Pulmonary abnormalities associated with occupational exposures at the Savannah River Site

Our plain-English summary of Pulmonary abnormalities associated with occupational exposures at the Savannah River Site, by T. Makie, D. Adcock, D.T. Lackland, et al (American Journal of Industrial Medicine, 2005).

The study

• Authors: T. Makie, D. Adcock, D.T. Lackland, D.G. Hoel
• Journal: American Journal of Industrial Medicine
• Published: 2005;48(5):365-72
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: A program of medical evaluation for former Savannah River Site (SRS) workers at health effects due to exposures to hazardous or radioactive agents was conducted.

Methods: This study includes data from 1,368 participants aged 45 years or older who were assessed regarding work-history and exposures to industrial agents. According to the standard industrial classification (SIC), participants were employed in five of the SIC divisions. Based on the International Labour Office Classification of Radiographs, two categories of pleural and parenchymal abnormalities were evaluated by a single radiologist. The SRS results were compared with the second national health and nutrition examination survey (NHANES II) results.

Results: The odds ratio of the SRS male aged 45-75 compared to NHANES was 2.4 for pleura abnormalities and 0.8 for parenchymal abnormalities. Using logistic regression, the highest-risk worker division was construction (OR = 2.76); asbestos exposure was clearly associated with pleural abnormality (OR = 2.15).

Conclusions: Pulmonary abnormalities were higher in former SRS workers than that in general population. Asbestos and possibly other exposures were related to pulmonary disease in this population.

In plain English

The study used chest X-rays of former Savannah River Site workers (a Department of Energy site in South Carolina) screened from 1999 to 2004. A single radiologist read X-rays of 1,368 workers over age 45 using the International Labour Office (ILO) system. Jobs fell into five divisions; workers reported exposure to nine agents, including asbestos (fiber type unstated). Overall, 11.3% had pleural abnormalities only, 5.4% parenchymal (lung tissue) abnormalities only, and 3.7% both. Compared with a national survey (NHANES II), men aged 45 to under 75 had odds ratios of 2.4 (95% confidence interval 1.9 to 3.0) for pleural and 0.8 (0.8 to 1.0) for parenchymal abnormalities. Against reference Division I2, adjusted for age, gender, race and smoking, Division C (construction jobs) had the highest odds ratios: 2.76 (1.64 to 4.64) pleural and 2.66 (1.39 to 5.10) parenchymal. Across the four divisions versus that reference, self-reported asbestos exposure was associated with pleural (2.15, 1.53 to 3.01) and parenchymal (1.95, 1.28 to 2.96) abnormalities. The authors concluded that reported asbestos exposure increased pleural abnormality risk and that other agents may contribute.

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: Cross-sectional analysis of chest radiographs from a medical screening program, compared with national survey data (NHANES II) and analyzed with logistic regression
• Who was studied: 1,368 former Savannah River Site (South Carolina) production workers over age 45 whose chest radiographs were read, out of 1,574 radiographs interpreted. Phase II ran from November 1999 to September 2004. Workers came from a list of 25,580 former workers.
• Exposure: Self-reported exposure to nine industrial agents: asbestos, lead, beryllium, welding fumes, hydrazine, hydrogen sulfide, solvents, and external and internal radiation. Jobs were also grouped into five Standard Industrial Classification divisions. Asbestos fiber types were not specified. In Division C, asbestos work included asbestos cement products or removed asbestos; Division E included work with asbestos thermal insulation products.
• Main results:
  • Among all 1,368 workers, 155 (11.3%) had pleural abnormalities only, 74 (5.4%) parenchymal abnormalities only, and 50 (3.7%) both.
  • SRS males aged 45 to under 75 compared with NHANES II males: pleural abnormalities 14.2% vs 7.0%, odds ratio 2.4 (95% CI 1.9, 3.0).
  • SRS males aged 45 to under 75 compared with NHANES II males: parenchymal abnormalities 8.1% vs 11.0%, odds ratio 0.8 (95% CI 0.8, 1.0).
  • In the four job divisions, about 25 to 30% of workers had X-ray abnormalities, compared with 13.6% in Division I2 (the reference group).
  • In logistic regression against Division I2, with age, gender, race and smoking status as adjustment factors (Table VI), Division C had the highest odds ratios: 2.76 (95% CI 1.64, 4.64) for pleural and 2.66 (1.39, 5.10) for parenchymal abnormalities.
  • In the analysis of the four divisions combined versus the reference division (Division I2), with age, gender, race and smoking status fixed in the model, self-reported asbestos exposure was associated with pleural abnormalities (odds ratio 2.15, 95% CI 1.53, 3.01) and parenchymal abnormalities (1.95, 1.28, 2.96).
  • Within single divisions, asbestos was associated with pleural abnormalities in Divisions C and D, internal radiation in Division E, and beryllium in Division I1.
• The authors' conclusion: The authors concluded that pulmonary abnormalities among male SRS workers were higher than in the general U.S. population, that reported asbestos exposure increased the risk of pleural abnormalities in this group, and that several other workplace agents may also increase the risk of pulmonary disease.
• Limitations the authors state:
  • Interpretation of chest X-rays under the ILO classification varies between readers.
  • Compared with an earlier study, the radiologist's readings appeared to slightly underestimate pleural abnormalities and slightly overestimate parenchymal abnormalities.
  • The NHANES II comparison data were not classified with the ILO system.
  • The results for parenchymal abnormalities were inconsistent, and exposure to many different agents made interpretation difficult.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Odds Ratio, Pleura, Asbestos Exposure.

Related studies

• Mortality among workers at the Savannah River Site — D.B. Richardson, S. Wing, et al. (2007)
• Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers — M.A. Mikulski, P.G. Hartley, et al. (2011)
• Pulmonary abnormalities as a result of exposure to Libby amphibole during childhood and adolescence-The Pre-Adult Latency Study (PALS) — J. Szeinuk, C.W. Noonan, et al. (2017)
• Open lung biopsy in patients with diffuse pulmonary shadowing — G.E. Venn, P.H. Kay, et al. (1985)
• Contrasting effects of alveolar macrophages and neutrophils on asbestos-induced pulmonary epithelial cell injury — D.W. Kamp, M.M. Dunn, et al. (1994)
• Lung sounds in asbestos induced pulmonary disorders — P. Piirilä, H. Lehtola, et al. (2000)

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