Document wDNb4gvK4egkz6GK1Mm4k9QME

23 IX. SUMMARY & CONCLUSIONS This is the final report of a study of the mortality of workers exposed to vinyl chloride and its polymers, which augments studies reported in 1974 and 1975. The current report increases the total population of workers studied from 8,384 to 10,173, with the number whose vital status was deter mined increasing from 7,128 (85 percent) to 9,677 (95.1 percent). The number of deaths has more than doubled; there are now 669 certified and available for analysis, compared with 328 in the original study. The follow up period concluded December 31, 1972, for both the original study and the augmented final study. The successive additions to the population and improved follow-up have been accompanied by a rise in the overall-cause Standardized Mortality Ratio (SMR) from 75 in 1974 to 89 in the current analysis. The major change has been in the SMR for cardiovascular and renal disease, which was originally 80 and is now 95. There has been a concurrent downward shift in the SMR for "all malignancies," which is now 104 compared with 110 in the previous report. In the current study the SMR's for malignancies of various sites are also lower than in the 1974 and 1975 reports. The SMR for gastrointestinal tract tumors dropped from 94 to 75 in successive reports (these included 5 deaths from hepatic angiosarcoma); that for respiratory tract cancer (uncorrected for smoking) dropped from 112 to 107; and that for cancer of other and unspecified sites from 155 to 147. There is, nevertheless, still some support for the hypothesis that vinyl chloride may increase the incidence of cancer slightly in sites other than the liver. The principal evidence for this is the observation that the incidence of lung cancer and miscellaneous cancers appears to be higher in individuals with higher maximum exposures DTH 000012802 24 and those with longer exposure periods. Brain tumors were found to be in excess, 12 observed vs. 5.9 expected ( significant at the 0.05 level ) but the incidence was not related to either duration of exposure or to intensity of exposure to VCM. This population should be studied again within the next 5 years. Since the time of observation after first exposures will be longer, and more deaths will be available for analysis, it is possible that some of the questions about cancer in sites other than the liver may be resolved. DTH 0000128C3 Table 1 Distribution of Vinyl Chloride Plants Studied by Product and Numbers of Workers 25 Product or Products Polyvinyl chloride only Vinyl chloride monomer only PVC and VCM Copolymers, resins, with or without PVC and VCM TOTALS Number of Plants Number of Workers Number Traced 18 6,848 6,468 11 1,214 1,177 3 935 910 5 1,176 1,122 37 10,173 9,677 DTH 000012804 26 Table 2 Distribution of Vinyl Chloride Plants and Vinyl Chloride Workers by Census Regions and Geographic Divisions Region Geographic Division Percent of U. S. male Population (1970) Number of Plants in Study All regions 100.0 37 Northeast New England Middle Atlantic North Central East North Central West North Central South South Atlantic East South Central West South Central West Mountain Pacific 23.8 5.8 18.0 27.9 19.8 8.0 30.9 15.1 6.3 9.5 17.4 4.1 13.2 8 2 6 6 6 - 22 5 4 13 1 1 Number of Workers in Study 10,173 1,619 467 1,152 1,872 1,872 -- 6,589 1,735 2,868 1,986 93 --_ 93 Number Traced 9,677 1,550 453 1,097 1,817 1,817 -- 6,218 1,620 2,655 1,943 92 92 DTH 000012805 Table 3 Follow-up Total Number 10,173 27 Traced 9,677 (95.1%) Alive 8,970 (92.7%) Dead 707 (7.3%) / Death Certificate 669 (94.6%) Death Certi ficate 38 (5.4%) Traced 496 (' .9%) DTH 000012806 I 28 I I + *d- m CM o o o o CM CM <V) CO *3- CM 1 o o o o o> 00 r*. O CO <d* CM l/) SfO Ol 1 LO r*> o o * o o cn CTi ID CO cr> CM i-- CM 0) r-- f-- >- '--" r-- X LU 1 o *dcr> o o> CO O CM r-- Oi r-- 4O O *r-- +-> cr> CO 00 3* CM CM ns U 3 o> CO r^. CM CO o> 00 1 ID CO *a-* CM r-- CM Q CM o ID CM o> 00 3- 00 CM O ID 00 r-- l CO c* p-* r CO CO ID *d- CM CO 00 ID ID to pN* cn CO CM CM O -P o CO # r-- * cr. oow. ID * 1^. * h- cn 1 r"* ' 4- c (U o ,--"N (0 u >> c* r-- *3" >E 3 "O o i- ro cr> r-- CM + &- O C 4- to c 3 <0 +-> n 0> S- O O UJ 4-> QJ +-> LL. CD Q. CD >- O H- o O ID o CM CM c <D X O co LU +J * DTH 000012807 29 Table 5 Observed/Expected Deaths and Standardized Mortality Ratios for Selected Causes of Death in 9,677 Vinyl Chloride Workers Cause of Death with ICD Number (a) All causes All malignancies (140-205) Malignant neoplasms, buccal and pharynx (140-148) Malignant neoplasms, digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasms, genital organs (170-179) Malignant neoplasms, urinary organs (180-181) Malignant neoplasms, other and unspecified sites (190-199) Malignant neoplasms, brain and other parts of nervous system (193) Leukemia and aleukemia (204) Lymphomas (200-203, 205) Major cardiovascular and renal diseases (330-334, 400-468, 592-594) Cirrhosis of liver (581) All other certified causes Number of workers Number of person-years Obs./Exp. 707/795.02 139/141.39 5/ 5.19 29/ 40.82 45/ 44.29 4/ 7.17 8/ 6.85 28/ 20.18 12/ 5.90 9/ 6.65 11/ 10.36 347/385.24 14/ 26.45 169/241.95 9,677 120,203 SMR (b) 89** 104 102 75 107 59 123 147 203* 143 112 95 56** 74** a. Cause-specific numbers indicated categories in the 1955 ( 7th ) revision of the International Classification of Diseases. b. SMR's (other than for All Causes) adjusted for 38 deaths with no death certificates by factor of +5.68% * Significant at the 0.05 level. ** Significant at the 0.01 level. DTH 000012808 30 Numbers indicate categories in the 1955 version of the In te rn a tio n a l C la s s ific a tio n of Diseases. SMR's other than fo r " a ll causes" adjusted fo r deaths w ith unknown cause ( i. e . missing death c e rtific a te s ) by fa cto rs o f +7.44%, +4.382%, and +2,439% re s p e c tiv e ly ; S ig n ifica n t at the 0.05 level. S ig n ifica n t at the 0.01 level. X O' 00 -- o O f-- CT> ID O <D r*s o co (S) CD i-- ID Cr-O. CidO CO o CO Ol ID X ID CD CO o CD t-v X o O o -- CO o id *t Lf> CO i-- CVJ fO N co fOp CO X SJ- 00 o> O 00 CD O 00 CO CM o . vd 2: r-- r* r-- r-- r-- r-- O "O 4O CO E r-- r*>. o QJ QJ P 3 r" CM CM O cn p r QJ <D > QJ "O QJ CO X0 * 0 ro cn CO CM VO cm 0 cn co CTi CTi to 0 D to id ro s. CM tO N ro PX X1 t CD CO UJ E 3 UJ ro ro p-- LO CM CM P-- cm ro VD 0> CO 00 lo r-- r-- ^ CO CM r-- u 14o0 4- m E X ro to \ V Xw O CM to f-- O 0*1 r--~ CO co ro to VD r- CM 0 to P"4 r-- CO D CM r-- OCO r0--) s f- > P > 3 PE f" CO r-- X CO CO 0) P S p-- U X o >, fo z: X p- -o -o QJ QJ M o_ r-- 3 "O o u <0 CD -a c ** * M <fc 4c cc Cn O^LDS CO ID CM CM CM CO CTi CD 00 CD cn CD cn CO id r- CD 00 sCO: id 5 cm 3O r^ co00 O VD CM 0 CM N ID O'* CM X CD CO CD cn m CM -- Ch O X UJ O CM ro ro CD CO LO CO CM r-- CM CM cn r-- C\J 00 ID to X) LO o CD CD co co LO LO 3- If) N (Jt 00 CO (O PP ID aj _x TO u o cO 3 C/I cu X -o P r* <o S- <11 o Q p-- X -a o 0) P r-- U >> QJ C CL r~ X> UJ '**NS> C -aoj > s. Q> to X o <0 to u CD QJ to X cn <0 E *0 ID U QJ 3 c QJ T-- O TD to Z ns > 4-> C r* r~ O 03 p-- >> <0 "O O r-- P LD U <0 u 'Q* --- O T3 to p-- r- 4-> ro s. O 1-- O QJ X r" C QJ CM *0 cn CJ cn l/l p X 4W ^--s. c m X 3 r* E CD QJ u 4-> in a; 1 4-> X "O 3 U cn 3 O ro O u CM to r- m QJ n CM cn QJ X 0 CM 1 #> to E CO *> to O E -P +< (O y--N E t to E-- i to E-- #> l/l E CO QJ E 0) _x -0 n ro to ID *-"44 r-- * CO to 3 to (/) p O to to r- to VD to cn C/l 1-- t/l 4-> 3 O CO D O QJr0 <73 r- UJ L to f-- ro to oo CO *r- QJ CM S- CD * r- I -- QJ i-- I I-- to -- I rd ^ -o Uf0 QJ O Q. X 0-0 X <0 O l >> 0^0 0 to OO OO OX) O 3 0 Q)`r to <+- to QJ 1-- QJ *3 QJ 1-- gj r-4. a> 00 o> QJ -O CM O O > *4- u onO CD C 4-^ c c c '-- r- 1-- r- 4--- to r-- *r-- QJ O 1-- <0 4W* V__- P rO <0 r-- P -X QJ O P X P p to P P P p- to > ^ u u S- to C C C to E C tO (O O ro fO 0^-4- QJ 0 aj 3 CO f0 >, ro c r0 CJ ro ro C ro QJ *r-- E *i-- ro 0 0 X CO to C c u c H3 c P C <0 C f0 C X E O 0 ro O QJ o> cn ro a> cn cn to o> 01 cn cn o> 41 0) f S- 1 41 S- p to I- X !- u p >-r- S- -i- U -r- -X X ro O -f- QJ 0 3 r-- r- Q-f-- 0 tO r-- Op-- O r-- 3 3 E <-> ro to x fO ro <0 rO o ro ro to QJ >> ro 0 P u u aE s z 2 P x S- --x 0 QJ a; 0u Xx r-- r-- r-J U 1-- E E r-- rO t- p-- 3 cc S O< z r0 X 4c * DTH 000012809 Standardized M o rta lity Ratlorand Observed Deaths Due to A ll Causes Among 9,677 Vinyl Chloride Workers by Duration of Exposure, Years Since Exposure Began, and Maximum Level o f Exposure(a) T o ta l 87 ( 5 6 ) 96 (3 9 3 ) 8 9 ** (7 0 7 ) * * to -- tn in m ^-- PO n-- CO in -- CO -- -- r -- z r-- -- Pi 4T to co eh cm no ^ tt *--* i--' e-- CM -- --- to -- p- CO CM 44 X pi ^ IT) CO cm no CO Ol in CO SO o r-- no 4T 4 n-- -- * VO -- V -- *-- fe -- _ii o CM o P- CM pi oi co go in fl oi o CM ID CO w w w w' CM -- CM -- x i 1 i i CO CO ww 7) x l 1 i N vp -- to -- to -- 00 -- t l i PO CM CO CM Z or CM O XI 44 o CM C <0 OJ t3 Ol 4O4 X in _il Zl 4T O XI 4-> Zl Ol O XI *> -il Zl oX 44 .O -J V- O , L 0*J*0 4- 3-- Ol 01 *> VI -- e u in u Of 3 <o > C to 4- 01 w c >1-0. -- ** OIXO C OILJ C 1 LU -- CO -- CM -- l l i vo cm pi m Pi Pi '"f' *"* m -- 00 -- vb -- 1 l i m cm so in vo pi p-- ^ PI -- 1 l i in cm in hp>i Si> to -- Pi -- no -- l i no m- 01 CO in fi -- pi -- CM -- l l tn cm O P0 p- CM CO -- -- ^ -- V -- 1l m fi Ol w-- CO Pi -- CO r- ^ IP" ip CM --v ID -- CM -- -- in -- l -- vo PV in cm pi 4T CO -- Ol -- pi. -- CD -- l e-- CM CM ID o in o vo f in i oo in ^ n CM no *-- f-" --` ^ r-- co no -- s-- OO co in cm no -- vo -- nm CO CO P- ID -- f" 4 O co-- in cm CM -- Ol 1 Pi -- ^ r-- no cm CM -- CM --'' -- l CM ^o VO -- no in CO -- vo At Pi -- o pe n no '--' -- eo m -- f- co -- w* CM p- -- ip Pi -- no n cm -- r-- CM -- VO M- vo--* CM p,w' vo -- no-- r-- p* in -- n vo w eo m p-- n-- 00 wCO no ri so ,w' iCO 1-* *-- CM Pi r-- w' Ol S' 1 CM + O O o o in 44 4-> 44 44 44 CM O )-- o o in o CM C i0<O//))i! *n0->1 m Cl fc. c 0) cl i3) t 10 Ol Of 1/1 44 4n4 u 3 TJ M 01 O > CL 0L1 OXl 1/1 .0o 4w4i 0) *JC 0410 0*-1 3 JC iO 01 c <0o c . *- -C 0) 0> * >> l- 01 01 to I-- p-- .e 44 LD -- O0) E3f OoOo si-gi *031 Oi 4m4 4ID4 IoB Iofuf 4- 4. to f - Xcc CO Ol Ol X -f-fl/l 31 DTH 000012810 Standardized M o rta lity Ratios and Observed Deaths Due to Malignancies Among 9,677 Vinyl Chloride Workers by Duration o f Exposure, Years Since Exposure Began and Maximum Level o f Exposure(a) 40 o CO -- m lo in -- CO o-- e- CO a-- 40* -- -- in *-- PO rO-- CO r**- 4* Ok CO a- -- X r-- 4-> X o - _J X 4- LT CM X -J X MO CM o 4-> X o CVI -J X Oh 4- X in _J X X o -- J X Ok o +4 X LO _l X X . -J 8<* Uo 4OJ X>5t 4- 3 --*. cn 4-> in ^ c L.U) L 40 -a- 3 * > c t/1 4- fl> i- C O O >- 0) *m Cl *-- 4-> 1 X ^ C ftlUJ c *- CD LkJ oo CIDO --CM o --* m oo ^ f*. ^e-- 00 *-- co -- n a-- 00 V m --. CO CM i -- f-- in i ^ *-- CM O CM f-- w fM. -- l 1 1 --* o *-- 00 -- O l 1 -- aO-- CCMO W mO VCO 1--* CaM---w O l a-- m w 00 -- k in w i -- CM -- -- *-- 1 1 1 00 -- -- cm in pm m CM ' CM -- 1 i 1 1 o O w ^ f** -- in -- 1 i 1 SO CM !* r- 4T CO CM w " I i 1 oo rs. -- V CM 1CO --CM w* CM --. in -- k -- w1 i 1 a* a* Ok PO k m-w- 1 CO -- 4^ -- 1 -- i oo k CO a-- *>--' CO CO CO*--' Ok V a-- "w* 1 i r*. -- CM f~ CO i CM *-- in -- k m Ok -- CO CM cn ^ 00 -- 00 -- 1 -- 1 CTM~ -- r** cm *r co CM a-- *- CO -- -- CO -- 1 o o O CM o o oo l CM *--* CM -- *** *--' 1 -- --* o -- PO -- o cm cn 00 CM l k CM `--' 1 OO <w' __, o 'w' oo w i -- 00 CM OO w' 00--* aC*--M CO -- oo w CM -- M- CM oo w o-- r** r*. w' oo w oo oo 00 CM CO -- O wCM r^. ^ hs. co ^-- l CM J_L oo CO -- r** -- in CM m --* O PO Nw CO -- l a-- mw k --* O CM CM ' Cp -- GO CM oo u oo 00--* CM ^ CO *--- CO CO Ok --* in in a-- r**.-- CO CM ' CM --* CO a-- r^--* r*. in m-- in cm w' ^ CM --' CM -- o> r* Ok -- rs. ok o-- ^ CM -- CM l -- io -- *-- Ok -- k in -- N m* CM w' V Oh mj- Ok CM to o 4-> 4O-> o 4-> O 4-> CM 4-> o o in 1-- CM W iL 01 0> 01|/k r- C 0) u4-> co O) o. ^c 40 > O) 40tft 4-> .e u 40 * t3 *0) m > CL LX 0l/>1 4) O *i/->l 0) o> 1/1 ^ 3 -C ^e 10 * </> o * 40 E 85 TJ fei 8 8 -X os X- 32 DTH 000012811 Standardized M o rta lity Ratios and Observed Deaths Due to Malignancies o f the Digestive Organs and Peritoneum Among 9,677 Vinyl Chloride Workers by Duration o f Exposure, Years Since Exposure Began, and Maximum Level o f Exposure(a) T otal 0O0h ^CM in -- t--o --in OIDh --ID* V -- P*- SO PIDM --Oh CM = +> x -J z A CM X _J X +o) X Co\1 --J z Oh 4O- X id _J z eX -- z Oh oX 4-1 IT _J z 4o-> X A J oo ro-- r ^ o o ___ h- CM Oh -- M w-- --CM" CO -- 1*> 1-- ID -- --N ^ -- so Pm -- e-- ID i-- PM -- SO O 00 r* CO -- CM -- Oh -- CO CM 0- CM ID -- co Cr*M. --^ 1 1 1 1 ^co --p-* -- 5C 1 , 1 1 SO '"'wr I--D ---- _ 1 1 1 1 o _ J--__ - 1 1 1 oo 1 1 PM -- 1 oo 00 -- -- 'w' 1 1 1 o wo IFD" --*p---<r 00 ---- w 1 1 _ OG PCOM --w-- CmO F- mf CM CM w 1 1 oo w" O w> -- 4T ---- , I oo oo Oh -- ID -- CCOO ---- wr 1 _ oo oo--* 4^ w o w oo w' IC--DM M----F 1 iPns, ---- ^ --F-* CM w r** -- ID -- CM --ro 1 1^v oo f0P--O0 ----CM' FID-- --' ID -- so -- *w' IPDO --^ -- *--* o o o oo o oo w" --% oo o MoF oo CM -- o MoF ---- wCM so so -- CM o o ^. oo oo OPMh --CM PO -- ^ CM o CO *-- CM -- _ oo 'w' pm --*-- _ r-. -- CO**--' oo CM -- o 00 ID --F-- _ oo ID CO --co -- -----* -- CM POMh --SO >--8(*- .-coOACul v43>t-)s--tufl- 10 >u 4> ^ i--DCe- )3lC/XhL 40O- 1O0J >- w Oh 4o-> o o Oh o +J LD CM o +> CM + ID CM 4e- >--o 4 Ui C LU i --U. 2L </> tfl A) ft) in -- 4*. Ife m 4- o. 9 u**C* -4M> c Qi oQ. C o> si m O0)) f 10(/) 4-> 4- U *U S/i A) e > a. t. K Ot/> 0) .o 4- O va>) 6 a) C IS) ^ 3C -D --* -.C <0 E "3Xa> 5r48 33 DTH 000012812 c o IQ 3 > W k01- M L. O -s fc. r-* ch V O' z o p *o 01 c 03 IQ (A c IQ P <Q 0) 2" 0> 9 > 4A S- 04/1 K* ^O -o U1 od> viciC ic*" O V) Ip 10 ^Q 3I/) P t Cl . X o P O! O <0 p V . Duration o f Exposure (Years) 10 v--* CO -- CM--* CM Cm--* op V-- CM CO p^ m i O l ---- -- CM --V -- px 1-- p X IT) X CM p X CM oX p o CM p X X i p X oX p o p X oX VO p X oX --,, . w' w' CO -- ^ --* 4 --* C*. CO WK _^ 4 CO ^ *w c- oo CM -- p -- r** --- V CM CM -- r*. ^ cm 4 -- CO -- -- r*. N --* O LO CM -- CO CO N --. -- r-- ^ SO --* -- w' CM --* r-- w i i 1 1 oo oo w p- --* -- i i 1 1 1 CM 4 CM CM w CM hp _ i i 1 1 OG O CO--* cm--* 4 --* i i 1 4 r-- VO CM CO' CM w CM w ---- __ _ i i 1 o o oo 1 *p" --I. wi i 1 oo oo oo w' urn* _ ift--* -- i i Oo CO -- OG w *p CM -- i i " 4 4 -- O VO *--* L --' CM hp --* N -- --H i i o r*. co CO ^ ,w' ^ w' r-- ,w' --w OJo i oo CO i-- oo oo -- ,w' COW -- 'fc-' -- --* --* VO --* i oo CM -- ---- 4 e- CO "H-' CM s-> i o O o w* CO -- W> L o CM--* r-*. e-- -- o ,w' VO CM "-- _ oo o oo N --* -- CO w p --p o--* SO -- CO HP oo J--^ o o -- 00 --* -- CM w oo ^ --* CO CM o OO _ G VO -- -- O' CO CO W CO --> -- CO ------ oo o 1--* c** -- HP 00--* H r** cm w P CO CM hp CO CO -- H-- -- 4 -- *p C*H -- CO CO VO 4 o*- >* pop- p 9-- *3- c3> 01 p SA -- Li/i i. 40>W01 T*cc"- 9 . IQ /> P 01 OOP CL W o p o o p o O P 4 CM O P o 1 CM Po p *1 OIXT3 CM p c p i/i 0) 011/> IQ 0)4/1 -- JS P P IQ co 0) CL m fe01" g ^ 3ll/i 01 o > CL. fc. 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O Si " *De- S s 34 DTH 000012813 Standardized M o rta lity Ratios and Observed Deaths Due to Malignancies o f the Urinary Organs Among 9,677 Vinyl Chloride Workers by Duration o f Exposure, fears Since Exposure Began, and Maximum Level o f Exposure(a) S co--*-- O to VC CO _ _ _,_u Z oo oo o o at -- m ---* at --* 4-> o o o o CSI CNJ *-- CO o m -' -- CO---* CO --* _ o o co ^ o o o csi m in mw CSI w' wZ I i i 1 o o o -- in x 1 i i 1 o o cm 1 i i 1 o z 1 i i o o oo 'w' CNJ w wo 1 i i oo o o 4J o CVJ _l 1 i i o o z o IT) 1 1 1 _---- i o e o o o r-*> CO*-* i r**-- o o CM r-- CSJ W CM c-*--* ^* wi o o o o CO r- CNJ e-- CO - CSJ'--' Z 1 oo oo oo OO o O o --1 -- oo oo GO w' w' 1 oo oo o o Z o oo o oo oo oo at -- -- -- o oo oo oo oo oo oo +> *** m r**. o in *-- o w- ^ (Sjw CD <-->* in csj CSJ - Z o JQ oo oo oo oo oo oo oo o --* oo o o o O o CNJ m --o --> CM CO W r- -- CO CSJ CSI -- at-- in csi E O 4- O >s U 0*>tJ 4. 3 * at O) QJ 4-> 1/1 at CSi -- c s. m t- 4- 10 O ! 3 40 o o o o n jj > e U1 U- 4-> csi o t. e o o >- i-- 0) -- Q. w o in 5) X T3 CSI e oiu c ^ CD LU TJ O 4> CL 4-* C 1 1 CSJ m 4-> u> m 4) 4) IA -- 4- m 4C> o 0 4Q. *3 C 41 T- 4-> 4. CO 4J CL > 41 *- u o> Q) tC- o <0 Z 40 M U 40 41 4) 13 U 3 T5 i/ 41 O 4. X 4> 41 V) > +> 4) in **3 JZ UC o 5 o O 41 ^n C i 3 Z 4- f*- Z *, </> o 4-> 40 E 41 3 T3 *- "O w a? OE * 4) 6 4J e-- 3 II Z -z o z 35 DTH 000012814 IQ CM --* --* --* co ID--s fs. a-N 4*1 SD -- rv -- CO n o -- CM > ID IA 0) o 0> &u 11V) fc- o xu ax 01 >IA Q) u u**" ftj e o *o *M c IQ vioi oi 3 ^ IA 0) o > Q. 8 O <0 *- OI f (A i-- o <0 a. <M x i- ui o X +J X o t-- -J X IT) X CM -J X r (SI X S J X Ok X IT) J X OX o P" _J X oX ID _l X oX -D 8*. o as 1- *-> -D s- 3 -- +J (A -- C kvi u o f* 3 IQ > c IA 01 fc. c O O >" 01 f- CL **-- v O) X v UJ c UJ o o oo ID CO ro --' . -- ID 4Jf-- W' ID -- 1 1 o CM -- 1 1 r- -- qn --- CM *-- f-* f-- 1 1 -- CM CM f>s --* c-. v i i CO CM w --^ 4T _ oo Oi -- CO CM w S <n W --V -- _ o w' --* CO CM ___ 1 1 1 i OO oo " ^--* l 1 1 ^ ! eo 2t W CO w> j--, __ l 1 1 o oo oo ^0* m-- 1 1 Al a-- CM CM CO " i/--' ID*--' --. CO . 16 -- 1 1 CM -- -- CM CM *--* -- 1 1 o' gP SP iD -- CM CM^ 49* --* CM --^ l 1 gC lO CM w O CM cn W 4* Ww -- _ _-- 1 oo o O o oo *--* -- _ ID--* 1 o o *-- CO CM CO w' ' w CM -- l oo _ oo oo -- ,w' ID --' N *-- CM _ O w' oo w OO 'w' N __ oo w o oo CD p*ID w oo 1' LD--^ CO -- ^w CO CM ^ <w 1 -- --. 4 w oo CM o o _ oo --' _ oo *--' n--. -- CM ^ 00 --- *-- -- CM -- CM w ___ o gp P- -w- CO p-- w rv 4r " w oo oo o *-- oo CM -- " CM o o o O ID +J 4-> 4-> 4-> CM o ID CM 3 o & 5 ? C\J <e ia m a> o> 01IA fSIS gfe v a. o C 0) * 4-> 1. co oi a. ig gi1 A Ol O' (A 4-> <0M U<0 s g 3 *C (A 41 O > Cl W0) 0X1 (A XI 4- O (A 4> x u (A 3 II *o - <0 X IA <0 X I 36 DTH 000012815 Standardized M o rta lity Ratios and Observed Deaths Due to Leukemia and Aleukemia Among 9,677 V inyl C hloride Workers by D uration o f Exposure, Years Since Exposure Began, and Maximum Level o f Exposure(a) 40-0 O Vr*% **---* ^CM wc- O -- CCOD CM rC*O- ro --. ^ H X 4-> 1-- X --1 X tCoM X -J X CM oX 4-1 CM Iwf0OA1 --J X 0Y oX to --J X 4o-7 X o -J X 4J X to _J X 4t oX Xi -J wE o O 4-7 ->) -- *0 CC7I U3 (43/^> *--tA> <w0 <L>P. mC fCcC-D XL(OCUATL5DLOclfJ- ->WC*l c- CO o o o r-" -- oo o to-- CM ' OtoY*C--M1* CO o--* ro co ecog --e-*> i i o 1 1 rC-O1---- eg i i V r-* 1 I V CM _ O to _ _ i 1 i i o t 1 t _ oo o w' wo i 1 t w c\tDDowr*--^ _^ UO p-- uo ' __ i 1 i o --> w' ._. _^ i 1 o o i 1 CO -- o p-- CO '1W~' i 1 oo o oo w' w* w' i oo oo oo --_ ^1-- _ i oo o o G oo '--' t oo CM to oo oo o oo oo o 4CtoO^ --m- -- l--. oo oo oo o oo rt>o 1-- - rCsO, *--* oo . o to > CO w*--- o *w' oo oo #-- CM to --' oo _ o o o w _ oo w' sc CM **--' P-- co ^ *-- _ o wo c0o* --CM1 CTY 4J- Cl CM 4o-J o 4o7 o 4o- to 4o-> CM CtoM* 4-5 K- *3 t0A1 0o0i tA f-- to a. Ce- 40U->) CO o>> ao>. N- t- o0) ^ fr- to ^4llO-a> 4OOW-c>iI g 3 tA 0>1 oa. W0) X0) ->tA 4 (0A5 0)crn tA r- 3 JZ to B TO3i 5- fe I * ia -at X to -J* 37 DTH 000012816 Standardized M o rta lity Ratios and Observed Deaths Due to Lymphomas Among 9,677 Workers In Plants Producing V inyl C h lo rid e , by Duration o f Exposure, Years Since Exposure Began, and Maximum Level o f Exposure(a) T o ta l oo oo V OJ in -- CM Oh--* in c- CM -- - oo -- -- X oo oo oo o f m- -- CMw 00 -- o -- CO -- 4-> X oo CM u*h o --^ CM w- __ oo o _ r**. CM K-- CM me -- CD X in X CM .J X fsj oX o CM _J X oX 4-7 in _J X mr oX 4J O -- _J X Oh OX 4- in J X oX - _1 1 1 i I O w' w' u j-- _ 1 1 i 1 oo OO w' w' 1 1 i 1 oo oo --s -- 1 1 i o oo oo 1 1 i o oo o w' 1 1 i o r-- CM--* -- 1 1 oo oo in -- CO f-- mr w -- fO--* -- 1 1 oo o p -- CO -- CO **** -- w 1 1 o oo w' <w' ___ 1 o oo o o '-- ' 00 -- *--* -- 1 o CO -- oo r* co CM V Oh w oo w w 1 _ oo oo _ j--^ oo oo ^s oo w' o oo J--^ J--^ o oo o o o <WI' o %"'r CM -- o oo _ oo -- --* r-- CM'*' -- ns. cm ,, oo o o oo CD >-- o w' in --- m- o CO .-- ro -- CD -- .-- CM 8w H- so o 4-> > -O 3-- mr O 4-7 to Oh CM *-- c tin t ID f- 3 ID o o o <D O m 4-> > C V) H- O 4-> 4-> 4-> 4-> CM o w c O O >- H- O **- a, *-- o o m 4J > X -O CM C OILU C CO LU 0 X0a1 Q. CO eo oo. it ID O 10 4-> s t3 o o*3 1/1 >LOin. OQX. oO 4/1 c> -oo *u in o S --I g i *3on II * <C X m* -X Xoe * to _J 38 DTH 000012817 (/i U OJ .K ko. 3 Xo paa JoZ >> p4a0. Os I oe0c1 * PD 0V S' "0O) 0k3J >& VoI 0) Q. 40 K *<o"0u1 ec IB ID (O*0- 1u0. 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CO p x _ px p z IeDvj z X Ctl po z ofVJ --J z 0 PO z ID _J z V PO X o J z 0 po z ID --1 X po z XI *PP--18w>10c--1-* *--eOeec040*.e-4i)uPO0ttOCSXjo)LiTo*PUPOea30J5s---PiIttstBO.J o o COJ- CO ID r~. id GO ID CM --* CO ID CrC--MM ^f^-- 0rS. -e----G0O4 CIDM P` 0 ID 'w' - --* rO-- GO r. --- CO ID '-- P^. 0 ICDO CfsM. --COa O-- --CM 0ID --ID* GO CCMO 0 O wOr" I0D Ir-Da 1 1 l 1 CJ P- W ^ <w 1 1 l 1 _^ P* lf--a --- W' 1 1 l 1 ID CM BVCT --CM` t 1 l oo VIDC aCO-' 1 1 1 fp<--* GO CM Or% ^go* CO -- P^ 1o-- 1 1 l oo CM *-- 0 CO w' CPSO. w00 1 1 ID---ID *-- w' CM *-- CCOMM--'I--D*' CVOC --PSa w' 1 ID -- GO tC OIf--D --CCMM*> a--* CM f-- 0CM 1 1 (IDM<CO^ o01^I~D opa fr>-- PS --a --O VCOM 1 ^CCMO S--f--.** CCOM--CM* CM -- ^0 MVO-o oo ID --* ^0 1 C0CMM ----CM- CM #-- ----ID* IoD --*Vw^ 0 ID --- 0 ICDM 1 oo 'w' CO --*^ CM p-- srp-*- 0> -- 0> ID 'w' CCMM CM iC--M P---oo ,w' N --* I--D CM C<Oo --a Cf--O 0co GMO- --^ w' oo CPOs --CMa r>* *--% rv id r> e-- CM ID C--M OCM ID p- --CPO0s 6-- *> oo 0-s O __ ID e-- ^ CO ID -- CO*w< ICDO --^ FO-- ^CM *-' CO ID tt IcDo "S'* 0 --a o-- rs ^ CM --* ID ID CO ^*-- <oa~a fOa NImD*' ID ---* 0> CO ID * 0 r*** 0--^ O CO w ICDO --* 0-- GO 0 --CCOM^ w CO --a GO CO o 0 I--IDD w' 0 04 CM PO po PO po IC+DM PIoB o ID CoM P 40 10 IB 0> 01 40 4> P P IB <0 P CL d C 0/ -r- P k. co 0) a Oi 0) k k. O0> 0 to P JC IB PU -0o1 GuJ. 3 ^ 40 X) P O t0o> X 0) 0> 3 40 -- IB UC i6 *ooi f 04 P f- *- -r 4i W*uOSr- jC P ID * |EdO &l.s 3 II C *0 IB 0*U 40 -P*- -cxc x - --oc> lO J 40 39 DTH 000012818 Standardized M o rta lity Ratios and Observed Deaths Due to C irrh o s is o f the L iv e r Among 9,677 V inyl C hloride Workers by Duration o f Exposure, Years Since Exposure Began, and Maximum Level o f Exposure(a) - * * * V -- V0 -- co <-- 10 *--4 so 4-> oo IT) r-- CM m- so ^ f- CO i0 C 1-- - __ z oo oo oo oo oo o w- <w' m 10 ` 10 -e-H so 4J X oo oo Oi f-- O CM CO ^ r^. o 1-- 41 10 110 10 --4. CM --* CO --- _ o Oi 4-- oo 10 CM CO -- w x1 1 1 1 oo o 4^ 10 X 1 1 1 1 o oo CM _ _J 1 1 1 1 o z CM OX o CM _l z 1 oX L0 -J z E oX o -- 1 1 1 oo oo 4""` w -- m --. 1 1 1 oo ff> *-- -- 4--' e-- -- t 1 1 oo oo oo 4"'' 1 1 oo oo oo oo 4--'' 4--" -- so --4 co-^ 1 1 oo cn eg '4--' CM --** wm *W *--<* --- __ 1 1 oo oo oo o 4--' J_ ^ -- _ 1 oo oo oo oo o 4*-" 4--' ro ^ 1 oo O p- oo CM -- r- CM 4-'' co"--- 4--' _J z i eX IT) z OX - -J 1 oo '-- oo w oo w' oo w oo w' os *-- t-- w oo oo _ oo 10 m- _ o '--' oo oo 4--*' 1o o * oo 4--' oo o oo oo oo oo 'w" CO CM r*. cm _ oo w' oo oo ,w' -- oo oo oo oo 4--' oo 4--" oo L0 --** so -- f-- *-- CO 4-- oo CO --- CO --K oo CO 4- k o 4- >1 49) --C 3 '-- --> lO > 1 CM 40 * 3 40 V) (U i- c > o 4-> 4o-> o 4-> o CM 41 . --' 4-> > X * o o c uuj e o CM i-4 CD UJ .Ol0c/1ll 01 +> 4-> 1C eQ. oe*- 4o->i eo> Uo. e (0 1 z"*M(0-O>1 jtuel Ok3.) TO>t>-) OOx. 01 01 (f) oO 4J 01 15 oi C (ft c . V- ^ 4) 01 X U 0>1 >0> (A J4-Z> -10 -- Si -*-00 fell! H- <M 4- X 4-> 4-> OI o *o - o u in * A*. -o; x cotoci x L0 _J GO 10 40 DTH 000012819 C kO at a. X UJ k01 k 4-> *O0-) p--- >0) o> **- *1 xto; -o 4J c 0 IB 5. *D 1c0 >OJ 01 et1kt0t CO 0> oo. X Of tS) >5 S'* 3 *T3 (O 0> O N Q. X *0 UJ k 4-o O e >> * * ft + -- -- <0 00 SO *-- so os CM ^ 4- la as CO CM r*. r- ps. N o -- t-- X CM *-- oo r-fc -- LA IA -- SP fN. -- r*. CM * ** rs. v &-- -- ^-- *-- -- LA * p-* CM 4-> X o o LA CM >ft * ph CM -- -- ft -- _l G SO CM r- rv P-> CM w __ x i 1 l 1 w' _ X i 1 1 1 o o CM J 1 1 1 t X CM eX 4-> o CM J X oX 4J LA ** --I X OX -4-> o P" _J X OS oX +> tr> -J X oX +j .c --J I. o >> k o M t? 4- 3 --. CD at 4-> V) --c co u C 1- 3 *0 > c to m- at k c O o >- at i- a. *-> Ol X "D c at uj c --< CO UJ l 1 1 -- p- ^p --. -- l 1 1 Sm* h* -- -- P**--* i 1 1 fo. p-- ^ w PH --* P* -- i 1 O PN, ^ o ^ **** -- W' '"p' SO -- P--P-- 1 1 o oo ^ p* F* " ^"p **P -- --. 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CM -- ^ LA to--. -- r*. -- la --s -- LA CM p-- '' <D CO fv. ***^ -- P^ CM ft P*-. p-- OS Os H- o o O O tA 4-> 4-> 4-> +-> 4- o o tA o t-- CM g k & ko ftiou k *o 5S k 0c) oa e g&0) tO 4-> (0 4-> W 1Q0J 0> 3O k *3 to Q>J Oa. k01 aX; to X> 4-> o0 to 40301* .*c" r "O > 0) .C 41 QJ >> k at 0) O p- -- -o4o) E5*- o o k at at at O E -C -C 3 II C C x --Of cr> OS t/> --j t/> to 41 DTH 000012820 O CVJ CD CO o VO i-- o O r-- VO CM VO 00 VO LD VO 00 LD 00 00 *3" r-- o o lo ^ 42 *0" CM * 1 LO CD LO CM 00 r-- r-x CO -- CD ^ o i-- r*x. r> VO CO Observed/Expected Deaths fo r Selected Causes o f Death in 9,677 V inyl Chloride Workers Grouped by Total Integrated Dose(a) CD r-- O <- CD 010 o <D r-- L^O r\-- 'x*.. o CO O') o CO LO CD CD CM I o o> o CVJ tOo O "O CD CD P CD fLO. r-- I CD o CL) o P E CD f-- r-- CM VO VO f-- CM O CO f-- o 00 oo vo vo cm 00 rO LO P oO CD rj- VO I vo CM O If) CD CM CM CD CO CD <3- 00 3" 00 1 CM CM '--, M r* r-. oo CO VO CM r-- CM CO CO 1 CO vo O CM O CM LD O r-- f-- VO C"*. r-- r-- CD CD *3" CM r-- 00 r-- CM f*-. CM CM CM CD CD VD LO -- r-- ^ CM r-- CM 00 CD -- O VO I-- r-- r^. CD LO CM r^. -- p-- 00 CO I-- co -- cm CM O CM VO CO CO vo r- ^ r-- CO CO O i-- p-- CM r- LO CM CO M *sxs. M rx. 00 o ^ CSJ CM CM i-- CD O VO CO Or-VO CO LO CO r- LO VO MW * 1-- CO CD LO CO VO r> vo -- o co CO vo co S, M M. VO 1-- CM VO CM 00 00 o CM CM CD * r-- CD VO VO CD vo lo r-x. *3* LO 00 LO LO CM O *53- X^, ^ X^ * * O CM 1-- CM LO CD ^ CM 00 CO r-- ^3" CO LO CD VO r-x lo O O 00 fM MMM * * CD ^ CO CM VO LO CM 00 ' CD Lf) fM CM 00 CO o 03 r-x. 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CM to 03 s- o -- X) 03 q: z E P LO 3 03 CD oo CX Cx. rt3 X) o DTH 000012821 Standardized M o rta lity Ratios fo r Selected Causes o f Death in 9,677 Vinyl Chloride Workers Grouped by Total Integrated Dose(a) + o o oo cvvoj oooo to c rotnr* M00 OOJpCN-J * * LO ON csj a> oo oo on LO 43 U1 ON OO O 00 o on oo o o oo CNJ oo oo o SOLD OO CO cn oo cn -- CNJ * iO OO LO r- fS CO LO O LO LO r-- r-- LD LOn LO on ON CNJ o o OCtOnD CNJ "D OJ Oi Or ro i- i a;CD o o p-- r*-. f-- on CNJ CVJ CD ON 00 o o CNJ LO Lr--O 00 CO CNJ 00 cnj r^. CNJ r-- r-- CNJ CNJ t-- CNJ r-- LO O LO 00 on o LO ^ p^ ^p r-- * ONN CO CNJ CO CNJ r-- CNJ LO o ON * t-- l-- +* cn oo OON r-- LO LO CNJ o s ** CNJ LO CM on Or oo LO i oo <-- CNJ O CNJ LO 00 LO o r-- 00 CD oo CNJ CO LO LO r-- i-- CNJ i-- * LO CNJ rs co oo r^ LO OO OO p # CNJ LO CVJ * on * *3" 00 r- l LO 00 CNJ CVJ r-- * on o ON i-- f" rs. n p- n CNJ ** *** lo m n P^. 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Q. 1 CL 1 CL 1 0-4- ro O r- 1 -C 0X0 O OOOOOO-I- 0 30 <D M in CD C CD "O CD lO QJN 0)00 (U UT3 CVJ u CO > tn rO 0) C V> C C C r-- C r-- C f" C <D C <n CO r- O) <D r- S- ro ON s^ s.*!' s*" Q, ro ro -- tn Q UP (0D LO 4-) +j +j 4-> tn tn > 3 C C -C c to C E c on c wn c: c rO rO O tn 4- ro 4- ro ro O. ro C ro CD ro C ro C (O 3 r-- E *r~ QJ OO O cn C C C ro o c P C ro C ro C E o -o i/i a- 0> ON ON "O ON ON LO ON V) O) ON ON Q) ON "O <D -C s- ro ON cn %. (D in i- -1- C -r- >.r- -r- S- -r- C -X Q- ro OJ 1 r- CD cn 3 r" p * r" o r-- tn i-- O i-- O -- ro 3 E o tn cvj cn JC 3 ro ro ro ro ro r0 ro ro CD r ON O 4-> rO OSS s S T S S -J -J S- "O Lf) -C o O F--* o s*ro i. 1-- re p- r- c -a: 2C o <c tn S. <o <D >5 tn 1 S- c 0) o J* tn So a> 3 o. 4- 4OO s- ia> <D JO XI EE 33 z: Z CD > LO C LO 5Oc IO--N ^c xCD: 3 4-> -C c +-> *r- p- t-- QJ QJ 5 cn > > QJ CD <D tn *r-- x: s- 4-> O LO ro ONO O CD QJ "O 4-> o O ro S- O OJ 0) o sz JZ 4- QJ 4-> 4-> +> TJ rO 4J 4-> OJ O ro ro 4-) *r- cn T3 4-> 4-> 3 C C C. TT) - ro ro "O O O ro tn p~ r~ S- 4~ 4- cn Qj r r-- - -Q C C E ON ON 2: 3 r- r~ cn z cn tn -k ro -Q K * dTH 000012822 44 Table 20 Observed and Expected Deaths and Standardized Mortality Ratios for Selected Causes of Death Among Vinyl Chloride Workers with Medium or High Exposures* in Plants Producing Only PVC and Whose First Exposure to VC Began 20 or More Years Before the End of the Study Cause of Death , with ICD Number1 Deaths Observed/Expected All Causes All malignancies (140-205) Malignant neoplasms of buccal cavity and pharynx (140-148) Malignant neoplasms of digestive organs and peritoneum (150-159) Malignant neoplasms, respiratory system (160-164) Malignant neoplasm genital organs (170-179) Malignant neoplasm, urinary organs (180-181) Malignant neoplasms, other and unspecified sites Leukemia and aleukemia (204) Lymphomas (200-203, 205) Major cardiovascular and renal disease (330-334, 400-468, 592-594) Cirrhosis of liver (581) All other causes 210/249.27 46/ 46.04 1/ 1.73 9/ 13.63 17/ 14.75 1/ 2.23 2/ 2.30 10/ 6.33 2/ 1.97 4/ 3.10 104/127.54 6/ 7.95 43/ 67.74 SMR2 84** 106 61 70 122 47 92 167 107 136 86 80 67** 1 Numbers indicate categories in the 1955 edition of the International Classification of Disease 2 * SMR's adjusted for deaths with unknown cause, i.e. no death certificate Significant at the 0.05 level Significant at the 0.01 level DTH 000012323 >> alO to to o Q) t OJ I 4-> >- >- 3 <C to to qj o a> >- z > id <D +J id r4- 44 SQJ o x: 44 to id QJ cn o id to c to o <d oc OJ c> id C3 r- to r-- id CQ _c "O +-> c id <d o> o io 0J to o 3 .c id 44 o CM 4- 0) to .o id to <d 4- 0) EOU CL 3 3 O r-- tO OJ r- 0) O z x > a. id aj x 44 Z --J UJ c id c "D O) ro E 0)0 z i- *r- J-- t-- a; o3 44 -O Qj to aj 3 sz to o 44 o c a. lO o x XT s: ixj +4 rd at 44 -C o Id 44 id QJ Qj DlQ < 4o x: +3 CL) <d 44 a) oid o QJ 0) S- +J i- id 3= Q "O 3O 44 3 in to JZ 44 c to CSJ 4-> %____ c id o CO c r-- U VJ- a) Id > O -r- r-- id a) cz i O 4-- a o x id id X) o 0) c N *ii- V r- S-. id id &_ u 0) c a> o to -C 44 c o u 0) > 4O a> X) o -M _C a> p" s~ id O u iid to o *rCO c < to sz 44 c g to ^--< =x u Id rL. 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Z ra o E EE 3 3 3 3 3 33 o F o F* oO -J TD -J "O TO _J _l <D <D 0) Z s: z 3 o in to CO 00 00 *d- i-- CO r^v CSJ to CSJ 00 o CSJ LT) 00 00 CD fH f( iH CD CSJ to 1--1 00 o os O to CO Lf> LT> to tn LD 00 o CSI os m 00 o CSi o OS to to LO to to to i1 1 i 1--1 CSJ 1--1 CO co to CSJ f--1 *--1 o CSJ 1 oo CO CO CO to LO to 111 1 00 fH co 00 to to i o i-- i--i CO to s*. CSJ co o CO 3O os os to to OS PZ o co in to 00 r^. o 00 CSJ to to to 00 Os < CSJ fH CO c Duration of illn e s s as shown on death c e rtific a te s is given in parentheses. 46 to DTH 000012825 >i la a. o p 3 cC ro a> p fO u *n P p* P P o o -C p ro 0) o LA oc Po r CO c <D XJ > a; p p- o P p LA CJ ro 0) CL x: 4/) P c ro ZD d) O XJ cP ro O P 0) d) to -C 3 P ro OO oo P <\j O Q> CO r-- E .0 to ITS CO H- 1-- _ P CU Q. 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O CC VC r>. i-H p 00 CO CD <0- r--t o O) cc CO o p co 00 CO CO LO LO p p CM 00 CM r^v c r*- i i1i CO m CM 00 CD P CD LO 00 CM LO LO 00 i 00 rP p <D p LO o CO CO CM CM p P r*^ CM CC CO co CO CD CO p CC CC LO 11 CO 1 P rP CM CO rH P LA (1) CO d) JZ p c flj p ro Q. c p c CU > r O) LA LA d) P ro U -- Pp> P P CJ o XT P ro d) XJ c o f5 o LA LO fO CO CO CJ c oo r^. LO LO co CO i i1i CM 00 00 o O P pp O o CC CO CO LO o *5d- CO 00 rv CD CM CO CO CM r>s CM co CM i1 I LO CM CD CO o CC D) 00 o CO 00 CM LO in p o c o p ro P 3 o ro DTH 00001282f >i o I Iz O l/l Z >0) l o c 48 oo zz </> o >0-J z Glioblastoma multiforme (brain tumor) (8 months) QJ k ro CJ r- k n k k O) o x 4-> ro <D o t/> C QJ o k r* c uo CU > "O r-- cu cd k (/> ro cj 0J X Q. 4-> l/l rO c k 1o ro Ovl to E O) to (O 4- CU X r-- EOk rO CL 3 3 k- O Er- W O) - 0) o X > CL rO 0> X1 k s: -j uj C ro C "O CD 1 (D r-- Q) k ro f- E X k <o r DO -- |-- <1> o k -o 0> </> a> 3 X to o -k o C Q. 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L.: Standard error of the age-adjusted death rate. Vital Statistics Special Reports, 47: 275-285, 1961. Creech, J. L. and M. N. Johnson: Angiosarcoma of liver in the manufacture of polyvinyl chloride. J. Occup. Med., 16: 150-151, 1974. Fox, A. J. and P. F. Collier: Mortality experience of workers exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain. Br. J. Industrial Medicine, 34, 1-10, 1977. Gaffey, W. R.: A critique of the standardized mortality ratio. J. Occup. Med., 18: 157-160, 1976. Lloyd, J. W.: All you ever wanted to know about SMRs but were afraid to ask. J. Occup. Med., 18 (3): 149, 1976. McMichael, A. J.: Standardized Mortality Ratios and the "Healthy worker effect": Scratching beneath the surface. J. Occup. Med., 18 (3): 165-168, 1976. Tabershaw, I. R. and W. R. Gaffey: Mortality study of workers in the manufacture of vinyl chloride and its polymers. J. Occup. Med., 15: 509-518, 1974. Waxweiler, R. 0., W. Stringer, J. K. Wagoner and J. Jones: Neoplastic risk among workers exposed to vinyl chloride. Ann. N.Y. Acad. Sci., 271: 40-48, 1976. DTH 000012828