Active Surveillance of Engineered Stone Workers Facilitates Early Identification of Silicosis: A Discussion of Surveillance of Occupational Lung Diseases

Abstract

Silicosis in workers exposed to respirable crystalline silica while fabricating engineered stone products is an emerging respiratory health issue. We describe silicosis in engineered stone workers in California and examine clinical features by the source of identification. Cases were identified passively using hospital-based patient discharge data or actively through outreach and medical testing following enforcement investigation. Outcomes were examined based on the source of case identification. We identified 18 cases diagnosed between 2006 and 2020. Cases identified passively compared to other identification methods were associated with lower percent predicted forced vital capacity (FVC) ( P ≤ .01), forced expiratory volume in 1 s (FEV1) ( P ≤ .01), and diffusing capacity of the lungs for carbon monoxide (DLCO) ( P < .01) at the time of diagnosis and were more likely to be identified following death or lung transplant ( P = .01). Our experience demonstrates delays in diagnosis and case identification when relying on passive surveillance methods. Enhanced public health surveillance systems can improve the early detection of occupational lung disease and inform future prevention policies.

Preventing the Continuing Tragedy of Silicosis—Reply

“…In addition to compliance with and enforcement of regulatory standards, medical surveillance of engineered stone workers is urgently needed, as well as public health reporting of cases of silicosis. A recent subsample analysis of the California silicosis cases found that cases identified through active medical surveillance and public health outreach had less severe, earlier-stage disease than cases identified passively through hospital discharge data . That analysis also highlighted the critical importance of connecting public health reporting of occupational diseases by clinicians with workplace exposure monitoring and surveillance efforts.…”

Routine Disasters, Routine Injustice

“…The case of workers, disproportionately Latino, who cut engineered stone for countertops is regrettably similar. In Active Surveillance of Engineered Stone Workers Facilitates Early Identification of Silicosis: A Discussion of Surveillance of Occupational Lung Diseases, 7 Gandhi et al argue for active surveillance of lung diseases such as silicosis, especially found in workers who cut engineered stone for countertops. The authors report that 89% of the cases identified were Latino workers.…”