Document nw24wqB108GXNpGOyEo4y95a

Brief Report Update to Vinyl Chloride Mortality Study 60S I 9 101$ The mortality experience of 593 Dow Michigan Divi sion employees potentially exposed to vinyl chloride after first exposure to vinyl chloride. Both individuals had only short-term exposure in jobs categorized as less was recently updated through 1982. An earlier study than 200 ppm time-weighted average (TWA). evaluated this group for the time period 1942 through There were six deaths from emphysema or chronic 19T3 and found an excess of total malignancies among obstructive pulmonary disease (approximately 5 ex the subgroup considered to have the highest exposure.' pected). None of these individuals worked in areas where However, during the additional period of follow-up there was a potential for exposure to polyvinyl chloride (1974 to 1982), a deficit of malignant neoplasms was dust. observed for this subgroup. An increased risk of lung cancer was not found (stand During the 9 years of additional follow-up. the total ardized mortality ratio = 39) and the study was capable deaths in the study group increased by 63 (to 155) and of ruling out more than a 60% increase with 95% the person-years by 4.234 (to 17.114). The study's certainty. The lack of an association with lung cancer primary focus was directed at cancers of the liver is consistent with the findings from the majority of other (including angiosarcoma), biliary tract, lung, and brain, studies, especially those with the greatest statistical and to emphysema because of previous reports Uniting power to detect an excess.9 these conditions to vinyl chloride exposure in some worn To examine for a dose-response relationship, subjects forces.1'3 No deaths from angiosarcoma were found and were allocated to one of four intensity-of-axposure cat there were no statistically significant excesses for any egories (undetermined, 'ess than 25 ppm TWA. 25 to of the other conditions of interest. 200 ppm TWA. and 200-r ppm TWA) based on their Only those employees identified for the original study highest rated job assignment held for at least 1 month. were included in the recent investigation and their work During the updated follow-up period (1974 to 1982), a histories and exposures were updated through 1977 to deficit of total cancer occurred in the highest exposure ensure a minimum 5-year induction latency period. Con category (3 observed v 5.4 expected); however, for the sistent with past practice, separate analyses were con entire foilow-up period this subgroup experienced an ducted first including and then excluding the subset of excess which was confined principally to the men with employees with prior, competing exposures to arsenic at least 5 years of exposure above 200 ppm (7 observed insecticides/ v 2.8 expected). As was noted in the original study,1 Cause-specific mortaiity among the study group was there was no predominant tumor site nor was there a contrasted both with expected levels based on age- and uaiaue histologic type among this subgroup, weakening era-specific mortality rates for US white men. and also any interpretation of a causal link with vinyl chloride. with the mortafity experience of 24.410 other male employees from this company location1 who were not exposed to vinyl chloride or arsenic. The comparison with US men is shown in the Table. Wendy 3. Dakar, MPH Total malignant neoplasms were less than expected in Gregory G. Bond, PhD. MPH the updated follow-up period (1974 to 1982), 12 v 16.3 and for the total follow-up period (1942 to 1982), 27 v Elsie A. McLaren, RN 31.7. There were no statistically significant excesses for Fred L. Sabel, MS any of the diseases of interest. Similar results were seen for the comparison with other employees from this com pany location. One death from liver cancer occurred in the study group (0,6 expected). The pathology and autopsy re ports indicated that it was an intrahepatic bile duct uarcinoma. There were two deaths from brain cancer Thomas E. Lipps, MD Ralph R. Cook. MD, MPH The Dow Chemical Company Epidemiology Health and Environmental Sciences 1803 Building (1.2 expected), one of which occurred less than 5 years Midland. MI 48674 3) (A o NO> 4ro* 03 648 Update to Vinyl Chloride Mortality Study/Dahar et al ST0I6I5I0 R&S 020424 TABLE ODsarvea ana Expected Deaths for Selected Causes Excluding Employees with Prior Exposure to Arsenic Insecticides Causa of Oestn (IC3-8) 1942- 1973 Obs Exp- Period o( Follow-up 1974-1912 Obs Exp Obs 1942-1982 Exp SMRf 95% at f All causes All cancers (140-209) 80 84.9 50 67.0 130 151.9 15 15.4 12 16.3 27 31.7 86 72-102 85 56-124 Digestive system cancer (150-159) 6 4.4 3 4.1 9 8.5 106 48-201 Liver cancer (155.156) 0 0.3 1 0.3 1 0.6 --5 4-899 Respiratory system cancer (160-163) 4 4.9 6 6.4 10 11.3 89 42-163 Brain cancer (191.192) 1 0.6 1 0.5 2 1.1 --5 23-682 All circulatory diseases (390-453) 38 41.1 27 34.3 65 75.4 36 67-110 All nonmaiignant respiratory diseases (460-519) 6 4.2 3 4.4 9 8.6 104 48-198 All accaents (E30Q-E949) 7 8.4 1 2.5 8 10.9 74 32-144 ' Excectea numoere are based on calendar time and age-soeafic mortality r i of US white men. T Standardized mortality ratio; observed divided by expected numoer of deatsia x 100. Ci. confidence interval of Cbs/Exo, Nor calculated wnen expected numoer of deaths fewer than S. References -- 1. Ott MG. Lupur 3IL Haidar 35: Vinyl chloride exposure ip s r-jXMKroUed indtiscnsi environment. Area Farina Soaith 1973:30:333- "^339. 2. Wong- O. Wborcan MS. Bsglnad D, et ah An update of an - ecidaniologic study of vinyl chloride worker*. 1943-1989. Prepared for tho Chemical Manufacturer'! Association. Ootobor 17, 1988. 3. Purchase ZFB. Stafford J. Psddlo GM; Vinyl chloride: An iiHumin: of tho risk of occupational srposurs. Food Cheat Toxicol 1987.-35:187-309. 4. Ott MG. Holder 3B. Gordon HXg Sespiratory eaacor and oc cupational exposure to srsanicaUa. Arch Farina Health 197*1^29:250- 238. 3. Bead GG. McLaren 5A. Carcmill J5. at si: Cause-specific mortality among- mslo ehomicsl workers. Am J lad Mrd 1987:13:363383. 8. 3saumont JJ, 3rwlow ITS: Powsr conaidarstlons in epidetniologic studios of vinyi cblorids workers. Am J Spidtmioi 1981:114:738734. Nurses' Little Helpers: Care on the Cheap The [British] government last week gave broad approval to the proposed changes to nurses education put forward IS months ago by the United Kingdom Central Council for Nursing and Midwifery (UKCC). Nurses at the Royal C'Uege of Nursing's annual conference in Brighton gave John Moors, the Secretary State for Health, a standing ovation. Only the fresh air or the nurses' recently fattened pay packets can explain the euphoria. An analysis of Mr Moore's response gives grounds for concern for two reasons: first, the changes will mean most of the hands-on-care will be done by non-nurses or "nurse helpers." putting standards of patient care at risk: second, these changes smack of a pian to make "caring" cheaper. **** Who will take on nurse helper jobs? Work that has been labeled as menial and is poorly paid is unlikely to lead to a satisfied work force. 7et these are the people who will look after hospital patients in the future. --From "UPFRONT" by Pamela Holmes in New Statesman, 1988:115(2984):5. Journal of Occupational Medicine/Volume 30 No. 8/August 1988 649