Document ganN7Dymk3Y105xR5Z2pO2Z0a

FILE NAME: Asbestos Cement Pipe and Sheet (ACPS) DATE: 1994 Sept DOC#: ACPS037 DOCUMENT DESCRIPTION: Unpublished Conference Presentation - Mortality Study of Italian Workers Compensated for Asbestos 1980-1990 YsAJTM P l1 > H IO U 6 ^ M c o c o P a t i o *A i h c a i t h / t^^-yy l^o-X3> S-c|=*fcox-c t sy M P o sio H MORTALITY STUDY OF ITALIAN WORKERS COMPENSATED FOR ASBESTOSIS (1980-1990) Daniela Germni (l).Mario Grignoli (2).Stefano Belli (2).Pietro Maiozzi (2), Luigi Anibaldi (l).Ottavio Raparelli (1),Pietro Comba (2) (1) National Institute for Insurance of Occupational Accidents (IHA1L),Rome,Italy (2) flationai Institute of Health {IS5),Rome.Italy t 1 OBJECTIVES The purpose o f the present investigation is to study cause-specific mortality in a cohort of subjects com pensated for asbestosis . The rationale for this study can be sum m arized as follows. Even if the carcinogenic action of asbestos has been ascertained with regard to lung cancer and mesothelioma of pleura, peritoneum, pericardium and tunica vaginalis of testis, conflicting opinions exist about other cancer sites (Edelman 1992, Qarabrant et ai 1992, Homa et al 1994). The present cohort , which deals with sub jects certainely exposed to elevated concentrations of asbestos, can provide inform ation in this respect. Furthermore, it m ay be of interest to com pare the mortality pattern of asbestosic subjects from different industrial sectors, corresponding to different m odes of exposure to asbestos. Finally, this study may contribute to the very issu e o f the mortality experience o f a sb esto sic patients, which has been the o b ject o f so m e previous stu d ies in various countries and is currently being debated (B erryl981, C ookson et al 1 9 8 5 , Browne 1 9 8 6 , H ughes Weill 1991 ). METHODS The cohort included all subjects com pensated \ for asbestosis who were alive at 31.12.1979, altogether 3417 subjects ( 2 7 7 6 men and 641 women). The source of data was constituted by the files o f the Statistical Actuarial Service of iriAIL. Information available for every cohort m em ber included among else anagraphic data and branch of activity, which were abstracted. Vital status was ascertained at 3 0 ,6 .1 9 9 0 ; for deceased subjects, causes of death were obtained from the Registry office of the municipality where death had occurred. The subjects whose vital status was unknown at th e end of the study period were assumed to b e alive. Cause-specific mortality ratios, standardized j for age ( five-year bands ), sex and five-years \ calendar periods, were calculated using the j PC-OCMAP package ( Marsh et al 1986 ). The ; mortality rates of the Italian population were ! used as standard; two-sided 95% confidence . intervals ( 95% Cl ) of standardized mortality ratios ( SMR's ) were computed assuming a Poisson distribution; the exact method was u sed when observed death were fewer than 2 0 0 ; the chi-square approssimation was considered in the remaining cases. / ax reu de Pg: -.-i-ijr - i ; x i / V > y ^ ',.. /V /;> . Table 1 Distribution of cohort members b sex and branch of activity Asbestos-cement industry Textile industry Naval industry Insulators Others Total Men No. (%) 1298 159 369 '5 7 893 (4 6 .8 ) ( 5,7) (1 3 .3 ) ( 2.0) (3 2 .2 ) 2776 Women No. (%) 261 (40; 209 (32 1 ( 0 170 (26 641 x reu de : Pg: 6 i * - - Table 2 Mortality among asbestosic subjec (men) CAUSE OP DEATH OBS All causes 980, Infectious diseases 7 Cardiovascular diseases 223 All malignancies 380 Benign and unspecified tumours 0 Blood disorders 0 Respiratory diseases 184 Digestive diseases 46 Cirrhosis of the liver 33 Diseases of the genito-urinary tract 4 Psychological disorders 0 Diseases of the nervous system 3 Diabetes 5 Violence 32 111 defined and unknown 7 SMR 153 (* 201 84 (* 188 (* 361 (* 99 107 44 34 (* 31 <* 125 111 ! CAtfCER S IT E S Buccal cavity 8 Digestive tract 88 Esophagus 2 Stomach 24 Small intestine 2 Big intestine 14 Rectum 10 Liver . 14 Pancreas 8 Peritoneum 11 Respiratory tract 217 Nasal sinuses 0 Larinx 4 Bronchus and lungs 180 Pleura 27 Connective tissue 1 Melanoma 2 Skin 1 Prostate 11 Bladder . 13 Kidney 4 Nervous system 6 Thyroid 0 Lymphohaematopoietic tissue 10 Pg: 7 126 125 <*) 41 108 697 140 162 114 107 1344 <*) 297 <*) -- 59 281 (*) 2408 (*) 362 185 150 88 128 98 150 -- 88 lower limit of 95% Cl > 100 or upper limit of 95% Cl < 100 cix r e u d e ,; ' j*'. - - ^'Xy- pg: 8 Table 3 Mortality among asbestosic subjects (women) CAUSE OF DEATH . OBS All causes 154 Infectious diseases 0 Cardiovascular diseases 43 All malignancies . 58 Benign and unspecified tumours 0 Blood disorders 0 Respiratory-diseases 34 Digestive diseases 3 Cirrhosis of the liver 2 Diseases of the genito-urinary tract 3 Psychological disorders 0 Diseases of the nervous system 0 Diabetes 3 Violence 2 111 defined and unknown 1 SMR 151(*) -- -- 86 228 (*) -- -- 653 (*> 55 69 224 -- 55 59 49 4e$u de : . ' ,-v -c - . ... CANCER SITES '1. r. - i : . - . - Buccal cavity Digestive tract Esophagus Stomach Small intestine Big intestine Rectum Liver Pancreas . Peritoneum Respiratory tract Nasal sinuses Larynx Bronchus and lungs Pleura Connective tissue ' Melanoma Skin Breast 'Ovary Bladder Kidney Nervous system Thyroid Lymphohaematopoietic , tissue 0 17 0 1 2 7 1 0 2 3 , * 34 1 0 10 7 1 0 0 4 6 0 0 0 0 1 Pg: -- 163 -- 36 4652 (*) 371 (*) 104 -- 166 1481 (*) 653 (*) 5486 (*) -- 538 (*) 5967 (*) 1910 -- -- 89 545 (*) -- -- -- -- 55 (*) *= lower limit of 95% Cl > 100 or upper limit of 95% Cl < 100 . ^fax r e u d e ' t'g ia Table 4 Mortality among asbestosic subjects in asbestos-cement industry (Casale Monferrato plant) CAUSE OF DEATH All causes Respiratory diseases . All malignancies | MN of lung pleura peritoneum intestine and rectum ovary OBS SMR 248 154 (*) 49 409 (*) 124 258 (*) 50 381 (*) 19 7348 (*) 5 2192 (*) 8 189 3 844 (*) i Table 5 Mortality among asbestosic subject in asbestos-cement industry (other plants) CAUSE OF DEATH OBS SMR All causes Respiratory diseases All malignancies MN of lung pleura peritoneum 199 122 (* 28 245 (* 61 113 26 153 (* 2 665 (* 2 849 (* ,.x r e u d e : Pg-` il Table 6 .. Mortality among asbestosic subjects in textile industry CAUSE OF DEATH All causes Respiratory diseases All malignancies MN of lung pleura peritoneum intestine and ovary rectum OBS SMR 141 178 (*) 33 583 (*) 46 221 (*) 19 428 (*) 2 1878 (*) 2 1765 <*) 3 148 3 910 (*) Table 7 Mortality among asbestosic subjects in naval industry CAUSE OF DEATH All causes Respiratory diseases All malignancies MN of lung pleura peritoneum OBS 115 19 53 26 5 1 SMR 126 (*) 259 (*) 185 <*) 290 (*) 3153 (*) 871 Table 8 Mortality among asbestosic insulators CAUSE OF DEATH All causes Respiratory diseases All malignancies MN of lung pleura peritoneum intestine and rectum OBS 21 1 12 8 0 0 1 SMR 227 <*; 161 367 (*) 722 (*) -- -- 407 RESULTS At the end of the study period, 2255 subjects were alive and 1154 deaths occurred; 48 subjects were lost, corresponding to 1,4 % of the initial cohort. The cause of death was not ascertained for 78 subjects, corresponding to 6.9 % of the deceased. Observed and expected mortality for men and wom en are shown in tables 2 and 5, respectively. Mortality from all causes, all malignant neoplasm s and diseases of the respiratory tract were significantly increased in both sexes. The increase in neoplasms was essentially due to tumors of the respiratory tract (lung and pleura) and peritoneum and, among women, ovary and intestine. Analysis by branch of activity provided som e further information of interest. Asbestos cement workers constituted the largest subcohort; about half of them cam e from a single facility located in Casale Monferrato ( Piedmont ), and they were the object of a separate analysis ( table 4 ). As it can be seen asbestos cem ent workers from Casale showed significant increases for m ost SMR's in both sexes. Asbestos cem ent workers from other facilities ( table 5 ) showed significant increases for most of the causes of death at study, even if SMR's were lower than in the Casale subcohort, among men; among women, because of limited size, no final conclusion could be reached. ` Significantly increased SMR's for m ost of the causes of death at study were seen among textile workers in both sexes ( table 6 ). naval industry workers, all men , show ed significantly increased mortality for lung and pleural neoplasms, all neoplasm s, respiratory diseases and all causes of death ( table 7 ). Among insulators, 57 male subjects, ar striking increase of lung cancer was detected ( 8 observed versus 1.1 expected ). CONCLUSIONS The present study revealed significant increases in mortality from respiratory \ disease and from cancer among asbestosic subjects; the excesses in neoplastic causes of death concerned pleural and peritoneal m esoth eliom as lung, intestinal and ovarian cancer. Tills study Is consistent with other cohort studies of asbestosic subjects performed In Finland { fluushonen 1978 ), Qeat Britain ( Berry 1981 ), Australia ( Cookson et al 1985 ) and US (Hughes and Weill 1991 ), and with previous findings from Italy ( Rubino et al 1981 ). besides confirming tire causal association between exposure to asbestos and occurrence of lung cancer and pleural and peritoneal mesothelioma, this study detected a significant increase of ovarian and intestinal cancer. Ovarian cancer has previously been associated with occupational exposure to asbestos with special reference to the manufacture of gas masks (Wignali Fox 1982 , Acheson et al 1982 ), of asbestos textiles ( Hewhouse et al 1985 ) and the extraction of rock salt ( Tarchl et al 1994).The Issue of intestinal cancer in asbestos workers has been studied with conflicting results. Ehrlich et al (1991) detected asbestos fibres in the colon of can cer patients previously exposed to asbestos but not in colon carcinoma patients without previous occupational exposure and Vineis et al (1993) described an excess risk of colon cancer among pipefitters and boilermakers; on the other hand, no association between colon cancer and asbestos exposure was found by Qarabrant et al (1992) in a large case-control study. Recently, noma et al (1994) suggested that exposure to relatively high concentrations of amphiboles in required in order to induce colon cancer. The present study detected significant increases in risk associated with different occupations, in agreement with previous results from various countries ( IARC 1987 ). The extremely severe disease pattern of asbestos cement workers from the Eternit facility In Casale Monferrato is coherent with the findings of the Casale occupational cohort (Magnani et al 1987), the workers wives cohort ( Magnani et al 1993 ), and the figures on mesotheliomas in Casale's general population (Magnani et al 1991 ). The major limitation of the present study is due to potential misclassification of causes of death. In Italy, death certification of lung cancer has a good agreement with clinical diagnosis ( over 80% ), but it underestimates the occurrence of the disease if a comparison is made with necropsy data ( Delendi et al 1991 ). A national survey showed that about 75% of pleural mesothelioma cases are correctly classified on death certificates, while a necropsy based study in Trieste provided a much higher estimate of false negatives (80%), and a 20% estimate of false positives ( Delendi et al 1991 ). Misclassification of abdominal neoplasms,including peritoneal mesothelioma and ovarian cancer, Is commonly thought to be relatively high (Bruno et al 1990). `Best pathologic evidence' procedures, such as those applied by Selikoff to US and Canadian insulators, may be Implemented with respect to the cohort at study in order to achieve a deeper Insight in the emerging pattern of disease. With respect to misclassification, it should finally be noted that three more subjects had a mention of mesothelioma in the death certificate ( in one case it was not the underlying cause of death; in two cases the localization was not specified), while for 8 subjects the cause of death was peritoneal carcinosis or peritoneal neoplasm of unspecified nature; 14 deaths were ascribed to unspecified neoplasms. Permanent epidemiologic surveillance of the cohort of Italian asbestosic s u b je c ts is required in order to follow In time th e evolution of their cause-specific mortality; in the meanwhile, a limited number of actions aim ed at decreasing Individual risk of these subjects, sue h a s ad hoc antism oke campaigns, should be seriously con sidered. REFERENCES Marsh et al. 1986 Amer. Statist. 40:308-309 Edelman 1992 Int. Ard. Occup. Environ. Health 63:469-475 Qarabrant et al. 1992 Amer. J. Epidemiol. 135:843-853 (toma et al 1994 Amer. J. Ind. Med. 139:1210-1222 Huuskonen 1978 Scand. J. Work Environ. Health 4:265-274 Berry 1981 Br. J. Ind. Med. 38:130-137 Cookson et al. 1985 Br. J. Ind. Med. 42:461-468 Browne 1986 Br. J. Ind. Med. 43:145-149 Hughes & Weill 1991 Br. J. Ind. Med. 48:229-233 Rubino et al. 1981 Atti 44 Congr.Haz.Soc.It.Med.Lav. Ig.Ind..Padova 73-79 Wignall & Fox 1982 Br. J. Ind. Med. 39:34-38 Acheson et al. 1982 Br. J. Ind. Med. 39:344-348 Newhouse et al. 1985 Br. J. Ind, Med. 42:4-11 Tarchi et al. 1994 Amer. J. Ind. Med. 25:251-256 Ehrlich et al, 1991 Amer. J. Ind. Med. 19:629-636 Vineis et al. 1993 Tumori 79:301-303 IARC 1987 Suppl. 7:106-116 Magnani et al. 1987 Med. Lav. 78:441-453 Magnani et al. 1993 Br. J. Ind. Med. 50:779-784 Magnani et al. 1991 Lancet 338:50 Delendi et al. 1991 IARC Sci. Pubi. 112:55-62 Bruno et al. 1990 Epid. Prev. 45:39-47 \