Document rxLwD6BdMpBVd8amLpoZ1MbYE

PLAINTIFF'S EXHIBIT AL-1260 PROPORTIOHATE MORTALITY STUDY OP ALCOA WORKERS (1980-1987) Howard E. Rockette, Ph.D. Department of Biostatistics University of Pittsburgh Vincent C. Arena, Ph.D. Department of Clinical Epidemiology and Preventive Medicine University of Pittsburgh MARCH 1990 511971 0292 Acknowledgements - The authors wish to acknowledge Mrs. Bonnie Besseck for coding the death certificates, Mr. Rao Damaraju, Ms. Cora Wixey for coding employment histories and help in preparing the report, and Mrs. Betty Valentine for typing the manuscript. He would also like to thank Ms. Barbara Peterson for her diligence in obtaining the death certificates. vt - 511971 0293 Background This study provides an evaluation of the mortality patterns of workers in the aluminum industry that can be used with the information from the previously reported Tripartite Study to help assess potential health problems in the aluminum industry. The Tripartite Study was initiated in May 1978 and a report of study findings was made in November 1981. Progress of the study was reported quarterly throughout the duration of the contract period to a Tripartite Committee consisting of representatives of labor, management and government. The study population consisted of 21,829 men employed at least five years in a reduction operation in one of the 14 plants between January 1, 1946 and December 31, 1973 (1). Vital Status determination as of December 31, 1977 was made on 99.3% of the cohort and death certificates were obtained for 97.6% of the men believed to be deceased. The priorities which directed the analysis of the Tripartite data were as follows: (1) Mortality patterns of workers in the potroom and/or carbon departments were given the most attention in the analysis. (2) Respiratory cancer was to be investigated thoroughly >' and was the disease category given the highest priority. (3) Lymphopoietic cancers were to be investigated and were second only to respiratory cancer as a disease category to be given special attention. (4) For diseases other than respiratory cancer ahd lymphopoietic cancer, enough preliminary analysis was 1 511971 0294 done to identify any excess mortality that was associated with a particular plant or process. (5) Causes of death associated with the aluminum reduction process in other studies were reinvestigated using the Tripartite data. In order to satisfy these objectives, the mortality patterns of employees in the fourteen reduction plants was compared to the total D.S. male population for 59 selected causes of death. Analysis was done by plant, process, calendar time period, time since first employment and selected exposure measurements. Industrial hygiene measurements were available for total particulates, benzene solubles, benzo(a)pyrene, particulate polycyclic organic matter, sulfur dioxide and total fluorides. Based on these analyses and the previous research literature on mortality of reduction plant workers, some categories of disease were selected for more detailed investigation. The major findings of the Tripartite Study were as follows: (1) There were no strong associations of lung cancer mortality and work in the reduction plant. Overall the lung cancer SMR of the total cohort based on 272 observed deaths was 96.4. Formal tests of a dose-response relationship to cumulative r years employment in the potroom and carbon departments, cumulative years of employment in the reduction plant, and cumulative exposure to benzene solubles, particulate polycyclic organic matter, benzo(a)pyrene, total particulates, total fluorides and sjjlfur dioxide, showed no statistically significant relationship.` 2 511971 0295 There were two exceptions to the lack of an excess for lung cancer mortality. One plant, a horizontal Soderberg, had an SMR of 162.0 (p<0.05) for white males. However, the region in which the plant was located has a high lung cancer rate in the general population and when the data was reanalyzed using local rates, the SMR was below 100. The second excess was in the baked carbon department of one of the plants where there was an SMR of 266.8 (p<0.05) based on eight observed deaths. However, this excess was not observed in the baked carbon departments of the remainder of the prebake plants. (2) The SMR for leukemia was 124.9 based on 43 observed deaths. This excess was not statistically significant. The SMR for the prebake process was 123.5 and for the Soderberg process was 130.2. The SMR for potroom workers in the Soderberg process was 169.1 and for potroom workers in the prebake process was 124.6. Analysis by duration of employment was not consistent by process with men in the prebake showing more excess with longer term employment and men in the Soderberg process showing greater excess with short term employment. (3) The SMR for pancreatic cancer was 122.3 and was not statistically significant. However, there was a significant Excess for men with more than 15 years employment in the potroom department in both the Soderberg (SMR=271.3, p<0.05) and prebake process (SMR=222.2, p<0.05). (4) The SMR for kidney cancer in the prebake process was 144.9. The excess was greater in men with less than 20 years employment and greater in men employed outside the carbon and potroom departments. 3 511971 0296 (5) Although the number of observed deaths was small there was an excess of bladder cancer in men employed 5 or more years in the potroom or carbon department of the Soderberg process. (6) The only cause of death which was statistically elevated for an entire process was benign and unspecified neoplasms. For the prebake process the SMR for this cause was 193.5 (p<0.05) based on 14 observed deaths. The estimated risk was greater for men employed twenty-five or more years, and was higher outside the potroom and carbon departments. (7) There was an excess of emphysema in the potroom and carbon departments of the Soderberg process (SMR=216.5, p<0.05; SMR=258.9, p<0.05). Although the excess in the prebake process was elevated, it was not statistically significant. The emphysema risk may have been understated in the prebake process because of a tendency to code many death certificates to "chronic obstructive lung disease" after 1970. If these cases were considered to be emphysema there would be a statistically significant excess in the prebake process. For men with more than 20 years employment in the prebake process there was an SMR of 260.2, (p<0.01) for asthma. The present study is a PMR Study without detailed work ifistories and without exposure measurements available. Thus, the conclusions that can be drawn from this study are more limited than those that could be obtained from the Tripartite Study. Nevertheless, this study provides us with an independent data base on which to confirm the interpretation of some of the findings in the Tripartite Study and also provides a means of 4 511971 0297 obtaining a preliminary evaluation of mortality patterns of nonreduction plant workers. Specifically, the primary objectives of the present study are as follows: (1) To obtain mortality data from aluminum reduction plants independent of the Tripartite cohort that can be used to further clarify the relationship of employment in aluminum reduction plants to excess mortality from cancer. Because the majority of ALCOA workers were employed in the prebake process, it is for workers in this process that we expect the most information to be obtained. The mortality patterns in the PMR study will be contrasted with those obtained from the Tripartite Study. (2) To obtain a profile of the mortality experience of nonreduction plant workers. Little information is available on the mortality experience of nonreduction plant workers since most studies have focussed on exposure in the potroom and carbon departments. This part of the investigation is limited because of the lack of detailed coding within the nonreduction plants. However, by investigating the consistency of any excess among plants with similar processes we may identify potential associations for future investigation. (3) On the basis of this PMR study, the Tripartite Study and a preview of the literature of potential health hazards in the aluminum industry, we will make specific recommendations of studies we feel are necessary in order to determine the association of disease with exposure in the aluminum industry. Such studies will be primarily hypotheses testing as opposed to hypothesis generating. 5 511971 0298 Methods The study population assembled by ALCOA consisted of all deaths known to the company as determined by insurance claims during the time period 1/1/80 through 12/31/87 in one of the 37 study plants. Any former employee whose beneficiary had either filed a claim or was receiving death benefits from the company was included in the study population. The initial list supplied by ALCOA was reviewed for duplicates and incomplete or inconsistent names. The resultant study population contains 6433 workers. Death certificates were obtained for all but 60 (0.9%) of the study population. These deaths were coded by a nosologist according to the ninth revision ICD and it is these 6373 death certificates on which the analyses in the present report are based. The frequencies of deaths for each cause are given in the Appendix. Detailed work histories were not coded and analyzed for this study, since to provide such coding for such a large variety of plants and processes would have required considerable effort. For this report an employee was classified in the plant where he was last employed. Using this method of classification, 2777 workers were coded to one of the eight reduction plants. For 'hese eight reduction plants we further coded whether they had ever worked in the potroom or carbon department as well as the department they spent the majority of time. Nine employees could not be included in this analysis because we dig not have work histories. The departments in the reduction process used to classif*y majority of time were potroom, carbon, i,ngot, mechanical maintenance, electrical maintenance, and power. A total of 1320 6 511971 0299 employees in the eight reduction plants spent the majority of their time in a nonreduction process. He have done analysis separately for the 3596 employees in nonreduction plants, the 1320 employees in a nonreduction process of a reduction plant and the 1448 employees in the reduction process. The proportionate mortality ratio was the primary summary index of risk. The analysis was done using the computer program OCMAP (2) and five year average annual age, race and sex-specific U.S. rates for the control group. As a secondary analysis we used a proportionate cancer mortality index (PCMR) (3). This index uses "all cancer mortality" as the base on which to base proportionate mortality rather than "all cause"' mortality and is believed by many investigators to be less subject to the healthy worker effect. Both the PMR and PCMR were adjusted for age, sex, race and calendar time. To meet the primary objectives of this study we completed the following analyses: (1) The PMR and PCMRs were computed for 62 selected causes of death by race, sex, and race-sex combinations for the total cohort, for nonreduction plants, and for plants with a reduction process (reduction plants). '? (2) For plants with a reduction process PMRs and PCMRs were computed for employees with a majority of their time in each of the following: a) nonreduction process, b) potroom department, c) carbon department, d) ingot department, e) mechanical maintenance, f) electrical maintenance, and g) power. Mortality indices were also 7 511971 0300 computed for employees "ever employed in the potroom department" and employees "ever employed in the carbon department". (3) PHRs and PCMRs were computed for each plant for all 62 selected causes of death. Because of the large number of comparisons we expect some statistically significant excesses as well as deficits. When interpreting our data we will give emphasis to the excesses, but when interpreting excesses we will take into consideration the consistency of the result with the Tripartite Study as well as the consistency with other plants that have a similar process. In most cases we have required that either the observed or expected number of deaths be 5 before we attempt to interpret results for a specific cause of death. Population Characteristics A total of 6373 .death certificates was obtained and coded for the years 1980 to 1987 in the 37 study plants. A total of 6112 (95.9%) death certificates were for males and 5816 (91.3%) were for whites. Table 1 summarises the distribution of deaths by year. The number of deaths were approximately equal-for each of the seven years of the study. The age at death is summarized in Table 2. Pifty-one percent of the deaths occurred at ages 6579. The distribution of deaths for the 37 study plants is shown in Table 3. The eight plants with a reduction process contributed 44% of the total deaths and 28% of the total deaths were for employees who at one time were in a reduction process evaluated in the Tripartite - Study. Of the 2777 workers in onh 8 511971 0301 of the eight plants with a reduction process, all but 9 had employment histories. Of the 2768 workers with employment histories, 1320 spent the majority of their time in a nonreduction process. The distribution of the number of employees spending the majority of their time in a specific reduction department is given in Table 4. Of the 1448 employees with the majority of time in one of the reduction departments, 556 (36%) had the majority of their time in the potroom. The second largest group was mechanical maintenance which accounted for 433 (29.9%) of the deaths. 'f 9 511971 0302 Year 1980 1981 1982 1983 1984 1985 1986 1987 TOTAL V Table 1 Distribution of Employees by Year of Death Frequency 766 772 781 824 793 759 819 859 6373 Percent 12.0 12.1 12.3 12.9 12.4 11.9 12.9 13.5 100.0 Table 2 Distribution of Employees by Aqe at Death Value Label Frequency Percent 20 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85 - 89 90 - 94 >95 7 19 29 41 57 80 172 293 573 1002 1261 1182 838 541 206 72 .1 .3 .5 .6 .9 1.3 2.7 4.6 9.0 15.7 19.8 18.5 13.1 8.5 3.2 1.1 Table 3 Distribution of Workers by Plant Plant Marne Frequency Percent Tennessee Vernon Point Comfort Nassena Hew Kensington Cleveland Cressona Buffalo Vancouver Warrick Chillicothe Richmond Detroit East St. Louis Edgewater Chicago Corona Bridgeport Edison Davenport Wentachee Lafayette Lancaster Marshall Logans Perry Mobile Lebanon Anderson Badin Bauxite Addy Ate Port Meade Franklin Rockdale Rosiclare Tiffon Total 1325 210 167 630 754 448 231 7 196 116 54 74 76 145 282 27 12 36 103 247 88 355 31 11 16 149 8 2 152 148 8 89 4 23 103 36 10 6373 20.8 3.3 2.6 9.9 11.8 7.0 3.6 .1 3.1 1.8 .8 1.2 1.2 2.3 4.4 .4 .2 .6 1.6 3.9 1.4 5.6 .5 .2 .3 2.3 .1 .0 2.4 2.3 .1 1.4 .1 .4 1.6 .6 .2 100.0 11 511971 0304 Table 4 Department Where Reduction Plant Workers Spent Majority of Time Department Frequency Percent Potroom Carbon Ingot Mech Maintenance Elec Maintenance Power 556 140 183 433 113 23 38.4 9.7 12.6 29.9 7.8 1.6 Results A. Mortality for Total Cohort The cause-specific mortality for 62 selected causes of death is shown in Table 5. The PMR for the category "all malignant neoplasms" is 103.7 based on 1605 observed deaths. Pive causes of death are significantly elevated. These are cancer of the kidney (PMR=158.1, p<0.01), all other malignant neoplasms (PMR=134.3, p<0.01), benign and unspecified neoplasms (PMR=195.6, p<0.01), nephritis and nephrosis (PMR-242.2, p<0.01) and cerebral vascular disease (PMR=111.4, p<0.05). Since males comprise 91% of the cohort, it is not surprising that when we restrict our analysis to the population of males (Table 6) the vsame causes of death show a significant excess. For females (Table 7), all other malignant neoplasms (PMR=240.2, p<0.01), benign neoplasms (PMR-600.5, p<0.01) and all other causes of death (PMR=135.1, p<0.05) show a statistically significant excess. When mortality patterns for the total cohort atfe 12 L 511971 0305 Table 5 Observed and Expected Deaths and Proportionate Mortality Ratios for the Total Population Cause of Death (ICOA oth Revision Codas) oas All Causas of Daath 373 Tuberculosis 4 All Malignant Neoplasms 1BOS Cancar of Bucc.l Cavity A Pharynx 11 Canear of Dtoastlva Organs A Porlt SIS Cancar of Esophagus It Cancar of Stomach St Cancar of Larga Intastlna Cancar of Rectum iss 30 Cancar of illtary Passagas A Llvar 30 Cancar of Pancroas 74 Cancar of All Othar Dlgosttvo Organs 7 Cancar of Rasplratory Systaa set Cancar of Larynx v7 Cancar of Bronchus. Trachoa. Lung BBS Cancar of All Other Respiratory 3 Cancar of Breast 13 All Utertna Cancers (Females only) 4 Cancer of Cervix Uteri (Females only) 1 Cancer of Othar Female Genital Organs 4 Cancer of Prostata (Males only) 147 Canear of Tastas and Other Mala Genital Organs 3 Cancer of Kidney S3 Cancer of Bladder and Other Urinary Organs 41 Malignant Melanoea of Skin Cancer of Eye It 1 Cancer of Central Nervous Systae 24 Cancer of Thyroid A Other Endocrine Glands 4 Cftncsr of Ions 3 Cancer of All Lysphatlc. Haematopoietic Tissue 147 Lyaphosarcoea A Retlculosarcoam IS Hodgkins Disease 7 Lou(mHs 6 Altukilii B5 Cancer of All Othar Lymphopoietic Tissue a All Other Malignant Neoplasms 1S4 Benign Neoplasms 2S 01abates Nellltus 32 Cerebrovascular Disease 4M All Heart Disease 2SBB Rheumatic Heart Disease XseftMte Hurt Dluau 14 itaa Chronic Endocard. 01s.; Other Myocard. Insuff. 134 Hypertension with Heart Disease 62 A11 Other Heart Disease 466 Hypertension w/o Heart Disease 23 Non-amiIgnant Respiratory Disease 482 Influenza A Pneumonia 1B3 Bronchitis. E^hysema. Astham 73 Bronchitis Eaphysama 10 64 Asthma t Other Non-ami Ignant Respiratory Disease 236 Ulcer of Stomach A Duodenum . Cirrhosis of Liver 22 66 Nephritis A Nephrosis 86 All External Causes of Death Accidents 216 1t1 Motor Vehicle Accidents All Other Accidents Suicides 80 111 74 Homicides A Other External Causes All Other Causes of Death 23 668 Unknown Causes (In All Causes Category Only) 0 Significant at 8% Level; Significant at IS Level EXP 373.00 a. is 1B4B.32 33.86 sai.ao 38.as 83.BA 181.SI 28.70 34.70 78.10 10.88 848.78 17. aa 822.88 4. SB 14.28 3.23 1.33 4.17 is?.aa 2.46 33.82 48.32 18.88 0.78 28.12 3.42 2.80 128.48 13.74 4.78 83.81 87.03 122.11 14.82 88.41 418.28 2887.87 22.81 2217.28 128.14 2.38 481.67 17.23 880.81 188.70 88.BO 18.83 88.12 8.80 287.82 18.08 60.48 38.08 288.28 178.11 8.83 111.10 72.88 33.82 81.61 SPMR 100.0 48.8 103.7 83.8 100.8 81.6 * 108.8 108.2 101.0 88.2 88.8 3.8 104.1 38.1 108.7 1.8 81.0 123.8 78.2 88.8 87.8 121.8 188.1 103.8 112.8 127.3 82.4 118.8 120.0 113.8 118.8 148.8 102.0 121.0 134.3 * 188.8 8.4 111.4 88.8 1.4 88.2 < 107.1 83.4 100.8 133.8 82.4 * 77.0 82.8 4.4 78.3 188.3 82.1 118.2 1.8 242.2 100.8 108.8 118.1 8.8 102.0 -88.4 108.3 K Limits LOVER UPPER ... 18.7 88.4 34. 1 tl.8 33.2 84.8 84.0 70.7 80.4 78.8 30.7 88.3 18.2 88.8 20.1 83.8 48.8 10.8 38.4 74.7 38.4 121.2 78.2 71.8 18.0 88.3 43.8 38.8 8.8 71.4 70.2 78.4 88.7 118.8 138.8 78.7 102.1 88.6 36.8 12.2 80.6 3.7 82.8 88.0 76.8 88.0 8.7 34.8 0.8 81.2 72.S 78.0 47.8 187.3 00.8 83.2 83.2 83.2 81.8 48.2 88.1 127.6 106.1 64.4 111.1 60.0 141.2 126. t 144.3 123.2 123.6 133.2 112.6 76.6 115.4 166.6 163.6 326.6 624.4 262.6 102.6 377.1 206.3 137.4 178.3 ttt.o 122.7 311.1 371.3 133.2 166.6 306.6 132.7 183.0 166.2 276.6 116.1 121.6 102.6 103.0 66.3 126.0 106.2 110.1 200.6 86.6 66.6 103.6 116.0 103.3 266.6 62.6 174.6 60.0 267.4 112.1 122.1 142.0 120.0 127.5 101.3 113.0 13 S,,971 0306 Table 6 Observed and Expected Deaths and Proportionate Mortality Ratios for Males Causa of Daath (ICDA 6 th Revision Codas) OBS EXP All Causes of Daath 6112 6112.00 Tuberculosis All Malignant Neoplasas 4 7.88 IBS3 1482.B2 Caneor of Buccal Cavity A Pharynx IB 32.68 Cancar of Digestive Organs A Perttoneua 367 368.61 Cancar of Esophagus IB 36.20 Caneor of Stoaacn 87 82.24 Cancar of Largo Intestine 166 144. B4 Cancar of Rectua 38 28.48 Cancar of Biliary Passages A Llvar 2S 33. IB Cancar of Pancreas 71 71.87 Cancar of All Other Olgestlve Organs 7 10.40 Cancer of Respiratory Systaa BS7 633.38 Cancar of Larynx 7 17.68 Cancer of Bronchus. Trachea. Lung B47 BIO.87 Cancar of All Other Respiratory 3 4.73 Cancar of Breast All utartna Cancers (Faaales only) vO 1.63 0 0.00 Cancar of Cervix Uteri (Feaales only) 0 0.00 Cancar of Other Faaale Qenttal Organs 0 0.00 Cancer of Prostata (Males only) 147 167.88 Cancar of Tastes and Other Mala Oenltal Organs 3 2.46 Cancer of Kidney S3 32.42 Cancer of Bladder and Other Urinary Organs 48 4B.3S Malignant Melanoau of Skin 18 16.18 Cancer of Eye 1 0.74 Cancar of Central Nervous Systaa 31 27.66 Cancer of Thyroid A Other Endocrine Glands 4 3.16 Cancer of Bona 3 2.38 Cancer of All Lyephatlc. Haaaatcpofetlc Tissue 141 123.61 Lyaphosarcoaa A Ret1culosarcoaa 16 13.03 Hodipdns Disease 7 4.BB LateTaala A Aleukaala B3 81.71 Cancer of All Other Lyaphopoletlc Tissue 65 84.32 All Other Malignant Neoplasas 1B1 116.70 Benign Neoplasas 24 13.88 Olabetes Mai1 Itus BB 88.86 Cerebrovascular Disease 446 384.33 All Heart Disease 346? 2468.77 Rhauaatlc Heart Otsease 13 20.40 lschaalc Heart Olsease 1823 2137.37 Chronic Endocard. 01s.; Other Myocard. Insuff. 128 118.10 Hypertension with Heart Disease B2 88.04 All Other Heart Disease 4B1 443.3B Hypertension w/o Heart Disease 22 16.41 Non-aalIgnant Respiratory Disease 4S1 843.17 Influenza A Pneuaonla 148 180.83 Bronchitis. Eephyseaa. Asthaa 72 SB.81 Bronchitis 10 18.04 Eephyseaa S3 68.64 Asthaa 8 8.36 Other Non-aalIgnant Respiratory Disease 230 278.76 Ulcer of Stoaach A Duodena 20 18.28 Cirrhosis of Liver SB 87.23 Nephritis A Nephrosis 82 33.71 All External Causes of Death 278 27B.S4 Accidents 184 172.47 Motor Vehicle Accidents 7B 66.67 All Other Accidents 108 107.28 Suicides 71 70.78 Hoalcldes A Other External Causes 23 32.28 All Other Causes of Death 648 621.26 Unknown Causes (In All Causes Category Only) 0 Significant at IS Level; Significant at IS Level SPMR 100.0 80.1 103.4 BB. 1 100.4 B2.B 106.1 107.8 101.8 84.B 68.2 67.3 104.4 38.6 107.1 63.4 -* 87.8 121.6 183.8 108.7 117.4 134.B 78.8 126.8 128.8 114.1 122.8 183.6 102.B 118.7 128.4 aa 171.B 64.8 113.1 86.8 63.7 86.3 107.B 88.1 101.7 134.1 83.0 78.1 S3.8 66. B 78.7 168.1 82.2 <08.3 63.1 243.2 *a 100.8 100.7 112.B 101.6 100.3 71.2 103.8 . BBS Ltelts LOVER 18.2 68.0 38.0 80.8 33.8 84.3 62.4 70.8 ftl.4 78.7 32.3 66.8 18.4 88.8 20.6 ------- 74.7 36.4 128.3 76.8 78.0 18.1 48.6 47.6 40.7 B6.8 78.3 73.8 78.4 84.0 110.8 118.6 76.8 103.4 60.6 37.2 82.2 80.6 67.2 83.1 88.8 76.1 66.8 66.7 36.0 61.0 86.1 72.8 70.6 48.7 187.4 80.7 83.0 BO.8 84.8 78.B 48.1 86.8 UPPER ----m 130.8 108.0 86.7 110.8 1.6 141.3 126.0 146.4 123.2 128.0 140.4 113.0 SO.8 11B.8 184.B -.."." 102.6 377.1 213.3 140.2 183.7 648.2 116.1 336.2 388.2 134.3 200.1 320.8 134.0 1S2.4 181.8 284.6 117.2 123.7 103.0 108.1 88. B 127.S IIS.4 111.2 203.2 80.6 61.3 10S.4 122.8 104.0 320.6 83.2 188.4 81.7 288.7 112.3 122.4 136.8 122.2 128.0 10S.6 111.7 511971 0307 Table 7 Observed and Expected Deaths and Proportionate Mortality Ratios for Females Cam of Oaath (ICOA tth Revision Codas) oas All Causos of Doath SB1 Tuberculosis 0 All Malignant Naoclasos 7a Cancor of Buccal Cavity A Pharynx 0 Cancor of Digestive Organs A Perltc It Cancor of Esophagus 0 Cancor of Steeach 2 Canear of Largo Intostlna 10 Caneor of Ractiaa 1 Cancor Biliary Passages A Liver 2 Cancor of Pancreas 3 Cancor of All Other Digestive Organs 0 Caneor of Besplratory Systao 11 Cancor of Larynx 0 Cancor of Bronchus. Trachea, Lung 11 Cancor of All Other Respiratory 0 Cancor of Breast 13 All utarlna Canears (Faaalos only) 4 Caneor of Cervix uteri (Faaalos only) 1 Cancor of Other Foetal e Genital Organs 4 Cancor of Prostata (Males only) 0 Canear of Testes and Other Mala Genital Organs Cancor of Kidney 0 0 Cancor of Bladder and Other Urinary Organs 0 MalIignant Melanoma of Skin Cancer of Eye 0 0 of Central Nervous Systao 3 Cancer of Tlohmyroid A Other Endocrine Glands 0 0 Cancer of All Lyophatlc, Haooatepoletlc Tissue Lysphosarceea A Rattculosarcooa 0 Hoddtins Disease a Almkaata 0 2 Caneor of All Other Lysphcpotettc Tissue 4 All Other Malignant Neoplasm 13 Benign Neoplasm 01 abates Mel 11tus B 7 Cerebrovascular Disease 20 All Heart Disease 86 Rheumtlc Heart Disease 1 Ischmlc Heart Dlseasa 66 Chronic Endocard. 01s.; Other Myocard. Insuff. 6 Hypertension with Heart Disease 0 All Other Heart Disease Hypertension w/o Heart Dlseasa 11 1 Non-ml Ignant Respiratory Olsease 11 Influenza A Pnetmonla 4 Bronchitis. Eaphysam. Asthm 1 Bronchitis 0 1 Asthm 0 Other Non-oslIgnant Respiratory Disease e Ulcer of Stomach A Duoderam 2 Cirrhosis of Liver 1 Nephritis A Nephrosis 3 All External Causes of Death 10 Aectdunti 7 Motor Vehicle Accidents B All Other Accidents 2 Suicides 3 Homicides A Other External Causes All Other Causes of Death 0 41 Unknown Causes (In All Causes Category Only) 0 Significant at 8% Level; Significant at IS Level EXP 261.00 0.20 68.80 0.B7 16. It 0.6S 1.64 7.44 1.22 1.64 3.83 o.ss 12.36 0.22 12.00 0.14 12.68 3.33 1.33 4.17 0.00 0.00 1.10 0.B3 0.6S 0.04 1.46 0.26 0.12 S.B4 0.70 0.23 2.20 2.70 S.41 0.83 S.B6 21.B3 87.80 2.41 7t.R0 0.04 3.32 IB.32 0.12 17.74 7.87 2. St 0.41 1 .SB 0.44 7.84 0.B0 3.27 1.3S B.7B 6.64 2.67 3.83 1.77 1.34 30.34 SPMR 100.0 108.4 -m- 111.2 mm 122.2 114.4 81.8 121.7 B4.8 mm - v tl.O 81.6 mmm 102.7 123.t 76.2 88.8 mm mm. mm mm- mmm mmm 306.4 mm mmm 102.8 mmm -mm 80.8 147.3 240.2 600.S ee 118.8 83.6 60.0 41.6 A2.6 38.4 mmm 81.8 121. t 62.0 SO.8 38.7 ----m 63.4 mm 76.6 280.3 30.6 217.8 102.6 106.3 174.4 S2.3 168.6 136.1 n Llelts LOWER mmm mm .80.3 mmm 71.2 30.t 73.2 11.6 30.6 27.7 mmm 60.3 mmm 81.6 UPPER ____ 132.6 173.7 488.3 346.8 B7B.7 483.2 260.7 187.2 162.1 60.8 46.8 10.t 36.4 mmm mmm mmm mm- mmm mm. 68.2 mmm 46.6 mmm 22.8 86.3 142.7 278.6 87.6 88.2 76.8 6.3 67.8 48.2 173.3 326.6 824.4 282.8 mm mm- mmm mmm mmm 618.7 226.4 mmm 360.6 388.4 404.2 1284.8 248.3 126.4 108.8 274.4 100.6 216.8 :4, 38.3 18.8 8.8 8.2 34.8 66.8 4.8 72.6 88.2 82.0 76.6 13.6 86.8 nu 108.0 130.4 282.6 438.2 167.6 882.6 160.4 684.7 160.7 213.4 388.7 201.1 808.7 101.8 178.8 15 511971 0308 Table 8 Observed and Expected Deaths and Proportionate Mortality Ratios for Whites Cmih of Death (ICOA Sth Revision Codes) DBS All Causes of Death BA IB Tuberculosis 3 All Malignant Neoplasms 1431 Cancer of Buccal Cavity A Pharynx 13 Cancer of Olgestive Organs A Perlte 340 Cancer of Esophagus 17 Cancer of Stemsen 46 Cancer of Large Intestine 1B3 Cancer of Reetiai 39 Cancer of Biliary Passages A Liver 32 Cancer of Pancreas 66 Cancer of All Other Olgestive Organs 7 Cancer of Respiratory Systea 820 Cancer of Larynx 7 Cancer of Bronchus. Trachea. Lung BIO Cancer of All Other Respiratory 3 Cancer of Breast 13 All Uterine Cancers (Females only) 3 Cancer of Cervix Uteri (Feamles only) 0 Cancer of Other Feaale Gent tar Organs 4 Cancer of Prostate (Males only) 123 Cancer of Testes and Other Male Genital Organs 3 Cancer of Kidney 49 Cancer of Bladder and Other Urinary Organs 44 Malignant Melanges of Skin 1ft Cancer of Eye 1 Cancer of Central Nervous Systee 22 Cancer of Thyroid A Other Endocrine Glands 4 Ctncsr of loot 9 Cancer of All Lyephatlc. Haeeatepoletlc Tissue 132 Lyephosarcose A Retlculosarcoea 13 Hodcpdns Disease 7 uulMla ft AlMftaaia BO Cancer of All Other Lymphopoietic Tissue 62 All Other Malignant NeapIasms 147 Benign Neoplasms 26 Diabetes Mellltus 73 Cerebrovascular Disease ~ 422 All Heart Disease 2371 Rheumatic Heart Disease 14 Ischaelc Heart Disease 1777 Chronic Endocard. DIs.; Other Myocard. Insuff. 129 Hypertension with Heart Disease 36 All Other Heart Disease 416 Hypertension w/o Heart Disease 20 Non-ealignant Respiratory Olsease 430 Influenza A Pneumonia. 143 Bronchitis, Esphysaaa, Asthma 69 Bronchitis Emphysema Asthma 10 60ft Other Non-mallgnant Respiratory Olsease 21ft Ulcer of Stoauch A Duodena 21 Cirrhosis of Liver B0 Nephritis A Nephrosis 76 All External Causes of Death 261 Accidents 174 Motor Vehicle Accidents 70 All Other Accidents 104 Suicides 70 Homicides A Other External Causes 17 All Other Causes of Death 826 Unknown Causes (In Alt Causes Category Only) 0 Significant at SX Level; Significant at IX t eve! EXP 8916.00 B.B6 1407.46 29.99 344.43 30.B1 46.47 140.94 27.60 30.69 69.29 10.17 499.49 IB.91 479.07 4.49 13.67 3.04 1.1ft 4.09 143.49 2.23 31.B6 43.B6 16.66 0.77 29.06 3.22 2.31 120.B9 13.13 4.B1 80.69 B2.26 110.86 13.60 64.63 373.12 2371.79 21.7B 2092.36 113.99 46.63 409.99 14.42 821.14 190.39 93.92 14. *7 66.12 8.02 269.47 17.B6 93.04 29.99 2BS.72 160.96 83. B1 99.79 70.11 24.69 893.B2 SPMR 100.0 80.3 102.2 43.8 99.7 8S.7 99.0 109.6 109.1 71.2 96.7 69.9 104.1 44.0 106.B 66.9 V 99.1 99.9 aaa 97.9 89.7 134.9 192.1 aa 101.0 10ft. 1 129.9 79.4 124.2 130.0 109.B 99.0 IBB. 1 99.7 119.6 133.0 aa 191.2 aa 66.3 113.1 aa 100.0 64.4 98.3 * 112.4 72.B 102.B 139.7 62. B a 79.3 a 91.0 67.2 76.9 1B9.4 91.3 a 119.6 60.2 a 2S1.0 aa 102.1 109.1 110.2 109.3 99.9 69.0 107.3 9BX Limits LOWER ... 18.6 97.7 2B.7 69.1 34.9 74.2 92.9 73. 1 47.0 76.0 33.0 96.0 21.4 99.0 21.7 86.2 32.2 aaa 37. 1 72.0 43.7 11B.0 76.3 69.2 19.4 81.9 46.7 42.1 92.B 87. B 74.4 74.9 92.6 113.4 131.1 69.7 103.2 96.9 39.3 92.2 94.7 82. B 93.4 99.7 78.4 87.6 64.0 36.3 89.3 90.2 71.4 79.0 4B.9 201.6 91.4 83.9 89.0 67.2 79.4 43.4 89.6 UPPER __ 162.S 106.ft 73.6 10ft. 4 ft.ft 132.0 127.0 181.1 107.9 122. ft 143.7 112.9 0.3 116.6 209.3 160.9 303.6 aaa 297.7 102.0 416.0 201.3 139.6 171.4 917.0 11E.9 330.2 401.9 12ft. 170.4 323.3 130.0 182.0 186.0 279.9 109.3 124.0 103.1 108.1 ft.6 133.4 100.3 112.4 214.4 0.3 3.0 102.6 124 3 101.1 316.6 2.4 163.1 79.9 312.1 114.0 124.6 139.0 127.2 126.6 10ft.6 IIS.8 16 511971 0309 Table 9 Observed and Expected Deaths and Proportionate Mortality Ratios for Monwhites Cause of Death (ICDA sth Revision Codes) OSS A11 Causes of Death S87 Tuberculosis 1 All Malignant Neoplasms 167 Cancer of Buccal Cavity a Pharynx S Cancer of Digestive Organs A Peril AS Cancer of Esophagus 2 Cancer of Stomach 13 Cancer of Large Intestine 13 Cancer of Rectum i Cancer of Biliary Passages A Liver a Cancer of Pancreas a Cancer of All Other Digestive Organs 0 Cancer of Respiratory Systea 41 Cancer of Larynx 0 Cancer of Bronchus. Trachea. Lung AS Cancer of All Other Respiratory 0 Cancer of Breast 0 All uterine Cancers (resales only) 1 Cancer of Cervix uteri (Feaales only) 1 Cancer of Other Feaale Genital Organs 0 Cancer of Prostate {Mates only) 24 Cancer of Testes and Other Male Genital Organs 0 Cancer of Kidney B Cancer of Bladder and Other Urinary Organs 4 Malignant Malanoaa of Skin 1 Cancer of Eye 0 Cancer of Central Nervous Systeo 2 Cancer of Thyroid A Other Endocrine Glands Cancer of Bona 0 0 Cancer of All Lyephatlc. Haematopoietic Tissue IB Lyephosarcoau A Rettculosarcosm 2 Hodgkins Olsease 0 Leukemia A Aleukemia B Cancer of All Other Lymphopoietic Tissue 7 All Other Maltpiant Neoplasms 17 Benign Neoplasms 3 Diabetes Mellltus IB Cerebrovascular Olsease 44 All Heart Disease ISA Rheuutle Heart Disease 0 Ischemic Heart Olsease 112 Chronic Endocard. 01s.; Other Myocard. Insuff. B Hypertension with Heart Dll 16 All Other Heart Olsease BO Hypertension w/o Heart 01 3 Non-malIgnant Respiratory Disease 32 Influenza A Pneumonia 10 Bronchitis. Eaphysama, Asthma B Bronchitis 0 Emphysema 4 Astham 1 Other Non-matIgnant Respiratory Disease 17 Ulcer of Stomach A Ouodonum 1 Cirrhosis of Liver 6 Nephritis A Nephrosis 10 All External Causes of Death 27 Accidents 17 Motor Vehicle Accidents 10 All Other Accidents 7 Suicides 4 Homicides A Other External Causes 6 All other Causes of Death 60 Unknown Causes (In All Causes Category Only) Significant at BS Level; Significant at IS Level EXP 857.00 2.22 140.31 3.66 37.37 6.34 7.41 11. IB 2.11 3.60 6.31 0.73 46.27 1.33 43.30 0.33 0.62 0.13 0.14 0.03 24.43 0.24 1.36 2.76 0.23 0.02 1.07 0.20 0.13 3.37 0.61 0.26 3.23 4.77 11.86 1.22 10.73 48.14 135.77 1.07 134.32 11.25 12.72 SB.63 2.30 33.77 13.32 4.B7 0.66 3.00 0.73 13.18 1.82 7.45 8.21 23.87 13.18 6.02 12.31 2.48 3.33 63.03 SPMR 100.0 48.1 113.8 138.6 120.4 31.8 175.8 118.6 47.8 208.1 117.4 m-- 103.7 ... 103.3 -- 813.2 837.7 --- 33.0 --- 284.8 a 145.0 43S.3 --- 137.0 --- 169.2 a 495.0 a* 184.3 146:3 147.1 248.3 176.1 a 97.8 3-4-.0- 33.0 a 83.3 128.3 99.3 107.0 30.8 84.6 a 109.3 --- 133.4 121.1 93.6 68.6 30.8 192.1 a 91.3 93.7 186.0 86.9 163.6 66.3 83.1 98% Limits LOWER 6.7 104. 1 87.3 BO.9 8.6 103.0 63.1 7.0 104.4 89.0 UPPER 302. a 138.0 928.6 188.8 118.0 299.1 188.e 321.2 403.1 233.6 79.3 138.7 3.3..8. ... 90.6 132.1 v 143.1 ... 2903.6 3686.6 6.6..4. 103.8 84.3 72.6 144.7 691.9 333.2 2B19.7 47.8 103.0 173.7 729.9 ... 277.9 1371.1 68.1 70.8 82.2 32.2 113.8 73. B 83.7 363.8 305.8 234.7 732.1 273.2 129.3 105.8 70.7 24.8 77.8 69.1 34.6 67.7 30.0 48.7 97.4 116.1 203.9 118.9 330.7 112.2 99.3 261.8 80.4 19.3 83.7 B.4 36.6 104.3 64.3 89.1 90.9 27.7 62.6 31.3 63.6 383.2 603.1 149.4 487.6 176.3 382.0 129.7 143.8 303.3 116.9 427.7 140.7 111.6 17 511971 0310 investigated by race, the white population shows a similar mortality pattern to that observed for the total cohort (Table 8). Por nonwhites, causes of death (Table 9) for which there were five observed or expected deaths and where there was a statistically significant excess were all malignant neoplasms (PMR=118.6, p<0.05), cancer of the stomach (PMR=175.5, p<0.05), cancer of the liver (PMR=205.1, p<0.05), cancer of the kidney (PMR=254.5, p<0.05), cancer of the lymphatic and haematopoietic tissue (PMR=169.2, p<0.05), diabetes mellitus (PMR=176.1, p<0.05), and nephritis and nephrosis (PMR=192.1, p<0.05). B. Nonreduction Process A total of 3596 employees worked in a plant that had no reduction process (Table 10). The overall PMR for these employees was 105.2. The only excess within the category of neoplasms was for "all other malignant neoplasms" where the PMR was 145.9 (p<0.01). Other causes of death showing a statistically significant excess were benign and unspecified neoplasms with a PMR of 227.3 (p<0.01), "all other heart disease" with a PMR of 117.2 (p<0.01), and "nephritis and nephrosis" with a PMR.of 293.8 (p<0.01). Investigation separately for males and females indicated no causes of death other than those identified in excess for the total cohort. When we evaluated mortality patterns separately for race, in addition to the four causes of death in excess for the total group of nonreduction plant workers we found for whites a PMR of 122.8 (p<0.05) for cancer of the large intestine and a PMR of 135.4 (p<0.01) for chronic endocarditis and other myocardial insufficiency. For nonwhites', we found that 18 511971 0311 <1[V. the excess of stomach cancer, liver cancer, lymphatic cancer and nephritis reported in the nonwhite population comprising the total cohort occurred in these nonreduction plants. The PMR for all malignancies for nonwhites in the nonreduction plants was 128.0 (p<0.01). Of the 2777 workers in the 8 plants with a reduction process, 1320 spent the majority of their time in a nonreduction process. For this group of workers the PMR for all malignant neoplasms was 93.6. There were statistically significant excesses of cancer of the lymphatic and haematopoietic tissue (PMR=140.1, p<0.05), cerebrovascular disease (PMR=126.9, p<0.05), hypertension without heart disease (PMR=230.2, p<0.05) and nephritis and nephrosis (PMR=196.8, p<0.01). We also note the excess for asthma (PMR=331.0, p<0.05) based on only four observed deaths. There were only 56 females in this group of workers so the mortality pattern of the total group is essentially the same as that observed for males. For whites, the excesses were the same as that observed for the total group of 1320 workers. For nonwhites, excesses occurred in hypertension with heart disease (PMR=239.2, p<0.05) and "all other causes of death" (PMR=202.9, P<0.01). V* ' 19 511971 0312 Table 10 Observed and Expected Deaths and Proportionate Mortality Ratios for Monreduction Plant Employees Ceuse of Death (XCDA 9th Revision Codes) OBS EXP All Cauaa* of Daath 3596 Tuberculosis 3 All Malignant Naoplaam* 906 Cancar of Buccal Cavity 6 Pharynx 11 Canear of Digaativ* Organa 6 Paritonaua 225 Cancar of Eaophagu* 11 Cancar of Stomach 36 Cancar of Larga Intaatina 103 Cancer of Rectum 20 Cancar of Biliary Paaaagaa ( Livar 17 Cancar of Pancraaa 35 Cancer of All Other Digestive Organs 3 Cancar of Raapiratory Syatam 316 Caneer of Larynx 4 Caneer of Bronchus* Trachea* Lung 310 Cancar of All Othar Raapiratory 2 Cancer of Breast 9 All Otarina Cancar* (Faaalaa only) 3 Cancar of Carvix Otari (Famala* only) 0 Cancar of Othar Famala Ganital Organa 2 Cancer of Prostate (Males only) 84 Cancar of Taataa and Othar Mala Ganital Organa 1 Cancer of Kidney 25 Cancer of Bladder and Othar Urinary Organs 28 Malignant Malanoma of Skin Cancer of Eye 11 1 Cancar of Cantral Narvoua Syatam 14 Cancer of Thyroid 4 Other Endocrine Glands 4 Cancer of Bone 1 Cancar of All Lymphatic, Baamatopoiatic Xiaaua 72 Lymphoaarcoma 6 Raticuloaarcoma 6 Bodgkina Oiaaaaa 2 Laukauia 4 Alaukamia 27 Cancar of All Othar Lymphopoiatic Xiaaua 37 All Other Malignant Neoplusi 99 Banign Naoplaama 19 Diabataa Mallitua 55 Cerebrovascular Disease 237 All Heart Disease 1477 Rheumatic Heart Disease 8 lachaadc Baart Diaaaaa 1038 Chronic Endocard. Dia.; Othar Myocard. Inauff. 95 Bypartanaion with Baart Diaaaaa 28 All Othar Baart Diaaaaa 308 Bypartanaion w/o Baart Diaaaaa 11 Mon-malignant Raapiratory Diaaaaa 258 Influansa 4 Pnaumonia 85 Bronehitia, Eaphyaama, Aatha* 40 Bronchitia 4 Emphyaama 34 ;* Aathma 2 Other Non*melignent Respiretory Diseese 133 Ulcar of Stomach 4 Duodanum 13 Cirrhoaia of Livar 30 Haphritia 4 Maphroaia 60 All Extarnal Cauaaa of Daath 140 Accidents 99 Motor Vehicle Accidents 43 All Othar Accidanta 56 Suicidaa 27 Bomicida* 4 Othar Extarnal Cauaaa 14 All Othar Cauaaa of Daath 387 Unknown Ceuses (In All Ceuimi Category Only) 0 * Significant at *5% Laval; ** Significant at 1% Laval 3596.00 4.62 861.09 18.19 213.51 20.10 30.13 85.59 16.64 19.49 41.81 6.17 297.08 9.69 284.73 2.65 10.45 2.45 0.98 3.16 96.35 1.29 18.32 26.32 8.9S 0.44 15.51 1.89 1.36 71.84 7.54 2.51 30.06 31.74 67.83 8.36 54.16 245.53 1457.21 12.85 1254.88 73.19 35.66 262.71 10.03 322.34 117.33 49.83 8.85 38.27 3.25 163.39 10.91 47.45 20.42 147.02 93.90 34.82 59.93 36.77 16.36 371.99 SPKR 100.0 65.0 105.2 60.5 10S.4 54.7 ft 119.5 120.3 120.2 87.2 83.7 48.6 106.4 41.3 108.9 75.4 86.1 12.2..7. 63.3 87.2 77.4 136.5 106.4 123.0 229.1 90.3 211.7 73.5 100.2 79.6 79.8 89.8 116.6 145.9 ft* 227.3 ft 101.6 96.5 101.4 62.2 82.7 129.8 ft* ft 78.5 117.2 ft 109.7 80.0 72.4 ft 80.3 45.2 88.8 61.5 81.4 ft 119.1 63.2 ft 293.8 ft 95.2 105.4 123.5 93.4 73.4 85.6 104.0 95% Limit* LOWER UPPER 21.2 99.5 33 a 8 92.9 30.7 88.4 99.5 77.7 54.3 80.3 16.1 95.8 16.0 97.9 18.9 45.8 40.0 16.3 70.7 11.0 92.5 73.6 68.2 34.1 53.6 81.3 10.4 79.7 35.9 20.0 61.7 84.6 120.2 146.9 78.1 85.4 97.5 31.4 78.8 106.5 54.4 - 105.3 60.8 71.3 58.9 59.1 17.4 63.6 15.6 69.0 69.3 44.5 231.0 81.7 87.3 92.6 72.2 50.8 51.5 94.7 199.5 111.3 108.3 119. 97.7 165.4 145.6 186.0 140.0 116.3 147.0 118.1 106.4 121.0 299.8 161.8 376.1 246.3 107.6 546.2 201.4 153.9 221.5 1539.1 152.1 551.4 517.5 126.0 176.7 317.7 130.8 160.6 177.2 351.8 132.0 109.1 105.4 123.5 86.8 158.2 113.4 130.5 197.8 89.9 89.1 109.1 117.2 124.1 242.6 96.0 204.8 89.8 373.6 111.0 127.4 164.8 120.9 106.2 142.3 114.3 20 5-U9-H 0313 Table 11 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees in Reduction Plants Spending the Majority of Their Time in a Ronreduction Process Cause of Death (XCDA 9th Revision Codes) OBS -- --'* XI1 Causes of Death 1320 Tuberculosis 0 All Malignant Neoplasms 302 Canear of Buccal Cavity 4 Pharynx 2 Cancar of Digestive Organa 4 Peritoneum 78 Canear of Esophagus 1 Canear of Stomach IS . Canear of Larga Xntaatina 30 Canear of Reetum 4 Canear of Biliary Paaaagaa 4 Livar Canear of Pancraaa 18 Cancar of All Othar Digaativa Organa 2 Cancar of Aaapiratory Syataa 91 Canear of Larynx 2 Cancar of Bronchus, Trachea, Lung 89 Cancar of All Othar Aaapiratory 0 Canear of Braaat 4 All Oterine Caneera (Females only) 1 Canear of Cervix Otari (Females only) 1 Canear of Othar Female Genital Organa 1 Canear of Prostate (Males only) 32 Cancer of Testes and Other Male Genital Organa 1 Canear of Kidney 11 Cancar of Bladder and Othar Orinary Organa 10 Malignant Melanoma of Skin Canear of Eye 3 0 Canear of Central Nervous System ' 3 Canear of Thyroid 4 Other Endocrine Glands 0 Canear of Bona 2 Canear of All Lymphatie, Haematopoietic Tissue 38 Lymphosareosm 4 Reticuloearcoma C Hodgkins Disease 3 Leukemia 4 Aleukemia 13 Canear of All Othar Lymphopoietic Tissue 1C All Other Malignant Neoplasms 2S Benign Neoplasms 5 Diabetes Mellitus IS Cerebrovascular Disease 108 All Heart Disease S31 Rheumatic Heart Disease 4 Isehesde Heart Disease 422 Chronic Endocard. Die.; Other Myocard. Insuff. 18 Hypertension with Heart Disease 11 All Othar Heart Disease 74 Hypertension v/o Heart Disease 8 Non-malignant Respiratory Disease 103 Influenza 4 Pneumonia 39 Bronchitis, Esphyses^, Asthma 17 Bronchitis 4 v , Emphyaesta 9 Asthma 4 Other Mon-malignant Respiratory Disease 47 Ulcer of Stomaeh 4 Duodenum 3 Cirrhosis of Liver IS Nephritis 4 Nephrosis 14 All External Causes of Death CC Accidents 44 Motor Vehicle Aeeidents 19 All Other Aeeidents 2S Suicides 21 Homicides 4 Other External Causes 1 All Other Causes of Death Unknown Causes (In All Causes Category Only) ISO 0 Significant at 5% Level; ** Significant at 1% Level. EXP **-- -- 1320.00 1.43 322.52 4.98 79.22 7.54 11.09 31.44 4.20 7.20 15.44 2.28 114.28 3.73 109.S3 1.02 3.10 0.71 0.32 0.90 34.IS 0.51 7. OS 9.41 3.59 0.17 4.21 0.72 0.53 27.12 2.91 1.03 11.31 11.87 2S.39 3.08 19.44 85.13 530.71 4.81 440.01 2S.51 12.55 94.54 3.48 115.44 40.23 18.47 3.23 14.23 1.21 59.55 3.93 19.05 7.11 41.82 38.34 15.37 23.28 15.70 7.79 133.99 SPUR ---- --_ 100.0 ... 93.4 28.7 98.5 13.2 135.2 94.8 94.8 83.4 115.1 87.8 79.4 53.4 81.3 * -- 128.9 140.9 314.4 110.7 93.7 194.7 154.1 104.1 83.5 ... 48.3 ... 375.9 140.1 204.3 291.2 115.0 134.8 98.5 142.2 74.3 124.9 100.1 83.1 91.7 70.4 87.4 80.4 * 230.2 89.2 94.9 92.1 123.8 43.3 331.0 78.9 74.3 78.7 194.8 * 104.8 114.8 123.7 107.4 133.8 12.8 111.9 95% Limits LOWER -- ... 85.0 7.8 79.4 2.5 81.9 44.4 43.4 37.4 72.8 22.0 45.4 13.7 44.7 ... 50.2 20.4 49.7 15.9 44.4 28.5 87.0 54.2 27.0 UPPER 103.2 104.7 122.1 49.3 223.4 135.0 215.1 ies.0 182.1 350.4 94.7 209.3 98.9 331.4 974.4 1991.8 748.0 131.8 1332.3 280.0 193.0 257.8 14.0 ... 103.5 102.5 94.4 99.0 44.9 82.9 44.8 48.1 44.2 105.9 93.7 31.3 85.0 44.8 48.7 44.8 117.5 74.3 71.3 57.4 44.4 33.2 131.4 59.8 24.7 47.8 117.9 84.0 84.8 80.5 73.1 88.1 2.7 94.2 145.4 ... 1344.5 191.4 450.9 854.3 197.4 219.1 145.1 384.0 125.9 1S2.0 104.8 220.7 99.0 111.2 157.4 99.7 450.8 107.2 131.8 147.5 328.9 120.4 833.2 104.2 235.3 129.4 328.4 132.4 151.8 190.0 157.8 203.0 41.7 130.2 511971 0314 C. Mortality for the Reduction Process There were 1866 workers who had some employment in the reduction process. The overall PMR for cancer was 106.6 which was not statistically significant (Table 12). The PMR for lung cancer was 117.8 with a corresponding 95% confidence interval of (103.1, 134.5). Cancer of the kidney was also elevated with a PMR of 200.1 and a corresponding 95% confidence interval of (131.7, 303.8). The only nonmalignant cause of death with a statistically significant excess was cerebral vascular disease with a PMR of 135.3 and a corresponding 95% confidence interval of (116.0, 157.7). The PMR for the category ischemic heart disease was low [PMR=87.2 with corresponding confidence interval of (81.6, 93.2)]. Since only 6 women were employed in the reduction process, the mortality patterns in Table 12 are essentially the same for males. When analysis was done by race, some additional causes were in excess. For whites, in addition to respiratory and kidney cancer, there was an excess in cancer of the lymphatic and haematopoietic tissue (PMR=132.2, p<0.05). For nonwhites, the only excess was for diabetes where the PMR was 389.5 (p<0.01). When the 62 causes of death were re-evaluated for men r spending the majority of their time in the reduction process, the mortality patterns were similar to those "ever employed in the reduction process" but tended to be slightly increased for many of the malignancies (Table 13). The PMR for the category all malignant neoplasms increased from 106.6 to 109.5 (p<0.05). Similarly, the PMRs for cancer of the lung and kidney were 22 511971 0315 Table 12 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Ever Employed in a Reduction Process Cause of Death (ICO* Bth Revision Codas) OBS All Causes of Death Tuberculosis All Malignant Neoplasms Cancer of Buccal Cavity A Pharynx Cancer of Digestive Organs A Pertti lasa 1 419 6 105 Cancer of Esophagus 7 Cancer of Stomach Cancer of Large Intestine Cancer of Rectum Cancer of Biliary Passages A Liver Cancer of Pancreas Cancer of All Other Olgesttve Organs Cancer of Respiratory Systea Cancer of Larynx 13 39 S 9 SB 3 197 1 Cancer of Bronchus. Trachea. Lung Cancer of All Other Respiratory Cancer of Breast All Uterine Cancers (Faaalas only) Cancer of CervIx'Utert (Females only) IBS 1 0 0 0 Cancer of Other Feaale Genital Organs 1 Cancer of Prostate (Males only) SB Cancer of Testes and Other Male Genital Organs Cancer of Kidney Cancer of Bladder and Other Urinary Organs 2 21 14 Malignant Melonne of Skin Cancer of Eye Cancer of Central Nervous Systea 7 0 B Cancer of Thyroid A Other Endocrine Glands 0 2 Cancer of All Lyaphatlc. Haeaatopotetlc Tissue BO Lymphosarcoma A RetIculosarcoaa S Hodgkins Disease 3 LmjKmIb & AltAMll 20 Cancer of All Other Lyephopoletic Tissue 22 All Other Malignant Neaplasas 47 Benign Neoplasms S Diabetes Mellltus 28 Cerebrovascular Disease 1SI All Heart Olsease 710 Rheumatic Heart Olsease S Xscheolc Heart Disease sei Chronic Endocard. Ois.; Other Myocard. Xnsuff. as Hypertension with Heart Disease 17 All Other Heart Disease 104 Hypertension w/o Heart Disease 8 Non-aallgnant Respiratory Disease 126 Influenza A Pneumonia 42 Bronchitis. Emphysema. Asthma 22 Bronchitis S Emphysema ie As than 3 Other Non-malignsnt Respiratory Disease 82 Ulcer of Stomach A Duodenum 7 Cirrhosis of Liver 15 Nephritis A Nephrosis IB All External Causes of Death 105 Accidents 67 Motor Vehicle Accidents 25 All Other Accidents 42 Suicides 30 Homicides A Other External Causes B All Other Causes of Oeath IBB Unknown Causes (In All Causes Category Only) 0 Significant at SX Level; Significant at IX Level EXP 1866.00 2.4B 468.17 10.BO 114.26 11.86 16.25 44.60 B.B1 10.38 22. OS 3.21 172.88 5.76 165.57 1.54 1.00 0.11 0.05 0.16 47.68 0. S3 10.50 13.26 5.58 0.24 8.56 1.04 0.7B 38.07 4.22 1.58 16.05 17.21 37.12 4.33 27.65 111.64 742.22 6.62 543.10 33.76 18.13 133.88 4.76 156.86 52.52 25.71 4.38 18.86 1.72 82.30 5.42 31.06 8.66 88.28 68.94 24.64 35.77 25.77 12.67 186.30 * SPMR 100.0 40.3 106.6 B5.6 81.9 59.0 80.0 87.6 56.8 86.7 127.8 83.5 114.0 17.4 117.8 * 64...8. -- 643.6 . 81.8 240.0 200.1 105.6 12-5-.2- 8-3-.7- 256.7 128.0 118.5 18S.B 124.6 127.9 126.6 115.5 101.3 135.3 65.7 45.3 97.2 *> 74.1 63.8 77.7 . 126.1 60.3 80.0 85.6 68.4 60.6 174.7 75.3 128.2 48.3 155.3 106.8 111.9 101.4 117.4 116.4 63.6 106.3 MX Matts LOVER 6.1 98.9 25.3 76.4 28.5 46.6 64.3 24.0 45.2 89.2 30.2 69.9 3.1 103. 1 9 m.3m ... 120.0 60.1 62.7 121.7 62.7 59.9 UPPER __ 207.2 114.9 121.9 110.6 122.4 137.2 119.8 134.6 100.1 193.4 299.6 130.0 97.0 134.5 452.4 __ . 3450.7 111.3 818.1 303.9 177.8 261.7 4.2..0. 67.5 87.4 48.4 62.2 80.6 84.4 65.5 48.1 70. 1 116.0 BO.4 15.1 81.6 50.3 58.5 64.6 56.6 68.0 59.5 56.5 22.2 49.5 57.2 59.1 61.8 29.6 94.1 60.0 88. 1 69.6 87.3 82.1 32.8 83.1 166.7 676.1 168.2 284.0 B74.3 192.0 183.6 167.B 276.9 146.3 167.7 101.2 130.2 93.2 109.0 160.4 03.4 276.6 94.9 107.5 129.5 210.2 131.0 633.7 96.0 270.1 79.7 256.1 126.8 140.1 147.8 157.9 165.0 123.5 121.3 23 511971 0316 Table 13 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Spending a Majority of Time in a Reduction Process Causa of Daath (ICOA (th Revision Codas) All Causas of Daath TiAierculosIs All Malignant NoopIssms Canoar of Buccal Cavity A Pharynx Canear of Digestive Organs A Perttoneua Cancar of Esophagus Canear of stomach Cancar of Large Intastlna Canear of Reetue Canear of gillary Passagas A Llvar Cancar of Pancreas Canear of All Other Digestive Organs Canear of Respiratory Systaa Canear of Larynx Canear of Bronchus. Trachea, Lung Canear of All Other Respiratory Canear of Breast All Uterine Cancers (Feeales only) Canear of Cervix uteri (Faaules only) Canear of Other Faaule Genital Organs Canear of Prostata tMales only) Canear of Tastes and Other Mala Genital Organs Canear of Kidney Canear of Bladder and Other Urinary Organs Malignant Melanoaa of Skin Canear of Eye Canear of Central Nervous Systaa Canear of Thyroid A Other Endocrine Glands Ctnctr of Sons Canear of All Lyaphatlc, Haeawtopolettc Tissue Lyephosarcema A Ret leu I osarcoats Hodbtlns Disease LouKMiift ft AltukMla Cancor of All Otter Lyophopolotfe Tissue All Other Malignant Neoplasas Benign Neoplasas Diabetes Mel1Itus Cerebrovascular Disease All Heart Disease Rheunatte Heart Otsaasa lschaaic Heart Disease Chronic Endoeard. Ota.; Other Myoeard. Xnsuff. Hypertension with Heart Otsaasa All Other Heart Disease Hypertension w/o Heart Otsaasa Non-aalIgnant Respiratory Disease Influenza A Pneueonla Bronchitis, Eaphysaaa, Asthma Bronchitis Eaphysaaa Astham Other Non-aalIgnant Respiratory Olseasa Ulcer of Stomach A Duodena Cirrhosis of Liver Nephritis A Nephrosis All External Causes of Death 1 Accidents Motor Vehicle Accidents All Other Accidents Suicides Hoaieides A Other External Causes Alt Other Causes of Death Unknown Causes (In All Causes Category Only) * Significant at SS Level; Significant at IS i OBS 144# 1 397S 12 7A 33 4 7 31 2 161 1 IS# 1 0 0 0 1 31 1 17 10 5 0 7 0 0 37 4 3 IS IS 40 S 33 121 S45 3 438 30 13 3 aa#4 10 3 11 BS3 .6 11 11 S3 4ft 1ft 30 36ft 145 EXP 1449.00 1.S3 363.63 A.34 st.se 6. IS 13.S# 34.BS 6.S3 A. 06 17. S5 3.4# 133.S# 4.45 137.BS 1.30 0.73 0.08 0.04 0.11 37.37 0a.6.iSi 10.34 4.31 0.18 7.38 0.81 0.60 30.31 3.37 1.33 13.47 13.33 38.73 3.36 31.48 S7.1S S76.37 S. 13 4*1.82 26.38 14.07 103.63 3.70 122.38 40. B# 30.08 3.43 1S.B2 1.33 64.27 4.32 23.68 7.SI 76.20 46.72 16.30 27.78 20.01 a.46 144.BS SPMR 100.0 81.B 109.S 60.0 92.6 76. S 63.S as.s 88.6 68. 119.6 BO.3 120.S 22.S 124.3 8-3-.7--- --- 948.9 a* 83.2 153.1 209.7 aa #6.7 115.9 BS. 1 -aa 122.1 122.2 162.2 120.3 120.0 139.3 a 148.7 102.4 138.8 aa *4.6 39.1 98.7 aa 76.1 62.4 79.0 a 108.0 SO.9 a 88.8 a 79.7 88.3 70.9 225. S SB.6 142.2 46.1 aa 146.4 107.6 102.7 *3.3 108.0 12*. a 94.8 100.1 BBS Llalta LOWER ... 7.8 100.6 2S.3 78.1 36.7 32. 1 68.2 22.3 41.8 78.3 20.2 104.2 3.6 107.3 11-.8... --- 198.9 st.a 21.9 132.0 82.2 48.4 UPPER ... 3SS. 1 119.1 142.2 114.2 1S9.6 12S.9 133.8 1S3.9 181.8 182.9 320.0 139.4 134.2 144.0 S91.9 ... ... 4SS7.1 117. S 100ft.ft 333.3 179.3 277.7 48.8 ... aa.s 46.0 41.2 72.7 73.7 102.6 62.3 67.7 117.0 88.6 10.3 79.4 49.4 83.B 64.2 40.6 67. 1 47.7 - 49.1 14.9 3S.S 7B.0 66.1 64.2 26.1 B1.8 68.7 78.7 86.* 76.1 a*. 4 43.1 88.9 1*9.0 ... 167.8 324.8 639.1 168.9 105.3 199.0 3S4.8 IBS. 1 164.7 100.0 148.3 *2.4 117.2 1S8.6 97.2 287.2 97.6 68.3 129.S 229.0 127.1 677.7 110.7 314.9 01.3 262.9 130.6 134.1 148.1 183.3 188.8 16S.9 116.9 24 511971 0317 increased slightly (PMR=124.3 and 209.7, respectively). The remainder category "all other malignant neoplasms" is also significant with a PMR of 139.3 (p<0.05). Since the primary departments of interest in the Tripartite Study were the potroom and carbon departments, we investigated mortality patterns separately for these two departments. There were 943 employees with some experience in the potroom department. The PMR for all malignancies was 106.8 with a corresponding 95% confidence interval of (96.1, 118.6) (Table 14). The PMR for cancer of the lung was 111.9 with a corresponding confidence interval of (92.6, 135.2). The only malignancy with five or more observed deaths and a statistically significant elevation was kidney cancer with a PMR of 297.9 and a corresponding 95% confidence interval of (187.1, 474.2). There was also an excess of ulcer of the stomach and duodenum based on six observed deaths and 2.69 expected (PMR=223.0, p<0.05). For employees with a majority of time in the potroom the PMR for all malignant neoplasms was 114.8 with a corresponding 95% confidence interval of (100.7, 130.9) (Table 15). Of those causes with more than 5 observed or expected deaths, cancer of the kidney and ulcer of the stomach were elevated (PMR=285.8, p<0.01 and PM&=317.2, p<0.05, respectively). Ischemic heart disease was significantly low (PMR=80.6, p<0.01). The carbon department had fewer workers than the potroom department. For the 489 employees with some employment in the carbon department, the PMR for all malignancies was 105.8 (Table -16);.. Both cancer of the. kidney (PM.R=250.7 > p<0.01) and 25 511971 0318 Table 14 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Ever Employed in the Potroom Department Caul* of Daath (ICOA 9th tovlflen Codas) OBS All Causal of Daath 943 Tubarculosls 0 All Malignant Neoplasas 296 Canear of Buccal Cavity A Pharynx. 9 Cancar of Olgasttva Organs A Parttonoua 91 Canear of Esophagus 4 Cancar of Steaaen 7 Cancar of Larga Intastlna 17 Cancar of Rectua 3 Cancar of Biliary Passages A Liver 6 Cancer of Pancreas 12 Cancar of All Other Digestive Organs 2 Cancar of Respiratory Systaa 97 Cancar of Larynx 1 Canear of Bronchus. Trachea, Lung 99 Cancer of All Other Respiratory 0 Cancar of Breast 0 All Uterine Caneers (Faaales only) 0 Cancer of Cervix Utarl <Fees)as onlv) 0 Cancar of Other Feaale Genital Organs 0 Cancar of Prostata (Males only) 24 Cancar of Tastes and Other Mala Genital Organs 2 Cancar of Kidney 16 Cancar of Bladder and Other Urinary Organs 6 Malignant Melanoau of Skin 3 Canear of Eye 0 Cancer of Central Nervous Systaa 1 Canear of Thyroid A Other Endocrine Glands 0 Cancar of Bona 2 Canear of All Lyaphatlc, Haaaatopolettc Tissue 27 Lysphosarcoaa A Retlcutosarceaa 1 Hodgkins Disease 2 Latfaala A Alaukaata 11 Cancar of All Other Lysphopotettc Tissue 12 All Other Mai 1 jpiant Neoplasas 22 Benign Neoplasas 0 Otabates Metlltus 12 Cerebrovascular Disease a Ail Heart Disease 364 Rhauaatlc Heart Disease 2 Ischealc Heart Olseasa 274 Chronic Endocard. Ols.: Other Myocard. Insuff. 14 Hypertension with Heart Disease 10 All Other Heart Olseasa 60 Hypertension w/o Heart Disease 2 Non-aalIgnant Respiratory Olseasa 64 Influenza A Pnauaonla 20 Bronchitis. Eaphyseas.- Asthaa 13 Bronchitis 0 Eaphysaaa 11 Asthaa 2 Other Non-aalIgnant Respiratory Olseasa Ulcer of Stoaach A Hi innon a Cirrhosis of Liver 39 6 7 Nephritis A Nephrosis 7 All External Causes of Oeath 64 Accidents 34 Motor Vehicle Accidents All Other Accidents 13 21 Suicides 14 Hoatcldes A Other External Causes All Other Causes of Death 6 19 Unknown Causes (In All Causes Category Only) Significant at 9% Level; Significant at IS Level EXP 943.00 1.34 239.41 9.67 94.46 6.36 4.41 22.42 4.44 9.39 11.63 1.61 44.62 3.02 49.40 0.40 0.26 0.00 0.00 0.00 23.91 0.49 6.37 6.91 2.44 0.12 4.97 0.94 0.41 19.S6 2.16 0.44 4.04 4.74 19.09 2.14 14.11 94.44 370.47 3.34 319.30 16.49 4.99 64.19 2.42 76.41 29.24 12.71 2.14 9.79 0.49 40.99 2.69 16.46 4.69 64.64 32.61 13.69 14. 16 13.99 7.74 93.74 SPMR 100.0 ... 106.4 44.2 47.2 62.4 43.2 79.4 67.9 112.2 103.2 123.9 104.2 33.1 111.9 ... ... --- -- ... 100.4 441.4 297.9 > 92.2 104.2 --- 20.1 ..a 493.7 139.9 46.6 399.9 138.1 136.9 119.2 --- 49.1 124.0 94.3 60.0 47.1 94.4 104.7 44.0 42.7 94.6 74.1 102.2 aaa 112.3 223.7 48.2 223.0 42.6 144.2 64.4 103.3 92.9 109.6 100.1 77.9 105.0 9* LIBit* LOWER UPPER aaa a. 66.1 36.6 66.9 23.9 39.9 47.6 22.0 90.6 64.4 31.1 46.7 9.2 92.6 aaa a. aaa aa. aaa 67.7 124.9 147.1 41.6 33.7 aaa aa. 114.6 211.1 113.7 169.6 173.4 121.1 207.3 249.0 141.1 493.6 130.6 212.9 139.2 aa aaa aa. aaa 144.4 1964.9 474.2 204.6 322.1 3.9 116.9 141.6 83.7 6.B 123.4 79.7 77. B 76.2 1720.4 197. 1 314.7 1024.2 244.9 239.2 174.2 44.6 94.6 60.7 19.3 79.2 60.6 96.6 66.0 20.4 70.6 61.9 66.6 149. 1 199.9 106.4 239.6 99.7 142.9 193.4 112.3 329.4 111.0 121.9 176.4 62.4 94.1 62.4 102.4 20.4 69.2 74.2 79.4 99.4 72.2 60.1 38.2 47.6 202.0 461.6 119.1 446.9 46.4 300.6 124.4 141.5 196.0 166.4 166.6 166.0 127.2 511971 0319 26 * I AHAMA Table 15 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Spending a Majority of Time in the Potroom Department Causa of Oaath (ICOA 8th Revision Codas) All Causes of Death Tuberculosis All Malignant Neoplasms Cancer of Buccal Cavity A Pharynx Cancer of Olgesttve Organs A Perltoneun Cancer of Esophagus Cancer of Stomach Cancer of Large Intestine Cancer of Rectum Cancer of Biliary Passages A Liver Cancer of Pancreas Cancer of All Other Olgesttve Organs Cancer of Respiratory Systee Cancer of Larynx Cancer of Bronchus. Trachea. Lung Cancer of All other Respiratory Cancer of Breast All Uterine Cancers (Females only) Cancer of Cervix Uteri (Feeales only) Cancer of Other Feeale Genital Organs Cancer of Prostate (Males only) Cancer of Testes and Other Male Genital Organs Cancer of Kidney Cancer of Bladder and Other Urinary Organs Malignant Melanoea of Skin Cancer of Eye Cancer of Central Nervous Systee Cancer of Thyroid A Other Endocrine Glands Cancer of Bona Cancer of All Lysphatlc. Haematopoietic Tissue Lysphosarcoma A Rati cut osarcona Hodsplns Otsease Leikamla A AleUtamla _ Cancer of All Other Lymphopoietic Tissue All Other Malignant Necplases Benign Necplases Olabetas Matlttus Cerebrovascular Disease All Heart Olseasa Rhmmittc Heart Disease itehMic Htirt Ptfit Chronic Endocard. DIs.; Other Myocard. Insuff. Hypertension with Heart Olseasa All Other Heart Disease Hypertension w/o Heart Disease Non-nallgnant Respiratory Disease Influenza A Pneumonia Bronchitis, Emphysema, Asthma Bronchitis Emphysema Asthma Other Non-malIgnant Respiratory Disease Ulcer of Stomach A Duodenum Cirrhosis of Liver Nephritis A Nephrosis All External Causes of Death Accidents Motor Vehicle Accidents All Other Accidents Suicides Homicides A Other External Causes A11 Other Causes of Death Unknown Causes (In All Causes Category Only) Significant at S% Level; Significant at 1% oas BS6 0 tea 4 33 3 S 13 1 4 1 62 0 62 0 0 0 0 0 17 1 9 2 2 0 2 0 0 17 1 2 A 6 14 0 A 41 202 2 150 7 7 36 1 41 10 0 6 2 23 6 B S 34 17 7 10 11 6 81 c EXP BBS.00 0.82 141.BA 3.38 34.63 3.82 S.03 13.21 2.BO 3.18 6.88 o.ts B3.04 1.79 B0.77 0.47 0.16 0.00 0.00 0.00 14.32 0.28 3. IS 3.80 1.68 0.07 2.81 0.32 0.24 11.73 1.26 0.B0 4.78 8.22 11.31 1.28 8.38 32.26 216.90 1.84 166.07 8.63 B. 78 40.38 1.44 44.88 14.66 7.47 1.24 8.78 0.83 23.88 1.86 8.62 2.86 33.36 20.30 8.88 11.66 6.81 4.SS B5.88 i 10.0..0. 114.8 > 118.8 88.3 78.6 88.4 88.4 38.4 12S.7 87.2 105.7 11.6..8. 12....2.....1.... ... 118.7 388.2 288.8 < 82.6 11.8..2. 66.7 ... ... 144.8 78. B 386.8 168.3 IIS.0 123.8 ... 88.3 127.1 83.2 103.0 90.6 72.7 121.1 88.1 68.3 81.2 69.2 10.7..2. 104.4 374.4 * 86.B 317.2 82.0 173.4 101.8 83.7 76.6 66.8 128.3 132.0 81.8 *5S Limits LOWER ...... 100.7 48. 1 69.S 28.6 41.8 87.8 S. 8 47.4 39.4 14.8 82.4 w- 86.S UPPER ._._.. 130.8 316.9 132.S 241.8 237.7 168.4 282.2 333.2 182.8 746.8 14.7..6. 154.8 ... ...... ... 74.4 87.6 183.4 13.8 30.0 --- 17.4 ... 80.8 11.3 110.3 as. 1 81.8 73.8 ... 47.8 64.8 83.7 28.8 70.8 38.0 88.1 68. 1 8.8 68.1 37.2 8.3..8. 47.1 103.1 64.7 138.8 22.2 73.2 76.2 84.0 38.3 47.3 73.0 61.0 70.8 ......... ... 188.3 2241.7 832.8 204.8 474.3 --- 271.1 --... 231.3 860.6 1428.6 333.0 2S4.B 207.7 --199.6 170.7 103.7 410.6 81.7 180.8 252.8 122.0 468.1 122.1 124.6 213.1 231.2 1386.3 143.7 726.4 - 121.8 410.8 136.3 128.8 186.1 188.2 228.0 288.8 118.0 27 511971 0320 cerebrovascular disease (PMR=136.2, p<0.05) were significantly elevated. There were only 140 men spending the majority of their time in the carbon department (Table 17). Thus the statistical power to a true excess is limited. The only cause of death with a statistically significant excess is cerebrovascular disease with a PMR of 195.3 and corresponding 95% confidence interval of (124.6, 306.3). The PMRs were also computed for the employees spending the majority of their time in mechanical maintenance, electrical maintenance, ingot and power. For most of these departments the number of employees was not sufficient to evaluate many of the specific cancer sites. Table 18 summarises the observed and expected deaths and PMRs for all malignant neoplasms for employees with the majority of their time in each of the departments in the reduction plant. Those workers with the majority of time in the potrooms show an elevated PMR of 114.8 (p<0.05). The site-specific PMRs for cancer have already been discussed for the potroom and carbon departments. For the other four departments the only significant excess was for lung cancer in mechanical maintenance. The PMR was 138.3 with a corresponding 95% confidence interval of (107.2, 176.4). 28 511971 0321 Table 16 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Ever Employed in the Carbon Department Causa of Death (ICOA Ith RaviSion Codas) OBS All Causas of Oaath ABB Tubarculosls 0 All MaiIgnant Neoplasms 133 Caneor of Buccal Cavity A Pharynx 2 Cancar of Oldest Ive Organs A Peritoneum 27 Caneor of Esophagus 1 Cancar of Stomach 8 Caneor of Largo Intestine to Cancar of Rectum 1 Cancar of Biliary Passagas A Llvar 3 Cancar of Pancroas e Cancar of All Othar Dtgesttva Organs 1 Caneor of Rasplratory Systoa 81 Cancar of Larynx 0 Cancer of Bronchus. Trachea. Lung 51 Cancar of All Othar Rasplratory 0 Cancer of Broast 0 All Uterine Cancers (Faamlas only) 0 Cancer of Carvtx Uteri (Females only) 0 Cancar of Othar Famalo Genital Organs 0 Cancar of Prostate (Males only) 12 Cancer of Testes and Other Male Genital Organs Cancar of Kidney Cancer of Bladder and Other Urinary Organs Malignant Melanoma of Skin Cancer of Eye Cancer of Central Nervous System 1 7 3 2 0 0 Cancer of Thyroid A Other Endocrine Glands Cancer of Bono 0 1 Cancer of All Lyaphatlc. Haematopoietic Tissue 12 Lymphosarcoma A Retlculosarcoam Hodipdns Olsease 1 1 LeiStomla A Aleukemia 3 Cancer of All Other Lymphopoietic Tissue All Other Malignant Neoplasms Benign Neoplasam Diabetes Mellttus Cerebrovascular Olsaase All Heart Olsaase Rheumatic Heart Olsease Ischemic Heart Olsease Chronic Endocard. 01s.; Other Myocard. Insuff. Hypertension with Heart Olsease All Other Heart Disease Hypertension w/o Heart Olseasa Non-malIgnant Respiratory Olsease Influenza A Pnetaonla Bronchitis. Emphysema, Asttwm Bronchitis Emphyseaia Asthma Other Non-amiIgnant Respiratory Disease Ulcer of Stomach A Duodenum Cirrhosis of Liver Nephritis A Nephrosis AlI External Causes of Death Accidents 7 IS 1 11 31 1B0 1 149 10 3 27 1 25 9 3 0 1 2 13 1 7 4 31 17 Motor Vehicle Accidents Al1 Other Accidents Suicides Homicides A Other External Causes AH Other Causes of Oeath Unknown Causes (In All Causes Category Only) 6 11 12 2 47 Significant at SX Level; Significant at IX Level EXP 488.00 0.78 128.72 3.OB 30.64 3.88 4.82 11.44 2.28 2.84 6.09 0.82 47. 16 1.62 45.12 0.42 0. 14 0.00 0.00 0.00 12.34 0.26 2.79 3.19 1.88 0.06 2.68 0.26 0.22 10.37 1.10 0.47 4.15 4.68 10.12 1.14 7.52 27.80 187.93 1.70 188.73 6.25 8.37 36.11 1.29 36.06 12.61 6.26 1.03 4.77 0.48 20.10 1.36 6.17 2.88 31.80 19.10 8.38 10.99 8.03 4.77 48.22 %pm 10.0..0. 108.8 68.4 SI. 1 27.8 110.7 87.4 44.3 108.7 98.5 121.4 101.1 --- 113.0 -------- ... 87.2 389.4 250.7 94.1 121.8 ...... 456.9 118.7 81.2 213.8 72.2 180.8 148.2 87.8 146.2 136.2 * 101.1 88.8 93.3 121.2 55.9 74.8 77.2 68.6 71.4 47.8 ... 20.8 407.2 64.7 73.3 78.4 187.1 87.2 88.0 71.8 101.1 149.5 41.9 88.8 8SX Limits LOWER ... 81.8 16.6 61.2 4.8 46.3 47.4 6.6 34.2 44.5 17.2 8-3-.-8-- 87.2 ... ... ...... ... 88.8 63.4 122.9 30.5 3...2....8... 76.8 66.2 12.9 31.6 23.8 72.4 90.1 12.4 91.6 100.3 90.5 9.5 91.9 65.7 18.8 82.1 11.0 48.3 37.7 16.0 ... 3.6 113.5 38.2 10.4 36.9 88.6 71.6 87.2 33.7 86.8 96.7 11.5 72.8 UPPER ...... 122.3 . 287.2 126.8 172.7 264.9 161.1 286.6 326.4 219.1 887.8 14.0.. .1 146.5 ... ... ...... ... 169.5 2382.3 511.5 290.6 81...1....8... 2717.1 202.4 645.4 1444.0 221.8 313.0 243.7 621.6 261.9 194.9 112.9 407.6 106.3 223.7 169.1 107.3 543.6 9S.2 135.2 143.9 122.2 1461.2 109.5 818.1 159.1 413.9 131.9 138.8 183. 1 179.9 287.8 182.3 128.1 29 511971 0322 Table 17 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Spending a Majority of Time in the Carbon Department Causa of Ooath (I COA 8th Revision Codas) OBS All Causas of Ooath 140 Tubarculosls 0 All Malignant Neoplasas 38 Cancar of Buccal Cavity A Pharynx 0 Cancar of Otgastiva Organs A Parltonaua B Cancar of Esophagus 1 Cancar of Stomach 0 Cancar of Large Intestine 3 Cancar of Rectue 1 Cancer of Biliary Passages A Ltvar 0 Cancar of Pancreas 3 Cancar of All Other Olgasttve Organs 0 Cancar of Respiratory Systaa 16 Cancer of Larynx v 0 Cancar of Bronchus, Trachea, Lung 16 Cancar of All Other Respiratory 0 Cancar of Breast 0 All Utartne Cancers (Females only) 0 Cancer of Cervix Uteri (Females only) 0 Cancer of Other Female Genital Organs 0 Cancer of Prostate (Males only) 3 Cancer of Testes and Other Male Genital Organs 0 Cancer of Kidney 2 Cancer of Bladder and Other Urinary Organs 1 Malignant Melanoma of Skin 0 Cancer of Eye 0 Cancer of Central Nervous System 0 Cancer of Thyroid A Other Endocrine Glands 0 Cmnemr of ftooi 0 Cancer of All Lymphatic, Haematopoietic Tissue 3 Lyephosarcoma A Retlculosarcoeu 0 HodeFtlns Olsease LmimiIi & Mtukaalt 0 1 Cancer of All Other Lymphopoietic Tissue 3 All Other Malignant Neoplasms Benign Neoplasms 0!abates Mallttus Cerebrovascular Disease All Heart Disease Rheumatic Heart Olsease Ischemic Heart Olsease 8 1 3 17 SO 0 40 Chronic Endocard. 01s.: Other Myocard. Insuff. Hypertension with Heart Disease All Other Heart Disease Hypertension w/o Heart Olsease Non-malIgnant Respiratory Olsease Influenza A Pneumonia Bronchitis. Eaphysema. Astlwa Bronchitis Eaphysema Asthma Other Non-eal Ignant Respiratory Olsease Ulcer of Stomach A Duodenum Cirrhosis of Liver Nephritis A Nephrosis A11 External Causes of Death Accldtnti Motor Vehicle Accidents A!I Other Accidents Suicides Homicides A Other External Causes A11 Other Causes of Death Unknown Causes (In All Causes Category Only) 2 0 6 0 s 0 0 0 0 0 8 0 2 1 B 6 4 2 3 0 14 Significant at SX Level; Stmif leant at IX Level EXP 140.00 0.28 38.4B O.BB S .74 1.04 1.31 3.28 0.64 0.32 1.71 0.23 13.01 0.48 12.44 0.11 0.04 0.00 0.00 0.00 3.80 0.06 0.75 0.65 0.37 0.02 0.66 0.08 0.06 2.SB 0.29 0.11 1.18 1.30 2.84 0.32 2. IS 8.70 84.44 0.46 45.69 2.82 1.65 to.SB 0.40 11.82 3.SI 1.88 0.31 1.41 0. 14 6.03 0.40 2.34 0.7B 7.43 4.84 1.S1 2.77 1.78 1.11 14.41 SPMR 100.0 --. 107. 1 --- B1.2 S6.0 --- 01.6 18-6-.-0 178.0 --- 123.0 -- 126.6 --... -- -- ... 76.S ... 265.2 105.5 ... ... ... ... ... 10.8..0. ... 46.7 183.7 178.8 308.8 136.8 188.3 81.B ... *7.2 78.4 ... 7.8..8. 43.4 ... ... ... ... ... 82.8 ... 88.6 126.6 121. i 132.2 221.4 72.2 167.8 ... 87.2 * 8% Limits LOVER ... ... 81.8 ... 46.7 13.7 ... 28.8 22.4 ... 87.7 ... 77.4 ... 80.8 ... ... ... ... ... 28.4 UPPER ... ... 140.7 ... 178.1 67.4..8. 278.8 106.4..9. 830.8 ... 188.4 204.8 ... ... ... ... 233.0 70.3 18.0 ... ... ... ... 34.3 ... 12.3 38.1 74.7 48.3 44.8 124.6 74. 1 1001.3 743.4 ... ... ... ... 321.8 ... 608.6 604.1 413.7 1882.7 418.8 306.3 113.9 67.6 20.2 ... 38.8 112.1 312.2 140.5 19.3 ... ... ... ... 38.3 7.6 ... ... ... ... 194.7 21.8 18.0 67.0 61.8 87.8 18.7 86.3 ... 68.2 334.8 687.8 216.8 282.3 887.8 278.2 BOO. 1 188.8 30 511971 0323 I Table 18 Observed and Expected Deaths and Proportionate Mortality Ratios by Department for All Malignant Neoplasms OBS EXP PMR 95% LOWER UPPER POTROOM CARBON INGOT MECH. MAINT. ELECT. MAINT. POWER 163 141.98 114.8* 100.7 130.9 38 35.48 107.1 81.5 140.7 44 44.33 99.3 76.9 128.1 117 108.00 108.3 \ 30 27.60 108.7 92.7 79.8 126.6 148.0 5 5.05 99.0 46.2 212.3 D. Selected Causes of Death For those causes of death that were in excess or for which we have particular interest because of the Tripartite Study, we now present more detailed analysis. (1) Kidney cancer - The PMR for kidney cancer for the total cohort is 158.1 based on 53 observed deaths and 33.52 expected. All cases of kidney cancer were in males and both white males and nonwhite males had an excess (PMR=157.5 and 257.8, respectively. Of the 53 employees with kidney cancer as a cause of death, 49 had more than 20 years employment. For those employees ever employed in the reduction process, the PMR is 200.1 based on 21 observed deaths and 10.5 expected and a corresponding 95% confidence interval of (131.7, 303.8). This compares to a PMR of 136.5 with a corresponding 95% confidence interval of (92.5, .201.4) for workers in nonreduction plants. Further investigation within the reduction process indicates 31 511971 0324 that there is no particular area that appears to have a concentration of excess deaths (Table 19). The excess is not much affected when a PCMR is used instead of a PMR (Table 20). The investigation of kidney cancer by individual plant indicated no pattern for the excess although the distribution of only 53 observed deaths among 37 plants results in numbers too small to conclude that no clustering exists. Table 19 Observed and Expected Deaths and Proportionate Mortality Ratios by Job Location for Kidney Cancer 95% OBS EXP PMR LOWER UPPER NONREDUCTION PLANT REDUCTION PLANT NONREDUCTION PROCESS REDUCTION PROCESS POTROOM CARBON INGOT MECH. MAINTAIN. ELECT. MAINTAIN. POWER 25 28 11 17 9 2 2 4 0 0 18.32 15.20 7.05 8.11 3.15 .75 .99 2.48 .61 .11 136.5 184.2** 156.1 209.7** 285.8** 265.2 201.8 161.1 -- -- 92.5 128.1 87.0 132.0 153.4 70.3 52.1 61.2 -- -- 201.4 265.0 280.0 333.3 532.5 1001.3 ` 781.4 423.7 -- -- 32 577977 0325 Table 20 Observed and Expected Deaths and Proportionate Cancer Ratios by Job Location for Kidney Cancer 95% OBS EXP PMR LOWER UPPER NONREDUCTION PLANT. REDUCTION PLANT NONREDUCTION PROCESS REDUCTION PROCESS POTROOM CARBON INGOT MECH. MAINTAIN. ELECT. MAINTAIN. POWER 25 28 11 17 9 2 2 4 0 0 19.25 15.62 6.60 9.01 3.64 .84 1.02 2.74 .67 .10 129.9 88.2 179.3** 125.0 166.6 93.5 188.6** 118.8 247.1** 132.4 237.9 63.1 195.8 51.1 146.2 55.8 ---- ---- 191.1 257.2 296.9 299.4 '461.2 897.5 750.7 382.7 -- -- (2) All other cancers - The PMR for the category "all other cancers" was 134.3 (p<0.01) with 164 observed deaths and 122.1 expected. The excess did not appear to be restricted to any particular race or sex. Of these, 138 were cancer of an unspecified site, 14 were cancer of multiple sites, and 12 were cancer of soft or connective tissue. (3) Benign and unspecified neoplasms - The PMR for benign and unspecified neoplasms was 195.6 with a corresponding 95% confidence interval of (136.9, 279.5). The PMR was higher in the nonreduction plants than in the reduction plants (PMR=227.3, p<0.01) and PMR=154.7, respectively. The cases did not appear confined to any specific race or sex. The median age at death 33 511971 0326 for the 29 workers with this cause of death was 70.9. Of the 29 observed deaths, 2 were benign brain tumors and 10 were brain tumors of unspecified nature. (4) Nephritis and nephrosis - The PMR for nephritis and nephrosis was 242.2 based on 85 observed deaths and 35.09 expected. The excess appeared in reduction as well as nonreduction processes and was not restricted to a specific sex or race group. This ICD classification is often a result of insufficient coding of the death certificate and a review of individual death certificates indicated "renal failure" as a frequent cause of death designated on the death certificates with this cause. Investigation of individual plants indicates that five plants accounted for 52 observed deaths when 13.95 were expected. These plants were both reduction and nonreduction plants. (5) Cerebral vascular disease - The total cohort had approximately an 11% excess in cerebrovascular disease. This excess appeared restricted to white males where the PMR was 115.2 (p<0.01) based on 403 observed deaths and 349.8 expected and was higher in plants with a reduction process where the PMR was 135.3 (p<0.01) based on 151 observed deaths compared to a PMR of 98.9 fop the remainder of the white male population. For reduction plant workers this represents 30 observed deaths in excess which is approximately the same as the deficit observed for the category "all heart disease". Although the excess occurs in reduction plants it is not confined to the reduction process. The white males who spent the majority of their time in a nonreduction process had a PMR of 132.1 (p<0.01) compared to 34 511971 0327 138.8 (p<0.01) for the white males spending the majority of their time in a reduction process. (6) Respiratory cancer - The primary hypothesis in the Tripartite Study was to determine if there was an excess of lung cancer in the potroom and carbon departments of the reduction process. The overall SKR for lung cancer in that study was 96.4 with a corresponding 95% confidence interval of (83.2, 105.9). The corresponding SMR of the plants in the Tripartite Study which have been included in this study is 91.7 with a corresponding 95% confidence interval of (78.4, 106.5). For this study the PMR for lung cancer shows a slight excess. The PMR for lung cancer for employees in the reduction process is 124.3 with a corresponding confidence interval of (107.3, 144.0). This compares to a PMR of 108.9 for workers in plants with no reduction process and a PMR of 81.3 (p<0.05) for workers in a reduction plant that spent the majority of their time in a nonreduction process. Further investigation was conducted by department within the reduction process (Table 21). Workers spending the majority of their time in the potroom, carbon or ingot department all have excesses of 20%-30% that are not statistically significant. Workers spending the majority of '-t time in mechanical maintenance have a significantly elevated PMR of 136.3 (p<0.05). When the risk is estimated using a proportionate cancer mortality ratio (Table 22), the risk is slightly increased for employees in the nonreduction process of the reduction plant (PCMR=87.9) and decreased for employees in the reduction process 35 511971 0328 (PCMR=111.9). Neither of these is significantly different from 100. The only significant excess using the PCMR occurs for maintenance workers where the PCMR is 125.7 with a corresponding 95% confidence interval of (101.6, 155.6). Table 21 Observed and Expected Deaths and Proportionate Mortality Ratios by Job Location for Cancer of Bronchus, Trachea and Lung 95% OBS EXP PMR LOWER UPPER NONREDUCTION PLANT REDUCTION PLANT NONREDUCTION PROCESS REDUCTION PROCESS POTROOM CARBON INGOT MECH. MAINTAIN. ELECT. MAINTAIN. POWER 310 248 89 159 62 16 19 53 8 1 284.73 238.24 109.53 127.95 50.77 12.44 15.13 38.34 9.53 1.69 108.9 97.9 104.1 92.5 81.3* 66.7 124.3** 107.3 122.1 96.5 128.6 80.9 125.6 82.0 136.3* 107.2 83.9 43.5 59.2 9.4 121.0 117.1 98.9 144.0 154.5 204.5 192.4 178.3 162.0 372.4 36 511971 0329 The observed and expected deaths and PMRs are shovn for each plant in Table 23. There was a statistically significant excess, at both the Mobile and Vancouver plants (PMR=161.2 and 154.4, respectively). Two other plants with Soderberg processes, had excesses greater than 40% that failed to achieve statistical significance. When we restricted analysis within each plant to employees with reduction experience, the PMR for Vancouver was 162.4 (p<0.01), for Point Comfort was 164.6 (p<0.05) and for Warrick was 161.8 (not statistically significant). Table 22 Observed and Expected Deaths and Proportionate Cancer Mortality Ratios by Job Location for Bronchus, Trachea and Lung 95% OBS EXP PCMR LOWER UPPER NONREDUCTION PLANT REDUCTION PLANT NONREDUCTION PROCESS REDUCTION PROCESS POTROOM CARBON INGOT MECH. MAINTAIN. ELECT. MAINTAIN. POWER 310 248 89 159 62 16 19 53 8 1 300.93 243.32 101.23 142.09 59.27 13.09 15.70 42.15 10.39 1.50 103.0 101.9 87.9 111.9 104.6 122.2 121.0 125.7* 77.0 66.5 94.2 112.7 92.3 112.6 74.4 103.9 98.6 126.6 85.9 127.4 82.6 - 180.8 84.7 172.9 101.6 155.6 44.3 133.8 13.6 324.5 The PCMRs for the Point Comfort and Vancouver plants were also significant (151.9, P<0.01 and 143.2, p<0.05, respectively). The PGMR for Warrick was 112.0. 37 511971 0330 Table 23 Observed and Expected Deaths and Proportionate Mortality Ratios for Lung Cancer by Plant Plant 95% OBS EXP PMR LOWER UPPER ADDY ANDERSON ALCOA BAD IN BAUXITE BRIDGEPORT BUFFALO CHICAGO CHILLICOTHE CLEVELAND CORONA CRESSONA DAVENPORT DETROIT EAST ST. LOUIS EDGEWATER EDISON FORT MEADE FRANKLIN LAFAYETTE LANCASTER LEBANON LOGANS FERRY MARSHALL MASSENA MOBILE NEW KENSINGTON POINT COMFORT RICHMOND ROCKDALE . ROSICLARE TENNESSEE TIFFON VANCOUVER VERNON WARRICK WENTACHEE 3 .71 -- 1 .11 -- ---- 8 7.47 107.2 55.5 206.8 12 12.19 98.5 57.5 168.7 13 12.29 105.8 63.1 177.3 4 1.94 -- -- -- 0 .16 -- --. -- 3 2.45 -- -- -- 6 4.87 123.2 57.8 262.6 42 36.63 114.7 86.0 152.8 0 1.08 -- -- -- 23 23.53 97.8 66.5 143.8 29 23.39 124.0 88.0 174.8 2 4.39 -- -- -- 5 7.99 62.6 27.1 144.5 17 18.26 93.1 59.0 146.8 11 8.17 134.6 76.9 235.7 0 .31 -- -- -- 2 1.95 -- -- -- 21 30.36 69.2 46.2 103.6 .5 2.69 185.5 81.8 420.8 2 .85 -- -- -- 3 1.60 -- -- -- 3 1.09 -- -- -- 47 53.08 88.5 67.5 116.1 22 13.65 161.2* 108.8 238.7 54 52.96 102.0 79.0 131.5 25 17.42 143.5 99.4 207.3 4 5.94 67.3 26.7 170.0 5 9.58 52.2 23.1 117.7 5 2.45 204.4 89.9 464.8 107 109.3 1 .72 97.9 -- 81.7 '-- 117.2 -- 27 17.49 154.4* 108.3 220.1 21 16.75 125.4 83.6 188.1 16 11.10 144.2 91.0 228.4 9 8.07 111.5 60.1 207.0 511971 0331 1 (7) Cancer of the Lymphatic and Haematopoietic Cancer - The PMR for the total cohort for lymphatic and haematopoietic cancer was 113.6 with a 95% confidence interval of (96.8, 133.2). The PMR for workers in nonreduction plants was 100.2 compared to a PMR of 130.2 (p<0.05) for. workers in reduction plants. Within the reduction plants, those workers spending the majority of their time in a nonreduction process had a higher PMR than those in a reduction process [PMR=140.1, p<0.05 and PMRS122.1 (not significant), respectively]. The PCMR was 146.7 (p<0.05) for workers in the nonreduction process and 111.3 for workers in the reduction process. Analysis based on majority of time in individual departments yielded no statistically significant results. Potroom workers had a PMR of 144.9 with a 95% confidence interval of (90.8, 231.3) and electrical maintenance workers had a PMR of 217.3 with a corresponding 95% confidence interval of (93.3, 506.3). The only individual plant with a significant excess was Tennessee which had a PMR of 172.1 (p<0.01. The PMR for leukemia in the total cohort was 102.0. The PMR for those in reduction plants was 117.4 compared to 89.8 for those in nonreduction plants. The number of deaths was small on which to do an analysis by department. However, 8 of the 15 deaths '-y occurred in the potroom with a subsequent PMR of 168.3 based on 8 observed deaths and 4.75 expected with a corresponding 95% confidence interval of (85.1, 333.0). The only individual plant with a significant excess was Edgewater with a PMR of 260.7 (p<0.05). '- (8) Paxrcreatic cancer - In this study, the PMRs for 39 511971 0332 pancreatic cancer did not show a significant excess for either reduction plant workers or workers spending the majority of their time in the potrooms (PMR=103.2 and 87.2). This compares to an SMR of 134.8 for workers in the potrooms of the Tripartite Study. The significant finding of the Tripartite Study was for potroom workers with more than 15 years employment, where the excess was more than twofold. With the data available in the present study a risk for longterm employees could not be obtained. E. Analysis by Plant Mortality for each of the 62 selected causes of death was done for each of the 37 study plants. Such analysis must be interpreted with caution since by random chance alone some plants would be expected to deviate from the average value. In addition, many of the plants did not have sufficient numbers for an individual analysis. Because of these limitations, we view the results as preliminary and any plants that are identified should be given consideration for a more detailed study (if feasible) in a second phase. Table 24 summarizes the observed, expected deaths and Proportionate Mortality Ratios by plant. Of the 29 plants with sufficient sample size to compute a PMR, 14 had a PMR less than 100 and 15 had a PMR greater than 100. Pour plants had a statistically significant excess, but one was based on only 5 observed deaths. One plant had a borderline excess of PMR=130.5 with a corresponding 95% confidence interval of (99.9, 170.4). Numbers were often too small to do an analysis of individual plants for many of the specific cancers. Nevertheless, in reviewing the results from those plants we note the following 40 5*7977 0333 Table 24 Observed and Expected Deaths and Proportionate Mortality Ratios for All Malignant Neoplasms by Plant Plant 95% OBS EXP PMR LOWER UPPER ADDY ANDERSON ALCOA BAD IN BAUXITE BRIDGEPORT BUFFALO CHICAGO CHILLICOTHE CLEVELAND CORONA CRESSONA DAVENPORT DETROIT EAST ST. LOUIS EDGEWATER EDISON FORT MEADE FRANKLIN LAFAYETTE LANCASTER LEBANON LOGANS FERRY MARSHALL MASSENA MOBILE NEW KENSINGTON POINT COMFORT RICHMOND ROCKDALE ROSICLARE TENNESSEE TIFFON VANCOUVER VERNON WARRICK WENTACHEE 5 1 21 40 34 12 0 5 16 138 1 64 85 14 28 60 30 1 5 78 7- 3 5 3 148 45 160 45 19 23 10 330 4 52 52 39 22 2.00 .37 22.02 37.11 36.16 7.04 .91 7.06 14.98 110.16 2.85 62.75 64.20 16.17 29.04 61.07 24.75 .88 5.85 87.57 7.83 2.16 4.36 2.78 152.68 38.58 168.55 45.95 19.81 26.44 7.78 323.35 2.33 49.27 51.06 29.89 22.55 250.6* -95.3 107.8 94.0 170.5* -- 70.8 106.8 125.3** -102.0 132.4** 86.6 96.4 98.2 121.2 -- 85.4 89.1 89.4 -- 104.7 -- 96.4 116.6 94.9 97.9 95.9 87.0 128.5 102.1 -- 105.8 101.8 130.5 97.6 123.2 -66.1 82.5 70.4 103.7 -- 33.5 70.8 108.6 -- 82.8 110.5 54.6 69.5 78.7 89.1 -- 40.4 73.6 47.4 -- 54.5 -- 84.4 90.8 83.0 76.5 65.6 61.4 74.7 93.0 -- 83.6 80.6 99.9 68.3 509.9 -- 137.6 140.7 125.5 280.3 -- 149.4 161.0 144.6 -- 125.6 158.6 137.3 133.9 122.6 165.0 -- 180.5 107.8 168.3 -- 24.7 -- 111.4 149.8 108.6 125.4 '140.1 123.2 220.9 112.0 -- 133.2 128.7 170.4 139.5 neoplasms which were in excess at particular plants: (1) The Cleveland plant had PMRs of 280.5 for stomach cancer (based on 12 observed deaths, p<0.01), 298.8 for cancet of 511971 0334 the rectum (based on six observed deaths, p<0.05) and 464.7 for cancer of the breast (based on 4 observed deaths, p<0.01). (2) The Cressona plant had a PMR of 247.4 for stomach cancer (based on five deaths, p<0.05), 261.9 for kidney cancer (based on four deaths, p<0.05), and 530.4 for melanoma (based on four deaths, p<0.01). (3) The Davenport plant had a PMR of 177.0 for all digestive cancers (based on 27 observed deaths, p<0.01). The PCMR was not significantly elevated for this cause. (4) The Edgewater plant had a PMR of 260.7 for leukemia (based on six observed deaths, p<0.05). (5) The Massena plant had a PMR of 283.2 for lymphosarcoma (based on 4 observed deaths, p<0.05). (6) The Mobile plant had a PMR of 161.2 (p<0.05) for lung cancer. The PCMR was 135.3. (7) The Tennessee (Ale) plant had a PMR of 172.1 (based on 46 observed deaths, p<0.01) for cancer of the lymphatic and haematopoietic tissue. (8) The Vancouver plant had a PMR of 154.4 for lung cancer (based on 27 observed deaths, p<0.05) and a PMR of 356.1 (based on 4 observed deaths, p<0.05) for kidney cancer. 511971 0335 Summary Conclusions from this study must be drawn more cautiously than was necessary for the Tripartite Study because of the inherent limitations of the PHR study design as well as the less specific job classification used in the present study. Furthermore, the large number of estimates of risk that were computed will result in a larger number of false positive findings than can be inferred from the p-values. Conversely, the small number of workers available for many of the estimates of risk precludes any strong statements in regard to those findings that were negative. With these limitations stated, we now summarize the findings we feel are most important. Consistent with the study objectives, we have given most attention in our summary to malignant neoplasms.- The PMR for malignant neoplasms for the total study population was 103.7 and was not significantly different from the total U.S. population. The only specific cancer site which was significantly elevated was kidney cancer with a PHR of 158.1 and a corresponding 95% confidence interval of (121.2, 206.3). The nonspecific disease categories of benign and unspecified neoplasms, nephritis and nephrosis and "all other malignant neoplasms" were elevated and appeared to result from lack of complete specification of cause of death on the certificate. The only other disease category that was elevated for the total cohort was cerebral vascular disease with a PHR of 111.4 (p<0.05) and this was accompanied by a deficit in ischemic heart disease (PHR=85.2, p<0.01). The analysis by work area yielded the following: 43 511971 0336 (1) For the combined group of workers in nonreduction plants the PMR for all malignant neoplasms was 105.2. The only statistically significant excesses occurred for nonspecific disease categories (i.e., nephritis., benign and unspecified neoplasms, all other cancers).. Analysis by race indicated that whites had an excess of colon cancer and nonwhites had an excess of stomach, liver and lymphatic cancer. (2) For the 1320 workers in a reduction plant who spent the majority of their time in a nonreduction process, the PMR for all malignant neoplasms was 93.6. The only specific neoplastic site with a significant elevation was cancer of the lymphatic and haematopoietic tissue (PMR=140, p<0.05). (3) Workers with the majority of their employment in the reduction process had a PMR of 109.5 (p<0.05) for all malignant neoplasms. These workers had a PMR of 124.3 for lung cancer (p<0.01) and a PMR of 209.2 for kidney cancer (p<0.01). When a PCMR was computed, the estimate of risk for lung cancer was a nonsignificant 111.9 but remained significant for kidney cancer (PCMR=188.6, p<0.01). The workers spending the majority at their time in the reduction process had a significant excess for two of the study plants. Neither of these plants had an excess in the Tripartite Study. Workers spending the majority of their time in mechanical maintenance also had an excess of lung cancer. (4) Although workers in reduction plants had a significantly elevated PMR of 130.2 (p<0.05), for cancer of the lymphatic and haematopoietic tissue it was greater in workets in the reduction plant, spending the majority of their time, in a 44 511971 0337 nonreducticn process (PMR=140.1, p<0.05). No individual department had a statistically significant excess, although the small number of observed deaths when analyzed by department makes the results inconclusive. (5) Analysis by plant is limited by small numbers and a further increase in the expected false positives due to the larger number of estimates of risk. Overall, 14 plants had a PMR for "all malignant neoplasms" below 100, 15 plants were above, and 8 had less than 5 observed deaths from neoplasms. Of plants \ with greater than 5 observed deaths for "all malignant neoplasms", three had a statistically significant excess and one had borderline significance. Eight of the plants had at least one specific site that showed a statistically significant excess. We could identify no consistent pattern in site-specific cancers among plants with similar processes, although such inferences are clearly limited by small numbers and lack of more detailed job classifications in plants with multiple processes. 45 511971 0338 References 1. Rockette HE,, Arena VC: Mortality .studies of aluminum workers: potroom and carbon department. Journal of Occupational Medicine 25(7), 1983. 2. Marsh GM, Preininger M: OCMAP: A user-oriented occupational cohort mortality analysis program. American Statistician 34: 245-246, 1980. N 3. Wong O, DeCoufle P: Methodological issues involving the standardized mortality ratio and proportionate mortality ratio in occupational studies. Journal of Occupational Medicine 24:299-304, 1982. 46 511971 0339 Appendix Distribution o causes of death using 4 digit ICD codes ICD 88 119 189 310 360 381 384 388 389 419 498 499 539 543 703 1159 1169 1175 1179 1350 1363 1369 1409 1419 1449 1459 1460 1469 1479 1481 1490 1505 1509 1510 1519 1522 1529 1531 1532 1533 1534 1536 1539 1540 1541 1550 1551 1552 Freq. 1 3 1 1 1 3 7 1 54 1 1 1 1 1 2 2 1 1 2 1 2 1 1 2 1 2 2 1 3 1 5 2 17 3 56 2 1 1 2 4 2 5 152 6 24 12 2 .8 ICD 1562 1569 1570 1579 1590 1599 1619 1625 1629 1639 1640 1701 1706 1709 1712 1713 1716 1719 1722 1725 1727 1729 1734 1749 1790 1809 1820 1830 1850 1869 1874 1889 1890 1891 1892 1899 1909 1910 1913 1916 1919 1930 1940 1946 1950 1990 1991 2000 Freq. 1 1 5 69 3 1 7 1 557 2 1 1 1 1 1 1 1 9 1 2 1 15 1 13 2 1 1 4 147 1 2 47 48 1 4 1 1 1 2 1 20 1 2 1 1 14 . 136 5 . ICD 2008 2019 2020 2021 2024 2028 2030 2040 2041 2049 2050 2051 2080 2081 2089 2159 2169 2251 2252 2302 2373 2384 2387 2389 2390 2391 2395 2396 2398 2399 2429 2449 2500 2501 2502 2503 2504 2505 2506 2507 2509 2535 2554 2558 2599 2639 2651 2733 Freq. 4 7 1 1 1 41 25 5 8 2 17 6 9 1 7 1 1 1 1 1 1 1 4 2 2 1 1 10 1 1 1 .1 72 2 2 6 1 1 6 1 1 1 1 1 1 3 1 1 47 511971 0340 Table (continued) Distribution of causes of death using 4 digit ICD codes ICD 1560 1561 2761 2762 2765 2773 2780 2793 2810 2848 2849 2859 2866 2888 2898 2899 2900 2901 2910 3030 3089 3109 3229 3239 3240 3310 3312 3314 3319 3320 3334 3352 3400 3418 3419 3429 3481 3483 3485 3489 3561 3570 3760 3940 3941 3949 3959 Preq. 4 2 1 2 4 2 1 1 1 2 2 1 2 2 1 1 4 2 1 1 1 5 1 2 1 19 1 2 2 16 3 12 3 1 1 2 3 1 1 1 1 2 1 2 1 s 1 ICD 2001 2002 4049 4100 4109 4110 4120 4130 4140 4141 4148 4149 4151 4160 4169 4210 4239 4240 4241 4249 4254 4255 4271 4273 4274 4275 4278 4279 4280 4281 4284 4289 4290 4291 4292 4299 4300 4301 4310 4321 4329 4330 4331 4340 4341 4349 4360 Preq. 6 1 4 1017 16 11 9 1 617 1 14 203 36 3 5 3 1 5 23 6 67 2 1 3 4 164 1 19 80 2 4 14 2 1 150 4 6 5 46 6 5 1 4 49 2 27 275 ICD Preq. 2738 1 2754 1 4402 3 4409 65 4410 4 4411 1 4412 1 4413 41 4414 3 4415 7 4416 3 ' 4429 1 4439 8 4440 1 4449 5 4472 1 4479 1 4512 1 4519 2 4539 1 4549 1 4560 4 4578 1 4589 3 4590 5 4599 1 4660 1 4787 1 4809 1 4810 4 4820 3 4823 . 1 4824 1 4828 1 4829 1 4830 1 4850 35 4860 103 4870 1 4878 1 4900 3 4912 6 4919 1 4920 54 4939 9 4940 i 4960 141 48 511971 0341 Table (continued) Distribution of causes of death using 4 digit ICD codes ICD 3980 3989 4019 4029 4039 5070 5109 5118 5119 5120 5130 5140 5150 5163 5168 5183 5184 5185 5188 5199 5301 5304 5309 5314 5315 5319 5324 5325 5326 5329 5334 5335 5339 5369 5400 5409 5532 5539 5560 5570 5579 5580 5601 5602 5608 5609 5621 5660 Freq. 1 4 11 48 12 17 3 1 4 4 3 6 13 1 2 1 2 3 9 1 1 1 1 4 2 1 2 2 1 1 6 2 1 1 1 1 2 1 1 8 1 1 1 1 1 5 5 1 ICD 4370 4371 4378 4379 4380 5715 5718 5719 5722 5724 5728 5733 5739 5742 5743 5750 5751 5754 5761 5770 5771 5789 5809 5829 5838 5839 5845 5849 5850 5860 5900 5901 5908 5920 5938 5939 5959 5990 6019 6029 6821 6829 6861 6954 7070 7101 7802 7855 Freq. 16 1 1 15 7 34 2 3 1 3 19 4 2 2 1 3 1 1 3 5 1 11 1 4 1 2 1 12 19 45 1 2 3 1 1 4 1 25 1 1 1 1 1 1 6 1 2 6 ICD 5000 5010 5020 5050 5064 8120 8121 8122 8129 8130 8147 8150 8159 8169 8190 8191 8192 8199 8209 8219 8220 8249 8259 8261 8300 8309 8329 8480 8682 8689 8698 8781 8782 8789 8799 6809 8810 8811 8820 8839 8849 8870 8880 8902 8903 8909 8920 8939 Freq 18 1 1 1 1 9 1 3 16 4 6 2 2 2 7 2 3 16 1 1 1 1 1 1 1 1 1 1 1 3 1 1 -2 1 5 7 4 1 1 1 2 1 10 4 2 4 1 1 49 511971 0342 t Table (continued) Distribution o causes of death using 4 digit ICD codes ICD 5679 5698 5699 5710 5712 5713 5714 9138 9190 9192 9198 9199 9220 9221 9222 9229 9239 9240 9250 Preq. 1 4 1 1 13 2 1 1 5 1 2 2 1 1 1 5 1 1 1 ICD 7860 7970 7981 7982 7991 7999 8109 9251 9289 9323 9345 9520 9530 9538 9540 9550 9551 9552 9554 eq. 1 2 5 44 41 62 2 1 15 1 1 4 5 1 1 4 4 2 52 ICD 9000 9053 9068 9102 9108 9110 9120 9571 9600 9651 9652 9654 9660 9689 9821 9830 9851 9854 9947 Preq. 1 1 1 1 3 4 2 1 1 1 1 7 2 2 4 1 1 2 1 'f 50 511971 0343 PROPORTIONATE MORTALITY STUDY OF ALCOA WORKERS (1980-1987) Howard E. Rockette, Ph.D. Department of Biostatistics University of Pittsburgh Vincent C. Arena, Ph.D. Department of Clinical Epidemiology and Preventive Medicine University of Pittsburgh MARCH 1990 Acknowledgement a - The authors wish to acknowledge Mrs. Bonnie Besseck for coding the death certificates, Mr. Rao Damaraju, Ms. Cora Wixey for coding employment histories and help in preparing the report, and Mrs. Betty Valentine for typing the manuscript. He would also like to thank Ms. Barbara Peterson for her diligence in obtaining the death certificates. S,,S7'0345 Background This study provides an evaluation of the mortality patterns of workers in the aluminum industry that can be used with the information from the previously reported Tripartite Study to help assess potential health problems in the aluminum industry. The Tripartite Study was initiated in May 1978 and a report of study findings was made in November 1981. Progress of the study was reported quarterly throughout the duration of the contract period to a Tripartite Committee consisting of representatives of labor, \ management and government. The study population consisted of 21,829 men employed at least five years in a reduction operation in one of the 14 plants between January 1, 1946 and December 31, 1973 (1). Vital Status determination as of December 31, 1977 was made on 99.3% of the cohort and death certificates were obtained for 97.6% of the men believed to be deceased. The priorities which directed the analysis of the Tripartite data were as follows: (1) Mortality patterns of workers in the potroom and/or carbon departments were given the most attention in the analysis. (2) Respiratory cancer was to be investigated thoroughly >' and was the disease category given the highest priority. (3) Lymphopoietic cancers were to be investigated and were second only to respiratory cancer as a disease category to be given special attention. (4) For diseases other than respiratory cancer and lymphopoietic cancer, enough preliminary analysis was } 1 511971 0346 done to identify any excess mortality that was associated with a particular plant or process. (5) Causes of death associated with the aluminum reduction process in other studies were reinvestigated using the Tripartite data. In order to satisfy these objectives, the mortality patterns of employees in the fourteen reduction plants was compared to the total D.S. male population for 59 selected causes of death. Analysis was done by plant, process, calendar time period, time since "first employment and selected exposure measurements. Industrial hygiene measurements were available for total particulates, benzene solubles, benzo(a)pyrene, particulate polycyclic organic matter, sulfur dioxide and total fluorides. Based on these analyses and the previous research literature on mortality of . reduction plant workers, some categories of disease were selected for more detailed investigation. The major findings of the Tripartite Study were as follows: (1) There were no strong associations of lung cancer mortality and work in the reduction plant. Overall the lung cancer SMR of the total cohort based on 272 observed deaths was 96.4. Formal tests of a dose-response relationship to cumulative years employment in the potroom and carbon departments, cumulative years of employment in the reduction plant, and cumulative exposure to benzene solubles, particulate polycyclic organic matter, benzo(a)pyrene, total particulates, total fluorides and "sulfur dioxide showed no statistically significant relationship. 2 511971 0347 There were two exceptions to the lack of an excess for lung cancer mortality. One plant, a horizontal Soderberg, had an SMR of 162.0 (p<0.05) for white males. However, the region in which the plant was located has a high lung cancer rate in the general population and when the data was reanalyzed using local rates, the SMR was below 100. The second excess was in the baked carbon department of one of the plants where there was an SMR of 266.8 (p<0.05) based on eight observed deaths. However, this excess was not observed in the baked carbon departments of the remainder of the prebake plants. (2) The SMR for leukemia was 124.9 based on 43 observed deaths. This excess was not statistically significant. The SMR for the prebake process was 123.5 and for the Soderberg process was 130.2. The SMR for potroom workers in the Soderberg process was 169.1 and for potroom workers in the prebake process was 124.6. Analysis by duration of employment was not consistent by process with men in the prebake showing more excess with longer term employment and men in the Soderberg process showing greater excess with short term employment. (3) The SMR for pancreatic cancer was 122.3 and was not statistically significant. However, there was a significant ^excess for men with more than 15 years employment in the potroom department in both the Soderberg (SMR=271.3, p<0.05) and prebake process (SMR=222.2, p<0.05). (4) The SMR for kidney cancer in the prebake process was 144.9. The excess was greater in men with less than 20 years employment and greater in men employed outside the carbon and potroom departments. 3 511971 0348 (5) Although the number of observed deaths was small there was an excess of bladder cancer in men employed 5 or more years in the potroom or carbon department of the Soderberg process. (6) The only cause of death which was statistically elevated for an entire process was benign and unspecified neoplasms. For the prebake process the SMR for this cause was 193.5 (p<0.05) based on 14 observed deaths. The estimated risk was greater for men employed twenty-five or more years, and was higher outside the potroom and carbon departments. (7) There was an excess of emphysema in the potroom and carbon departments of the Soderberg process (SMR=216.5, p<0.05; SMR=258.9, p<0.05). Although the excess in the prebake process was elevated, it was not statistically significant. The emphysema risk may have been understated in the prebake process because of a tendency to code many death certificates to "chronic obstructive lung disease" after 1970. If these cases were considered to be emphysema there would be a statistically significant excess in the prebake process. For men with more than 20 years employment in the prebake process there was an SMR of 260.2, (p<0.01) for asthma. The present study is a PMR Study without detailed work histories and without exposure measurements available. Thus, the conclusions that can be drawn from this study are more limited than those that could be obtained from the Tripartite Study. Nevertheless, this study provides us with an independent data base on which to confirm the interpretation of some of the findings in the Tripartite Study and also provides a means of 4 511971 0349 obtaining a preliminary evaluation of mortality patterns of nonreduction plant workers. Specifically, the primary objectives of the present study are as follows: (1) To obtain mortality data from aluminum reduction plants independent of the Tripartite cohort that can be used to further clarify the relationship of employment in aluminum reduction plants to excess mortality from cancer. Because the majority of ALCOA workers were employed in the prebake process, it is for workers in this process that we expect the most information to be obtained. The mortality patterns in the PMR study will be contrasted with those obtained from the Tripartite Study. (2) To obtain a profile of the mortality experience of nonreduction plant workers. Little information is available on the mortality experience of nonreduction plant workers since most studies have focussed on exposure in the potroom and carbon departments. This part of the investigation is limited because of the lack of detailed coding within the nonreduction plants. However, by investigating the consistency of any excess among plants with similar processes we may identify potential associations for future investigation. (3) On the basis of this PMR study, the Tripartite Study and ac review of the literature of potential health hazards in the aluminum industry, we will make specific recommendations of studies we feel are necessary in order to determine the association of disease with exposure in the aluminum industry. Such studies will be primarily hypotheses testing as opposed to hypothesis generating. fi 5 511971 0350 Method? The study population assembled by ALCOA consisted of all deaths known to the company as determined by insurance claims during the time period 1/1/80 through 12/31/87 in one of the 37 study plants. Any former employee whose beneficiary had either filed a claim or was receiving death benefits from the company was included in the study population. The initial list supplied by ALCOA was reviewed for duplicates and incomplete or inconsistent names. The resultant study population contains 6433 workers. Death certificates were obtained for all but 60 (0.9%) of the study population. These deaths were coded by a nosologist according to the ninth revision ICD and it is these 6373 death certificates on which the analyses in the present report are based. The frequencies of deaths for each cause are given in the Appendix. Detailed work histories were not coded and analyzed for this study, since to provide such coding for such a large variety of plants and processes would have required considerable effort. For this report an employee was classified in the plant where he was last employed. Using this method of classification, 2777 workers were coded to one of the eight reduction plants. For hese eight reduction plants we further coded whether they had ever worked in the potroom or carbon department as well as the department they spent the majority of time. Mine employees could not be included in this analysis because we did not have work histories. The departments in the reduction process used to classify majority of time were potroom, carbon, ingot, mechanical maintenance, electrical maintenance, and power. A total of 1320 6 511971 0351 employees in the eight reduction plants spent the majority of their time in a nonreduction process. He have done analysis separately for the 3596 employees in nonreduction plants, the 1320 employees in a nonreduction process of a reduction plant and the 1448 employees in the reduction process. The proportionate mortality ratio was the primary summary index of risk. The analysis was done using the computer program OCMAP (2) and five year average annual age, race and sex-specific D.S. rates for the control group. As a secondary analysis we used a proportionate cancer mortality index (PCMR) (3). This index uses "all cancer mortality" as the base on which to base proportionate mortality rather than "all cause" mortality and is believed by many investigators to be less subject to the healthy worker effect. Both the PMR and PCMR were adjusted for age, sex, race and calendar time. To meet the primary objectives of this study we completed the following analyses: (1) The PMR and PCMRs were computed for 62 selected causes of death by race, sex, and race-sex combinations for the total cohort, for nonreduction plants, and for plants with a reduction process (reduction plants), v (2) For plants with a reduction process PMRs and PCMRs were computed for employees with a majority of their time in each of the following: a) nonreduction process, b) potroom department, c) carbon department, d) ingot department, e) mechanical maintenance, f) electrical maintenance, and g) power. Mortality indices were also 7 511971 0352 computed for employees "ever employed in the potroom department" and employees "ever employed in the carbon department". (3) PMRs and PCMRs were computed for each plant for all 62 selected causes of death. Because of the large number of comparisons we expect some statistically significant excesses as well as deficits. When interpreting our data we will give emphasis to the excesses, but when interpreting excesses we will take into consideration the consistency of the result with the Tripartite Study as well as the consistency with other plants that have a similar process. In most cases we have required that either the. observed or expected number of deaths be 5 before we attempt to interpret results for a specific cause of death. Population Characteristics A total of 6373.death certificates was obtained and coded for the years 1980 to 1987 in the 37 study plants. A total of 6112 (95.9%) death certificates were for males and 5816 (91.3%) were for whites. Table 1 summarizes the distribution of deaths by year. The number of deaths were approximately equal-for each of the seven years of the study. The age at death is summarized in Table 2. Fifty-one percent of the deaths occurred at ages 6579. The distribution of deaths for the 37 study plants is shown in Table 3. The eight plants with a reduction process contributed 44% of the total deaths and 28% of the total deaths were for employees who at one time were in a reduction process -^ evaluated in the Tripartite Study. Of the 2777 workers in one 8 511971 0353 L F of the eight plants with a reduction process, all but 9 had employment histories. Of the 2768 workers with employment f histories, 1320 spent the majority of their time in a [ nonreduction process. The distribution of the number of employees spending the majority of their time in a specific reduction department is given in Table 4. Of the 1448 employees with the majority of time in one of the reduction departments, 556 (36%) had the majority of their time in the potroom. The second largest group was mechanical maintenance which accounted for 433 (29.9%) of the deaths. 9 511971 0354 Year 1980 1981 1982 1983 1984 1985 1986 1987 TOTAL Table 1 Distribution of Employees by Year of Death Frequency 766 772 781 824 793 759 819 859 6373 Percent 12.0 12.1 12.3 12.9 12.4 11.9 12.9 13.5 100.0 Table 2 Distribution of Employees by Age at Death Value Label Frequency Percent 20 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85 - 89 90 - 94 >95 7 19 29 41 57 80 172 293 573 1002 1261 1182 838 541 206 72 .1 .3 .5 .6 .9 1.3 2.7 4.6 9.0 15.7 19.8 18.5 13.1 8.5 3.2 1.1 " 10 6,,S71 0356 Table 3 Distribution of Workers by Plant Plant Name Frequency Percent Tennessee Vernon Point Comfort Massena Mew Kensington Cleveland Cressona Buffalo Vancouver Warrick Chillicothe Richmond Detroit East St. Louis Edgewater Chicago Corona Bridgeport Edison Davenport Wentachee Lafayette Lancaster Marshal1 Logans Ferry Mobile Lebanon Anderson Badin Bauxite Addy Ate Fort Meade Franklin Rockdale Rosiclare Tiffon Total 1325 210 167 630 754 448 231 7 196 116 54 74 76 145 282 27 12 36 103 247 88 355 31 11 16 149 8 2 152 148 8 89 4 23 103 36 10 6373 20.8 3.3 2.6 9.9 11.8 7.0 3.6 .1 3.1 1.8 .8 1.2 1.2 2.3 4.4 .4 .2 .6 1.6 3.9 1.4 5.6 .5 .2 .3 2.3 .1 .0 2.4 2.3 .1 1.4 .1 .4 1.6 .6 .2 100.0 11 511971 0356 I Table 4 Department Where Reduction Plant Workers Spent Majority of Time Department Frequency Percent Potroom Carbon Ingot Mech Maintenance Elec Maintenance Power 556 140 183 433 113 23 38.4 9.7 12.6 29.9 7.8 1.6 Results A. Mortality for Total Cohort The cause-specific mortality for 62 selected causes of death is shown in Table 5. The PMR for the category "all malignant neoplasms" is 103.7 based on 1605 observed deaths. Five causes of death are significantly elevated. These are cancer of the kidney (PMR=158.1, p<0.01), all other malignant neoplasms (PMR=134.3, p<0.01), benign and unspecified neoplasms (PMR=195.6, p<0.01), nephritis and nephrosis (PMR&242.2, p<0.01) and cerebral vascular disease (PMR=111.4, p<0.05). Since males comprise 91% of the cohort, it is not surprising that when we restrict our analysis to the population of males (Table 6) the same causes of death show a significant excess. For females (Table 7), all other malignant neoplasms (PMR-240.2, p<0.01), benign neoplasms (PMR^600.5, p<0.01) and all other causes of death (PMR=135.1, p<0.05) show a statistically significant excess. When mortality patterns for the total, cohort are 12 511971 0357 L Table 5 Observed and Expected Deaths and Proportionate Mortality Ratios for the Total Population Causa of Oaath (ICDA 9th Revision Codai) OBS All Causes of Oaath 8373 Tuberculosis 4 All Haltgnant Naoplasats 100S Cancar of Buccal Cavity A Pharynx 18 Cancar of Digestive Organs a Peritoneum 336 Cancar of Esophagus 18 Cancar of Stomach 59 Cancer of Largo Intestine 165 Cancar of Kactia 30 Cancar of Bl1Iary Passages a Llvar 30 Cancar of Pancreas 74 Cancar. of All Other Digestive Organs 7 Cancar of Aasplratory System 568 ' Cancer of Larynx 7 Cancar of Bronchus, Trachea, Lung BSS Cancar of All Other Respiratory 3 Cancer of Breast 13 All Uterine Cancers (Females only) 4 Cancer of Cervix Uteri (Feaales only) 1 Cancer of Other Faaale Qenltal Organs 4 Cancar of Prostate (Hales only) 147 Cancar of Testes and Other Hale Genital Organs 3 C^nctr of Kidnty Cancer of Bladder and Other Urinary Organs S433 Ha11gnant Helanoaa of Skin 19 Cancer of Eye 1 Cancer of Central Nervous Systae Cancer of Thyroid a Other Endocrine Glands 34 4 Cinctr of font 3 Cancer of AH Ly^hatlc, Haeeatopotetlc Tissue Lymphosarcoma a Rettculosarcoea 147 IB Hodgkins Olsease Leukemia a Al3camla Cancer of All Other Lymphopoietic Tissue 7 B5 ae All Other Hal tgnant He op lasee Benign Neoplasae 184 as 01abetas Hellltus 33 Cerebrovascular Olsease 480 All Heart Olsease 3B8S Rheumatic Heart Olsease 14 lichHtC Hurt nttftt 1338 Chronic Endocard. 01s.; Other Hyocard. Xnsuff. 134 Hypertension with Heart Disease 63 All Other Heart Olsease 468 Hypertension w/o Heart Olsease 33 Non-mat Ignant Respiratory Dtsoasa Influenza a Pramaonta 483 183 Bronchitis, E^ihysama. Asthma 73 Bronchitis Emphysema 6140 Asthsm 9 Other Non-mal 1 giant Respiratory Olsease 338 Ulcer of Steswch a ffimnenim . 33 Cirrhosis of Liver 56 Nephritis A Nephrosis 86 All External Causes of Death Accidents motor vehicle Accidents 383 131 SO All Other Accidents 111 Suicides 74 Homicides a Other External Causes All Other Causes of Oeath 33 686 Unknown Causes (In All Causes Category Only) 0 Significant at BS Level; Significant at IS Level EXP ---- 6373.00 3.18 1648.33 33.B8 331.30 38.35 63.33 181.33 38.70 34.73 76.10 10.BS 648.76 17.83 833.38 4.83 14.33 3.33 1.33 4.17 167.33 3.48 33.63 48.33 16.68 0.73 33.13 3.43 3.60 138.46 13.74 4.73 83.31 67.03 133.11 14.33 36.41 418.38 3887.87 33.31 3317.33 136.14 83.36 481.87 17.33 680.81 133.70 83.80 18.63 83.13 8.30 387.83 13.03 30.48 38.03 336.33 178.11 68.63 111.10 73.66 33.83 861.81 SPNR 100.0 43.3 103.7 63.8 100.8 81.6 109.8 109.3 101.0 86.3 93.6 83.9 104.1 38.1 108.7 81.8 91.0 133.8 78.3 85.8 87.6 131.9 168.1 < 109.6 112.6 137.3 83.4 118.9 130.0 113.8 118.6 148.6 103.0 131.0 134.3 136.8 ** 38.4 111.4 99.6 61.4 86.3 107.1 83.4 100.9 133.8 33.4 77.0 33.6 84.4 73.3 186.3 33.1 * 118.3 81.9 343.3 100.9 108.6 116.1 99.9 103.0 -83.4 106.3 95S Limits LOVER ... 18.7 93.4 34.1 91.8 33.3 84.9 94.0 70.7 60.4 78.6 30.7 38.3 19.3 98.8 30. 1 63.3 48.9 10.8 38.4 74.7 39.4 131.3 78.3 71.8 18.0 86.3 43.9 33.8 98.8 71.4 70.3 73.4 96.7 118.8 138.9 73.7 103.1 98.6 38.6 33.3 90.8 63.7 93.5 38.9 76.8 88.0 86.7 34.8 60.9 81.3 73.6 78.0 47.9 197.3 90.9 93.3 93.3 83.3 81.8 48.3 98.1 UPPER __ 127.6 106.1 64.4 11S. 1 60.0 141.2 126.6 144.9 123.2 123.6 133.2 112.5 79.6 IIS.4 166.6 163.9 328.8 524.4 252.9 102.8 377.1 208.3 137.4 176.9 899.0 122.7 311.1 371.3 193.2 189.9 305.9 132.7 159.0 156.2 279.6 116.1 121 ;6 102.5 103.0 66.9 126.6 109.2 110.1 300.8 69.6 99.9 103.6 119.0 103.3 296.6 92.9 174.9 80.0 297.4 112.1 122.1 142.0 120.0 127.6 101.3 113.0 511971 0358 Table Observed and Expected Deaths and Proportionate Mortality Ratios for Males Causa of Death (ICDA *th RavitIon Codas) A1I Causas of Oaatn Tubareulosla All Malignant Naoplasas Canear of Buccal Cavity A Pharynx Caneor of Otgestlve Organs A Peritoneum Canear of Esophagus Caneor of Stomach Canear of Largo Intastlna Cancar of Rectum Canear of Rlllary Passages A Liver Canear of Pancreas Cancer of All Other Digestive Organs Canear of Respiratory System Cancer of Larynx Caneor of Brenehus, Trachea. Lung Cancer of All Other Respiratory Cancer of Croast All Uterine Cancers (resales only) Cancer of Cervix Uteri (Females only) Cancer of Other Female Qenltal Organs Cancer of Prostate (Males only) Cancer of Testes and Other Male Genital Organs Cinfftr of Ktdnoy Cancer of Bladder and Other Urinary Organs Malignant Melanoma of Skin Cancer of eye Cancer of Central Nervous System Cancer of Thyroid A Other Endocrine Glands Cancer of Bone Cancer of All Lymphatic. Haematopoietic Tissue Lyephosarcoma A Raticulosarcoma Hodgkins Disease Leukemia A Aleukemia Canear of All Other Ljmphapotetlc Tissue All Other Malignant Neoplasms Benign Neoplasms Diabetes Naltltus Cerebrovascular Disease All Heart Disease Rheumatic Heart Disease Ischemic Heart Disease Chronic Endocard. Dim.; Other Myocard. Insuff. Hypertension with Heart Disease All Other Heart Olsease Hypertension w/o Heart Disease Non>maltgnant Respiratory Disease Influenza A Pneumonia Bronchitis. E^hysama, Asthma - Bronchitis Other Non-mal tgyiant Respiratory Disease Ulcer of Stomach A Duodenum Cirrhosis of Liver Nephritis A Nephrosis All External Causes of Death Accidents Motor Vehicle Accidents All Other Accidents Suicides Homicides A Other External Causes All Other Causes of Death Unknown Causes <In All Causes Category Only) > Significant at H Level; Significant at 1% OBS 6112 4 1833 It 667 It 67 186 at 28 71 7 857 7 647 3 O 0 0 0 147 3 83 4S IS 1 31 4 3 141 16 7 63 65 151 34 as 448 2467 13 1823 12S 82 481 22 451 145 72 10 83 B 230 20 85 82 275 154 75 10S 71 23 6405 EXP 6112.00 7.BA 14S2.82 32.6* 365.61 36.20 82.24 144.84 2S.4* 33.15 71.87 10.40 633.34 17.6S 810.87 4.73 1.63 0.00 0.00 0.00 167.B* 2.48 32.42 45.3S 16. IB 0.74 27.68 3.16 2.3* 123.61 13.03 4.85 81.71 84.32 116.70 13.SS 85.66 384.33 248*.77 20.40 2137.37 115.10 85.04 443.35 IB.41 843.17 1*0.S3 ss.ai 15.04 66.84 8.36 27*.7* 15.25 87.23 33.71 278.84 172.47 66.67 107.35 70.75 32.25 621.26 SPMR 100.0 80.1 103.4 85. 1 > 100.4 52.5 105. 1 107.5 101.5 54.5 *5.2 67.3 104.4 35.6 107.1 63.4 --- ... --- S7.B 121.5 163.5 105.7 117.4 134.8 75.5 126.5 125.5 114.1 122.5 183.8 102.8 115.7 125.4 171.6 *4.8 113.1 SS .8 63.7 55.3 107.5 84.1 101.7 134.1 53.0 74.1 63.5 66.8 78.7 188.1 82.2 105.3 63.1 243.2 100.8 106.7 112.5 101.6 100.3 71.2 103.8 _ IS* Limits LOVER mmm 14.2 88.0 35.0 80.5 33.8 84.3 82.4 70.5 at. 4 78.7 32.3 86.5 15.4 58.5 20.6 UPPER __ 130. t 103.0 30.7 110.3 31.0 141.3 126.0 143.4 122.2 125.0 140.4 113.0 50.8 115.5 184.5 mm. nmm ... 74.7 35.4 125.3 75.5 75.0 15.1 45.6 47.6 40.7 to.t 78.3 73.5 75.4 *4.0 110.8 115.6 76.8 103.4 86.8 37.2 52.2 80.6 67.2 *3.1 85.5 76. 1 66.5 66.7 38.0 61.0 88.1 72.5 70.6 48.7 187.4 80.7 83.0 60.5 64.5 75.5 45.1 56.5 mm. mmm mmm 102.8 377.1 213.3 140.2 183.7 845.2 lie. i 336.2 388.2 134.3 200.1 320.5 134.0 152.4 151.5 254.6 117.2 123.7 103.0 105.1 85.5 127.5 115.4 111.2 203.2 50.6 81.3 105.4 122.8 104.0 320.6 83.2 168.4 51.7 285.7 112.3 122.4 138.8 122.2 128.0 105.6 111.7 Table 7 Observed and Expected Deaths and Proportionate Mortality Ratios for Females Causa of Oaath (XCOA Sth Revision Codes) OBS a. All Causes of Death Tuberculosis All Malignant Neoplasas Cancer of tuccal Cavity A Pharynx Cancer of Digestive Organs A Peril Cancer of Esophagus Cancer of Stoaacn 281 0 72 0 18 0 2 Cancer of Large Intestine to Cancar of Rectua Cancer of Rtllary Passages A Liver t 2 Cancer of Pancreas Cancer of All Other Digestive Organs Cancer of Respiratory Svstea Cancer of Larynx a 0 11 0 Cancer of Rronchus. Trachea. Lung Cancar of All Other Respiratory Cancer of Rreast it 0 13 All Uterine Cancers (Faaales only) Cancar of Cervix Uteri (Faaales only) 4 1 Cancer of Other Faaala Qenltat Organs Cancer of Prostate (Males only) Cancar of Testes and Other Male Genital Organs Cancer of Kidney Cancer of Bladder and Other Urinary Organs Malignant Melannaa of Skin Cancer of Eye Cancer of Central Nervous Systaa Cancer of Thyroid A Other Endocrine Glands Cancar of loni 4 0 0 0 0 0 0 3 0 0 Cancer of All Lyephstlc, Haematopoietic Tissue Lyephosarceau A Retleuioserccea Hoddiins Disease Leukeate A Aleukemia Cancer of All Other Lymphopoietic Tissue All Other Malignant Neoplasas Benign Neoplasas Diabetes Neilltus Cerebrovascular Disease All Heart Disease 0 0 2 4 13 8 7 30 88 Rheuaattc Heart Disease Xschaaic Heart Disease 66t Chronic Endocard. 01s.; Other Nyocard. Insuff. Hypertension with Heart Disease 0 All other Heart Disease Hypertension v/o Heart Disease ib 1 Non-eelI grant Respiratory Olsease 11 Influenza A Pneiaonle 4 Bronchitis. Eephysaaa. Asthaa t Bronchitis 0 Eephyseaa 1 Asthaa 0 Other Non-aal1grant Respiratory Olsease e Ulcer of Stoaach A flymen a 2 Cirrhosis of Liver 1 Nephritis A Nephrosis 3 All External Causes of Death 10 Accidents 7 Motor Vehicle Accidents s All Other Accidents 2 Suicides 3 Hoaicldes A Other External Causes 0 All Other Causes of Death 41 Unknown Causes (In All Causes Category Only) 0 Significant at SS Level; Significant at IS Level EXP aaa 381.00 0.20 8.80 0.87 18.18 0.88 1.84 7.44 1.22 1.84 3.83 0.88 12.38 0.22 102..1040 12.88 3.23 1.33 4.17 0.00 0.00 1.10 0.83 0.88 0.04 1.48 0.38 0.12 8.84 0.70 0.23 2.20 3.70 8.41 0.83 8.88 23.83 87.80 2.41 78.80 8.04 3.32 'Mi 17.74 7.87 3.at 0.48 1. BA 0.44 7.84 0.80 3.37 1.38 8.78 S.S4 3.87 3.83 1.77 1.34 0.34 SPMR aaaa 100.0 108.4 aaa 111.2 aaa 112324..24 18211..87 84.8 aaa 88.0 aaa 81.8 aaa 102.7 123.8 78.2 88.8 aaa aaa aaa aaa aaa aaa 208.4 aaa aaa 102.8 aaa aaa 80.8 147.8 340.2 ** 800.6 118.8 83.8 80.0 41.8 82.8 88.4 aaa 81.8 131.8 3.0 SO.8 38.7 3.4 7a. 350.3 30. 317.8 110035..83 174.4 1SS38..3 13S.1 * in Malts LOWER UPPER ... aaa 80.3 ... 71.2 30.8 731301...288 27.7 aaa 80.3 ... 81.8 aa. 60.8 48.8 10.8 38.4 ... ... ... ... ... ... 88.2 ... ... 48.8 ... aaa 22.3 88.2 217482..87 87.8 88.2 78.8 78..83 48.2 aa. ... 132.8 173.7 488.3 248.8 878.7 248803..72 tS7.2 182.1 ... 173.3 328.6 824.4 282.8 ... ... ... ... ... 818.7 ... ... 228.4 ... 338808..84 404.2 1221482848...834 108.8 274.4 2to1o8..8e S'.4, 35.3 188..88 8.3 183838..18 108.0 130.4 383.8 438.3 34.8 8.8 4.8 73.8 88.3 82.0 78.8 13.6 80.8 818827..88 180.4 84.7 180.7 213.4 388.7 201.1 808.7 101.8 178.8 15 511971 0360 Table 8 Observed and Expected Deaths and Proportionate Mortality Ratios for Whites Causa of Oaath (ICOA atn Revision Codas) oas EXP All Causas of Oaath BA IS Tifeerculosts 3 All Malignant Neoplasam aCaneor otf MBuNc^cail wCaavvii\tyj a rPnhaairynrwx 143* 13 Canear of OOttfgestlve Organs a Parit 340 Cancar of Esophagus t7 Canear of Stomach 46 Cancar of Larga Xntasttna 183 Cancmr of Rectum as Cancar of Biliary Passagas a LIvar 22 Cancar of Pancroas 66 Cancar of All Othar Olgastlva Organs 7 Cancar of Rosplratory Systaa 830 Cancar of Larynx 7 Cancar of Bronchus, Trachoa, Lunn BIO Cancar of All Othar Rasplratory 3 Cancar of Broast 13 All Uterlna Canears (Feamles only) 3 Cancar of Carvix Utari (Females only) 0 Cancar of Othar Female Genital Organs 4 Cancar of Prostata (Malas only) 133 Cancar of Testes and Othar Mala Oanltal Organs 3 Cancar of Kldnay 48 Cancar of Bladder and Othar Urinary Organs 44 Malignant Malanoaa of Skin It Cancmr of Eye 1 Cancar of Central Nervous Systaa 33 Cancar of Thyroid A Other Endocrine elands C^nctP of loot 4 3 Cancar of All Lymphatic. Haematopoietic Tissue 133 Lymphosarcoma A Rattculosarcoma 13 Hodgkins Olseesa 7 CoLitoafo A Aloictsii SO Cancer of Alt Other Lyaphopolettc Tissue S3 All Othar Malignant Naoplasats 147 Benign Neoplasms 36 Diabetes Mellltus 73 Carabrovascular Olsaasa ' 433 All Heart Olsaasa 3371 Rheiautlc Heart Olsaasa 14 Ischemic Heart Olsaasa 1777 Chronic Endocard. 01s.; Othar Myocard. Xnsuff. 12S Hypertension with Heart Olsaasa 36 All Othar Heart Olsaasa 416 Hypertension w/o Heart Olsaasa 30 Non-mallgnant Respiratory Olsaasa 430 Influenza A Pnavaaonta 143 Bronchitis, E^hysams. Asthau 6* Bronchitis Emphysema JSOO Asthma 8 Other Hon-malIgnant Rasplratory Olsaasa 2lt Ulcer of Stomach A Duodenum 31 Cirrhosis of Liver 80 Nephritis A Nephrosis 75 All External Causas of Oaath 261 Accidents 174 Motor Vehicle Accidents 70 All Other Accidents 104 Suicides 70 Homicides A Othar External Cauaes 17 All Othar Causes of Oaath 636 Unknown Causas (In All Causes Category Only) Significant at SS Laval; Significant at IS Lava) S816.00 S.S6 1407.45 38.68 344.43 30.SI 46.47 140.84 37.80 30.68 68.38 10.17 488.48 15.61 478.07 4.48 13.87 3.04 1.18 4.08 143.48 2.33 31.SB 43.SB 16.as 0.77 28.05 3.22 2.31 120.88 13.13 4.61 SO.SB 52.26 110.SS 13.BO 64.S3 373.12 2371.78 21.75 2082.36 113.68 46.63 405.88 14.42 B21.14 180.38 63.82 14.6? 65.12 5.02 268.47 17.86 83.04 28.88 2SS.72 160.86 63.81 B8.78 70.11 24.65 883.S2 SPMR 100.0 BO.3 102.2 43.6 68.7 85.7 * 88.0 108.6 105.1 71.2 86.7 68.8 104.1 44.0 106.5 66.8 65.1 88.8 mm 87.8 85.7 134.8 152.1 * 101.0 108.1 128.8 76.4 124.2 130.0 108.5 88.0 155.1 86.7 118.6 133.0 181.2 * 86.3 113.1 100.0 64.4 85.3 112.4 72.B 102.8 138.7 82.8 76.3 61.0 87.2 76.8 156.4 81.3 116.6 60.2 * 251.0 * 102.1 108.1 110.2 105.3 88.6 68.0 107.3 85% Limits LOWER UPPER mmm 16.6 67.7 25.7 88.1 34.8 74.2 82.8 73. 1 47.0 76.0 33.0 86.0 21.4 88.0 21.7 86.2 32.2 37.1 72.0 43.7 115.0 75.3 68.2 18.4 81.8 46.7 42.1 82.5 57.5 74.4 74.8 82.6 113.4 131.1 68.7 103.2 86.8 38.3 62.2 64.7 82.5 83.4 68.7 75.4 67.8 64.0 36.3 56.3 80.3 71.4 76.0 45.8 301.6 81.4 83.8 68.0 67.2 76.4 43.4 88.6 mmm 152.8 106.6 73.6 108.4 68.6 132.0 127.0 151.1 107.8 122.8 143.7 112.8 60.3 115.6 205.3 180.6 303.6 mmm ' 257.7 102.0 416.0 201.3 135.6 171.4 817.0 118.8 330.2 401.8 128.6 170.4 323.3 130.0 152.0 156.0 278.8 108.3 124.0 103.1 108.1 88.6 133.4 100.3 112.4 214.4 80.3 83.0 102.5 134 3 101.1 316.6 82.4 163.1 78.8 312.1 114.0 124.8 138.0 127.2 125.6 108.5 115.5 16 511971 0361 Table 9 Observed and Expected Deaths and Proportionate Mortality Ratios for Monwhites Causa of Death (ICOA 8 th Revision Codes) OBS All Causas of Death TLOarculosts All Malignant Neoplasam BB7 1 t7 Canear of Buccal Cavity A Pharynx S Cancar of Dtgastlva Organs A Peritonei* AS Canear of Esophagus Cancar of Stomach 2 13 Cancar of Largo tntosttna 13 tiMtp of ftaetUi 1 Canear of Biliary Passagas A Ltvor * Cancar of Pancreas S Cancar of All Other Dtgastlva Organs 0 Cancar of Respiratory Systaa AS Cancar of Larynx 0 Cancar of Bronchus. Trachea, Lung AS Cancar of All Other Respiratory 0 Cancar of Breast 0 All Uterine Cancers (Females only) 1 Cancer of Cervix Uteri (Paulas only) 1 Cancer of Other Paula Genital Organs 0 Cancer of Prostate (Males only) 2A Cancar of Testes and Other Male Genital Organs Cancer of Kldey Cancer of Bladder and Other Urinary Organs 0 B 4 Malignant Mslanou of Skin 1 Cancer of Eye 0 Cancer of Central Nervous Systu Cancer of Thyroid A Other Endocrine Glands 2 0 Cancer of Bone Cancer of All Lyaphattc. Kaeutopolatlc Tissue 0 IB Lymphosarcou A RetIculosarcou 3 Hodgpctns Disease Leukemia A Aleukemia 0 B Canear of All Other Lymphopoietic Tissue 7 All Other MaiIgnant Neoplasms 17 Benign Neoplasam 3 Diabetes Mellltua IB Cerebrovascular Disease AA All Heart Olseasa ISA Rheuuttc Heart Disuse 0 Ischemic Heart Disuse 112 Chronic Endocard. Die.; Other Nyocard. lnsuff. Hypertension with Heart 01 sum IS All Other Heart 01 sum BO Hypertension w/o Heart 01 sum Non-u 11gnant Respiratory OImom 3 32 Influenza A Pnaumonta 10 Bronchitis. E^ahysau. Asthu B Bronchitis 0 Eaphysau 4 Asthu 1 Other Non-ul Ignant Respiratory D1 sum 17 Ulcer of Stomach A Duodenum 1 Cirrhosis of Liver B Nephritis A Nephrosis 10 All External Causes of Death 27 Accidents 17 Motor Vehicle Accidents 10 All Other Accidents 7 Suicides A Homicides A Other External CauMS 6 All Other Causes of Death BO Unknown Causes (in All Causes Category Only) Significant at n Level; Significant at 1% Level EXP BS7.00 2.22 1A0.SS 3.60 37.37 G.3A 7.A1 11.IB 2.11 3.BO 6.SI 0.7S AS.27 l.tl A3. BO 0.34 0.82 0.1S 0.1A O.OS 2A.AS 0.2A 1.86 2.76 0.23 0.02 1.07 0.20 0. IS S.S7 0.61 0.26 3.23 A.77 11.66 1.22 10.76 AB.1A IBS.77 1.07 13A.S2 11.2B 12.72 BB.6S 2.60 3B.77 IS.32 A.67 0.66 3.00 0.7S IS.IB 1.82 7.AB B.21 2S.B7 IS. IS 6.02 12.31 2.AS 8.68 BA. OS SPMR 100.0 AB.1 118.B 136.6 120. A 31.6 17S.6 116.6 A7.B 208. 1 117.A ... 103.7 --.-- 103.3 --.-- 613.2 687.7 --- BS.O ... 2SA.B 148.0 A3B- -.S- 187.0 169.2 ASS.O .e>m 184.9 146.S 147.1 24B.3 176.1 97.B 94.0 83.0 > S3.3 12B.S S9.S 107.0 90.B B4.6 10.9..3. 133.4 12S.S 93.6 6B.6 SO.B 192.1 91.3 93.7 166.0 86.9 163.6 66.S BS.1 BBS Limits LOVER ... 6.7 104.1 87.3 80.9 s.e 103.0 68.1 7.0 104.4 BS.O UPPER ... 302.S 13B.0 325.6 1B9.B 118.0 299.1 199.6 321.2 403. 1 233.6 78.3 ... 93.6 90.6 13.2..1. 66.4 ... 109. B B4.9 72.8 13.8..7. 14.3..1. ... 2908.6 3688.6 1AA.7 681.8 3S3.2 2618.7 A7.8 ... 103.0 178.7 ... 65.1 70.6 92.2 B2.2 113.B 73. S S3.7 ... 70.7 24.B 77.6 69.1 34.6 B7.7 30.0 AS.7 ... BO.4 IS. 3 68.7 a.a 38.6 104.8 64.S B9.1 90.8 27.7 62.6 31.S SB. 6 72S.9 ... 277.9 1371.1 368.8 30S.B 234.7 732.1 273.2 129.3 108.B ... 97.4 116.1 203.9 116.8 330.7 112.2 99.3 261. B ... 353.2 04.1 149.4 4B7.6 176.8 382.0 128.7 148. B 303.3 116.4 427.7 140.7 111.6 Sl1971 0362 17 investigated by race, the white population shows a similar mortality pattern to that observed for the total cohort (Table 8). Por nonwhites, causes of death (Table 9) for which there were five observed or expected deaths and where there was a statistically significant excess were all malignant neoplasms (PMR=118.6, p<0.05), cancer of the stomach (PMR=175.5, p<0.05), cancer of the liver (PMR=205.1, p<0.05), cancer of the kidney (PMR=254.5, p<0.05), cancer of the lymphatic and haematopoietic tissue (PMR=169.2, p<0.05), diabetes m'ellitu's (PMR=17 6.1, p<0.05), and nephritis and nephrosis (PMR=192.1, p<0.05). B. Nonreduction Process A total of 3596 employees worked in a plant that had no reduction process (Table 10). The overall PMR for these employees was 105.2. The only excess within the category of neoplasms was for "all other malignant neoplasms" where the PMR was 145.9 (p<0.01). Other causes of death showing a statistically significant excess were benign and unspecified neoplasms with a PMR of 227.3 (p<0.01), "all other heart disease" with a PMR of 117.2 (p<0.01), and "nephritis and nephrosis" with a PMR_of 293.8 (p<0.01). Investigation separately for males and females indicated no causes of death other than those identified in excess for the total cohort. When we evaluated mortality patterns separately for race, in addition to the four causes of death in excess for the total group of nonreduction plant workers we found for whites a PMR of 122.8 (p<0.05) for cancer of the large intestine and a PMR of 135.4 (p<0.01) for chronic endocarditis and other myocardial insufficiency. Por nonwhites, we found that 18 511971 0363 the excess of stomach cancer, liver cancer, lymphatic cancer and nephritis reported in the nonwhite population comprising the total cohort occurred in these nonreduction plants. The PMR for all malignancies for nonwhites in the nonreduction plants was 128.0 (p<0.01). Of the 2777 workers in the 8 plants with a reduction process, 1320 spent the majority of their time in a nonreduction process. For this group of workers the PMR for all malignant neoplasms was 93.6. There were statistically significant excesses of cancer of the lymphatic and haematopoietic tissue (PMR=140.1, p<0.05), cerebrovascular disease (PMR=126.9, p<0.05), hypertension without heart disease (PMR=230.2, p<0.05) and nephritis and nephrosis (PMR=196.8, p<0.01). We also note the excess for asthma (PMR=331.0, p<0.05) based on only four observed deaths. There were only 56 females in this group of workers so the mortality pattern of the total group is essentially the same as that observed for males. For whites, the excesses were the same as that observed for the total group of 1320 workers. For nonwhites, excesses occurred in hypertension with heart disease (PMR=239.2, p<0.05) and "all other causes of death" (PMR=202.9, p<0.01). y 19 511971 0364 Table 10 Observed and Expected Deaths and Proportionate Mortality Ratios for Monreduction Plant Employees Causa of Daath (ICDA 9th Revision Coda*) OBS EXP All Cauaaa of Daath 3596 Tubarculoal* 3 All Malignant Naoplaam* 906 Cancar of Buccal Cavity 6 Pharynx 11 Cancar of Digaativa Organa ( Paritonaum 22S Cancar of Esophagus 11 Cancar of Stomach 36 Cancar of Largo Intaatina 103 Cancar of Rocturn 20 Cancar of Biliary Paaaagoa C Livar 17 Cancar of Fancraaa 35 Cancar of All Othar Digaativa Organa 3 Cancar of Roapiratory Syatam 316 Cancar of Larynx 4 Cancar of Bronchua, Trachaa, Lung 310 Cancar of All Othar Raapiratory 2 Cancar of Braaat 9 All Otorina Cancar* (Famalaa only) 3 Cancar of Carvix Otari (Famalaa only) 0 Cancar of Othar Famala Ganital Organa 2 Cancar of Proatata (Mala* only) 84 Cancar of Taata* and Othar Mala Ganital Organa 1 Cancar of Kidnay 25 Cancar of Bladdar and Othar Orinary Organ* 28 Malignant Molanoma of Skin 11 Cancar of Eya 1 Cancar of Control Harvoua Syatam 14 Cancar of Thyroid C Othar Endocrina Gland* 4 Cancar of Bona 1 Cancar of All Lymphatic, Baamatopoiatie Tiaaua 72 Lymphoaareoma * Rotieuloaarcoma 6 Hodgkin* Diaaaaa 2 Laukamia 4 Alaukomia 27 Cancar of All Othar Lymphopoiatic Tiaaua 37 All Othar Malignant Naoplaams 99 Banign Naoplaama 19 Diabataa Mallitu* 55 Carabrovaacular Diaaaaa 237 All Boart Diaaaaa 1477 Rhoumatic Eaart Diaaaaa 8 lachomic Baart Diaaaaa 1038 Chronic Endocard. Dia.; Othar Myocard. Inauff. 95 Bypartanaion with Baart Diaaaaa 28 All Othar Baart Diaaaaa 308 Bypartanaion v/o Baart Diaaaaa 11 Non-wa1ignant Raapiratory Diaaaaa 258 Influanxa 4 Pnaumonia 85 Bronchitia, Eaphyaama, Aathma 40 Bronchitis 4 Emphyaama 34 Aathma 2 Othar Ron-malignant Raapiratory Diaaaaa 133 Clear of Stemaeh 4 Duodanum 13 Cirrhoaia of Livar 30 Naphritia 4 Naphroaia 60 All Extarnal Cauaaa of Daath 140 Accidanta 99 Motor Vahicla Accidanta 43 All Othar Accidanta 56 Suicidaa 27 Bomicida* 4 Othar Extarnal Cauaaa 14 All Othar Cauaaa of Daath Unknown Cauaaa (In"All Cauaaa Catagory Only) 387 0 * Significant at 5* Laval; ** Significant at 1% Laval 3596.00 4.62 861.09 18.19 213.51 20.10 30.13 85.59 16.64 19.49 41.81 6.17 297.08 9.69 284.73 2.65 10.45 2.45 0.98 3.16 96.35 1.29 18.32 26.32 8.95 0.44 15.51 1.89 1.36 71.84 7.54 2.51 30.06 31.74 67.83 8.36 54.16 245.53 1457.21 12.85 1254.88 73.19 35.66 262.71 10.03 322.34 117.33 49.83 8.85 38.27 3.25 163.39 10.91 47.45 20.42 147.02 93.90 34.82 59.93 36.77 16.36 371.99 SPMR 100.0 65.0 105.2 60.5 105.4 54.7 119.5 120.3 120.2 87.2 83.7 48.6 106.4 41.3 108.9 75.4 86.1 122.7 --- 63.3 .87.2 77.4 136.5 106.4 123.0 229.1 90.3 211.7 73.S 100.2 79.6 79.8 89.8 116.6 145.9 * 227.3 * 101.6 96.5 101.4 62.2 82.7 * 129.8 78.5 117.2 ** 109.7 80.0 ** 72.4 * 80.3 45.2 88.8 61.5 81.4 * 119.1 63.2 293.8 95.2 105.4 123.5 93.4 73.4 85.6 104.0 95* Limit* LOWER ... 21.2 99.5 33.8 92.9 30.7 86.4 99.5 77.7 54.3 60.3 16.1 95.8 16.0 97.9 18.9 45.8 40.0 -- 16.3 70.7 11.0 92.5 73.6 68.2 34.1 53.6 81.3 10.4 79.7 35.9 20.0 61.7 84.6 120.2 146.9 78.1 85.4 97.5 31.4 78.8 106.5 54.4 ' 105.3 60.8 71.3 58.9 59.1 17.4 63.6 15.6 69.0 69.3 44.5 231.0 81.7 87.3 92.6 72.2 50.8 51.5 94.7 OFFER 199.5 111.3 108.3 119.6 97.7 165.4 145.6 186.0 140.0 116.3 147.0 118.1 106.4 121.0 299.8 161.8 376.1 246.3 107.6 546.2 201.4 153.9 221.5 1539.1 152.1 551.4 517.5 126.0 176.7 317.7 130.8 160.6 177.2 351.8 132.0 109.1 105.4 123.5 86.8 158.2 113.4 130.5 197.8 89.9 89.1 109.1 117.2 124.1 242.6 96.0 204.8 89.8 373.6 111.0 127.4 164.8 120.9 106.2 142.3 114.3 20 511971 0365 Table 11 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees in Reduction Plants Spending the Majority of Their Time in a Honreduction Process Cauaa of Daath (ICDA 9th Raviaion Cottaa) OBS EXP All Cauaaa of Daath 1320 Tuberculosis 0 All Malignant Haoplaama 302 Cancar of Buccal Cavity ( Pharynx 2 Cancar of Digaativa Organa 6 Paritonaum 78 Cancar of Eaophagua 1 Cancar of Stomach Cancar of Largo Intaatina IS 30 Cancar of Ractum C Cancar of Biliary Paaaagea 6 Livar c Cancar of Pancraaa 18 Cancar of All Othar Digaativa Organa 2 Cancar of Raapiratory Syatam 91 Cancar of Larynx 2 Cancar of Bronchua, Trachaa, Lung 89 Cancar of All Othar Raapiratory 0 Cancar of Braaat 4 All Otarina Cancan (Famalaa only) 1 Cancar of Carvix Otari (Faaialaa only) 1 Cancar of Othar Female Genital Organa 1 Cancar of Proatata (Malaa only) 32 Cancar of Toataa and Othar Mala Ganital Organa 1 Cancar of Kidney 11 Cancar of Bladdor and Othar Urinary Organa 10 Malignant Halanoa* of Skin 3 Cancar of Eya 0 Cancar of Control Harvoua Syataa ' 3 Cancar of Thyroid ( Othar Endocrino Clanda 0 Cancar of Bona 2 Cancar of All Lymphatic, Baamatopoiatic Tiaaua 38 Lymphoaarcoma Roticuloaarcoma C Hodgkins Disease 3 Laukamia 4 Alaukamia 13 Cancar of All Othar Lymphopoiatic Tiaaua 1C All Othar Malignant Raoplaama 25 Bonign Neoplasms 5 Diabataa Mallitua 15 Cerebrovascular Disease 108 All Baart Diaaaaa 531 Rhaumatic Baart Diaaaaa 4 lachoadc Baart Diaaaaa 422 Chronic Endocard. Dia.; Othar Myocard. Znauff. 18 Bypartanaion with Baart Diaaaaa 11 XI1 Othor Hoart Disease 76 Bypartanaion w/o Baart Diaaaaa 8 Ron-malignant Raapiratory Diaaaaa 103 Influanxa 6 Pnaumonia 39 Bronchitia, Eaphyaama, Aathma 17 Bronchitia 4 '> Enphyitsa 9 Aitlm 4 Othar Mon-malignant Raapiratory Diaaaaa 47 Ulcor of Stomach ( Duodanua 3 Cirrhoaia of Livar 15 Haphritia 6 Mophroaia 14 All Extarnal Cauaaa of Daath CC Accidents 44 Motor Vahicla Aecidanta 19 All Othar Aecidanta 25 Suicidaa 21 Boaieidaa C Othar Extarnal Cauaaa 1 All Other Causes of Death ISO Unknown Cauaaa (In All Cauaaa Citi^ery Only) 0 * Significant at 5% Laval; Significant at 1% Laval 1320.00 1.C3 322.52 C.98 79.22 7.56 11.09 31.64 6.20 7.20 15.64 2.28 114.28 3.73 109.53 1.02 3.10 0.71 0.32 0.90 34.15 0.51 7.05 9.61 3.59 0.17 6.21 0.72 0.53 27.12 2.91 1.03 11.31 11.87 25.39 3.08 19.66 85.13 530.71 4.81 460.01 25.51 12.55 94.56 3.48 115.44 40.23 18.47 3.23 14.23 1.21 59.55 3.93 19.05 7.11 61.82 38.34 15.37 23.28 15.70 7.79 133.99 SPMR 100.0 --- 93.6 28.7 98.5 13.2 135.2 94.8 96.8 83.4 115.1 87.8 79.6 * 53.6 81.3 * ----- 128.9 140.9 314.6 110.7 93.7 194.7 156.1 104.1 83.5 --- 48.3 --- 375.9 * 140.1 206.3 291.2 115.0 134.8 98.5 162.2 76.3 126.9 * 100.1 83.1 91.7 * 70.6 87.6 80.4 * 230.2 89.2 96.9 92.1 123.9 63.3 331.0 s 78.9 76.3 78.7 196.8 106.8 114.9 123.7 107.4 133.8 12.8 * 111.9 95% Haiti LONER UPPER -- a... 85.0 7.8 79.4 2.5 81.9 66.6 43.6 37.6 72.8 22.0 65.6 13.7 66.7 --- 50.2 20.4 49.7 ir.9 66.6 28.5 87.0 56.2 27.0 ' 16.0 -- 103.5 102.5 94.4 99.0 66.9 82.9 66.8 68.1 46.2 105.9 93.7 31.3 85.0 44.9 48.7 64.8 117.5 74.3 71.3 57.4 46.6 33.2 131.4 59.8 24.7 47.8 117.9 86.0 86.8 90.5 73.1 88.1 2.7 96.2 ... --- 103.2 104.7 122.1 69.3 223.4 135.0 215.1 185.0 182.1 350.4 96.7 209.3 98.9 331.4 974.6 1991.8 768.0 131.8 1332.3 280.0 193.0 257.8 ----- 145.6 --- 1364.5 191.6 450.9 8S6.3 197.4 219.1 145.1 386.0 125.9 152.0 106.8 220.7 99.0 111.2 157.6 99.7 450.8 107.2 131.8 147.5 328.9 120.4 833.2 104.2 235.3 129.6 328.6 132.6 151.8 190.0 157.8 203.0 61.7 130.2 21 511971 0366 C. Mortality for the Reduction Process There were 1866 workers who had some employment in the reduction process. The overall PMR for cancer was 106.6 which was not statistically significant (Table 12). The PMR for lung cancer was 117.8 with a corresponding 95% confidence interval of (103.1, 134.5). Cancer of the kidney was also elevated with a PMR of 200.1 and a corresponding 95% confidence interval of (131.7, 303.8). The only nonmalignant cause of death with a statistically significant excess was cerebral vascular disease with a PMR of 135.3 and a corresponding 95% confidence interval of (116.0, 157.7). The PMR for the category ischemic heart disease was low [PMR=87.2 with corresponding confidence interval of (81.6, 93.2)]. Since only 6 women were employed in the reduction process, the mortality patterns in Table 12 are essentially the same for males. When analysis was done by race, some additional causes were in excess. For whites, in addition to respiratory and kidney cancer, there was an excess in cancer of the lymphatic and haematopoietic tissue (PMR=132.2, p<0.05). For nonwhites, the only excess was for diabetes where the PMR was 389.5 (p<0.01). Hhen the 62 causes of death were re-evaluated for men spending the majority of their time in the reduction process, the mortality patterns were similar to those "ever employed in the reduction process" but tended to be slightly increased for many of the malignancies (Table 13). The PMR for the category all malignant neoplasms increased from 106.6 to 109.5 (p<0.05). Similarly, the! PMRs for* cancer of "the lung and kidney were 22 511971 0367 Table 12 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Ever Employed in a Reduction Process Cause of Death (1COA sth Revision Codes) OBS All Causa* of Daath TiAserculosIs All Malignant Nooplasas Cancor of Buccal Cavity A Pharynx Cancor of Dlgosttvo Organs A Peritoneum Cancor of Esophagus taaa 1 419 105 7 Cancor of Stoaacn Cancor of Largo tntostlno Cancor of Rectum 13 35 5 Cancor of Biliary Passages A Llvor Cancor of Pancreas Cancor of All Other Digestive Organs Cancor of Respiratory Systoo Cancer of Larynx 25 3 157 1 Cancor of Bronchus. Trachoa. Lung Cancor of All Other Respiratory Cancor of Breast All Utorlne Cancor* (Faaules only) IBS 1 0 0 Cancor of Cervix'Uterl (Fooulos only) 0 Cancer of Other Fooulo Genital Organs 1 Cancor of Prostate (Males only) 39 Cancor of Testes ond Other Male Genital Organs Cancer of Kidney Cancer of Bladder and Other Urinary Organs 2 21 14 Malignant Malanoea of Skin Cancer of Eye Cancer of Central Nervous Systee 7 0 Cancer of Thyroid A Other Endocrine Glands Ctneir of loot Cancer of All Lyephatlc. Haematopoietic Tissue 0 2 SO Lyephosarcoea A Rettculosarcoau Hodgkins Disease 4 Aliukcsli Cancer of All Other Lymphopoietic Tissue All Other Malignant Nooplasas Benign Nooplasas Diabetes Nellltus Cerebrovascular Disease All Heart Disease Rheumatic Heart Olsease Ischealc Heart Olsease 8 3 20 22 47 5 25 151 710 3 501 Chronic Endocard. 01s.; otner Myocard. Insuff. 2S Hypertension with Heart Disease A11 Other Heart Olsease 17 104 Hypertension w/o Heart Disease Non-aallgnant Respiratory Olsease Influenza A Pneuaonta 126 42 Bronchitis. Eaphysaaa. Asthsu 22 Bronchitis 3 Eaphysaaa 16 Asthsu 3 Other Non-aalIgnant Respiratory Disease 62 Ulcer of Stoeuch A Duodanue 7 Cirrhosis of Liver 16 Nephritis A Nephrosis 16 A11 External Causes of Death Acctdmts 105 67 Motor Vehicle Accidents 25 All Other Accidents Suicides 42 30 Hoaicldes A Other External Causes 8 All Other Causes of Oeath 188 Unknown Causes (In All Causes Category Only) 0 * Significant at B% Level; Significant at Level EXP IS04.00 2.4S SSI.17 10.10 114.26 tl.SS IS.25 44.BO S.S1 10.39 22.es 3.21 172.SS S.76 165.87 1.84 1.00 0.11 0.05 0.16 47.6S 0.S3 10.50 13.28 B.BS 0.24 s.se 1.04 0.7S 38.07 4.22 1.89 16.08 17.21 37.12 4.33 27.68 111.84 742.22 8.62 843.10 33.76 IS. 13 133.as 4.76 186.66 82.82 28.71 4.39 is.ae 1.72 82.30 8.42 31.06 9.66 88.21 88.94 24.64 38.77 28.77 12.87 166.30 SPMR 100.0 40.3 106.6 88.6 S1.S 89.0 SO.O 87.8 86. S 86.7 127. S 93.8 114.0 17.4 117. S 64.S "- --- -- 643.6 81.S 240.0 200.1 * 108.6 125.2 --- S3.7 -- 254.7 12S.0 IIS.8 1SS.B 124.6 127.9 126.6 118.8 101.3 138.3 SB.7 45.3 S7.2 74. 1 S3.S 77.7 * 126.1 SO.3 SO.O SB.6 68.4 SO.6 174.7 78.3 128.2 48.3 a 188.3 106.S 111.8 101.4 117.4 116.4 63.8 106.3 - 8% Limits LOWER ... 6.1 ss.s 25.3 75.4 28.5 46.6 64.3 24.0 45.2 S8.2 30.2 SS.S 9.1 103. 1 S..... ..3 -- 120.0 60. 1 62.7 131.7 62.7 61.S UPPER _a 367^2 114.5 121.5 110.6 122.4 137.3 115.5 134.5 156.1 153.4 255.5 130.0 57.6 134.5 482.4 _ ... 3450.7 111.3 515.1 303.5 177.6 261.7 4.2..0. 67.5 97.4 48.4 62.2 SO.8 84.4 SS.B 46.1 70.1 116.0 80.4 15.1 51.6 80.3 88.8 64.6 86.S 65.0 69.8 86.8 22.2 49.8 87.2 89.1 61.S 29.6 54. 1 50.0 89. 1 69.6 87.3 82.1 32.8 83.1 166.7 576.1 166.2 2S4.0 674.3 162.6 153.6 167.6 276.5 146.3 167.7 101.2 136.2 69.2 105.0 150.4 63.4 276.6 54.6 107.5 126.6 210.2 131.0 633.7 66.0 270.1 76.7 256.1 126.6 140. 1 147.6 157.6 165.0 123.5 121.3 23 511971 0368 Table 13 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Spending a Majority of Time in a Reduction Process Causa of Death (XCOA 8th Revision Codas) OBS A1I Causas of Death 1441 Tuberculosis 1 All Malignant Neoplasas 387 Cancer of Buccal Cavity A Pharynx S Cancer of Digestive Organs A Parlte 82 Cancer of Esophagus 7 Cancer of Steepen 8 Cancer of Large Intestine 33 Cancer of Rectua 4 Cancer of Biliary Passages A Liver 7 Cancer of Pancreas 21 Cancer of All Other Digestive Organs 2 Cancer of Respiratory Systea 161 Cancer of Larynx 1 Cancer of Bronchus. Trachea, Lung 158 Cancer of All Other Respiratory 1 Cancer of Breast 0 All uterine Cancers (Feaales only) 0 Cancer of Cervix Uteri (Feaales only) 0 Cancer of Other Feaule Genital Organs 1 Cancer of Prostate {Males only) 31 Cancer of Testes and Other Male Genital Organs Cancer of Kidney 1 17 Cancer of Bladder and Other Urinary Organs Malignant Nelanoaa of Skin Cancer of Eye Cancer of Central Nervous Systea 10 6 0 7 Cancer of Thyroid A Other Endocrine Glands Cancer of Bone 0 0 Cancer of All Lyephatlc, Haeaatopolatlc Tissue 37 Lyephosarccea A Retlculosarcoaa Hodbtins Disease 4 2 Laufceata A Aleukeala 15 Cancer of All Other Lyaphopolettc Tissue IB All Other Malignant Neoplasas 40 Benign Neoplasas 8 Diabetes Mellltus 22 Cerebrovascular Disease 121 All Heart Disease 545 Rheuaattc Heart Disease 2 Ischaalc Heart Disease 428 Chronic Endocard. 01s.; Other Nyocard. Xnsuff. 20 Hypertension with Heart Disease 13 All Other Heart Disease 82 Hypertension w/o Heart Disease 4 Non-aaltgnant Respiratory Disease B8 Influenza A Pneueonta 28 Bronchitis. Eaphyseaa, Asthaa 16 Bronchitis 2 Eaphyseaa ii Asthaa 3 Other Non*aal1gnant Respiratory Disease 55 Ulcer of Stoaacn A Duodenua .6 Cirrhosis of Liver 11 Nephritis A Nephrosis ii All External Causes of Death 2 Accidents 48 Motor Vehicle Accidents 18 All Other Accidents 30 Suicides 26 Hoaictdes a Other External Causes A1l other Causes of Death 148 Unknown Causes (In All Causes Category Only) 0 Significant at 5% Level; Significant at 1% La' EXP -- 1448.00 1.83 362.63 8.34 88.56 8.15 12.58 34.55 6.83 8.06 17.65 2.48 133.58 4.45 127.85 1.20 0.73 0.08 0.04 0.11 37.27 0.65 8.11 10.34 4.31 0.18 7.36 0.81 0.60 30.31 3.27 1.23 12.47 13.33 28.72 3.36 21.48 87.15 576.37 5.12 488.62 26.28 14.07 103.83 3.70 122.38 40.88 20.08 3.43 15.52 1.33 64.27 4.22 23.68 7.51 76.20 46.72 18.30 27.78 20.01 8.46 144.85 SPUR 100.0 51.8 108.6 60.0 S2.6 76.5 63.5 66.5 58.6 86.B 118.6 80.3 120.5 22.5 124.3 * 83.7 ------ -- 848.8 s 83.2 153.1 208.7 86.7 115.B BB.1 --- 122.1 122.2 162.2 120.3 120.0 138.3 148.7 102.4 138.8 9 84.6 38.1 SB. 7 99 76.1 82.4 7B.0 108.0 80.6 68.B 78.7 68.3 70.B 225.5 SB.6 142.2 46.1 146.4 107.6 102.7 as.3 108.0 128.8 84.B 100.1 S% Llalts LOWER ... 7.6 100.6 25.3 75.1 36.7 32.1 68.2 22.3 41.5 78.3 20.2 104.2 3.8 107.3 11.8 ... ...... 185.8 58.8 21.8 132.0 52.2 48.4 UPPER ... 355.1 118.1 142.2 114.2 158.6 125.8 133.8 153.8 181.8 182.8 320.0 138.4 134.2 144.0 58..1...8.. -- 4587.1 117.5 1068.8 333.3 178.3 277.7 45.5 ... 88.8 46.0 41.2 72.7 73.7 102.6 62.3 67.7 117.0 88.6 10.3 78.4 48.4 53.8 64.2 40.6 67.1 47.7 - 48.1 14.8 38.5 75.0 66.1 64.2 26.1 81.5 88.7 78.7 88.8 78.1 88.4 43.1 85.8 18..8...0.. 167.8 324.8 638. 1 188.8 185.3 188.0 354.8 155.1 164.7 100.8 143.3 93.4 117.3 158.6 87.2 287.2 67.6 66.3 128.5 226.0 127.1 877.7 110.7 314.8 81.3 262.8 130.6 134.1 145.1 153.3 188.8 16S.3 116.8 24 511971 0369 increased slightly (PMR=124.3 and 209.7, respectively). The remainder category "all other malignant neoplasms" is also significant with a PMR of 139.3 (p<0.05). Since the primary departments of interest in the Tripartite Study were the potroom and carbon departments, we investigated mortality patterns separately for these two departments. There were 943 employees with some experience in the potroom department. The PMR for all malignancies was 106.8 with a corresponding 95% confidence interval of (96.1, 118.6) (Table 14). The PMR for cancer of the lung was 111.9 with a corresponding confidence interval of (92.6, 135.2). The only malignancy with five or more observed deaths and a statistically significant elevation was kidney cancer with a PMR of 297.9 and a corresponding 95% confidence interval of (187.1, 474.2). There was also an excess of ulcer of the stomach and duodenum based on six observed deaths and 2.69 expected (PMR=223.0, p<0.05). For employees with a majority of time in the potroom the PMR for all malignant neoplasms was 114.8 with a corresponding 95% confidence interval of (100.7, 130.9) (Table 15). Of those causes with more than 5 observed or expected deaths, cancer of the kidney and ulcer of the stomach were elevated (PMR=285.8, p<0.01 and PMR=317.2, p<0.05, respectively). Ischemic heart disease was significantly low (PMR=80.6, p<0.01). The carbon department had fewer workers than the potroom department. For the 489 employees with some employment in the carbon department, the PMR for all malignancies was 105.8 (Table 16). Both- cancer of the kidney (PMR=250.7, p<0.01) and 25 511971 0370 Table 14 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Ever Employed in the Potroom Department Cause of Death (XCOA 4th Revision Codas) All Causas of Daath Tubareulosls All Malignant Neoplasms Canear of tuecal Cavity A Pharynx Canear of Otgestiva Organs A Peritoneum Canear of Esophagus Canear of Stomach Canear of Large Intastlna Canear of Reetum Canear of Biliary Passagas A LIvar Canear of Paneroas Canear of All Other Digestive Organs Canear of Respiratory Systaa Canear of Larynx Canear of Bronehus, Trachea, Lung Canear of All Other Respiratory Canear of Breast All Uterina Cancers (Females only) Canear of Cervix Uteri (Females onlv) Canear of Other Female Genital Organs Canear of Prostata (Males only) Canear of Tastes and Other Mala Genital Organs Canear of Kidney Canear of Bladder and Other urinary Organs Malignant Me 1anoau of Skin Canear of Eye Canear of Central Nervous Systaa Canear of Thyroid A Other Endocrine Glands Canear of Bona Canear of All Lyaphatic, Haematopoietic Tissue Lysphosarcoaa A Ratieulosareoaa Hodgkins Disease I msiamla A Ataukaata Canear of All Otnar Lymphopoietic Tissue All Other Malignant Neoplasms Benign Neoplasms Dlabates Mallltus Cerebrovascular Olsaasa All Heart Disease Rhaimmtte Heart Olsaasa Ischemic Heart Disease Chronic endocard. 01s.; Other Myocard. Xnsuff. Hypertension with Heart Olsaasa All Other Heart Olsaasa Hypertension w/o Heart Olsaasa Non-malignant Respiratory Disease Influenza A Pneumonia Bronehitts. Emphysema.- Asthma Bronchitis Emphysema Asthma Other Non-malignant Respiratory Olsaasa Ulcer of Stoamch A Duodenum Cirrhosis of Liver Nephritis A Nephrosis A11 External Causes of Death Accidents Motor Vehicle Accidents All Other Accidents Suicides Homicides A Other External Causas All Other Causes of Death Unknown Causes (Xn All Causes Category Only) Significant at S% Level; Significant at IS OBS B43 0 250 5 SI 4 7 17 3 0 12 2 B7 1 SO 0 0 0 0 0 24 2 10 0 3 0 1 0 2 27 1 3 It 12 22 0 12 04 384 2 274 14 10 80 2 84 20 13 0 11 2 35 8 7 7 B4 34 13 21 14 8 a0s EXP 843.00 1.34 239.SI 8.87 BA.40 0.30 B.41 22.42 4.44 S.3S 11.83 1.81 SB.82 3.02 SB.SO 0.40 0.20 0.00 0.00 0.00 23.91 0.45 B. 37 8.B1 2.BA 0.12 4.B7 0.B4 0.41 19.SB 2. IB 0.84 S.OI S. 79 19.09 2.19 14.11 B4.S4 370.47 3.34 319.30 10.49 9.BS 81. IB 2.42 70.B1 25.29 12.71 2.14 9.79 0.B9 40. BB 2.89 18.45 4. SB 84.84 32.81 13.SB 19.18 13.99 7.74 B3.7S SPMR 100.0 --- 108.9 SB.2 87.2 82.9 S3.2 7B.B 87.B 112.2 103.2 123.9 10A.2 33.1 111.9 --- e.e. ... 100.4 441.4 297.9 * 92.2 104.2 ... 20.1 493.7 13B.S 48.8 355.S * 138.1 138.B 11B.3 45.1 124.0 9A.3 80.0 47.1 44.B 104.7 44.0 42.7 St .s 74.1 102.2 ... 112.3 223.7 48.2 223.0 42.S 144.2 94.4 103.3 92.B 108.8 100.1 77.B 10S.8 BBS Limits LOVER ... ... SO. 1 30.9 80.9 23.4 39.9 47.B 22.0 50.B BB.t 31.1 49.7 S. 2 92.0 ... ... ... ... ... 87.7 124.B 147.1 41.8 33.7 3.B 141.8 S3.7 8.B 123.4 7B.7 77.9 78.2 44.8 st.a 90.7 18.3 79.2 BO.8 88.8 89.0 20.4 70.8 81.B B4.B ... 82.4 B4.1 82.4 102.4 20.9 89.2 74.2 7B.4 BB.t 72.2 80.1 38.2 47.8 UPPER ... ... 114.8 211.1 113.7 10S.S 173.4 121.1 207.3 249.0 141.1 493.8 130.5 212.B 13S.2 ... ... -- --- ... 144.4 1584.S 474.2 204.B 322.1 ... 110.9 --- 1720.4 197.1 314.7 1024.2 244. S 239.2 174.2 ... 149. 1 1S5.9 108.4 239.0 SB.7 142.B 1B3.4 112.3 329.4 111*0 121.B 17B.4 ... 202.0 081.8 118.1 4BS.S 40.4 300.0 124.4 141.B 150.0 180.4 100.0 100.0 127.2 26 511971 0371 Table 15 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Spending a Majority of Time in the Potroom Department Cause of Osath (ICOA ath Revision Codes) OBS AM Causes of Death ssa Tuberculosis 0 AM Malignant Neoplasas IBS Cancer of Buccal Cavity A Pharynx 4 Cancer of Digestive Organs A Perlt 33 Cancer of Esophagus 3 Cancer of Stoatacn S Cancer of Large Intestine 13 Cancer of Roctusi t Cancer of Biliary Passages A Liver 4 Cancer of Pancreas e Cancer of AM Other Digestive Organs i Cancer of Respiratory System Cancer of Larynx S3 0 Cancer of Bronchus. Trachea. Lung 02 Cancer of AM Other Respiratory 0 Cancer of Breast 0 A11 Uterine Cancers (Feaules only) 0 Cancer of Cervix Uteri (Feaales only) 0 Cancer of Other Female Genital Organs 0 Cancer of Prostate (Males only) 17 Cancer of Testes and Other Male Genital Organs 1 Cancer of Kidney Cancer of Bladder and Other Urinary Organs 2 Malignant Melanoau of Skin 2 Cancer of Eye 0 Cancer of Central Nervous System 2 Cancer of Thyroid A Other Endocrine Glands 0 Cancer of Bone 0 Cancer of A1I Lyaphatlc, Haeautopotetlc Tissue 17 Lysphosarcoau A Retlculosarcoau 1 Hodgkins Disease 2 Ltiaaals A AleUteeta . Cancer of A11 Other Lymphopoietic Tissue 6 AM Other Malignant Neoplases 14 Benign Neoplasas 0 Diabetes MelIt tut s Cerebrovascular Disease 41 A11 Heart Disease 202 Rheumatic Heart Disease 2 Itehamle Hurt DituiA 1B0 Chronic Endocard. Dis.; other Myocard. Insuff. 7 Hypertension with Heart Disease 7 All Other Heart Disease 30 Hypertension w/o Heart Disease 1 Non-aultjyiant Respiratory Disease 41 Influenza A Pnaueonla 10 Bronchitis, Emphysema, Asthau Bronchitis 0 Eephysaaa 0 As thas 2 Other Mon-malignant Respiratory Disease 23 Ulcer of Stomach A Ouodenua 0 Cirrhosis of Liver 0 Nephritis A Nephrosis 0 All External Causes of Death 34 Accidents 17 Motor Vehicle Accidents 7 AM Other Accidents 10 Suicides 11 Hoelctdes A Other External Causes e A11 Other Causes of Death 01 Unknown Causes tin A11 Causes Category Only) Significant at n Level; Significant at IX Level EXP 550.00 0.02 141,oa 3.35 34.03 3.32 5.03 13.21 2.00 3.1A 0.05 0.05 S3.04 1.7B 50.77 0.47 0.10 0.00 0.00 0.00 14.32 0.25 3. IS 3.00 1.05 0.07 2.01 0.32 0.24 11.73 1.20 0.50 4.75 5.22 11.31 1.25 5.39 32.20 210.50 1.04 150.07 0.03 5.75 40.3* 1.44 44.05 14.00 7.47 1.24 5.75 0.53 23.05 1.55 5.02 2.55 33.30 20.30 5.05 11.50 0.51 4.55 55.55 SPMR 100.0 ... 114.5 110.5 35.3 75.0 00.4 05.4 35.4 125.7 57.2 105.7 113.3 ... 122.1 ... ... ... - -- 115.7 350.2 255.5 52.0 110.2 --- 05.7 144.0 70.5 200.0 105.3 115.0 123.5 *-- 5.3 127.1 3.2 103.0 0.0 72.7 121.1 0.1 00.3 1.2 05.2 107.2 mmm 104.4 . 274.4 00.5 217.2 52.0 173.4 101.0 03.7 75.5 00.5 120.3 132.0 1.0 St Ltalts LOWER ... ... 100.7 45.1 05.5 25.0 41.5 57.5 6.5 47.4 30.4 14.0 32.4 ... 0.5 ...... ... ... 74.4 57.0 153.4 13.5 30.0 mmm 17.4 ... ... 00.5 11.3 110.3 55.1 51.0 73.5 ... 47.0 4.0 3.7 25.5 70.0 35.0 55.1 5.1 0.0 05.1 37.2 53.0 ... 47.1 103.1 4.7 135.5 22.2 73.2 70.2 54.0 30.3 47.3 73.0 1.0 70.5 UPPER __ 130.3 316.3 132.3 241.8 237.7 168.4 252.2 333.2 182.8 745.0 147.8 154.5 ...... __ 100.3 2241.7 532.5 204.5 474.3 ... 271.1 ... 231.3 500.0 1425.0 333.0 254.0 207.7 ... 188.6 170.7 103.7 410.0 1.7 150.0 252.5 122.0 455.1 122.1 134.0 213.1 mmm 231.2 1350.3 143.7 720.4 121.5 410.0 130.3 120.0 155.1 155.2 220.0 255.5 110.0 27 511971 0372 cerebrovascular disease (PMR=136.2, p<0.05) were significantly elevated. There were only 140 men spending the majority of their time in the carbon department (Table 17). Thus the statistical power to a true excess is limited. The only cause of death with a statistically significant excess is cerebrovascular disease with a PMR of 195.3 and corresponding 95% confidence interval of (124.6, 306.3). The PMRs were also computed for the employees spending the majority of their time in mechanical maintenance, electrical maintenance, ingot and power. For most of these departments the number of employees was not sufficient to evaluate many of the specific cancer sites. Table 18 summarizes the observed and expected deaths and PMRs for all malignant neoplasms for employees with the majority of their time in each of the departments in the reduction plant. Those workers with the majority of time in the potrooms show an elevated PMR of 114.8 (p<0.05). The site-specific PMRs for cancer have already been discussed for the potroom and carbon departments. For the other four departments the only significant excess was for lung cancer in mechanical maintenance. The PMR was 138.3 with a corresponding 95% confidence interval of (107.2, 176.4). r 28 511971 0373 Table 16 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Ever Employed in the Carbon Department Causa of Oeath (ICO* 8th Revision Codes) OBS *11 Causes of Oeath ASS Tuberculosis *11 Malignant Nooplasas 0 133 Cancer of Buccal Cavity * Pharynx 2 Cancer of Digestive Organs * Peritoneum 27 Cancer of Esophagus 1 Cancer of Stoaacn 5 Cancer of Large Intestine 10 Cancer of Rectum 1 Cancer of Biliary Passages A Liver 3 Cancer of Pancreas 6 Cancer of All Other Digestive Organs 1 Cancer of Respiratory Systea SI Cancer of Larynx 0 Cancer of Bronchus. Trachea. Lung SI Cancer of *11 Other Respiratory 0 Cancer of Breast 0 *11 Uterine Cancers <resales only) 0 Cancer of Cervix Uteri (Feaales only) 0 Cancer of Other feoale Genital Organs 0 Cancer of Prostate (Males only) 12 Cancer of Testes and Other Male Genital Organs 1 Cancer of Kidney 7 Cancer of Bladder and Other Urinary Organs 3 Malignant Melanesia of Skin 2 Cancer of Eye 0 Cancer of Central Nervous Systea 0 Cancer of Thyroid * Other Endocrine Glands 0 of Bono 1 Cancer of All LyRSiatle, Haeautopotettc Tissue 12 Lymphosarcoau * Retlculosarcoeu 1 Hoddlns Disease 1 Leukemia * AleiAteala 3 Cancer of All Other Lymphopoietic Tissue 7 All Other Malignant Nooplasas IS Benign Nooplasas 1 01 abates Mallltus 11 Cerebrovascular Disease 38 All Heart Disease ISO Rhauaatic Heart Disease 1 Ischaalc Heart Disease 149 Chronic Endocard. 01s.: Other Myocard. Insuff. 10 Hypertension with Heart Disease 3 All Other Heart Olsease 27 Hypertension w/o Heart Disease 1 Non-aalignant Respiratory Olsease 25 Influenza A Pneumonia 9 Bronchitis, Emphysema. Asthaa 3 Bronchitis 0 Emphysema 1 Asthaa 2 Other Non-aalIgnant Respiratory Disease 13 Ulcer of Stomach * Duodenum 1 Cirrhosis of Liver 7 Nephritis A Nephrosis 4 A11 External Causes of Oeath 31 Accidents 17 Motor Vehicle Accidents e All Other Accidents ii Suicides 12 Homicides A Other External Causes 2 All Other Causes of Oeath 47 Unknown Causes (In All Causes Category Only) ivel Significant at SS Level; aa Significant at 1% L< EXP ASS. 00 0.78 125.72 3.00 30. BA 3.SS A.S2 11.44 2.26 2.SA 6.09 0.82 A7. IS 1.62 45.12 0.A2 0. 14 0.00 0.00 0.00 12.38 0.26 2.79 3.19 1.65 0.06 2.85 0.28 0.22 10.37 1.10 0.47 4.15 a.as 10.12 1.14 7.52 27.90 187.83 1.70 158.73 8.25 5.37 36.11 1.29 38.08 12.61 6.26 1.03 A.77 0.49 20. 10 1.36 8. 17 2.55 31.90 19.10 8.35 10.99 8.03 A.77 AS. 22 s?m 100.0 105.8 bs.a 81.1 27.8 110.7 7.4 44.3 105.7 88.5 121.4 109.1 --- 113.0 -------a.. ... 87.2 389.4 250.7 94.1 128.8 ------- 456.9 115.7 81.2 213.5 72.2 150.5 1A8.2 87.8 1A6.2 136.2 101.1 58.8 83.3 121.2 55.8 7A.8 77.2 65.6 71.A A7.S --- 20.8 A07.2 A.7 73.3 78.A 157.1 87.2 88.0 71.8 101.1 149.5 A1.S BS.S 5% Limits LOVER __ -- - 91.5 is.e 61.2 A.5 46.3 47.4 6.6 34.2 AA.S 17.2 83.5 --- 87.2 -------- ..a 55.8 63. A 122.8 30.5 32.5 ... ... ... 76.8 66.2 12.9 31.6 23.5 72. A 90.1 12. A 81.6 100.3 80.5 8.5 81.9 65.7 18.5 52.1 11.0 AS.3 37.7 16.0 ... 3.6 113.5 38.2 10.4 36.8 58.6 71.6 57.2 33.7 56.8 86.7 11.5 72.8 UPPER _._._. 122.3 257.2 126.8 172.7 26A.8 161.1 286.6 326.4 218.1 857.5 1 AO. 1 ... 1A6.5 -- --... ... 169.5 2382.3 511.5 290.6 51.1..5. ... ... 2717.1 202. A BAS .A 1444.0 221.8 313.0 2 A3.7 621.6 261.8 184.9 112.8 A07.6 106.3 223.7 169. 1 107.3 543.6 85.2 135.2 14_3_.8 122.2 1A61.2 108.5 S1S.1 158.1 A13.S 131.8 138.5 153. 1 179.9 257.8 152.3 125.1 29 5`\A9`7<' 037* Table 17 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Spending a Majority of Time in the Carbon Department Causa of Oaath (ICOA th Revision Codas) OBS All Causas of Oaath 140 Tubarcutoslf 0 All Malignant Neaplasas 31 Canear of Buccal Cavity A Pharynx 0 Cancar of Olgastlve Organs A Perlt Canear of Esophagus 1 Canear of Stomach 0 Cancar of Large Xntastlna 3 Cancar of Rectum Cancar of Biliary Passagas A Llvar 1 0 Cancar of Pancraas 3 Cancar of All Othar Olgastlva Organs 0 Cancar of Respiratory Systaa 16 Cancar of Larynx 0 Cancar of Bronchus. Trachea, Lung 16 Cancar of A1I Other Resplratory 0 Cancar of Breast 0 All Uterine Cancers (Females only) 0 Cancer of Cervix Uteri (Females only) 0 Cancar of Other Female Genital Organs 0 Cancar of Prostata (Males only) 3 Cancar of Tastes and Other Mala Genital Organs 0 Cancar of Kidney Cancar of Bladder and Othar Urinary Organs 2 1 Malignant Melanoma of Skin 0 Cancar of Eye 0 Cancar of Central Nervous Systaa 0 Cancar of Thyroid A Other Endocrine Glands 0 Cinctr of ftoM 0 Cancer of All Lymphatic. Haematopoietic Tissue Lymphosarcoau A Ret Iculosarcoma 3 0 Hodcpclns Disease 0 Leukemia A Aleukemia 1 Cancar of All Othar Lymphopoietic Tissue 2 All Othar Malignant Neoplasms 5 Benign Neoplasms 1 01 abates Mallltus Cerebrovascular Oiseasa 3 17 All Heart Disease Rheumatic Heart Oiseasa Ischemic Heart Disease Chronic Endocard. Oil.; Other Myoeard. Insuff. 50 0 40 2 Hypertension with Heart Oiseasa All Othar Heart Oiseasa Hypertension w/o Heart Disease Non-malIgnant Respiratory Oiseasa Influenza A Pneumonia Bronchitis. Eephysema. Asthma Bronchitis Emphysema Asthem Other Non-malIgnant Respiratory Disease Ulcer of Stomach A Duodenum Cirrhosis of Liver Nephritis A Nephrosis All External Causes of Death Acctdinti Motor Vehicle Accidents A!1 Other Accidents Suicides Homicides A Other External Causes All Other Causes of Death Unknown Causes (In All Causes Category Only) 0 t 0 s 0 0 0 0 0 s 0 2 1 1 6 4 2 3 0 14 Significant at 5% Level; > Significant at IS Level EXP 140.00 0.25 35.48 0.66 A.78 1.04 1.31 3.28 0.64 0.82 1.71 0.23 13.01 0.45 12.44 0.11 0.04 0.00 0.00 0.00 3.60 o.oe 0.75 0.65 0.37 0.02 0.66 0.08 0.06 2.86 0.29 0. 11 1.15 1.30 2.84 0.32 2.19 8.70 54.44 0.46 45.89 2.52 1.65 10.59 0.40 11.62 3.91 1.85 0.31 1.41 0.14 6.03 0.40 2.34 0.79 7.43 4.54 1.81 2.77 1.79 1.11 14.41 SPMR 100.0 --- 107.1 --- 91.2 96.0 ... 81.6 150.0 --- 175.0 --- 123.0 --- 128.6 --- --- --- --- ... 76.B --- 265.2 ' 105.5 --- -m. -------- -m- 105.0 --- --- 86.7 153.7 175.8 309.5 <36.9 195.3 91.8 m-m 87.2 79.4 mmm 75.5 --- 43.4 --- mm. mm. mm. ... 82.9 ... 85.6 126.6 121.1 132.2 221.4 72.2 167.8 mm m 97.2 > 95* Ltml t* LOVE 9 UPPER ... ... 81.5 ... 46.7 13.7 ... 29.9 22.4 ... 57.7 ... 77.4 ... 80.9 ... ... -- ... ... 25.4 ... 70.3 15.0 ... ... ... ... ... 34.3 ... ... 12.3 39.1 74.7 48.3 44.8 124.6 74. 1 ... 67.8 20.2 ... 38.9 ... 19.3 ... ... ... ... ... 35.3 ... 21.9 18.0 67.0 61.9 87. B 18.7 56.3 ... 59.2 ... ... 140.7 ... 178.1 674.5 ... 279.9 1084.9 ... 530.9 ... 195.4 ... 204.5 ... ... ... ... ... 233.0 ... 1001.3 743.4 ... ... ... ... ... 321.5 ... ... 609.6 604.1 413.7 1982.7 418.8 306.3 113.9 112.1 312.2 146.5 ... 97. S ... ... ... ... 194.7 ... 334.9 887.9 218.8 282.3 557.5 279.2 500.1 ... 159.5 30 511971 0375 Table 18 Observed and Expected Deaths and Proportionate Mortality Ratios by Department for All Malignant Neoplasms OBS EXP PMR 95% LOWER UPPER P0TR00M CARBON INGOT MECH. MAINT. ELECT. MAINT. POWER 163 141.98 114.8* 100.7 130.9 38 35.48 107.1 81.5 140.7 44 44.33 99.3 76.9 128.1 117 108.00 108.3 92.7 126.6 30 27.60 108.7 79.8 148.0 5 5.05 99.0 46.2 212.3 D. Selected Causes of Death For those causes of death that were in excess or for which we have particular interest because of the Tripartite Study, we now present more detailed analysis. (1) Kidney cancer - The PMR for kidney cancer for the total cohort is 158.1 based on 53 observed deaths and 33.52 expected. All cases of kidney cancer were in males and both white males and nonwhite males had an excess (PMR=157.5 and 257.8, respectively. Of the 53 employees with kidney cancer as a cause of death, 49 had more than 20 years employment. For those employees ever employed in the reduction process, the PMR is 200.1 based on 21 observed deaths and 10.5 expected and a corresponding 95% confidence interval of (131.7, 303.8). This compares to a PMR of 136.5 with a corresponding 95% confidence interval of (92.5, 201.4) for workers in nonreduction plants. Further- investigation within the reduction process indicates 31 511971 0376 Table 17 Observed and Expected Deaths and Proportionate Mortality Ratios for Employees Spending a Majority of Time in the Carbon Department Causa of Ooath (ICOA 9th Revision Codas) OBS All Csusas of Ooath 140 Tuberculosis 0 All Malignant hooplasox 31 Cancer of Buccal Cavity A Pharynx 0 Cancer of Digestive Organs A Perl to Cancer of Esophagus 1 Cancar of Stomach 0 Cancer of Large Intestine 3 Cancar of Rectue 1 Cancer of Biliary Passages A Liver 0 Cancar of Pancreas 3 Cancer of All Other Olgesttve Organs 0 Cancer of Respiratory Systea 16 Cancar of Larynx 0 Canter of Bronchus. Traehaa. Lung 18 Cancar of All Other Respiratory 0 Cancer of Breast 0 All Uterine Cancers (Featales only) 0 Cancer of Cervix Uteri IFeiaates only) 0 Cancer of Other Female Ganttal Organs 0 Cancer of Prostate (Males only) 3 Cancer of Testes and Other Male Genital Organs Cancer of Kidney 0 2 Cancer of Bladder and Other Urinary Organs 1 Malignant Melanoau of Skin Cancer of Eye 0 0 Cancer of Central Nervous Systea 0 Cancer of Thyroid A Other Endocrine Glands Cftnc0r of 0 0 Cancer of All Lyaphattc. Haematopoietic Tissue Lymphosarcoma A RatIculosarcoma Hod*. Ins Otseasa LeUcamla A AleUcamia 3 0 0 1 Cancar of All Other Lysphopolettc Tissue All Other Malignant Neoplasas Benign Neoplasas Diabetes Nellttus Cerebrovascular Disease All Heart Olsease Rheumatic Heart Olsease Ischemic Heart Olsease Chronic Endocard. 01s.; Other Myocard. Insuff. Hypertension with Heart Olsaasa All Other Heart Disease Hypertension w/o Heart Disease Non-aullgnant Respiratory Disease Influenza A Pneumonia Bronchitis. Eaphysama. Asthma Bronchitis Eaphysaaa Asthorn 3 8 1 3 17 50 0 40 2 0 t 0 5 0 0 0 0 0 Other Non-aaltgnant Respiratory Disease Ulcer of Stoauch A Duodenum Cirrhosis of Liver Nephritis A Nephrosis All External Causes of Death Accidents Motor Vehicle Accidents All Other Accidents Suicides Homicides A Other External Causes A1I Other Causes of Death Unknown Causes (In All Causes Category Only) Significant at 5% Laval; Significant at 3 0 3 1 9 6 4 2 3 0 14 0 IS Lev/meyl EXP ----. 140.00 0.33 35.48 0. SB a.78 1.04 1.31 3.38 0.64 0.92 1.71 0.33 13.01 0.4S 13.44 0.11 0.04 0.00 0.00 0.00 3.90 0.08 0.75 0.95 0.37 0.02 0.88 0.08 0.08 2.88 0.29 0.11 1. IS 1.30 2.84 0.32 2.19 8.70 54.44 0.46 45.89 2.52 1.8S 10.S9 0.40 11. B2 3.81 1.65 0.31 1.41 0.14 8.03 0.40 2.34 0.79 7.43 4.S4 1.81 2.77 1.79 i.ii 14.41 SPUR .... 100.0 ... 107. 1 --- 91.2 98.0 --" 91.8 138.0 ... 173.0 123.0 --- 128.8 --- --... --... 78.9 ... 283.2 105.5 ... ... ... ... ... 105.0 ... --- 88.7 153.7 175.8 309.5 136.9 195.3 91.8 ... 87.2 79.4 ... 75.5 ... 43.4 > ... ... ... ... ... 82.9 ... 85.6 128.5 121.1 132.2 221.4 72.2 167.8 ... 97.2 3% Limits LOVER ... ... 81.5 ... 48.7 13.7 ... 29.9 22.4 ... 57.7 ... 77.4 ... 80.9 ... ... ... ... ... 25.4 UPPER __ ... 140.7 176.1 874.5 279.9 1064.9 530.9 195.4 204.5 ... ... ... _____ 233.0 70.3 15.0 ... ... ... ... 34.3 ... 12.3 39.1 74.7 48.3 44.6 124.6 74.1 ... 87.8 20.2 1001.3 743.4 __ ___ _ _... _ 321.5 ... 609.6 604.1 413.7 1962.7 419.8 306.3 113.9 112.1 312.2 38.9 146.5 19.3 ... ... ... ... 35.3 ... 21.9 16.0 87.0 81.9 87.9 16.7 58.3 ... 59.2 97.6 _. _____ ___ _____ 194.7 334.9 697.9 216.6 282.3 557.5 279.2 500.1 159.5 i ii i rl 30 511971 0377 Table 18 Observed and Expected Deaths and Proportionate Mortality Ratios by Department for All Malignant Neoplasms OBS EXP PMR 95% LOWER UPPER POTROOM CARBON INGOT MECH. MAINT. ELECT. MAINT. POWER 163 38 44 117 V 30 5 141.98 35.48 44.33 108.00 27.60 5.05 114.8* 107.1 99.3 108.3 108.7 99.0 100.7 81.5 76.9 92.7 79.8 46.2 130.9 140.7 128.1 126.6 148.0 212.3 D. Selected Causes of Death For those causes of death that were in excess or for which we have particular interest because of the Tripartite Study, we now present more detailed analysis. (1) Kidney cancer - The PMR for kidney cancer, for the total cohort is 158.1 based on 53 observed deaths and 33.52 expected. All cases of kidney cancer were in males and both white males and nonwhite males had an excess (PMR=157.5 and 257.8, respectively. Of the 53 employees with kidney cancer as a cause of death, 49 had more than 20 years employment. For those employees ever employed in the reduction process, the PMR is 200.1 based on 21 observed deaths and 10.5 expected and a corresponding 95% confidence interval of (131.7, 303.8). This compares to a PMR of 136.5 with a corresponding 95% confidence interval of (92.5, 201.4) for workers in nonreduction plants. Further investigation within the reduction process indicates 31 511971 0378 that there is no particular area that appears to have a concentration of excess deaths (Table 19). The excess is not much affected when a PCMR is used instead of a PMR (Table 20). The investigation of kidney cancer by individual plant indicated no pattern for the excess although the distribution of only 53 observed deaths among 37 plants results in numbers too small to conclude that no clustering exists. " Table 19 Observed and Expected Deaths and Proportionate Mortality Ratios by Job Location for Kidney Cancer 95% OBS EXP PMR LOWER UPPER NONREDUCTION PLANT REDUCTION PLANT NONREDUCTION PROCESS REDUCTION PROCESS POTROOM CARBON INGOT MECH. MAINTAIN. ELECT. MAINTAIN. POWER 25 28 11 17 9 2 2 4 0 0 18.32 15.20 7.05 8.11 3.15 .75 .99 2.48 .61 .11 136.5 184.2** 156.1 209.7** 285.8** 265.2 201.8 161.1 -- -- 92.5 128.1 87.0 132.0 153.4 70.3 52.1 61.2 -- -- 201.4 265.0 280.0 333.3 532.5 1001.3 '781.4 423.7 -- -- 32 511971 0379 Table 20 Observed and Expected Deaths and Proportionate Cancer Ratios by Job Location for Kidney Cancer 95% OBS EXP PMR LOWER UPPER NONREDUCTI ON PLANT. REDUCTION PLANT NONREDUCTION PROCESS REDUCTION PROCESS POTROOM CARBON INGOT MECH. MAINTAIN. ELECT. MAINTAIN. POWER 25 28 11 17 9 2 2 4 0 0 19.25 15.62 6.60 9.01 3'. 64 .84 1.02 2.74 .67 .10 129.9 88.2 179.3** 125.0 166.6 93.5 188.6** 118.8 247.1** 132.4 237.9 63.1 195.8 51.1 146.2 55.8 ---- -- -- 191.1 257.2 296.9 299.4 461.2 897.5 750.7 382.7 -- -- (2) All other cancers - The PMR for the category "all other cancers" was 134.3 (p<0.01) with 164 observed deaths and 122.1 expected. The excess did not appear to be restricted to any particular race or sex. Of these, 138 were cancer of an unspecified site, 14 were cancer of multiple sites, and 12 were cavncer of soft or connective tissue. (3) Benign and unspecified neoplasms - The PMR for benign and unspecified neoplasms was 195.6 with a corresponding 95% confidence interval of (136.9, 279.5). The PMR was higher in the nonreduction plants than in the reduction plants (PMR=227.3, p<0.01) and PMR=154.7, respectively. -The cases did not appear confided to any specific race or sex. The median age at death 33 511971 0380 for the 29 workers with this cause of death was 70.9. Of the 29 observed deaths, 2 were benign brain tumors and 10 were brain tumors of unspecified nature. (4) Nephritis and nephrosis - The PMR for nephritis and nephrosis was 242.2 based on 85 observed deaths and 35.09 expected. The excess appeared in reduction as well as nonreduction processes and was not restricted to a specific sex or race group. This ICD classification is often a result of insufficient coding of the death certificate and a review of \ individual death certificates indicated "renal failure" as a frequent cause of death designated on the death certificates with this cause. Investigation of individual plants indicates that five plants accounted for 52 observed deaths when 13.95 were expected. These plants were both reduction and nonreduction plants. (5) Cerebral vascular disease - The total cohort had approximately an 11% excess in cerebrovascular disease. This excess appeared restricted to white males where the PMR was 115.2 (p<0.01) based on 403 observed deaths and-349.8 expected and was higher in plants with a reduction process where the PMR was 135.3 (p<0.01) based on 151 observed deaths compared to a PMR of 98.9 for the remainder of the white male population. For reduction plant workers this represents 30 observed deaths in excess which is approximately the same as the deficit observed for the category "all heart disease". Although the excess occurs in reduction plants it is not confined to the reduction process. The white males who spent the majority of their time in a nonreduction process had a PMR of 132.-1 (p<0.01) compared to 34 511971 0381 138.8 (p<0.01) for the white males spending the majority of their time in a reduction process. (6) Respiratory cancer - The primary hypothesis in the Tripartite Study was to determine if there was an excess of lung cancer in the potroom and carbon departments of the reduction process. The overall SMR for lung cancer in that study was 96.4 with a corresponding 95% confidence interval of (83.2, 105.9). The corresponding SMR of the plants in the Tripartite Study which have been included in this study is 91.7 with a corresponding 95% confidence interval of (78.4, 106.5). For this study the PMR for lung cancer shows a slight excess. The PMR for lung cancer for employees in the reduction process is 124.3 with a corresponding confidence interval of (107.3, 144.0). This compares to a PMR of 108.9 for workers in plants with no reduction process and a PMR of 81.3 (p<0.05) for workers in a reduction plant that spent the majority of their time in a nonreduction process. Further investigation was conducted by department within the reduction process (Table 21). Workers spending the majority of their time in the potroom, carbon or ingot department all have excesses of 20%-30% that are not statistically significant. Workers spending the majority of time in mechanical maintenance have a significantly elevated PMR of 136.3 (p<0.05). When the risk is estimated using a proportionate cancer mortality ratio (Table 22), the risk is slightly increased for employees in the nonreduction process of the reduction plant (PCMR=87.9) and decreased for employees in the reduction process 35 511971 0382 (PCMR=111.9). Neither of these is significantly different from 100. The only significant excess using the ,PCMR occurs for maintenance workers where the PCMR is 125.7 with a corresponding 95% confidence interval of (101.6, 155.6). Table 21 Observed and Expected Deaths and Proportionate Mortality Ratios by Job Location for Cancer of Bronchus, Trachea and Lung OBS NONREDUCTION PLANT REDUCTION PLANT NONREDUCTION PROCESS REDUCTION PROCESS POTROOM CARBON INGOT MECH. MAINTAIN. ELECT. MAINTAIN. POWER 310 248 89 159 62 16 19 53 8 1 EXP 284.73 238.24 109.53 127.95 50.77 12.44 15.13 38.34 9.53 1.69 95% PMR LOWER UPPER V 108.9 97.9 121.0 104.1 92.5 117.1 81.3* 66.7 98.9 124.3** 107.3 144.0 122.1 96.5 154.5 128.6 80.9 204.5 125.6 82.0 192.4 136.3* 107.2 178.3 83.9 43.5 162.0 59.2 9.4 372.4 36 511971 0383 1 The observed and expected deaths and PMRs are shown for each plant in Table 23. There was a statistically significant excess, at both the Mobile and Vancouver plants (PMR=161.2 and 154.4, respectively). Two other plants with Soderberg processes, had excesses greater than 40% that failed to achieve statistical significance. When we restricted analysis within each plant to employees with reduction experience, the PMR for Vancouver was 162.4 (p<0.01), for Point Comfort was 164.6 (p<0.05) and for Warrick was 161.8 (not statistically significant). Table 22 Observed and Expected Deaths and Proportionate Cancer Mortality Ratios by Job Location for Bronchus, Trachea and Lung 95% OBS EXP PCMR LOWER UPPER NONREDUCTION PLANT 310 REDUCTION PLANT ,248 NONREDUCTION PROCESS 89 REDUCTION PROCESS 159 POTROOM CARBON 62 16 INGOT 19 MECH. MAINTAIN. 53 ELECT. MAINTAIN. 8 POWER 1 300.93 243.32 101.23 142.09 59.27 13.09 15.70 42.15 10.39 1.50 103.0 101.9 87.9 111.9 104.6 122.2 121.0 125.7* 77.0 66.5 94.2 112.7 92.3 112.6 74.4 103.9 98.6 126.6 85.9 127.4 82.6 - 180.8 84.7 172.9 101.6 155.6 44.3 133.8 13.6 324.5 The PCMRs for the Point Comfort and Vancouver plants were also significant (151.9, P<0.01 and 143.2, p<0.05, respectively). The .'PCMR.for Warrick tras 112.0. 37 511971 0384 Table 23 Observed and Expected Deaths and Proportionate Mortality Ratios for Lung Cancer by Plant Plant ADDY ANDERSON ALCOA BAD IN BAUXITE BRIDGEPORT BUFFALO CHICAGO CHILLICOTHE CLEVELAND CORONA CRESSONA DAVENPORT DETROIT EAST ST. LOUIS EDGEWATER EDISON FORT MEADE FRANKLIN LAFAYETTE LANCASTER LEBANON LOGANS FERRY MARSHALL MASSENA MOBILE NEW KENSINGTON POINT COMFORT RICHMOND ROCKDALE ROSICLARE TENNESSEE TiFFON VANCOUVER VERNON WARRICK WENTACHEE OBS 3 1 8 12 13 4 0 3 6 42 0 23 29 2 5 17 11 0 2 21 .5 2 3 3 47 22 54 25 4 5 5 107 1 27 21 16 9 EXP .71 .11 7.47 12.19 12.29 1.94 .16 2.45 4.87 36.63 1.08 23.53 23.39 4.39 7.99 18.26 8.17 .31 1.95 30.36 2.69 .85 1.60 1.09 53.08 13.65 52.96 17.42 5.94 9.58 2.45 109.3 .72 17.49 16.75 11.10 8.07 PMR -- 107.2 98.5 105.8 -- -- -- 123.2 114.7 -- 97.8 124.0 -62.6 93.1 134.6 -- --. 69.2 185.5 ---- 88.5 161.2* 102.0 143.5 67.3 52.2 204.4 97.9 -- 154.4* 125.4 144.2 111.5 95% LOWER UPPER -- 55.5 57.5 63.1 -- -- -- 57.8 86.0 -- 66.5 88.0 -- 27.1 59.0 76.9 -- -- 46.2 81.8 -- -- -- 67.5 108.8 79.0 99.4 26.7 23.1 89.9 81.7 -- 108.3 83.6 91.0 60.1 -- --> -- 206.8 168.7 177.3 -- -- -- 262.6 152.8 -- 143.8 174.8 -- 144.5 146.8 235.7 -- -103.6 420.8 -- -- -- 116.1 238.7 131.5 207.3 170.0 117.7 464.8 117.2 -- 220.1 188.1 228.4 207.0 38 511971 0385 (7) Cancer of the Lymphatic and Haematopoietic Cancer - The PMR for the total cohort for lymphatic and haematopoietic cancer was 113.6 with a 95% confidence interval of (96.8, .133.2). The PMR for workers in nonreduction plants was 100.2 compared to a PMR of 130.2 (p<0.05) for. workers in reduction plants. Within the reduction plants, those workers spending the majority of their time in a nonreduction process had a higher PMR than those in a reduction process [PMR=140.1, p<0.05 and PMR=122.1 (not significant), respectively]. The PCMR was 146.7 (p<0.05) for workers in the nonreduction process and 111.3 for workers in the reduction process. Analysis based on majority of time in individual departments yielded no statistically significant results. Potroom workers had a PMR of 144.9 with a 95% confidence interval of (90.8, 231.3) and electrical maintenance workers had a PMR of 217.3 with a corresponding 95% confidence interval of (93.3, 506.3). The only individual plant with a significant excess was Tennessee which had a PMR of 172.1 (p<0.01. The PMR for leukemia in the total cohort was 102.0. The PMR for those in reduction plants was 117.4 compared to 89.8 for those in nonreduction plants. The number of deaths was small on which to do ,an analysis by department. However, 8 of the 15 deaths occurred in the potroom with a subsequent PMR of 168.3 based on 8 observed deaths and 4.75 expected with a corresponding 95% confidence interval of (85.1, 333.0). The only individual plant with a significant excess was Edgewater with a PMR of 260.7 (p<0.05). ('8') Paficreatic cancer - In this study, the PMRs for 511971 0386 39 pancreatic cancer did not show a significant excess for either reduction plant workers or workers spending the majority of their time in the potrooms (PMR=103.2 and 87.2). This compares to an SMR of 134.8 for workers in the potrooms of the Tripartite Study. The significant finding of the Tripartite Study was for potroom workers with more than 15 years employment, where the excess was more than twofold. With the data available in the present study a risk for longterm employees could not be obtained. E. Analysis by Plant Mortality for each of the 62 selected causes of death was done for each of the 37 study plants. Such analysis must be interpreted with caution since by random chance alone some plants would be expected to deviate from the average value. In addition, many of the plants did not have sufficient numbers for an individual analysis. Because of these limitations, we view the results as preliminary and any plants that are identified should be given consideration for a more detailed study (if feasible) in a second phase. Table 24 summarizes the observed, expected deaths and Proportionate Mortality Ratios by plant. Of the 29 plants with sufficient sample size to compute a PMR, 14 had a PMR less than li>0 and 15 had a PMR greater than 100. Four plants had a statistically significant excess, but one was based on only 5 observed deaths. One plant had a borderline excess of PMR=130.5 with a corresponding 95% confidence interval of (99.9, 170.4). Numbers were often too small to do an analysis of individual plants for many of the specific cancers. Nevertheless, in reviewing the results from thpse plants we note the following 40 511971 0387 Table 24 Observed and Expected Deaths and Proportionate Mortality Ratios for All Malignant Neoplasms by Plant Plant 95% OBS EXP PMR LOWER UPPER ADDY ANDERSON ALCOA BAD IN BAUXITE BRIDGEPORT BUFFALO CHICAGO CHILLICOTHE CLEVELAND CORONA CRESSONA DAVENPORT DETROIT EAST ST. LOUIS EDGEWATER EDISON FORT MEADE FRANKLIN LAFAYETTE LANCASTER LEBANON LOGANS FERRY MARSHALL MASSENA MOBILE NEW KENSINGTON POINT COMFORT RICHMOND ROCKDALE ROSICLARE TENNESSEE TIFFON VANCOUVER VERNON WARRICK WENTACHEE 5 1 21 40 34 12 0 5 16 138 1 64 85 14 28 60 30 1 5 78 7- 3 5 3 148 45 160 45 19 23 10 330 4 52 52 39 22 2.00 .37 22.02 37.11 36.16 7.04 .91 7.06 14.98 110.16 2.85 62.75 64.20 16.17 29.04 61.07 24.75 .88 5.85 87.57 7.83 2.16 4.36 2.78 152.68 38.58 168.55 45.95 19.81 26.44 7.78 323.35 2.33 49.27 51.06 29.89 22.55 250.6* -- 95.3 107.8 94.0 170.5* -- 70.8 106.8 125.3** -- 102.0 132.4** 86.6 96.4 98.2 121.2 -- 85.4 89.1 89.4 -- 104.7 -- 96.4 116.6 94.9 97.9 95.9 87.0 128.5 102.1 -- 105.8 101.8 130.5 97.6 123.2 ' -- 66.1 82.5 70.4 103.7 -- 33.5 70.8 108.6 -- 82.8 110.5 54.6 69.5 78.7 89.1 -- 40.4 73.6 47.4 -- 54.5 -- 84.4 90.8 83.0 76.5 65.6 61.4 74.7 93.0 -- 83.6 80.6 99.9 68.3 509.9 -- 137.6 140.7 125.5 280.3 -- 149.4 161.0 144.6 -- 125.6 158.6 137.3 133.9 122.6 165.0 -- 180.5 107.8 168.3 -- 24.7 -- 111.4 149.8 108.6 125.4 '140.1 123.2 220.9 112.0 -- 133.2 128.7 170.4 139.5 neoplasms which were in excess at particular plants: (1) The Cleveland plant had PMRs of 280.5 for stomach cancer (based on 12 observed deaths, p<0.0l), 298.8 for cancer of 41 0386 1 the rectum (based on six observed deaths, p<0.05) and 464.7 for cancer of the breast (based on 4 observed deaths, p<0.01). (2) The Cressona plant had a PMR of 247.4 for stomach cancer (based on five deaths, p<0.05), 261.9 for kidney cancer (based on four deaths, p<0.05), and 530.4 for melanoma (based on four deaths, p<0.01). (3) The Davenport plant had a PMR of 177.0 for all digestive cancers (based on 27 observed deaths, p<0.01). The PCMR was not significantly elevated for this cause. (4) The Edgewater plant had a PMR of 260.7 for leukemia (based on six observed deaths, p<0.05). (5) The Massena plant had a PMR of 283.2 for lymphosarcoma (based on 4 observed deaths, p<0.05). (6) The Mobile plant had a PMR of 161.2 (p<0.05) for lung cancer. The PCMR was 135.3. (7) The Tennessee (Ale) plant had a PMR of 172.1 (based on 46 observed deaths, p<0.01) for cancer of the lymphatic and haematopoietic tissue. (8) The Vancouver plant had a PMR of 154.4 for lung cancer (based on 27 observed deaths, p<0.05) and a PMR of 356.1 (based on 4 observed deaths, p<0.05) for kidney cancer. 5AA9-H 39 42 Summary Conclusions from this study must be drawn more cautiously than was necessary for the Tripartite Study because of the inherent limitations of the PMR study design as well as the less specific job classification used in the present study. Furthermore, the large number of estimates of risk that were computed will result in a larger number of false positive findings than can be inferred from the p-values. Conversely, the small number of workers available for many of the estimates of risk precludes any strong statements in regard to those findings that were negative. With these limitations stated, we now summarize the findings we feel are most important. Consistent with the study objectives, we have given most attention in our summary to malignant neoplasms.- The PMR for malignant neoplasms for the total study population was 103.7 and was not significantly different from the total U.S. population. The only specific cancer site which was significantly elevated was kidney cancer with a PMR of 158.1 and a corresponding 95% confidence interval of (121.2, 206.3). The nonspecific disease categories of benign and unspecified neoplasms, nephritis and nephrosis and "all other malignant neoplasms" were elevated and appeared to result from lack of complete specification of cause of death on the certificate. The only other disease category that was elevated for the total cohort was cerebral vascular disease with a PMR of 111.4 (p<0.05) and this was accompanied by a deficit in ischemic heart disease (PMR=85.2, p<0.01). The analysis by work area yielded the following: 43 S,1^o390 (1) Por the combined group of workers in nonreduction plants the PMR for all malignant neoplasms was 105.2. The only statistically significant excesses occurred for nonspecific disease categories (i.e., nephritis., benign and unspecified neoplasms, all other cancers).. Analysis by race indicated that whites had an excess of colon cancer and nonwhites had an excess of stomach, liver and lymphatic cancer. (2) For the 1320 workers in a reduction plant who spent the majority of their time in a nonreduction process, the PMR for all malignant neoplasms was 93.6. The only specific neoplastic site with a significant elevation was cancer of the lymphatic and haematopoietic tissue (PMR-140, p<0.05).' (3) Workers with the majority of their employment in the reduction process had a PMR of 109.5 (p<0.05) for all malignant neoplasms. These workers had a PMR of 124.3 for lung cancer (p<0.01) and a PMR of 209.2 for kidney cancer (p<0.01). When a PCMR was computed, the estimate of risk for lung cancer was a nonsignificant 111.9 but remained significant for kidney cancer (PCMR=188.6, p<0.01). The workers spending the majority of their time in the reduction process had a significant excess for two of the study plants. Neither of these plants had an excess in the Tripartite Study. Workers spending the majority of their time in mechanical maintenance also had an excess of lung cancer. (4) Although workers in reduction plants had a significantly elevated PMR of 130.2 (p<0.05), for cancer of the lymphatic and haematopoietictissue it was greater in workers in the reduction" plant, spending the majority of their time in a 44 511971 0391 nonreducticn process (PMR=140.1, p<0.05). No individual department had a statistically significant excess, although the small number of observed deaths when analyzed by department makes the results inconclusive. (5) Analysis by plant is limited by small numbers and a further increase in the expected false positives due to the larger number of estimates of risk. Overall, 14 plants had a PMR for "all malignant neoplasms" below 100, 15 plants were above, and 8 had less than 5 observed deaths from neoplasms. Of plants with greater than 5 observed deaths for "all malignant neoplasms", three had a statistically significant excess and one had borderline significance. Eight of the plants had at least one specific site that showed a statistically significant excess. We could identify no consistent pattern in site-specific cancers among plants with similar processes, although such inferences are clearly limited by small numbers and lack of more detailed job classifications in plants with multiple processes. 45 511971 0392 References 1. Rockette HE, Arena VC: Mortality studies of aluminum workers: potroom and carbon department. Journal of Occupational Medicine 25(7), 1983. 2. Marsh GM, Preininger M: OCMAP: A user-oriented occupational cohort mortality analysis program. American Statistician 34: 245-246, 1980. 3. Wong O, DeCoufle P: Methodological issues involving the standardized mortality ratio and proportionate mortality ratio in occupational studies. Journal of Occupational Medicine 24:299-304, 1982. 46 511971 0393 Appendix Distribution of causes of death using 4 digit ICD codes ICD 88 119 189 310 360 381 384 388 389 419 498 499 539 543 703 1159 1169 1175 1179 1350 1363 1369 1409 1419 1449 1459 1460 1469 1479 1481 1490 1505 1509 1510 1519 1522 1529 1531 1532 1533 1534 1536 1539 1540 1541 1550 1551 1552 Preq. 1 3 1 1 1 3 7 1 54 1 1 1 1 1 2 2 1 1 2 1 2 1 1 2 1 2 2 1 3 1 5 2 17 3 56 2 1 1 2 4 2 5 152 6 24 12 2 8 ICD 1562 1569 1570 1579 1590 1599 1619 1625 1629 1639 1640 1701 1706 1709 1712 1713 1716 1719 1722 1725 1727 1729 1734 1749 1790 1809 1820 1830 1850 1869 1874 1889 1890 1891 1892 1899 1909 1910 1913 1916 1919 1930 1940 1946 1950 1990 1991 2000 Preq. 1 1 5 69 3 1 7 1 557 2 1 1 1 1 1 1 1 9 1 2 1 15 1 13 2 1 1 4 147 1 2 47 48 1 4 1 1 1 2 1 20 1 2 1 1 14 . 136 5 ICD 2008 2019 2020 2021 2024 2028 2030 2040 2041 2049 2050 2051 2080 2081 2089 2159 2169 2251 2252 2302 2373 2384 2387 2389 2390 2391 2395 2396 2398 2399 2429 2449 2500 2501 2502 2503 2504 2505 2506 2507 2509 2535 2554 2558 2599 2639 2651 2733 Preq. 4 7 1 1 1 41 25 5 8 2 17 6 9 1 7 1 1 1 1 1 1 1 4 2 2 1 1 10 1 1 1 .1 72 2 2 6 1 1 6 1 1 1 1 1 1 3 1 1 47 511971 0394 Table (continued) Distribution of causes of death using 4 digit ICD codes ICD 1560 1561 2761 2762 2765 2773 2780 2793 2810 2848 2849 2859 2866 2888 2898 2899 2900 2901 2910 3030 3089 3109 3229 3239 3240 3310 3312 3314 3319 3320 3334 3352 3400 3418 3419 3429 >3481 3483 3485 3489 3561 3570 3760 3940 3941 3949 3959 Freq. 4 2 1 2 4 2 1 1 1 2 2 1 2 2 1 1 4 2 1 1 1 5 1 2 1 19 1 2 2 16 3 12 3 1 1 2 3 1 1 1 1 2 1 2 1 5 1. ICD 2001 2002 4049 4100 4109 4110 4120 4130 4140 4141 4148 4149 4151 4160 4169 4210 4239 4240 4241 4249 4254 4255 4271 4273 4274 4275 4278 4279 4280 4281 4284 4289 4290 4291 4292 4299 4300 4301 4310 4321 4329 4330 4331 4340 4341 4349 4360 Freq. 6 1 4 1017 16 11 9 1 617 1 14 203 36 3 5 3 1 5 23 6 67 2 1 3 4 164 1 19 80 2 4 14 2 1 150 4 6 5 46 6 5 1 4 49 2 27 275 ICD Freq. 2738 2754 4402 4409 4410 4411 4412 4413 4414 4415 4416 4429 4439 4440 4449 4472 -4479 4512 4519 4539 4549 4560 4578 4589 4590 4599 4660 4787 4809 4810 4820 4823 4824 4828 4829 4830 4850 4860 4870 4878 4900 4912 4919 4920 4939 4940 4960 1 1 3 65 4 1 1 41 3 7 3 1 8 1 5 1 1 1 2 1 1 4 1 3 5 1 1 1 1 4 3 .1 1 1 1 1 35 103 1 1 3 6 1 54 9 1 141 48 511971 0395 Table (continued) Distribution of causes of death using 4 digit ICD codes ICD Freq. ICD Freq. ICD Freq 3980 3989 4019 4029 4039 5070 5109 5118 5119 5120 5130 5140 5150 5163 5168 5183 5184 5185 5188 5199 5301 5304 5309 5314 5315 5319 5324 5325 5326 5329 5334 5335 5339 5369 5400 5409 5532 >5539 5560 5570 5579 5580 5601 5602 5608 5609 5621 5660 1 4 11 48 12 17 3 1 4 4 3 6 13 1 2 1 2 3 9 1 1 1 1 4 2 1 2 2 1 1 6 2 1 1 1 1 2 1 1 8 1 1 1 1 1 5 5 1 4370 4371 4378 4379 4380 5715 5718 5719 5722 5724 5728 x 5733 5739 5742 5743 5750 5751 5754 5761 5770 5771 5789 5809 5829 5838 5839 5845 5849 5850 5860 5900 5901 5908 5920 5938 5939 5959 5990 6019 6029 6821 6829 6861 6954 7070 7101 7802 7855 16 1 1 15 7 34 2 3 1 3 19 4 2 2 1 3 1 1 3 5 1 11 1 4 1 2 1 12 19 45 1 2 3 1 1 4 1 25 1 1 1 1 1 1 6 1 2 6 5000 5010 5020 5050 5064 8120 8121 8122 8129 8130 8147 8150 8159 8169 8190 8191 8192 8199 8209 8219 8220 8249 8259 8261 8300 8309 8329 8480 8682 8689 8698 8781 8782 8789 8799 8809 8810 8811 8820 8839 8849 8870 8880 8902 8903 8909 8920 8939 18 1 1 1 1 9 1 3 16 4 6 2 2 2 7 2 3 16 1 1 1 1 1 1 1 1 1 1 1 3 1 1 -2 1 5 7 4 1 1 1 2 1 10 4 2 4 1 1 49 511971 0396 Table (continued) Distribution of causes of death using 4 digit ICD codes ICD 5679 5698 5699 5710 5712 5713 5714 9138 9190 9192 9198 9199 9220 9221 9222 9229 9239 9240 9250 Preq. 1 4 1 1 13 2 1 1 5 1 2 2 1 1 1 5 1 1 1 ICD 7860 7970 7981 7982 7991 7999 8109 9251 9289 9323 9345 9520 9530 9538 9540 9550 9551 9552 9554 Preq. 1 2 5 44 41 62 2 1 15 1 1 4 5 1 1 4 4 2 52 ICD 9000 9053 9068 9102 9108 9110 9120 9571 9600 9651 9652 9654 9660 9689 9821 9830 9851 9854 9947 Preq 1 1 1 1 3 4 2 1 1 1 1 7 2 2 4 1 1 2 1 511971 0397 50