Document jgkjjrMBXB3OK216MZ7G2011p

NATIONAL INSTITUTE FOR OCCUPATIONAL HEALTH Pathology Division Surveillance Report: Demographic Data and Disease Rates for January to December 2004 Ntombizodwa Ndlovu Jill Murray Geoff Candy Gill Nelson NIOH Report 7/2005 PO Box 4788 JOHANNESBURG 2000 e-mail: jill.murray@nioh.nhls.ac.za NATIONAL HEALTH LABORATORY SERVICE ACKNOWLEDGEMENTS We thank the following staff members of the NIOH Pathology Department, for their invaluable contribution to the autopsy service: Anna Khumalo Goodman Rani Jay Vallabh Jemima Cantrell Johanna Dibedi Johannes Makoena Joseph Mukhovi Julienne Mkhize Juliet Buthelezi Martha Rikhotso May Humby Nora Ngutshane Patrick Mbhontsi Phyllis Back Rosinah Soko Simon Seopela Wilson Mashele Thanks also to Michelle Kotze and Thomas Msiza (IT Directorate, National Department of Health) for upgrading and maintaining the PATHAUT system. National Institute for Occupational Health, PO Box 4788, Johannesburg, 2000, South Africa ISSN 1812-7681 EXECUTIVE SUMMARY During 2004, 2 055 cases came to autopsy at the NIOH. Of these, 69.5% were black men, 29.0% were white, 1.1% were coloured and 0.4% were submitted without information on population group. Overall disease rates (per 1000 autopsies) for 2004 are shown in Figure 1. 300 250 ooo 200 0Q). 150 0) 100 50 0 Pulmonary tuberculosis Emphysema Silicosis Primary lung cancer 41 25 12 14 7 3 Asbestosis Mesothelioma Massive fibrosis Coal workers' pneumoconiosis Mixed dust pneumoconiosis FIG. 1 OVERALL DISEASE RATES FOR 2004 In 2004 the overall prevalence of silicosis increased from that in previous years. The prevalence of pulmonary tuberculosis (PTB) also increased, following the trend of the last several years. The rise in PTB was particularly evident in black gold miners where the rate increased from 328 per thousand in 2003 to 341 per thousand in 2004. Concerted efforts to obtain service histories resulted in fewer cases with incomplete information in 2004. With the increase in numbers of female cases submitted for autopsy, efforts are underway to include females in the 2005 surveillance report. During 2004, four journal articles utilising the PATHAUT data were published (see Appendix 2) and research findings were presented at a number of forums. An MSc student (University of the Witwatersrand) also used the data for her dissertation. i TABLE OF CONTENTS EXECUTIVE SUMMARY GLOSSARY SECTION 1: BACKGROUND SECTION 2: DEMOGRAPHIC DATA SECTION 3: ACTIVE TUBERCULOSIS SECTION 4: SILICOSIS SECTION 5: OTHER PNEUMOCONIOSES Massive Fibrosis Coal Workers' Pneumoconiosis Mixed Dust Pneumoconiosis Asbestosis and pleural plaques SECTION 6: EMPHYSEMA i iv 1 2 8 11 13 13 13 13 14 SECTION 7: MESOTHELIOMA 16 SECTION 8: PRIMARY LUNG CANCER 18 SECTION 9: CLINICAL CAUSES OF DEATH 20 LIST OF TABLES Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 3.1 Table 3.2 Table 4.1 Table 4.2 Table 4.3 Distribution of autopsies by year and population group (1975-2004) Number and proportion of autopsies by type and population group (2004) Number and proportion of autopsies by age and population group (2004) Number and proportion of autopsies by commodity and population group (2004) Number and proportion of autopsies by years of service and population group (2004) Mean age by commodity and population group (2004) Mean duration of service by commodity and population group (2004) Number of cases and prevalence of active PTB by commodity and population group (2004) Number of cases and prevalence of active PTB by age and population group (2004) Number of cases and prevalence of silicosis by commodity and population group (2004) Number of cases and prevalence of silicosis in the gold mining industry, by age and population group (2004) Number of cases and prevalence of silicosis in the gold mining industry, by years of service and population group (2004) 2 3 3 5 6 7 7 9 10 11 12 12 ii Table 5.1 Table 6.1 Table 6.2 Table 6.3 Table 7.1 Table 7.2 Table 8.1 Table 8.2 Table 9.1 Number of cases and prevalence of asbestosis by age and population group (2004) Number of cases and prevalence of emphysema by age and population group (2004) Number of cases and prevalence of emphysema by commodity and population group (2004) Number of cases and prevalence of emphysema by years of service and population group (2004) Number and proportion of mesothelioma cases by age and population group (2004) Number and proportion of mesothelioma cases by commodity and population group (2004) Number of cases and prevalence of primary lung cancer by age and population group (2004) Number of cases and prevalence of primary lung cancer by commodity and population group (2004) Clinical causes of death by population group (2004) 13 14 15 15 16 17 18 19 20 LIST OF FIGURES Figure 1 Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 9.1 Overall disease rates for 2004 Distribution of autopsies by age and population group (2004) Distribution of autopsies by commodity and population group (2004) Distribution of autopsies by years of service and population group (2004) Distribution of active TB by site (2004) Active PTB rates in all black miners at autopsy (1975 to 2004) Clinical cause of death as given by the clinicians who submit the organs to the NIOH (2004) i 4 5 20 APPENDICES Appendix 1: Distribution of autopsies according to the last mine where the deceased worked (2004) Appendix 2: PATHaUt publications and activities (2004) 21 25 CD 0 0 CT) iii GLOSSARY Asbestosis Coal workers' pneumoconiosis Emphysema Massive fibrosis Mesothelioma Miner Mixed exposures Prevalence Silicosis Surveillance Lung fibrosis caused by asbestos fibres Lung fibrosis caused by exposure to coal dust Lung disease caused by the destruction of the alveolar walls Lung fibrosis caused by exposure to dust and measuring more than 1 cm in diameter A malignant tumour of the pleural cavity of the lungs A person who has worked in a controlled mine or works The multiple dust types to which a miner may be exposed, having worked in several mining commodities in his lifetime The number of cases in a defined population at a given time Lung fibrosis caused by inhalation of silica dust; detected by the presence of silicotic nodules in the lung tissue The ongoing and systematic collection, analysis and interpretation of data related to either occupational exposure or adverse health outcomes iv SECTION 1 - BACKGROUND The Occupational Diseases in Mines and Works Act, 1973 (Act 78 of 1973) requires that the cardio-respiratory organs of a deceased person who has worked at a controlled mine or a controlled works be examined for the presence of occupational disease, regardless of the clinical cause of death and provided that the next of kin agrees. These examinations are performed by pathologists at the National Institute for Occupational Health (NIOH). A detailed report on each case examined is sent to the Medical Bureau for Occupational Diseases (MBOD). Cases certified as having a compensable disease are then referred to the Compensation Commissioner's office, where the payment for compensation is managed. Since 1975, the pathological findings from the autopsy examinations have been recorded on the computerised PATHAUT database. PATHAUT comprises data from autopsy examinations and clinical files which include occupational histories. The database is unique and provides an important resource for both surveillance and research. These data are the only comprehensive surveillance data on occupational lung disease in the South African mining industry. The data presented in this report summarise the PATHAUT system surveillance results, i.e. the results of the systematic collection, collation, and analysis of the pathology findings in the cardio-respiratory organs of mine workers. Data from PATHAUT are exported into, and analysed, using SAS v9.1. This is the eighth consecutive annual report and describes autopsy cases examined during the year 2004. Many of the cases had "mixed" exposures in that they had been employed in more than one commodity. For simplicity, cases are categorised according to the commodity in which most years of service were recorded, i.e. the commodity in which the miners had worked for the longest period. In Appendix 1, however, the cases are listed according to the most recent (last) mine at which the miners worked. All disease rates reported in this document are expressed per 1000. In all calculations, the denominators used are the total numbers of autopsies in specific commodities, age groups or population groups. Some of these rates must be viewed with caution, as the denominators are very small. This applies, for example, to those commodities where few workers are employed (such as manganese mining), and to the older age groups in some instances. 1 SECTION 2 - DEMOGRAPHIC DATA The number of autopsies performed since 1975 is presented in Table 2-1. TABLE 2-1 DISTRIBUTION OF AUTOPSIES BY YEAR AND POPULATION GROUP (1975 - 2004) Year of autopsy Black N% White N% Coloured N% Indian N% Unknown N% 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996* 1997 1998 1999 2000 2001 2002 2003 2004 2 190 2 335 2 351 2 245 2 118 2 338 2 209 2 312 2 096 1 966 2 275 2 456 2 594 2 518 2 138 2 172 2 143 2 144 1 863 1 737 2 830 766 2 223 1 977 1 656 1 798 1 690 1 677 1 536 1 428 71 68 69 67 66 64 66 63 65 64 64 68 68 67 65 64 65 66 65 61 71 68 69 69 65 69 67 67 66 69 854 1 072 1 039 1 090 1 026 1 274 1 117 1 302 1 109 1 098 1 200 1 125 1 168 1 165 1 090 1 155 1 080 1 049 956 1 021 1 059 329 897 836 832 761 813 763 745 596 28 31 30 32 33 35 33 36 34 36 34 31 30 31 33 34 33 32 33 36 27 29 28 29 33 29 32 30 32 29 32 1 27 1 33 1 32 1 45 1 46 1 33 1 44 1 41 1 28 1 66 2 45 1 78 2 77 2 60 2 51 2 66 2 70 2 65 2 94 3 99 2 19 2 70 2 49 2 29 1 41 2 13 1 50 2 23 1 22 1 1 1 **1 14 1.2 18 0.6 17 0.6 12 0.5 8 0.3 13 0.5 28 1.1 13 0.6 **8 0.4 Total 61 781 66 29 621 32 1 448 2 30 131 0.1 * Data for only 6 months are available for 1996 ** In all subsequent analyses, the Indian and unknown population groups have been combined Total N 3 076 3 434 3 423 3 367 3 189 3 658 3 359 3 658 3 246 3 092 3 541 3 626 3 840 3 760 3 288 3 378 3 289 3 263 2 884 2 852 3 988 1 128 3 208 2 880 2 529 2 608 2 529 2 518 2 318 2 055 92 984 It is important to note that a referral bias exists: there is a low autopsy rate for black men who have left employment at the mines, whereas the majority of white retired miners come to autopsy. The numbers of miners coming to autopsy has decreased steadily over the years, 2 probably reflecting the concomitant decrease in the number of miners. In 1994 there were around 344 000 people employed in the gold mining industry compared to approximately 177 000 in 2004. The pathologists at the NIOH perform two types of autopsy examinations. For men dying distant from Johannesburg, the cardio-respiratory organs are removed locally, preserved in formalin and sent to the NIOH. Full autopsies are undertaken on men who die close to Johannesburg. Table 2-2 shows the distribution of autopsies by population group for 2004. Autopsies of only the cardio-respiratory organs comprised 94.2% of all examinations. TABLE 2-2 NUMBER AND PROPORTION OF AUTOPSIES BY TYPE AND POPULATION GROUP (2004) Autopsy type Cardiorespiratory organs only Full autopsy Total Black N% 1422 99.6 6 0.4 1428 White N% 484 81.2 112 18.8 596 Coloured N% 21 95.5 1 4.5 22 Unknown N% 9 100 0- 9 Total N% 1936 94.2 119 5.8 2055 The age distribution of autopsies for 2004 is shown in Table 2-3 and Figure 2-1. The mean age at autopsy for black men has increased annually from 37.9 years in 1998 to 44.5 years in 2004. The mean age of white men at autopsy (64.6 years) has remained essentially unchanged. TABLE 2-3 NUMBER AND PROPORTION OF AUTOPSIES BY AGE AND POPULATION GROUP (2004) Age group Black (years) N % White N% 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total 52 327 690 295 33 15 4 12 1 428 3.6 2 22.9 18 48.3 61 20.7 103 2.3 186 1.1 165 0.3 61 0.8 0 596 0.3 3.0 10.2 17.3 31.2 27.7 10.2 - Coloured N% 003 13.6 6 27.3 5 22.7 6 27.3 2 9.1 0- 22 Unknown N% Total N% 0 - 54 2.6 0 - 345 16.8 1 11.1 755 36.7 0 - 404 19.7 1 11.1 225 10.9 0 - 186 9.1 0 - 67 3.3 7 77.8 19 0.9 9 2 055 3 800 700 (/> 600 CD o 500 *4-- 400 CD -Q 300 z3 200 100 0 20-29 o 05 CD 30-39 40-49 50-59 60-69 Age group (years) 70-79 80+ Black White Coloured FIG 2-1 DISTRIBUTION OF AUTOPSIES BY AGE AND POPULATION GROUP (2004) Table 2-4 and Figure 2-2 show the distribution of autopsies by commodity and population group for 2004. The percentage of autopsies received from the gold mining industry has been consistent over the last four years, at around 69%. The percentage of autopsies from platinum miners doubled from 8.3% in 1999 to 16.0% in 2004. As in previous years, the majority of coloured men who came to autopsy (68.2%) were asbestos miners. Cases were placed in categories according to the commodity in which they had worked for the longest duration (most exposure). Many men, however, worked in a number of different mining commodities during their lifetimes and had "mixed" exposures. This was not taken into account in the analysis of exposure type (commodity). All results are presented using longest exposure. 4 TABLE 2-4 NUMBER AND PROPORTION OF AUTOPSIES BY COMMODITY AND POPULATION GROUP (2004) Commodity Gold Platinum Coal Asbestos Iscor Diamond Copper Manganese Industry Other Unknown Total Black N% 997 69.8 303 21.2 52 3.6 37 2.6 1 0.1 7 0.5 08 0.6 4 0.3 8 0.6 11 0.8 1428 White N% 425 71.3 25 4.2 49 8.2 20 3.4 19 3.2 5 0.8 14 2.3 3 0.5 9 1.5 16 2.7 11 1.8 596 Coloured N% 00015 68.2 005 22.7 0002 9.1 22 Unknown N% 1 11.1 01 11.1 00000007 77.8 9 Total N% 1 423 328 102 72 20 12 19 11 13 24 31 69.2 16.0 5.0 3.5 1.0 0.6 0.9 0.5 0.6 1.2 1.5 2055 Note: this table shows only those commodities where a total of 10 or more cases were received Black 3.6 21.2 White Coloured 69.8 2.6 2.7 I~1 Gold dl Coal dl Platinum d| Asbestos HH Other* FIG 2-2 DISTRIBUTION OF AUTOPSIES BY COMMODITY AND POPULATION GROUP (2004) * Includes Iscor, copper, diamond, quarry, silica (silicon smelters), manganese, zinc, minerals, steel, chrome, iron, manganese, emerald and other industries, as well as cases where no service histories were obtained. Detailed information about the years in mining service by population group is presented in Table 2-5 and Figure 2-3. In 2004, duration of service was obtained for all but 4.4% of the cases. This is much lower than previous years (e.g. 21.8% in 2003) and is attributable to improvement in the follow-up of cases to obtain complete service histories. 5 TABLE 2-5 NUMBER AND PROPORTION OF AUTOPSIES BY YEARS OF SERVICE AND POPULATION GROUP (2004) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41 + Unknown Total Black N% 20 1.4 137 9.6 233 16.3 291 20.4 381 26.7 179 12.5 92 6.4 24 1.7 12 0.8 059 4.1 1 428 White N% 1 0.2 42 7.0 61 10.2 86 14.4 63 10.6 75 12.6 93 15.6 78 13.1 53 8.9 23 3.9 21 3.5 596 Coloured N% 05 22.7 2 9.1 1 4.5 2 9.1 1 4.5 3 13.6 2 9.1 2 9.1 1 4.5 3 13.6 22 Unknown N% 0000001 11.1 0008 88.9 9 Total N% 21 1.0 184 9.0 296 14.4 378 18.4 446 21.7 255 12.4 189 9.2 104 5.1 67 3.3 24 1.2 91 4.4 2 055 Years of service: < 1 1 - 5Q 6 - 10 11 - 15 16 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 + FIG 2-3 DISTRIBUTION OF AUTOPSIES BY YEARS OF SERVICE AND POPULATION GROUP (2004) 6 The mean age and duration of service by commodity type and population group for those cases for which information was available are shown in Tables 2-6 and 2-7. TABLE 2-6: MEAN AGE BY COMMODITY AND POPULATION GROUP (2004) Black White Commodity N Mean SD* N Mean SD* Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown Total 989 52 302 37 7 0 1 20 8 1416 (years) 44 45 45 58 54 41 51 48 44 8 9 8 14 8 12 14 9 (years) 425 64 13 49 66 14 25 60 13 20 67 9 5 71 14 14 67 9 19 64 9 28 64 11 11 63 14 596 65 12 * Standard deviation TABLE 2-7: MEAN DURATION OF SERVICE BY COMMODITY AND POPULATION GROUP (2004) Black Commodity N Mean SD* Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown Total 962 48 297 35 7 0 1 18 1 1369 (years) 16 19 15 10 17 14 10 36 16 7 9 8 10 9 - 7 - 8 *Standard deviation White N Mean SD* (years) 421 24 11 46 18 11 24 17 8 19 13 11 5 18 14 14 21 8 19 23 10 27 18 0- 11 - 575 22 11 7 SECTION 3 - ACTIVE TUBERCULOSIS The distribution of active tuberculosis (TB) by anatomical site is presented in Figure 3-1 (n=592). Active pulmonary TB (PTB) was diagnosed in 23.9% (492) of all cases autopsied in 2004, compared to 16.4% (416) in 2000. Most of the men with PTB were black (93.5%; 460 cases), 5.7% (28 cases) were white, 0.4% (2 cases) were coloured and in 0.4% (2 cases) the population group was unknown. 4.3 1.9 20.4 13.9 57.1 Lungs & nodes (338; 57.1%) Lungs, nodes & pleura (14; 2.4%) Lungs only (121; 20.4%) Lungs, nodes & pericardium (11; 1.9%) Nodes only (82; 13.9%) Other combinations (26; 4.3%) FIG 3-1 DISTRIBUTION OF ACTIVE TB BY SITE (2004) 8 The overall rate of PTB (239/1000) has increased from 160/1000 in 2000. This is attributed to the increase in the PTB rate in black men from 217/1000 in 2000 to 322/1000 in 2004 (Fig 3.1). As indicated previously, cases are assigned to categories according to the commodity in which the most years of service occurred. In black gold miners, the rate of PTB has increased annually from 171/1000 in 1999 to 341 in 2004. Rates in black platinum miners have decreased in the last few years from 383/1000 in 2002 to 310/1000 in 2004. Year FIG 3-2 ACTIVE PTB RATES IN BLACK MINERS AT AUTOPSY (1975 to 2004) The distribution of active PTB cases by commodity is shown in Table 3-1. Rates in this and the following tables are expressed per 1000. The majority of active PTB cases (72.8%) came from the gold mining industry (69.2% of all autopsy cases came from that commodity). TABLE 3-1 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY COMMODITY AND POPULATION GROUP (2004) Commodity Black N Rate White N Rate Coloured N Rate Gold Platinum Coal Asbestos Diamond Copper Other Unknown 340 341 94 310 11 212 6 162 1 0 3 5 18 42 3 120 3 61 3 150 0 1 0 0 0001 67 0 1 0 0 Total 460 322 28 47 2 91 Note: rates have not been calculated where numbers are small Unknown N Rate 001 1000 00 0 0 1 2 222 Total N Rate 358 252 97 296 15 147 10 139 1 2 3 6 492 239 9 The age distribution of cases with active PTB is shown in Table 3-2. Most (48.2%; 237 cases) were in the age group 40-49 years, followed by 22.8% (112 cases) in the 30-39 year age group. TABLE 3-2 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY AGE AND POPULATION GROUP (2004) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 Unknown Total Black N Rate 14 269 111 339 232 336 86 292 8 242 4 267 5 417 460 322 White N Rate 01 56 5 82 10 97 8 43 4 24 0- 28 47 Coloured N Rate 001 333 001 167 0- 2 91 Unknown N Rate 00001 1000 01 143 2 222 Total N Rate 14 259 112 325 237 314 97 240 17 76 9 48 6 316 492 239 10 SECTION 4 - SILICOSIS Silicotic nodules were found in the lungs of 432 cases (21.0% of all autopsies), 91.2% of which came from the gold mining industry. Of all cases of silicosis, occasional silicotic nodules were found in 55.8% of cases, a few in 17.8%, a moderate number in 22.9% and a large number in 2.3%. The distribution of cases with silicosis by commodity and population group is presented in Table 4-1. The rate of silicosis in gold miners has increased from 191/1000 in 2000 to 277/1000 in 2004. TABLE 4-1 NUMBER OF CASES AND PREVALENCE OF SILICOSIS BY COMMODITY AND POPULATION GROUP (2004) Commodity Black N Rate White N Rate Coloured N Rate Gold Platinum Coal 305 306 15 50 6 115 89 209 3 120 5 102 0 0 0 - Asbestos 1 0 0 Diamond 1 0 0 Copper 0 4 0 Unknown 1 2 0 Total 329 230 103 173 0 - Note: rates have not been calculated where numbers are small Unknown N Rate 000- 0 0 0 0 0- Total N Rate 394 277 18 55 11 108 1 1 4 3 432 210 11 Although the silicosis rates increased with increasing age in both black and white men, the age distribution of cases with silicosis differed between the two population groups (Table 4-2). Silicosis was diagnosed in blacks at younger ages (<40) and in men who were exposed to silica for fewer years (< 5 years) (Table 4-3). TABLE 4-2 NUMBER OF CASES AND PREVALENCE OF SILICOSIS IN THE GOLD MINING INDUSTRY, BY AGE AND POPULATION GROUP (2004) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 1 29 27 105 186 377 77 418 10 667 1 250 1 333 2 250 305 306 White N Rate 007 140 8 118 28 226 32 271 14 292 0- Coloured N Rate - - 89 209 0 - Unknown N Rate 00000000- 0- Total N 1 27 193 85 38 33 15 2 394 Rate 29 99 355 337 273 270 294 222 277 TABLE 4-3 NUMBER OF CASES AND PREVALENCE OF SILICOSIS IN THE GOLD MINING INDUSTRY, BY YEARS OF SERVICE AND POPULATION GROUP (2004) Years of service 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41+ Unknown Total Black N Rate 12 162 28 159 57 264 101 357 52 433 35 583 8 444 3 333 09 257 305 306 White N Rate 05 152 11 190 5 106 12 214 20 294 17 258 12 261 7 318 0- 89 209 Coloured N Rate 0000000000- 0- Unknown N Rate 0000000000- 0- Total N Rate 12 121 33 158 68 248 106 321 64 364 55 430 25 298 15 273 7 318 9 225 394 277 12 SECTION 5 - OTHER PNEUMOCONIOSES MASSIVE FIBROSIS There were 29 (1.4%) cases of massive fibrosis (25 black, 4 white). Twenty six were from the gold mining industry. COAL WORKERS' PNEUMOCONIOSIS There were 15 (0.7%) cases of coal workers' pneumoconiosis. MIXED DUST PNEUMOCONIOSIS There were 6 (0.3%) cases of mixed dust pneumoconiosis. ASBESTOSIS AND PLEURAL PLAQUES There were 51 cases of asbestosis of which 58.8% (n=30) had slight, 33.3% (n=17) moderate and 7.8% (n=4) marked fibrosis. Thirty seven of these cases had worked in the asbestos mining industry at some time in their lives. Only 13 cases had asbestos plaques. However, the parietal pleura (the site where plaque formation usually occurs) is seldom submitted with the lungs. The distribution of asbestosis by age and population group is shown in Table 5-1. No asbestosis was diagnosed in cases younger than 40 years of age. TABLE 5-1 NUMBER OF CASES AND PREVALENCE OF ASBESTOSIS BY AGE AND POPULATION GROUP (2004) Age group (years) 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 69 8 27 7 212 6 400 1 250 0- 28 20 White N Rate 1 16 09 48 4 24 1 16 0- 15 25 Coloured N Rate 002 400 3 500 2 1000 0- 7 318 Unknown N Rate 000001 143 1 111 Total N Rate 79 8 20 18 80 13 70 4 60 1 53 51 25 13 SECTION 6 - EMPHYSEMA There were 434 cases of emphysema, the extent of which was mild in 81.8% (n=355), moderate in 17.1% (n=74) and marked in 1.2% (n=5). The distribution of emphysema by age and population group is presented in Table 6-1. TABLE 6-1 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY AGE AND POPULATION GROUP (2004) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 1 19 11 34 92 133 52 176 17 515 7 467 2 500 0- 182 127 White N Rate 0010 164 26 252 93 500 78 473 29 475 0- 236 396 Coloured N Rate 0003 500 5 1000 3 500 1 500 0- 12 545 Unknown N Rate 001 1000 01 1000 002 286 4 444 Total N Rate 1 19 11 32 103 136 81 200 116 516 88 473 32 478 2 105 434 211 14 The majority of black and white men with emphysema were from the gold mining industry (65.9%, n=286) (Table 6-2). TABLE 6-2 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY COMMODITY AND POPULATION GROUP (2004) Commodity Black White Coloured Unknown Total N Rate N Rate N Rate N Rate N Rate Gold Platinum Coal Asbestos 111 111 175 412 0 - 0 - 286 201 28 92 7 280 0 - 0 - 35 107 21 404 21 429 0 - 1 - 43 422 16 432 7 350 6 400 0 - 29 403 Iscor 06006 Copper 0 4 4 0 8 Diamond 1 3 00 4 Other 3 10 0 0 13 Unknown 2 3 2 3 10 Total 182 127 236 396 12 545 4 444 434 211 Note: rates have not been calculated where numbers are small TABLE 6-3 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY YEARS OF SERVICE AND POPULATION GROUP (2004) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41 + Unknown Total Black N Rate 2 100 17 124 25 107 30 103 43 113 30 168 16 174 7 292 3 250 09 153 182 127 White N Rate 1 1000 13 310 19 311 37 430 23 365 28 373 44 473 31 397 24 453 11 478 5 238 236 396 Coloured N Rate 02 400 1 500 1 1000 002 667 1 500 1 500 1 1000 3 1000 12 545 Unknown N Rate 0000001 1000 0003 375 4 444 Total N Rate 3 143 32 174 45 152 68 180 66 148 58 227 63 333 39 375 28 418 12 500 20 220 434 211 15 SECTION 7 - MESOTHELIOMA The number of cases of mesothelioma in 2004 (n=25) was comparable to that in previous years (14 in 2000, 17 in 2001, 25 in 2002 and 36 in 2003). TABLE 7-1 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY AGE AND POPULATION GROUP (2004) Age group (years) 40-49 50-59 60-69 70-79 80+ Total Black N% 2 20 3 30 2 20 2 20 1 10 10 White N% 18 2 15 6 46 3 23 18 13 Coloured N% 01 50 01 50 0- 2 Total N% 3 12 6 24 8 32 6 24 28 25 The distribution of mesothelioma by commodity and population group is presented in Table 7.2. Forty eight percent of the miners had worked in asbestos mining at some stage in their careers. 16 TABLE 7-2 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY COMMODITY AND POPULATION GROUP (2004) Commodity Asbestos Gold Platinum Coal Other Unknown Total Black N% 6 60 1 10 2 20 001 10 10 White N% 2 15 7 54 018 2 15 18 13 Coloured N% 2 100 00000- 2 Total N% 10 40 8 32 28 14 28 28 25 17 SECTION 8 - PRIMARY LUNG CANCER Eighty five cases of primary lung cancer were found at autopsy, 25.9% of which were in black, 69.4% in white and 4.7% in coloured men. Most of the cases were large cell lung carcinomas (30.6%; n = 26), followed by squamous cell type (23.5%; n = 20), small cell type and adenocarinomas (22.3%; n = 19 each). One case of bronchoalveolar carcinoma was diagnosed. The distribution of primary lung cancer by age and population group is presented in Table 8-1. TABLE 8-1 NUMBERS OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY AGE AND POPULATION GROUP (2004) Age group (years) 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 8 12 11 37 3 91 000- 22 15 White N Rate 3 49 12 117 22 118 17 103 5 82 0- 59 99 Coloured N Rate 02 333 1 200 1 167 00- 4 182 Total N Rate 11 15 25 62 26 116 18 97 5 75 00 85 41 18 The distribution of primary lung cancer by commodity and population group is presented in Table 8-2. The majority of cases came from the gold mining industry. TABLE 8-2 NUMBER OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY COMMODITY AND POPULATION GROUP (2004) Commodity Gold Platinum Coal Asbestos Iscor Copper Diamond Other Unknown Total Black N Rate 99 4 13 2 38 5 135 0 0 0 2 0 22 15 White N Rate 36 85 5 200 7 143 2 100 1 1 1 4 2 59 99 Coloured N Rate 0001 67 0 1 0 0 2 4 182 Total N Rate 45 32 9 27 9 88 8 111 1 2 1 6 4 85 41 19 SECTION 9 - CLINICAL CAUSES OF DEATH Table 9-1 and Figure 9-1 show the clinical cause of death stated in the accompanying documents submitted with the cardio-respiratory organs, by population group. Diseases of the respiratory system were the most frequent (46.5%) overall. Black men had the highest proportion of unnatural causes of death (10.2%). The proportion of unnatural deaths in black men decreased from 12.2% in 2003 to 10.2% in 2004. In 13.9% of all cases the cause of death was not stated. TABLE 9-1 CLINICAL CAUSES OF DEATH BY POPULATION GROUP (2004) System Respiratory Cardio-vascular Central Nervous System Gastro intestinal Genito urinary Haematological Unnatural Miscellaneous Not stated Total Black N% 789 55.3 60 4.2 124 8.7 68 4.8 21 1.5 6 0.4 145 10.2 98 6.9 117 8.2 1428 White N% 150 25.2 89 14.9 20 3.4 24 4.0 15 2.5 3 0.5 39 6.5 97 16.3 159 26.7 596 Coloured N% 12 54.5 3 13.6 00001 4.5 3 13.6 3 13.6 22 Unknown N% 2 22.2 00000007 77.8 9 Total N% 953 46.5 152 7.4 144 7.0 92 4.5 36 1.8 9 0.4 185 9.0 198 9.6 286 13.9 2055 Black 55% White 7% 0.4% Respiratory Cardiovascular CNS Gastro intestinal Genito urinary Haematological Unnatural Miscellaneous Not stated FIGURE 9-1 CLINICAL CAUSE OF DEATH AS GIVEN BY THE CLINICIANS WHO SUBMIT THE ORGANS TO THE NIOH (2004) 20 APPENDIX 1: DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE WHERE THE DECEASED WORKED (2004) Commodity Asbestos Total from asbestos mines Chrome Total from chrome mines Coal Last mine worked African Chrysolite Asbestos Asbestos Mine Blackrich Asbestos Cape Blue Danielskuil Asbestos mine Everite Gefco Havelock Asbestos Mine Koegas Penge Asbestos Pomfret Asbestos Mine Wandrag Asbestos Mine Dikolong Chrome Mine Eastern Chrome Mine Montrose Chrome Mine Samancor Western Chrome Alpha Anthracite Colliery Arnot Colliery Bank Colliery Barbrook Colliery Blinkpan Colliery Cornelia Colliery Coronation Colliery Delmas Colliery Douglas Colliery Duiker Colliery Durnacol Mine Duvha Opencast Ermelo Coal Gloria Colliery Goedehoop Colliery Greenside Colliery Kilbarchen Colliery Kleinkopje Colliery Koornfontein Coal Kriel Colliery Landau Colliery Matla Coal New Clydesdale Colliery New Denmark New Largo Colliery Optimum Colliery Rietspruit Colliery Sasol Coal Mine S A Coal Estates Savemore Colliery Secunda Colliery Springbok Colliery Springfield Colliery Black 2 33 1 1 2 39 2 1 3 5 2 1 2 3 3 6 1 4 2 12 1 2 3 4 White 1 3 1 1 2 4 1 3 4 Coloured 1 1 4 1 2 6 Unknown 20 15 1 1 2 4 1 1 1 1 2 1 2 1 4 2 1 1 3 11 2 1 2 1 3 2 1 4 4 2 Total 1 4 1 5 4 2 39 1 10 4 1 2 74 2 1 1 3 7 1 6 3 1 2 1 2 1 5 2 1 1 3 2 3 3 2 6 1 4 2 14 1 2 1 2 1 6 2 5 4 4 2 21 Commodity Coal (continued) Total from coal mines Copper Total from copper mines Diamond Total from diamond mines Gold Last mine worked Springlake Colliery Tavistok Colliery Twistdraai Usutu Colliery Van Dyk's Drift Vierfontein Colliery Witbank Collieries Black 1 1 53 Copper Mine Messina Copper O'Kiep Copper Prieska 1 1 Cullinan Diamond Mine De Beers Consolidated Diamond Mine Loxton Exploration Premier Diamond Rex Diamond Mine Star Diamond Zaaiman Diamond Mine 5 1 1 1 8 African Rainbow Minerals & Exploration Angilon GM Anglo American GM Anglogold Business Service Anglogold Great Noligwa GM Anglogold Health Service (Free State) Anglogold Metallurgy Anglogold Vaal River Operation Bambanani GM Bankfontein GM Barberton GM Beatrix Gold Blyvoorquizicht Bracken Mines Brakpan GM Buffelsfontein Gold Cementation Consort GM Crown Mines Deelkraal Doornfontein Driefontein Cons GM Duff Scott Memorial Hospital Durban Roodepoort Deep East Champ GM East Driefontein 9 1 4 17 1 3 15 27 1 62 2 1 11 3 81 1 1 19 White 1 1 1 1 1 1 3 53 Coloured Unknown 1 2 2 33 42 11 5 2 1 3 1 1 8 1 1 2 2 1 3 17 5 14 2 1 1 5 7 4 11 1 10 Total 1 1 1 1 2 1 4 107 2 2 6 7 17 2 5 1 1 4 1 1 1 16 10 1 1 6 17 1 3 15 29 1 1 65 19 5 1 25 2 1 1 5 10 85 1 12 1 29 22 Commodity Gold (continued) Last mine worked East Geduld East Rand Prop Elandsrand Evander GM Freddies Gold Free State Geduld Free State Saaiplaas Gencor Goldfields Grootvlei Prop Harmony Hartebeesfontein J.I.C. Gold Mine Joel Kinross Kloof Kopanang GM Leeudoorn Leslie Libanon Loraine Luipaardsvlei Estate GM Masimong Gold Mine Matjabeng Gold Mine Merriespruit GM Middelburg GM Moab Khotsong GM New Kleinfontein GM Nigel GM Oryx Placer Dome GM President Brand President Steyn Randfontein Robinson Gold Mine Roodekop GM S A Land Sallies SAMAT GM Simmer & Jack GM South Deep GM South Roodepoort St Helena Stilfontein Tautona GM Target Gold Mine Tshepone GM Ubuntu Small Scale GM Unisel GM Vaal Reefs Ventersport Vlakfontein Waterpan GM Welkom GM West Driefontein West Rand Consolidation Black 1 5 35 4 3 1 3 3 56 44 17 6 12 77 17 2 1 2 23 17 9 1 1 1 25 22 6 7 16 1 21 1 1 15 4 5 145 1 1 2 11 0 White Coloured Unknown 18 4 3 2 13 3 1 7 23 19 2 3 3 13 4 1 8 5 1 2 1 2 2 1 4 11 15 1 1 1 1 2 1 2 2 8 2 1 33 7 1 3 8 9 6 Total 1 23 4 38 6 16 3 1 4 10 79 63 19 9 15 90 17 6 2 10 5 1 23 19 9 1 1 1 3 27 23 10 18 31 1 1 1 1 1 2 1 2 23 9 2 2 15 4 5 178 8 1 4 10 20 6 23 Commodity Gold (continued) Total from gold mines Platinum Total from platinum mines Emerald Iron Iron & Manganese Manganese Lead & Minerals Phosphate Quarries Total from quarries Silica Sinkers Steel & Iron Zinc Non-Miner Unknown Last mine worked Western Areas Western Deep Levels Western Holdings Western Reef GM Winkelhaak Wit Niqel GM Amandlabult Platinum (Rustenburq) Anglo Platinum Mine Atok Platinum Bafokenq Deilmann Haniel SA (Northam) Impala Platinum Karee Platinum Lebowa Platinum Northam Platinum Rustenburq Platinum Swartklip Platinum Western Platinum Wildebeestfontein Zondereinde Platinum Gravelotte Iron Ore Mine Associated Manganese Hotazel Manganese Mine Manganese Mine S A Manganese Blackmountain Foskor Beperk Hippo Quarries Quarry Mine Bon Accord Quarry Silicon Smelters Shaft Sinkers Iscor Zinc Corporation Industry NCOH (NIOH) Non-miner Transnet Unknown TOTAL Black 3 70 2 3 962 White 10 27 9 3 Coloured Unknown 1 398 1 1 4 1 6 118 2 2 34 159 2 2 331 3 2 1 6 6 2 1 1 3 1 1 10 1428 10 1 2 20 1 1 1 37 1 1 2 1 1 2 2 1 1 1 2 4 28 1 7 1 2 9 596 2 22 7 9 Total 13 97 11 3 3 1 1360 1 1 4 1 6 128 3 2 36 179 1 1 2 3 368 1 1 5 3 1 3 2 1 1 1 8 10 2 1 29 1 10 1 2 2 28 2 055 24 APPENDIX 2: PATHAUT PUBLICATIONS AND ACTIVITIES (2004) Journal articles Published: Gerston KF, Blumberg L, Tshabalala VA and Murray J. Viability of mycobacteria in formalinfixed lungs. Human Pathology 2004; 35: 571-575. Murray J, G Candy, Nelson G and Ndlovu N . Occupational disease rates in South African miners at autopsy: Surveillance report 2003. Occupational Health SA 2004;10 (6):16-17. Murray J, Back P and Nelson G. Pulmonary nocardiosis in autopsies of South African miners. The Southern African Journal of Epidemiology and Infection 2004;19(2): 60-62. Murray J and Nelson G. Demographic data and disease rates in deceased South African miners. Occupational Health SA 2004: 10(1):16. In press: Murray J, Nelson G, Ndlovu N, Ross M, Shearer S and Barnes D. Occupational diseases in South African miners. Letter to the editor (in press December 2004) Submitted: Koichi H, Murray J and Nelson G. Intrapulmonary lymph nodes in South African miners - an autopsy study. Int J Tuberc Lung Dis, September 2004. Reports Murray J, Candy G, Nelson G and Ndlovu N. Pathology Division Report: Demographic data and disease rates in January to December 2003. NIOH Report 15/2004 ISSN 1812-7681 Murray J, Wong M, Hopley M and Lowe JP. Monitoring and evaluation of sustained clinical performance and tuberculosis management in the SA mining industry. Final report SIM 02 08-02. Safety in Mines Research Advisory Committee, 2004. Congresses Phillips J I, Asbestos, SV40 and mesothelioma. Wits School of Public Health Annual Research Day, 7 May 2004, Wits Medical School Murray J. Viability of Mycobacteria in formalin fixed lungs. Wits Faculty of Health Sciences Research Day, 4 August 2004, Wits Medical School Nelson G and Murray J. Respiratory disease trends in South African platinum miners: an autopsy study (Abstract number: PC-476-516). Int J Tuberc Lung Dis 8 (11):S109. 35th UNiOn World Conference on Lung Health. 28 October-November 2004, Paris, France 25 Phillips J I. Asbestos, simian virus 40 and mesothelioma. NIOH Research Day: 29 October 2004, NIOH Ndlovu N, Murray J, Candy G, Nelson G and Ross M. Pathaut as a tool for surveillance in the mining industry. NIOH research day: 29 October 2004, NIOH Sawry S, Murray J, Kielkowski D, Phillips JI and Garton E. Attribution of lung cancer to asbestos exposure in South African miners. NIOH research day: 29 October 2004, NIOH Gerston K, Blumberg L, Tshabalala V, Murray J. The survival of M tuberculosis in formalinfixed lungs. NIOH research day: 29 October 2004, NIOH Nelson G, Murray J, Candy G and Ross M. Lung disease in platinum miners. NIOH research day: 29 October 2004, NIOH Higher degrees Chauhan-Sawry S. MSc in Epidemiology and Biostatics: Attribution of lung cancer to asbestos exposure in miners in South Africa. Ongoing, started 2003. School of Public Health, University of the Witwatersrand. 26