The following paragraphs highlight selected findings based on data from the United States presented in this and previous WoRLD Surveillance Reports.
Asbestosis and Related Exposures
• Asbestosis deaths among U.S. residents age 15 and over have increased from 78 in 1968 to 1,493 in 2000 and then decreased slightly to 1,470 in 2004. (Ref. No. 2007F01-01, 2007T01-01)
• Over the 10-year period from 1995 to 2004, there were more than 13,000 asbestosis deaths and annual asbestosis death counts increased by one-fourth. (Ref. No. 2007T01-01)
• During the 10-year period from 1995 to 2004, asbestosis deaths accounted for nearly half of all pneumoconiosis deaths. (Ref. No. 2007T06-06)
• For each year since 1998, asbestosis deaths outnumbered coal workers’ pneumoconiosis (CWP) deaths, displacing CWP as the most frequent type of pneumoconiosis death. (Ref. No. 2007T01-01, 2007T02-01)
• Asbestosis was designated as the underlying cause of death in over one-third of all asbestosis deaths from 1995 to 2004. (Ref. No. 2007T01-01)
• Residents of California, Florida, New Jersey, New York, Pennsylvania, Texas, Virginia, and Washington together accounted for nearly half of all asbestosis deaths in the 1995 to 2004 period. (Ref. No. 2007T01-04)
• For the period from 1995 to 2004, three counties (one in Montana, one in Mississippi, and one in Texas) had age-adjusted asbestosis death rates that exceeded the national rate by more than 20-fold. (Ref. No. 2007T01-02, 2007T01-10)
• Based on a large subset of the national data for which decedents’ usual occupation and industry information was available, the construction industry accounted for nearly one-fourth of decedents with asbestosis from 1990 through 1999. Apart from construction, asbestosis deaths were reported in a wide range of industries, with no particular industry predominating. Similarly, no one occupation emerged as being particularly common, though the most frequently listed occupational group was plumbers, pipefitters, and steamfitters. (Ref. No. 2007T01-06, 2007T01-07)
• From 1990 to 1999, decedents whose death certificate indicated that they worked in the miscellaneous nonmetallic mineral and stone products industry or the ship and boat building and repairing industry had proportionate asbestosis mortality more than 15 times higher than that of all industries combined. (Ref. No. 2007T01-08)
• From 1990 to 1999, decedents whose death certificate indicated that they were insulation workers or boilermakers had proportionate asbestosis mortality 20 times higher than that in all occupations combined. (Ref. No. 2007T01-09)
• Hospital discharges associated with asbestosis have increased from approximately 9,000 in 1995 to 21,000 in 2004. (Ref. No. 2007T01-11)
• Data from the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA) indicate a trend towards lower asbestos exposure levels from 1979 to 1999, concomitant with mandated reductions in the OSHA permissible exposure limit (PEL). However, data indicate a steady increase in asbestos exposure levels in the mining industry for the years 2000 through 2003 and a slight rise in all other industries in the two years previous to 2003. (Ref. No. 2007F01-05, 2007T01-12)
• For the period 1995 to 2003, less than 5% of the MSHA and OSHA asbestos exposures exceeded the recommended exposure limit (REL). The nonmetallic mining and quarrying, except fuel and miscellaneous nonmetallic mineral and stone products industries had the highest percent of samples exceeding the REL (9.9% and 8.7%, respectively). (Ref. No. 2007T01-13)
Coal Workers’ Pneumoconiosis (CWP) and Related Exposures
• Among active coal miners with 20–24, 25–29, and over 30 years of underground mining who were examined in a federally-administered health monitoring program, the prevalence of radiographically evident CWP declined from 20%, 25%, and 35% in the early 1970s to about 3%, 3%, and 7% in the late 1990s; however, it increased to 6%, 8%, and nearly 10% in the mid 2000s, respectively. (Ref. No. 2007T02-12, 2007F02-05)
• CWP deaths among U.S. residents age 15 and over continue a long-term decline, from well over 2,500 deaths annually in the early 1980s to well below 1,000 in the early 2000s. (Ref. No. 2007F02-01)
• CWP deaths accounted for over one-third of pneumoconiosis deaths during the 10-year period from 1995 to 2004. (Ref. No. 2007T06-06)
• CWP was designated as the underlying cause of death in over one-third of all CWP deaths from 1995 to 2004. (Ref. No. 2007T02-01)
• For the decade from 1995 to 2004, more than three-fourths of all CWP decedents were residents of Pennsylvania, West Virginia, Virginia, and Kentucky. Pennsylvania alone accounted for nearly half of all CWP deaths in this period. (Ref. No. 2007T02-04)
• For the period from 1995 to 2004, seven counties (two in Virginia, one in Pennsylvania, one in Kentucky, and three in West Virginia) had age-adjusted CWP death rates that exceeded the national rate by more than 100-fold. (Ref. No. 2007T02-10)
• From 1990 to 1999, a large majority of CWP deaths were associated with employment in the coal mining industry, for which proportionate CWP mortality was more than 50 times higher than that of all occupations combined. (Ref. No. 2007T02-06, 2007T02-08)
• Federal “Black Lung” Program payments totaled more than $675 million for nearly 105,000 beneficiaries in 2005. These figures reflect a continuing slow decline from over $1.8 billion paid out for over 500,000 beneficiaries in 1980. (Ref. No. 2007T02-13)
• Data from MSHA indicate that from the early 1980s to 2003 the underground coal mining industry experienced little change in level of exposure to respirable coal mine dust. Surface mine exposure levels have also remained fairly steady although there is some evidence of a decline in exposure levels since the early 1990s. (Ref. No. 2007F02-07, 2007T02-14)
• During the period 1995 to 2003, one-fourth of coal mine dust exposures recorded by MSHA exceeded the REL. (Ref. No. 2007T02-15, 2007T02-16)
Silicosis and Related Exposures
• Over the past several decades, silicosis mortality has declined, from well over 1,000 deaths annually in the late 1960s to fewer than 200 per year in the mid 2000s. (Ref. No. 2007F03-01)
• Silicosis was designated as the underlying cause of death in over half of all silicosis deaths from 1995 to 2004. (Ref. No. 2007T03-01)
• Silicosis deaths among U.S. residents age 15 and over represented nearly 7% of all pneumoconiosis deaths in the U.S. during the 10-year period from 1995 to 2004. (Ref. No. 2007T06-06)
• Compared to asbestosis, CWP, and byssinosis, silicosis mortality appears to be somewhat less concentrated by geographic region or by industry. However, Pennsylvania, alone, accounts for 14% of silicosis deaths for the 1995 to 2004 period, ranking first among all states in number of silicosis deaths and fourth in age-adjusted silicosis death rates behind West Virginia, Colorado, and Utah. (Ref. No. 2007T03-04, 2007T03-05)
• For the period from 1995 to 2004, five counties (two in North Carolina and one each in West Virginia, Pennsylvania, and Missouri) had age-adjusted silicosis death rates that exceeded the national rate by more than 25-fold. (Ref. No. 2007T03-10)
• Based on a large subset of the national data for which decedents’ usual occupation and industry information was available, the construction and mining industries accounted for at least one-third of decedents with silicosis from 1990 through 1999. (Ref. No. 2007T03-06)
• Throughout the 1995–2004 period, silicosis death rates were higher among black males than among white males. (Ref. No. 2007T03-02)
• Based on data from the SENSOR silicosis programs in Michigan, New Jersey, and Ohio for the period from 1993–2002, approximately 7% of confirmed silicosis cases for which duration of exposure was ascertained had less than 10 years of potential occupational exposure to silica dust. (Ref. No. 2007T03-13a, 2007T03-13b)
• Data from MSHA indicate that respirable quartz exposure levels have remained relatively constant in the coal mining industry from 1979 to 2000 then decreased in 2001 through 2003. Levels in the metal/nonmetal mining industry appear to have declined from 1979 to 1987, increased substantially in 1988 when MSHA implemented a different quartz analytical standard, declined from 1989 to 1995, increased from 1996 to 1999 and remained the same thereafter. Data from OSHA indicate that respirable quartz exposure levels declined in the nonmining industries during the period 1989 to 1992 when the OSHA PEL was changed from a formula for respirable dust containing quartz to a respirable quartz concentration of 0.1 mg/m3. (Ref. No. 2007F03-06a, 2007F03-06b, 2007T03-16a, 2007T03-16b, 2007T03-20)
• For the period 1993 to 2003, the percentages of exposures greater than the PEL were approximately 23% in coal mining, 11% in metal/nonmetal mining, and 40% in other industries. (Ref. No. 2007T03-18, 2007T03-19, 2007T03-20)
• For the period 1993 to 2003, iron and steel foundries; construction; machinery, except electrical; and fabricated structural metal products were the industries with at least one-third of their exposures exceeding the PEL and about half of their exposures exceeding the REL based on at least 100 samples. Coal mining, with over 100,000 samples, had nearly one-fourth of its samples exceeding the MSHA PEL (Ref. No. 2007T03-17)
• For the period 1993 to 2003, Arizona, Indiana, Virginia, Tennessee, Southern West Virginia, and Kentucky had geometric mean respirable quartz exposure levels in the coal mining industry which exceeded 0.04 mg/m3 MRE based on at least 10 samples analyzed by MSHA. (Ref. No. 2007T03-18, 2007F03-07)
• For the period 1993 to 2003, 19 states had geometric mean respirable quartz exposure levels in nonmining industries which exceeded the NIOSH REL of 0.05 mg/m3 based on at least 10 samples analyzed by OSHA. (Ref. No. 2007T03-20, 2007F03-09)
Byssinosis and Related Exposures
• In comparison with other pneumoconioses, byssinosis deaths among U.S. residents age 15 and over remain relatively few—10 or less, annually since 1996. (Ref. No. 2007T04-01)
• Nearly one-third of byssinosis decedents in the 1995 to 2004 period were female. (Ref. No. 2007T04-01)
• Byssinosis was designated as the underlying cause of death in half of all byssinosis deaths from 1995 to 2004. (Ref. No. 2007T04-01)
• Over one-half of byssinosis decedents in the period from 1995 to 2004 were residents of North Carolina, South Carolina, and Georgia. (Ref. No. 2007T04-04)
• Only one industry— yarn, thread, and fabric mills—was associated with a significantly high byssinosis proportionate mortality for the 1990 to 1999 period. (Ref. No. 2007T04-08)
• Although cotton dust exposure data are sparse, over one-fourth of the exposures measured by OSHA exceeded the REL for the period 1995 to 2003. (Ref. No. 2007T04-12)
Unspecified/Other Pneumoconioses
• The pattern of deaths from unspecified/other pneumoconioses, which account for 10% of all pneumoconiosis deaths during the 1995–2004 period, tends to resemble coal workers’ pneumoconiosis (and, less so, silicosis) mortality with respect to geographic distribution, a similar peak in 1972, and similar occupations and industries associated with high PMRs (in the 1990–1999 period). This indicates that most unspecified pneumoconiosis deaths are likely to be CWP deaths. (Ref. No. 2007F05-01, 2007F05-02, 2007T05-01, 2007T05-04, 2007T05-08, 2007T05-09, 2007T06-06)
All Pneumoconioses and Related Exposures
• During the 10-year period from 1995 to 2004, there were more than 28,000 pneumoconiosis deaths nationwide, accounting for more than 276,000 years of potential life lost to life expectancy. (Ref. No. 2007T06-01, 2007T06-03)
• Overall pneumoconiosis mortality in the U.S. has been gradually declining over the past three decades, from a peak of more than 5,000 deaths in 1972 to 2,531 pneumoconiosis deaths in 2004. (Ref. No. 2007F06-01, 2007T06-01)
• Pneumoconiosis was designated as the underlying cause of death in over one-third of all pneumoconiosis deaths from 1995 to 2004. (Ref. No. 2007F06-01)
• The pattern of all pneumoconiosis mortality is largely influenced by asbestosis, given that asbestosis deaths represent nearly half of all pneumoconiosis deaths from 1995 to 2004. Asbestosis deaths have exceeded CWP deaths since 1998. (Ref. No. 2007T01-01, 2007T02-01, 2007T06-06)
• Based on a major survey of private industry employers, annual estimates for the number of new cases of pneumoconiosis over the late 1990s and early 2000s have ranged from 1,300 to 3,500 among employees. There has been no clear trend in these estimates since 1980. The highest estimated rates have been consistently associated with mining, particularly with coal mining. (Ref. No. 2007T06-12, 2007T06-13, 2007T06-14a, 2007T06-14b)
• For the overall period 1993 to 2003, industries with over 200 exposure samples and about 28% of the exposures exceeding the REL were miscellaneous nonmetallic mineral and stone products, structural clay products, iron and steel foundries, pottery and related products, and coal mining. (Ref. No. 2007T06-16)
Malignant Mesothelioma
• There were over 15,000 malignant mesothelioma deaths among U.S. residents age 15 and over accounting for more than 200,000 years of potential life lost to life expectancy in the 1999–2004 period. (Ref. No. 2007T07-01, 2007T07-03)
• Mesothelioma was designated as the underlying cause of death in nearly 95% of all malignant mesothelioma deaths in the 1999–2004 period. (Ref. No. 2007T07-01)
• For 1999–2004, nearly 20% of mesothelioma decedents were female. (Ref. No. 2007T07-01)
• For 1999–2004, more than one-third of mesothelioma decedents were residents of just five states (California, Florida, New York, Pennsylvania, and Texas). (Ref. No. 2007T07-04)
• For the period from 2000 to 2004, two counties (one each in Maine and Minnesota) had age-adjusted malignant mesothelioma death rates that exceeded the national rate by more than five-fold. (Ref. No. 2007T07-10)
• Based on a large subset of the national data for which decedents’ usual occupation and industry information was available, the construction industry accounted for nearly 15% of decedents with malignant mesothelioma in 1999. (Ref. No. 2007T07-06)
• In addition to the construction industry, other industries associated with significantly increased mesothelioma proportionate mortality in 1999 include ship and boat building and repairing, industrial and miscellaneous chemicals, petroleum refining, and electric light and power. (Ref. No. 2007T07-08)
• Occupations associated with significantly elevated mesothelioma mortality in 1999 include plumbers, pipefitters, and steamfitters; mechanical engineers; electricians; and elementary school teachers. (Ref. No. 2007T07-09)
Hypersensitivity Pneumonitis (HP)
• The annual number of hypersensitivity pneumonitis (HP) deaths has been generally increasing, from less than 20 per year in 1979 to over 60 in 2004. (Ref. No. 2007F08-01)
• HP was designated as the underlying cause of death in over 70% of all HP deaths from 1995 to 2004. (Ref. No. 2007T08-01)
• The highest HP death rates for the 1995–2004 period are in the upper Midwest, northern Plains, Mountain, and New England states. (Ref. No. 2007F08-02, 2007T08-05)
• For the 1995–2004 period, one county in North Carolina had an age-adjusted HP death rate that exceeded the national rate by 29-fold. (Ref. No. 2007T08-10)
• For the 1990–1999 period, agricultural production industries (both livestock and crops) and the farmers, except horticulture occupation were associated with significantly elevated PMRs for HP. (Ref. No. 2007T08-08, 2007T08-09)
Asthma
• For the 1990–1999 period, agriculture production, livestock and child day care services were associated with the highest PMRs for asthma. Among the other top five industries with significantly elevated PMRs for asthma were drug stores; health services, not elsewhere classified; and colleges and universities. (Ref. No. 2007T09-01)
• For the 1990–1999 period, half of the 22 occupational groups associated with significantly elevated PMRs for asthma was related to health care and education. (Ref. No. 2007T09-02)
• Public health surveillance programs in four states (California, Massachusetts, Michigan, and New Jersey) have identified over 4,000 cases of work-related asthma for the 1993–2002 period. About 68% represented asthma caused by occupational exposure, while 20% represented preexisting asthma aggravated by occupational exposure. (Ref. No. 2007T09-03)
• Of all the work-related asthma cases from California, Massachusetts, Michigan, and New Jersey associated with various categories of reported putative agents for 1993–2002, nearly 20% were associated with miscellaneous chemicals, 13% with mineral and inorganic dust, 12% with cleaning materials, 11% with indoor air pollutants, and 4% with exposures to polymers, among others. Within agent categories, isocyanates and hydrocarbons, not otherwise specified, had the greatest proportion of cases classified as occupational asthma, at 89% and 83%, respectively; pyrolysis products had the greatest proportion of cases classified as work-aggravated asthma, at 29%. (Ref. No. 2007F09-01)
• Based on national household surveys of the U.S. population in which respondents’ current industry and occupation were ascertained for the 1997–2004 period, social services, religious and membership organizations; health services, except hospitals; eating and drinking places; banking and credit agencies; elementary and secondary schools and colleges; and legal, engineering and other professional services were the current industries associated with an estimated asthma prevalence that significantly exceeded the estimated 9.1% national asthma prevalence. (Ref. No. 2007T09-14)
• Based on the survey noted above for the period 1997–2004, health service and health technologist and technicians were the current occupations associated with an estimated asthma prevalence that significantly exceeded the estimated 9.1% national asthma prevalence. (Ref. No. 2007T09-17)
• For the period 1997–2004, the estimated asthma prevalence among females was significantly higher than the estimated asthma prevalence among males. (Ref. No. 2007T09-15, 2007T09-16, 2007T09-18, 2007T09-19)
• For the period 1997–2004, health services, except hospitals and eating and drinking places were the current industries associated with significantly higher estimated asthma prevalence for current smokers than the estimated 9.3% national asthma prevalence for all U.S. adult current smokers. (Ref. No. 2007T09-08a)
• For the period 1997–2004, health service was the current occupation associated with significantly higher estimated asthma prevalence for current smokers than the estimated 9.3% national asthma prevalence for all U.S. adult current smokers. (Ref. No. 2007T09-11a)
Chronic Obstructive Pulmonary Disease (COPD)
• Coal mining led the list of industries with significantly elevated PMRs for COPD in 1999. Two other mining industries were in the top five industries for COPD mortality, as were trucking service and automotive repair and related services. (Ref. No. 2007T10-01)
• The top five occupations for COPD mortality in 1999 included washing, cleaning, and pickling machine operators; helpers, mechanics and repairers; textile cutting machine operators; mining machine operators; and construction trades, not elsewhere classified. (Ref. No. 2007T10-02)
• Based on a national household survey of the U.S. population conducted in which respondents’ current industry and occupation were ascertained for the 1997–2004 period, social services, religious and membership organizations; health services, except hospitals; and general merchandise stores were the current industries associated with a significantly higher estimated COPD prevalence than the estimated 4.0% national asthma prevalence. (Ref. No. 2007T10-09)
• Based on the survey noted above for the period 1997–2004, other educational services; health services, except hospitals; and social services, religious and membership organizations were the industries associated with significantly higher estimated COPD prevalence for current smokers than the estimated 6.5% national COPD prevalence for all U.S. adult current smokers. (Ref. No. 2007T10-03)
Respiratory Conditions due to Toxic Agents
• Based on a major survey of private employers, the annual estimated number of cases of respiratory conditions due to toxic agents has decreased to approximately 14,500 for 2001, down from annual estimates of about 25,000 in the early and mid 1990s. (Ref. No. 2007T11-01a)
• The major industry groups associated with the highest annual estimated rates of work-related respiratory conditions due to toxic agents in 2001 are transportation equipment; transportation by air; local and interurban passenger transit; and health services. The transportation equipment industry has consistently ranked in the top three industry sectors during the 1996–2001 period. (Ref. No. 2007T11-03)
Respiratory Tuberculosis
• Among the industries associated with significantly elevated proportionate tuberculosis mortality in the 1990–1999 period were the healthcare industries (offices and clinics of health practitioners; hospitals; and miscellaneous personal services); industries also associated with significantly elevated silicosis mortality (nonmetallic mining and quarrying, except fuel; metal mining; other primary metal industries; and coal mining); carpets and rugs; automotive services, except repair; miscellaneous repair services; and agricultural production, crops. (Ref. No. 2007T12-01, 2007T03-08)
• Among the occupations associated with significantly elevated proportionate tuberculosis mortality in the 1990–1999 period were agricultural occupations (farm workers and farmers, except horticulture); occupations also associated with significantly elevated silicosis mortality (crushing and grinding machine operators; mining machine operators; construction laborers; and laborers, except construction); sailors and deckhands; bar tenders; heating, air conditioning, and refrigeration mechanics; clinical laboratory technologists and technicians; and garbage collectors. (Ref. No. 2007T12-02; 2007T03-09)
Lung Cancer
• A variety of industries and occupations associated with significantly elevated proportionate lung cancer mortality are listed in this section. (Ref. No. 2007T13-01, 2007T13-02)
Other Interstitial Pulmonary Diseases
• A variety of industries and occupations associated with significantly elevated other interstitial pulmonary diseases mortality are listed in this section. (Ref. No. 2007T14-01, 2007T14-02
Pneumonia and Influenza
• A variety of industries and occupations associated with significantly elevated pneumonia and influenza mortality are listed in this section. (Ref. No. 2007TXX-02)
Various Work-Related Respiratory Conditions
• Data from the Bureau of Labor Statistics Annual Survey and the Association of Occupational and Environmental Clinics Database, both of which include information on a wide range of work-related respiratory diseases, serve to remind readers that there is much more to work-related lung disease and other occupational respiratory diseases than they might otherwise realize. Data are presented on work-related upper airway disorders (e.g., allergic rhinitis), malignant diseases (e.g., nasal and laryngeal, as well as pulmonary and pleural), infectious diseases (e.g., influenza, pneumonia, and Legionnaires’ disease), and other respiratory diseases (e.g., pneumonitis and interstitial fibrosis). (Ref. No. 2007T15-01 to 2007T15-05)
Smoking Prevalence by Occupation and Industry
• Based on data from the National Health Interview Survey for 1997–2004, estimated smoking prevalences range widely among the various industries, from 12% among elementary and secondary schools and colleges to over 38% among eating and drinking places. Similar wide-ranging smoking prevalences are seen among occupational groups, ranging from 5% in health diagnosing to nearly 39% in forestry and fishing. (Ref. No. 2007T16-01 to 2007T16-06)
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