Asbestos and Mortality from Diseases

Our plain-English summary of Asbestos and Mortality from Diseases, by P.E. Enterline.

The study

• Author: P.E. Enterline
• Published: n.d.
• Type of article: Conference paper
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This study followed deaths among 21,755 white men who worked at some time during 1948 to 1951 in U.S. asbestos building products, friction materials and textile products industries. Using Social Security records and death certificates, the author tracked deaths at ages 15 to 64 through June 1963. Only lung cancer and asbestosis were analysed; "lung cancer" here also included some other respiratory-system cancers. "Asbestos lung cancer" meant lung cancer deaths above the number expected from U.S. rates for white men. Environmental data ranked building products lowest in dust exposure and textiles highest. Death rates from both diseases followed this ranking, the link being considerably stronger for asbestosis. Excess lung cancer deaths appeared later than asbestosis deaths: none in 1948 to 1952, 12 in 1953 to 1957 and 20 in 1958 to June 1963, by then nearly equalling asbestosis deaths. The author concluded that lung cancer took longer to develop than asbestosis. The author suggested small doses might produce more lung cancer than asbestosis, and large doses more asbestosis. The author noted that the short follow-up limited these comparisons.

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: Retrospective cohort mortality study using U.S. Social Security records and death certificates, comparing observed lung cancer deaths with deaths expected from U.S. rates
• Who was studied: 21,755 white men employed at some time during 1948 to 1951 in three groups of U.S. asbestos products industries (building products, friction materials, textile products). They were listed on tax returns for quarters ending March 31 of 1948, 1949, 1950 or 1951. Deaths at ages 15 to 64 were followed for up to 15 1/2 years, to June 1963.
• Exposure: Asbestos dust in asbestos products work (fiber types not specified). The three industries were ranked from environmental data, from lowest dust exposure (building products) to highest (textile products). Length of employment and time since first exposure were approximated by whether men were already employed in March 1948 or were hired later.
• Main results:
  • "Asbestos lung cancer" deaths were defined as the excess of observed over expected lung cancer deaths.
  • In this study, "lung cancer" covered all deaths coded to international list numbers 160 to 164, which include some cancers of the respiratory system other than the lung.
  • By industry, the "asbestos lung cancer" death rate was 10.0 per 100,000 person-years in friction materials and 28.6 in textile products. Building products had 15 such deaths.
  • Death rates from both diseases followed the dust ranking, but the relationship was considerably stronger for asbestosis than for lung cancer.
  • In the highest-exposure industry (textile products), there were considerably more deaths from asbestosis than from lung cancer during the study period.
  • All three industries combined: "asbestos lung cancer" deaths numbered 0 in 1948 to 1952, 12 in 1953 to 1957 and 20 in 1958 to June 1963.
  • All three industries combined: asbestosis death rates were 14.8, 20.5 and 22.9 per 100,000 across the same three periods.
  • In the last period (1958 to June 1963), "asbestos lung cancer" deaths nearly equalled asbestosis deaths.
  • For 1953 to June 1963, the asbestosis death rate was 6.2 per 100,000 among men first employed after March 1948, compared with 35.0 among men employed in March 1948 or earlier.
  • Most men hired after March 1948 worked only briefly. Because transient workers have unusual mortality, the author judged that comparisons between later hires and earlier hires were probably invalid.
  • Among men employed in March 1948 or earlier, "asbestos lung cancer" deaths numbered 0, 6 and 12 across the three five-year periods.
  • For the same group (men employed in March 1948 or earlier), 10 lung cancer deaths were observed in 1948 to 1952 against 11.4 expected.
• The authors' conclusion: The author concluded that, when the industries were ranked by dust exposure, there was a direct relationship with death rates from both "asbestos lung cancer" and asbestosis, stronger for asbestosis. The author also concluded that lung cancer took longer to develop than asbestosis, and that time since first exposure and/or duration of exposure are probably more important for lung cancer than for asbestosis. The author suggested that small doses might produce more lung cancer than asbestosis, while large doses might produce more asbestosis than lung cancer.
• Limitations the authors state:
  • The relatively short follow-up limits any estimate of ultimate response and direct comparisons between lung cancer and asbestosis.
  • Expected lung cancer deaths may have been overstated, because the workers were all at work, while the U.S. population used for expected rates included men too ill to work.
  • Dose was measured only crudely, by ranking industries.
  • Appropriate expected death rates could not be developed for briefly employed (transient) workers.

Topics

Medical terms in this study, explained in our Lexicon: Death Certificate, Lung Cancer.

Browse return to medical research.