Trends in Pneumoconiosis Deaths - United States, 1999-2018

Our plain-English summary of Trends in Pneumoconiosis Deaths - United States, 1999-2018, by J.L. Bell, J.M. Mazurek (MMWR. Morbidity and Mortality Weekly Report, 2020).

The study

• Authors: J.L. Bell, J.M. Mazurek
• Journal: MMWR. Morbidity and Mortality Weekly Report
• Published: 2020;69(23):693-698
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pneumoconioses are preventable occupational lung diseases caused by inhaling dust particles such as coal dust or different types of mineral dusts (1). To assess recent trends in deaths associated with pneumoconiosis, CDC analyzed multiple cause-of-death data*,† for decedents aged ≥15 years for the years 1999-2018, and industry and occupation data collected from 26 states§ for the years 1999, 2003, 2004, and 2007-2013. During 1999-2018, pneumoconiosis deaths decreased by 40.4%, with the exception of pneumoconiosis attributed to other inorganic dusts (e.g., aluminum, bauxite, beryllium, iron, and tin oxide), which increased significantly (p-value for time trend <0.05). The largest observed decreases in pneumoconiosis deaths were for those associated with coal workers' pneumoconiosis (69.6%) and silicosis (53.0%). Asbestosis was the most frequently reported pneumoconiosis and was associated with working in the construction industry. The ongoing occurrence of deaths associated with pneumoconiosis underscores the importance of occupational dust exposure reduction, early case detection, and continued surveillance to monitor trends.

In plain English

This CDC report analyzed U.S. death certificate data for 1999–2018 on pneumoconioses, lung diseases caused by inhaling dust. It counted 43,366 people aged 15 or older whose death certificates listed a pneumoconiosis as the underlying or a contributing cause. Nearly all were male. Total pneumoconiosis deaths fell 40.4%, from 2,738 in 1999 to 1,632 in 2018. Asbestosis (pneumoconiosis due to asbestos and other mineral fibers) was the most frequently reported type, listed in 26,059 deaths (60.1%). Asbestosis deaths numbered 1,258 in 1999 and 1,092 in 2018, and the authors reported that the yearly number began declining in 2001. Montana had the highest age-adjusted asbestosis death rate, 20.0 per million. In 26 states with job data for selected years, 820 of 3,284 asbestosis deaths (25.0%) were in the construction industry, and 264 (8.0%) were among pipe layers, plumbers, pipefitters and steamfitters. The authors noted that death certificates were not checked against medical records and that the usual job listed may not be where exposure occurred. They concluded that the decline indicates prevention strategies are effective, while continuing deaths underscore the need for exposure reduction and surveillance.

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: Descriptive surveillance analysis of national multiple cause-of-death (death certificate) data, with joinpoint regression of time trends
• Who was studied: 43,366 decedents aged 15 years or older in the United States, 1999–2018, whose death certificates listed pneumoconiosis as underlying or contributing cause. Industry and occupation data came from 26 states for 1999, 2003, 2004 and 2007–2013, and were available for 6,223 of 6,436 deaths.
• Exposure: Occupational dusts as captured by death certificate disease codes: coal dust (coal workers' pneumoconiosis), asbestos and other mineral fibers (asbestosis), silica (silicosis), other inorganic dusts, unspecified, and specific organic dust. Usual industry and occupation were recorded on the death certificate. No fiber types or doses were analyzed.
• Main results:
  • All pneumoconiosis deaths decreased 40.4%, from 2,738 in 1999 to 1,632 in 2018. Age-adjusted death rates fell from 12.8 to 5.3 per 1 million population.
  • Asbestosis was associated with 26,059 (60.1%) of the 43,366 pneumoconiosis deaths, followed by coal workers' pneumoconiosis (11,203; 25.8%) and unspecified pneumoconiosis (3,409; 7.9%).
  • Annual asbestosis-associated deaths began to decline in 2001. Table 1 shows 1,258 asbestosis deaths (age-adjusted rate 5.8 per million) in 1999 and 1,092 (3.5 per million) in 2018.
  • Among states, Montana had the highest age-adjusted asbestosis death rate for 1999–2018: 20.0 per million population (363 deaths).
  • Of 3,284 asbestosis deaths with industry and occupation data from 26 states, the largest numbers were in the construction industry (820; 25.0%) and among pipe layers, plumbers, pipefitters and steamfitters (264; 8.0%). Electricians accounted for 145 (4.4%) and carpenters for 110 (3.4%).
  • The largest decreases were in coal workers' pneumoconiosis deaths (69.6%, from 1,002 in 1999 to 305 in 2018) and silicosis deaths (53.0%, from 185 to 87).
  • Pneumoconiosis attributed to other inorganic dusts increased significantly, from 12 deaths in 1999 to 25 in 2018 (108.3%; p less than 0.05). None of the distinct disease categories in this group increased significantly.
• The authors' conclusion: The authors concluded that the decrease in pneumoconiosis deaths indicates prevention strategies are effective. They also concluded that ongoing deaths underscore the importance of reducing occupational dust exposure, early case detection and continued surveillance, with particular focus on other inorganic dusts.
• Limitations the authors state:
  • Death records were not validated against medical records, so results might be subject to misclassification.
  • Some silicosis-associated deaths might not be work-related.
  • The usual industry and occupation on the death certificate might not be the one in which exposure occurred.
  • Age-adjusted rates used the general population, which includes people not at occupational risk.
  • Small death counts prevented evaluating trends for distinct diseases within the other inorganic dusts category.

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Occupational Lung Disease, P-Value, Silicosis.

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