Document gaqxQgowz66JKkajrd03NNJMq

8 IV. EXPOSURE LEVELS Of the *677 workers who were traced, 6,$V8 (67%) worked in plants *-'-ich ,produced'polyvinyl chloride (PVC) from vinyl chloride monomer (VCM) made elsewhe^, while!|t209 (33%) worked in plants which produced VCM, with or ''without $fOTymei*ization operations on the same site. About 1,122 of the latter Jjr 11.6% of the total study population worked in plants which produced copolymers; s- v . vAh-:'t1&ini&#isrmac* to estimate the relative levels of exposure to "'V.CM tyi%$fe1fr9i#fiagement and industrial hygiene personnel in each plant to cte^tfjr each exposed job as having "high," "medium," or "low" exposure. Since measurements of atmospheric concentrations of vinyl chloride had seldom been.made in the past, these estimates were subjective and indicated" only the relative levels'Of exposure within a given plant. It fs quite possible that* in object!vetterms,, a "high1' in one plant might have corresponded to a "medium". In another, and that a "low" in 1950 might correspond to a "high" in 1970 In the same plant. However, it seems reasonable to assume that those jobs Iabell6d;"h1gh" would on the average have a higher level of exposure than those labelled "medium," and that the latter in turn would on the average have a greater exposure than those labelled "low." The estimated exposure levels of the jobs were used in two ways to characterize the exposure history of workers in the study. First, all workers were classified by their estimated maximum exposure to VCM. More specifically, they were classified by the estimated maximum level at or above which they had been exposed for at least 12 months. For example, a worker who had worked for 13 months in a "high" level job was classified as "high." If he had worked for 10 months at a "high" level job, 3 months BFG16849 21850013 at a "medium" level job, and 15 months at a "low" level job, he was classified as "medium." Secondly, all workers were classified by their estimated integrated or cumulative exposure. A man was given a score of 1 for each month in a "low" level job, 2 for each month in a "medium" level job, and 3 for each month in a "high" level job. The total score over a worker's working life time provided a rough estimate of his cumulative exposure. It is recognized that this arbitrary scoring need not accurately reflect quantitative relationships between levels of exposure; scales of 1, 10, and 100 for low, medium, and high might have served equally well. There was, however, no factual basis for choosing an alternative scale.- The use of the two preceding exposure estimates resulted in a total of four ways of characterizing the exposure of each worker: (1) Duration of exposed employment (2) Interval from beginning of exposure to end of observation (3) Estimated maximum exposure over 12 months or more (4) Estimated integrated exposure. In the mortality tables, cause-specific mortality will be shown for various combinations of these estimates. BFG16850 21850014 V. CALCULATIONS OF MORTALITY The usual method of describing the risk of death in a study of this kind is to compare the number of deaths which actually occurred with the number which would have been expected in a comparable male population observed over the same age and time intervals. This comparison, expressed as a percentage, is called the Standardized Mortality Ratio (SMR). The use and limitations of the SMR has been the subject of a number of recent articles (Lloyd, 1976; Gaffey, 1976; McMichael, 1976). Each worker in the study, i.e. every one whose vital status was ultimately known, was considered to have been under observation from the date on which he attained a year of exposed employment or from the date when his plant's records were complete, whichever came later. Observation periods ended December 31, 1972 or on the date of death, whichever occurred first. In order to calculate the number of expected deaths, it was 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, which determined the calendar year during which a man of this age was observed. Workers were grouped by birth date into 5-year intervals, and the number of person-years contributed by each such cohort for each 5-year age interval was calculated. Age and cause-specific mortality rates for United States males with the same birth dates, and the same ages for the years 1950, 1955, 1959, 1965, and 1970 were applied to these person-years to obtain the expected number of deaths. The use of rates for the entire U.S. male population has the advantage that statistics are available on an annual basis, and these rates provide a BFG16851 21850015 11 common base-line for comparison with mortality studies in other industries and plants. While the geographical distribution of the study population might have suggested the use of regional or state standards, these standards share with U.S. standards the defect that they do not take into account differences between the total male population and the employed male popula tion. The effect of such differences may be particularly Important in states where there is a marked disparity in the standard of living between employed and unemployed, or between industrial and agricultural workers. Observed deaths were classified by cause according to the 1955 revision of the International Classification of Disease (ICD) by an experienced nosologist. Published mortality statistics for the U.S. population before 1955 and after 1967 are classified using differing revisions of the ICD from the one used in this study. The discrepancies, however, in the classi fications are quite small except for some causes in the "all other" category for deaths before 1955, and for subcategories in the "major cardiovascular and renal" category for deaths after 1967. Deaths for which death certificates could not be obtained were assumed to have the same cause distribution as the death certificates that were obtained. The number of observed deaths for each cause was therefore inflated to adjust for the missing certificates in each table. In practice, this was done by multiplying the calculated Standardized Mortality Ratio (SMR or percentage of observed deaths relative to expected deaths) by an appropriate correction factor. For example, in Table 5 there are 707 deaths, for which death certificates could not be obtained for 38. The SMR for each known cause was therefore increased by 38/669 or 5.68% to correct for the 38 missing certificates. 16852 21850016 12 The statistical significance of the deviation of each SMR in the study population from an expected value of 100 was tested by a method derived from Chin Leong Chiang (1961). The formula for determining the standard error of the SMR was SE * f 100 x SMR which follows from the formulas presented in the foregoing paper. If an observed SMR differed from 100 by more than 1.96 standard errors. It was regarded as significant at the 5* level, if it differed by more than 2.57 standard errors. It was regarded as significant at the 1% level. In other words, the latter difference would not be expected by chance more often than one time in one hundred. SMR's based on fewer than 5 observed cases were not tested for significance. 21850017 BFG16853 13 VI. RESULTS: STANDARDIZED MORTALITY RATIOS A. For the Total Population An initial analysis was made of the mortality experience of the total study population, with full recognition of the fact that it covered such a wide range of exposures and ages that some effects might have been obscured. Table 5 shows the results during 120,203 person-years of observation in 9,677 individuals. The overall mortality, leading to an SMR of 89, is significantly lower than 100. This so-called "healthy worker effect" is commonly found in mortality studies based upon employed populations. The SMR for "all malignancies" was 104, that for neoplasms of the digestive organs and peritoneum was 75, that for malignancies of the respiratory system was 107, that for the urinary tract was 123, that for leukemia and aleukemia was 143 and that for lymphomas was 112. None of the SMRs for malignancies was significantly greater than 100. The SMR for major cardiovascular and renal diseases, 95, although less than 100, was higher than usually found in employed populations, which commonly show significant deficiencies in deaths due to this group of causes. It is noteworthy that cirrhosis of the liver was found to cause significantly fewer deaths than expected (SMR 3 56) and also that residual deaths, from all other certified causes not listed, were significantly fewer than expected (SMR =74). B. For the Population Grouped by Maximum Estimated Exposure Level Table 6 shows SMRs for the population grouped by the maximum estimated exposure level, i.e. "low,'' "medium," and "high." These groups contributed 58,741, 39,927, and 21,535 person-years respectively. BFG16854 !T 21850018 14 The only trends suggested were those in the SMR's for "all malignancies" and for "malignant neoplasms of the respiratory organs." There is a disproportionately small number of observed and expected deaths in workers categorized as having "high" maximum exposures when compared with those in the "low" and "medium" groups. The number of observed/expected deaths per 100 men studied in the "high" exposure group was 4.9/5,8, with the number of observed/expected deaths per 100 man-years of observation being 0.39/0.46, Corresponding figures for the "low" exposure group were 7.3/8.2 and 0.61/0.68; those for the "medium" exposure groups were 8.7/9.7 and 0.66/0.73. This suggests that the "high" exposure group was younger during the period of observation, which is difficult to explain unless the exposure levels of men whose employment began in the 1930's and 1940's had been underestimated. Most of the SMR's presented in Table 6 are also shown as marginal totals in Tables 7 through 17. C. Consideration of Duration, Time of Exposure, and Maximum Exposure In Tables 7 through 15, SMR's are arrayed with reference to the total duration of exposure to vinyl chloride, the interval since exposure began, and the maximum estimated exposure, for eleven selected causes of death. Detailed tables are not included for cancer of the buccal cavity (5 deaths) or for cancer of the genital tract (4 deaths). Each of the tables has 60 cells over which the observed deaths can be distributed. Consequently, in the table for "all causes," there is an average of less than 12 observed deaths per cell, while for "all malignancies," th average per cell is only slightly above 2 observed deaths. For causes of particular interest, such as digestive tract cancer, respiratory tract BFG16855 'T 21850019 15 cancer, cancer of other and unspecified sites, and leukemia and aleukemia, the average number of observed or expected deaths per cell would be less than one. As a result, the SMR's in the body of a table will often be either extremely high or extremely low. For example, Table 9 shows SMR's from cancer of the digestive tract. The five observed deaths in the high exposure group cannot fall into more than five cells of the table, while the 4.27 expected deaths are distributed over all of the 20 cells representing "high'' exposure, with much less than one expected death in any cell. Consequently, every cell in which an observed death occurs will have a large excess mortality, while the rest of the cells show zero mortality. Interpretation of such tables must necessarily be highly tentative and they should be looked at in terms of patterns and not individual SMR's. For no cause of death was there a convincing trend, either with respect to duration of exposure, maximum estimated exposure, or interval from onset of exposure to end of study. A possible exception is malignancies of the respiratory tract (Table 10), where SMR's for "low," "medium," and "high" maximum exposure groups were 92, 116, and 141 respectively. The SMR for this cause in men observed 20 or more years after beginning of exposure, was greater than for groups with shorter observation periods. In the absence of information on the specific smoking histories of the workers involved, or for vinyl chloride workers in general, it is impossible to consider what influence, if any, cigarette smoking might have had on the mortality pattern. The SMR for cancers from "other and unspecified sites" (Table 12) and the SMR for lymphoma (Table 14) in men with over 15 years of observation were also slightly higher than in men with shorter exposures. In themselves, these do not warrant any conclusions. BFG16856 IT Z18500Z0 16 D. Integrated Doses Tables 18 and 19 show observed and expected deaths and SMR's for the 13 groups of causes arrayed by estimated total integrated exposure to vinyl chloride. The "integrated dose" is the total score obtained by crediting a worker with 1 point for each month in a "low" exposure job, 2 points for each month in a "medium" exposure job, and 3 points for each month at "high" exposure. An integrated dose of 300, for example, would be given to a person who worked 25 years (300 months) at "low" exposure, or 8.3 years at "high" exposure, or 10 years at "low" exposure plus 7.5 years at "medium" exposure. It is recognized that an exposure rated as "high" was not necessarily three times as great as one rated as "low," but we have no factual basis for setting a multiplier. The effect of a "high" dose over a short time may not be the same as a "low" dose over a long period of time, and "high" doses in the distant past may be more significant in terms of current disease than more recent "high" doses. The scores, therefore, must be interpreted with caution. The only cause for which there was a suggestive association with inte grated dose was digestive tract cancer, where there was an excess mortality when the integrated dose exceeded 400, with lower mortality than expected for all lower doses. The Integrated doses for the 5 known angiosarcomas were 307, 116, 486, 714, and 642. Respiratory tract cancer, cancer of other and unspecified sites, leukemia, and lymphomas showed slight excess mortality when the integrated doses exceeded 400, but showed inconsistent mortality patterns over lower ranges. Table 16, which shows the distribution of the 14 deaths from hepatic cirrhosis, is of particular interest. Not only is the overall SMR for this BFG16857 21850021 cause significantly low, but there is no association with maximum estimated exposure or duration of exposure and only a marginal association with the interval from beginning of exposure to end of observation. E. Analysis of Long-term PVC Production Workers A separate analysis was made of a group of workers who had worked only in plants which produced polyvinyl chloride, who had begun work with vinyl chloride 20 or more years before the end of the study period, and whose maximum estimated exposure had been either "medium" or "high." As shown in Table 20, the pattern of mortality was not different from either the total study population or the study population ranked by "low," "medium," and "high" exposure categories. BFG16*58 21850022 18 VII. SELECTED GROUPS OF DEATHS Malignancies of the digestive tract. Deaths due to malignancies of the digestive tract are of special interest because malignancies of the liver fall into this group. Details of the 10 deaths attributed to cancer of the liver and biliary passages (CD code 155) are given in Table 21. For three of these, angiosarcoma was given as the cause in the death certificate. These were case study numbers 5765, 6666, and 7376. In addition, although not so stated on the death certificates, cases 7303 and 7385 were known, from other sources, to have had angiosarcomas. Details of the 5 angio- sarcoma cases are given below Study No. Maximum Exposure Level Total Integrated Dose Duration (years) Years from Beginning of Exposure to Date of Death 5765 Medium 307 13 23 6666 High 116 4 18 7303 High 486 14 15 7376 High 714 19 19 7385 High 642 17 18 From the foregoing information, one can locate these cases on Table 9. Four of the five were in the "high" maximum exposure category, the fifth was in the "medium" category. All were in individuals who had had 15 or more years of possible observation since beginning of exposure and all deaths occurred 15 or more years after the beginning of exposure. 21850023 BFG16859 19 Malignant Neoplasms of Urinary Organs. Although urinary tract tumors were not in excess, detailed data on the 3 deaths from this cause are shown in Table 22. Tumors of Brain and Other Parts of Nervous System. Table 23 summarizes in formation on the 28 deaths from tumors of other and unspecified sites, including 12 deaths from tumors of the brain, as opposed to 5.9 expected, giving an SMR of 203, significant at the 0.05 level. Of these, 4 are classified as glioblastoma multiforme, but only one of these 4 v/as definitely confirmed by autopsy, and in 2 cases, autopsy was certified as not performed. Five of the brain tumors were classified either as "malignant brain tumors" or "carcinoma of the brain", but none of these diagnoses was definitely confirmed by autopsy, and in 3 cases the absence of autopsy was certified. Of the remaining 3 brain tumors, 2 were classified as astrocytoma, both confirmed by autopsy, and one as "ependymoma of the 4th ventricle" confirmed by craniotomy. Of the 12 brain tumors, 7 occurred in workers from plants producing only PVC, 2 were in plants producing both PVC and VC (one of which also produced copolymers), 2 were in plants producing only honopolymers or copolymers, and one was in a plant producing only VC. There v/as no apparent relationship with maximum exposure or total integrated exposure: 6 deaths were in individuals whose maximum level of exposure was classified as "low", while 3 each occurred in categories "medium" and "high". Five deaths were in men whose time-weighted dose was calculated as having been less than 100. It is difficult to interpret the significance of this finding of an anparent excess of brain tumors. In the absence of definite confirmation by either autopsy or craniotomy in 8 of the 12 cases, it is quite possible that some might have been secondary brain tumors, with unrecognized primary sites, or other non-malignant space-occupying lesions in the cranial cavity. It is of interest to note that an excess of malignant brain tumors was also reported by Waxweiler, R.J. et al of NI0SH 16860 1T 21850024 20 (Annals of the New York Academy of Science, 271_:40-48, 1976) from a much smaller study (136 deaths and 12,720 person-years), confined to 4 plants with at least 15 years history of operation in the polymerization of VC. These authors reoorted an SMR of 329 based on only 3 deaths, all from glioblastoma multiforme, all histologi cally confirmed. In fact the NIOSH group claimed in this report to have identified altogether 9 histologically confirmed cases of glioblastoma multiforme in workers exposed to vinyl chloride in U.S. industry. It is difficult to say to what extent their study population overlaps that of the presently reported EEH study. In view of all the above, further investigation of the question of malignant brain tumors in workers exposed to vinyl chloride should be pursued. BFG16861 21850025 VII. DISCUSSION 21 Although the present study when compared with the first study reported in 1974 increased the study size from 7,128 to 9,677 workers who were traced, the personyears of observation from 77,846 to 120,203, and the certified deaths available for analysis from 328 to 669, it did not strengthen any of the associations suggest ed in the initial report. The successive additions to the population and the improved follow-up have been accompanied by a rise in the overall-cause Standardized Mortality Ratio from 75 to 89. The major change has been in the SMR for major cardiovascular and renal disease, which was originally 80 and is now 95. There has been a concurrent downward shift in the SMR for "all malignancies", which is now 104 compared with 110 in the 1974 report. In the current study, the SMR's for malignancies of various specific sites are also lower than in the 1974 report. For example, the SMR for digestive tract cancer has changed from 94 to 75, that for respiratory tract cancer from 112 to 107, that for cancer of other and unspecified sites from 155 to 147. The latter included 12 cancers of the brain as shown in Table 23 and discussed on the preceding page. No conclusion can be reached as to whether or not this apparent excess is related to occupational exposure to vinyl chloride, and further investigation is desirable. All SMR's based on more than five deaths were tested for statistical significance, and three were found to be significantly lower than 100 ( see Table 5 ). In general, since the health of an employed population is better than that of the general United States population, these significantly small SMR's are not surprising. With the single exception of the brain tumors, already discussed above, none of the SMR's ( based on more than five deaths ) that exceeded 100 was significantly different from 100. Inferences 21850026 BFG16862 97 about the association between various causes of death and occupational exposure had to be based on the occurrence of excess mortality that increased as one or more measures of exposure increased. There is less support for the hypothesis that vinyl chloride is a "weak general carcinogen" than there was in the report by Tabershaw & Gaffey (1974). However, based on the observation that lung cancer (uncorrected for smoking) and miscellaneous cancers are still slightly higher in individuals with higher maximum exposures, higher integrated exposures, and in those with longer periods of possible latency, weak carcinogenic action in a number of sites must still be considered. Fox and Collier (1977), in a recently reported study from Great Britain, found no evidence to support the hypothesis that cancers other than those of the liver are associated with exposure to vinyl chloride monomer. An unexpected finding was the relatively high ratio of deaths attributed to cardiovascular and renal disease. There were no apparent relationships with duration or intensity of exposure, and there is no basis for relating this to vinyl chloride per se. When considering this study in the context of previous reports involving part of the same population, it should be stressed that the successive reports do not represent different studies. The mortality experience of the popula tion that was included in the 1974 report strongly influenced the final results; thus, this should not be regarded as an independent study that confirmed the previous one. The fact that many of the site-specific cancer ratios were lower than those in the initial study can represent either a refining of rates by an increase in number of person-years and number of deaths, or could reflect a different exposure experience in the populations that were added. BFG16863 21850027 23 IX. SUMMARY & CONCLUSIONS This is the final report of a study of the mortality of workers exposed to vinyl chloride and its polymers, which augments studies reported in 1974 and 1975. The current report increases the total population of workers studied from 8,384 to 10,173, with the number whose vital status was deter mined increasing from 7,128 (85 percent) to 9,677 (95.1 percent). The number of deaths has more than doubled; there are now 669 certified and available for analysis, compared with 328 in the original study. The follow up period concluded December 31, 1972, for both the original study and the augmented final study. The successive additions to the population and improved follow-up have been accompanied by a rise in the overall-cause Standardized Mortality Ratio (SMR) from 75 in 1974 to 89 in the current analysis. The major change has been in the SMR for cardiovascular and renal disease, which was originally 80 and is now 95. There has been a concurrent downward shift in the SMR for "all malignancies," which is now 104 compared with 110 in the previous report. In the current study the SMR's for malignancies of various sites are also lower than in the 1974 and 1975 reports. The SMR for gastrointestinal tract tumors dropped from 94 to 75 in successive reports (these included 5 deaths from hepatic angiosarcoma); that for respiratory tract cancer (uncorrected for smoking) dropped from 112 to 107; and that for cancer of other and unspecified sites from 155 to 147. There is, nevertheless, still some support for the hypothesis that vinyl chloride may increase the incidence of cancer slightly in sites other than the liver. The principal evidence for this is the observation that the incidence of lung cancer and miscellaneous cancers appears to be higher in individuals with higher maximum exposures BFG16864 218500Z8 and those with longer exposure periods. Brain tumors were found to be in excess, 12 observed vs. 5.9 expected ( significant at the 0.05 level ) but the incidence was not related to either duration of exposure or to intensity of exposure to VCM. This population should be studied again within the next 5 years. Since the time of observation after first exposures will be longer, and more deaths will be available for analysis. It Is possible that some of the questions about cancer in sites other than the liver may be resolved. BFG16865 Z18500Z9 Table 1 Distribution of Vinyl Chloride Plants Studied by Product and Numbers of Workers 25 Product or Products Polyvinyl chloride only Vinyl chloride monomer only PVC and VCM Copolymers, resins, with or without PVC and VCM TOTALS Number of Plants Number of Workers Number Traced 18 6,848 6,468 11 1,214 1,177 3 935 910 5 1,176 1,122 37 10,173 9,677 21650030 BFG16866 26 Table 2 Distribution of Vinyl Chloride Plants and Vinyl Chloride Workers by Census Regions and Geographic Divisions Percent of U.S. male Number of Number of Geographic Population Plants Workers RegionDivision(1970) in Studyin StudyTraced All regions 100.0 37 10,173 Northeast New England Middle Atlantic North Central East North Central West North Central South South Atlantic East South Central West South Central West Mountain Pacific 23.8 5.8 18.0 27.9 19.8 8.0 30.9 15.1 6.3 9.5 17.4 4.1 13.2 8 2 6 6 6 - 22 5 4 13 1 1 1,619 467 1,152 1,872 1,872 -- 6,589 1,735 2,868 1,986 93 93 Number 9,677 1,550 453 1,097 1,817 1,817 -- 6,218 1,620 2,655 1,943 92 ... 92 21850031 BFG16867 Table 3 Follow-up Total Number 10,173 Alive 8,970 (92.7%) Dead 707 (7.3%) Death Certi ficate 669 (94.6%) No Death Certi ficate 38 (5.4%) 27 BFG16868 28 CL+fM> CCMO o o o o CCMO T0tfo>t) UJ 4O- TUWC3J O+pIcOU3QJp -O> ^3u04o) 4o-> 4UU3<OQ0cQxo/-1J>l.**Cc^----M**. CPO 01 .hma- "--O04Or-) ccOae*o>-i-f04uto)) .oco44-owo; '>>-- >* >cprv 4a>4Q->J*(4o3/->> r*. c vo* o> "O 4O- c C 4Of->- CVE>> .434(ar-/>-) *U--OQEJ, 5 CM f-^ CM -- CT CO p><t40-oo)n o-->1 lp--o p o o aau>n* pVaO-- CM CM 'Wl' 0tOa43Xo). uj pOP"1- VO o 00 oCO> CO CoM o> o> 4O- c o -O(4r3M--0 tO1 cC(ToO> CMp rC**O* p CCCMMO VO CM op--> C0CMM0 p-1 CCOOp CoM CMp VO CoO CM tCoO 00 p0--0 to p-- 4<->0 1--O r-* VCOhp pCCT--O>p rCC*TMTOi CCpC--MOOp Crvi--nrM>p tn orp*--p. CT> 4- p4(>--Q CM 6O U. -cp- cC 0OJ* 4O- CO 0V). o O(3/) -a Uc UQXJ. O +> > VO *o u <3p *00) V/)-->'- p<--o +j o h- a\ i o p-- 1 po"* o* 1 pto-- CM OCM1 + tCoM 21850033 BFG16869 29 Table 5 Observed/Expected Deaths and Standardized Mortality Ratios for Selected Causes of Death in 9,677 Vinyl Chloride Workers Cause of Death with ICD Number^3^ All causes All malignancies (140-205) Malignant neoplasms, buccal 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) Malignant neoplasms, brain and other parts of nervous system (193) Leukemia and aleukemia (204) Lymphomas (200-203, 205) Major cardiovascular and renal diseases (330-334, 400-468, 592-594) Cirrhosis of liver (581) All other certified causes Number of workers Number of person-years Obs./Exp. 707/795.02 139/141.39 5/ 5.19 29/ 40.82 45/ 44.29 4/ 7.17 8/ 6.85 28/ 20.18 12/ 5.90 9/ 6.65 11/ 10.36 347/385.24 14/ 26.45 169/241.95 9,677 120,203 SMR^ 89** 104 102 75 107 59 123 147 203* 143 112 95 56** 74** a. Cause-specific numbers indicated categories in the 1955 ( 7th ) revision of the International Classification of Diseases. b. SMR's (other than for All Causes) adjusted for 38 deaths with no death certificates by factor of +5.68X * Significant at the 0.05 level. ** Significant at the 0.01 level. 21850034 BFG16870 Observed/Expected Deaths and S tandard!2 ed M o r ta lity R atios f o r S elected Causes o f Death in V in y l C h lo rid e Workers, Grouped by Maximum Levels o f Estim ated Exposure Numbers in d ic a te categories in th e 1955 version o f the In te rn a tio n a l C la s s ific a tio n o f Diseases. SMR's o th e r than fo r " a ll causes" adjusted fo r deaths w ith unknown cause ( i. e . m issing death c e r tific a te s ) by fa c to rs o f +7.44%, +4.382%, and +2.439% re s p e c tiv e ly ; S ig n ific a n t at the 0.05 le ve l. S ig n ific a n t a t the 0.01 le v e l. 21950034 30 00 o f-- oi mo'fl pm o pm oo pm -- <n CO CO r*-. in 3= UCXJL OJ(O3 po-- o1o-- moo* vron vo 00 voo o M^ o vroo *3* in oo\ in r. iVnO o r*. O o r*^s.-o-- oo CVI f-- r-- ^ -- r- nr^. icno f-- CVJ CO NCO* V'CvOO "O*n C0MM0i CM c3oo Q. X .O Q Oi 00 Os o CLOM VO VO O Of--s o co 00 oo m vo ** r** vo in Ol Pm VO s <-- rs. 3 CM CM 4> Q O Oflt > 4) . Q. 05 o f-* as as O VO CO o o> n CO vo cm vo vn o n (MOOi CM VO PM co CaOv LU ro CO in r*s CM CM Pm CM CO vo as co E 'M, OV in r-- cf co s3 CM vn SN.M MMV X n CM VO r-- O as o VO in p-- CO CO CO vo VO PM CM r-- co n zfO: CM * o: o as CO Oi in vo CM PM CM a CM 00 co in os <r ^ *-- vo 00 VO 00 9> Os lO Pm r-- F"-- 00 in p- I CM a X CO CO CO O vO VO 03 VO CM as o in cm pm m* as cm -- * in as cm O lO m* 00 in UJ p> CM O CM CO co O' co in VO CM -- o fM CM CM p-- CM r" p--* 1/1 "M, n in o VO vo M's's \SS as CO in mso> r" p" PM CO 0in1 o> > imn Q O "O in S- cm m u 4>1 *4r->U41) *-- i Fwom-- o 4m- u p Ql rm-- p r" o > c43 im- V. c 41 F4v"nJ --^ T3 ' com +- ** m as s.2 .C 0M3 o o 3 ar- S .O -O 3 in o * 4C> CM i/l ---'*1/1_0 oi <E/l0m0* m6 ^*- in 41 W * V/l W i/) VO c4) FL. o> 3 x; 4- o * vE/1 -- (s/! --- Ein l/> ON </) .- t/> --c m m- vn o cm wqj cm as in Sqj 3 co *o cm in --"* -- CmO (0A) in 3 mo v0t) i3n rO O ^ (Of- fl V (Op* r-- r-- I r-- 4} f-- I ^ 0.0 a. a. 0.0 vo oCJ -- o4J "O aOifv--o flJC^CCCw 0r- 4-> X <13 M 1/1 C C C C vo C s <a <o >> m c <tj a> c c t- c c *> f0--1 o> -<CU *rO-- CLO. 'rC--O vVoj (Q P*** <13 00 <0 *f-- 4) a. o-T a. m 0 0 0 0 0^0 4; N Qj CO O 4J 'O 4C0C<IS--0>10vC4i-o31-4-C0mCC-I>-)0tcmtO1--Cmcocr>;u4*piacciA--/lm'-CffoEx- Oo CM' solmO -aC. m 3 Omm *>o#osm- <( ( 0)r-- -- Q.I-- 0^-10 r- O r- O r-- 3 3 O ( mm m m m to -o i4-) 4#1- s- i> <O+. 4OJ i .i1--A Sa-) i <OS1 -+C> E E *O*0 -.c o ik- r- m s4) -X Sa. o5 a> .a vo J<L0 4>i1> co vw1o> a. n4> <9 o < * ** BFG16871 21850035 31 1 Standardized M o rta lity Ratlorand Observed Deaths Due to A ll Causes Aatong 9,677 V inyl Chloride Wort: & by Duration o f I X & ts asu S Q. it t * -M(CA +4UD*l ^S9Itf i'. UX 47 47 IS ffi --S rt ^ k 4>|)7 >) 7 *IA^> IOO |oo oi** i* tO>l 51*7*7 T*9"91 M CU CW Q r 21850036 32 1 Table i X & I <441-* Xw so Iot . 2? S& .vc a*u It 4>) Oa bft) XV It: * us H *V tfi e II fel II a .o BFG16873 21850037 BFG16874 :r Standardized M o rta lity Ratios i Observed Deaths Due to Malignancies o f the Respiratory System Among 9,677 Vinyl Chloride Workers by Duration o f Exposure, Years SI ! Exposure Began, and Maximum Level o f Exposure(a) - ^ -- m -- oo-- psj-- -- zi o oo -- -- Sen Xl OO (o eg 5 c\j So? Jl esi -- esd -- in1 --e-- fo<* --in rOv --<-- 21850038 34 -il xJ -j| Oi pam e in -- ^ -- OO OO O O 00 o < OO ---- M OO m -- OO OO OO OO Nm- oo oo oo oo sS oo ^ Sr V0I)i --(I JS t. e V me> *ok*>. e41 Oe. *t Oi si 01 VI *1 5S it9 o Vi sw xi 4IAi 4 U 41 Ol V9I --X' US e,, e *-3im * S4- mI-- "*V3OI l X V) *! BFG16875 Table 11 o -8 u* i :i l oM *X 0*0 a3 C xO*1<0A0 femDi0S>t s> c9 k VI K& 2 IS 5oCm "2>. = C3 ** VI II o ^ So 5s-S*c3s--1sc3=m* MO SUaxJ.> 21850039 35 | X & vVO>t *4) JE SS. it 1 V O 01 8V- VI s va.*).x31 TMs H SS s- x4J o i; *4 * -- T'OVa*SI X v> JC BFG16876 n Standardized M o rta lity Ratios and Observed Deaths Due to Malignancies o f Other and Unspecified S ites taong 9,677 V inyl Chloride Workers 21850040 n CSV --* O'--* ON -- On O' ** n T 00 P- ___ j_u --* Z O oo oo m wen- ---- in ^ *" w Z OO oo O C*S eg cm O 00 8S1 o Vw CM -- -- w' SO--* eg --* CM--* r* --* --* On --* _J * ^ o- -- r* -- f* *r ON* _-- wX 1 < i t oo e o w z 1 1 i i S eg h CM CSV r**-- P* -- __ 1 1 i i OO OO w -- --N --* X ( i N*-- oo *-- ^-- eg ez ** eg m 07 X On oz NO o mU 1 1 1 1 ( 1 o o oo o o Q --. <n--* _ ^ 1 CM CM on m O'-- in -- m w -- o> --* n -- 10 -- 1 oo CM -- r -- CM CM O' w -- ___ 1 o o 8- *--* * CM ^-- ^--* oo--* p*--* CM--* t sc to -- CM'-- O CM eo--- (A , l--. __ X 1 oo oo o o oo OO M*" *-- or *" oz 4-* __ 1 o o oo O o <-- m CM f*> ---- &o ' t 1 o o e o p** -- o o P** -- w' _ _ _ __ - _ X oo o o oo O *O-- oo o o S Ol _ _ --_ e o + z ooN-- o e ri -- -- *n--' o Vo-- m -- 4*1 CM -- w- (A 01^ -- o o o o o o On cm X __ oo _ oo _ oo oo --* O-- ^-- _ oo 8- z oo -- CM -- CM *-- 8- ON--* PM ^ + w> On*--' ---- eo oo OO o-- oo NO--* CM -- B*. o > k O 4J ^ 9-- ON Oh skul k k e (/I ^ 01 o >- o V o V oo 5Sg o>x" ui e UJ #" m* f o no gg CM >- i e ? ** u a 9 *o z* 36 BFG16S77 r Standardized M o rta lity Ratios and Observed Deaths Due to Leukemia and Aleukemia Among 9,677 Vinyl Chloride Workers by Duration o f Exposure, Years Since Exposure Began, and Maximum Level o f Exposure(a) a mt --O. e-- Z1B50U41 37 -- CO CM mv m --* v fM. X o o CO -- o o o o -- ** <e 4- X oo o o wo> X--. ID CM CO--** m co 1' _ _ Ofc -- -- ^ -- or _j N <-- o m eCM W mw-- ' M CM r~ to kO --- -- 1 1 1 t o w' -- mX I 1 1 1 OO oo CM __ _t 1 1 I 1 o o __ X 1 1 f o o OO o o *--' *--* CM - co-- _____ eX 4J 1 i o o to ~ kO m a- k/) -- _O Cm _ -- u _J 1 1 o o o 4t W1 X1 t oo oo oo oo w O' X 4-> 1 a-- CO -- 1 o o -- Q-- w kO (__ __ --, 1 1 oo oo Oo oo 'w> __ __ -- X 1 oo o `x' o w oo oo __ 1_ __ J---- L __ 4o~ X 1 oo oo o e wo> - o _ --J 1 o o o o o o o o -- w' __ -- - __ wX o oe o oo w oo oo sOh X oe oe oo f* CO . am -- oo S- V/) CM oo o o o CM m- m or o mo --* X (__ __ -1 wlo o oo o o o o o oo oo r* <-- ir >--* o CM s- e >* L. e e o Siit OlXV uj c UJ o ' +> e o o CM o o "C a at0/1ti at O. Se/ Suea. uat ooai.t +> u St > eo UX 4e 4- m -i a13/1t ot *tfl oL 3H O X tO O A BFG16878 Standardized M o rta lity Ratios and Observed Deaths Due to Lynphoaas faong 9,677 Workers In Plants Producing Vinyl Chloride, by Duration 21850042 38 BFGl68"79 !T 21830043 143 (3 ) 82 2) \r>--- u-> -- Scm oo ao to ^ a- cm r> m Qooo to i/> -- o *-- ^ cm 01 sk. xl o o' CM --* 00 10 OS -- r*. --- to--* ^ --* CM os m xl in v 00 IA CM 00 CM (2 1 ) O il CM --* -ll r** CD 5C S(o -- to to 00 CM 8C sc Oi 9 IA0 O IA 5 43 e ~ t U lA 41 O -- a. 3X U UJ ~ in Vu10 0>011 OJ -J y el O +4 o s IA ! ,4c- ' os l 01 3 u> (oA va IA X <S` eo *e* /> *e (A rf --3 *uto> o(A & 2 sc Si p* -- O-- O O Ot CO tO -- CM .-- xl xl -ll zl SC CM -- 00 -- CM OS to -- w 0*0 IA -- -- OS CP -- CM CM CM -- CM--* tn o--* to Os iA ^ --* Os lO CM m-- c cm OS--* OS to CM -- -- p* fM -- SO OS P) 9 a* co-** cm--* --* n<-* >0 O -- CM CM oo cn -- Czl NN NIA NO f> r-> S-ll n<- -** N^*c-n* W^--- SC - CM -* fO-->* Ifl-** r* 4r os cn --* Sr**. Sot *3 i k. a *- 3 <0 ew 55 w I ioia o to 4P f*>SC -->* OS LA (O OS 4T *-- --e 3 i/> v o -- e a- CM eo u> Ce o o >, o> 3. ' 4-* o --I O W 4-> to o e eOS X 3 CM -- m ui tA 41 O (A -- +* * fe 4a e01 eft it eg m os tA J .C ** u 33 ei kX 0) 0 (A 8S o o at US 1.S ! 4> 3 I** OO *i *-- IA <M 3M C m 310 z ^U V. <A * --- f* " W _l </> 39 BFG16880 :r Standardized M o rta lity Ratios and Observed Deaths Due to C irrhosis o f the Liver Among 9,677 Vinyl Chloride Workers by Ouratlon 21850044 OO k/> -- CVJ m- f SO OO OO OO OO OO s?> o O O 9 *-- 9) <SJ o o o <-- > o cvi oo *r 40 I oo oo oo I k. +> i t 9 9) o lA oo oo o< o o ^-- W-- -- -- S) c oo oo e< oo oo oo e wao i T3 2 t i9ft & ) e /) uUt 3C o o <v -- OO OO * -- OO 35C OO OO oo oo oo OO O( > o OO OO OO 00 cvi oo oo oo oo oo 4- u 2 so &2 kai X e* ..Jo s i 9 o o' o o' o' SC SC r-, CM OIf) oeT SC o oC CO -- *- >a IA ~*<>w0c)0----ee>uvoo3Xj* --TUoeDl : Os -- -- cm o 4- ao-> do- o o -- -- CM o* BFG16881 T Ok --"* 1A 0i Otcvj iDm iA9i oo eg v r. r*. <nj <-- o t/> in SC sc (b^> AO --* --------*-- <-- 5 CO 35 9 21350045 41 g. Standardized M o rta lity Ratios and Observed Deaths Due to A ll Other C e rtifie d Causes Among 9,677 Vinyl Chloride Workers by Duration o f Exposure, Years Since Exposure Began, and Maximum Level o f Exposure(a) - O O tAM* O fx * O O K. V o o o o -- i > e- fx o oo csj s;o o -- rs. m OO ^ V <M *- C OO O O 00 CNJ o < s ^ I^x n> C>d O O -- <*> un -- --* m --- OiA 111 sp-r~*- tfc>o----` 0--0--^* eo u*)* .--* I or i in n *-- co oiN rx n - >> L Q*>t Si+ l. f<mC> Wa lfllm. >u ec oa o*- >o>o> -- a. - c w e+* o X *0 B LU *-- CM | & o> %i /l -- 2+w - ife a. <*- Q c 01 o. S ?o t9 ^Oi oV> >& 0b1 OXf (/I -i *2 e -e o o> * wSS 1-- 4>i *hnr> se --i^oo fe *21 ~S S 01 tl^*f *> 9 U CC --rJ u<0 4u0 g 90 v> j tn t/> BFG16882 r Observed/Expected Deaths f o r S elected Causes o f Death in 9,677 V in y l Cl o rid e Workers Grouped by Total Integrated Dose(a) 5 6 .6 6 SMR's a d ju ste d f o r deaths w ith unknown causes. Numbers in d ic a te ca te g o rie s in the 1955 ve rsio n o f the In te rn a tio n a l C la s s ific a tio r o f Diseases. R efer to Table 5 fo r to ta l expected deaths. The to ta l o f the in d iv id u a l c e lls in 1 ble 18 w i l l not equal 795.02 due to rounding e rro r. O CM in os co lO -- S^. s^ oo lO CM 21830056 42 00 lO in CO co in oo s^ -s* ps* rs. o o in r- CM in cm oo co -- MW Or-S CO in *-- os os ps. * in OS f-- o cr> co Os -- 1 in -- o o co os o CO Os Os , ,, iCM OO in oo Ta3; o as fO r-- &. t o> O 0) O O CO -- o co po rs* m tD CM oo r. "M. o to in o o Oai>N J* lO lO CM oin a* CM CM os co CO PO I CM CM, P's. 00 m cm *sr co CM ps. in CO PO O f*^ --. Ss ***^ co o CM O CM in o -- o> cr> ^ m P'S. -- -- CM 1-- MM CM m in <y> a\ -- -- '--. "S*, 00 CTi S^ o in CM r-- CM p^. os in CM 00 CO i-- s* Cs. CO 1-- CM 'Ss, CM O M Si^ CM in CO PO in -- 00 oo O r-- CM r-- in CM PO rM ps^ CO o s^ CM CM CM r-ClO O *-- ID CO e-- VMM p-- co os co in co in co m m * in ID ps* m i-- co to co 00 CM m co 00 CM o ON MMM in -- rvi 0> o> in in ^ in m rs. in oo m m CM MMM o m #> OMi- CM in o> CM 00 CO r- 3* po in os in in o o PO Ps. <Ns* s^ SN,, tk * Ol PO CM in in ^ CM co <T> in ps. cm 00 co o Os rs. CM CM VMM A * r- rON CM *^p Ps. <D o u > 4- 0) <T3 *-- n 4-> V. S S- e in i- 4-> (O i- 3 o c co 3--s*r- <V 0> i- 4^ in ^-s o in o WO 3 L. O) 3 oo/o in w i o t-- in 0) o *-- * c ** 4-> *i- o o # "*- E cm -o o (SI l/l 1 VI O tn tn tn tn tn o c -* n 1 E O E +-> E--s E^ -X m 00 4J 5 O in /- ^ <0 -- l- pa ^ - -* pa HJ /l (/I oi (/) r-- m -o 3 /O lO (O pv co moo pM PB ^ ^ ^ f" *p" co O L. 1 to PO in s^* twn a(O> S-* Q. Q. CL a i a i Q. 1 Q.4- m O r-- 1 Lb </>x: OXO o o o o OO O " O 30 03 </>4-> tn 0) C O) *T3 a lO 0) PS* 0) 00 oo-o CM O PO > &. /O JlOjCC-' C i-- c m m Os m +J 4-J c C 03 c s-- m co M 4-> in </)> 03 tn -X 3 i- &. oE CO ECtninm Om m 03 iQ ie a <T3 C I r0 Q3 rQ C to Cm 3 - v - U Q. n 0) ce cn wo mo o Old 4-> C m O) (/) O) O) Cm CT O 0>*0 E *0 i/ 4lO k lOOl V) k /l *r C r- V- (3Q f--*T} >--fl <0 m o -r- >)- S-*f-S.*eC^CMQ.Oa> I'^O) ------------------------------------------- S u WCM wr to to to to 0) 3S *f- oo o +> at --i -j s- -o in -c o O L. a> .0 0) _a << f"J L. r-- E E tO - -- c_j < m -O O BFG16883 Standardized M o rta lity R atios f o r Selected Causes o f Death in 9,677 V in yl C hloride Workers Grouped by T o ta l In te g ra te d Dose(a) 154 S ig n ific a n t a t the 0.05 le v e l. S ig n ific a n t a t the 0.01 le v e l. c O p-* cm o^3- CO 10 21850047 o o CO in ^ CM OJ CM -- IT) px. cm Px. <d* co <x> CO o co o CO CM CO CO n in CO CO CO P-- CM * co U1 r- P- CO un in LO r-- f-- CM 1 0) CM CO o o 01 +-> ttJ 1 OJ +J c PH r-- to 4-> o h- 1 o r-x -- CM p* CM px co 1-- o in CM CM CM CM CM pxx px r--> r-x CM ^ CM CM i-- CM o ^ If) o cs. r-- GO o p-- co CM CO Px. Px j-- r-- CM r-- * ONP p-- CM r-- CM CM p-- r-- p-- i-- * Cxx CM p-- CM CM X CM Px. p- o CO r-x pp CM * oo -- CO *0" CM px. Px. *co f*---- -It * -It -It minusn oo co px. CM p-x CM <ian/>> to OJ o +o c o C" to o L- i/) i/) to (_J p-- to c o p+-i to c L. oj 0) -C a >i-i L. O>J o 0J p* (-- 4J tLo. --(O >L. E rO </) >p IQ L. o -- 3 Z o o -C *-> U OJ (J /> 3 ---- -3 E3 It fn ft 0J c CM1 o B O^ o E \n P*"> a. *r- c 0J CM rO - Vi OLJ. C tOJ s3- -C 4O-> l/l x--' p-x C OJ 0J <o i- i k k k k p* PE o CM T3 o O Ct) t/1 i/l --O'X' E/> p^ </) p- t/> Et/ tt> a ^O3J CO* Cto - if) pp lQf O La.i to (O N JO to 0J QJO <o CO tO ooj ain; 3tO t0S)> co 3 ofl3 aup/>)cto C -- i-- s10 CL OX aj c cb M <0 C J= to Q. C 01-0 r- C r<--0 (Q oO. a> c 4-> c to c r-- t-- <0 CL -a cto ^ in </> *ci to too U r-- Ow Q. O0) C C to c ri---- <0 I -- E 01 +-> Ci>/Ol CL * Q. I CL**" O Op- I OOOOO-I- 030 oj px. a) ai o *o cm on c -- c -- c a; c--* i/> m X--p x--P a JO <tl to x--P C </ C tt> c t C fi C <a c <o 9 'p i O cc ` C to C to cT3 SOJ OT> s. W O' <o f p. L *r-- L -p- O'- Or- C <C 3 CEL Oto 0<1/) NI tO <0 <0 0) >i -- z j j Looin iOJ > r- MO in r- O -C V </> 0J l/> 3 to O L. 0J f *M o -p-> U r- <C < Xto p p O< to L. to 0J >> t/1 1 S- c 0J o U1 u L. o OJ 3 Q. 4oO i. SOJ OJ EE 33 Z fO l/l i- -i/i 01 cc E SLOC 23 tO -It BFG16884 44 Table 20 Observed and Expected Deaths and Standardized Mortality Ratios for Selected Causes of Death Among Vinyl Chloride Workers with Medium or High Exposures* in Plants Producing Only PVC and Whose First Exposure to VC Began 20 or More Years Before the End of the Study Cause of Death , with I CD Number1 2 Deaths Observed/Expected All Causes All malignancies (140-205) Malignant neoplasms of buccal cavity and pharynx (140-148) Malignant neoplasms of digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasm genital organs (170-179) Malignant neoplasm, urinary organs (180-181) Malignant neoplasms, other and unspecified sites Leukemia and aleukemia (204) Lymphomas (200-203, 205) Major cardiovascular and renal disease (330-334, 400-468, 592-594) Cirrhosis of liver (581) All other causes 210/249.27 46/ 46.04 1/ 1.73 9/ 13.63 17/ 14.75 1/ 2.23 2/ 2.30 10/ 6.33 2/ 1.97 4/ 3.10 104/127.54 6/ 7.95 43/ 67.74 2 SMR^ 84** 106 61 70 122 47 92 167 107 136 86 80 67** 1 Numbers indicate categories in the 1955 edition of the International Classification of Disease 2 SMR's adjusted for deaths with unknown cause, i.e. no death certificate * Significant at the 0.05 level ** Significant at the 0.01 level 21850048 BFG16885 ir Deaths Due to M alignant Neoplasms o f the L iv e r and B ilia r y Passages although not sta te d on the death c e r t if ic a t e . 21850Q49 oJ in t/> (S) m O] o 01 iI 0) I1 O 11 OJ o o> <1.1 45 *--* rO P ruo r- P L. 01 o X p ro 01 o c o c 0) > *" o m X P (0 01 o P o 01 m a ro C-J in 01 in ro E PO to P ro ro > L. |H E >, <S) L. 01 X *o 01 p "O A"- * in P G. 01 01 6x pu a. X V) P X ** Xc P l/> L- Po r- 01 01 E sn 2P r" >r-- E in o X l- u pw X CM P P s^> p c ai m > rO p *-- c r-* O %mo w E 1-- *o ro S 0) c CO > p> faa. so P ro O (. 01 u c k 01 > p x: p p u 3 -o 01 T3 rO Q 2--f L. EX sn 01 f > to r-- X P r r* u<0 L- O ! ro ON OE P 0) o -o P P < *o O Ow ES s- ro E o rr*O X S01 JZ 01 > F* 41 *- o ro > *-- La ro (J >> (0 01 fO rTM (0 ON u lu ai <o > U *r- r-- ro 01 CX -r- p E OP *D O " to e *o o 01 c N **- o P u E> U so P o -o o rO E O !U F-- c sn o <s P ro o i- E ro L. La L. rO P x: o Q. SO O P E E E o o 2 E w o; Q. sn c O o r* L> 01 > 1" (/) o CJ 4/> o s- L- c "O P ro i L. ro Cl ro r- a> *r- l/) cn > r-- O f-- r* 01 XT P ro O 01 >> 01 sn "O o rO *r A 01 u A 2 A L. x: l. r0 C ON s- in P P L. a; E CNJ OC 3 <n uro P o *- L. O w CL ro sn 01 E o -o 3^-. c r-- o &. O c i-- SO *-- tr ro O ro p L. i~u *o 4, .F r- U -r- P -r- P ro O J- E O so ro P \Si P E r- L. <0 <0 t- o 01 c 01 C3 <0 3 <n e o f- & o L. c ro < VP *- cn > c C3 <3 f*E Ol o Xp PC l- 8 01 > in r- H -J ' rO <0 (J P O tA A3 01 P -O 01 <E U ro ro p r sn "O ro p ro 01 O UO r- c P *rrO U Q. u 01 ro XO U rO "O w ro O <4- 0) O S- 3 e-- L0 0) o >a 0) X _J Ui TJ i-- p ro _C P CT O i- P 0) 3 -o in 01 _c m Po C CL oX uj p^ OP ro 01 01 < Sp ox P 0) <o P 01 rO O O 01 0) L. p f* r0 IC Q X o _l to r-N H SO SO SO SO i o p On 1 to "O 3O PZ </> CNJ CSI to ^4 s 3 X x: F" O o _J F X x: cn r- X r-* f-a, to 3 to ^4 rH tH to 00 o r-. o t^o4 tn to r-* *--4 to to rf SO 00 CO CO CO o\ VO SO SO t1< CO r^. co i ON LO o to Lf> 11 1 to in x to to p-% to X--3* 4^ SO 00 SO o to to to m to i f"4 ^4 < X3 CO o co po. 2 JZ s JC 2 3 O ON ON O I-- P *F" F" --J XX CM CM m X CO fH ON CM H r>. to 43* CM 00 in co 00 co rH ON f4 H CM CM CM o CSJ CO r-. CO p"*. in to sn to co o tn SO SO to r SO i 1ii ON 4# CM CO H tn 4^ ON X f4 CM 43- i 1 111 ON VC o H 43* H o *--^ ON SO tn CO to Ps. 00 p>. CO CO co SO so PN. p^. r>* ON ON 2E o u La ro sn rO-- ON C <o E O s_ p "O 01 1" T? 01 > <o X o p in in 01 01 sn o 01 iX3 PO in 01 U La <o 01 XX P CO co 01 >p ON C 2 sn o f- c p sn 01 01 P L. ro 01 u2 F p tn r- 00 p cn L- f^a 01 SJ T3 c x <o p ro ro *00J o ro pFa c o m co 2x o X >i cn "O 3 in P ro m in * sn in 01 01 so p* rtS I---- (a) ITS PE OO u C SO ro r- in PO ro vL. ON 3C O < ro X BFG16886 T Deaths Due to M a lig n a n t Neoplasms o f U rin a ry Organs D u ra tio n o f illn e s s as shown on death c e r tific a te s is given in parentheses. m>i a. o iB <v 4-> to u 4u So0) -C 4-> 5J 0) o c o c 03 > ro in IB .c 4-> 53 0) Q 4O 03 in 3 iB O 4- a> Eou 33 E -- m **- a> o X > CL ib a> x S --1 U4 -o 1 a> r-- 03 M 0 E -C -> r OlO -- h-- 0) 3 TJ W 1) </) 4J O ca 5.2 +-> .c 53 4>J cro < 4O -4C-> 4C->l <0o) 10 O O 01). 30) r IB 3= Q 21B5005 oo zz * in -C 4-> Qc 2 ** IB p s pc 3 p-- > CO 0) .c e *- *o c r- O -x 4- O O w*-H IB i >> 5 a) cc *- -5 O -pfc. -X IB O 4- o u r- IB 4J E IQ O 4-> C m *-- IB U 4-3 L. a? b u L. 0) -o "O IB **' JO m <3j -C -C 4J 4-> C Q 4SO CM iB -- E O iB C -- T-- EO 0L3. t(B=5 O t * J0) -a *3 pBB* .O 4O IB 53 ES oo cr-- *cruu L. SL 53 IB ou o zI in z +j c o E 00 pH 1 00 >t 03 c "O r .X 4-> 403 * r" in p- 4in o o +-> e CO OE E CM IB 'U 03 m> 03 03 mm IB -- 4-> in ib IB E 4> O ^E Cr- U >% 4 4 IB 53 U C O r~~ 53 -- C 3 03 q. 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U Q.O l. |o IB O 4-> -a i- 53 53 3 i. 0 C 53 O o i-- a, SOU 2 o E 3 2 O E 3p- p 3 p- 22 O5 pj 5 --i *a 03 z: o 5 -J --j 2 o --J LT> !*** $ 00 co B- H CO N CM CO CM m r* f0H0 00 ac pH aH> pH CM CO 00 o OS r^. o CO CO in lO CO m cn 00 13 ps* CO o m CM CO o r^. r*** oc co co l1 rtH pH CM ?h pH CO co co CM o 1 CO CM 1 CO pH CO 00 co ini pH co in 5f CO 00 00 o CM 00 o CM OS m co CO orH pH 00 1 CO 2S "O CM co o H CO 3O 4-> Z l/> o CM co CO CO in co co CO 00 CO CO Os O as <c CM pH oo < 46 BFG16887 r D eaths Due to M a lig n a n t N eoplasm s o f O th e r and U n s p e c ifie d S ite s 21850051 47 t/T OJ P 3 <n 1 >P- o z oO zZ in P >- 1 tn P >- zo tn eft >01- 01 >- s Z >> PE c ^O #> <o oP ^"O P S01 z Zp ro 01 o e o c >01 o tn ro P c <0 e ON n-- ro .A E i- ro 01 y 'S >> tn z Hw* p c o E re B 5 e 00 to p ro E B o a n cp I-- p to* *op- u P &. Sc O to p in eft u P ro <4-Q-. C-- Peft P0) >> u C 01 01 > Z o. ym-- c *-- tn Q.-*- E 2 ro O *C *D ro p p 01 P tuO z01 ^L 01 P ro V "O in o. ^o rLo. OO c >E> to 0i-1 p1 Sp 2 tn Z PC c o* Q. O 01 in tn cl u i- tn 3>*r- o tn p pC -pr- * trn- jPz p 01 PC Cp z p r- p cE p ro o c E" to 2 CM ro S-W' C tn ai c -O *ur- zP c- o E CrO P(0 Qc CE 3 P p Ep C ptn t#no pc Ps S- E r0 p rs. oi c 3 01 CL pin" in " 3*o o *o > pro oC p a. P 01 ro P r* (-- pm c OL. 01 U m z z p cg ra U ro m *u-- 0) Q.'~> tn 2 p C + in -rL^- t>ON 3 *fi 0S1- >i-, 01 pp f- u *o a. c 3* in s O in or L. PP L. <o M co cp E m eft r" eft to P in ro z 01 pL. P> <0 Q cr- O --* z cm in in e ro *r 1u eft 01 P 0) Ui- p ro O G to p L. eft ^ tO to U UP 1- -o Q.*" pO tn m to E o c to 0) ca.**cT3 to Or*N ro c .a *-H >-- p_e w *rro- cO Peft x_ E PO tn u ro rO PU z ON 01 co zp o z P 5 ro U tn tO a; a. cm eft u ro O Pto r3o o E3 O r- p P r- r- U ov*- U>> &<0- ro g u <o o tO i. c EP 8L. 1O rO c *rO C L. - P cc op *O" Z0) *ur- s- s. s. in *- OO fie t- u CO ZP P> <n -< fQ ai iq U <J u P E3 O 2 3 E -- in f 01 O 2 oo 2 o * o X>a to p X Z -J U1 -o *o I P p- fP to zP i- ON O on eo 3 PP cn ON ON 0* to CM tr"o4 r^s cn a) "O (/i a; zm po c a. o> to 8 CO ON O5Nf CO EE E 3f 3 Zcn 3 T3 *5 -a 0) p z 2 ON CM tn "3* in icnn Cr-O < C**O4 ON o CO CO CM eft Peft 4/ c IaD. c P > tn P P to u u pu P tO <D "O c o rC P r0 pp 0)0 <c r- CO VO CO 00 CO tn vn p oz p 0) ro US CM ON r** Z i1 ON cn rH P-* I cn CM Cv 1( tn CM CO z I 00 CM r*> i ON a o cn co r^. in z ai ai wp LO 11 *3* z in ^3* i Ii i i " ro zo o ON H CM H CO 00 OO H >> *o 3O z5 ON o in oz O co co CO mP Z o r** CM CM 00 CM n* cn ON cn vo vo CM vo tn ON co rH z Zz z 1 1 11 i-H H H H CM cn CM Cn. CM cn CM ^* i l 11 in CM Pv z 8 O VO on r***. 3 to CM r-s tn in o Z in m m ih p c r-- *r" P o c o J_j ro L. 3 a BFG16888 T Autopsy G lioblastom a m ultiform e (b ra in tumor) (8 months) Cause o f Death as Given on Death C e r tific a te 21350QSZ 48 <0/>> 4> >- -o <v G. i/> 'i L -4C-> 5! C -91 0) U in .0 c 00 u US L > CO s01 <D </) > 4-) e +J r (0 c 4-> Q O. 10 M C O rH -- o> r-* c g E E <9 * +J CM 0) t/) E Eo IS) E cn (S) 4-> 4- 0- -C O e </) 4-> 4- 0 4- 4-> to e to e 4- Q r* e <e c to c E 5cc <o 2c E5 o> F* o> O) O) c 2E C o <4-- fO L .O 5* 2 4-* V> <3 26 U < 0) OE <J to E o IM <0 o4<</0.) <to/> Sice .5 .5 > 2 2 4L) e 00 CO JO o CO | 13 -C E3 x "D L "D *o cn o O 91 `r F- -O o> 3 m-o --O3I 2 2 O3 -4 o o 40 40 CM o> 40 O) 40 cn H P^. on cn vo 40 CM cn Ok cn CM 40 9k CM rH CM 40 CM CM P** CM 0> o on CM CM 40 40 40 o 00 CM 40 CM cn CO rH l-S. rH CO 40 H CO rH 0 i-h Hf P*- 00 O as Ok cn CM H CM CM - CM CM CM CM Low 263 263 Time- Maximum H ire Date o f Age a t Months Weighted Level o f Date Death Death Exposed T o ta l Exposure A311 2 -3 0 9-67 57 Ok 40 00 Ok o** 40 r% 40 cn 40 10 cn oo as 40 p's. 00 Ok 40 40 40 40 9 40 irH On. CM P-* CM rv CM Pv o rH P's* ps* cn 40 40 40 o P**H rH O** tH PN. 40 r-* 40 CM r*v 40 10 1 40 1i CM o\ Ok rH I 1111 10 CM H cn 40 cn 40 00 40 as 40 CTk CM rH i40 1 Ok o 40 40 10 *u* 00 o Ok H o 40 01 mI rH CM H CM Ok Pv 40 40 00 o * 40 Ii1 i 1 m i cn i CM o rH cn rH H as rH cn Ho 40 cn co N* 40 9) 00 04 m cn 40 p-* 40 40 40 H Ps. Ok O rH 40 rH P-s 00 40 o O) VO p-CM P-*. o ro S P^ s P'S PV cn P*v 8838 00 40 o on 40 o 10 40 s 40 as LT> O) o> Ok BFG16889 Study No. REFERENCES Chiang, C. L.: Standard error of the age-adjusted death rate. Vital Statistics Special Reports, 47: 275-285, 1961. Creech, J. L. and M. N. Johnson: Angiosarcoma of liver in the manufacture of polyvinyl chloride. J. Occup. Med., 16: 150-151, 1974. Fox, A. J. and P. F. Collier: Mortality experience of workers exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain. Br. J. Industrial Medicine, 34, 1-10, 1977. Gaffey, W. R.: A critique of the standardized mortality ratio. J. Occup. Med., 18: 157-160, 1976. Lloyd, J. W.: All you ever wanted to know about SMRs but were afraid to ask. J. Occup. Med., 18 (3): 149, 1976. McMichael, A. J.: Standardized Mortality Ratios and the "Healthy worker effect": Scratching beneath the surface. J. Occup. Med., 18 (3): 165-168, 1976. Tabershaw, I. R. and W. R. Gaffey: Mortality study of workers in the manufacture of vinyl chloride and its polymers. J. Occup. Med., 15: 509-518, 1974. Waxweiler, R. J., W. Stringer, J. K. Wagoner and J. Jones: Neoplastic risk among workers exposed to vinyl chloride. Ann. N.Y. Acad. Scl., 271: 40-48, 1976. BFG16890 21850053