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NATIONAL INSTITUTE FOR OCCUPATIONAL HEALTH Pathology Division Surveillance Report: Demographic Data and Disease Rates for January to December 2005 Ntombizodwa Ndlovu Jill Murray Geoff Candy Gill Nelson NIOH Report 2/2006 PO Box 4788 JOHANNESBURG 2000 e-mail: jill.murray@nioh.nhls.ac.za NATIONAL HEALTH LABORATORY SERVICE ACKNOWLEDGEMENTS We thank the following staff members of the NIOH Pathology Department, for their invaluable contribution to the autopsy service: Anna Khumalo Estelle Garton Goodman Rani Jay Vallabh Jemima Cantrell Jim Phillips Johanna Dibedi Johannes Mokoena Joseph Mukhovi Julienne Mkhize Juliet Buthelezi Martha Rikhotso May Humby Nora Ngutshane Patrick Mbhontsi Phyllis Back Rosinah Soko Simon Seopela Wilson Mashele Zukiswa Fipaza Thanks also to Michelle Kotze (IT Directorate, National Department of Health) for upgrading and maintaining the PATHAUT system. National Institute for Occupational Health, PO Box 4788, Johannesburg, 2000, South Africa ISSN 1812-7681 EXECUTIVE SUMMARY During 2005, 1 876 cases came to autopsy at the NIOH. Of these, 68% were black men, 30% were white, 1% were coloured and 1% were submitted without information on population group. Overall disease rates (per 1000 autopsies) for 2005 are shown in Figure 1. 300 250 oo 200 Q. 150 0) (0 100 50 0 216 223 37 29 25 10 Pulmonary tuberculosis Emphysema Silicosis Primary lung cancer Asbestosis n Mesothelioma Massive fibrosis |-| Coal workers' pneumoconiosis Mixed dust pneumoconiosis FIG.1 OVERALL DISEASE RATES FOR COMPENSABLE LUNG DISEASES (2005) In 2005 the overall prevalence of silicosis increased from that in previous years. The prevalence of pulmonary tuberculosis (PTB) also increased, following the trend of the last several years. The rise in PTB was particularly evident in black gold miners where the rate increased from 341 per thousand in 2004 to 348 per thousand in 2005. For the first time, some data on females is included in the annual report (Section 10). Forty three (2.3%) of the cases examined in 2005 were women. Concerted efforts to obtain service histories resulted in fewer cases with incomplete information in 2005. During 2005, four journal articles utilising the PATHAUT data were published and research findings were presented at a number of forums (see Appendix 2). An MSc student completed her studies (University of the Witwatersrand) and a PhD has been registered (University of the Witwatersrand). Both dissertations are based on PATHAUT data. i TABLE OF CONTENTS EXECUTIVE SUMMARY GLOSSARY SECTION 1: BACKGROUND SECTION 2: DEMOGRAPHIC DATA SECTION 3: ACTIVE TUBERCULOSIS SECTION 4: SILICOSIS SECTION 5: OTHER PNEUMOCONIOSES Massive Fibrosis Coal Workers' Pneumoconiosis Mixed Dust Pneumoconiosis Asbestosis and pleural plaques SECTION 6: EMPHYSEMA SECTION 7: MESOTHELIOMA SECTION 8: PRIMARY LUNG CANCER SECTION 9: CLINICAL CAUSES OF DEATH SECTION 10: AUTOPSY FINDINGS IN WOMEN i iv 1 2 8 11 13 13 13 13 14 16 17 18 19 LIST OF TABLES Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 3.1 Table 3.2 Table 4.1 Table 4.2 Table 4.3 Table 5.1 Distribution of autopsies by year and population group (1975-2005) Number and proportion of autopsies by type and population group (2005) Number and proportion of autopsies by age and population group (2005) Number and proportion of autopsies by commodity and population group (2005) Number and proportion of autopsies by years of service and population group (2005) Mean age by commodity and population group (2005) Mean duration of service by commodity and population group (2005) Number of cases and prevalence of active PTB by commodity and population group (2005) Number of cases and prevalence of active PTB by age and population group (2005) Number of cases and prevalence of silicosis by commodity and population group (2005) Number of cases and prevalence of silicosis in the gold mining industry, by age and population group (2005) Number of cases and prevalence of silicosis in the gold mining industry, by years of service and population group (2005) Number of cases and prevalence of asbestosis by age and population group (2005) 2 3 3 5 6 7 7 9 10 11 12 12 13 ii Table 6.1 Table 6.2 Table 6.3 Table 7.1 Table 7.2 Table 8.1 Table 8.2 Table 9.1 Table 10.1 Table 10.2 Number of cases and prevalence of emphysema by age and population group (2005) Number of cases and prevalence of emphysema by commodity and population group (2005) Number of cases and prevalence of emphysema by years of service and population group (2005) Number and proportion of mesothelioma cases by age and population group (2005) Number and proportion of mesothelioma cases by commodity and population group (2005) Number of cases and prevalence of primary lung cancer by age and population group (2005) Number of cases and prevalence of primary lung cancer by commodity and population group (2005) Clinical causes of death by population group (2005) Number and proportion of autopsies in females by age and population group (2005) Number and proportion of autopsies in females by commodity and population group (2005) 14 14 15 16 16 17 17 18 19 19 LIST OF FIGURES Figure 1 Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 9.1 Overall disease rates for 2005 Distribution of autopsies by age and population group (2005) Distribution of autopsies by commodity and population group (2005) Distribution of autopsies by years of service and population group (2005) Distribution of active TB by site (2005) Active PTB rates in all black miners at autopsy (1975 to 2005) Clinical cause of death as given by the clinicians who submit the organs to the NIOH (2005) 4 5 18 APPENDICES Appendix 1: Distribution of autopsies according to the last mine where the deceased worked (2005) Appendix 2: PATHaUt publications and activities (2005) 21 26 CD 0 0 CT) iii GLOSSARY Asbestosis Coal workers' pneumoconiosis Emphysema Massive fibrosis Mesothelioma Miner Mixed exposures Prevalence Silicosis Surveillance Lung fibrosis caused by asbestos fibres Lung fibrosis caused by exposure to coal dust Lung disease caused by the destruction of the alveolar walls Lung fibrosis caused by exposure to dust and measuring more than 1 cm in diameter A malignant tumour of the pleural cavity of the lungs A person who has worked in a controlled mine or works The multiple dust types to which a miner may be exposed, having worked in several mining commodities in his lifetime The number of cases in a defined population at a given time Lung fibrosis caused by inhalation of silica dust; detected by the presence of silicotic nodules in the lung tissue The ongoing and systematic collection, analysis and interpretation of data related to either occupational exposure or adverse health outcomes iv SECTION 1 - BACKGROUND The Occupational Diseases in Mines and Works Act, 1973 (Act 78 of 1973) requires that the cardio-respiratory organs of a deceased person who has worked at a controlled mine or a controlled works be examined for the presence of occupational disease, regardless of the clinical cause of death and provided that the next of kin agrees. These examinations are performed by pathologists at the National Institute for Occupational Health (NIOH). A detailed report on each case examined is sent to the Medical Bureau for Occupational Diseases (MBOD). Cases certified as having a compensable disease are then referred to the Compensation Commissioner's office, where the payment for compensation is managed. Since 1975, the pathological findings from the autopsy examinations have been recorded on the computerised PATHAUT database. PATHAUT comprises data from autopsy examinations and clinical files which include occupational histories. The database is unique and provides an important resource for both surveillance and research. These data are the only comprehensive surveillance data on occupational lung disease in the South African mining industry. The data presented in this report summarise the PATHAUT system surveillance results, i.e. the results of the systematic collection, collation, and analysis of the pathology findings in the cardio respiratory organs of mine workers. Data from PATHAUT are exported into, and analysed, using SAS v9.1. This is the ninth consecutive annual report and describes autopsy cases examined during the year 2005. Some of the earlier reports and this report can be accessed at www.nioh.ac.za. Throughout this report (except in Section 10), the term 'men' and all data include both men and women. Many of the cases had "mixed" exposures in that they had been employed in more than one commodity. For simplicity, cases are categorised according to the commodity in which most years of service were recorded, i.e. the commodity in which the miners had worked for the longest period. In Appendix 1, however, the cases are listed according to the most recent (last) mine at which the miners worked. All disease rates reported in this document are expressed per 1000. In all calculations, the denominators used are the total numbers of autopsies in specific commodities, age groups or population groups. Some of these rates must be viewed with caution, as the denominators are very small. This applies, for example, to those commodities where few workers are employed (such as manganese mining), and to the older age groups in some instances. 1 SECTION 2 - DEMOGRAPHIC DATA The number of autopsies performed since 1975 is presented in Table 2-1. TABLE 2-1 DISTRIBUTION OF AUTOPSIES BY YEAR AND POPULATION GROUP (1975 - 2005) Year of autopsy Black N% White N% Coloured N% 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996* 1997 1998 1999 2000 2001 2002 2003 2004 2005 2 190 2 335 2 351 2 245 2 118 2 338 2 209 2 312 2 096 1 966 2 275 2 456 2 594 2 518 2 138 2 172 2 143 2 144 1 863 1 737 2 830 766 2 223 1 977 1 656 1 798 1 690 1 677 1 536 1 428 1 274 71 854 68 1 072 69 1 039 67 1 090 66 1 026 64 1 274 66 1 117 63 1 302 65 1 109 64 1 098 64 1 200 68 1 125 68 1 168 67 1 165 65 1 090 64 1 155 65 1 080 66 1 049 65 956 61 1 021 71 1 059 68 329 69 897 69 836 65 832 69 761 67 813 67 763 66 745 69 596 68 562 28 31 3' 32 33 35 33 36 34 36 34 31 30 31 33 34 33 32 33 36 27 29 28 29 33 29 32 30 32 29 30 32 27 33 32 45 46 33 44 41 28 66 45 78 77 60 51 66 70 65 94 99 19 70 49 29 41 13 50 23 22 22 1 1 1 1 1 1 1 1 1 2 1 2 2 2 2 2 2 2 3 2 2 2 2 1 2 1 2 1 1 1 Total 63 055 66 30 183 32 1 470 2 * Data for only 6 months are available for 1996 Indian N% 1 1 1 30 Unknown N% 14 1.2 18 0.6 17 0.6 12 0.5 8 0.3 13 0.5 28 1.1 13 0.6 8 0.4 18 1.0 149 0.2 Total N 3 076 3 434 3 423 3 367 3 189 3 658 3 359 3 658 3 246 3 092 3 541 3 626 3 840 3 760 3 288 3 378 3 289 3 263 2 884 2 852 3 988 1 128 3 208 2 880 2 529 2 608 2 529 2 518 2 318 2 055 1 876 94 860 It is important to note that a referral bias exists: there is a low autopsy rate for black men who have left employment at the mines, whereas the majority of white retired miners come to autopsy. The numbers of miners coming to autopsy has decreased steadily over the years, probably reflecting the concomitant decrease in the number of miners. In 1994, there were around 344 000 people employed in the gold mining industry compared to approximately 155 000 in 2005. 2 The pathologists at the NIOH perform two types of autopsy examinations. For men dying distant from Johannesburg, the cardio-respiratory organs are removed locally, preserved in formalin and sent to the NIOH. Full autopsies are undertaken on men who die close to Johannesburg. Table 2-2 shows the distribution of autopsies by population group for 2005. Autopsies of only the cardio-respiratory organs comprised 95.7% of all examinations. TABLE 2-2 NUMBER AND PROPORTION OF AUTOPSIES BY TYPE AND POPULATION GROUP (2005) Autopsy type Cardiorespiratory organs only Full autopsy Total Black N% 1 271 99.8 3 0.2 1 274 White N% 484 86.1 78 13.9 562 Coloured N% 22 100 0- 22 Unknown N% 18 100 0- 18 Total N% 1 795 95.7 81 4.3 1 876 The age distribution of autopsies for 2005 is shown in Table 2-3 and Figure 2-1. The mean age at autopsy for black men has increased annually from 37.9 years in 1998 to 45.2 years in 2005. The mean age of white men at autopsy (63.8 years) has remained essentially unchanged. TABLE 2-3 NUMBER AND PROPORTION OF AUTOPSIES BY AGE AND POPULATION GROUP (2005) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N 48 280 585 274 45 14 13 15 1 274 % 3.8 22.0 46.0 21.4 3.5 1.1 1.0 1.2 White N% 4 0.7 16 2.8 65 11.6 112 19.9 156 27.8 142 25.3 63 11.2 4 0.7 562 Coloured N% 03 13.6 4 18.2 5 22.7 3 13.6 6 27.3 1 4.5 022 Unknown Total N N% 001 5.6 1 5.6 00016 88.9 52 2.8 299 15.9 655 34.9 392 20.9 204 10.9 162 8.6 77 4.1 35 1.9 18 1 876 3 700 600 500 (/> coo ou-- 400 CD Q 300 E3 200 LO CO LO 20-29 30-39 40-49 50-59 60-69 Age group (years) Black White Coloured 70-79 80+ FIG 2-1 DISTRIBUTION OF AUTOPSIES BY AGE AND POPULATION GROUP (2005) Table 2-4 and Figure 2-2 show the distribution of autopsies by commodity and population group for 2005. The percentage of autopsies received from the gold mining industry has been consistent over the last five years, at around 69%. The percentage of autopsies from platinum miners doubled from 8.3% in 1999 to 16% in 2004 and remained fairly constant in 2005 (15%). As in previous years, the majority of coloured men who came to autopsy (72.7%) were asbestos miners. Cases were placed in categories according to the commodity in which they had worked for the longest duration (most exposure). Many men, however, worked in a number of different mining commodities during their lifetimes and had "mixed" exposures. This was not taken into account in the analysis of exposure type (commodity). All results are presented using longest exposure. 4 TABLE 2-4 NUMBER AND PROPORTION OF AUTOPSIES BY COMMODITY AND POPULATION GROUP (2005) Commodity Black N% White N% Coloured N% Unknown N% Total N% Gold 863 67.7 429 76.3 2 9.1 0 - 1294 Platinum 257 20.2 24 4.3 1 4.5 0 - 282 Coal 35 2.7 32 5.7 1 4.5 0 - 68 Asbestos 76 6.0 17 3.0 16 72.7 0 - 109 Iscor 2 0.2 16 2.8 0 -0 - 18 Diamond 10 0.8 8 1.4 0 -0 - 18 Copper 4 0.3 6 1.1 1 4.5 0 - 11 Manganese 13 1.0 3 0.5 0 -0 - 16 Industry 4 0.3 8 1.4 0 -0 - 12 Other 6 0.5 11 2.0 0 -0 - 17 Unknown 4 0.3 8 1.4 1 4.5 18 100 31 Total 1 274 562 22 18 1 876 Note: this table shows only those commodities where a total of 10 or more cases were received 69.0 15.0 3.6 5.8 1.0 1.0 0.6 0.9 0.6 0.9 1.7 Black 2.7 20.2 76.3 6.0 67.7 i.4 White .7 4.3 3.0 0.6 Coloured I~1 Gold dl Coal HH Platinum Asbestos HH Other* FIG 2-2 DISTRIBUTION OF AUTOPSIES BY COMMODITY AND POPULATION GROUP (2005) * Includes Iscor, copper, diamond, quarry, silica (silicon smelters), manganese, zinc, minerals, steel, chrome, iron, manganese, emerald and other industries, as well as cases where no service histories were obtained. Detailed information about the years in mining service by population group is presented in Table 2-5 and Figure 2-3. In 2005, duration of service was obtained for all but 3.5% of the cases. This is much the same as in 2004 (4.4%) and much lower than previous years (e.g. 21.8% in 2003). The decrease is attributed to improvement in the follow-up of cases to obtain complete service histories. 5 TABLE 2-5 NUMBER AND PROPORTION OF AUTOPSIES BY YEARS OF SERVICE AND POPULATION GROUP (2005) Years of service <1 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41 + Unknown Total Black N% 21 169 216 219 318 188 84 30 3 3 23 1 274 1.6 13.3 17.0 17.2 25.0 14.8 6.6 2.4 0.2 0.2 1.8 White N% 027 4.8 52 9.3 70 12.5 76 13.5 106 18.9 80 14.2 70 12.5 44 7.8 18 3.2 19 3.4 562 Coloured N% 05 22.7 4 18.2 1 4.5 4 18.2 1 4.5 001 4.5 06 27.3 22 Unknown N% 000000000018 100 18 Total N% 21 201 272 290 398 295 164 100 48 21 66 1 876 1.1 10.7 14.5 15.5 21.2 15.7 8.7 5.3 2.6 1.1 3.5 Years of service: < 1 1 - 5Q 6 - 10 11 - 15 16 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 + FIG 2-3 DISTRIBUTION OF AUTOPSIES BY YEARS OF SERVICE AND POPULATION GROUP (2005) 6 The mean age and duration of service by commodity type and population group for those cases for which information was available are shown in Tables 2-6 and 2-7. TABLE 2-6 MEAN AGE BY COMMODITY AND POPULATION GROUP (2005) Commodity N Gold 853 Coal 34 Platinum 257 Asbestos 76 Diamond 10 Copper 4 Iscor 2 Manganese 13 Industry 4 Other 6 Unknown 0 Total 1 259 * Standard deviation Black Mean (years) SD* 43 8 47 7 45 8 60 13 51 11 65 5 43 23 51 8 41 15 61 21 045 10 N 429 32 24 17 8 6 15 3 8 11 5 558 White Mean (years) SD* 64 13 63 11 63 13 67 10 61 14 61 16 66 8 54 14 62 10 60 16 59 8 64 13 TABLE 2-7 MEAN DURATION OF SERVICE BY COMMODITY AND POPULATION GROUP (2005) Black Commodity N Mean (years) Gold 855 16 Coal 34 20 Platinum 255 16 Asbestos 70 7 Diamond 10 19 Copper 4 21 Iscor 22 Manganese 13 13 Industry 2 12 Other 6 12 Unknown 00 Total 1 251 15 *Standard deviation SD* 8 10 8 8 12 8 1 13 15 6 8 White N Mean SD* (years) 424 24 32 20 22 20 15 10 8 17 5 19 15 19 3 24 8 22 10 12 1 26 543 23 10 8 7 9 9 9 8 7 12 10 - 10 7 SECTION 3 - ACTIVE TUBERCULOSIS The distribution of active tuberculosis (TB) by anatomical site is presented in Figure 3-1 (n=558). Active pulmonary TB (PTB) was diagnosed in 25.1% (470) of all cases autopsied in 2005, compared to 16.4% (416) in 2000. Most of the men with PTB were black (93.2%; 438 cases), 5.7% (27 cases) were white, 0.9% (4 cases) were coloured and in 0.2% (1 case) the population group was unknown. 2.7 2.3 21.9 55.2 13.8 Lungs & nodes (308; 55.2%) Lungs only (122; 21.9%) Nodes only (77; 13.8%) Lungs, nodes & pleura (23; 4.1%) Lungs, nodes & pericardium (13; 2.3%) Other combinations (15; 2.7%) FIG 3-1 DISTRIBUTION OF ACTIVE TB BY SITE (2005) The overall rate of PTB (251/1000) has increased, from 160/1000 in 2000. This is attributed to the increase in the PTB rate in black men from 217/1000 in 2000 to 344/1000 in 2005 (Table 3.1). As indicated previously, cases are assigned to categories according to the commodity in which the most years of service occurred. In black gold miners, the rate of PTB has increased annually from 171/1000 in 1999 to 379/1000 in 2005. Rates in black platinum miners have decreased in the last few years from 383/1000 in 2002 to 315/1000 in 2005. Error! Not a valid link. FIG 3-2 ACTIVE PTB RATES IN BLACK MINERS AT AUTOPSY (1975 to 2005) 8 The distribution of active PTB cases by commodity is shown in Table 3-1. Rates in this and subsequent tables and figures are expressed per 1000. The majority of active PTB cases (74%) came from the gold mining industry (69% of all autopsy cases came from that commodity). TABLE 3-1 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY COMMODITY AND POPULATION GROUP (2005) Commodity Black N Rate White N Rate Coloured N Rate Gold 327 379 20 47 1 500 Platinum 81 315 1 42 0 - Coal 7 200 1 31 0 - Asbestos 19 250 2 118 2 125 Diamond 2 0 0 Copper 0 1 0 Other 1 2 0 Unknown 1 0 1 Total 438 344 27 48 4 182 Note: rates have not been calculated where numbers are small Unknown N Rate 00000 0 0 1 1 56 Total N Rate 348 269 82 291 8 118 23 211 2 1 3 3 470 251 The age distribution of cases with active PTB is shown in Table 3-2. Most (45.5%; 214 cases) were in the age group 40-49 years, followed by 24.5% (115 cases) in the 30-39 year age group. TABLE 3-2 NUMBER OF CASES AND PREVALENCE OF ACTIVE PTB BY AGE AND POPULATION GROUP (2005) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 Black N Rate 15 313 114 407 204 348 88 321 8 178 4 286 White N Rate 008 123 5 45 10 64 3 21 Coloured N Rate 01 333 2 500 01 333 0- Unknown N Rate 000000- Total N Rate 15 288 115 385 214 327 93 237 19 93 7 43 9 80+ Unknown Total 2 154 3 200 1 16 0- 438 344 27 48 004 182 01 63 3 39 4 114 1 56 470 251 10 SECTION 4 - SILICOSIS Silicotic nodules were found in the lungs of 418 cases (22.3% of all autopsies), 91.4% of which came from the gold mining industry. Of all cases of silicosis, occasional silicotic nodules were found in 50.7% of cases, a few in 19.6%, a moderate number in 26.6% and a large number in 3.1%. The distribution of cases with silicosis by commodity and population group is presented in Table 4-1. The rate of silicosis in gold miners has increased from 191/1000 in 2000 to 295/1000 in 2005. TABLE 4-1 NUMBER OF CASES AND PREVALENCE OF SILICOSIS BY COMMODITY AND POPULATION GROUP (2005) Commodity Black N Rate White N Rate Coloured N Rate Gold Platinum Asbestos Coal Diamond Copper Other Unknown 273 316 109 254 0 9 35 2 83 0 7 92 0 -0 3 00 3 10 0 11 1 20 1 10 - Total 297 233 116 206 1 45 Note: rates have not been calculated where numbers are small Unknown N Rate 0000 0 0 0 4 4 222 Total N Rate 382 295 11 39 7 64 3 4 2 3 6 418 223 11 Although the silicosis rates increased with increasing age in both black and white men, the age distribution of cases with silicosis differed between the two population groups (Table 4-2). More cases of silicosis were diagnosed in blacks at younger ages (<40) and in men who were exposed to silica for fewer years (< 5 years) (Table 4-3). TABLE 4-2 NUMBER OF CASES AND PREVALENCE OF SILICOSIS IN THE GOLD MINING INDUSTRY, BY AGE AND POPULATION GROUP (2005) Age group (years) 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 27 122 155 366 77 484 5 417 3 1000 1 500 5 500 273 316 White N Rate 1 71 8 174 9 99 30 275 41 366 20 370 0109 254 Coloured N Rate 00000000 Unknown N Rate 00000000 Total N Rate 28 114 163 347 86 344 35 289 44 383 21 375 5 500 382 295 TABLE 4-3 NUMBER OF CASES AND PREVALENCE OF SILICOSIS IN THE GOLD MINING INDUSTRY, BY YEARS OF SERVICE AND POPULATION GROUP (2005) Years of service 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41 + Unknown Total Black N Rate 5 63 21 126 44 275 101 428 64 481 26 500 8 444 1 1000 1 1000 2 250 273 316 White N Rate 1 71 3 81 7 143 9 184 17 191 17 279 28 424 18 429 9 529 0109 254 Coloured N Rate 0000000000- 0 Unknown N Rate 0000000000- 0 Total N Rate 6 64 24 117 51 244 110 385 81 365 43 381 36 429 19 442 10 556 2 154 382 295 12 SECTION 5 - OTHER PNEUMOCONIOSES MASSIVE FIBROSIS There were 18 (1%) cases of massive fibrosis (15 black, 3 white). Sixteen were from the gold mining industry. COAL WORKERS' PNEUMOCONIOSIS There were 6 (0.3%) cases of coal workers' pneumoconiosis. MIXED DUST PNEUMOCONIOSIS There were 5 (0.3%) cases of mixed dust pneumoconiosis. ASBESTOSIS AND PLEURAL PLAQUES There were 54 cases of asbestosis of which 57.4% (n=31) had slight, 33.3% (n=18) moderate and 9.3% (n=5) marked fibrosis. Forty eight of these cases had worked in the asbestos mining industry at some time in their lives. Forty three of the cases had asbestos plaques. However, the parietal pleura (the site where plaque formation usually occurs) is seldom submitted with the lungs. The distribution of asbestosis by age and population group is shown in Table 5-1. Only one case was diagnosed in cases below 40 years of age. TABLE 5-1 NUMBER OF CASES AND PREVALENCE OF ASBESTOSIS BY AGE AND POPULATION GROUP (2005) Age group (years) 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 14 6 10 11 40 14 311 5 357 6 462 043 34 White Coloured Unknown N Rate N Rate N Rate 0003 19 2 14 1 16 0- 6 11 0001 333 2 333 1 1000 0- 4 182 0000001 63 1 56 Total N Rate 13 69 11 28 18 88 9 56 8 104 1 29 54 29 13 SECTION 6 - EMPHYSEMA There were 406 cases of emphysema, the extent of which was mild in 85.5% (n=347), moderate in 13.6% (n=55) and marked in 1% (n=4). The distribution of emphysema by age and population group is presented in Table 6-1. TABLE 6-1 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY AGE AND POPULATION GROUP (2005) Age group (years) 20-29 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 1 21 9 32 82 139 48 175 16 356 3 214 7 538 2 133 168 132 White N Rate 007 108 37 330 72 462 77 542 30 476 1 250 224 399 Coloured N Rate 0004 800 2 667 4 667 0010 455 Unknown N Rate 00000004 250 4 222 Total N Rate 1 19 9 30 89 136 89 227 90 441 84 519 37 481 7 200 406 216 The majority of black and white men with emphysema were from the gold mining industry (64.5%, n=262) (Table 6-2). TABLE 6-2 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY COMMODITY AND POPULATION GROUP (2005) Commodity Black N Rate White N Rate Coloured N Rate Gold Platinum Coal Asbestos 97 112 165 385 32 125 12 500 12 343 14 438 21 276 8 471 0009 563 Diamond 2 4 0 Copper 1 1 1 Other 3 18 0 Unknown 0 2 0 Total 168 132 224 399 10 455 Note: rates have not been calculated where numbers are small Unknown N Rate 00000 0 0 4 4 222 Total N Rate 262 202 44 156 26 382 38 349 6 3 21 6 406 216 14 TABLE 6-3 NUMBER OF CASES AND PREVALENCE OF EMPHYSEMA BY YEARS OF SERVICE AND POPULATION GROUP (2005) Years of service <1 1 -5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41 + Unknown Total Black N Rate 6 286 15 89 22 102 18 82 40 126 35 186 20 238 6 200 1 333 2 667 3 130 168 132 White N Rate 014 519 14 269 25 357 33 434 33 311 34 425 32 457 23 523 10 556 6 316 224 399 Coloured N Rate 01 200 3 750 1 1000 1 250 000004 667 10 455 Unknown N Rate 00000000004 222 4 222 Total N Rate 6 286 30 149 39 143 44 152 74 186 68 231 54 329 38 380 24 500 12 571 17 258 406 216 15 SECTION 7 - MESOTHELIOMA The number of cases of mesothelioma in 2005 (n=41) was higher than in previous years (14 in 2000, 17 in 2001, 25 in 2002, 36 in 2003 and 25 in 2004). TABLE 7-1 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY AGE AND POPULATION GROUP (2005) Age group (years) 40-49 50-59 60-69 70-79 Total Black N% 7 27 8 31 8 31 3 11 26 White N% 2 14 3 21 5 36 4 29 14 Coloured N% 1 100 0001 Total N% 10 24 11 27 13 32 7 17 41 The distribution of mesothelioma by commodity and population group is presented in Table 7.2. Sixty six percent of the miners had worked in asbestos mining at some stage in their careers. TABLE 7-2 NUMBER AND PROPORTION OF MESOTHELIOMA CASES BY COMMODITY AND POPULATION GROUP (2005) Commodity Asbestos Gold Platinum Copper Manganese Industry Other Unknown Total Black N% 16 61 14 14 28 28 14 3 11 026 White N% 2 14 6 43 017 03 21 17 17 14 Coloured N% 1 100 0000000- 1 Total N% 19 46 7 17 12 37 25 4 10 4 10 12 41 16 SECTION 8 - PRIMARY LUNG CANCER Sixty nine cases of primary lung cancer were found at autopsy, 29% of which were in black, 63.8% in white and 4.3% in coloured men. Most of the cases were large adenocarcinomas (39.1%; n = 27), followed by squamous cell type (27.5%; n = 19), small cell lung carcinoma (17.4%; n=12) and large cell lung carcinoma (15.9%; n = 11). The distribution of primary lung cancer by age and population group is presented in Table 8-1. TABLE 8-1 NUMBERS OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY AGE AND POPULATION GROUP (2005) Age group (years) 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N Rate 27 59 6 22 5 111 1 71 1 77 020 16 White N Rate 02 31 8 71 15 96 16 113 3 48 044 78 Coloured N Rate 002 400 1 333 0003 136 Unknown N Rate 0000002 125 2 111 Total N Rate 27 7 11 16 41 21 103 17 105 4 52 2 57 69 37 The distribution of primary lung cancer by commodity and population group is presented in Table 8-2. The majority of cases came from the gold mining industry. TABLE 8-2 NUMBER OF CASES AND PREVALENCE OF PRIMARY LUNG CANCER BY COMMODITY AND POPULATION GROUP (2005) Commodity Gold Platinum Coal Asbestos Diamond Copper Other Unknown Total Black N Rate 67 3 12 2 57 6 79 1 0 2 0 20 16 White N Rate 31 72 1 42 04 235 1 1 5 1 44 78 Coloured N Rate 0003 188 0 0 0 0 3 136 Unknown N Rate 0000- 0 0 0 2 2 111 Total N Rate 37 29 4 14 2 29 13 119 2 1 7 3 69 37 17 SECTION 9 - CLINICAL CAUSES OF DEATH Table 9-1 and Figure 9-1 show the clinical cause of death stated in the accompanying documents submitted with the cardio-respiratory organs, by population group. Diseases of the respiratory system were the most frequent (38.2%) overall. Black men had the highest proportion of unnatural causes of death (11.6%) increasing from 10.2% in 2004. In 15.7% of all cases the cause of death was not stated. TABLE 9-1 CLINICAL CAUSES OF DEATH BY POPULATION GROUP (2005) System Black N% White N% Coloured N% Unknown N% Total N% Respiratory Cardio-vascular Central Nervous System Gastro intestinal Genito urinary Haematological Unnatural Miscellaneous Not stated Total 589 42 139 69 17 8 148 153 109 1 274 46.2 3.3 10.9 5.4 1.3 0.6 11.6 12.0 8.6 116 20.6 90 16.0 20 3.6 17 3.0 9 1.6 050 8.9 96 17.1 164 29.2 562 12 54.5 4 18.2 00001 4.5 2 9.1 3 13.6 22 0 - 717 0 - 136 0 - 159 0 - 86 0 - 26 0 -8 0 - 199 018 100.0 251 294 18 1 876 38.2 7.2 8.5 4.6 1.4 0.4 10.6 13.4 15.7 Black 9% 12% 5% 11% 3% White 29% 46% 17% Respiratory Cardiovascular CNS Gastro intestinal Genito urinary Haematological 16% Unnatural Miscellaneous 4% l"l Not ctated 9% FIGURE 9-1 CLINICAL CAUSE OF DEATH AS STATED BY THE CLINICIANS WHO SUBMIT THE ORGANS TO THE NIOH (2005) 18 SECTION 10 - AUTOPSY FINDINGS IN WOMEN There has been an increase in the numbers of cases of women submitted for autopsy. Of the 1 876 cases examined in 2005, 43 (2.3%) were women. Of these 35 (81%) were black, 3 (7%) were white and 5 (12%) were coloured. The mean age at autopsy for black women (58.3 years) was higher than that for black men (44.8 years). TABLE 10.1 NUMBER AND PROPORTION OF AUTOPSIES IN FEMALES BY AGE AND POPULATION GROUP (2005) Age group (years) 30-39 40-49 50-59 60-69 70-79 80+ Unknown Total Black N% 3 8.6 7 20.0 9 25.7 8 22.9 1 2.9 6 17.1 1 2.9 35 White N% 01 33.3 1 33.3 1 33.3 0003 Coloured N% 001 20.0 03 60.0 1 20.0 05 Total N% 3 7.0 8 18.6 11 25.6 9 20.9 4 9.3 7 16.3 1 2.3 43 Table 10.2 summarises the distribution of autopsies in women by commodity and population group. The majority of the women (70%) had most exposure to asbestos. The second highest exposure was to gold (19%). TABLE 10.2 NUMBER AND PROPORTION OF AUTOPSIES IN FEMALES BY COMMODITY AND POPULATION GROUP (2005) Commodity Gold Platinum Coal Asbestos Copper Other Unknown Total Black N% 8 22.9 1 2.9 1 2.9 24 68.6 01 2.9 035 White N% 0001 33.3 1 33.3 01 33.3 3 Coloured N% 0005 100.0 0005 Total N% 8 18.6 1 2.3 1 2.3 30 69.8 1 2.3 1 2.3 1 2.3 43 The predominant diseases in women were related to asbestos exposure. There were 8 cases of asbestosis and 9 of mesothelioma. 19 APPENDIX 1: DISTRIBUTION OF AUTOPSIES ACCORDING TO THE LAST MINE WHERE THE DECEASED WORKED (2005) Commodity Asbestos Total from asbestos mines Chrome Total from chrome mines Coal Last mine worked African Chrysolite Asbestos Asbestos Mine Black Rock Asbestos Mine Bretby Asbestos Cape Blue Danielskuil Asbestos Mine Dublin Asbestos Mine Everite Gefco Koegas Mamoesa Asbestos Mine Penge Asbestos Pomfret Asbestos Mine Chrome Mine Marble Lime Chrome Samancor Western Chrome Arnot Colliery Bank Colliery Black Wattle Colliery Cornelia Colliery Coronation Colliery Delmas Colliery Douglas Colliery Duiker Colliery Durnacol Mine Duvha Opencast Goedehoop Colliery Greenside Colliery Kleinkopje Colliery Klipfontein Kriel Colliery Matla Coal Middlebult Coal Mine New Denmark New Vaal Colliery Newcastle Coal Mine Optimum Colliery Phoenix Colliery Rooifontein Coal Mine Black 3 3 3 2 73 1 White 1 1 1 1 1 1 1 3 3 1 1 Coloured 1 1 2 1 5 2 Unknown Total 1 5 1 3 5 5 1 1 77 8 1 1 3 85 15 2 1 1 12 0 112 2 1 1 13 1 4 2 1 1 1 1 1 2 1 43 3 4 1 32 61 1 11 1 1 13 3 1 0 04 1 4 2 1 1 1 1 1 2 1 7 3 4 1 5 7 1 2 1 1 4 3 1 20 Commodity Coal (continued) Total from coal mines Copper Total from copper mines Diamond Total from diamond mines Gold Last mine worked Sasol Coal Mine S A Coal Estates Savemore Colliery Secunda Colliery Slater Coal Mine Spitzkop Springfield Colliery Springlake Colliery Tavistok Colliery Tweefontein Vryheid Coronation Copper Mine Messina Copper O'Kiep Copper Phalaborwa Prieska Cullinan Diamond Mine De Beers Consolidated Loxton Exploration Messina Diamond Mine Premier Diamond Star Diamond African Rainbow Minerals & Exploration Afrikaner GM Angilon GM Anglogold Business Service Anglogold Great Noligwa GM Anglogold Health Service (Free State) Anglogold Vaal River Operation Bambanani GM Barberton GM Beatrix Gold BernetCo GM Blyvoorquizicht Bracken Mines Buffelsfontein Gold Cementation City Deep Crown Mines Black 1 1 4 36 2 1 White 1 1 1 2 1 1 1 2 1 36 1 1 1 Coloured 1 1 1 1 Unknown 0 Total 2 1 1 3 4 1 1 1 1 2 1 73 1 1 2 2 2 33 71 4 2 1 2 1 2 08 8 4 2 1 2 1 10 8 0 0 18 88 22 11 66 11 11 11 49 8 17 1 2 98 5 1 10 2 5 20 24 2 1 57 18 2 103 1 10 2 25 6 2 1 21 Commodity Gold (continued) Last mine worked Daggasfontein Deelkraal Doornfontein Doringkop GM Driefontein Cons GM Durban Roodepoort Deep East Driefontein East Geduld East Rand Gold & Uranium East Rand Prop Eastern Transvaal Consolidated EGGO Sands GM Elandsrand Evander GM Freddies Gold Free State Geduld Free State Saaiplaas Goldfields Grootvlei Prop Harmony Hartebeesfontein J.I.C. Gold Mine Joel Kinross Kloof Kopanang GM Kuikenspoort GM Leeudoorn Leslie Libanon Loraine Luipaardsvlei Estate GM Marievale GM Masimong Gold Mine Matjabeng Gold Mine Merriespruit GM Oryx Placer Dome GM President Brand President Steyn Primrose GM Randfontein Sallies Black 58 1 3 1 1 2 White 3 6 2 1 3 5 13 1 15 Coloured Unknown Total 3 6 2 1 61 6 16 1 2 17 1 12 24 20 1 11 1 18 11 23 29 120 26 33 15 45 31 15 65 19 10 1 2 15 58 19 1 1 13 2 2 43 2 6 5 7 10 1 23 18 2 1 1 3 6 21 12 9 2 5 11 146 48 9 4 16 84 1 1 2 6 13 10 1 1 13 2 2 45 6 5 17 1 41 2 22 Commodity Gold (continued) Total from gold mines Platinum Total from platinum Last mine worked SAMAT GM Savuka GM Simmer & Jack GM Sonpan GM South Roodepoort St Helena State GM Stilfontein Sub Nigel Target Gold Mine Tshepone GM Ubuntu Small Scale GM Unisel GM Vaal Reefs Ventersport Vlakfontein Welkom GM West Driefontein West Rand Consolidation West Witwatersrand Western Areas Western Deep Levels Western Holdings Western Reef GM Winkelhaak Zandpan GM Atok Platinum Bafokeng Eastern Platinum Mine Impala Platinum Impala Platinum Refinery Kroondal Mine Lebowa Platinum Messina Platinum Mine Modikwa Platinum Mine Northam Platinum Rustenburg Platinum San Labour Hire (contract) Unknown Platinum Western Platinum Wildebeestfontein Zondereinde Platinum Black 1 1 7 1 1 4 1 100 1 5 1 52 4 2 831 2 2 113 1 3 3 14 130 1 1 4 3 2 279 White 1 1 2 5 7 1 1 2 32 8 4 5 13 8 2 16 23 10 1 4 1 413 1 14 1 1 1 1 1 15 1 1 37 Coloured 1 1 1 Unknown 0 0 Total 1 1 1 1 2 12 1 8 1 1 4 1 2 132 8 4 6 18 8 2 17 75 14 1 6 1 1245 2 2 1 128 1 2 4 1 4 14 145 1 2 5 3 2 317 23 Commodity Iron Total from iron mines Manganese Total from manganese mines Emerald Iron & Manganese Lead & Minerals Lime Quarries Sinkers Steel Steel & Iron Non-Miner Unknown TOTAL Last mine worked Boeshoek Iron Mine Iron Ore Mine Sishen Iron Mine Hotazel Manganese Mine Manganese Mine S A Manganese Gravelotte Associated Manganese Blackmountain Lime Acres Bon Accord Quarry Hippo Quarries Marikana Granite Quarry Mine Shaft Sinkers Highveld Steel and Vanadium Iscor Industry NCOH (NIOH) Non-miner Transnet Unknown Black 3 2 5 2 1 1 White 1 1 2 1 Coloured 0 Unknown 0 Total 3 1 2 6 4 1 2 43 1 4 1 4 1 1 2 11 0 1 07 1 4 1 1 4 1 1 2 2 1 3 5 1 274 1 16 7 1 1 1 10 562 2 2 22 1 17 10 1 3 1 18 35 18 1 875 24 APPENDIX 2: PATHAUT PUBLICATIONS AND ACTIVITIES (2005) Journal articles Published: Naidoo RN, Robins TG, Murray J, Green FHY, Vallyathan V. Validation of autopsy data for epidemiologic studies of coal miners. Am J Ind Med 2005; 47: 83-90. Manfredi JJ, Dong J, Liu W-j, Resnick-Silverman L, Qiao R, Chahinian P, Saric M, Gibbs AR, Phillips JI, Murray J, Axten Cw, Nolan RP, Aaronson SA. Evidence against a role for SV40 in human mesothelioma. Cancer Res 2005; 65 (7): 2602-2609. Murray J, Nelson G, Ndlovu N, Ross M, Shearer S, Barnes D. Occupational diseases in South African miners (letter to the editor). Occup Health Southern Africa 2005; 11(2):4. Naidoo RN, Robins TG, Murray J. Respiratory outcomes among South African coal miners at autopsy. Am J Ind Med 2005; 48: 217-224. Submitted: Ndlovu N, Murray J, Candy G, Nelson G. Occupational lung diseases in South African miners at autopsy: Surveillance report 2004. (Submitted Occup Health Southern Africa, October 2005) Reports Ndlovu N, Murray J, Candy G, Nelson G. Pathology Division Report: Demographic data and disease rates in January to December 2004. NIOH Report 15/2005 ISSN 1812-7681. National Institute for Occupational Health, National Health Laboratory Services, South Africa. Congresses Murray J, Hnizdo E. Development of radiological and autopsy silicosis in a cohort of South African gold miners. International Symposium on Environmental Monitoring and Silica Dust Exposure Assessment.14-17 April 2005. Wuhan, China Murray J, Hnizdo E. Development of silicosis in a cohort of South African gold minersradiological and autopsy based study. The 10th International Conference on Occupational Respiratory Diseases.19-22 April 2005. Bejing, China Nelson G, Murray J, Ross M. Silicosis in South African platinum miners - case control study. The 10th International Conference on Occupational Respiratory Diseases.19-22 April 2005. Beijing, China Ndlovu N, Seopela S. Autopsy database? Is this a useful tool for disease surveillance? MMOA 8th Annual Congress. 6 May 2005. Hannah Lodge, Ohrigstad. Ndlovu N, Murray J, Candy G, Nelson G. PATHAUT as a tool for surveillance in the South African mining industry. The International Occupational Hygiene Association (IOHA) Conference. 19 - 23 Sept 2005. Pilanesburg. 25 Candy GP, Veller MG, Nelson G, Ndlovu N, Murray J. Prevalence of cerebro-vascular accident in South African miners: NIOH PATHAUT mining autopsy data. Abstract 49. 33rd Annual Meeting of the Surgical Research Society of Southern Africa. 22-23 June 2005. Stellenbosch University. Published in South African Journal of Surgery 2005; 43. Sawry S, Kielkowski D, Murray J. Attribution of lung cancer to asbestos exposure in miners in South Africa. 17th World Congress of Epidemiology. 21-25 August 2005. Bangkok, Thailand. Higher degrees Chauhan-Sawry S. MSc in Epidemiology and Biostatics: Attribution of lung cancer to asbestos exposure in miners in South Africa. Completed 2005. School of Public Health, University of the Witwatersrand (Awarded the Wits 'W Harding Le Riche Medal in Epidemiology for 2005) Gill Nelson, PhD, Occupational respiratory diseases: rates, trends and risks in platinum and diamond miners coming to autopsy from 1975 to 2004. Started 2005. School of Public Health, University of the Witwatersrand 26