D. C. F. Muir

A follow-up study of synthetic rubber workers

Although 1,3-butadiene (BD) has been classified as an animal carcinogen, epidemiologic research has reported inconsistent results on the relationship between BD and lymphopoietic and other cancers in humans. This study evaluated the mortality experience of 15649 men employed for at least 1 year at any of eight North American styrene-butadiene rubber (SBR) plants. About 75% of the subjects were exposed to BD; 83% were exposed to styrene (STY). During 1943-1991, the cohort had a total of 386172 and an average of 25 person-years of follow-up, with 3976 deaths observed compared to 4553 deaths expected based on general population mortality rates (standardized mortality ratio (SMR) = 87, 95% confidence interval (CI) = 85-90). More than expected leukemia deaths occurred in the overall cohort (48 observed/37 expected, SMR = 131, CI = 97-174) and among ever hourly subjects (45/32, SMR = 143, CI = 104-191). The excess was concentrated among ever hourly subjects with 10+ years worked and 20+ years since hire (28/13, SMR = 224, CI = 149-323) and among subjects in polymerization (15/6.0, SMR = 251, CI = 140-414), maintenance labor (13/4.9, SMR = 265, CI = 141-453) and laboratories (10/2.3, SMR = 431, CI = 207-793), three areas with potential for relatively high exposure to BD or STY monomers. Some cohort sub-groups had slight increases in deaths from lymphopoietic cancers other than leukemia, but mortality patterns by race, years worked and process group within the SBR industry did not indicate a causal association with occupational exposures. These results indicate that exposures in the SBR industry cause leukemia.

A study of mortality in workers engaged in the mining, smelting, and refining of nickel. II: Mortality from cancer of the respiratory tract and kidney.

This paper describes observed and expected mortality from cancers of the lung, larynx, nose, and kidney in a cohort of 54,509 nickel workers followed for 35 years. For analysis purposes the cohort was subdivided into men with and without service in one of the three high nickel dust areas of the operation: the Sinter Plants at Copper Cliff and Coniston, and the Leaching, Calcining and Sintering (LC&S) department at Port Colborne. At Copper Cliff Sinter Plant workers experienced three times the expected number of lung cancer deaths; the SMR rose steeply with increasing duration of service peaking at 943 with 10 to 15 years. A similar overall excess risk of lung cancer was seen in the smaller Coniston Sinter Plant again with an indication of an exposure risk gradient. Men in the LC&S department at Port Colborne also experienced a dose related excess risk of lung cancer death that rose to an SMR of 806 with 20 to 25 years of service. Nasal cancer deaths were increased at both the Copper Cliff Sinter Plant (6 deaths) and the LC&S department at Port Colborne (19 deaths), representing SMRs of 3,704 and 7,755, respectively, for this rare cancer. Laryngeal cancer and kidney cancer, both previously associated with nickel, were not in excess in these high risk groups. A further exploration of death from these causes in the lower exposure remainder of the cohort revealed an epidemiologically modest elevation in lung cancer death in miners (probably not nickel related) and parts of the Copper Refinery. No evidence of laryngeal cancer excess was found. Kidney cancer death was slightly increased in miners but as a whole was reasonably in line with expected. The results are consistent with either nickel subsulphide or nickel oxide, or both, being carcinogens.

Polycyclic aromatic hydrocarbons (PAHs): a possible cause of lung cancer mortality among nickel/copper smelter and refinery workers

A retrospective industrial hygiene investigation was undertaken to explain the cause of a statistically significant excess lung cancer mortality observed in a subset of a large cohort of nickel workers involved in mining, smelting, and refining of nickel and copper in Ontario. The focus of this paper is to demonstrate how an industrial hygiene follow-up assessment of an epidemiologic finding can help to identify a likely cause. Polycyclic aromatic hydrocarbons (PAHs) alone or in association with particulate and gaseous contaminants (e.g., SO2) were likely the causative agents of the excess lung cancer observed among the lead welders, cranemen, and arc furnace workers of the copper refinery.

Occupational sensitization to lactase

Occupational sensitization to lactase is reported in workers formulating and packaging this consumer product, which is used for the relief of gastrointestinal symptoms caused by intolerance to lactose. Allergic rhinitis, conjunctivitis, and some cases of asthma were noted. There was suggestive evidence that atopic individuals may be at greater risk of sensitization. Lactase should be added to the list of potential occupational respiratory sensitizers.

A study of mortality in workers engaged in the mining, smelting, and refining of nickel. I: Methodology and mortality by major cause groups.

Following the publication of the NIOSH nickel criteria document in 1977, the Joint Occupational Health Committee of the International Nickel Company (INCO) commissioned a mortality study of the companys Ontario workforce. This paper describes the detailed methodology and primary mortality results of the ensuing study; subsequent papers will describe more detailed findings of cause-specific mortality. An historical prospective mortality study of approximately 54,000 INCO workers has been conducted. Men with six months or more of service were followed for mortality during a 35-year period by computerized record linkage to the Canadian National Mortality Data Base. From a company-provided list of men known to have died and through independent follow-up of a random sample of 1,000 subjects of unknown status, we estimate a mortality ascertainment rate of 95%. Cause-specific standardized mortality ratios calculated with respect to Ontario provincial mortality rates indicate an excess of accidental deaths in men working in the Sudbury area and an excess of cancer deaths at the companys Port Colborne nickel refinery. A strong healthy worker effect was found for both all-disease mortality ad cancer mortality. The lower than expected mortality persisted for about 15 years beyond initial hiring.

Mortality experience of glass fibre workers.

A historical prospective mortality study was conducted at an insulating wool plant in Ontario, Canada, on 2576 men who had worked for at least 90 days and were employed between 1955 and 1977. Eighty eight deaths were found in the 97.2% of men traced. Mortality was compared by the person-years method with that of the Ontario population. Measurements taken since 1977 show very low fibre concentrations. The overall standardised mortality ratio (SMR) was 78%, significantly below 100. Among plant only employees, seven deaths were attributed to lung cancer compared with 4.22 expected, a non-significant excess (SMR = 166; 95% confidence limits 67 to 342). No confirmed cases of mesothelioma were observed and no other disease was significantly increased in plant workers.

Cause of occupational disease.

The concept of causality is reviewed with special emphasis on occupational diseases. Separate approaches from the philosophical, scientific, and legal points of view are identified. There is controversy over the methodology of logical causality; inductive and deductive methods are described and reference is made to the verification or refutation approach. Application of the methods to epidemiology are reviewed. It is likely that many diseases have multiple causes and that only a component of occupational causality can be identified in each patient. Methods of assigning such a component are discussed. The difficulties of developing an equitable compensation policy in such circumstances are reviewed. The possible benefits of proportional compensation are noted.

Prevalence of small opacities in chest radiographs of nickel sinter plant workers

Radiographs from 745 nickel sinter plant workers were taken and classified by five readers using the International Labour Office (1980) protocol. Each reader worked independently and the films were randomly mixed with films from a non-dust exposed office population and also with films from subjects known to have silicosis or asbestosis. The prevalence of small irregular opacities was selected as the outcome of interest. In the sinter workers this was within the range identified in cigarette smokers or in workers exposed to dusts of low fibrogenicity. Only minimal evidence of small round opacities was noted. There was no evidence from the chest radiographs that exposures to high concentrations of dusts containing compounds of nickel caused an inflammatory or fibrogenic response in the lungs of the exposed population.

Aesthesiometric threshold changes over the course of a workshift in miners exposed to hand-arm vibration.

The objective of this study was to investigate whether aesthesiometric threshold changes occur over the course of a workshift in vibration exposed hard rock miners relative to workers unexposed to vibration during the shift. The subjects were 99 miners and 40 smelter workers; four subjects declined to participate and nine were excluded from the analysis because of apparent failure to comprehend the testing procedure. Two point discrimination and depth sense aesthesiometry were conducted at the beginning and at the end of the workshift in all digits of both hands excluding the thumbs. In addition to the use of a vibrating tool during the shift, age, digital temperature, signs of arm injury, presence of fingertip callus, and handedness were documented. In the analysis the difference between postshift and preshift readings was studied in relation to these variables, particularly exposure to the jackleg drill during the shift. With the exception of exposure of the jackleg drill, no associations were observed between these variables and change over the workshift in aesthesiometric results, on both unadjusted comparison of means and backward elimination regression analysis. A statistically significant association, however, was found between the use of a jackleg drill and change in two point discrimination and in depth sense aesthesiometric results over the course of the shift, for the right hand. Evidence of the occurrence of a learning effect, particularly for two point discrimination aesthesiometry, was observed. The occurrence of an effect in the right, but not the left, hand reflects dominant handedness and relatively greater vibration exposure in the right hand in our subjects. This study supports the incorporation of an exposure free interval before aesthesiometric testing of vibration exposed workers.

Cancer of the respiratory tract in nickel sinter plant workers: effect of removal from sinter plant exposure.

The risk of death due to cancer of the nose or lung was studied in nickel sinter plant workers during the period after they left the sintering operations. It was found that the excess risk of death from both diseases continued for many years after leaving the sinter plant. No effect of age at first exposure could be found. Possible explanations for the continued risk include an irreversible cellular change or the persistence of carcinogenic nickel compounds in the mucosa.