Document mp98xa43r45aor1oNnM3GmQZ0

FILE NAME: Pennsylvania (PA) DATE: 1960 Aug DOC#: PA021 DOCUMENT DESCRIPTION: PA Medical Journal Article - Pneumoconiosis Mortality in PA Pneumoconiosis Mortality in Pennsylvania John H. Vinyard, Jr., M.P.H. and Jan Lieben, M D. Harrisburg, Pennsylvania P E N N S Y L V A N IA has had a pneumoconiosis problem lo r" many yearsLand &n active ag gressive preventive'program is Tong overdue. The need for such a program is partially re vealed by the records of the Pennsylvania Oc cupational Disease Fund, which indicate that these diseases have a tremendous physical and financial impact. During the 1957-1959 biennium $21,000,000 was paid from Commonwealth funds to 5800 claimants. These payments are made under the Pennsylvania Occupational Disease Act of 1939 which provides for procedures that are separate and distinct from the Workman's Compensation Act in connection with cases of silicosis, anthracosilicosis, and asbestosis. This act was amended in 1953 and further provides "that in those cases where disability or death is not conclusively proved to be the result of the last occupational exposure all compensation shall be paid by the Commonwealth." Since occupational pneumoconiosis is a chronic disease and m o st w o rk m e n do not stay on the same job throughout their working lives, most of the claims are paid in full by the Commonwealth rather than by an insurance carrier or the in dustry responsible for the dust hazard. 'Die State assumed 100 per cent financial responsibility tor 92 per cent of the claims paid during 1957-1959, and shared responsibility with employers in the remaining cases. The planning of the preventive program is based on chest x-ray surveys of coal mining em ployees and dust studies in the mines which will result in recommendations for reduction of dust exposures. Both are currently being conducted. M r. V inyard is chief of slatistk-al m ethods and D r. Liobon is dire c to r of occupational health of Ihe P e n n s y lv n n ia D e p a r t ment of Health. AUGUST, I960 This startling fact'is .sel .. paper to hulietc die moret.about ibis niilbic .> *SB S l ; SOR#,. \YV- . imucoiiiosis in tfiti ..if**;Xn .v \..u.....b.....I . - ora this informative ) doctors to know ; ' The findings of these studies will be reported at a later date. Further insight into the problem can be gained through the examination of mortality records. According to the most recent figures compiled by the National Office of Vital Statistics of the U. S. Department of Health, Education, and Welfare, 50 per cent of the pneumoconiosis mortality in the United Stales occurs in Pennsylvania. Their figures also indicate that approximately 93 per cent, of all deaths from anthracosilicosis are re ported from Pennsylvania (see Table I). The number of Pennsylvanians dying each year with occupational lung disease indicated to he the underlying cause of death has increased slightly since 1950 as shown in Table II. It is also of interest to note that since 1950 the number of deaths attributed to tuberculosis complicated by occupational lung disease (code number 001 of the International Statistical Classi fication of Diseases, W H O ) has remained fairly constant (1950, 152 deaths; 1954, 116; 1955, 135; 1956, 148; 1957, 144; and 1958, 144), al though mortality from all forms of tuberculosis during the same period has been reduced 59 per cent (2474 deaths in 1950 to 1016 deaths in 1958). On the basis of tabulations for the first ten months of 1959, it is estimated that for the entire year about 850 deaths will be classified as due to pneumoconiosis and about 150 will be re ported as due to tuberculosis with mention of an associated occupational lung disease. 1117 ! When the age of decedents is examined, it is to the number of times this condition was in :nd that occupational lung disease is the eighth dicated to be the underlying cause of death. Dur st frequent cause of death among males aged ing the period there were 2957 male deaths re years and older, and is 1.2 per cent of total ported with mention of occupational lung disease Je mortality in this age group. Among males in the certification of cause of death. Slightly ed 45 to 64 years, pneumoconiosis is the ninth more than one-half of these reports (1604) stated i .st frequent underlying cause and is 1.7 per at of total male mortality in this age group, ily 1 per cent of the males dying from this that the occupational lung disease was the under lying cause of death, while for the other 1353 deaths pneumoconiosis was specified to be an as sease were under 45 years of age. sociated morbid condition existing at the time of In the five Pennsylvania counties where most death. the occupational lung disease is concentrated, The 2957 deaths involving pneumoconiosis artality from this cause among males over 44 were 2.2 per cent of the 132,600 males who died ars of age is far more frequent. Pneumoconio- from all causes during the two-year period. In i is the second most frequent underlying cause 13 of the 67 counties in Pennsylvania the propor death in Luzerne and Schuylkill counties, tion of males dying with pneumoconiosis ex :ing exceeded in frequency only by heart dis ceeded 2.2 per cent. Of the total deaths involv uses. These lung diseases ranked fourth in fre- ing pneumoconiosis in the State, 80.2 per cent lency as an underlying cause of death among occurred in these same 13 counties, and 73.6 per ales in this age group in Carbon, Lackawanna, cent of the total were concentrated in five counties id Northumberland counties, being exceeded (Luzerne, Schuylkill, Lackawanna, Carbon, and ily by heart diseases, cancer, and vascular Northumberland). Fig. 1 indicates the 13 coun sions affecting the central nervous system. ties in which the proportion of male mortality The figures indicated in the foregoing do not involving pneumoconiosis exceeded 2.2 per cent. :11 the whole story, since they are based only on These counties include nine hard coal and four ) ibulation of the underlying cause of death. An bituminous coal producing areas. xamination of 237,471 death certificates filed The specific types of occupational lung disease uring the two-year period March 1, 1957, were reported as follows: anthracosilicosis, 2101 trough Feb. 28, 1959, was made to determine deaths; silicosis, 376; pneumoconiosis, unquali ow frequently pneumoconiosis was reported as fied 283; silicotuberculosis, 226; anthracosis, 63; complication or contributory cause in addition asbestosis, 17; and one death from berylliosis. F I G U R E ]. C O U N T I E S WI TH M A L E M O R T A L I T Y F R O M P N E U M O C O N I O S I S ] IN E X C E S S OF 2 . 2 % OF T O T A L M A L E M O R T A L I T Y : M ORTALITY FROM ( United Stay Underlying Cause of Death S ilic o s is ................. Anthracosilicosis .. Asbestosis ............. Pneumoconiosis . . . Other specified (unqualified) pneumoconiosis . (not due to silica) Total ............. * International Statist and C auses of D eath, t P e n n s y lv a n i a /U , SS o u k ce: F o r a ll tafc Office of V ital S ta tistii Pennsylvania D epartm cr The underlying ca where occupationa be only an associat in Table I I I. The quite different iron over 44 years of ag example, in Penn the deaths of male older are attribute this group of mail cupational lung c< 21.4 per cent died per cent of the me Pennsylvania are flueriza, while in per cent of the d causes. The prop the pneumoconiosi State (13.9 and 1 t h e Pe n n sy l v a n ia m ed ic a l jo u r n a l N umber of D ea' P ennsyl Year 1958 1957 1956 1955 1954 1950 AUGUST, I960 TABLE I M ortality from O ccupational P neumoconiosis in U nited States and P ennsylvania, 1957 Underlying Cause of Death Code* Number of Deaths Uniied Pennsyl' Per States vania cent t Silicosis ................. Anthracosilicosis . Asbestosis ............. Pneumoconiosis .. . Other specified (unqualified) pneumoconiosis . (not due to silica) 523.0 523.1 523.2 523,4 524,0 618 97 15.7 658 614 93.3 21 9 42.9 219 ......55 25.1 74 20 27.0 Total ............. 1590 795 50.0 * International Statistical Classification o Diseases, ] njuries, and Causes of Death, WHO, ]955 Revision. 1 Pennsylvania/t, S.. x 100. Source: For all tables, United States data from National Office oi Vital Statistics, H EW , and Pennsylvania data from Pennsylvania Department of Health. The underlying causes of death for the 1353 men where occupational lung disease was indicated to be only an associated morbid condition are shown in Table III. The distribution of these causes is quite different from that found for male decedents over 44 years of age in the State as a whole. For example, m Pennsylvania only 1.2 per cent of the deaths of males who are 45 years of age or older are attributed to tuberculosis, whereas in this group of males known to have had an oc cupational lung condition at the time of death 21.4 per cent died from tuberculosis. About 27 per cent of the males dying in this age group in Pennsylvania are victims of pneumonia and in fluenza, while in the pneumoconiosis group, 5 per cent of the deaths are attributed to these causes. The proportion dying from cancer in the pneumoconiosis group is less than that in the State (13.9 and 16.2 per cent); however, 31.9 TABLE II N um ber of D e a t h s from P n e u m o c o n io sis in P e n n s y l v a n ia . 1950, 1954-1958 Number Year of Deaths 1958 ................................................................... 793 1957 ........................................................ . . . . 795 1956 ....................................... 740 1955 695 1954 . ....................... 627 1950 728 AUGUST, i960 per cent of those dying of cancer with occupa tional lung disease complications were specified to be due to cancer of the respiratory system, while without pneumoconiosis as an associated condition only 23,2 per cent of the total cancer deaths in this sex-age group are attributed to neoplasm of the respiratory system. The three most frequent causes of death tor males in this broad age group (heart disease, cancer, and vascular lesions affecting the central nervous system) generally amount to at least 74 per cent of the total deaths. In the group with associated occupational lung disease, these three causes claim only 58.8 per cent of the total be cause of the predominance of deaths from tuber culosis, pneumonia and influenza, and other chronic respiratory diseases. When the occupations which are reported on this group of death certificates were, examined, it was found that 2257 or 76.3 per cent of the total indicated work which may be associated with an inhalant hazard. Occupations which were re- TABLE ill U nderlying Causes of D eath Reported on Certificates M entioning P neumoconiosis as an A ssociated M orbid Condition in P e n n sy l v a n ia , M arch 1, 1957, to F eb. 28, 1959 Underlying Couse of Death Number Per cent m Deaths of Total All causes .......................................... 1353 Heart disease .................................... 560 Tuberculosis ...................................... 289 Malignant neoplasms (respiratory system, 60 deaths) ... .... 188 Pneumonia and influenza ................. 67 Vascular lesions of central nervous system .......................................... 48 Accidents ............................................ 26 General arteriosclerosis ................... 23 Bronchitis .......................................... 12 A sth m a................................................ 5 All other causes ................................ 100.0 41.4 21.4 13 9 S.O 3.5 1.9 1.8 0.9 0.4 9.<8 1~ ported are shown in Table IV. Since the occu pation entered on the death certificate is usually the latest employment of the decedent, it is very possible that those reported as farmers and hotel workers mav have been miners, steel workers, and brickyard workers earlier in their lives. It is possible that the railroad workers had worked in the railway yard foundry, and the laborers could be exposed to many different inhalant hazards. i l i9 TABLE IV eighth in frequency among males who are over Occupations Reported on D eath Certificates F iled 64 years of age. f for Males D ying with S ome Mention of 3. In Luzerne and Schuylkill counties pneu Occupational L ung D isease in Pennsylvania, March 1, 1957, to Feil 28, 1959 moconiosis is the second most frequent underly ing cause of death among males over 44 years of Occupation age, and in Carbon, Lackawanna, and N orthum Number berland counties this disease is the fourth most of Deaths frequent underlying cause in that sex-age group. i Ail occupations .......... Mine w o r k e r .................... . . . Laborer .................. Steel mill worker ......................... . . . 2957 2007 199 . . 123 4. W hen death certificates filed during a twoyear period were examined, it was found that 1353 records indicated occupational lung disease to be a morbid condition existing at the time of Stone worker ........................................ 65 Railroad worker ............................... .. . . 38 Carpenter ................................. . . . . . . . . . . . 37 Farm er ................................................................... 33 Hotel worker ....................................................... 32 Machinist ............................................................ 17 Bricklayer ............................................... 15 Blacksmith . . . . . 8 W eaver ................................................................... 5 Pottery worker ......................................... 3 Other, specified ......... . . . . . . . . . . . . . . . 214 Retired and unspecified ..................... 161 death (b u t not the underlying cause) in addition to 1604 certificates which stated pneumoconiosis to be the underlying cause of death. 5. T h e total of 2957 deaths involving occupa tional lung disease was 2.2 per cent of the 132,600 males who died during the same two-year period, and 80.2 per cent of these deaths were reported from the 13 counties that comprise the larger part of Pennsylvania's coal mining areas. 6. W here pneumoconiosis was a m orbid con dition mentioned on the death certificate but not Summary the underlying cause, it was found that the under lying causes were distributed differently in fre- ^ 1. M ortality statistics indicate that the number quency than causes of death in the general popu of deaths in Pennsylvania from pneumoconiosis lation of males over 44 years of age. T here was j (prim arily anlhracosilicosis) has increased dur a distinct predominance of deaths attributed to ing; the last ten years, even though coal mining tuberculosis, pneumonia, influenza, and other operations in the State have been curtailed and respiratory diseases. i there are fewer mines in operation. 7. Seventy-six per cent of the occupations in 2. Occupational lung disease is the ninth most dicated on the death certificates of persons dying frequent underlying cause of death among Penn from or with pneumoconiosis could be associated sylvania males aged 45 to 64 years, and is ranked with an inhalant hazard. i Why a Medical Society I am ashamed now to confess that not many years ago I seriously considered not paying my dues and drifting out of the medical society. The dues seemed always to be getting higher and 1 resented going to meetings m general and, too, it seemed that the outfit was run by a clique who seemed to perpetuate themselves in office. The possible loss of hospital privileges and malpractice insurance was the deciding factor, so I stayed. The reason I bring this up is that I know there are quite a lew right now who feel as I once did. Some oi yon readers will now say, "Old Clyde has been brain washed." You can call it that if you wish, but it took about five years to do it--one year on the Professional Committee and about four years on the Board of Direc tors. The less opinionated among you could sec the light sooner, I'm sure. I wish everyone at some time could be on the Griev ance Committee or Professional Committee, or on the Board of Directors. It's interesting, educational, and revealing, and makes you want to strive to be a better physician. Come to the medical meetings and get up on your hind legs and speak your piece; perhaps something needs changing or improving. Mew ideas are weicome both at (he general and at the Board of Directors meetings. Add a few names to the list of candidates for offices, serve on committees when asked, and if you have a pet one, ask to be put on it. If you never attend a meeting and make yourself heard, you have no more reason to gripe, than the taxpayer who yells but never bothers to vote.--Clyde J. Barker, J., M.D., president of Maricopa County Medical So ciety, Phoenix, Ariz. THE PENNSYLVANIA MEDICAL JOURNAL Ti NDUCTIC x and is as,s present care the past deca are safe and : Induction indicated. H! the convenien no obstetric ( Indicated indi be term inated Elective inc since these p time. Indicate hazardous. E nique, and fa pointing0 Me obsteiricaily, ; need for cesar Elective Indue Elective in< icnce of the p Hons to justif 1. To prev 2. To prev to hosp labors, lack of i 3. To reli. labor. 4. Superv- 5. H ospitt slant. 6. Family vance. 7. Benefit being e cry. To develt sate, a stud 1950, at the From die Dcj Medicine, Untv. AUGUST, ic