph.D. Animal studies have shown that inhalation of vinyl chloride produces in rats angiosarcoma of the liver as well as cancers of the lung, kidney, skin and other sites. Although workers in occupations involving exposure to vinyl chloride have been found to have an increased risk of hemangiosarcoma. no excess of other cancers has so far been reported. This historical prospective mortality study of 8384 men who had at least one year of occupational ex posure to vinyl chloride before December 31, 1972, demonstrated that cancers of the digestive system (primarily angiosarcoma), respiratory system, brain, and cancers of unknown site, as well as lym phomas. occurred more often than expected in those members of the study population with the greatest estimated exposure. The mortality from other cancers was lower than that of the general male population, with the exception of cancers of the buccal cavity and pharynx. There was an excess of these cancers, which however was inversely related to estimated exposure. The explanation for the latter finding is not apparent The other major findings of the study are: (1) The overall mortality of the study population was ap proximately 75% of what would be expected in a comparable population of U.S. males; (2) No cause of death showed a statistically significant excess over what would be expected in a comparable U.S. male population; and, (3) No deaths identified as angiosarcoma of the liver were found other than those previously identified. This is the first epidemiological study which suggests that in humans vinyl chloride may also be associated with cancer of multiple sites. BFG37193 On. rabenhaw and Cattey ,rom rabunhaw-Cooper AmocmM. Inc. Suit* H8. WHO lucutiv* Mvd. Rockville. MO 10852. * the inearth nn v.Mch thn irpnn n bavsd was supported by a group oi companies engaged in (he ivnIheus andfor the putymenuuon oI vinyl cMonde, and administered in ihnr behall by die Manufactunng Chemms Allocation Of Occupational Medicine/Vol. 16. No. 8/August 1974 SGC 002128 u?f0 o o 5 509 *0 w <i Vinyl chloride in ns manufacture and polymerization has been identified as a narcotizing agent,' as a liver toxin,* 1 and as a vasospastic agent producing a specific occupational disease, acroosteolysis.4 Recently, vicryl chloride has been incriminated as a carcinogen producing in a group of workers engaged in the manufacture of polyvinyl chloride a rare fatal liver tumor, hemangiosarcoma.5 Large doses of the chemical in rats reportedly produced cancer of the skin, lung and other organs.4 Unpublished but public in formation' indicates that inhalation ex periments with rats in doses easily reached in manufacturing operations produces in addition to angiosarcoma of the liver, skin, kidney and other malignant lesions. The present study, however, was not restricted to the conditions and sites suggested by the above investigations, but concerned itself with the entire spec trum of causes of death, to the extent permitted by the size of the study group. The objectives of the study were: (1) To compare the mortality of individuals who have worked in vinyl chloride plants with that of the general population; (2) To compare mortality patterns within the population of vinyl chloride workers, based upon estimated occupational exposure; and (3) To com pare mortality among vinyl chloride workers with the mortality of other oc cupational groups. The study population consisted of in dividuals from 33 plants who had worked for at least one year in a job in volving 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 of death determined. The observed mor tality was compared with that of the United States male population. particularly those producing the monomer, this determination could be made on the basis of |ob 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 ex posure had to be made on a case-by case basis by plant officials. Data were collected for as far back in time as complete records were kept. In most cases this covered the entire history of the plant. In others, records were kept for a fixed period such as a decade. In a lew, records were kept for different periods, depending on whether the worker had died on the job or had left employment. In most plants it was impossible to quantify exposure. However, industrial hygiene and safety personnel in each plant were able to identify certain jobs and locations as involving the highest exposures in the plant, and to classify other exposures as medium or low relative to the "high" represented by the jobs with the greatest exposure. Con sequently, each exposed job in a worker's history was scored 1, 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 the scores usually do not take into account changes in exposure over time. A worker with long service may therefore 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 characterizing 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 (he greatest exposur. those with low scores will have least, even though the true expo,Ur^ each group may vary considerably ,* person to person. rjf>i The estimated exposure history 0| worker was summarized by calcul * an Exposure Index (El). This wa, d by multiplying the number of month,0"* each job by the exposure score, roran ^ these overall exposed jobs, and div.q,"' by the total number of months o< posure. n Follow-up of Study Population A follow-up procedure was msrj,^ for those who had left employment whose vital status could not be det mined at the local plant, using diftr. marl follow-up and retail credit bur4 investigations. Table 1 shows the V,J status of the population as of Decerns. 31, 1972. Follow-up is 35% comply.. Those who were not found were brr(and began their exposure) about teyears before the group on which lollo* up was complete, and had about tu the duration of employment in exposejobs with a slightly higher El. Althourthere appears to be nothing very unusu* about this group in terms of work history and exposure, it is nevertheless true ih*their exposures took place further back in time than that of the group so, cessfully traced. It is therefore possibi. that their mortality, after a substantia latent period, might show a sotnew hadifferent pattern from that of the tracrd group. All of the subsequent analysis is con cemed with the 7128 workers on v Ivyfollow-up was complete. Table 2 showtheir distribution by duration of expo**? employment and the year in which thaemployment began. Although alrruv half the study group first entered e* posed employment in 1960 or lar* there are nevertheless 854 workers wit20 years or more exposure, and iw with 15 years or more. Table 3 shows the relationship between duration of * posure and El. There does not appear t be a close relationship between the b Data Collection In each plam. data were collected for each worker stated by the plant management to have been employed for at least one year in a job involving ex posure to vinyt chloride. In some plants. 510 BFG37194 TaM* L -- Me** State if 131* tfleji CMarMa Warkats. Tat* OattCartMaW lart ** 1,1 uu 1771 3J2 100.1 Ki <7 mi 15.0 Kl .7 Mortality Study of Workers in Manufacture of Vinyl CMoride/Tabershaw GGC 00212? r jrnt the duration of exposure, that is * alters with a higher 1 da not differ ^bstantiaily in duration of exposure -,xn those with a lower El. One im.'..caiiort is that in assessing the relation ship between mortality and exposure. %<h duration and level of exposure can v examined separately, as well as in , rnbmation. Calculation of Risk of Death The risk of death is expressed as a Standardized Mortality Ratio (SMR), hich is the ratio of Ibe number of Oserved deaths in the study population to ihe number of deaths to be expected n a comparable population of U S. males. SMR's were calculated for overall mortality and for 33 major cause groups. Table 4 shows observed and expected <*iths. and the SMR, for each of these rruses for the total study group. In ratculating the SMR's for specific causes, ** 24 deaths for which no certificates we found were assumed to have the same cause distribution as those for fch certificates were available. the standard population, each SMR nuid be equal to 100. Therefore, the eatistical significance of the deviation of SMR in the study population from ** "peered value of 100 was tested.* A w'gle dagger indicates those SMR's f*ich differed significantly from 100 at ** 5% level, that is. which had a Jxnbability of .05 or less of occurring by A double dagger indicates those were significant at the 1% level. r* b*sed on fewer than five ob- cases were not tested for *th'*cance. r<l>le S shows the same SMR's for nAets M with an Exposure Index below k. <hoS* at 15 abov*- *** P',U * 1-5 rePres*nB * leve* f hu **tWeen "'ow" and "medium." 6 shows similar results for ^ with less than five years ex Trite 2. -- SfrtribirtiM * MmHh | Samti tmtlimm* kr raw i* Wife* nrtxrT lfnt l 1121 mist Uterite Itertwt itk CtnpteM M T la. Start* mo-is 194*41 1999 114041 111011 Trttf Tout 15 2 tou US 1962 IIS 32U 1114 715 115 7121 ntt u-ui 4 93 257 1442 126-171 i U9 5*3 115 Oat* * tain iui zam 300-331 4 iu t$l 277 237 >31 2S2 340-419 5 34 im m m S69 25* 39 * > 2 29 17 n posure versus those with five years or more. In order to examine the possible in teraction between duration and level of exposure, the study population was divided into four groups on the basis of both El (low vs high) and duration of ex posure (short vs long) using the same dichocomization as Tables 5 and 6. Table 7 shows the results for short ver sus long exposure in the low El group, and Table 8 shows the same comparison in the high El group. In each of the above tablfes, 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 ad justed upward by a percentage which varied in each subgroup^ Results of 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 4 shows that no specific cause of death was statistically significantly greater than expected. Several, par ticularly heart disease, accidents and "other diseases" not detailed in the tables, were significantly below their ex pected values. When the study population is divided according to intensity and duration of exposure (Tables 5 and 6) and com binations of these measurements (Tables 7 and 8) three major panerns emerge. For malignant neoplasms as a whole, the SMR increases with increasing ex posure. whether measured by level, duration, or both. In the high exposure group with 5 years or more exposure (Table 8) there are 36 observed cases and 26.11 expected. For cardiovascular -- renal diseases as a group, there are also increases in the SMR with increasing exposure, but the numbers of observed cases remain less than expected, the differences being statistically significant in all groups ex cept the high exposure, long duration group in Table 8. For ail other causes, there are no con sistent relationships with exposure. Within the malignant neoplasms, the largest (although not statistically) significant SMR is in cancers of the buc cal cavity and pharynx, with five ob served, 2.84 expected, and an SMR of 189. However, Tables 5 to 8 show that all these cases have Exposure Indexes below 1.5 and four out of the five have less than five years exposure. Table 10 is a listing of these deaths with age at death, duration of exposure, and cause as stated on the death certificate Cancer of the digestive system shows KWOOOSZ i u+ Ttete 1-- h. Ml f 4 7128 had Otertei mows W rt tnwi tester*Mt ni tennis Mm. 1 twn M* H* 4032 non 3051 non n ua tun <n te % ms (43) 12M (it) so (* MU It f us on 171(21) list 05) 12M71 %t tit no sinn lo-io t i 40 (tO 30 US 2(10 io no tom ht 7(7) st no * 10(0 ow It 12(2) tS (5) St (4) 10411 H. 1 It (O 21 (1) (> -- s (I) >M< * Occupational Mwficint/Vol. 16. No. S/August 1974 511 BFG37195 GGC 002130 Ttte 4, -- 0>n* PtluA*ettee Deitta m4 StaMireinC Mortalit) litiet I* m*ft CMarMe WkIhi Cam 4 Own a** CCD. SMtor U mm 35240720 ~----------------. Tutoroitoii (tIOt-OH) Tutotailow 4 nttHHam ml" (001401) Wiitfnifri aaopmatt 0*0-206) MgfifWtt wotittJi*. butt* CJtTY M* tftaryni (140-14J) Minfwrt MooitsAl 4if*nw arpni ptfitOAtt" (150 159) Mahptwt MaetoAs. r0ff*orr (163-164) WttifriMH iwoobims. femfa* v(mi (170)75) Uktipwit Mootaunt. wniun orpm UWlli) Mahfnwit mottatttt. Mm a*4 tftsaaofetf vtn 050-169) lawkatwa a4 ttafccma (204) lymphomas (200-201 205) 1/5.71 1/5.34 - - ----------- >1 75/77.15 5/2.04 ------ --^ 114 15/21.57 ln 75/23.53 54 3/3.55 llJ 1/360 I7/U75 " * 3/377 * ________ --_______________________ _________ 51 0n6tm mtttitvs (260) utw eardienacMr *4 m *ieaat (31413*. 4004M. S9Z-S94) Yaxuto Imn tUtetmt C (330.334) tonmMK toe * dMMM rtomwc Mat Sis. (400402. 110416) Mtomctoa* Don tixw (420) XMrtovaunc momtoxi* (421. *22) Hmnwim tom *um (44443) Ottoi (444447) CtK i inmM wo/inm l m4 ictooa> (592 554) _________7*M 155/207.40 13/24.41 5/1.17 121/11733 >* M.33 3/2.00 MV ~-- *: J Jnftwma Ml pwamwma (410493) Ukar af Maich m4 Swomaam (640. 641) 5/5.H 2/1.0 T7~ *totodtn (SS4SS3) Hem we iemUtot toanctm ISM. Sit. 570) 0A).CC 1/1.51 "` Gmntn. Oetotoito. mtoitu we aMij (543. S71. 572) 171-17 n-- Cartons 4 hm (511) 3/tl.U ' DyM>4an 4 (rants (010) 0A.35 " Symptoms. sambty aatf ii4a0aa0 (710-7)6) 1/734 1S------ M otter km (ro4e4) 2txs.n ,, Meter 4M> ntaR (0!4t35) 17/3170 54V Ottor actmeto 1100402. 144542) 11/3400 u Smbtt (503. 574571) HoWoe <504. MOMS) 1C/1SJ3 1/ll.SI iu ~ ) ~~ At 4 vtert hwi tmn 7m 77SU ' SMTi Mjettee 'to OaMto < cam itoai. tStoaicaat x toel S>imi It toM. no excess in the study population as a whole. However in those workers with an El of 1.5 or higher, there are 12 ob served cases where 9.14 are expected (Table 5). In the subgroup of the above workers with five years or more ex posure. there are 11 observed cases and 7.47 expected. Respiratory cancer shows a slight ex cess in the total group, and a similar pat tern 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 ex pected when, in addition, the duration of exposure is five years or more. 512 Malignant neoplasms of other and un specified sites show an excess in the total group, and an increase with both level and duration of exposure (Tables 5 and 6). The relationship with exposure is more pronounced, since those with ex posures of less than five years have fewer cases than expected. The lymphomas, 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 four cases observed and 1.84 expected. Cancers of the genital and urinary organs, and leukemia, have fewer ca'- 3 than expected. The number of case* /- 5 too small to examine any trends. % Discussion $ The favorable overall mortality of it* ' study population is a phenomenon com monly observed in working population- standardized Mortality Ratios in the lo 80's and below have been found * 11 Even in occupations with well defined hazards which cause an increased ri-i from a specific cause, the overall rmv^jj tality may still be favorable because the low risk from other major cause- death, frequently in the cardiovasculJg -- renal category." -t-* Mortality Study of Workers in Manufacture of Vinyl Chloride/Tabershaw. GaffrQ BFG37196 OOC 002131 TtM* 1 -- 0*um* Duta/ComM Suita ** ftmUtxinX Mvulity tabu ix H* CMwita WvkkfX 5y Ubnuttb Ut at Cnxwrx /_4 MX m> (CJL. * 0 1J DiU Qta/Uf sur 0ta*9 SM- 1* innaa 10/27103 70 * 132/115.(4 Sft 1 TaMicwma lOOl 019) TuMrcutois if n inttm (001-OOt) Xiitfiwt woruvM (140-205) UgttpjM .'woo'ttmv buccal uvrtr an* pitarmi (1*0-141) KaltpaM NWttm. dtftam or|M *M pritMwni uSO-Iii! *<rpa*x ncooMsms. moftnirt tram U50-IM) nMoutm. ftmt* orpn* (170*179) fitiipum uniur *pft (ISO-lit) Hifcgpiit Nnuua. ottm an* unspaoteft (190-199) limn M aaukama (204) tiMtMS (ZOO-M3. 105) 3/3 31 3/3.15 37,4* 21 s/i 2(12.50 U/13.5* in 30 1/7.07 3/0.57 1/213 1/3.40 0 0 90 330 &0 r U 93 51 m if 31 mn 0/2.1S *1/32.57 0/1.21 12,3.11 (3/10.23 1/1.0 Ort.H S/4 52 2/1.57 5/2.S4 0 0 134 0 1*1 135 73 0 190 US 217 9 iWk mutm (2541 5/1(5 14$ 2/2.55 SI mm cMmoiv at* rMjt iiittw (330-334. 400401, 592 34) CNS (330-334) taexic kw 4 draxc ikautkOc IMkit til (40S401 l.Wlt) UllUkHU kott kwu (4211) Berk--auk* aMoorkifii <<2t. 42!) *emnnk Nun jnm (*44443) Oita kmiw dluM (444442) Onta * MkBM MMntn 4 raxal idran (512 SS*> Ww aaa wamxoiu (440413) unmi 7/14.47 1/10 51/2054 374,20 ll%M 1/1.57 0/7.50 5/5.10 25 57 * M 17 55/3433 MOLD* 1/245 5U31M 0 1/Ml If 1/3.34 20 2/l.W 0 0/1.22 17 ft/t.o 15 u 25 15 St 54 201 9 0 <*> * aw M0 4w*m> (S4ft 3*1) hi mi utk (S5S553) uui 10.31 a mu 0 M77 ft "ne m0 MOM* Mn<M (544 541. 570) MOO 0 1A43 171 fta*k. 4>dmiXx axonXa axO caMn (543. 57t. 577) On** at Sm (Sll) 0/0.21 2/150 0 1455 150 a 14(4 11 "tartaxa a groxei |(10) ktahta. tmHtr M 41 4i4m4 iMXXiMW (TIP215) OftTS 0/4.22 0 0A14 ft 1/10* 0 34 ** * wm> InM) 14/21.50 Mil* *1 * "tax tcatmt (110435) - ** Tiloxi (400401 440>M2) S/15.03 1171743 a* 1/1140 M * 402.47 77 50* (141 370171) _ "tatax (14*. 340-305) in.23 0/1* N 2/7.07 107 ft t/4.94 21 ** * wrtan ^n> 401 45354 Sftftf me ?* **hx ta taHn mx am , s*m M st mi a It lata ,,'***" of these facts. SMR's which ,* ghee than expected may be worthy rttention even if they are not *Mie*"v significant. This is especially ^ 'tt the present study since the numV'JT ******** from many causes is quite . and even a relatively high SMR H I0* ,**ch statistical significance, addition, a particular cause 1 consistent pattern of increase ^ **posure or estimated exposure. bindings are particularly interesting. a. . th**e criteria, mortality from ftv* c*ncer, respiratory cancer, can cer of other and unspecified sites, and lymphomas, appear to be related to ex posure as defined in this study. In view of the association between vinyl chloride exposure and angiosar coma of the liver, the digestive cancers were examined further to see what con tribution angiosarcoma made to the ob served mortality pattern. Of the 19 digestive cancers, seven were liver cancers, of which two were angiosarcomas according to the death certificate. However, among angiosar coma deaths in vinyl chloride workers ^of Occupational Medicine/Vol. 16. No. 8/August 19/4 identified by other investigators, there were six which occurred in the present study population during the study period. They were all found in the course of the study. Table 11 shows these cases with the cause of death as given on the death certificate. Note that one case was certified as cirrhosis, and was so considered throughout this study, since the validity of comparisons with population data required that cause of death be determined only from information on ihe death certificate. The other five were correctly classified as 513 BFG37197 OGC 002132 900000SZ rr Tibia a. -- 0bwm4 0aatta.Cjactt4 Daatta tn4 SUr>4ii4ita4 ttartilit) litiw m fuifl CMariOa *ltri bj Duratta* at Eiptul Eraatarmant. Can* * ftaaUi fitk LCD. It W (MM (Mu *404033 W mm ua wr | 37 * 3.(0 Matts Ot&fca 231/12*30 IN* 73T rutaeuMus <0014Ji9> TutocitteM * mutuary nttw (OOl OOt) MitafpatM Maatam (140-705) Uatiftwl ModiMa. bacat ctntr mi tntrni (140 140) MtbvuM wannii. tpti aw aaitoiw (150-15*) MaMna* aaaaatiaa. mmmm tram ilU-lM) Mrtomn imlim itfutjl atpm (170 IT*) Mtbfaoa Mnlnm. timtti atom (1*0141) Uliana* Mottwm. otlMt mi wmoM win <1)0 1*3) IkiMm mi aauaama (204) (maaaan (zoom, mi Diabatti non (2(0) M<i otOmoeHar at ioia atom 0)0334. JOO-tU. 5)2 5*4) VncaUt Maat aflacnaf CMS (330-334) Kuwait bwr i ckramc rig--ait ban M. ((00402. 410411) (iurmdaok bwt taw (420) naatowgic aHatirtitii (421. 422) Hypmmam mat (rtaaa (440443) OUm fclUrt--tm 4mt* (144447) Cbmac 0 aataariOM aaabnta 1 ini icltfain (5*25*4) 0/2.23 0/2.07 13/11* 44.70 2/524 3/152 0/0.* 0/0.13 2/3.40 1/1.23 1/2.01 2/1.00 23/31.43 4/1*7 2/2.3* 21/1231 0/1.2* 1/2.42 0.0.7* 0/1.53 9 9 70 300 4S 33 0 0 71 N N 174 35 tl 101 71 * 0 41 0 0 0/3.55 0/3.33 35/37.51 1/71* 17/11.33 71/11.31 3/2.73 1/2.7* 15/323 2/2.33 5/4 07 S/4.54 125/157.31 9/1171 3/4 53 9I/105J9 1/323 2/7.01 3/1.12 0/2.73 0 lit 41 ! Ill 112 37 117 1] 121 m 11* u * n 30 173 9 Maoin mi gitiam (4I04S3) 3/2.33 121 7/703 21 Uk at StflMad * Mw (540. $41) 1/1.03 112 1/7.70 37 *Mtaam4n (550-553) 00-24 0 0/0.43 0 Haw at Mama omtrgaca (MO. id. 370) 0/0.42 0 1/1.10 *3 Omtnta. OaaOaatln. Manta w4 eOitn (543. 371. S72) 1/0.40 301 047.32 Q Carbarn 4 tm (SSI) 1/4.4* 20 2(11.11 11 HniaMaaa 4 aaatatt (tin 0007 0 0033 0 Spaatom, nail*) aat *Mmi rwaaitiu (7107*3) 1/220 31 0/3.0* 0 M amt batrn (iaa4wl) 4/11.07 40 13/23.34 S3 : Mala tabMa teams (ItOCS) 10/1014 73 ;. 43 OOaa imitatt (100002. 140*0} 7/1234 33* 10/1722 51' SaicMa (SOX *70*7*) Honoat (*14. (00)03) 0034 1/1M 114 1a iono.29 0020 in 9 0a. 4 Martin row pan 21* 34201 4134 41240 ' sun tOpM (at MM mat carl# ortaas*. tSifttkaM a if Imt Siptiinm altmt 5000007 BFG37198 514 Mortality Study of Workers in Manufacture of Vinyl Chloride/Tabersha*. G*1**' GGC 002133 TiUt 7. -- OOaiiM Otithi/tiMCtiO Otitis in* IbndtiOin* Martalitf Ditto in Kin* CNwiO* Wwkiri ith inauttt IMittt Jtlor 1.5. Si Dwition M EioomO Cnpiomut Own 4 Own vitfe tC.ll. k U Cmm ruMrcvlem 4001 019) ftibsroJo** at mmntorf jystim (Q0100I) Mwiatm (140-209) MilifMM mnuvn. Sacat artt m4 Hxtu (lio-lil) toipu* mMimh. tfi|UM o>ian m< jritwwr (ISO-1541 Ut/MM tmuttmt. rngran trtm U50-144) IDiDUM MOtnu. tMrtlt |M1 (170-179) ali|NM MWam. imaarf r(tu (110-111) **lMM Montana torn W wnoocitW nta (190 199) (Mtwo to Mm (204) iMm (200-201 mi 0>MNi MMn (HO) Mr attank M not Maw (330-B4. 4004*1. 592 994) ** tow WOO cm (730-334) Mtt imt 4 ctroK ttMMUhc Wit 4a (400-101. <10411) 4Kmetrnc Hart im (470) Moot tMnar*tn (421.477) ****** haft tana (U0-44J) Ottar hyurtwpm dnoM (444407) ___ Orao 4 imwoM |M) 0 M sdras (592 504) Mki im n.w.,1 (41041)) gt Mate* w 4w4ma (540. 541) _ MiiiMuu (550553) _ '** W hmm oMnctw (540. 541. 570) **t 404001. MOO W <OU (543. 571. 572) _ t"lw 4 Wr (541) _ *maw 4 nw (410) . - *"" Wti w 4WM MM 1740700) * * OilUM (raMM) -*** '** 4MS (110135) --Mn (H0402. 140942) (943. 970-9701 (944. 91090) ^-------------- ** torn rai mm whom. * M IwL 1 * 1% iMt < 40 Months Cj^ssm* SMI* sinji O/Ul 0/1.31 1712.34 4/0.4$ 1/143 27151 Otf.91 0/0.55 1097 04.70 on.zt z/us 2173134 27193 271.50 14721.14 071.14 mu 0/0150 10.97 371.14 MCI 10.15 0/0.27 0/0.24 1/2.10 10.05 071.4J 4/7.4J 379 17 1/794 1/4 04 073.55 U* 0 0 n 1039 34 (5 0 9 in 9 a 203 73 * 155 n 0 74 0 0 144 0 0 0 a <2 9 0 41 35 a 14 9 I71S 21419 7. 54 MU Ciwwa 0hvi t* 112/111.21 0/1.97 O/IH 25/11.44 1/1.17 6/9.09 9/10.00 2/1.42 1/1.53 I/Ml 1/2.40 1/2.2) j/rso 41*4.12 5/1041 1/141 524747 0/3.02 0/3.90 1/1.02 0/1.53 271)5 171.53 M.24 0/0.41 M51 1/1.05 00.20 07279 10712.92 5022 175.15 17155 07143 73* 0 0 9$ 11 44 53 127 57 117 n 49 124 75 41 * 41 93 0 0 101 0 93 (7 0 0 0 IS 0 0 79 94 4) 109 0 2317 73520 800000SZ Occupational MetBcine/Vol. 16. No. 8/Au*u*t 1974 BFG37199 3GC 0021.34 515 pr TiM* l -- QOurM DutteiutctH Dtttht in* StiiMartilU MortiKtr litiu Mi Miyt CM*rM Nortiri via Licourt Mien K 1.5 m Srutir, by Duritn at llama ImaUyiMVt Cana at 0H> vM IU. ta. ratoatot (Ml 411) TabvrcvMl it mamttn mtvt (001404) UiNmm malum (1*0205) Utfput ntoumt. HaA amt M iMyn (1*0141) Maipnat aaaauuu. trynm orpat 4 vnm (150-159) Mco+wn. mpntorf tfUtn (IW-1W) KtMpuat aaoaUvm. part* arpn (1701711 Utlrpiaat oaoaiasJB*. anaary orpat (ISO-Ill) SUeiw* ucalBiai. M> tat raipaotl via (1)01117 InUmi M Vaataaw (204) ImpMu (20020). 205) (240) 1 Main tvtivmtvlv m4 mat tom (3)013*. *00441. 5*2 514) (Meat* Mm tiMoy CHS (330334) Hanmv M I dMK rttfthe tort ia. (404402. 410411) > (420) I (421. 422) i (44044)) OtM MttMtiw tom (44444)) CMM 0 ui)in4U ut>ntu 4 nut mm (542-534) ; Mwn U* |MMH (410413) : liar p yurt t Mm (540. Ml) imlintt (55055)) (Praia M MU Mnttia* (SM. SiL 571) ; CartriU. tailaiU. aatanU M MU (541 571. 572) 1 CinMn 4 IM (Ml) Millin if pnsutt (MO) . Spouu. Mfity M *U4aU Ml (710)15) - 41 ttto Um (MU) MM Mch icnlun (114435) r Otto KfiUab (MOW. HOW) SaUU (W. 17007*) HMtiU (K*. aoa It Mitotan (! <M Maatu lyin OkUa SM' 3M7J1 a W7 M).n MSI M2) 171.1) m.n mji OAS 1/1.10 1A.44 1A.71 0A.41 0 0 a 0 n n 0 0 107 2tt 171 704.14 Mil oas 5/10.41 M.57 oas 0027 OO.S4 DOJI 54* us o ii 0 0 0 0 0 IAS OAS M2 * 0A14 0 1A14 M4 MS 0 SA01 0 1AJ0 MS IM 7AS 11* 474S 107 )i2.M 1(2.11 150 a * u<a 0/1.57 on .a 34724.11 M>.W 11/2.47 I2AS 1/2.41 0/121 mu 1/1.13 4/1.14 212.04 am.44 trf.ll MM *174715 1(222 20.10 Mil 0(12) 00.13 MS 0A.11 IAS MW1 IAS 0A1) MS MIS 2/7*3 inn (71.42 vtn 1*12 Mf Ml ISl It* n a< * 2a ia a a ia a t* H 25) 0 1 4 m 1 a 0 0 sr a 70 u 9 tSipitCMt it 51 Inti *SirtcMt * 15 Ml 7.5000009 BFG37200 516 Mortality Study of Workers in Manufacture of Vinyl CMoride/Tabershaw. G)**' GGC 002135 i TaWa 1. -- Otkar Mlli|rundn (190-199. LCD.) ill TOM EaiOmniafj ShiOy 7oeultio. : >( )Mi *ft EXHM4 C*sa as Urn lalaaaf 27U 31 1700 <4 184 micipti# musooc mtuum (I f.> tfllifllMt fflttMOftl 4 tick 50 Mahfwrt imisMoms witfc 4n>iirt nctansa F /* zm 17 39U u UJ3 $4 n On* lunar Umiaana) (1 am.) (4 Misngtii w4 (S shi) ?9i44ymM4 fautft (2 s peti-S* VUMtfFBf) 11 Astrocytoma. mdtftortto* artotf fuawsftart 0 f ) t* F UN 51 Carpaana at On krai* irtariaadanan fnaaaana Oaa ta oak Tnaaaacn m nn 57 771 Iran taanr. iMtaatana anMaraa (II am.) 7300 44 711 Son taanr. anlQiaat (2 am) 7371 51 7300 53 3l %rm buMf. matipMt 211 DqrnO nrtiaana * aianmiaa as Nft 57H 57 52U 17 zno 14 231 CprOMMUlSM CiffiMM wttknl My 201 Uoaaartana aM nuttn (1 am) in Carriaaamaaii ariaaiy n*a aat laaaa (Pan Nakiy. ilinnatatt arOaila. niaarkai lafarctiaa) m m 477* 54 30* CarOiaa arrak (1 Dr.) laafaltl arm n< earaira kiaaaa (2 Ural m*mwi mmmabt orcgtcM (2 am) <711 ii 311 OMfttinO smnbm wirikF aakatai (7 am) Taaanaai caO nrtiaana. annarr all aalalariaiaaO m STD 7301 5S 1 Mmttttt fqmm if jMvm> CmkF jito m4HM4km4 (Nl--sirp pfc)nMN) 131 Cirnanmaaii (1 am) Tnanr) an aatwraiaaa M OTOQOOSJS * Occupational Medicine/Vol. 16. No. 8u(ust 1974 BFG37201 517 GGC 002136 liver carirpr. but only Iwo were specified as angiosarcoma If there had been no angiosarcomas, the number of deaths c'assmed as cirrhosis in this study would have decreased by one. and :*e number classified as digestive cancer would have decreased by five The oattern of duration and intensity ci eoosure in these five cases was such that if thev had not been present there wouic have been no relationship berween exposure and digestive cancer. The mociaiirv paltern in this cause group is therefore attributable to angiosarcomas of the iiver The other cause grouo worth further investigation is cancer of other and un specified sites, both because it is a heterogeneous category and because it seems, unlike the other cancers, to be more related to duration than to level of exposures. Table 9 shows a list of the specific causes included in this category, which is essentially brain cancer and generalized cancer with primary site unknown. About 40% of the observed deaths were due to brain cancer. In the general male population, about 22% of this category is due to brain cancer, so that not only is the mortality from cancer of other and unspecified sites excessive, but brain cancer is overrepresented within the category. The possibility exists based on the lack of specificity of some of the listed causes that some of the brain cancers were not primary, but metastases 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, that ex posures to other substances were in volved. or that the mouth and pharynx may be peculiarly susceptible because of the gaseous nature of the chemical. Possible Biases in the Calculation of Risk There are two major potential sources of bias in the study. The first is that the follow-up rate is lower than is desirable. The second is that observations of workers with long exposures followed by a long latent period are not adequately represented, so that the power of the study to detect causes of death associated with long exposure and long latency is impaired. Populations with such characteristics exist and 513 TaMa JO. -- Uili|MRt Raadatmi at leaal Canty tag ntarym (MO-iga i" KM EMamMety Stagy fomtitsm. SMl *. l|f K Oertft HM. llMMi Cam (aw 3001 n un H <1 CftroAaftB 4 H ** iwitttRi U tun| mi wet <S rO 30 Puimwimj rfwn (SO mm) mttsssm (Ciremoma. imdtrmml. tow* 3001 57 mi *4 1354 (3 71 UstntaM laaaama Ml ca. anniry lasua aauat <0 Attmetsi) iw n mmttuvt to iiutoittMMit (l met) mtkiftM metisrim to Sraa. trwr 1 mmwtmm <1 yt.) Utememoeoma at mmI 9huyn <2 in.) 25 Xrum Mmrrtrft u tndtoetra Jm last toryxea-yktryaiKtaaiy. M ngef at* toiacMa hMilhratuta laramiriag taaawn Ml oraaaaa at lag Harn mas lam.) m ! i l m m m TaMa It. -- tagiaurcaau Daaths ia KM Efi4aaualaty Stagy Pagalaban. Stogy an use 4255 57(5 7301 7336 7355 tya at talt M W IS 31 52 4} Mas. bgaaag Caw* m fitm 203 CarMan g Inai (ax. aaakt) 211 dagiag km laaeanau (3 days) (Liatau airaont 1(7 rimaamnu rt toit af riar 110 am) 174 liver Were (1 me.) tmm 4 fewr. primary (IS met.) 23S CvAk (mkhIb mi mmm till Imwwi (mm*.) Wt4*f mttBStahe immurcem* 4 Hm (4 met.) 211 HMfaC Mart fnmart orememi femr May m jm m m should be investigated. References 1. tester O. Greenberg LA. Adams WR. Ef fects of single and repealed exposures ol humans and rats to vinyl chloride. Am Ind Hyg Assoc t 24:265-75. 1963. 2. MarsteHef HI. lelbach WK. Muller R. al: |Chrome toxic liver lesions in the PVC (polyvinyl chloride I -- producing workers. | Dock Med Wochenschr 98 2311-14. 1973 3. Kramer CG. Mutchler IE: The correlation of clinical and environmental measurements for workers exposed lo vinyl chloride. Am Ind Hyg Assoc / 33 19-30. 1972. *. Dodson VN. Dmman BD. Whitehouse WM. et al: Occupational acroosieolysn III A clinical study. Arch tnviron Hllh 22:83-91. 1971. S. Creech |l. lohnson MN: Angiosarcoma of liver in the manufacture ol polyvinyl chloride. / Occup Med 16 150-51. 1974. 6. Viola PI. Bigotli A. Cuputo A i ceogenic response of rar skin. June- . bones to vinyl chloride. Cancer Res 31 Si- . 1971. 7 Occupational Safety ind Ht-ai'*- - ministration Occupational Safety and H.. Standards Emergency Temporary SianiU- Exposure to Vinyl Chloride, federal K>s 39 (67| 12342-44. April 5. 1974 8 Chung Cl Standard erroi ol i* adiusied death rate. Vml Statistics v- - Reports. 47 (1961) pp 275-285 j.- 9 llovd l\V, Ciocco A Long-term m.-CVJ ostudy ol steelworkers. I Methodolncs cup Med 11 229-310. 1969 . 10 Tabershaw'Cooper Associate- in- <3 published /-* 11. Redmond CK. Ciocco A. llovd M g? HW: long-term mortality snirt-v3 Steelworkers IV Mortality itom neoplasms among coke oven workei- (MI cup Med 14 621-629. 1972 Mortality Study of Workars in Manufacture of Vinyl Chloride/Tabershaw. Ga - BFG37202 0GC 0021 37