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DEPARTMENT OF HEALTH
____________________________________________________________________________
Pathology Division Report:
Demographic Data and Disease Rates for
January - December 1998
Dr Jill Murray Lizet Coetzee
NATIONAL CENTRE FOR OCCUPATIONAL HEALTH
NCOH Report
P O Box 4788 JOHANNESBURG 2000
TABLE OF CONTENTS
Executive Summary
Section 1: Introduction
Section 2: Data Description Distribution of autopsies by year & ethnic group (1975-1998) Number of autopsies by age & ethnic group (1998) Distribution of autopsies (%) by age & year of autopsy (1975-1998)
-for black miners -for white miners Number of autopsies by type & ethnic group (1998) Number of autopsies by industry & ethnic group (1998) Number of autopsies by years of service & ethnic group (1998) Mean duration of service and mean age by type of mine & ethnic group (1998)
Section 3: Active Tuberculosis Distribution of active tuberculosis by anatomical site (1998) Number and prevalence of pulmonary tuberculosis by age & ethnic group(1998) Number and prevalence of pulmonary tuberculosis by industry & ethnicgroup(1998) Prevalence rates of pulmonary tuberculosis from 1975-1998
Section 4: Silicosis Number and prevalence of silicosis by age & ethnic group (1998) Number and prevalence of silicosis by industry & ethnic group (1998) Prevalence ratesof silicosis from 1975-1998
Section 5: Massive Fibrosis, Coal Workers' Pneumoconiosis, Mixed dust Fibrosis & Asbestosis
Number and prevalence of asbestosis by age & ethnic group (1998)
Section 6: Emphysema Number and prevalence of emphysema by age & ethnic group (1998) Number and prevalence of emphysema by industry & ethnic group (1998)
Section 7: Mesothelioma Number of mesothelioma cases by age & ethnic group (1998) Number of mesothelioma cases by industry & ethnic group (1998)
Section 8: Primary Lung Cancer Number and prevalence of primary lung cancer by age & ethnic group (1998) Number and prevalence of primary lung cancer by industry & ethnic group(1998)
Section 9: Causes of death Causes of death by ethnic group (1998)
Appendix: Distribution of autopsies according to the last mine the deceased worked at
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5 6 7 7 8 8 9 10
11
12 13 13 14
15 16 16
17 18
19 20
21 21
22 23
24
25
2
EXECUTIVE SUMMARY
South African law requires the examination of the cardiorespiratory organs of deceased miners and ex-miners for compensation purposes, provided the next of kin agrees. These examinations are performed at the National Centre for Occupational Health (NCOH) and the findings are recorded on a computerized database (PATHAUT). This database is unique and provides an important resource for surveillance and research. During 1998, 2880 cases came to autopsy at the NCOH. Of these, 68.65% were black men, 29.03% whites, 1.7% coloureds, 0.03% Indian and 0.59% were submitted without information on the ethnic group. Overall disease rates (per 1000 cases) for 1998 are as follows:
Emphysema (198/1000) n Silicosis (157/1000) Tuberculosis (149/1000) Primary lung cancer (29/1000) Asbestosis (18/1000) Massive fibrosis (9/1000) Mesothelioma (7/1000) Coal Workers' pneumoconiosis (4/1000) Mixed dust pneumoconiosis (4/1000)
The rate of pulmonary tuberculosis for all commodity groups has increased markedly since 1990
The rate of silicosis is unchanged since 1975
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SECTION 1 - INTRODUCTION
The Pathology Department of the National Centre for Occupational Health (NCOH) provides an autopsy service for miners and ex-miners to determine the presence of occupational lung disease. Under the Occupational Diseases in Mines and Works Act (ODMWA, 1973) it is obligatory for the last attending doctor to remove the cardiorespiratory organs and send them for examination provided the next of kin agrees. A detailed report of each case is sent to the Medical Bureau for Occupational Diseases (MBOD). Cases certified as having a compensatable disease are then referred to the Compensation Commissioner's office, where payment of compensation is managed.
Since 1975 the pathological findings have been recorded on the PATHAUT database which is a unique computerized source of information for research. PATHAUT combines data from autopsy summary sheets and clinical files (including occupational histories) onto a single database. The structure of this database was changed in 1995/1996 and new programs were written, upgrading and enhancing the existing database by improving the quality of the system and making better use of existing data (SIMRAC Project GEN509). This is the second of the new format reports and describes autopsy cases examined during 1998, and presents disease rates from 1975-1998.
Data from PATHAUT are exported into the Statistical Analysis System (SAS System) where programs have been written using the Structured Query Language (SQL) permitting the user to analyze data on the SAS System related to any aspect of the PATHAUT database. During 1998 this was done for the 1975-1995 database, converting these data to a similar format as the current PATHAUT database.
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SECTION 2 - DATA DESCRIPTION
The number of autopsies performed since 1975 is presented in Table 2-1. The numbers shown in the 1997 report have been updated because the 1975-1995 database can now be accessed using the SAS system.
TABLE 2-1 DISTRIBUTION OF AUTOPSIES BY YEAR & ETHNIC GROUP (1975-1998)
Year of
Black
White
Coloured
autopsy
N %N
%N
%
1975
2190 71 854 28 32 1
1976
2335 68 1072
31
27
1
1977
2351 69 1039
30
33
1
1978
2245 67 1090
32
32
1
1979
2118 66 1026
33
45
1
1980
2338 64 1274
35
46
1
1981
2209 66 1117
33
33
1
1982
2312 63 1302
36
44
1
1983
2096 65 1109
34
41
1
1984
1966 64 1098
35
28
1
1985
2275 64 1200
34
66
2
1986
2456 68 1125
31
45
1
1987
2594 68 1168
30
78
2
1988
2518 67 1165
31
77
2
1989
2138 65 1090
33
60
2
1990
2172 64 1155
34
51
2
1991
2143 65 1080
33
66
2
1992
2144 66 1049
32
70
2
1993
1863 65 956 33 65 2
1994
1737 61
1021
36
94
3
1995
2830 71
1059
27
99
2
1996*
766 68 329 29 19 2
1997
2223 69 897 28 70 2
1998
1977 68 836 29 49 2
TOTAL 51 996 66 25 111 32 1 270 * Data for only 6 months are availab e for this year
1.6
Indian N%
1 0.03 1 0.001
Unknown N%
14 1 18 1 17 1 49 0.06
Total N
3076 3434 3423 3367 3189 3658 3359 3658 3246 3092 3541 3626 3840 3760 3288 3378 3289 3263 2884 2852 3988 1128 3208 2880 78 427
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It is important to note that there is a referral bias in that black men are infrequently autopsied after leaving employment in the mines, whereas the majority of whites come to autopsy after retirement.
The age distribution of autopsies for 1998 is shown in Table 2-2 and Fig 2-1.
TABLE 2-2 NUMBERS OF AUTOPSIES BY AGE & ETHNIC GROUP (1998)
Age group Black
White
Coloured Indian
Unknown All races
N
%N
%N
%N % N % N
%
0-19
4
0.2 0
0.0 0
0.0 0 0.0 0 0.0 4 0.1
20-29
123 6.2 22 2.6 1
2.0 0 0.0
0 0.0
146 5.1
30-39
644 32.6 52 6.2 2
4.1 1 100.0
0 0.0
699 24.3
40-49
704 35.6 86 10.3 7 14.3 0 0.0
0 0.0
797 27.7
50-59
290 14.7 164 19.6
14 28.6 0 0.0
0 0.0
468 16.3
60-69
32
1.6 248 29.7
14 28.6 0 0.0
0 0.0
294 10.2
70-79
3
0.2 183 21.9 7 14.3 0 0.0
0 0.0
193 6.7
80-89
1
0.1 73 8.7 3
6.1 0 0.0
0 0.0
77 2.7
90+
1
0.1 3
0.4 1
2.0 0 0.0 0 0.0 5 0.2
Unknown
175 8.9 5
0.6 0
0.0 0 0.0
17 100
197 6.8
Total
1977 100 836 100
49 100 1 100
17 100
2880 100
FIG 2-1 DISTRIBUTION OF AUTOPSIES BY AGE & ETHNIC GROUP(1998)
800
700
600
500
^F=o 400
n0) E3
300
200
L L L Hi100
0
0-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89
Agegroup
90+
Black White Coloured
In 1998 the mean age for black miners was 37.9 years and for white miners 61.3 years. The difference in autopsy distribution by age over the period 1975-1998 is illustrated in Table 2-3 and in Figures 2-2 and 2-3 this distribution is shown for black and white miners. The
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proportion of miners younger than 30 years decreased from 27.1% ('75-'77) to 6.2% ('96 '98).
TABLE 2-3 DISTRIBUTION OF AUTOPSIES (%) BY AGE & YEAR OF AUTOPSY (1975-1998)
Year of autopsy
'75-'77
Age at
Death
0-19
2.8
20-29
24.3
30-39
19.3
40-49
17.7
50-59
14.8
60-69
13.8
70-79
5.7
80+ 1.6
'78-'80
1.5 23.4 19.4 16.9 15.1 14.6
7.1 2.0
00
0 c
'84-'86 '87-'89 '90-'92 '93-'95
Proportion of miners (%)
0.9 0.4 0.4 0.1 23.6 22.8 19.0 13.1 19.7 20.0 22.5 24.3 16.1 16.5 17.3 19.0 14.8 15.1 15.6 16.6 15.0 14.0 12.6 13.1
8.3 9.4 10.0 10.6 1.6 1.7 2.7 3.3
0.1 7.8 24.4 22.4 18.2 12.4 10.3 4.3
'96-'98
0.2 6.0 23.1 26.7 16.8 10.0 6.6 3.2
FIG 2-2
DISTRIBUTION OF AUTOPSIES BY AGE OVER TIME FOR BLACK MINERS
1JrJi
J1iJ1
i u
H
Li
b
t
75-77
78-80
81-83
84-86
87-89
90-92
93-95
96-98
Time
0-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
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FIG 2-3
DISTRIBUTION OF AUTOPSIES BY AGE OVER TIME FOR WHITE MINERS
75-77
78-80
81-83
84-86
87-89
Time
90-92
93-95
0-19 20-29 30-39 40-49 50-59 60-69 70-79 80+ T '
96-98
The pathologists at the NCOH perform 2 types of examinations. For men dying distant from Johannesburg, the cardiorespiratory organs are removed locally, preserved in formalin and sent to the NCOH. Full autopsies are undertaken on men who die close to Johannesburg.
Table 2-4 presents the distribution of autopsies by ethnic group for 1998. Autopsies of cardiorespiratory organs only comprised 92% of examinations.
TABLE 2-4 NUMBER OF AUTOPSIES BY TYPE & ETHNIC GROUP (1998)
Cardiorespiratory organs only Full autopsy
TOTAL
Black N%
White Coloured N %N%
Indian N%
1932 98 656 79 48 98 1
45 2 180 21 1 2 0
1977
836
49
1
100 0
Unknown N%
17 100 00
17
TOTAL N%
2654 226
2880
92 8
Table 2-5 and Figure 2-4 show the distribution of autopsies by industry and ethnic group for 1998. The majority of miners were from the gold mining industry (77%). Coloured miners comprised 81% of the 84 cases from asbestos mines.
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TABLE 2-5 NUMBER OF AUTOPSIES BY INDUSTRY & ETHNIC GROUP
Gold Coal Platinum Asbestos Diamond Copper Iscor Other Unknown
Total
(1998)
Black
N%
1587 80
80.3 4.0
188 9.5
20 1.0
13 0.7
4 0.2
4 0.2
18 0.9
63 3.2
1977
100
White N%
600 71.8 54 6.5 40 4.8 24 2.9 10 1.2 18 2.2 38 4.5 19 2.3 33 3.9
836 100
Coloured N%
1 2.0 0 0.0 0 0.0 40 81.6 2 4.1 4 8.2 1 2.0 1 2.0 0 0.0 49 100
Indian N%
1 100 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 100
Unknown N%
0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 17 100 17 100
TOTAL N%
2189 76.9 134 4.7 228 8.0 84 3.0 25 0.9 26 0.9 43 1.5 38 1.3 113 2.8
2880 100
FIG 2-4
DISTRIBUTION OF AUTOPSIES BY INDUSTRY & ETHNIC GROUP (1998)
Black
White
%
Coloured
0
Gold Coal Platinum Asbestos Other*
* Includes copper, diamond, quarry, silica (silicon smelters), manganese, tin, zinc, minerals, chrome and iron as well as cases where information about type of mining is missing
Detailed information about the years in mining service by ethnic group is given in Table 2-6. This is also presented in Fig 2-5. Cases are categorized according to the industry in which most years of service occurred. It is important to note the large percentage of cases with missing information on the duration of service (43%), which is a reflection of the poor quality of the data provided by the mines.
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TABLE 2-6 NUMBER OF AUTOPSIES BY YEARS OF SERVICE & ETHNIC
<1 1-5 6-10 11-15 16-20 21-25 26-30 31 + Missing
Total
GROUP( 998)
Black
White
N%
N%
29 1.5
9 1.1
132 6.7 64
7.7
168 8.5 66
7.9
231 11.7 77
9.2
272 13.8 96 11.5
69 3.5 84 10.0
30 1.5 81
9.7
9 0.5 170 20.3
1037 52.5 189 22.6
1977 100 836 100
Coloured N%
0 0.0 9 18.4 8 16.3 9 18.4 2 4.1 3 6.1 2 4.1 0 0.0 16 32.7 49 100
Indian N%
0 0.0 1 100 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 100
Unknown N%
0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 17 100 17
TOTAL N%
38 1.3 206 7.2 242 8.5 317 11.1 370 13.0 156 5.5 113 4.0 179 6.3 1259 43.0 2880 100
FIG 2-5 DISTRIBUTION OF AUTOPSIES BY YEARS OF SERVICE & ETHNIC GROUP (1998)
Black
White
<1 m-5 D6-10 D11-15 16-20 D21-25 D26-30 D31 +
10
The mean duration of service & age by mining type and ethnic group is shown in Table 2-7.
TABLE 2-7: MEAN DURATION OF SERVICE AND MEAN AGE BY MINE TYPE & ETHNIC GROUP (1998)
Minetype N
Black
Age
Service
Mean SD Mean SD
Gold
1587 37.2 14.3
Coal
80 40.5 11.4
Platinum
188 42.9 11.4
Asbestos
20
51.3 13.5
Diamond
13
37.3 18.5
Copper
4
51.0 14.4
Iscor
4 48.5 13.5
Other
18 48.3 10.5
Unknown 63
28.6 21.3
Total
1977
*Duration of service not known
13.7 15.0 10.5
7.1 13.0 0.0* 0.0 * 17.8 0.0
7.0 7.9 6.1 6.9 9.9 0.0 0.0 6.4 0.0
N
600 54 40 24 10 18 38 19 33 836
White
Age
Service
Mean SD Mean SD
62.2 14.8 22.9 12.1
54.3 18.3 20.7
9.8
59.2 13.4 15.5
9.8
63.0 7.9 12.7 8.8
59.5 14.3 18.3 12.1
61.9 12.7 19.7
7.9
57.6 11.2 17.8 11.7
59.3 17.5 16.9 11.2
61.6 19.2 0.0
0.0
11
TABLE 3-1 NUMBER & PREVALENCE OF ACTIVE PTB BY AGE & ETHNIC GROUP (1998)
Age group
Black
White
Coloured
Unknown
Total
N Rate N Rate N Rate N Rate
N Rate
20-29
23 187 0
00
00
0 23 157
30-39
131 203 1
19 0
00
0 132 189
40-49
145 206 0
01
143 0
0 146 183
50-59
53 183 7 43 2
143 0
0 62 132
60-69
5 156 7 28 0
00
0 12 41
70-79
1 333* 3 16 0
0 0 0 4 21
80-89
1 1000* 1
14 0
0 0 0 2 26
Missing
48 274 0
00
0 1 59 49 249
TOTAL
407 206 19 23 3
61 1
59 430 149
Rate per 1000; `because of small number of cases in denominator these rates may not be reliable;
Denominator: All autopsies in specific age group for specific ethnic group
The distribution of active PTB cases by industry is shown in Table 3-2. 87.4% of active PTB cases came from the gold mining industry (77% of all autopsy cases came from that industry).
TABLE 3-2 NUMBER & PREVALENCE OF ACTIVE PTB BY INDUSTRY &
ETHNIC GROUP (1998)
Industry
Black
White
Coloured
Unknown
Total
N Rate N Rate
N Rate
N Rate N Rate
Gold Coal Platinum Asbestos Iscor Diamond Unknown
361 227 14
8 100
0
21 112
1
5 250
2
1 250
0
0 01
11 175
1
23 1 00
25 0 83 2
00 100 0
30 0
1000* 0 0
50 0 0 0
0 0 0 0 0 0 1
0 376 172 0 8 60 0 22 96 0 9 107 0 1 23 0 1 40 59 13 27
TOTAL
407 206 19
23 3
61 1
59 430 149
Rate per 1000; `because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in a specific industry for specific ethnic group
13
The prevalence for PTB from 1975-1998 is presented in Fig 3-3. There was a gradual increase in the prevalence (per 1000) for PTB from 33 in 1975 to 50 in 1990 and a marked increase to 149.3 in 1998.
Note:: Rates for 1996 were calculated from data for approximately 6 months
Rate/1000
Fig 3-3 Rates of PTB from 1975-1998
160
/140 J120 /100
f
/80
60
40
-
20
K-*-
0
to fs o>
<0 to fs o>
05 to fs
fs fs fs 00 00 00 00 00 O) O) O) O)
o> o> o> o> O) O) O) O) O) O) O) O)
Year
14
SECTION 4 - SILICOSIS
Silicotic nodules were found in the lungs in 452 cases (16% of all autopsies). 91% of these cases came from the gold mining industry. Of all cases of silicosis, occasional silicotic nodules were found in 39%, a few in 20%, a moderate number in 25% and a large number in 16%.
The age distribution of cases with silicosis (Table 4-1) differed between ethnic groups. No clear trend was evident for increasing age and increasing rates of silicosis in black miners. One explanation is that relatively few older black miners who have retired came to autopsy.
TABLE 4-1 NUMBER & PREVALENCE OF SILICOSIS BY AGE & ETHNIC GROUP (1998)
Age group
Black
White
Unknown
Total
N Rate N Rate
N Rate
N Rate
30-39
42 65 2 38 0
0 44 63
40-49
158 224 8 93 0
0 166 208
50-59
78 269 25 152 0
0 103 220
60-69
7 219 43 235 0
0 50 170
70-79
0 0 37 202 0 0 37 192
80-89
1 1000* 22 301 0
0 23 299
90+ 0 0 3 1000* 0 0 3 600*
Missing
23 131
2 400* 1
59
26 132
TOTAL
309 156 142 170 1
59 452 157
Rate per 1000; *because of small number of cases in denominator these rates may not be reliable;
Denominator: All autopsies in specific age group for specific ethnic group
15
The distribution of cases with silicosis by industry and ethnic group is presented in Table 4-2. As indicated previously, cases are categorized according to the industry in which the most years of service occurred. Cases from the platinum mining industry with silicosis might be explained by unstated previous service in gold mines.
TABLE 4-2 NUMBER & PREVALENCE OF SILICOSIS BY INDUSTRY & ETHNIC GROUP (1998)
Industry
Black
White
Unknown
Total
N Rate
N Rate
N Rate
N Rate
Gold
286 180 125 208 0
0 411 188
Platinum
5 27
4 100 0
0
9 39
Coal
4 50
3 56 0
0
7 52
Copper
1 250*
3 167 0
0
4 154
Asbestos
2 100
1 42 0
0
3 36
Diamond
2 154 0 0 0 0 2 80
Other
0 0 2 105 0 0 2 53
Unknown
9 143 4 121 1 59 14 124
TOTAL
309 156 142 170 1
59 452 157
Rate per 1000; *because of small number of cases in denominator these rates may not be reliable;
Denominator: All autopsies in a specific industry and ethnic group
The prevalence of silicosis from 1975 to 1998 in the gold mines is presented in Fig 4-2. Overall the rate of silicosis is unchanged since 1975. The high rate in 1994 cannot be explained.
FIG 4-2 PREVALENCE RATES OF SILICOSIS FROM 1975-1998 in SA GOLD MINES
300
ooo
250 200
t(D: 150
7S 100
* 50
ft
A Si
0
K,
00
oo oo
*o K, oo 00
OJ
oo OJ
oo *o
OJ OJ
K,
OJ
OJ OJ OJ OJ OJ OJ OJ OJ OJ OJ OJ OJ
Year
16
SECTION 5 - MASSIVE FIBROSIS, COALWORKER'S PNEUMOCONIOSIS, MIXED DUST FIBROSIS & ASBESTOSIS
MASSIVE FIBROSIS
There were 27 (0.9%) cases of massive fibrosis (18 black, 9 white) and the majority of them (89%) came from the gold mining industry. Most cases were in the age group 40-49.
COAL WORKERS' PNEUMOCONIOSIS
There were 10 cases of coal workers' pneumoconiosis.
MIXED DUST FIBROSIS
There were 12 (0.4%) cases of mixed dust fibrosis of whom 83% came from the gold mining industry.
ASBESTOSIS
There were 51 (1.8%) cases of asbestosis of which 33% had slight interstitial fibrosis, 55% moderate and 12% marked. Amongst all cases with a history of asbestos exposure, there were only 9 in whom asbestos plaques were found. However, the parietal pleura which is usually the site affected by plaque formation is hardly ever submitted with the lungs. All except 1 of the coloured miners with asbestosis came from asbestos mines as did the majority of blacks and whites with this disease. Most of the remaining cases were from the gold mines.
17
The distribution of asbestosis by age and ethnic group is shown in Table 5-1.
TABLE 5-1 NUMBER & PREVALENCE OF ASBESTOSIS BY AGE AND ETHNIC GROUP (1998)
Age group
Black
White
Coloured
Total
N Rate
N Rate
N Rate
N Rate
30-39
3
50
0
0
03
4
40-49
5
70
0
1 143 6
8
50-59
4
14 5 30
2 143 11
24
60-69
3
94 11
44
6 429 20 68
70-79
0
0 4 22
4 571 8 41
80-89
1 1000* 0 0
2 667 3 39
TOTAL
16
8 20 24
15 306 51
18
Rate per 1000; *because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific age group for specific ethnic group
18
SECTION 6 - EMPHYSEMA
There were 571 cases of emphysema, the extent of which was mild in 72%, moderate in 24% and marked in 4%. The distribution of emphysema by age and ethnic group is presented in Table 6-1 and Fig 6-1.
TABLE 6-1 NUMBER & PREVALENCE OF EMPHYSEMA BY AGE &
ETHNIC GROUP (1998)
Age group
Black
White
Coloured Unknown
TOTAL
N Rate
N Rate N
Rate N Rate N Rate
20-29
2 16 0 0 0
00 0 2
30-39
46 71 2 39 0
00
0 48
40-49
112 159 22 256 1
143 0
0 135
50-59
63 217 44 268 3
214 0
0 110
60-69
11
344 113
456
5
357 0
0 129
70-79
1
333* 88
481
0
00
0 89
80-89
1 1000* 33 452
1
333* 0
0 35
90+ 0 0 1 333* 1 1000* 0 0 2
Missing
19 109 1 200* 0
0 1 59 21
TOTAL
255
129 304
364 11
224 1
59 571
Rate per 1000; *because of small number of cases in denominator these rates may not be reliable;
Denominator: All autopsies in specific age group for specific ethnic group
14 69 169 235 461 439 455 400* 107 198
FIG 6-1 DISTRIBUTION OF EMPHYSEMA BY AGE & ETHNIC GROUP (1998)
20-29
o 30-39
A
E
40-49
3 50-59
60-69
Black
White
Coloured
70-79 80-89
Ethnic group
90+
For black and white miners with emphysema, the majority were from the gold mining industry (76%) (Table 6-2), whereas all the coloureds came from asbestos mines (most autopsies on coloureds were referred from these mines)
19
TABLE 6-2 NUMBER & PREVALENCE OF EMPHYSEMA BY INDUSTRY &
ETHNIC GROUP (1998)
Industry
Black
White
Coloured Unknown
TOTAL
N Rate
N Rate N
Rate N Rate
N Rate
Gold Platinum Coal Asbestos Iscor Copper Diamond Other Unknown TOTAL
208 131 223 372
0
18 96
15 375
0
11 138
17 315
0
5 250
8 333 11
1 250* 11 289
0
0 0 10 555 0
1 77
3 300
0
4 222
6 316
0
7 111
11 333
0
255 129 304 364 11
00 00 00 275 0 00 00 00 00 01 224 1
0 431 197 0 33 145 0 28 209 0 24 286 0 12 279 0 10 385 0 4 160 0 10 263 59 19 168 59 571 198
Rate per 1000; `because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in a specific industry and ethnic group
20
SECTION 7 - MESOTHELIOMA
In comparison with the 11 cases of 1997, there were 19 cases of mesothelioma in 1998. The distribution of mesothelioma by age and ethnic group is presented in Table 7-1.
TABLE 7-1 NUMBER OF MESOTHELIOMA CASES BY AGE & ETHNIC GROUP (1998)
Age Group
40-49 50-59 60-69 70-79 80-89 Missing TOTAL
Black
N% 3 75.0 1 25.0 0 0.0 0 0.0 0 0.0 0 0.0 4
White
N% 0 0.0 1 10.0 4 40.0 3 30.0 1 10.0 1 10.0 10
Coloured
N% 0 0.0 4 80.0 0 0.0 0 0.0 1 20.0 0 0.0 5
TOTAL
N% 3 15.8 6 31.6 4 21.1 3 15.8 2 10.5 1 5.3 19
The distribution of mesothelioma by industry and ethnic group is presented in Table 7-2. Cases are categorized according to the industry in which the most years of service occurred. The asbestos mining industry provided 44% of the mesothelioma cases in this series and the highest proportion of mesothelioma cases was found in white miners.
TABLE 7-2 NUMBER OF MESOTHELIOMA CASES BY INDUSTRY & ETHNIC GROUP (1998)
Industry
Asbestos Gold Iscor Other Unknown TOTAL
Black
N% 3 75.0 1 25.0 0 0.0 0 0.0 0 0.0 4
White
N% 0 0.0 1 11.1 1 11.1 3 33.3 5 44.4 10
Coloured
N% 5 100.0 0 0.0 0 0.0 0 0.0 0 0.0 5
TOTAL
N% 8 44.4 2 11.1 1 5.6 3 16.7 5 22.2 19
*2 February 2006. In an earlier print run of this report, the total number of mesothelioma cases was given as 14. Changes have been made to the text and tables.
21
SECTION 8 - PRIMARY LUNG CANCER
84 cases of primary lung cancer were found at autopsy of which 25% were in black miners, 70% in whites and 5% in coloured miners. Most of the cases were of the small cell type (31%), followed by large cell (24%) and squamous cell (23%) types.
The distribution of primary lung cancer by age and ethnic group is presented in Table 8-1 and Fig 8-1. Most black miners were in the age group 50-59 whereas the highest proportion of whites and coloureds were 60-69 years old.
TABLE 8-1 NUMBER AND PREVALENCE OF PRIMARY LUNG CANCER BY
AGE & ETHNIC GROUP (1998)
Age group
Black
White
Coloured
TOTAL
N Rate N Rate N
Rate N Rate
20-29
1 80
00
01
7
30-39
2 3 1 19 0
03
4
40-49
695
58 1
143* 12
15
50-59
8 28 13
79 1
71 22
47
60-69
1 31 20
81 2
143 23
78
70-79
0 0 13 71 0
0 13
67
80-89
0 0 6 82 0
0 6 78
Missing
3 17
1 200* 0
0 4 20
TOTAL
21 11 59
71 4
82 84
29
Rate per 1000; *because of small number of cases in denominator these rates may not be reliable;
Denominator: All autopsies in specific age group for specific ethnic group
The distribution of primary lung cancer by industry and ethnic group is presented in Table 8 2. For black and white miners, the majority of cases came from the gold mining industry followed by the asbestos mining industry. For coloured miners, most cases were from the asbestos industry.
22
TABLE 8-2
NUMBER AND PREVALENCE PRIMARY LUNG CANCER BY INDUSTRY & ETHNIC GROUP (1998)
Industry
Black
White
Coloured
TOTAL
N Rate N
Rate N
Rate N
Rate
Asbestos
2 100 6 250 3
75 11
131
Coal
1 13 2 24 0
03
22
Copper
0 0 2 111 0
02
77
Diamond
1 77 1 100 1
500* 3
120
Gold
12
8 36
60 0
0 48
22
Iscor
0 0 6 158 0
0 6 140
Platinum
5 27 4 100 0
09
40
Unknown
0 0 2 38 0
02
18
TOTAL
21 11 59
71 4
82 84
29
Rate per 1000; `because of small number of cases in denominator these rates may not be reliable; Denominator: All autopsies in specific industry and ethnic group
The prevalence of lung cancer by age (a) and industry (b) is shown in Figure 8-2.
FIG 8-2 PREVALENCE (PER 1000) OF LUNG CANCER BY AGE (a) & INDUSTRY (b) FOR BLACK AND WHITE MINERS (1998)
20-29
30-39
40-49
50-59
60-69
Age category
70-79
80-89
(b) 300
250 200 150
100 50 0
Gold
Plat
Coal
Asbestos
Iscor
Copper Diamond
Industry
Black White
23
SECTION 9 - CLINICAL CAUSES OF DEATH
Table 9-1 & Figure 9-1 shows the clinical cause of death which accompanied the cardiorespiratory organs by ethnic group. Diseases of the respiratory system were the most frequent (47%). Black miners had the highest proportion of unnatural causes of death (23%). In 16% the cause of death was not stated.
TABLE 9-1 CAUSES OF DEATH BY ETHNIC GROUP (1998)
Respiratory Unnatural Not stated Cardiovascular Miscellaneous Nervous system GI tract Genito urinary Haematological TOTAL
Black
N% 998 50.5 458 23.2 271 13.7 36 1.8 61 3.1 94 4.8
39 19 1 1977
2 1 0.1
White N% 323 38.7 90 10.8 176 21.0 117 14.0 70 8.4 21 2.5
22 2.6 13 1.6 4 0.5 836
Coloured N%
30 61.2 5 10.2 6 12.2 4 8.2 2 4.1 00
2 4.1 00 00 49
Indian
N% 00 1 100 00 00 00 00
Unknown
N% 00 00 16 94.1 00 1 5.9 00
00 00 00 1
00 00 00 17
TOTAL
N% 1351 47.0 554 19.2 469 16.3 157 5.5 134 4.7 115 4.0
63 32 5 2880
2.2 1.1 0.2
FIG 9-1 CAUSE OF DEATH AS GIVEN BY THE CLINICIANS WHO SUBMIT THE ORGANS TO THE NCOH AS SHOWN IN TABLE 9-1
Black
White
Respiratory
Not stated
Cardio vascular
Unnatural
Nervous system
Gastro intestinal
Genito urinary
Haematological
Miscellaneous
24
DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE THE DECEASED WORKED AT
MINETYPE LAST MINE WORKED AT
Aluminium Aluminium Smelters
Total from aluminium mine
Asbestos African Chrysotile Asb
Asbestos Mine
Blackrich Asbestos
Blouputs Asbestos Mine
Cape Blue Asbestos
Danielskuil Asb Mine
Everite
Gefco
Glen Allen Asbestos Mine
Kliphuis Asbestos
Koegas Asbestos
Laagsotry Asbestos Mine
Mamoesa Asbestos Mine
Noupoort Asbestos Mine
Penge Asbestos
Pomfret Asb Mine
Wandrag Asbestos Mine
Total from asbestos mines
Chrome
Chrome Mine
Dilokong chrome Mine
Mooinooi chrome
Tweefontein
Waterkloof Chrome Mine
Winterveld Chrome
Total from chrome mines
Coal
Arnot Colliery
Bank Colliery
Blinkpan Colliery
Bosjesspruit Colliery
Brandspruit Colliery
Coalbrook Colliery
Cornelia Colliery
Delmas Colliery
Douglas Colliery
Duiker Colliery
Durban Navigation Colliery
Elandslaagte Colliery
Ermelo Coal
Greenside Colliery
Grootgeluk Colliery
Khutala Colliery
Kleinkopje Colliery
Koornfontein Coal
Kriel Colliery
Lakeside Colliery
Landau Colliery
Majuba Colliery
MINETYPE LAST MINE WORKED AT
Coal
Matla Coal
Middelbult Coal Mine
New Denmark
BLACK 0
5 0 0 1 1 0 0 5 0 1 2 1 0 0 0 1 0
1 1 1 5 0 0
2 2 1 5 3 0 0 0 1 3 1 0 0 1 5 7 0 4 2 0 1 0 BLACK 3 4 3
WHITE 1
1 3 1 0 2 5 0 4 1 2 0 0 0 1 1 1 1
2 0 0 1 1 1
2 1 0 0 2 2 2 1 6 0 0 1 1 2 4 0 2 1 1 1 0 1 WHITE 3 0 1
COLOURED 0
0 1 0 0 6 0 1 1 0 4 14 0 1 7 0 2 0
0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COLOURED 0 0 0
INDIAN 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 INDIAN 0 0 0
UNKNOWN 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 UNKNOWN 0 0 0
TOTAL 1
1 6 4 1 1 9 5 1 10 1 7 16 1 1 8 1 4 1
77 3 1 1 6 1 1
13 4 3 1 5 5 2 2 1 7 3 1 1 1 3 9 7 2 5 3 1 1 1 TOTAL 6 4 4
25
Nyati Coal Mine
Phoenix Colliery
Savemore Colliery
Secunda Colliery
Sigma Colliery
Spingfield Colliery
Spitzkop
Springlake Colliery
Tavistok Colliery
Transvaal Navigation Coal
Twistdraai
Usutu Colliery
Van Dyk's Drift
Vierfontein Colliery
Vryheid Coronation
Wankie Colliery
Welgedacht
Witbank Collieries
Total from coal mines
Copper
Copper Mine
Messina Copper Mine
O'Kiep Copper
Phalaborwa
Prieska
Roan Antilope Copper
Tsumeb Copper Mine
Total from copper mines
Diamonds Bellsbank Diamond Mine
Cullinan Diamond Mine
Daradale Asbestos Mine
De Beers Consolidated
Finch Diamond Mine
Loxton Exploration
Messina Diamond Mine
Premier Diamond
Total from diamond mines
Gold
Arcturus GM
Barberton GM
Beatrix Gold
Blyvoorquizicht
Bracken Mines
Brakpan Gold Mine
Bredlagte Gold
Buffelsfontein Gold
Carletonville GM
City Deep
Consolidated Main Reef
Consolidated Modderfontein
MINETYPE LAST MINE WORKED AT
Gold
Consolidated Murchison
Consort GM
Crown Mines
Daggasfontein
Deelkraal
Doornfontein
Durban Roodepoort Deep
0 1 2 9 0 0 3 0 3 0 8 0 1 0 0 0 2 2
0 0 2 1 0 0 0
1 1 0 7 1 0 1 2
0 0 40 12 0 0 1 21 0 0 0 0
BLACK 0 0 0 0 8 2 16
1 0 0 3 1 2 0 1 1 1 1 1 1 1 1 1 0 5
1 1 6 4 3 1 1
0 0 0 8 0 1 0 5
1 1 3 16 3 2 0 19 1 3 2 1
WHITE 2 1 3 4 5 15 11
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 3 0 0 0 0
0 0 1 2 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
COLOURED 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
INDIAN 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
UNKNOWN 0 0 0 0 0 0 0
1 1 2 12 1 2 3 1 4 1 9 1 2 1 1 1 2 7
134 2 1 11 5 3 1 1
24 1 1 1 17 1 1 1 7
30 1 1 43 28 3 2 1 40 1 3 2 1
TOTAL 2 1 3 4 13 17 27
26
East Driefontein
103 7
0
East Rand Prop
49 28 0
Eastern Transvaal
0 10
Consolidated
Elandsrand
44 5 0
Elsburg GM
0 10
Evander GM
4 10
Fairview Mine
0 10
Freddies Gold
63 3 0
Free State Geduld
5 21 0
Free State Saaiplaas
17
7
0
Goldfields
2 20
Grootvlei Prop
12 14 0
Harmony
118 18 1
Hartebeesfontein
121 18 0
J.I.C. Gold Mine
2 00
Joel 9 1 0
Kinross
28 6 0
Klipval GM
0 10
Kloof
81 16 0
Leeudoorn
30 5 0
Leslie
5 30
Libanon
40 12 0
Loraine
13 9 0
Luipaardsvlei Estate GM 0
30
Marievale
0 50
Masimong Gold Mine
1
00
Merriespruit GM
0 10
Modderfontein
2 20
Naledi GM
4 10
New Kleinfontein GM
0
10
Nigel GM
2 00
Oryx
16 2 0
President Brand
1 10 0
President Steyn
74 13 0
Primrose GM
0 10
Rand Mines
0 10
Randfontein
27 19 0
Roodekop GM
0 10
Rosedeep Gold
0 10
S A Land
0 40
Saaiplaas GM
0 20
South Roodepoort
0 10
Springs GM
0 10
St Helena
33 4 0
00 00 00
00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 10 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00
110 77 1
49 1 5 1 66 26 24 4 26 137 139 2 10 34 1 97 36 8 52 22 3 5 1 1 4 5 1 2 18 11 87 1 1 46 1 1 4 2 1 1 37
MINETYPE Gold
LAST MINE WORKED AT State GM Stilfontein Sub Nigel Unisel GM Vaal Reefs Ventersport Virginia GM Vlakfontein Vogelstruisbult Welkom GM West Driefontein
BLACK 0 2 0 1 266 0 3 0 0 2 103
WHITE 1 19 1 2 45 15 2 3 1 11 28
COLOURED 0 0 0 0 0 0 0 0 0 0 0
INDIAN 0 0 0 0 0 0 0 0 0 0 0
UNKNOWN 0 0 0 0 0 0 0 0 0 0 0
TOTAL 1 21 1 3 311 15 5 3 1 13 131
27
West Rand Consolidation 0
17 0
West Witwatersrand
1
10
Western Areas
32 19 0
Western Deep Levels
88
22 0
Western Holdings
53 11 1
Western Reef GM
0 10
Winkelhaak
8 80
Wit Nigel GM
0 20
Zandpan GM
0 20
Total from gold mines
Platinum
Amadelbult Platinum (Rustenburg)
4
00
Atok Platinum
11 1 0
Bafokeng
1 00
Impala Platinum
16 15 0
Northam Platinum
8 10
R.U.C. Platinum Mine
1
10
Rustenburg Platinum
146 34 0
Tarleton Platinum
1 00
Union Platinum
2 10
Western Platinum
1 70
Wildebeestfontein
2 00
Total from platinum mines
Iron
Thabazimbi Iron Mine
1
10
Iron &
Associated Manganese
Mangenese
2
10
Lead & Minerals
Blackmountain
0 01
Manganese S A Manganese
5 00
Minerals
African Rainbow Minerals 13
0
0
& Expl
Non Miner Non Miner
1 20
Quarry
Hippo Quarries
0 10
Van Dyk
0 10
Silica
Silicon Smelters
3 20
Steel
Highveld Steel and Vanadium
0 30
Union Steel Mine
0 10
Steel & Iron Iscor
4 38 1
Tin
Rooiberg Mineral Division 0
20
00 00 00 00 00 00 00 00 00
00
00 00 00 00 00 00 00 00 00 00
00 00
00
00 00
00 00 00 00 00
00 00 00
17 2 51 110 65 1 16 2 2 2125 4
12 1 31 9 2 180 1 3 8 2 253 2 3
1
5 13
3 1 1 5 3
1 43 2
MINETYPE LAST MINE WORKED AT BLACK
UIS Tin Mine
0
Unknown Unknown
70
Zinc Zinc Corporation
0
Total from miscellaneous mine types
TOTAL
1977
WHITE 1 50 2
837
COLOURED 0 1 0
49
INDIAN 0 0 0
1
UNKNOWN 0 16 0
16
TOTAL 1 137 2
223 2880
28