Mortality among asbestos products workers in the United States

Our plain-English summary of Mortality among asbestos products workers in the United States, by P.E. Enterline (Annals of the New York Academy of Sciences, 1965).

The study

• Author: P.E. Enterline
• Journal: Annals of the New York Academy of Sciences
• Published: 1965;132(1):156-65
• Cited by: 47 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. 001524).

Summary of the article

The author examined whether men who worked in the asbestos products industry in the United States had higher mortality, particularly from respiratory cancer. The cohort was 2,833 white men aged 15 to 64 who worked at some time during 1948-1951 for nine producers of asbestos textiles and one producer of asbestos friction materials. For comparison, 6,242 white men from three cotton textile plants were studied. Workers were identified from social security tax returns, and deaths through June 1963 from Social Security death claims. Death certificates were coded to the seventh revision of the International Classification of Diseases. Expected deaths were calculated from U.S. white male death rates. All-cause mortality among asbestos products workers was about 12 per cent above the U.S. rate (SMR 112.4). Among cotton textile workers it was about 12 per cent below (SMR 88.4). Asbestos products workers had significant excesses of respiratory cancer (24 observed, 11.9 expected), hypertensive heart disease and respiratory diseases. The respiratory disease excess was due entirely to 18 deaths from asbestosis. The respiratory cancer SMR rose to 258.6 in 1958-1963. When cotton textile workers' rates were used as the comparison, the SMRs were 130.8 for all causes, 219.7 for cancer and 438.6 for respiratory diseases. The author concluded that the data were consistent with an important past health hazard in the asbestos products industry, shown as increased cancer and asbestosis. He noted that smoking and length of exposure could not be assessed and called the results preliminary.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

The author followed 2,833 white men aged 15 to 64 who worked at some time in 1948-1951 at ten U.S. asbestos products plants. Most were asbestos textile makers, plus one friction materials plant, and the men were found through Social Security tax records. Deaths through June 1963 were compared with U.S. white male death rates and with 6,242 cotton textile workers. The asbestos workers had 286 deaths, about 12 per cent above national rates (a standardized mortality ratio of 112.4); cotton workers were about 12 per cent below. Three causes were significantly raised among asbestos workers: respiratory cancer (24 deaths, 11.9 expected), hypertensive heart disease and respiratory diseases. The respiratory disease excess was due entirely to 18 asbestosis deaths. The respiratory cancer excess grew over time, reaching over two and one-half times expected after roughly 10 years. Measured against cotton workers' rates, cancer deaths were over twice expected. A digestive cancer excess was not statistically significant. The author concluded the data were consistent with a past hazard in the industry showing as more cancer and asbestosis. The author noted that smoking and length of exposure could not be assessed.

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: Cohort mortality study of workers identified from Social Security tax records and followed for deaths. Observed deaths were compared with expected deaths from U.S. white male rates (standardized mortality ratios) and with rates among cotton textile workers.
• Who was studied: 2,833 white men aged 15 to 64 who worked at some time during 1948-1951 for ten U.S. asbestos products producers (nine asbestos textile producers and one friction materials producer). They were followed for deaths through June 30, 1963. The comparison group was 6,242 white men at three cotton textile plants.
• Exposure: Employment in asbestos products manufacture, mostly asbestos textiles, with one plant making asbestos friction materials. Fiber types and dust levels are not reported.
• Main results:
  • All causes, asbestos products workers compared with U.S. white males: 286 deaths observed, SMR 112.4, about 12 per cent higher. The expected number of deaths is garbled in the scanned table.
  • All causes, cotton textile workers compared with U.S. white males: 486 deaths observed, 549.6 expected, SMR 88.4, about 12 per cent below.
  • Asbestos products workers had significant excesses (P less than .05) for three causes: respiratory cancer (24 observed, 11.9 expected, SMR 201.7), hypertensive heart disease (14 observed, 5.8 expected, SMR 241.4) and diseases of the respiratory system (25 observed, 9.4 expected, SMR 266.0).
  • Among asbestos products workers, the respiratory disease excess was due entirely to 18 deaths with pulmonary asbestosis as the underlying cause. None of these 18 deaths had a malignancy recorded.
  • Of the 24 respiratory cancer deaths among asbestos products workers, two had asbestosis recorded as contributing to death.
  • Digestive system cancer among asbestos products workers: 21 observed, 13.9 expected, SMR 151.1. This excess was not statistically significant.
  • Respiratory cancer SMRs for asbestos products workers rose by calendar period: 136.4 in 1948-52 (3 deaths), 153.8 in 1953-57 (6 deaths) and 258.6 in 1958-63 (15 deaths).
  • Asbestos products workers compared with cotton textile worker rates: all causes 286 observed vs 218.6 expected (SMR 130.8); cancer 58 vs 26.4 (SMR 219.7); respiratory diseases 25 vs 5.7 (SMR 438.6). Each excess was reported as statistically significant.
  • Deaths from violence among asbestos products workers were below those expected from cotton worker rates (36 observed, 45.3 expected, SMR 79.5). This deficit was not statistically significant.
  • After excluding cancer and asbestosis, SMRs were similar for asbestos and cotton textile workers.
• The authors' conclusion: The author concluded that the data were consistent with the hypothesis that a health hazard had existed in the past in the U.S. asbestos products industry. In the author's view this hazard showed as increased cancer and asbestosis and did not appear to be present in the cotton textile industry.
• Limitations the authors state:
  • Not all workers were necessarily exposed to asbestos dust. Unexposed workers would dilute any excess.
  • The friction materials plant could not be separated from the asbestos textile plants.
  • Length of exposure could not be determined from Social Security records.
  • There was no information on cigarette smoking or on dusty versus non-dusty jobs. The author considered it possible that more smoking contributed to the respiratory cancer excess, but unlikely that smoking explained the whole excess.
  • U.S. white male rates were probably not an entirely appropriate comparison, because the workers were healthy enough to be employed and differed regionally and economically.
  • Some deaths were probably missed in Social Security records, so deaths were slightly understated for both groups.
  • Numbers of deaths in the calendar-period analysis were often small.
  • A third of the men had only one quarter of asbestos industry coverage, suggesting brief exposure for many.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Textiles, Death Certificate.

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