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FILE NAME Talc TALC DATE 1979 DOC TALC019 DOCUMENT DESCRIPTION Conference Presentation - Mortality Patterns Among Miners and Millers Occupationally Exposed to Asbestiform Talc of NorthCarolina ,Chapel Hill PATHOTOX PUBLISHERS INC : an 2405 BOND STREET SESSION III EXPOSURES AND HEALTH EFFECTS OF ASBESTOS MINERALS ..... MORTALITY PATTERNS 1940-1975 AMONG WORKERS EMPLOYED IN AN ASBESTOS TEXTILE FRICTION AND PACKING PRODUCTS MANUFACTURING FACILITY Cynthia Robinson Richard Lemen Joseph K. Wagoner . HOUSEHOLD EXPOSURE TO ASBESTOS AND RISK OF SUBSEQUENT DISEASE Henry Anderson Ruth Lilis Susan Daum Alf Fischbein Irving J. Selikoff 2.0... 2... cece ect eeenes ASBESTOS AND LUNG CANCER AN ANALYSIS OF THE EPIDEMIOLOGICAL EVIDENCE ON THE ASBESTOS INTERACTION Ne R. Saracci 2... ce ence ene eee nee eees OVERVIEW OF RESEARCH ON MECHANISMS BY WHICH ASBESTOS COULD ENTER DRINKING WATER William Hallenbeck and Carolyn Hesse .. OCCUPATIONAL INDOOR ASBESTOS POLLUTION Robert N. Sawyer .... 0... cece cece cece cence ete e ee .175 .175 MONITORING AND MEASURING AIRBORNE CONCENTRATIONS OF ASBESTOS FIBERS Gerald R. Chase ....... 0.0 ccc ccc ccc cece tence .181 .181 UNBIASED ESTIMATES OF COEFFICIENTS OF VARIATION FOR ASBESTOS COUNTING DETERMINED FROM MANVILLE DATA Kenneth A. Busch Richard W. Hornung Randall J. Smith Nelson A. Leidel .1 00.0 c c8 cc cece cccc ee5 .185 .185 DISCUSSION OF SESSION III Moderator Irving Selikoff .. cc1 cece cece9 eee eee9 ..199 SESSION IV EXPOSURES AND HEALTH EFFECTS OF INORGANIC SYNTHETIC FIBERS AND FIBROUS MINERALS .221.221 ENVIRONMENT AND MORTALITY OF WORKERS FROM A FIBROUS GLASS PLANT Philip E. Enterline and Gary M. Marsh ..221 A PRELIMINARY REPORT OF THE MORTALITY PATTERNS AND OCCUPATIONAL EXPOSURES OF A COHORT OF MINERAL WOOL PRODUCTION WORKERS Gregory Olaf Ness John M. Dement Richard J. Waxweiler Joseph K. Wagoner 0c ccccece nev ene .233 RESPIRATORY MORBIDITY OF WORKERS EXPOSED TO WOLLASTONITE THROUGH MINING AND MILLING D. Michael Shasby Martin Petersen Thomas Hodous Brian Boehlecke James Merchant ccc ene .25 .2 1 51 SESSION V TALCS CONTAMINATED WITH OTHER MINERALS ................... CHARACTERIZATION OF CLEAVAGE FRAGMENTS AND ASBESTIFORM AMPHIBOLE PARTICULATES William J. Campbell Eric B. Steel Robert L. Virta Michael H. Eisner 0... c cee eee eee eee neee .........0.0...0 OCCUPATIONAL EXPOSURES TO TALCS CONTAINING ASBESTIFORM MINERALS John M. Dement and Ralph D. Zumwalde .. 000s RESPIRATORY MORBIDITY AMONG MINERS AND MILLERS OF ASBESTIFORM TALC John Gamble William Fellner Michael J. DiMeo ............... MORTALITY PATTERNS AMONG MINERS AND MILLERS OCCUPATIONALLY EXPOSED TO ASBESTIFORM TALC David P. Brown John M. Dement Joseph K. Wagoner ......... STOMACH CANCER AMONG RUBBER WORKERS AN EPIDEMIOLOGIC INVESTIGATION Steve Blum Earl W. Arp Jr. Allen H. Smith Herman A. Tyroler ... 325 BIOLOGIC TESTS OF TREMOLITE IN HAMSTERS William E. Smith Doras D. Hubert Harold J. Sobel Eugene Marquet ... 0... cece cee eee cee tee te rene eee DISCUSSION OF SESSION V Moderator Richard Lemen cece cece cere eneeee ............... SESSION VI FIBROUS TALC ....... 0. cee eee eee MORTALITY AND MORBIDITY OF TALC MINERS AND MILLERS IN ITALY G.F. Rubino G. Scansetti G. Piolatto G. Gay .... OCCUPATIONAL EXPOSURES TO ASBESTIFORM TALC IN VERMONT Maryanne G. Boundy Karen Gold Kenneth P. Martin Jr. William A. Burgess John M. Dement 0.2 cece eee eee ........... MORTALITY PATTERNS AMONG MINERS AND MILLERS OF ASBESTIFORM TALC PRELIMINARY REPORT Sherry G. Selevan and John M. Dement Joseph K. Wagoner John R. Froines 00 ccc eee eee ence n anes AN ANIMAL MODEL FOR INHALATION EXPOSURE TO TALC J.C. Wagner G. Berry R.J. Hill J.W. Skidmore F.D. Pooley ....... FIBROUS MINERAL CONTENT OF CONSUMER CONTAINING PRODUCTS A.N. Rohl and A.M. Langer 0-0 ccece eee eens ........... DISCUSSION OF SESSION VI Moderator Donald Spatz . 22.2... eee eee tc er ccc ceeeenee 316 : GAMBLE ET AL Kleinfeld M. Diel C.P. Majeranowski J.F. and Messite .: Talc Pneumoconiosis Arch Env Hlth 7 107 1963 Kleinfeld M. Messite J. Shapiro J. Kooyman O. and Swencicki R Lung function in talc workers Arch Env Hlth 9 559 1964 Kleinfeld M. Messite J. Shapiro J. and Swencicki R Effect of talc dust inhalation on lung function Arch Env Hith 10 431 1965 Langlands J.H.M. Wallace W.F.M. and Simpson M.J.D Insulation workers in Belfast.2 in men still at work Brit J. Ind Med 28 217 1971 Leophante P. et al Les pneumoconioses par le talc Rev. Fran Malach Resp 3 363 1975 Morgan W.K.C. and Seaton A Occupational Lung Diseases W.K. Saunders Co. Philadelphia 1975 Muldoon B.C. and Warwick M Lung function studies in asbestos workers Brit J. Dis Chest 66 121 1972 Parkes W.R Occupational Lung Disorders Butterworths London 1974 Selikoff I.J The occurrence of pleural calcification among asbestos insulation workers Annals NY Acad Sci 351 1965 Sheers G. and Templeton A.R Effects of asbestos in dockyard workers Brit Med J. 574 1968 Solomon A Radiology of Asbestosis Env Res 3 320 1970 Soutar C.A. Simon G. and Warwick M The radiology of asbestos disease of the lungs Brit J. Dis Chest 68 235 1974 Thomson M.L. Pelzer A. and Smithe W.J The discriminant value of pulmonary function tests in asbestosis Ann N.Y. Acad Sci 132 421 1965 MORTALITY PATTERNS AMONG MINERS AND MILLERS OCCUPATIONALLY EXPOSED TO ASBESTIFORM TALC David P. Brown John M. Dement U.S. Department of Health Education and Welfare Public Health Service Center for Disease Control National Institute for Occupational Safety and Health Division of Surveillance Hazard Evaluations and Field Studies Industry Studies Branch Cincinnati Ohio 45226 Joseph K. Wagoner U.S. Department of Labor Occupational Safety and Health Administration Office of the Assistant Secretary Washington D.C. 20210 INTRODUCTION The term talc in the mineralogical sense denotes a specific forming mineral of the sheet silicate category however talc when referenced in the industrial or commercial setting may represent a varied mixture of associated minerals with similar physical properties as the mineral talc Rohl et al 1976 Minerals commonly found associated with the talc include calcite quartz diopside magnesite serpentines chrysotile antigorite and lizardite and fibrous and nonfibrous amphiboles tremolite anthophyllite and actinolite Rohl et al 1976 Stemple and Brindley 1960 Few studies however have been undertaken which adequately characterize the various minerals to which talc workers are exposed and simultaneously delineate the latent disease manifestations associated with those work environments Recognizing the need for additional research with regard to health hazards from industrial talc exposure the National Institute for Occupational Safety and Health NIOSH has undertaken an industrywide program to study the talc mining and milling industry for two different geographic areas New York State fibrous talc and Vermont fibrous talc This program included detailed industrial hygiene studies to characterize the various agents to which workers have been exposed sectional medical surveys to evaluate respiratory impairment and retrospective cohort studies to evaluate latent disease patterns among workers having been exposed to talc in the work environment The present report will restrict itself to an investigation of fibrous talc as mined and milled in the Gouverneur Talc District of upper New York State This talc mining district located in St. Lawrence County represents a complex association of amphiboles anthophyllite tremolite etc. talc quartz and serpentines Ross 1974 Previous studies by Kleinfeld et al 1967 1974 of asbestiform talc miners and millers in this district have demonstrated a significantly increased proportionate mortality due to both malignant and malignant respiratory diseases One company mining talcs in this district maintains that these studies are not appropriate with regard to all talcs in the Gouverneur Talc District This company has stated that talcs extracted from its original mine in the Gouverneur Talc District did not contain asbestiform minerals and has socertified these talcs as such In contrast however Kleinfeld et al 1973 demonstrated the presence of asbestiform tremolite and anthophyllite in talc extracted from this mine To address this contradiction the present study was restricted to that one mine and mill reported to be exploiting 318 BROWN AL The talc mine and mill chosen for this study began operations in the Gouverneur Talc District of upper New York State in 1947. Talcs extracted from this mine are used for a variety of applications including ceramincs pottery artware electrical insulators ceramic tile glaze and flux paint fillers in putties and in spackling compounds METHODS A retrospective cohort study was initiated to determine whether workers who have been employed at this mine and mill have experienced any unusual mortality patterns The study cohort was defined as all white males initially employed sometime between January 1 1947 and December 31 1959. This cutoff date was selected to allow for a sufficient latent period for any development of chronic disease An effort was made to determine the vital status of each individual in the cohort as of June 30 1975 and person at risk and duration of employment were accumulated until this date Vital status was determined through records maintained by Federal and State agencies including the Social Security Administration state vital statistics offices and state motor vehicle registration For those individuals who could not be located through these sources U.S. Postal Mail Correction Services and other follow searches were used For all those who were known to be deceased death certificates were re- quested and causes of death were interpreted by a qualified nosologist according to the International Classification of Diseases ICD Codes in effect at the time of death and then converted to the 7th Revision of the ICD Codes A modified life table technique was used to obtain person at risk of dying by five year calendar time periods by five year age groups by duration of employment and by number of years since initial employment at the talc company Comparison was made between the observed number of deaths among the study cohort and the number expected for this population using age calendar time cause specific mortality rates of the U.S. TABLE 1. Vital Status of 398 Talc Workers Employed Between 1947-1960 Known to be Alive Known to be Deceased Unknown Vital Status 308 77 74 19 16 % Total 398 general white male population The vital status of 96 of the cohort was confirmed Table ) Those with an unknown vital status are assumed to be alive as of June 30 1975 so as not to overestimate the true risk of mortality associated with exposure to talc ' Those cohort members where racial status was unknown were considered white for purposes of the MORTALITY PATTERNS AMONG MINERS 319 RESULTS A total of 398 workers meeting the study cohort definition generated 8,733 person years at risk of dying Fifty percent of the workers were employed less than one year while less than twenty percent were emplyed for ten years or more Tables 2 and 3 illustrate the distribution of the study population by duration of employment and by date of initial employment TABLE 2. Study of Cohort of Taic Workers According to Length of Employment Duration of Employment Number < month 1 month - 6 months 6 months - 12 months 1 year - 10 years 10 years Total 74 % 97 24 31 % 90 23 106 27 398 TABLE 3. Study Cohort of Talc Workers According to Date of Initial Employment Date of Initial Employment Number ee est 1947-1949 1947-1949 1947-1949 1950 - 1954 174 44 156 39 1955-1951995-195 1955-1959 68 17 Total 398 Tables 4 and 4a summarize the deaths observed from the study cohort and those expected based on death rates for the U.S. whilte male population Although the overall observed mortality is higher than expected this difference is not statistically significant However several specific causes of death exhibit increased mortality The standardized mortality ration SMR is significantly elevated for the cause of 320 BROWN TABLE 4. Observed and Expected Deaths According to Major Cause Among Talc Miners and Millers Cause of Death Respiratory T.B. Malignant Neoplasms Diseases of the Heart All Malignant Respiratory Disease Accidents Other Known Causes Number 001-008 140-205 400-443 470-493 E800 a Observed 3.0 19.0 27.0 8.0 10.0 7.0 Expected 0.49 10.6 26.5 2.9 6.4 14.4 SMR 610,, 180,, 102 277 156 - Total 0.05 0.01 74.0 61.3 120 TABLE 4a Observed and Expected Deaths According to Specific Cause Among Talc Miners and Millers _ Cause of Death Malignant Neoplasms Digestive System Respiratory System Bronchogenic Lymphatic and Hematopoietic Other Neoplasms All malignant Respiratory Disease Influenza Pneumonia Bronchitis and Acute Upper Respiratory Infection Other malignant Respiratory Disease Number 140-205 150-159 160-164 162-163 200-205 --- 470-527 Observed 19.0 3.0 10.0 9.0 4.0 2.0 8.0 Expected 10.6 3.0 3.5 3.3 1.2 2.9 SMR 180" 100 290" 270,, 330 69 2.9 280 470-502 3.0 510-527 5.0 1.5 200 1.3 380 0.05 0.01 death category all malignant neoplasms which is partly due to the significant increase in bronchogenic cancer 9 obs vs. 3.3 exp 0.05 Other statistically significant increases for specific causes of death occurred in the categories non- malignant respiratory disease other than influenza pneumonia hronchitic and MORTALITY PATTERNS AMONG MINERS 321 T.B. 3 obs vs. 0.49 exp 0.05 - two of which mention occupational disease of the lung and lymphatic and hematopoietic diseases 5 obs vs. 1.3 exp 0.05 One case of mesothelioma was observed Table 5 demonstrates the association between bronchogenic cancer and inter- val since initial date of employment latency As seen there is an increasing risk of bronchogenic cancer with increasing latency a trend consistent with an occupational etiology In addition the deaths due to bronchogenic cancer have an average latency of 20 years a period previously observed for a population occupationally exposed to anthophyllite and other minerals Kiviluoto and Meurman 1969 Meurman et al 1974 Nurminen 1962 TABLE 5. Bronchogenic Cancer Among Talc Miners and Millers According to Interval Since Onset of Employment Latency Interval Since Onset of Employment Years Observed Expected _ SMR ; 10 10-19 20-28 Total 03 0.5 03 1.5 200 1.3 460 9 3.3 270 0.01 Three additional deaths due to bronchogenic cancer are known to have occur- red among study members However these deaths occurred shortly after the cutoff date 6/30/75 for analysis and therefore were not included as observed deaths One individual worked for 17 continuous years at the talc company under study and died at the age of 50. The latency period was 24 years Another individual who worked for 2 months at the talc company died at the age of 54. The latency period was 27 years The third lung cancer death was that of a worker employed for 12 years at the company under study and 12 years previously at another New York talc company He died at the age of 59 and had a latency period of 23 years At least three cases of malignant respiratory disease among study cohort members are known to have been reported to the New York State Workmen's Compensation Board These individuals filed workmen's compensation claims for 1 pneumoconiosis chronic bronchitis 2 talcosis pulmonary fibrosis These individuals worked at the talc company under study for 18 years 18 years and 25 322 BROWN AL DISCUSSION The results of the present study demonstrate an excessive risk of mortality due to both lung cancer and malignant respiratory disease among a cohort of talc workers occupationally exposed to asbestiform tremolite anthophyllite and little free silica However several possible confounding factors must be taken into consideration before one can attribute these observed mortality patterns to occupational exposure received at this talc mine and mill One such factor that has been shown to be correlated with the causation of lung cancer is cigarette smoking The smoking patterns are largely unknown for this cohort as is the case with most retrospective studies However it has been estimated that in a heavy smoking worker population smoking by itself would increase the expected lung cancer mortality risk by no more than 49 Lundin et al 1971 Thus cigarette smoking is unlikely perse to account for the increased bronchogenic cancer risk observed among these talc miners and millers Another factor to be considered is other occupational exposure among cohort members resulting from prior employment Several of these individuals worked at other New York State talc companies located in the Gouverneur Talc District Due to these considerations an industrial hygiene analysis was carried out to compare the make of talcs in neighboring mines These comparisons are given in Table 6. The analysis of amphibole fiber exposure characteristics between the talc operations acknowledged to have asbestiform talc and the mine and mill under study showed them to be substantially the same Thus while exposure levels in other talc companies may have been higher all operations involve exposures to asbestiform TABLE 6. Comparison of Airborne Fiber Characteristics in Study Mine and Mill Operations with New York Talc Operations Acknowledged as Containing Asbestiform Minerals Airborne Fiber Characteristic Proportion Positive Asbestiform Mine and Mill 0.50 Study Mine and Mill 0.58 Proportion Anthophyllite Proportion Tremolite Median Fiber Length Anthophyllite Tremolite Median Fiber Diameter 0.47 0.03 1.61 ... 1 0.45 0.13 1.45 ...m 1.55 ...m Anthophyllite Tremolite Median Fiber Aspect Ration 0.16 ... i 0.13 ...m 0.19...m 0.19...m Anthophyllite Tremolite 9.9 9.5 1 7.5 % of Fiber < ...min Length Anthophyllite Anthophyllite Tremolite 92 90-92 1 97 Insufficient number of fibers observed for calculation of size distribution parameters C AL ... sit 4:48 bane Statistical Significance 0.05 NS2 0.001 21 21 NS 1 NS 1 NS | MORTALITY PATTERNS AMONG MINERS 323 amphiboles with similar fiber characteristics These operations when measured in 1975 were shown to have fiber exposures far in excess of established OSHA asbestos standards Thus exposures to asbestiform tremolite and anthophyllite stand out as the prime etiologic factors associated with the observed increase in bronchogenic cancer and nonmalignant respiratory disease among this study cohort Of interest is the fact that four of ten deaths due to bronchogenic cancer in this cohort were employed less than one year in the operations under study and only two of these cases are known to have previous exposures to talcs containing asbestiform minerals One of the two was employed in such operations less than six months Although this cohort is relatively small to assess actual risk due to these particular exposures it may be plausible that brief periods of exposure to elevated concentrations of asbestiform minerals may be associated with an increased bron- chogenic cancer risk Such an observation has previously been reported Seidman et al 1976 One death due to mesothelioma is known to have occurred in the study population This individual worked for 16 years in the talc operation and had 11 years previous employment in construction work Without full knowledge of this individual's exposure as a construction worker it is difficult to arrive at any conclusions regarding the etiologic role of talc exposure from this mine and mill for this case Although previous studies Kiviluoto and Meurman 1969 Kleinfeld et al 1967 Kleinfeld et al 1974 Muerman et al 1974 Nurminen 1962 have not shown an association between exposure to asbestiform anthophyllite or tremolite and subsequent development of mesothelioma a more recent study in Turkey by Baris 1975 has demonstrated an apparent increased risk of developing mesothelioma among residents of a particular community exposed to asbestiform tremolite probably from their drinking water Therefore the possible association between exposure to asbestiform tremolite and the risk of developing mesothelioma should be further studied by continual follow of the talc workers included in this study CONCLUSIONS AND RECOMMENDATIONS A study of mortality patterns among miners and millers of talc containing asbestiform amphiboles tremolite and anthophyllite demonstrated excessive mortality due to malignant respiratory disease and bronchogenic cancer These results are in agreement with other studies of occupational groups exposed to the same or similar minerals or mineral mixtures Although several cohort members had periods of prior employment in neighboring talc operations all mines and mills including the operations under study have been shown to have similar fiber exposure characteristics It must therefore be concluded that exposures to talcs from the Gouverneur mining area are associated with an increased risk of bronchogenic cancer and malignant diseases of the respiratory system REFERENCES Baris Y.I Pleural Mesothelioma and Asbestos Pleurisies Due to Environmental Asbestos Exposure in an Pe n ER ar 1617 324 BROWN ET AL and Meurman Kiviluoto R. .: Results of Asbestos Exposure in Finland In International Conference on Pneumoconiosis Johannesburg 1969 pp 107-108 Mortality Miners in Kleinfeld M. M. Messite J. J. and KooymanKooyman .: O Mortality Among Talc Miners and MillMeirsllers New York State Arch Environ Health 14 663-667 1967 M. Messite Kleinfeld J. and Langer A.M A Study of Workers Exposed to Asbestiform Minerals in Commercial Talc Manufacture Environ Res 6 132-143 1973 . Experiences Kleinfeld M. M. Messite J. J. and Zaki H Mortality H Mortality Experiences Among Talc A WorkeFrosllFoolwlow Occup Med 16 5 345-349 1974 Study Lundin Quantitative Wagoner J.K. and Archer V.E Radon Daughter Exposure and Respiratory Cancer Quantitative and Temporal Aspects Report from the Epidemiologic Study of U.S.U.S. Uranium MinersMiners U.S. DHEW PHS Monograph No. 1 1971 Meurman L.O. Kiviluoto R. and Hakama M Mortality and Morbidity Among the Working Population of Anthophyllite Asbestos Mines in Finland Br J. Ind Med 31 105-112 1974 ,. Workers in Anthophyllite Nurminen M M A Study of the Mortality WorkersWorkers in an AnthophylAnthoplylite ite in Asbestos Factory Finland Finland Work Env Health 9 112-118 1962 A.N. Rohl Langer Chemical Characterization J. Health Consumer A.M. Selikoff I.J. Tordini A. Klimentidis R. Bowes D.R. and Skinner D.L D.L D.R. Chemical Characterization Environ Talcums and Powders MiMnienerraall and J. Toxical Environ 2 225-294 225-294 1976 M SReoisdsman GPreesntoedlLoigliys R. Presented at Asbestos and Health Environ Health Perspect 9 123-124 1974 and Selikoff 1.J Short Asbestos Exposure and Delayed Cancer Risk Prevntion the Third International Symposium on Detection and PreventionPrevPenrteivoenntion of Cancer New York May April 1976 Stemple , I.S. and Brindley G.W G.W A Structural Study Study of Talc and TremotiteTremotite Relations Relations J. Ceramic Ceramic Soc 43 1 34-42 January 1960 STOMACH CANCER AMONG RUBBER WORKERS AN EPIDEMIOLOGIC INVESTIGATION Steve BlumEarl W. Arp Jr. Allen H. Smith Herman A. Tyroler Occupational Health Studies Group Univ of North Carolina Chapel Hill North Carolina 27514 In 1970 the United Rubber Workers Union negotiated with the six major U.S. rubber companies for a comprehensive program of research into work related health problems The Occupational Health Studies Group OHSG at the University of North Carolina is conducting research within four of these companies Goodyear Firestone Uniroyal and General Our first efforts after initiation of the contract included numerous analyses designed to indicate whether mortality from specific disease entities or categories was occurring at expected or greater than expected frequencies Expected numbers are based on age race and sex comparable data for the general U.S. population - a population assumed to be nonexposed to the specific pollutants found within the environment of the rubber industry This procedure yields a ratio the Standardized Mortality Ratio or SMR of observed to expected numbers of deaths from the disease under investigation When the SMR is greater than 100 we are observing more deaths than expected while a deficit indicated by a ratio under 100 While we observed an overall deficit of deaths from all causes combined we nevertheless observed specific disease entities which occurred in excess among which was stomach cancer which appeared in excess in both companies studied thus far The present study is based on the experience of groups within these two companies referred to as Companies A and B whose combined cohorts numbered approximately 17,000 employees and included members of both sex and race groups To qualify for inclusion in the cohort employees must have been aged 40-84 as of 1 January 1964 and were permitted to be either active or retired at that years follow for the time Their mortality experience was recorded with about 98 year period ending 31 December 1973. As can be seen from Table , our initial findings among male production workers revealed excess of stomach cancer in both companies as the SMR's indicate Because of this consistently observed excess we decided to conduct an analytic study to help us determine whether these excesses were artifactual whether they were occupational in origin or whether the excess was due to occupational factors presumably involving exposure to known or suspect stomach carcinogens believed to have been present within the environment of the rubber industry Table ) Accordingly a control design was chosen for this investigation which involved a comparison of the occupational and occupational characteristics of the 100 cases and 400 appropriately matched controls with the analyses conducted separately for each of the companies within the study These 100 cases were comprised mostly of individuals whose death certificates indicated stomach cancer as the underlying cause of death although some appeared elsewhere on the death