Mortality among persons with silicosis reported to disease surveillance systems in Michigan and New Jersey in the United States.

Michigan and New Jersey in the United States maintain silicosis disease registers. In 1988-1992, 372 cases of silicosis were confirmed in Michigan, and, in 1979-1992, 288 were confirmed in New Jersey. A proportionate mortality ratio (PMR) analysis was performed on data from 292 deceased silicotics. Increases in PMR values were found for nonmalignant respiratory disease (NMRD) and lung cancer. The PMR values for NMRD were statistically elevated in all the analyses. The overall proportionate cancer mortality ratio (PCMR) for lung cancer was 1.78 [95% confidence interval (95% CI) 1.22-2.61]. For patients having ever smoked cigarettes, the PCMR for lung cancer was 1.82 (95% CI 1.8-2.81). Never smoking silicotics had a lung cancer PCMR of 1.48 (95% CI 0.43-2.86). For those who had never applied for workers' compensation the corresponding PCMR was higher, 2.10 (95% CI 1.21-3.69), than for those who had applied, 1.45 (95% CI 0.70-2.99).

Silicosis surveillance--Michigan, New Jersey, Ohio, and Wisconsin, 1987-1990.

PROBLEM/CONDITION: Improved surveillance for silicosis is needed to target interventions to prevent this occupational lung disease caused by the inhalation of crystalline silica dust. REPORTING PERIOD COVERED: 1987-1990. DESCRIPTION OF SYSTEMS: State-based silicosis surveillance and intervention programs have been developed in Michigan, New Jersey, Ohio, and Wisconsin as part of the Sentinel Event Notification System for Occupational Risks (SENSOR) Program, initiated in 1987 by the National Institute for Occupational Safety and Health (NIOSH). RESULTS: From 1987 through 1990, the SENSOR program confirmed a total of 430 cases of silicosis reported from these four states. Overall, approximately 60% of these cases were in workers employed in primary metal industries, although the types of industries in which cases occurred varied by state. Some cases were attributable to relatively recent exposure, including new cases in seven persons first exposed since 1980 in New Jersey. Silicosis case reports have prompted measurement of respirable silica concentrations at 25 Michigan work sites, and 14 (56%) of these sites were found to have levels that exceeded the legally permissible exposure level. INTERPRETATION: The silicosis surveillance and intervention strategies piloted by state health departments in the NIOSH-funded SENSOR Program have demonstrated the feasibility and effectiveness of identifying specific silica-using work sites that need preventive intervention. ACTIONS TAKEN: On the basis of initial experience in these four states, NIOSH developed guidelines for state-based silicosis surveillance and awarded SENSOR cooperative agreements to three additional states where the applicability of these surveillance methods will be further evaluated.

Patterns of asbestosis in New Jersey.

Hospital discharge data from New Jersey were used to identify cases of asbestosis for the 8 years 1979-1986. Multiple admissions were deleted so that each individual was counted once at the time of his/her first hospitalization with an asbestosis diagnosis. White males had the highest age-adjusted average annual discharge rate of 19.3 cases/100,000 population, followed by black males (12.3 cases/100,000) and white females (1.2 cases/100,000). The discharge rate was positively associated with age in each race/sex category. The relationship between rates for black males and white males depended on age: under 65 years, the rates were almost equal, and at 65 years and older, the white rates were nearly twice the black rates. There were two areas of the state where the rates were highest: the north-central and southwest regions. These two areas represent manufacturing and shipbuilding applications of asbestos, respectively. During the years 1979-1986, the annual percentage increase in asbestosis rates was 20% for white males, 17% for black males, and 8% for white females. Continued surveillance will reveal when the rates for asbestosis stop increasing.

The use of portable peak flowmeters in the surveillance of occupational asthma.

The purpose of this study was to identify the strengths and limitations of using portable peak flowmeters to document suspected cases of occupational asthma that were reported to a statewide surveillance project. The New Jersey Department of Health conducts surveillance for occupational asthma as part of the federally sponsored Sentinel Event Notification System for Occupational Risks (SENSOR). Between May 1988 and January 1990, 70 cases were reported voluntarily by physicians. Subjects who were still employed in suspected work sites were requested to test themselves for at least 15 days, using portable peak flowmeters to generate serial measurements of their peak expiratory flow rate (PEFR). For each of the 14 subjects who were successfully tested, the PEFR data provided valuable information about their asthma-work association. However, a large number of subjects whose cases were reported (56) either could not be tested or were not successfully tested. The proportion of subjects completing the test would probably improve if it were conducted when their conditions were first diagnosed. Accordingly, the collection of serial peak flow measurements to document occupational asthma would best be initiated by the treating physician when the patient first sought care, rather than waiting until after the case was reported to the state health department.