Proportionate mortality ratios (PMRs) associating pneumoconiosis deaths with various occupations are presented in Figures 3� through 3�. A PMR above 1.0 indicates that more deaths occurred with the condition than expected in an occupation or industry. PMRs with lower 95% confidence limits that exceed 1.0 are statistically significant. PMRs calculated from a large subset of national data indicate that mining machine operators have extremely high relative mortality from CWP and from unspecified and other pneumoconioses (Figures 3� and 3�). Insulation workers and related occupations had the highest PMRs for asbestosis (Figure 3�). Workers in metal and plastic processing, hand molding and shaping, and crushing and grinding in mining occupations had the highest PMRs for silicosis mortality (Figure 3�). Textile machine operators and repairers had significant PMRs for byssinosis (Figure 3�).

Figure 3�. PMRs (and 95% CIs) for CWP by occupation桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)

Figure 3�. PMRs (and 95% CIs) for unspecified and other pneumoconioses by occupation桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)

Figure 3�. PMRs (and 95% CIs) for asbestosis by occupation桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)

Figure 3�. PMRs (and 95% CIs) for silicosis by occupation桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)       

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Figure 3�. PMRs (and 95% CIs) for byssinosis in textile machine operators and repairers桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)

Mortality due to malignant pleural neoplasm (cancer of the lung lining) can serve as a surrogate for mortality due to malignant mesothelioma (often a cancer of the lung lining) because no unique cause-of-death code is currently available for mesothelioma. Asbestos exposure is by far the leading cause of malignant mesothelioma. The number of deaths associated with malignant pleural neoplasm increased during 1968�96 (Figure 3�). A geographic distribution of cases is presented in Figure 3�. From 1987 to 1996, men accounted for 76% of the deaths from malignant pleural neoplasm (Figure 3�), and white U.S. residents accounted for 94% of these deaths (Figure 3�). Occupations with the highest PMRs for malignant pleural neoplasm (Figure 3�) are similar to those with high PMRs for asbestosis (Figure 3�).

Figure 3�. Number of deaths with malignant pleural neoplasm recorded as an underlying or contributing cause on the death certificate桿.S. residents aged 15 and older, 1968�96. (Source: NCHS [1999].)

Figure 3�. Number of deaths due to malignant pleural neoplasm by State桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)

Figure 3�. Distribution and number of deaths due to malignant pleural neoplasm by sex桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)

Figure 3�. Distribution and number of deaths due to malignant pleural neoplasm by race桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)

Figure 3�. PMRs (and 95% CIs) for malignant pleural neoplasm by usual occupation桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)       

Hypersensitivity pneumonitis is a lung disease that is often related to occupation. Examples of this disease are farmers' lung, mushroom workers' lung, and bird fanciers' disease. The annual number of deaths with hypersensitivity pneumonitis as an underlying or contributing cause has generally increased since 1979 (Figure 3�). A geographic distribution of cases is presented in Figure 3�. Nearly 30% of decedents during 1987�96 were women (Figure 3�), and 95% were white U.S. residents (Figure 3�). The only occupation with a significantly high PMR for this disease was nonhorticultural farmer, with a value of 11.6 (95% confidence interval [CI] = 8.5�.6).

Figure 3�. Number of deaths recorded with hypersensitivity pneumonitis as an underlying or contributing cause on the death certificate桿.S. residents aged 15 and older, 1979�96. (Source: NCHS [1999].)

Figure 3�. Number of hypersensitivity pneumonitis deaths by State桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)

Figure 3�. Distribution and number of hypersensitivity pneumonitis deaths by sex桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)

Figure 3�. Distribution and number of hypersensitivity pneumonitis deaths by race桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)     

PMRs for selected occupations and fatal illnesses are presented in Table 3�/A> using data from the National Occupational Mortality Surveillance System (NOMS). Deaths related to diseases other than the pneumoconioses and mesothelioma are difficult to link to the workplace. Therefore, any apparent excess of mortality for an occupation must be verified by more definitive studies. Statistically significant elevations of PMR do not necessarily indicate a causal relationship between an occupation and a fatal illness. Some PMRs may be elevated by chance, which is likely when a very large number of PMRs are tested for statistical significance. Other elevated PMRs may be associated more strongly with confounding factors such as cigarette smoking, alcohol use, or socioeconomic factors such as availability of health care and proper diet. The information in Table 3�/A> may be used to identify possible associations between fatal illnesses and occupations that warrant further study. The findings may also be used to describe, to evaluate the results of other studies, or to target occupational groups for health promotion activities. For additional discussion about the use of PMRs from NOMS, see Mortality by Occupation, Industry, and Cause of Death: 24 Reporting States (1984�88) [NIOSH 1997]. Additional information about lung diseases can be obtained from the Work-Related Lung Disease Surveillance Report (WoRLD) [NIOSH 1999].  

Table 3�/b>. PMRs for white and black men and women aged 18 to 90 for selected occupations and causes of death in 28 States, 1984�95