Document gb5oJZj4xvRLrgVxdr4ERkB9Q

J June 24, 1988 AN HISTORICAL PROSPECTIVE MORTALITY STUDY OF THE SARNIA DIVISION OF DOW CHEMICAL CANADA INC. SARNIA, ONTARIO (1950-1984) 1. PLAINTIFF'S EXHIBIT DOW-892 STO164400 R. D. Egedahl, M.D. Corporate Director of Occupational Health DOW CHEMICAL CANADA, INC. G. W. Olsen, D.V.M., Ph.D. Department of Epidemiology Health and Environmental Sciences THE DOW CHEMICAL COMPANY E. Coppock, B.Sc. Research Analyst Occupational and Environmental Health Research Unit STATISTICS CANADA M. L. Young Corporate Occupational Health DOW CHEMICAL CANADA, INC. I. M. F. Arnold, M.D. Regional Medical Director DOW CHEMICAL CANADA, INC. Any correspondence or requests for reprints should be sent to: Ronald D. Egedahl, M.D., Dow Chemical Canada Inc., P.0. Box 1012, Sarnia, Ontario, N7T 7K7 Telephone: 519-339-4919 * < 2. ABSTRACT AN HISTORICAL PROSPECTIVE MORTALITY STUDY OF THE SARNIA DIVISION OF DOW CHEMICAL CANADA INC. SARNIA, ONTARIO (1950-1984) (Egedahl RD, Olsen GW, Coppock E, Young ML and Arnold IMF) The mortality experience of 3,479 male Dow Canada employees who were employed at Sarnia Division for at least 12 continuous months during the years 1945 through 1983 was examined. Mortality ascertainment was obtained utilizing the Canadian Mortality Data Base maintained by Statistics Canada and covered the years 1950 through 1984. Cause-specific mortality analyses were accomplished using male, age and calendar-year adjusted death rates for Canada and the province of Ontario. Total mortality was observed to have been significantly below expectation whether the entire follow-up period (240 observed vs. 366.9 expected) or a 15-year latency period (171 observed vs. 290.4 expected) was considered. Statisti cally significant fewer observed deaths were found for all respira tory cancer, cancer of the bronchus and lung, circulatory disease, ischemic heart disease, cerebrovascular disease, digestive disease, cirrhosis and other liver disease and deaths due to accidents, poisonings and violence. The observation of three deaths due to mesothelioma, a rare cancer often associated with asbestos expo sure, was a significant finding as was a statistically significant elevation of observed deaths in the category "other forms of heart disease". ST0164 40 I 20*1 *13 I 01S 3. INTRODUCTION Large scale mortality analyses of petrochemical worker popula tions have been reported in recent years due to concerns about possible long-term effects of occupational exposures. 1-3 Studies of this nature may: 1) identify workplace hazardous exposures, 2) demonstrate the effectiveness of health and safety programs, and 3) delineate further areas of research. The present investigation studied the cause-specific mortality experience of 3,479 male employees of the Sarnia Division of Dow Chemical Canada Inc. who had at least one year of service from 1945 through 1983. The study included a comparison between the mortality experience among this employee cohort and those of the Canadian and Ontario male populations. Integral to the conduct of this study was the Canadian Mortality Data Base (CMDB) developed by Statistics Canada which allowed for the identification of deaths 4 since 1950. STOI 64 403 4. STUDY METHODS Description of the Sarnia Division The Sarnia Division chemical manufacturing site began operations in 1945. The Sarnia Division facility is a major Canadian producer of chlorine, sodium hydroxide, chlorinated solvents, styrene, vinyl chloride monomer, epoxy resins, vinyl ** ester resins (Derakane ), propylene oxide, polyols (Yoranol ), latex, plastics and glycols. Cohort Identification and Definition A Vital Status Registry (VSR) was established to assemble information on all active employees, retired pensioners, trans ferred and terminated workers who were employed for a minimum of one continuous 12 month period between 1945 and 1983. The com pleteness of the assembled cohort for employees since 1960, checked by. using the annual departmental employee census lists as a second independent data source, was found to be 100 percent. Prior to 1960 there were no available independent data sources that could be used to check for cohort completeness. it Trademark of The Dow Chemical Company *T0hh91 O is 5. The study cohort for the current investigation comprised all male Dow Chemical Canada Inc. employees of the Sarnia Division who worked for at least 12 continuous months between January 1, 1945 and December 31, 1983 and, if employed prior to 1950, were still actively employed as of January 1, 1950. The mortality experience of the study cohort was examined during the time period 1950 through 1984. Currently, approximately 20 per cent of the workforce is employed in administrative or office positions. Plant workers comprise 80 per cent including salaried engineers and chemists as well as hourly maintenance and operator personnel. Maintenance workers are employed as machinists, insulators, painters, pipefitters, boilermakers and carpenters. Historically, the percentage of plant workers has been at least as high as the current levels. Canadian Mortality Data Base The record linkage facilities of Statistics Canada were utilized to search the Canadian Mortality Data Base (CMDB) for deaths in the study cohort. The CMDB is a computer file maintained by Statistics Canada containing information derived from death certificates collected by the provincial vital statistics registries.^ It is frequently used for epidemiologic investigations. At the time of this study death data were available from 1950 to 1984. The mortality ascertainment procedure involved the computer-matching of the 3,479 males in the study S0*l'l9t01S 6. cohort with the CM08 file. For those found deceased, the date and underlying cause of death were abstracted from the CMOS. For each study cohort death a copy of the death certificate was made and assigned a standardized cause of death by Statistics Canada nosologists based upon the Manual of the International Classification of Diseases Adapted for Use in the United States, Eighth Revision (ICDA-8).5 Analysis The analysis used for the study data involved the calculation of a Standardized Mortality Ratio (SMR) for the various causes of death. Monson's computer program** has been expanded in accordance with the 174 codes of death developed by the Laboratory Center for Disease Control, Health and Welfare Canada.^ Person-years for the cohort members were accumulated across five year age and calendar-year specific categories from the date of their entry into the cohort (one year after their date of hire) until their date of death or study termination, whichever occurred first. The expected number of deaths was computed by multiplying the study cohort's age, sex and calendar-year stratum specific person-year estimates and the corresponding Canadian or Ontario cause-specific.mortality rates (1950-1984) together and summing the products across strata. SMR's were calculated and reported for all cause of death categories in which there were two or more observed deaths. Approximate ninety-five percent confidence intervals were calculated * and statistical significance was considered when the null value, 100, was not included in the interval. 7. RESULTS Descriptive The Sarnia Division study cohort comprised 3,479 males who accumulated 70,687 person-years between 1950 and 1984. Table 1 is a distribution of the 3,479 employees by age, onset of person-years experience and distribution. 90*1*19 I OiS The average age at hire was 26 years and the mean duration of follow-up was 20.3 years. Nearly 40 per cent of the cohort was hired before 1960 and accounted for 57 per cent of the person years experience. Comparison with the Canadian Male Population For all causes there were 240 observed and 367 expected deaths which resulted in an SMR of 65 (Table 2). The 95 percent con fidence interval (95 per cent C.I.) was 57-74. Three deaths known by the company from insurance records were not identified by Statistics Canada. If the three deaths were included among total deaths, the SMR would not differ appreciably (SMR 66, 95 per cent C.I., 58-75). Contributing to the reduced all-cause mortality were statistically significant fewer deaths in the following subgroups: respiratory cancer, circulatory disease, digestive diseases, and accidents, poisonings and violence (Table 2). Deaths due to malig nant neoplasms bordered on being a statistically S T 0 I6 U 4 0 1 8. significant deficit (SMR 78, 95 per cent C.I. 60-1C0). Four specific causes of death, cancer of the lung and bronchus ischemic heart disease, cerebrovascular disease, and cirrhosis of the liver showed statistically significant fewer observed deaths. Two causes of death were significantly elevated: pleural neoplasms and other forms ofheart disease. The latter is an ICDA-8 disease mortality classification that included cardio myopathy, congestive heart failure, pulmonary heart disease, cardiac dysarrythmia and myocardial insufficiency. There were three cause of death categories that had nonstatistically significant SMR's greater than 200: malignant melanoma, multiple sclerosis and musculoskeletal disease. All three categories had only two or three observed deaths and less than one expected death. SMR's were also calculated after ignoring person-years and deaths which had accumulated within 15 years of hire (Table 3). For all causes there were 171 observed and 290.4 expected deaths (SMR = 59, 95 per cent C.I. 50-68) which waslower than the corresponding SMR for the entire follow-up period analysis (SMR = 65). There were statistically significant fewer deaths due to all neoplasms and cancer of the bronchus and lung. Cancer of' the pleura remained the only cancer site that had a statistically significant excess with one of the three pleura deaths occurring within 15 years of hire. 80'l19 I01S 9. Comparison with the Ontario Male Population Tables 2 and 3 also show the number of expected deaths, SMR's and 95 per cent confidence intervals based on Ontario male mortality rates for the two follow-up periods of time. Cause specific mortality experience was comparable to that based on the corresponding Canadian male mortality rates. Mortality Distribution by Age and Number of Years Since Entering the Cohort The distribution of observed and expected number of total deaths by age and onset of person-years experience for the cohort is presented in Table 4. Only two age and calendar-year stratified SMR's were above the null value of 100 and they were based on only one observed and one or less expected deaths. DISCUSSION The observation of lower than expected mortality among the Sarnia Division employed population may be partially attributed to a the "healthy worker effect".' The "healthy worker effect" is greatest in younger working populations and has less effect as a study cohort ages. There is not a homogeneous effect across' all causes of death as cardiovascular disease generally shows a greater deficit of deaths than cancer. Exclusion of the first 15 years after hire minimizes the healthy worker effect, as well as con siders the latency aspect of carcinogenesis. A latency analysis 60VI9I01S 10. excludes the person-years at risk for a potential chemical induced cancer for which the cancer's clinical appearance would be unlikely. It is therefore noteworthy that the SMR for total cancer mortality was lower with the .fifteen year latency analysis than with the entire follow-up period. A major reason for the total neoplasms deficit was the 14 fewer than expected bronchus and lung cancer deaths. A contribut ing factor may have been the strict restriction of tobacco smoking in the operating units which has been observed elsewhere to have reduced lung cancer mortality in an occupational cohort.*** Wigle reported no increased risk for lung cancer among the Sarnia popula tion or of men whose usual lifetime occupation recorded on the death certificate was the Sarnia petrochemical industry.** Furthermore, the population of Lambton county has been shown to have no elevated risk for total cancer mortality or of any specific major cancer site. 12 Our findings further indicate that there has not been an elevated risk of total cancer or lung cancer among Dew Chemical workers in Sarnia. Three mesothelioma of the pleura deaths were observed with 0.1 expected. Increased risk of developing mesothelioma has been demonstrated among workers in asbestos mines, asbestos mills and factories, as well as asbestos manufacture and installation.*3 Of the three former Sarnia Division employees who died of mesothelioma of the pleura, one individual worked in various 11. positions in the warehouse for 22 years beginning in the early 1950's. During this time period the warehouse was the focal point for asbestos shipped to the plant site. The asbestos, in a loose, dry form, was transported by truck in boxes. Warehouse employees unloaded the asbestos shipments and stored this material or transported it to the end users on the plant site. Boxes would occasionally split open spilling the asbestos. Warehouse employees would then sweep up the asbestos and manually transfer this material to intact boxes. These workers also handled all asbestos gaskets shipped for use on the plant site. Consequently, it is evident that warehouse employees who worked at Sarnia Division in the 1950's and 1960's, including the individual who died of mesothelioma, routinely handled asbestos on a regular basis without the benefit of respiratory protection. Appropriate handling techniques were instituted in the early 1970's at Sarnia Division. This resulted in significant reduction to asbestos exposure. The second individual worked for 3 years as a pipefitter at Sarnia Division and had the potential of asbestos exposure during delagging operations. Asbestos exposure risk related to his non-Oow employment is unknown. The third man worked for 32 years as an operator in the solvents, ethylene and styrene plants. In some areas of these plants asbestos was used as an insulating material around piping and in high temperature furnaces. Although this material was well sealed, necessary maintenance could have led to greater risk of exposure. 0 I *1fl 9 I 0 1 S 12. In the residual category of "other forms of heart disease" there were 8 observed versus only 2.8 expected deaths. It is unlikely that this observation is occupationally related. It may be due to differential medical acumen from rural to urban, and - primary to tertiary medical care settings. Roberts et al have reported the sensitivity and specificity of the CMDB record linkage process. 14 A separate random sample of 1,000 study subjects of unknown mortality status was traced by independent means to provide an accuracy check. A total of 925 subjects were tracked and 63 of them were deceased. The record linkage of the CMDB detected 58 or 92 per cent of these deaths and did not wrongly identify any of the 862 study subjects found to be alive by the independent follow-up. In the present study the CMDB identified 150 of the 153 deaths (98* per cent) known by the company. One of the three deaths not identified by CMD8 died outside of Canada. It is possible that some past employees, who were presumed to be alive because they were not identified by Statistics Canada as deceased, may have died as citizens of other Commonwealth countries or of the United States. It was beyond the scope of this study and its resource's to address this issue, although it was felt there would be few additional deaths found if such a search was conducted. The findings of the present investigation, as well as the study by Roberts and his co-workers, support the conclusion that STOI6U4 I I 13. mortality ascertainment by use of the CMDB is both sensitive and specific for occupational cohort studies. Furthermore, the CKD8 allows the investigator to obtain the cause of death codes which is a more efficient process than that done in the United States where the National Center for Health Statistic's National Death Index only provides information on whether death has occurred. Cause of death information must be subsequently requested from the appropriate state's vital status registrar. Further studies will update the mortality experience of this cohort. A major goal is to computerize the cohort's retrospective work histories which will allow for analyses by occupation and duration of employment. ACKNOWLEDGEMENTS The authors wish to thank several of individuals at Statistics Canada whose assistance was critical to the successful completion of this study. The authors are indebted to G. Quesnel, M. Fair, and P. Lalonde of the Occupational and Environmental Health Research Unit of the Vital Statistics and Disease Registries Section of Statistics Canada. Also, we would like to thank the various provincial vital statistics registrars as the well as the Health Division of Statistics Canada for the use of the Canadian Mortality Data Base for this epidemiologic study and the provision of mortality analysis using Monson's computer program. The authors also wish to thank S. Raman and J. Gentleman for their helpful comments. ST0I6I. M 2 14. REFERENCES 1. Bond GG, McLaren EA, Cartmill JB, Wymer KT, Sobel W, Lipps TE, Cook RR. Cause-specific mortality among male chemical workers. Am J Ind Med 12:353-383, 1987. 2. Wen CP, Tsai SP, McClellan WA : Long-term mortality study of oil refinery workers. I. Mortality of hourly and salaried workers. Am J Epidemiol 118:526-542, 1983. 3. O'Berg MT, Burke CA, Chen JL : Cancer incidence and mortality in the DuPont Company: An Update. JOM 29:245-252, 1987. 4. Smith ME and Newcombe HB. Use of the Canadian mortality database for epidemiologic follow-up. Can J Public Health 73:39-46, 1982. 5. Manual of the International Statistical Classification of Diseases, Adapted for Use in the United States. Eighth Revision. U.S. Department of Education and Welfare, 1977. 6. Monson PR. Analysis of relative survival and proportional mortality. Comput Biomed Res 7:325-332, 1974. e l n*19 l OiS 15. 7. Raman S. Mortality Analysis using Monson's Computer Program. Statistics Canada, 1985 (unpublished). 8. Rothman KJ, Boice JO: Epidemiologic Analysis with a Programmable Calculator. U.S. Govt Printing Office, Washington, D.C., 1979. 9. Wen CP, Tsai SP. Anatomy of the healthy worker effect: A critique of summary statistics employed in occupational epidemiology. Scand J Work Environ Health 8 (Suppl): 48-52, 1982. 10. Lawler A8, Mandel JS, Schuman LM : A retrospective cohort mortality study of iron ore (hematite) miners in Minnesota. JOM 27:507-517, 1985. 11. * Wigle DT: The distribution of lung cancer in two Canadian cities. Can J Public Health 68:463-468, 1977. 12. Mortality Atlas of Canada. Canadian Government Publishing Centre Hull, Quebec, 1980. 13. Selikoff IJ and Hammond EC (Editors). Health hazards of asbestos exposure. Ann NY Acad Sci 330:1-811, 1979. ) I '1*] 9 I 0 1S 16. 14. Roberts RS, Julian JA, Muir DCF and Shannon HS. Cancer mortality associated with the high temperature oxidation of nickel subsulfide. IARC Scientific Publication 53:23-35, 1984. SI1'19I01S TABLE 1 DISTRIBUTION OF EMPLOYEES BY AGE ANO YEAR OF ONSET OF PERSON-YEARS EXPOSURE WITH PERSON-YEARS CONTRIBUTION TO THE STUDY IN PARENTHESES Aae < 20 20 - 29 30 - 39 40 - 49 50 - 59 60+ TOTAL Year of Onset of Person-Years Experience 1950 - 1959 157 (4,798) 719 (22,058) 353 (10,644) 100 (2,697) 16 (311) 5 (103) 1,350 (40,611) 1960 - 1969 136 (2,650) 670 (13,412) 129 (2,640) 36 (705) 3 (46) 0 (0) 974 (19/55) 1970 - 1979 206 (2,097) 621 (6,447) 96 (942) 19 (198) 4 (41) 0 (0) 946 . (9,725) 1980 - 1983 TOTAL 24 (107) 523 (9,652) 144 (613) 2154 (42,530) 33 (146) 611 (14,372) 7 (28) 162 (3,628) 0 23 (0) (398) 16 (4) (107) 209 (898) 3,479 (70,687) S T 0 I6 I.U 6 TABLE 2 OBSERVED (N > 2) AND EXPECTED DEATHST, SMR'S AND 95 PER CE7TT CONFIDENCE INTERVALS BY CAUSE FOR THE SARNIA DIVISION HALE EMPLOYEES (1950-1984) ANALYZED FOR THE ENTIRE FOLLOW-UP PERIOD 6ST0 I 1| 4 I 7 Cause of Death (ICDA-8th Revision Codes) Obs Exp Canada SMR 954 C. 1. Ontario Exp SMR 95% C.l. All Causes (000-999) 240 366.9 65 57 74 Infective and Parasitic Oisease (000-136) 2 3.8 52 6 - 189 Neoplasms (140-239) 63 80.9 78 60 - 100 Pharynx Cancer (146-149) 2 1.2 160 19 - 600 Digestive Cancer (ISO-159) 21 24.3 89 53 - 132 Esophagus (ISO) 3 1.8 164 33 - 479 Stomach (151) 4 5.9 68 18 - 174 Large Intestine and Rectum (153,154) 6 9.8 62 22 - 134 Liver ar.d Callbl adder (155,156) 2 1.4 143 16 - SI 6 Pancreas (157) 6 4.4 136 50 - 295 Respiratory Cancer (160-163) IS 26.9 S6 31 - 92 Bronchus and Lung (162.1) Pleura (163.0) Halignant Melanoma (172) 11 24. S 44 22 - 79 3 0.1 2073 417 - 60S3 3 1.1 270 54 - 789 Genital Cancer (185-187) Prostate (185) Urinary Cancer (188,189) Kidney (189.0,189.1,189.2) 2 4.2 48 5 - 173 2 3.4 59 7 - 212 4 3.9 102 23 - 262 2 2.1 ou 11 - 341 Bladder (188) 2 1.7 117 13 - 422 Brain anc Other Nervous System (191,192) 4 3.7 108 24 - 277 Brain (191) Lymphoid Malignancies (200-203) 4 3.2 126 34 - 323 5 5.2 97 31 - 226 Non-Kccckin's Lymphoma (200,202) 3 2.8 105 22 - 316 Multiple Myeloma (203) Leukemias (204-207) 2 1.0 193 22 - 698 3 3.4 87 18 - 255 Neoplasms, Secondary, Ml Defined and Benign (195-199,210-239) 4 3.4 102 27 . 260 Endocrine, Nutritional and Metabolic Diseases (240-279) 4 6.1 66 18 - 168 Nervous System and Sense Organ Disease (320-389) Multiple Sclerosis (340) Circulatory Disease (390-458) 3 4.9 61 12 179 2 0.7 282 32 * 1019 110 148.2 74 61 - 89 Hypertensive Heart Oisease (400-404) Ischemic Heart Oisease (410-413) 2 1.4 140 16 - 506 86 107.8 80 64 - 98 Other Forms of Heart Oisease (420-429) 8 2.7 298 128 - 587 357.7 2.5 79.7 1.3 23.9 2.0 5.1 10.7 1.5 4.2 26.4 24.3 0.1 1.4 4.2 3.3 3.9 2.0 1.3 3.8 3.4 5.0 2.7 1.0 3.5 67 80 79 155 83 148 78 59 13S 142 7 45 2738 215 48 61 102 93 112 105 117 100 112 192 86 59 m 76 9 - 288 61 - 101 17 - 559 54 - 134 30 - 434 21 - 200 21 - 128 15 - 483 52 - 308 32 - 94 23 - 81 530 - 8000 43 - 623 5 - 172 7 - 219 27 - 261 11 - 353 13 - 404 29 - 272 32 - 300 32 - 234 22 - 326 22 - 693 17 - 253 3.4 117 31 299 5.8 69 19 - 178 4.6 65 13 - 190 0.6 348 39 - 1255 153.7 72 59 86 1.2 163 18 * 587 115.7 74 59 - 92 2.0 397 171 782 TABLE 2 (continued) Cause of Oeath (ICDA-8th Revision Codes) Obs Exp Canada S.'IR 95* C. 1. Ontario Exp 5MR 95* C.1. Cerebrovascular Disease (430-438) Diseases of Arteries, Arterioles and Capillaries (440-448) Respiratory Disease (460-519) Pneumonia (480-486) Chronic Bronchitis, Emphysema and Asthma (490-493,519.3) Digestive Disease (520-577) Cirrhosis and Other Liver Disease (570-573) Cenitourinary Disease (580-629) Nephritis and Nephrosis (580-584) Musculoskeletal Disease (710-738) 111 Oefined Symptoms (780-796) Accidents, Poisoning and Violence(800-999) 9 17.2 52 24 -> 99 4 S.8 10 17.4 5 5.8 68 58 - 175 57 27 - 106 87 28 - 203 5 8.6 4 18.2 53 19 - 137 22 6 56 4 11.2 36 10 - 91 2 3.9 50 6 - 182 Z 2.1 95 11 - 342 3 0.7 414 83 - 1 210 3 3.1 97 20 - 285 33 74.0 45 31 - 63 17.3 52 24 - 99 6.2 65 17 - 166 16.8 59 23 - 109 6.3 80 26 - 186 8.0 63 20 - 147 18.1 22 6 - 57 11.6 3.8 2.1 0.7 2.4 63.5 34 52 96 434 123 52 9 - 88 6 - 189 11 - 346 87 - 1267 25 - 366 36 73 Based on male Canadian and Ontario mortal ty rates. ST0I644I8 TABLE 3 OBSERVED (N > 2) AND EXPECTED DEATHS', SMR'S AND 95 PER CENT CONFIDENCE INTERVALS BY CAUSE FOR THE SARNIA DIVISION HALE EMPLOYEES EXCLUDING PERSON-YEARS AND DEATHS WITHIN 15 YEARS OF HIRE Cause of Death (ICOA-Bth Revision Codes) Obs Exp Canada SMR 954 l:.i. Ontario Exp SMR 954 C. 1. All Causes (000-999) Infective and Parasitic Disease (000-136) Neoplasms (140-239) Pharynx Cancer (146-149) Digestive Cancer (150-159) Esophagus (150) Stomach (151) Large Intestine and Rectum (153,154) Liver and Gallbladder (155,156) Pancreas (157) Respiratory Cancer (160-163) Bronchus and Lung (162.1) Pleura (163.0) Malignant Melanoma (172) Urinary Cancer (188,189) Kidr.ey (189.0,189.1 ,189.2) Brain and Other Nervous System (191,192) Brain (191) Lymphoid Malignancies (200-203) Ncn-Koogkin's Lymphcma (200,202) Leukemias (204-207) Neoplasms, Secondary, 111 defined and Benign (195-199,210-239) Endocrine, Nutritional and Metabolic Diseases (240-279) Nervous System and Sense Organ Disease (320-389J Circulatory Disease (390-458) Ischemic Heart Oisease (410-413) Other Forms of Heart Oisease (420-429) 171 290.4 2 1.8 48 70.0 2 1.1 17 20.9 3 .1-7 3 4.8 4 8.5 2 1.2 5 3.9 11 24.9 .8 23.3 2 0.1 2 0.9 3 3.5 2 1.9 3 2.9 3 2.6 3 4.0 2 2.3 2 2.6 4 3.2 3 5.0 2 3.6 82 125.4 66 92.5 7 2.6 59 110 69 186 81 .179 63 47 162 127 44 34 1450 223 87 108 105 115 75 89 76 50 68 12 - 398 51 - 91 21 - 673 47 - 130 36 - 524 13 - 148 13 - 121 18 - 585 41 - 297 22 - 79 15 - 63 163 - 5235 26 - 823 18 - 254 12 - 390 21 - 306 23 - 335 15 - 220 10 - 321 o - 275 126 34 - 322 59 12 - 174 56 6 - 204 65 52 - B1 71 55 - 91 271 109 - 559 285.1 1.4 68.9 1.2 20.6 1.8 4.2 8.9 1.3 3.8 24.2 22.7 0.1 1.1 3.5 1.3 3.0 2.8 3.3 2.2 2.6 60 141 70 173 82 163 72 45 153 133 46 35 1917 182 87 111 101 105 78 93 75 51 70 16 - 508 SI - 92 19 - 626 48 - 132 33 - 476 14 - 210 12 - 115 17 - 552 43 - 311 23 - 82 15 - 69 215 - 6920 20 - 656 17 - 253 12 - 4CO 20 - 296 21 - 308 IS - 229 10 - 335 o - 274 2.8 141 38 - 352 4.7 64 13 - 185 3.4 ' 58 129.4 63 98.3 67 1.9 364 750 52 146 - 211 79 85 749 ST0I644I9 TABLE 3 (continued) Cause of Oeath (IC0A-8th Revision Codes) Obs Exp Canada SMR 954 iC.I. Ontario Exp SMR 954 C. 1. Cerebrovascular Oisease (430-438) Diseases of Arteries, Arterioles and Capillaries (*40-4^t8) Respiratory Oisease (460-519) Pneumonia (480-486) Chronic Bronchitis, Emphysema and Asthma (490-493,519.3) Digestive Disease (520-577) Cirrhosis and Other Liver Disease (570-573) Cenitourinary Disease (580-629) Nephritis and Nephrosis (580-584) Musculoskeletal Oisease (710-738) 111 Defined Symptoms (780-796) Accidents, Poisoning and Violence(800-999) S 14.5 41 15 - 90 2 5.3 38 4 - 136 9 14.9 60 27 - 114 5 4.7 106 34 247 4 7.8 3 15.3 51 14 - 131 20 4 - 57 3 9.9 30 6 - 88 2 2.6 76 9 - 275 2 1.1 175 20 - 633 3 0.6 513 103 - 1500 2 2.5 80 9 - 290 12 44.3 27 14 - 47 14.5 41 15 - 90 5.6 36 4 - 129 14.4 63 29 - 119 5.1 98 31 - 228 7.3 55 15 - 141 15.3 20 4 - 57 10.3 29 6 85 2.5 79 9 - '285 1.2 17S 20 - 630 0.6 526 106 - 1536 2.1 96 11 - 346 37.7 32 16 - 56 Based on male Canadian and Ontario mortality rates. 02 *| 'l 9 I 01S TABLE 4 DISTRIBUTION OF OBSERVED AND EXPECTED (O/E) DEATHS BY AGE AND YEAR OF ONSET OF PERSON-YEARS EXPERIENCE (SMR IN PARENTHESES)* Year of Onset of Person-Years Experience Age < 20 20 - 29 30 - 39 40 - 49 50 - 59 60+ TOTAL 1950 - 1959 4/12.1 (32.9) 61/94.1 (64.8) 77/108.3 (71.1) 56/57.2 (97.8) 11/13.4 (82.1) 4/10.1 ' (39.7) 213/295.2 (72.2) 1960 - 1969 2/4.4 (45.8) 10/26.7 (37.5) 3/13.0 (23.1) 3/7.4 (40.8) 1/1.0 (101.8) 0/0.0 * 19/52.5 (36.2) 1970 - 1979 2/3.3 (60.7) 4/9.9 (40.4) 1/2.3 (43.4) 0/1.5 (0) 1/0.6 (157.7) 0/0.0 8/17.6 (45.4) 1980 - 1983 TOTAL 0/0.2 (0) 8/20.0 (40.1) 0/0.9 (0) 75/131.6 (57.0) 0/0.3 (0) 81/123.9 (65.4) 0/0.1 (0) 59/66.2 (89.2) 0/0.0 13/15.0 (86.6) 0/0.1 (0.0) 4/10.2 (39.2) 0/1.6 (0) 240/366.9 (65.4) *SMR cannot be calculated because of zero observed person-years. CO --1 CD cn ro