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EPIDEMIOLOGICAL STUDY OF VINYL CHLORIDE WORKERS Final Report May 3, 1974 Submitted to The Manufacturing Chemists Association 1825 Connecticut Avenue N.- W. Washington, D. C. 20009 by Tabershaw/Cooper Associates, Inc. 2180 Milvia Street Berkeley, California 94704 ACKNOWLEDGMENT The research which forms the basis for this report was supported by the voluntary contributions of the following naned 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 Chemical Company Tenneco Chemicals, Inc. Union Carbide Corporation UNIROYAL, Inc. \W 1052 TABLE OF CONTENTS SECTION I. Summary 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 IX. Analysis X. Discussion XI. Possible Biases in the Calculation of Risk Page 1 2 3 4 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, for 7128 Vinyl Chloride Workers with Completed Follow-up 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 and 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 \W m3 gaa'iwiMM 7. Observed Deaths/Expected Deaths and Standardised Mortality Ratios in Vinyl Chloride Workers, by Estimated Level of Exposure 8. Observed Deaths/Expected 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 with 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 SMR Calculations 12. Results of Follow-up in Several Occupational Groups 13. Angiosarcoma Deaths in VCM Epidemiology Study Population 14. Other Malignancies (190-199, I.C.D.) in VCM Epidemiology Study Population 15. Malignant Neoplasms of Buccal Cavity and Pharynx (140-148, I.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 \W 1054 I' i'itttiSISsMi --i~ jSSCBBShfiTlL rscgsms -i-sS ag&ariTS ii EPIDEMIOLOGICAL STUDY OF VINYL CHLORIDE WORKERS Final Report - May 2, 1974 I. SUMMARY Eight thousand. three hundred arid 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 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. 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 well 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 levels than in the general male population, with the exception of cancers of the buccal cavity and pharynx. There was an excess of these 1055 ij i 23S 11 1 'Pw*V*W -2- imaunua!st& JsSssaiigagf I cancers, which however was inversely related to exposure. The explanation for this finding is not apparent. II. INTRODUCTION The study was begun by Tabeishaw/Cooper, Associates, Inc. on June 15, 1973, under contract from the Manufacturing Chemists Association. The original eight month period of the contract was 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 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 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 of death determined. The observed mortality was compared with that of the United States male population. \W 1056 ; ^gKfBMlBgW -3- III. SELECTION OF STUDY PLANTS The Manufacturing Chemists Association identified A3 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 wa$ found that information from these plants was defective in one 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 PVC production, which provided a study population of 8384 individuals. / / r- . ,-^v ' n ooV 1057 -4- IV. DATA COLLECTION In each plant, data were 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 exposure 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 few, records were kept for different periods, depending on whether the worker had died on the-job or had left employment. In the latter case it was necessary to exercise care in defining the period for which study data were to be collected. For 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 the 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 W 1058 time may hove 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 a 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. THE MEASUREMENT OF EXPOSURE The job history forms (Attachment C) were originally designed in the expectation that vinyl chloride exposure on each job could be quantified in parts per million. This proved generally to be Impossible. 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 other exposures as medium or low relative to the "high" represented by the jobs with the greatest exposure. Therefore, the attempt 6- - to obtain objective exposure data was abandoned, and each exposed job in the 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 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 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 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 OF STUDY POPULATION A follow-up procedure was Instituted for those who had left employment and whose vital status could not be determined at the local plant. A portion of the terminations was traced by mail, using a form letter sent to the last 1060 BT.cm 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 be found by the mail follow-up. Approximately 5500 of the study population came from plants in which direct mail 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 be 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 that mortality among those not 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 not 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 with 1920 for those not found) and the median duration of employ ment in an exposed job was 80 months '.44 months in those not found). The 8- " shortest exposures occur in both the oldest men, most of whoseworking life was over when vinyl chloride came into general use, and the 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 months of exposed employment, there were nevertheless 855 workers with 20 years or more exposure, and 1641 with 15 years or more. Table 3 shows the distribution by duration of exposure and the year in which exposure began. The median year in which exposure began was 1962 (versus 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 that 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 (El). The median FI is 1.44 (1.75 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 F.I 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 i 1 ' 1062 -9- which data were collected late in the study. Although there appear no 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. VIII, 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 these 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 ou whom follow-up was complete. This group represents 77,846 person-years of observation. For 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 about 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 populate a. 1063 -10- In the present study the U. S. male population was used as the standard of comparison, and the age-specific U. S, male death rates for the appropriate ages and years were applied to the corresponding cells of Table 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 SMR's for 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 those 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 given 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, 1967 rates were used. 2 Large-sample tests of significance were derived from: Chlang, C. L., "Standard error of the age-adjusted death rate," Vital Statistics Special Reports. 47 (1961) pp 275-285. ' ooW 1064 -11- Table 7 shows the same SMR's 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 8 shows similar results 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 EX (low vs high) and duration of exposure (short vs long) using the same dichotomization 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 SMR'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. 'OoW 1065 -12- When the study population is divided according to length and duration of exposure (Tables 7 and 8) and combinations of these measurements (Tables 9 and 10) three major patterns emerge. For malignant neoplasms as a whole, the SMR 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 SMR with increasing exposure, but the number of observed cases remain 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 SMR 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 r\ynJ 1066 -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 hasard which greatly increases the risk of death from a particular cause, the overall mortality may well be favorable. Table 12 shows the SMR's obtained in a number of recent studies of other occupational groups. Although for technical reasons these SMR's are not strictly comparable, the overall mortality in the present study is clearly favorable. SMR's which are higher than expected may be worthy of attention even 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 'coW 1067 t -nAilK^if-' -14- ' Viffi .arif^y * interestlng. 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 8, 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 the other cancers, to be more related to duration than to level of exposures. Table 14 shows a list of the specific causes included in this category, which is essentially brain cancer and generalized cancer with primary site iW 1068 I -JtajiajlSafeS:..'tj irV?" ;v':.': aAaaa -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 brdin 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, or that exposures to other substances were involved. XI. POSSIBLE BIASES IN THE CALCULATION OF RISK There are three areas in which bias could have entered the calculation of the above SMR's. The first is the choice of the U. S. male population 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 1500 workers whose exposures occurred up to 35 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 the 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. \W 1069 bL iunk^kb Vi^n'7 ijTi'i wrfiiiv1'iiiiMiiiiihWin'W I i~ i injUttaiUHnii iiTili I -v' -ir,- The workers who could not be traced may conceivably contain a dispropor tionate number of deaths, which could increase the overall SMR. It appears ualikely 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 cf death might become significant, or that some of the relationships found in this study might be diluted. The same comments apply 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. vW 1070 References: Archer, VE, Wagoner, JK, Lundin, FE, Jr: Cancer mortality among uranium mill workers. J Occup Med 15:11-14, 1973. Enterline, PE, DeCoufle, P, Henderson, V: Mortality in relation to occupational exposure in the asbestos Industry. J Occup Med 14:897-903, .1972. . Enterline, 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, JW, 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, JW, 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, WC, Balzer, JL: A Labor-management occupational health service in a construction industry. - Arch Environ Health 21:784-788, 1970. 1 . -*"** <aiWk..a lvL* ii-STli'-f'hfrf^tft`ir; . Table 1 Follow-up Status of 8384 Vinyl Chloride Workers Number Percent Total 8384 100.0 Alive b77b 80.S Dead 352 4.2 Unknown 125b 15.0 Death Certificates Rcc'd. Not Rec'd. 328 24 92.7 7.3 * April 15, 1974 ocsV io?2 t o CO * Year of birth 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 Total Total 1 5 7 21 38 89 214 404 648 897 940 877 986 1169 700 132 7128 Table 2 Distribution of Months in Exposed Employment by Birth Year, for 7128 Vinyl Chloride Workers with Completed Follow-up <60 l 1 3 10 9 33 79 145 229 276 287 454 664 632 132 2955 60-119 120-179 Months of exposure 180-239 240-299 300-359 360-419 Unknown 22l 33 792 4 9 12 2 13 21 22 17 27 35 37 43 62 58 72 73 96 80 120 105 191 98 143 160 214 118 ' 169 139 252 128 181 26 378 120 27 481 16 66 6 34 43 84 64 20 -.3 15 13 8 1 1 2 2 '5 4 '4 3 7 8 2 1796' 697 786 565 25 39 39 April 15, 1974 Table 3 DlstribuCion of Months Ln Exposed Employment by Year In Which Exposure Began, for 7128 Vinyl Chloride Workers with Completed Follow-up Year Exp. Started Total 1930-39 1940-49 1950-59 1960-69 1970-71 35 1048 1962 3368 715 Total 7128 <60 2 135 389 1714 715 2955 60-119 4 93 25? 1442 120-179 1 119 383 195 Months of Exposure 180-239 240-299 300-359 4 6 13 151 277 237 631 282 360-419 5 34 Unknown 2 20 17 1796 698 786 565 250 39 39 51 April 15, 1974 v W 1074 Exposure Index Total 1.0-1.4 1.5 + Unknown Total 4032 3057 39 7128 Table 4 Distribution by Months of Exposed Employment and Exposure Index for 7128 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 1240 671 295 380 291 159 2955 1796 697 786 565 251 18 21 39 39 ' 39 May 2, 1974 4 1075 Table 5 Person Years of Observation by Year of Birth.and Age for Vinyl Chloride Workers Age Totals Year of Birth 18 75 1880 1885 1890 1895 1900 L905 1910 1915 1920 1925 1930 1935 1940' 1945 1950 1879 1884 1889 1894 1899 1904 1909 1914 1919 1924 1929 1934 1939 1944 1949 1954 Total 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 77846 134 4070 12076 13861 13550 12031 9527 6368 3632 1684 632 202 58 16 5 13 92 124 317 705 1662 4055 6710 11038 14305 13807 9408 7239 6174 2023 174. 1 11 12 5 53 21 31 39 180 572 440 475 920 1301 143 32 335 1090 1882 1642 2173 4221 701 14 264 1054 2183 2 725 2863 3778 980 n 221 697 1685 2742 3688 3 706 808 5 70 524 1028 2044 3502 4113 745 56 241 710 1226 2631 384 7 816 35 135 334 762 1574 2768 760 22 88 155 363 886 1636 482 14 35 77 142 341 822 253 . 2 25 31 62 126 270 116 5 23 20 43 71 40 5 15 11 12 15 1 10 5 5 April 15, 1974 O TABLE 6 OBSERVED DEATHS/EXPECTED DEATHS AND STANDARDIZED MORTALITY RATIOS IN VINYL CHLORIDE WORKERS Cause of death with I.C.D. number ' All causes Tuberculosis (001-019) Tuberculosis of respiratory system (001-008) Malignant neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Malignant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203, 205) Diabetes mellltus (260) Major cardiovascular and renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting CNS (330-334) Rheumatic fever & chronic rheumatic heart dls. (400-402, 410-416) Arteriosclerotic heart disease (420) Nonrheumatic endocarditis (42l, 422) Hypertensive heart disease (440-443) Other hypertensive disease (444-447) Chronic 4> unspecified nephritis & renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of stomach and duodenum (540,541) Appendicitis (550-553) Hernia and Intestinal obstruction (560, 561, 570) Gastritis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hyperplasia of prostate (610) Symptoms, senility and ill-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (810-835) Other accidents (800-802, 840-962) Suicide (963, 970-979) Homicide (964, 980-985) Number of workers Person-years *SHR's adjusted for deaths with cause unknown. *Slgnlflcant at 5X level. **Slgniflcant at IX level. See Table 11. May 2, 1974 obs/exp SMR1 352/467.28 75** 1/5.71 1/5.34 79/77.16 5/2.84 19/21.67 25/23.93 3/3.55 1/3.60 17/11.75 3/3.77 6/6.06 7/6,31 155/207.46 13/24.48 5/6.87 121/137.33 1/6.58 3/9.33 3/2.60 0/4.27 '/9.96 2/3.83 0/0.66 1/1.51 1/1.31 3/15.60 0/0.39 1/7.34 21/45.78 17/32.70 18/30.64 16/16.83 1/11.98 19 20 110 189 94 . 112 91 30 155 85 106 12Q 80** 57** 78 95 16 35 124 0 54* 56 0 71 82 21 0 15 49** 56** 63** 102 9 7128 77846 1077 1078 TABLE 7 OBSERVED DEATHS/EXPECTED DEATHS AND STANDARDIZED MORTALITY RATIOS IN VINYL CHLORIDE WORKERS, BY ESTIMATED LEVEL C? EXPOSURE Cause of death wirh I.C.D. number EX <1. 5 obs/exp SMR1 Elil.5 obs/exp SMpA All causes 188/270.33 70** 157/195.68 80** Tuberculosis (001-019) Tuberculosis of respiratory system (001-008) Malignant neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Ma'lgnant neoplasms, urinary organs (180-181) Malignant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203, 205) Diabetes mellitus (260) Major cardiovascular and renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting CSS (330-334) Rheumatic fever & chronic rheumatic heart dis. (400-402, 410-416) Arteriosclerotic heart disease (420) Nonrheumatic endocarditis (421, 422) Hypertensive heart disease (440-443) Other hypertensive disease (444-447) Chronic & unspecified nephritis & renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of stomach and duodenum (540, 541) Appendicitis (550-*53) Hernia and Intestinal obstruction (560, 561, 570) Gastritis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hyperplasia of prostate (610) Symptoms, senility and ill-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (810-835) Other accidents (800-802, 840-962) Suicide (963, 970-979) Homicide (964, 980-985) 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 1/3.48 5/3.65 84/120.11 7/14.42 3/3.98 68/78.94 0/4.20 1/5.48 1/1.52 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 11/17.83 9/9.73 0/6.98 0 0 90 330 60* 86 93 51 146 49 31 146 75** 52** 80 92 0 19 70 0 92 48 0. 0 0. 23 0 0 68* 45** 66* 98 0 0/2.33 0/2.1841/32.67 b/l.il 12/9.14 13/.10.28 1/1.43 0/1.52 8/4,52 2/1.57 5/2.54 2/2.65 69/86.99 6/10.06 2/2.85 51/58.05 1/2.89 2/3.86 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 0 134 0 141 135 75 0 190 136 212 81 85* 64 75 95 38 56 201 0 0 68 0 171. 196 16 0 34 41** 72 i 50** 107 21 Humber of workers 4032 3057 Person-year 45354 ___________ 32108 4? 1 SHR's adjusted for deaths vlth cause unknown. *Sign! leant at 5% level. See Table 11. *Signlleant at IX level. May l> 1974 1 i % s k-fc o *<s CD TABLE 8 OBSERVED DEAT1TS/BXPECTED DEATHS AND ST.tND.iRDIZED MORTALITY- RATIOS IN VINYL CHLORIDE WORKERS BY DURATION 0? EXPOSED EMPLOYMENT Cause of death with I.C.D. number All caures Tuberculosis (001-019) Tuberculosis of respiratory system (001-008) M&llgnant neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) .lallgnant neoplasms, digestive organs and peritoneum (.50-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Malignant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203, 205) Diabetes mellltus (260) Hajor cardiovascular and renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting CMS (330-334) Rheumatic fever & chronic rheumatic heart dis. (400-402, 410-416) Arteriosclerotic heart disease (420) Nonrheumatic endocarditis (421, 422) hypertensive heart disease (440-443) Other hypertensive disease (444-447) <3ironlc & unspecified nephritis & renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of stomach and duodenum (540,541) Appendicitis (550-553) Hernia and Intestinal obstruction (560, 561, 570) Gastritis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hyperplasia of proatate (610) Symptoms, senility and 111-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (810-835) Other accidents (800-802, 840-962) Suicide (963, 970-979) Homicide (964, 980-985) Number of workers Person-years ^SMR's adjusted Cor deaths with cause unknown. ^Significant at 51 level. ^Significant at It level. See Table 11. May 2, 1974 <60 months obs/exp SMR* 94/140.53 67** 0/2.23 0/2.07 13/19.96 4/0.70 2/5.26 3/5.52 0/0.99 0/0.83 2/3.40 1/1.25 1/3.01 2/' .80 28/jl.45 4/5.97 2/2.39 21/32.54 0/1.79 1/2.42 0/0.79 0/1.55 3/2.93 1/1.07 0/0.24 0/0.42 1/0.40 1/4.49 0/0.07 1/2.28 4/11.07 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** . 81 101 78* 0 49 0 0 123 112 0 0 301 26 0 53 40 75 65* 114 20 2955 34201 ^60 months obs/exp SKSt* 251/329.30 76** 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 98/105.39 1/5.35 2/7.01 3/1.81 0/2.76 2/7.05 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 37 187 81 126 113 81** 49** 68 96 20 30 170 0 29 37 0 93 0 18 0 0 63* 43** 58* 100 0 4134 43240 f s& TABLE 9 OBSERVES DEATHS/EXPECTS9 DEATHS AND STANDARDIZED MORTALITY RATIOS IN VINYL CHLORIDE WORKERS WITH EXPOSURE INDICES BELOW 1.5, BY DURATION OF EXPOSED EMPLOYMENT Cause of death with I.C.D. number *60 months e xposure 260 months exposure obs/exp 5 MR1 obs/exp SMB* All causes 56/89.23 63** 132/181.28 73** Tuberculosis (001-019) Tuberculosis of respiratory system (001-008) Malignant neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Malignant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203,205) Diabetes mellltus (260) Major cardiovascular ant' renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting CNS (330-334) Rheumatic fever & chronic rheumatic heart dis. (400-402, 410-416) Arteriosclerotic heart disease (420) Nonrheumatic endocarditis (421, 422) Hypertensive heart disease (440-443) Other hypertensive disease (444-447) Chronic & unspecified nephritis & renal sclerosis (592-594) Influenza and pneumonia (480-493) Ulcer of stomach and duodenum (540, 541) Appendicitis (550-553) Hernia and Intestinal obstruction (560, 561, 570) Gastritis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hyperplasia of prostate (610) Symptoms, senility and ill-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (810-835) Other accidents (800-802, 840-962) Suicide (963, 970-979) Homicide (964, 980-985) 0/1.41 0/1.31 8/12.86 4/0.45 1/3.43 2/3.58 0/0.6C 0/0.55 1/0.97 0/0.79 0/1.26 2/1.15 21/33.38 2/3.93 2/1.50 16/21.14 0/1.18 1/1.58 0/0,50 0/0.97 3/1.86 0/0.68 0/0.15 0/0.27 0/0.26 1/2.80 0/0.05 0/1.43 4/7.45 3/9.87 3/7.98 3/4.08 0/3.55 0 0 73 1036 34 6* 0 0 120 0 0 203 73** 59 155 68 0 74 0 0 188 0 0 0 0 42 0 0 63 35 44 86 0 0/1.97 0/1.85 29/31.46 1/1.17 '6/9.08 9/10.00 2/1.62 1/1.53 8/4.43 1/1.40 1/2.23 3/2.50 03/86.82 5/10.51 1/2.2 9 52/0*.87 ' -0/J.O2 0/3.90 1/1.02 0/1.53 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 8/9.85 6/5.66 0/3.43 0 0 95 89 68 93 127 67 187 73 46 124 75** 49* 41 93 0. 0 101 0 53 67 0 0 0 16 0 0 79 56 83 109 0 Its is* Number of workers Person-years 1715 21418 2317 23920 O- *SMR's adjusted Tor deaths with cause unknown. See table 11. ^Significant at 5% level. ^Significant at IK level. o CO May 2, 1974 o TABLE 10 OBSERVED DEATHS/EXPECTED DEATHS i HD STANDARDIZED MORTALITY RATIOS IN VINYL CHLORIDE WORKERS WITH EXPOSURE INDICES OF 1.5 OR GREATER, BY DURATION OF EXPOSED EttPLOYMENT Cause of death with I.C.D. number <60 monthi exposure 260 months exposure obs/exp SMR1 ohs/exp SKR1 All causes 38/47.93 79 119/147.81 81* Tuberculosis (001-019) Tuberculosis of resporatory system (001-008) Malignant neoplasms (140-205) Malignant neoplasms, buccal cavity and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Malignant neoplasms, other and unspecified sites (190-199) Leukemia and aleukemia (204) Lymphosarcoma, lymphatic and hematopoietic tissues (200-203, 205) Diabetes mellltus (260) Major cardiovascular and renal diseases (330-334, 400-468, 592-594) Vascular lesions affecting CHS (330-334) Rheumatic fever & chronic rheumatic heart dis. (400-402, 410-416) Arteriosclerotic heart disease (420) Nonrheumatic endocarditis (42L, 422) Hypertensive heart disease (440-443) Other hypertensive disease (444-447) Chronic 6 unspecified nephritis & renal sclerosis (592-594) Influenza and pneumonia (480-493) 'ilcer of stomach and duodenum (540, 541) Appendicitis (550-553) Hernia and intestinal obstruction (560, 561, 570) Gastritis, duodenitis, enteritis and colitis (543, 571, 572) Cirrhosis of liver (581) Hyperplasia of prostate (610) Symptoms, senility and ill-defined conditions (780-795) All other diseases (residual) Motor vehicle accidents (810-835) Other accidents (800-802, 840-962) Suicide (963, 970-979) Homicide (964, 980-985) 0/0.76 0/0.71 5/6.57 0/0.23 I/L.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 1/0.35 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 0 76 71 0 0 107 288 178 0 54** 135 0 61* 0 0 0 0 0 362 0 0 904 0 0 158 0 146 107 158 58 0/1.57 0/1.48 36/26.11 0/0.9911/7:47 12/8.50 1/1.41 0/1 26 7/3.51 1/1.13 4/1.84 ' 2/2.04 62/70.46 4/8.19 ' 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 0/0.41 1/5.08 0/0.13 0/2.30 6/11.88 2/7.43 2/7.96 4/4.62 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 Number of workers Person-years 1240 12828 1817 19305 '*S ISMR's adjusted for deaths with cause unknown. See Table 11. n. ^Significant at 51 level. ^Significant at 11 level. May 2, 1974 1 I J 1081 . Table 11 Distribution of Deaths by Exposure Category and by Whether Cause of Death Was Determined, and Correction Factors Used for SMR Calculations Total* Exposure Index <1.5 21.5 Exposure Categori es Total Exposure Exposure Index and Total Exposure Time In Months in Months <60 2.60 <1.5 <1.5 21.5- .2 1.5 & <60 & 260 & <60 & >60 All causes 352 183 157 94 251 56 132 38' 119 Cause known 328 176 146 78 244 Cause unknown 24 12 11 16 7 48 128 84 30 8' 116 3 Percent increase 7.3 In SMR's 6.8 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. May 2, 1974 yW 1082 --uu7r"'- -^rL'umy i.i. i. .I. saggas^ Table 12 Results of Follow-up in Several Occupational Groups Study Population Number Years of SMR Observed Observation All causes Reference Asbestos building product workers 12,402 1951-1963 Enterlino & 89 Kendrick, 1967 Asbestos friction material workers 7,510 II Enterline & 89 Kendrick, 1967 Asbestos textile plant workers 1,843 ft Enterline & 121 Kendrick, 1967 Cotton textile workers 6,281 II Enterline & 88 Kendrick, 1967 White underground uranium miners 3,414 1950-1967 Lundin et al, 159 1969 Steelworkers 59,072 1953-1961 82 Lloyd 6 Ciocco, 1969 Asbestos insulation workers > 20 years 250 1946-1965 Tabershaw et al, 140 1970 Coke oven workers Asbestos maintenance service, etc. 4,661 438 1951-1966 1941-1969 98 Richmond et al, 1972 Enterline et 124 al, 1972 Asbestos insulation workers > 20 years 370 Asbestos insulation workers 17,800 Uranium mill workers 662 Lead smelter workers 2,352 Lead battery plant workers 4,680 Petroleum refinery workers 18,916 1963-1971 1967-1971 1950-1967 1946-1970 1946-1970 1962-1971 Hammond & 198 Selikoff, 1972 Hammond a 136 Selikoff, 1972 99 Archer et al, 1973 107 TCA, Inc., unpublished 99 TCA, Inc., unpublished 68 TCA, Inc., unpublished Hay 3, 1974 '-otW 1083 Tab It 13 Angiosarcoma Deaths In VCM Epidemiology Study Population Study Wo. 4250 4255 5765 7303 7375 7385 Age at Death 54 60 45 38 52 43 Mos. Exposed Cause as Given Autopsy 203 Cirrhosis of liver (sev. weeks) yes 281 Bleeding from hepatoma (3 days) ' yes (Laennecs cirrhosis) 167 Angiosarcoma rt. lobe of liver yes (10 mos.) 174 Liver failure (l mo.) - Cancer of liver, primary (15 mos.) 238 Cardiac tampunade and massive left hemothorax (mins.) Widely metastatic angiosarcoma of liver (4 mos.) 214 Hepatic failure Primary carcinoma liver yes April 15, 1974 "6- V80T Table 14 Other Malignancies (190-19''*, I.C.D.) in VCM Epidemiology Study Population Study No. 2744 3700 2096 3946 4433 4800 7279 7300 7371 7306 5769 Age at Death 38 48 67 43 54 61 57 44 58 53 S2 Mos. Expose'! Cause as Given Autopsy- 186 Widespread metastatic melanoma yes (1 yr.) Malignant melanoma of back 50 Malignant melanoma with widespread no metastases 69 Brain tumor (carcinoma) (8 mos.) - 64 Meningitis and pneumonitis (5 wks.) no Ependymoma, fourth ventricle-brain (2 mos. post-op craniotomy!' 81 Astrocytoma, malignant-left cerebral . yes hemisphere (1 yr.) 51 Carcinoma of the brain no Arteriosclerosis Pneumonia due to static congestion 271 Brain tumor, glioblasti. multiforme (18 mos.) 211 Brain tumor, malignant (2 mos. ) - 249 Brain tumor, malignant no 216 Thyroid carcinoma with metartases no 239 Carcinomatosis Carcinoma vertebral body yes O GO CA 1 'J 1086 Table 14 Other Malignancies (con;.) Study No. Age at Death 5246 67 2850 64 Mos. Exposed 201 193 Cause as Given Autopsy Liposarcoma with metastasis (3 mos.) yes Carcinomatosis, primary region not known (Past history, rheumatoid arthritis, myocardial infarction) no 4778 54 300 Cardiac arrest (l hr.) Respiratory arrest and cerebral hypoxia (2 days) Widespread metastatic carcinoma (2 mos.) 4786 61 318 Generalized metastasis undiffer- 'yes entiated (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 3>V* Table 15 Malignant Neoplasms of Buccal Cavity and Tharynx (140-148, I.C.D.) in VCM Epidemiology Study Population Study No. 3003 3431 3001 7365 3354 Age at Death 31 56 57 54 63 Mos, Exposed Cause as Given Autopsy 49 Carcinoma of lip with metastasis . no to lung and neck (5 yrs.) 30 Pulmonary edema (50'min.) no Pulmonary metastases (Carcinoma, epidermoid, tongue and mandible) 71 Metastatic squamous cell ca. - * yes primary lesion palate 40 Atelectasis due to metastasis to ' yes mediastinum (4 mos.) Multiple malignant metastases to brain, liver & mediastinum (1 yr.]) Adeno-carcinoma of nasal pharynx (2 yrs.) 26 Massive hemorrhage into tracheo- yes tree Status post laryngo-pharyngectomy, left radial neck dissection Well-dif ferentiated kerat inii ir.g squamous cell carcinoma of left pyriform sinus (mos.) April 15, 1974 \W 1087 *11 nu 5TATUS UNKi-lOWN rOLLOWUP 1 /ITAiL h* STATUS S :nown FIGURE I i&jgZ5gB8gilBL. r' --^7^j.-^^n"iFfflifrinft ii>~rih r--L* ftrVi'ijr'^-'1--'-*- *,n 2& Manufacturing Chemists Association VCM Epidemiology Study Parent Corporation _____________________________________ Plant Designation Address _________________________________________________ Telephone _J______ \-ext. TABERSHAW-COOPER ASSOCIATES' CONTACT FOR SUBJECT STUDY: Name Title Mailing Address Street Address (please identify with sufficient precision to serve as a taxi-driver's instruction) Telephone _J______ )_ Signed Name Title Company Address Telephone ______ )___________________ axt. ? 08^ "WHB*CSAST&!MTI)'m? Sv UHt ,iuissdSaK Tabershaw-Cooper Associates, Inc. 2180 Milvla St., Suite 104 Berkeley, California 94704 Manufacturing Chemists 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's 4. Please answer the appropriate one of the following questions about your retirement plan. a. No retirement plan b. 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 dii>d? c. for those who quit or were discharged? d. for those who died while employed? iT*r a nin/TMi* a ,y. BgyBBSBEZSl^ :>-.: TWAUM**;g'^flMmBUHgaillLlB images Tabershaw-Cooper Associates, Inc. page 2 6. Do the personnel records which are retained contain a record of job titles and dates of job title changes for the individual concerned? 7. Please list the job titles in the current work force which involve some exposure to vinyl chloride. ATTACHMENT B (cont.) VCM Epidemiological Study - Individual Work History Form B - Workers known to 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 date) 8. If death certificate is not available, please give name of worker so that death certificate can be obtained. No contact will be made with relatives or attending physician. Job no. Job history with estimated exposure Title 1 2 3 4 5from 6 7 from _______ to from to ________ from to from _____ to _________ to from . to _________ from ______ to Check estimated exposure in ppm *50 50-199 200-500 >500