Ntombizodwa Ndlovu

Three decades of silicosis : disease trends at autopsy in South African gold miners

Background Eliminating silicosis is a priority of the International Labour Organization and the World Health Organization. Prevalence is particularly high in developing countries. Objectives We describe trends in silicosis among South African gold miners who had had an autopsy between 1975 and 2007 and quantify the contributions of age at autopsy and employment duration to these trends. Methods South African miners and ex-miners are eligible for autopsy examination for occupational lung disease, regardless of the clinical cause of death, and the families of deceased mine workers may receive compensation from the government of South Africa. Miners who died from external causes and who had been employed in the gold mines for > 1 year were stratified by population group because of differences in exposure, patterns of employment, and autopsy referral patterns. We extracted data from PATHAUT (Pathology Automation System) and used Stata 10 to estimate trends in relative proportions of silicosis that were standardized for age and employment duration. Results The crude proportion of silicosis for white miners was six times that of black miners in 1975. By 2007, it was 1.5 times higher for black miners. The proportion of miners with silicosis increased from 0.03 to 0.32 for black miners and from 0.18 to 0.22 for white miners. The increase can be explained by increasing age and employment duration for white miners. For black miners, it can be only partly explained by these two factors. Conclusion As miners continue to age and work for longer periods, the burden of silicosis will continue to rise. South Africa is committed to global efforts to eliminate silicosis by 2030. The autopsy database allows for disease surveillance, which is necessary to monitor the success of this initiative.

Compensation for environmental asbestos-related diseases in South Africa: a neglected issue.

BACKGROUNDnEnvironmentally acquired asbestos-related diseases (ARDs) are of concern globally. In South Africa, there is widespread contamination of the environment due to historical asbestos mining operations that were poorly regulated. Although the law makes provision for the compensation of occupationally acquired ARDs, compensation for environmentally acquired ARDs is only available through the Asbestos Relief Trust (ART) and Kgalagadi Relief Trust, both of which are administered by the ART. This study assessed ARDs and compensation outcomes of environmental claims submitted to the Trusts.nnnMETHODSnThe personal details, medical diagnoses, and exposure information of all environmental claims considered by the Trusts from their inception in 2003 to April 2010 were used to calculate the numbers and proportions of ARDs and compensation awards.nnnRESULTSnThere were 146 environmental claimants of whom 35 (23.9%) had fibrotic pleural disease, 1 (0.7%) had lung cancer, and 77 (52.7%) had malignant mesothelioma. 53 (36.3%) claimants were compensated: 20 with fibrotic pleural disease and 33 with mesothelioma. Of the 93 (63.7%) claimants who were not compensated, 33 had no ARDs, 18 had fibrotic pleural disease, 1 had lung cancer, and 44 had mesothelioma. In addition to having ARDs, those that were compensated had qualifying domestic (33; 62.2%) or neighbourhood (20; 37.8%) exposures to asbestos. Most of the claimants who were not compensated had ARDs but their exposures did not meet the Trusts exposure criteria.nnnCONCLUSIONSnThis study demonstrates the environmental impact of asbestos mining on the burden of ARDs. Mesothelioma was the most common disease diagnosed, but most cases were not compensated. This highlights that there is little redress for individuals with environmentally acquired ARDs in South Africa. To stop this ARD epidemic, there is a need for the rehabilitation of abandoned asbestos mines and the environment. These issues may not be unique to South Africa as many countries continue to mine and use asbestos.Background : Environmentally acquired asbestos-related diseases (ARDs) are of concern globally. In South Africa, there is widespread contamination of the environment due to historical asbestos mining operations that were poorly regulated. Although the law makes provision for the compensation of occupationally acquired ARDs, compensation for environmentally acquired ARDs is only available through the Asbestos Relief Trust (ART) and Kgalagadi Relief Trust, both of which are administered by the ART. This study assessed ARDs and compensation outcomes of environmental claims submitted to the Trusts. Methods : The personal details, medical diagnoses, and exposure information of all environmental claims considered by the Trusts from their inception in 2003 to April 2010 were used to calculate the numbers and proportions of ARDs and compensation awards. Results : There were 146 environmental claimants of whom 35 (23.9%) had fibrotic pleural disease, 1 (0.7%) had lung cancer, and 77 (52.7%) had malignant mesothelioma. 53 (36.3%) claimants were compensated: 20 with fibrotic pleural disease and 33 with mesothelioma. Of the 93 (63.7%) claimants who were not compensated, 33 had no ARDs, 18 had fibrotic pleural disease, 1 had lung cancer, and 44 had mesothelioma. In addition to having ARDs, those that were compensated had qualifying domestic (33; 62.2%) or neighbourhood (20; 37.8%) exposures to asbestos. Most of the claimants who were not compensated had ARDs but their exposures did not meet the Trusts’ exposure criteria. Conclusions : This study demonstrates the environmental impact of asbestos mining on the burden of ARDs. Mesothelioma was the most common disease diagnosed, but most cases were not compensated. This highlights that there is little redress for individuals with environmentally acquired ARDs in South Africa. To stop this ARD epidemic, there is a need for the rehabilitation of abandoned asbestos mines and the environment. These issues may not be unique to South Africa as many countries continue to mine and use asbestos.

38 years of autopsy findings in South African mine workers

BACKGROUNDnSouth African miners have a statutory right to autopsies for occupational lung disease compensation. These autopsies also provide information for research and surveillance.nnnMETHODSnCardio-respiratory organs are removed where miners die and are examined at the National Institute for Occupational Health. We extracted data from the PATHAUT database and described key demographic, exposure and disease trends (1975-2013).nnnRESULTSnOf 109,101 autopsies, 72,348 (66.3%) were black, and 34,794 (31.9%) were white miners. Autopsies declined from over 3,000 (1975-1998) to 1,118 in 2013. Most were gold miners (74.0%). 78.6% black and 13.2% white miners died while in employment. Overall proportions of silicosis and pulmonary tuberculosis were 12.0% and 13.0% in black, and 20.5% and 2.4% in white miners, respectively. Disease increased over time.nnnCONCLUSIONSnHigh levels of disease persist. Black ex-miners are underrepresented, indicating a need for strategies to improve awareness and provision of autopsy facilities in labor-sending areas.

Asbestos-related diseases in mineworkers: a clinicopathological study

The accurate diagnosis of asbestos-related diseases is important because of past and current asbestos exposures. This study evaluated the reliability of clinical diagnoses of asbestos-related diseases in former mineworkers using autopsies as the reference standard. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. The 149 cases identified had clinical examinations 0.3–7.4u2005years before death. More asbestos-related diseases were diagnosed at autopsy rather than clinically: 77 versus 52 for asbestosis, 27 versus 14 for mesothelioma and 22 versus 3 for lung cancer. Sensitivity and specificity values for clinical diagnoses were 50.6% and 81.9% for asbestosis, 40.7% and 97.5% for mesothelioma, and 13.6% and 100.0% for lung cancer. False-negative diagnoses of asbestosis were more likely using radiographs of acceptable (versus good) quality and in cases with pulmonary tuberculosis at autopsy. The low sensitivity values are indicative of the high proportion of false-negative diagnoses. It is unlikely that these were the result of disease manifestation between the last clinical assessment and autopsy. Where clinical features suggest asbestos-related diseases but the chest radiograph is negative, more sophisticated imaging techniques or immunohistochemistry for asbestos-related cancers should be used. Autopsies are useful for the detection of previously undiagnosed and misdiagnosed asbestos-related diseases, and for monitoring clinical practice and delivery of compensation. Asbestos-related diseases are difficult to diagnose; 58% diagnosed at autopsy had been missed clinically http://ow.ly/L9u230dr0bv

Four decades of pulmonary tuberculosis in deceased South African miners : trends and determinants

Objective We investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners. Methods Statutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death. Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death, gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975–1989), rapid HIV spread (1990–2004) and antiretroviral therapy (2005–2014) periods. Results The proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners, and from 2.07% to 5.19% in white miners, with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis, increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission). Conclusions Changes in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction, together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis.

1391 Occupational lung diseases in deceased south african women in mining

Introduction Women have worked in South African mines for over a century. During the twentieth century, employment of women underground was legally prohibited. In the asbestos mining industry, women worked in surface processing activities e.g. hand-cobbing of asbestos. Most women were undocumented in mine employment records and were thereby excluded from medical surveillance and compensation. Women continue to be exposed to asbestos in the environment. The 2004 Mining Charter permitted women to work underground and set targets to their employment across the mining industry. From 2005, the National Institute for Occupational Health (NIOH) has recorded the sex of deceased individuals examined for the detection of OLDs for statutory compensation. We compared OLDs in deceased women and men. Methods Records were extracted from the PATHAUT autopsy database (2005–2015). The NIOH also performs autopsies for the Asbestos and Kgalagadi Relief Trusts that compensate qualifying miners and environmental claimants. Results Women comprised 2.47% (n=394) of 15u2009940 cases. The women were older (56.6±17.11 years) than men (53.63±14.44 years) and had shorter mining-related exposures (7.21±7.71u2009versus 18.18±18.20 years). Most women had asbestos mining (46.19%) or environmental (14.72%) exposure; 87 (22.08%) were gold and 37 were platinum (9.39%) miners. Among men, there were 64.28% gold, 18.47% platinum and 5.55% asbestos miners, and 0.30% had environmental asbestos exposure. Disease proportions in women and men were: emphysema, 16.00% and 27.73%; silicosis, 3.30% and 23.13%; tuberculosis, 17.77% and 23.13%; lung cancer, 4.31% and 3.67%; asbestosis, 16.75% and 4.28% and mesothelioma, 17.26% and 2.00%. Discussion The burden of asbestos-related diseases was high in women. The few cases of silicosis in women are an alert to high silica dust exposures. The study highlights the importance of autopsies for disease diagnosis, and education of women on mining and environmental OLD-related risks and their right to access statutory compensation.

Temporal trends in the epidemiology of cervical cancer in South Africa (1994-2012): Cervical cancer epidemiology in South Africa

Cervical cancer (CC) is the leading cause of cancer death among female South Africans (SA). Improved access to reproductive health services following multi‐ethnic democracy in 1994, HIV epidemic, and the initiation of CC population‐based screening in early 2000s have influenced the epidemiology of CC in SA. We therefore evaluated the trends in CC age‐standardised incidence (ASIR) (1994–2009) and mortality rates (ASMR) (2004–2012) using data from the South African National Cancer Registry and the Statistics South Africa, respectively. Five‐year relative survival rates and average per cent change (AAPC) stratified by ethnicity and age‐groups was determined. The average annual CC cases and mortalities were 4,694 (75,099 cases/16 years) and 2,789 (25,101 deaths/9 years), respectively. The ASIR was 22.1/100,000 in 1994 and 23.3/100,000 in 2009, with an average annual decline in incidence of 0.9% per annum (AAPC = −0.9%, p‐value < 0.001). The ASMR decreased slightly by 0.6% per annum from 13.9/100,000 in 2004 to 13.1/100,000 in 2012 (AAPC = −0.6%, p‐value < 0.001). In 2012, ASMR was 5.8‐fold higher in Blacks than in Whites. The 5‐year survival rates were higher in Whites and Indians/Asians (60–80%) than in Blacks and Coloureds (40–50%). The incidence rate increased (AAPC range: 1.1–3.1%, p‐value < 0.001) among young women (25–34 years) from 2000 to 2009. Despite interventions, there were minimal changes in overall epidemiology of CC in SA but there were increased CC rates among young women and ethnic disparities in CC burden. A review of the CC national policy and directed CC prevention and treatment are required to positively impact the burden of CC in SA.

Occupational emphysema in South African miners at autopsy; 1975–2014

PurposeTo determine the associations between exposure duration, measured by employment tenure, and emphysema presence and severity in black and white South African miners at autopsy.MethodsWe examined the association between mining tenure and emphysema presence or severity using the Pathology Automation (PATHAUT) database, 1975–2014. We used logistic regression models adjusted for age, tuberculosis, HIV status, and year of death. The effect of smoking on the presence and severity of emphysema was assessed in a sub-analysis of white miners.ResultsMining tenure was significantly associated with increased odds of emphysema presence in black and white miners. For every 10-year increase in tenure, black miners had a 17% increase in odds of emphysema [ORblacku2009=u20091.17 (95% CI 1.12, 1.22)] and white miners had a 7% increase in odds of the disease [ORwhiteu2009=u20091.07 (95% CI 1.04, 1.10)]. Tenure was significantly associated with emphysema severity among black miners [ORseverityu2009=u20091.16 (95% CI 1.06, 1.28)]. In a subset of white miners with smoking status, we found that for every 10xa0years of tenure, there is a significant increase in odds of emphysema presence and severity [ORpresenceu2009=u20091.14 (95% CI 1.09, 1.19); ORseverityu2009=u20091.06 (95% CI 1.00, 1.10)] after adjusting for smoking.ConclusionsWe observed a significant relationship between mining tenure and emphysema severity among South African miners in PATHAUT between 1975 and 2014. This relationship was evident in multi-variable analyses adjusted for smoking among white miners. Hazards from long term exposure to inhaled mineral dust leading to lung damage (silicosis, fibrosis, COPD) is evident and warrants further improvement of working conditions and prevention measures in South African mines especially for black workers. Further research is needed to determine if there is an effect of TB and HIV co-infection on the development of emphysema.