Since 1940, 760 cases of silicosis have been diagnosed as part of the State of North Carolina's (NC) pneumoconiosis surveillance program for dusty trades workers. Vital status was ascertained through 1983 for 714 cases that had been diagnosed since 1940 and death certificates were obtained for 546 of the 550 deceased. Mortality from tuberculosis, cancer of the intestine and lung, pneumonia, bronchitis, emphysema, asthma, pneumoconiosis, and kidney disease was significantly increased in whites. Mortality from tuberculosis, ischemic heart disease, and pneumoconiosis was significantly increased in non-whites. The standardized mortality ratio (95% CI) for lung cancer based on U.S. rates was 2.6 (1.8-3.6) in whites, 2.3 (1.5-3.4) in those who had no exposure to other known occupational carcinogens, and 2.4 (1.5-3.6) in those who had no other exposure and who had been diagnosed for silicosis while employed in the NC dusty trades. Age-adjusted lung cancer rates in silicotics who had no exposure to other known occupational carcinogens were 1.5 (.8-2.9) times higher than that in a referent group of coal miners with coalworkers' pneumoconiosis (CWP) and 2.4 (1.5-3.9) times higher than that in a referent group of non-silicotic metal miners. Age- and smoking-adjusted rates in silicotics were 3.9 (2.4-6.4) times higher than that in metal miners. This analysis effectively controls for confounding by age, cigarette smoking, and exposure to other known occupational carcinogens, and it is unlikely that other correlates of silica exposure could explain the excess lung cancer mortality in the silicotics.

We previously reported on the lung cancer mortality through 1983 of 760 males who were diagnosed with silicosis during 1930-1983 by the State of North Carolina's medical examination program for dusty trades workers. The lung cancer SMR (95% confidence interval) was 2.6 (1.8-3.6) among 655 white members of this group. In this paper, we report the results of a reanalysis of mortality among a subgroup for whom chest radiographs were currently available for rereading. Technically acceptable radiographs were available for 306 white males and were independently reclassified for pneumoconiosis by 3 "B" readers using the 1980 ILO Classification. Lung cancer SMRs were 1.7 (0.8-3.1) for the entire group of 306 white males, 2.5 (1.1-4.9) for 143 subjects reclassified as simple silicosis, and 1.0 (0.1-3.5) for 96 subjects whose radiographs were reclassified as ILO category 0. There were no lung cancer deaths among 67 subjects whose radiographs were reclassified as progressive massive fibrosis. Corresponding lung cancer SMRs for subjects who had never been employed in a job with exposure to known occupational carcinogens were 1.2 (0.2-4.4) for those reclassified as category 0, and 2.4 (1.0-5.0) for those reclassified as having simple silicosis. The age-adjusted lung cancer rate ratio among subjects with simple silicosis compared to those with category 0 was 1.5 (0.4-5.8). Our findings from this reanalysis, which effectively controls for misclassification of silicosis due to errors in radiograph interpretation by North Carolina program readers, offer additional evidence consistent with the hypothesis of an association between silicosis and lung cancer in this study group.

No abstract

This case-control study within a metropolitan fire department evaluated the effect of self-contained breathing apparatus (SCBA) and other risk factors on three types of injury at the scene of a fire (smoke inhalation, burns, and falls). Data on 75 injured fire fighters and 144 controls came from telephone interviews and department records. The two sets of uninjured fire-fighter controls were matched to cases on incident (n = 72) or on job position and fire type and size (n = 72). Smoke inhalation cases were not significantly different from controls in SCBA use, cigarette smoking, previous fires in the shift, or injury history. Jobs with high risk of burns included nozzle operator, engine officer, and forcible-entry person in first-due companies (OR = 20.1). Other risk factors for burns were: basement origin of fire (OR = 10.2); prior fire-fighting training outside the present department (same fire: OR = 11.2; similar fire: OR = 3.9); and on-duty injury in the prior 12 months (same fire: OR = 4.3; similar fire: OR = 3.5). When other risk factors were considered, consistent SCBA use was associated with falls (same fire: OR = 11.8; similar fire: OR = 4.3) but not with burns. Risk of falls also was elevated among members of truck companies (OR = 17.7) and fire fighters without children (same fire: OR = 8.4; similar fire: OR = 7.4). On-duty injury in the past 12 months was associated with falls when one compared cases with similar-fire controls (OR = 5.5), but not with controls attending the same fire. Neither age nor experience was related to injury in this population.

No abstract