GPJ.2trom OCCUPATIONAL MORTALITY IN WASHINGTON STATE 1950-1989 Samuel Milham, Jr., M.D., M.P.H. Washington State Department of Health Chronic Disease Epidemiology PO Box 47812 Olympia, Washington 98504-7812 Order No. 00913725 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Division of Surveillance, Hazard Evaluations and Field Studies Cincinnati, Ohio March 1997 DISCLAIMER The contents of this report are reproduced herein as received from the contractor. The opinions, findings, and conclusions expressed herein are not necessarily those of the National Institute for lyatn e o,fdihanttS aalr pa o tuennsncHoeeciomO t deyny efsnebstorameuop mtedmsaih notnttreccsoundoocrp National Institute for Occupational Safety and Health. This document is in the public domain and may be freely copied or reprinted. seip ofCo sih td ns rat eenHlh e:SbtemmOaoruoIlacrNiofadva Publications Dissemination, EID lanoitaN etutitsnI rof lanoitapuccO ytefaS dnahtlaeH yaw kariabPm u6l7o6C4 Cincinnati, Ohio 45226 Fax number: (513) 533-8573 s no lo Tyairt nt eeroaHnd foic SordatitOiohnsaluItt a pboNaleouubmavtcpareicoheofcneir )4764-6 5H3 S-,O0sI0mN8e --ll51bl3(oa-rc0p08-1 Contract deliverables submitted: May 1992. Current address for Dr. Milham: Samuel Milham, M.D. W,Npo ohLca eyBlleva r8G132 Olympia, Washington 98502-8837 phone: (360) 866-0256 331 - .6no9oNitacil b)uHPSO ISNH(HD ii CONTENTS TCARTSBA vi STNEMEGDELWONKCA v NOITCUDORTNI 1 DOHTEM 4 STLUSER 6 )9891 -,Y0yR 5 tAE9NiTL1OlNB aEAe1tMTlrMaoOMMC( 7 )9891 -,4y7 t9Yi1 Rl EAaNeLTtOlBNr aAEo2mTMMeMFO(C 39 )es uyyatbCilat reo lME aL3M B(YNAROTATNEMMOC 48 )es uyyatbCilat reolMa mE eL4 F BY(NAROTATNEMMOC 52 NOISSUCSID 54 NOISULCNOC 58 SNOITADNEMMOCER 59 SECNEREFER 60 :STIBIHXE Exhibit 1-- Death Certificate 64 sneodiotCa pdu ecti cif-Obi-id2hoxME 65 Exhibit 3-- PMR Calculation 81 Exhibit 4-- Occupation Grouping for Men 82 ng oniitpau porurocGfcOnemoW 95 N ER MOSFNOITAPUC CFXOOEDNI 101 NEM OR WOSFNOITAPUC CFXOOEDNI 134 SELB AETHCIFORCIM elbaT ,1 yetlialMatroM 155 elbaT ,y 2teillaamterFoM 164 ye th syitfublaoaa eCtlDraonMoit aep lue,bcl3acaTOM 167 ye th syitfublaoaae CtDlraonMoitap ueecl lca,bOm4aeTF 172 iii ABSTRACT The occupational and cause-of-death information on 588,090 Washington State male deaths for 1950- 1989 and 88,071 female deaths for 1974-1989 was analyzed using an age and year-of-death standardized etan oyittirloaptorro pmoitar .margorp A hdtealeid a-stfieosd-yelsaunaac 161( )sesuac si dehsilbup rof hcae fo912 . sse elr iaos rm fesoer iegfoldrle fan oatr nahgmaolocecfa iatnfteaooac ip8tu6acpcuocco The occupational mortality findings are compared with those of the Registrar General and with the published occupational mortality literature. The Washington State mortality pattern is, in general, consistent with both the Registrar General's results and with the published literature. Some of the new occupational mortality findings published in the 1950-1971 report and in the updated version have been confirmed. ehT suoiv egrnpidnif fo a aime keusealercni ni srekr odwesopxe ot cirtcele dna citeng asmdleifsi confirmed in this report. vi Acknowledgement: sih Tseires fo s egindiuntnsap s02 sraey saw e dealmbis syolpno htiw eht pleh dna drah krow foynam .elpoep , I,erofe rdelhutow ekil o tyllano skrneapht lla esoht ohw depleh.em ye:heTdulcni Rita Klein Eleanor McPherson Elnora McGraw otor odvraaLhciR dloraeHnaL Jim Thomas ll ayHggeP Marilee Smith Eric Ossiander l lkecmumhoCR v Introduction e t y fad dsodn suipoeithuchsTets Occupational Mortality in Washington State, 1950-1971, originally dehsi lybbu pHSOIN ni 679 1.)1( eh T td seerhtisafid lpnbuiup 3d8e9r1e veo hc9 t7s9r 1a.-e)0y25(91 sihyTduts srev o0c90,88 5etihw elam sh t9a8e9d1-059 1dna 170,88 etihw elame fs h,t9 a8ee9vd1i-s4u7l9c1xe fo965,431 .seviwesuoh enO w eeenllbbaa tT)(4 sa hn edeebdd ao t .stirhotpe r tI si a el byat tifelo laya tbmeresofuma cnieht yoti it t layeaeaRtmmt t ia ra sre lsyoneaole abfosMbl.stiuaa)nrtaTm3oo rc(imyo t b ps aeoekpsrlnuePbacharcTto )RMP( rof hcae esuac fo .htaed elbaT 4 ni eht 9791-0591 etadpu hcihw detsil tnacifingis sesuac fo htaednihtiw each occupation has been eliminated, since the same information is available in Table 1. sih Tyduts dah s gsntiinn ingieb a e slaocr tyndoucts )3( s f'eonsia kehgscdiiodh Hwdesu e hettatspwueN l.a n n kddoh oerrniteisooataltu Yc aeiaa erfmdfpchroor ut foedcayfhecednTw odu iostnhssasecfxoe gsnniokirtoawpduoc ocnwoi eh ts'ni kegsdaoeHsi dpuorg sa derapmoc ot de h.cstlaomrtnoc nehW naweivretni study (4) and a population-based study (5) confirmed this finding, I decided to examine the occupational pattern in re hdteotce leessuac fo h.tsagendipuorg l o drnetAhn soyicdl-ubetusspancu fo ela mredd arlebcnachtaed setacifitrec ni notgnihsaW etatS saw elba ot yfitnedi eht emas snoitapucco htiw desaercni ksir sa suoiverplacinilc dna weivretni seiduts .)9-6( ,oslA a yduts )01( fo aimekuel htaed setacifitrec ni notgnihsaW etatS dna nogerOsaw elba ot mrifno cdna dnetxe ya ldseutori ovn peo)eri1rpt1a(ic ofs osaaimek uhe.tls ingwoniitmarpaufcco ehT ycarucca dna ssenetelpmoc fo eht htaed etacifitrec lanoitapucco tnemetats no eht notgnihsaWetatS eta c sihaf twinateeredes cot e be t.iduoqo gl a nmoei tteia h pnTeuotc acseco khihstf tairaltoearfduescU" occupation during most of lifetime" (Exhibit 1, item 13a). Over 97% of adult male death certificates contained a usable occupation statement, i.e., only 3% had a blank or "retired" or "unknown" in the item 13a space. The death tl nadeirmroetc tsesauratdwsni oo t ydlertoroop preorf.esu eh Tycarucca fo l s aethntntoaeaicmetiedaftp iausttcars cwedocenimax erof e etrnh et.rserfefcindac roF men dying of Hodgkin's disease (4) and urinary bladder cancer, interviews with next of kin indicated that the death tlnaen moee i ttltsaaaaactcpwisiuftcinct eorodetic tdaehntiat bwyoebivre tnnii %57 fo ,ses aecvag adetaler " d t e.nyn %tsel ie5aern f l1lseofo peaf oymrcfnla"iAexd tene ol , ndip%ssi ntm0eafaao1swopcauccco ".re k "rsd rotole wn olksleswirv lmiymolielwamtpn"a"otistapucco nI a ye d rc uyuirtts nasiofeenposnuxrme a marro e ec,ty p) ltsp2h endo1temurc(ansooeoccedlerarew cin etgn o e . hemfayclnomfnbi oio aa ontr 4tctinb2riceen r dcesfagi sgrocnrAoei ehky5ftcrd2olnoeowmrsb a smddoerndo ilcyceelrirnayoc eno e r,ohmtae dna tuo f. otyntenduiosc er fO '0s s0rgh1enteianeeiodgBne deniatrecsa hguorht noinu ,sdrocer 89 erew dedoc ot eht gnieoB reenigne.yrogetac With this experience and confidence in the occupational information on the Washington State death record, I thought it appropriate to examine the mortality pattern for all occupational groups. The rationale behind d d ed eddwlspl lno unuaeualeooebonlbcivwiotef arei sc huoftasoacse/adlano ih t csata ap aowwushrecitpnchpota trohoc .seiduts ehT taerg laeppa fo gniyfitn ecdiifi cleapnsoitapuc csoesuac fo ytilatrom si ,tah t,yllacinhcet llaera preventable by environmental manipulation. ede en wt el: shonoarsisoat iondeaftt wfspb bcaoiumeacuhfenTd 1. htaeD sdrocer rof lla elam shtaed dah neeb ylenituor dedoc ot noitapucco ni siht ,eciffognitrats with 1972 deaths. Female deaths had also been coded to occupation starting with 1974 deaths. 1 2. A rebmun fo sgnidnif fo eh t1791-0 5y9d1uts dah d enteaeibtnat sn binuosital udpeospabseiduts (13-15). 3. The 1950-1971 and 1950-1979 tables had proven useful in a number of areas, but were not as tnerr usca. eslabwissop 4. HSOIN sa wgnikr ohwt iswuo isreatvats ot etomo rspiht tros f osisyla nddaneasserp xneatseretni ni gnitroppus a dnoces etadpu fo siht.yduts 5. ecniS 04 evituces nsorcaey fo atad erew ,tneserp I depoh taht emit sdnert nilanoitapucco mortality would now be discernable. The large increase (158,000 male deaths) in file size had osla edam ti elbissop ot kcehc no reilrae sgnidnif desab no llams srebmun fo.shtaed 6. I detnaw ot od a lanif etadpu dna sisylana erofeb I.deriter 2 t r soseipid heapTrmu :frssout eoeflfsobat noitap u ycyt cbieol la1bt are TolmaM noitap u ycytcbiol aet lre2bolama TmeF hs tef asodeuedatcc e nldi e ehys RktbsMninPaw oreil tb3aapT u eclcaoM hs tef asodeuedatcc e nldi e ehys RktbsMninPawori teal pb 4uaecTlc aomeF The tabular format has been changed in that mortality is now shown for two 13 year periods and one 14 year period: 1950-1962, 1963-1975, and 1976-1989. 3 Method Punch cards containing death record information were available for the years 1950-1971. Death certificate numbers of all male resident deaths in Washington State, age 20+, for the years 1950-1971 were listed in etacifitrec rebmun redro nihtiw raey fo .htaed ehT htaed drocer noitapucco stnemetats erew detcartsba dnadedoc using a modification of the 1960 U.S. Census Bureau code (Exhibit 2). The death certificate numbers and the noit aspeudcocco erew deyek otni a kced fo sdrac dna eseh tsdrac erew ne hdtehctam ot e hltani ghitraoe dsdracno year and death certificate number. For matching cards, the occupation code was punched into the initial death .drac s ehct a.e myrd-leenlwvoalNcoisree rlc edheTte lspdmroacc erew daer o tcnioten.geapmat roF elam shtaed 6891-2791 dna elamef shtaed ,6891- 4n7o9i1tapucco saw yllaunam dedoc ylenituor noa ylhtnom sisab dna dedda ot eht yliranidro deraperp retupmoc drocer fo .htaed esehT sdrocer erew dedda oteht existing 1950-1971 file. Occupational and industry literals were keyed in the death records from 1987-1989 and erew retupmoc dedoc ecnis neht htiw a launam.pukcab Since the study period included two International Classification of Diseases code changes, ninth and hthgie noisiver sedoc erew detalsnart ot htneves noisiver sedoc htiw a noitalsnart .elbat ehT sesuac fo htaednevig ni s iyh dtgun tiesdr raootc cn aoheith sntDie CvvsIeeyersc dn d hoeee;tcinrnicuio wimuiefmqtneIcpoDAecxe Syndrome (AIDs) is 9th ICD numbers 042-044 starting with 1987 deaths. In the years 1983-1986, AIDs was ytin udmemtiaide my- clfnloeei ccd ie, ofd1 hteo.Dtdc9C97I2 est hie thceawnde-iadnSmo npu ss enlaht %3 fo e hlt a,teo ltyief hdeter temtwoirm foe h ctsieslabbafto s i,hytdu trsof eht e.kyatsi efnoe gom o dhl elstAen leebsraeatr pro fe tsih ht.wayeldno tuO f o tenstehadttiasseedr erew osla detanimile morf eht.elif A computer program which performed an age and year of death standardized PMR analysis was written dna nur ees( tibihxE .)3 roF h c,aneoi tdaepvurcecsobo dna detcep xsehtaed dna a RMP era detneserp ybdeliated edss er u ,pa ,afhuefh cotoyo td ardan.eg ee aed stdr gdh aoha eterfcr tareaaceanee edeyfpgox Eeydhdetustansbo taht s'raey ytilatrom .ecneirepxe snoitatcepxE era neht demmus revo sraey fo htaed otni eht etairporppa sllec foeht s el .s slr hasr seaetaafawegaeolyaeycd - cerivofifif c,eeprsofe r,seehh rtt daa.eeetdlc beaptxE detcepxE htaed seicneuqerf era dednuor ot eht tseraen elohw rebmun erofeb ;gnitnirp ,revewohtcaxe se ildcaen ntee ocurdieqaetpelcxraa eftro oftdtneip usorragey d ndaep u,osregga os tah tes eshltato tyam eyblthgils t . rnnssae ae eerehsei yegtsh cy-faatmnbeflu evics duid f eqfAos teuencrnhge fitip) msx-de( e strinoifRrMpP de tnsa oeryiuebs lniyaevb vgid d eentu aclseas pvenxlaeh tes.ns)o eso lRtd gM(ienP ogivrnaaakle smniAretsa )*( retfa a RMP eul asvetacidn itaht eht devresbo dna detcep xseeulav rof taht RMP yelrta ntanceirfeifnfgiids taeht l e( v%e5l 2 3.84; p .)50. A elbuod ksiretsa )**( setacidni taht eht devresbo dna detcepxe shtaedera 1 yltnacifing itsnereffid ta eht %1 level ( 2 6.64; p .)10. s RdMe P tg ean d.rlitesausctecuaculxelaepacxve 1 l agcniittss iesttaawtS enod ylno ndoe vsreeuslbaov fo xis r oretae rdgna ni e hdtep usorragey fo htaed dna ega-02 46 .snmuloc esuaC fo htaed senil era detnirp ylno fi ereht si na devresbo ro detcepxe.htaed e hnToitapu cecdooc desu ni eh t1791-0 5y9d1uts saw denifer ot etanimile s anoita chicfuimsssaalcsim possible. For example, telephone installers and repairmen were separated from telephone linemen, and body and fender repairmen were separated from automobile mechanics and repairmen. For the years 1988-1989, a smoking question has been asked on the Washington state death certificate. ehT noitseuq sksa rehtehw eht tnedeced dekoms ni eht 51 sraey roirp ot .htaed tI si derewsna htiw a sey ro .on This information is used in the interpretation of the results, to help sort out the contribution of smoking to ytilatrom yb .noitapucco roF nosirapmoc ,serugif eht lla elam gnikoms ecnelaverp si ,%3.64 elihw eht llaelamef smoking prevalence is 29.7%. 4