Asbestos-related diseases in the Federal Republic of Germany

Our plain-English summary of Asbestos-related diseases in the Federal Republic of Germany, by H.J. Woitowitz, L. Beierl, M. Rathgeb, et al (American Journal of Industrial Medicine, 1981).

The study

• Authors: H.J. Woitowitz, L. Beierl, M. Rathgeb, K. Schmidt, K. Rödelsperger, U. Greven, R.H. Woitowitz, H.J. Lange, K. Ulm
• Journal: American Journal of Industrial Medicine
• Published: 1981;2(1):71-8
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001816).

Abstract

Until recently, in the Federal Republic of Germany there has been a lack of epidemiological data on asbestos-related tumors. Only the numbers of occupational diseases accepted for compensation by the German industrial injuries insurance institutes (Berufsgenossenschaften) can be stated. These show, for 1979, 94 cases of asbestosis, 21 cases of asbestosis associated with lung cancer, and 34 cases of mesothelioma. Since 1972 employees exposed to asbestos dust have been included in a central register by the industrial injuries insurance institutes and are medically examined periodically. By December 31, 1979, 28,476 persons were registered. Of those, 6,582 were still being followed medically, although they were no longer working with asbestos dust exposure. In January 1, 1977, a prospective epidemiological study was started with these people who were formerly exposed to asbestos dust. Up to December 31, 1980, altogether 2,944 people were enrolled in the study. Besides several other enrollment criteria, the individual's permission was required to evaluate his personal data. Of the people enrolled, 85 had died by December 31, 1980. Even if five questionable cases of lung cancer are excluded (n = 80), the observed rates of about 43% tumours of all sites, with 15% lung cancer and 6% mesothelioma, seem to be comparable to the international epidemiological mortality pattern.

In plain English

This preliminary report described a prospective study, started on January 1, 1977, of workers in the Federal Republic of Germany who had formerly been exposed to asbestos dust and were registered and periodically examined by the industrial injuries insurance institutes. Enrollment required at least three years of exposure that had since ended, more than nine years since first exposure, and age 30 or over. The article did not name fiber types. By December 31, 1980, 2,944 people were enrolled and 85 (78 men, seven women) had died. Compared with the age- and sex-specific pattern of deaths in the general population, the share of deaths from lung cancer (17 cases, standardized proportional mortality ratio 3.4) and from pleural and peritoneal mesothelioma (five cases) was raised, with p less than 0.01. After four lung cancers already evident at enrollment and one questionable diagnosis were removed, the ratio was about 2.5 (p less than 0.05). Of the remaining 80 deaths, about 43% were tumors, 15% lung cancer and 6% mesothelioma. The authors concluded that these rates seemed similar to the international mortality pattern. They cautioned that this ratio cannot replace a standardized mortality ratio and that tumor cases may be over-represented.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective epidemiological cohort study (preliminary report) using standardized proportional mortality ratios (SPMR) for deaths in the cohort
• Who was studied: Former asbestos-dust-exposed employees registered and periodically examined by the German industrial injuries insurance institutes. Enrollment criteria were: at least 3 years of exposure, since ended; more than 9 years since first exposure; age 30 or over; living in the Federal Republic of Germany; and consent. 2,944 were enrolled between January 1, 1977 and December 31, 1980, and 85 of them (78 men, 7 women) had died.
• Exposure: Occupational asbestos dust exposure of at least three years that had ended. Median duration of exposure was 14 years and median time since first exposure was 17 years for the cohort. Fiber types were not specified.
• Main results:
  • Among the 85 deaths, the SPMR exceeded one with p less than 0.01 for lung cancer and for pleural and peritoneal mesothelioma.
  • The SPMR for lung cancer was 3.4, based on 17 lung cancer deaths.
  • There were five mesothelioma deaths among the 34 deaths from tumors of the respiratory and digestive tract.
  • When four lung cancer cases whose illness was already evident at enrollment and one questionable lung cancer diagnosis were excluded, the SPMR was about 2.5, differing from 1 with p less than 0.05.
  • Of all 85 deaths, about 46% were tumors of all sites, 20% lung cancer and 6% mesothelioma.
  • Excluding the five questionable lung cancer cases (n = 80), about 43% of deaths were tumors of all sites, 15% lung cancer and 6% mesothelioma.
  • The 34 tumor deaths and the 51 deaths from other causes showed no significant differences in duration of exposure, time since first exposure or age (crude comparison).
  • Background figures reported in the article: in 1979, 94 cases of asbestosis, 21 cases of asbestosis associated with lung cancer, and 34 cases of mesothelioma were accepted for compensation in the Federal Republic of Germany.
• The authors' conclusion: The authors concluded that the observed tumor, lung cancer and mesothelioma rates among the deaths seemed similar to the international mortality pattern.
• Limitations the authors state:
  • The standardized proportional mortality ratio cannot substitute for the standardized mortality ratio, which was to be calculated in a later evaluation.
  • The enrollment criteria could not with certainty prevent an enrichment of tumor cases.
  • Death certificates were not available for all cases.
  • Diagnoses in the cohort used the best available medical information, while expected figures came from death certificates alone. The resulting overestimation of excess mesothelioma and lung cancer risk could not be quantified.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Occupational Disease, Lung Cancer, Mesothelioma.

Related studies

• Aspects of asbestos exposure in place in the Federal Republic of Germany — H.J. Woitowitz (1991)
• Asbestos consumption, asbestos exposure and asbestos-related occupational diseases in Germany — O. Hagemeyer, H. Otten, et al. (2006)
• Are the knowledge of non-malignant asbestos-related diseases and lung function impairment differentially associated with psychological well-being? A cross-sectional study in formerly asbestos-exposed workers in Germany — J. Lang, M.K. Felten, et al. (2019)
• Asbestos use and carcinogenicity in Germany and a comparison with animal studies — F. Pott (1994)
• Occupational respiratory diseases in the Czech Republic — P. Brhel (2003)
• Dose-response relationships for asbestos-related disease: implications for hygiene standards. Part II. Mortality — J. Peto (1979)

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