Survival and disease burden analyses of occupational pneumoconiosis during 1958-2021 in Huangshi city, China: a retrospective cohort study.

BACKGROUND: Pneumoconiosis, a chronic disease stemming from prolonged inhalation of dust particles, stands as a significant global burden of occupational diseases. This study aims to investigate the survival outcomes of pneumoconiosis patients in Huangshi city, China, while also evaluating the disease burden on afflicted patients. METHODS: Data for this study were sourced from the Huangshi Center for Disease Control and Prevention. Survival analyses of pneumoconiosis patients were conducted employing life tables and the Kaplan-Meier method. The Cox proportional hazards models were deployed to identify factors influencing pneumoconiosis patients' survival duration. Competing risks models were employed to confirm the validity of the model outcomes. Additionally, in the disease burden assessment, disability-adjusted life years (DALYs) were computed for various demographic groups and time frames. RESULTS: A total of 5,641 pneumoconiosis cases, diagnosed in Huangshi City, Hubei Province between 1958 and 2021, were incorporated into the cohort analysis. The probability of mortality and the risk ratio increased with advancing age. Notably, the median survival time of stage III pneumoconiosis patients was significantly shorter compared with those in stages I and II. The Cox proportional hazards model and competing risks analyses underscored several significant factors influencing survival time, including dust exposure duration (HR = 1.197, 95% CI: 1.104-1.298), age at first diagnosis (HR = 3.149, 95% CI: 2.961-3.349), presence of silicosis (HR = 1.378, 95% CI: 1.254-1.515), and stage II-III pneumoconiosis (HR = 1.456, 95% CI: 1.148-1.848). Cumulatively, DALYs amounted to 7,974.35 person-years, with an average of 1.41 person-years. The period between 2000 and 2019 witnessed the highest disease burden. CONCLUSION: Our findings highlight the urgent need for improved prevention, earlier detection, and more effective management strategies for the occupational pneumoconiosis population. This study not only underscores the persistent issue of pneumoconiosis in industrial environments but also serves as a crucial call to action for policymakers and healthcare providers.

[Analysis of clinical characteristics and causes of death in 38 patients with pneumoconiosis].

Objective: To analyze the clinical characteristics and causes of death of patients with pneumoconiosis, and to provide evidence for the prevention and management of pneumoconiosis. Methods: From June 2022 to July 2023, 38 dead patients with pneumoconiosis confirmed by Shandong Academy of Occupational Health and Occupational Medicine were selected as the research objects. The clinical data of patients were collected through hospital information system (HIS) and laboratory information management system (LIS) to analyze the basic situation of patients with pneumoconiosis who died, the distribution of industry types, the course of disease, the nature of work, the type of reimbursement, complications/comorbidities, and the direct causes of death. Univariate analysis of variance was used to compare the course of pneumoconiosis death in patients with different age of exposure to dust. Results: Among the 38 patients with pneumoconiosis, there were 37 males and 1 female. The age of exposure to dust was 5-37 (19.29±8.17) years, the duration of disease was 5-41 (20.26±8.53) years, and the age of death was 27-86 (70.42±12.26) years old. There were 10 cases of stage Ⅰ pneumoconiosis, 18 cases of stage Ⅱ, 10 cases of stage Ⅲ pneumoconiosis and 32 cases (84.21%) of silicosis. There were 30 (78.95%) people aged ≥65 years and 8 (21.05%) people aged <65 years. The industry was mainly metal products (18 workers, 47.37%), and the distribution of work was mainly excavation workers (11 workers, 28.95%). The death course of pneumoconiosis patients with 10-<30 years of exposure to dust accounted for 76.32% (29/38). The average course of pneumoconiosis patients with 20-<30 years of exposure to dust was the longest[ (24.00±9.39) years], and there was no statistically significant difference in the average course of disease among different age of exposure to dust groups (F=1.81, P=0.165). The working units of the deceased patients were private enterprises or factories, and the hospitalization expenses were borne by individuals for 21 people (55.26%). The working unit was a state-owned enterprise, and 17 people (44.74%) were reimbursed for hospitalization expenses and work-related injuries. The main comorbidities/complications of pneumoconiosis patients were respiratory infection in 18 cases (47.37%) and chronic pulmonary heart disease (47.37%). The top 3 direct causes of death were pneumoconiosis in 13 cases (34.21%), pulmonary infection in 10 cases (26.32%) and lung cancer in 7 cases (18.42%) . Conclusion: Most of 38 cases of pneumoconiosis patients death diseases such as multiple combination of respiratory system, cardiovascular system, respiratory system disease is a major cause of death in pneumoconiosis patients.

Trends in Pneumoconiosis Deaths - United States, 1999-2018.

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.

Transplantation for work-related lung disease in the USA.

OBJECTIVES: Work-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival. METHODS: Using US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers' pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis. RESULTS: The frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers' pneumoconiosis and 78 were for silicosis. Patients with coal workers' pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers' pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers' pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis. CONCLUSIONS: Lung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies.

Usefulness of occupation and industry information in mortality data in South Africa from 2006 to 2015.

BACKGROUND: There is no population based occupational health surveillance system in South Africa, thus mortality data may be a cost effective means of monitoring trends and possible associations with occupation. The aim of this study was to use deaths due to pneumoconiosis (a known occupational disease) to determine if the South African mortality data are a valid data source for occupational health surveillance in South Africa. METHODS: Proportions of complete occupation and industry information for the years 2006-2015 were calculated for working age and retired adults. Deaths due to pneumoconiosis were identified in the data set and mortality odds ratios calculated for specific occupations and industry in reference to those who reported being unemployed using logistic regression. RESULTS: Only 16.1% of death notifications provided a usual occupation despite 43.1% of the population being employed in the year. The MORs for occupation provided significant increased odds of pneumoconiosis for miners (9.04), those involved in manufacturing (4.77), engineers and machinery mechanics (6.85). Along with these jobs the Mining (9.8), Manufacture (2.2) and Maintenance and repair industries (6.0) have significantly increased odds of pneumoconiosis deaths. The data can be said to provide a useful source of occupational disease information for surveillance where active surveillance systems do not exist. CONCLUSION: The findings indicate valid associations were found between occupational disease and expected jobs and industry. The most useful data are from 2013 onwards due to more detailed coding of occupation and industry.

A review of mortality associated with elongate mineral particle (EMP) exposure in occupational epidemiology studies of gold, talc, and taconite mining.

BACKGROUND: Mining of gold, taconite, and talc may involve exposure to elongate mineral particles (EMP). The involved EMPs are typically non-asbestiform, include dimensions that regulatory definitions exclude, and have been less studied. METHODS: A review of the literature was undertaken for this exposure and occupational epidemiological studies that occur in gold, talc, and taconite mining. RESULTS: Quantitative EMP exposure information in these industries is incomplete. However, there are consistent findings of pneumoconiosis in each of these types of mining. A recent case-control study suggests a possible association between this exposure and mesothelioma. Lung cancer is inconsistently reported in these industries and is an unlikely outcome of non-asbestiform EMP exposure. There is evidence of cardiovascular mortality excess across all of these types of mining. CONCLUSIONS: Non-malignant respiratory disease and cardiovascular mortality have been consistently increased in these industries. Further investigation, including additional insights for the role of non-asbestiform EMP, is warranted. Am. J. Ind. Med. 59:1047-1060, 2016. © 2016 Wiley Periodicals, Inc.

Patterns of pneumoconiosis mortality in Kentucky: Analysis of death certificate data.

BACKGROUND: Mortality rates associated with total pneumoconiosis, including coal worker's pneumoconiosis (CWP), have remained elevated. METHODS: 2003-2013 pneumoconiosis mortality data obtained from National Center for Health Statistics and 2011-2013 Kentucky death certificates were analyzed. RESULTS: Total pneumoconiosis mortality rates showed significant linear decreases in West Virginia, Pennsylvania, Kentucky, and the U.S. from 2003 to 2013; Pennsylvania and Kentucky had comparable rates in 2003 but while Pennsylvania rates significantly decreased ∼3.0 deaths/million annually, Kentucky rates decreased only 0.5/million annually. Kentucky and Pennsylvania CWP fatality rates were also comparable in 2003 but while Pennsylvania rates decreased 82% over the study period, Kentucky rates decreased only 26%. Kentucky pneumoconiosis deaths primarily occurred in white Appalachian males in-hospital. Diseases leading to pneumoconiosis death were largely respiratory and cardiovascular, with autopsies rarely performed. CONCLUSIONS: Coal worker environmental exposure protection should be enhanced and pneumoconiosis surveillance improvements, including enhanced management of comorbid conditions like COPD, should be considered.

[Case fatality rate in patients with pneumoconiosis in China: a meta-analysis].

OBJECTIVE: To evaluate the fatality rate of pneumoconiosis as well as the contributory factors in China in order to provide a foundation for prolonging the patients' lives. METHODS: China National Knowledge Infrastructure (CNKI) and Wanfang Databases were searched to collect observational studies published between Jan, 2000 and Oct, 2013 on pneumoconiosis case fatality rate. Articles meeting the inclusion criteria were reviewed systematically, and analyzed by using Stata/SE 12.0, according to stage and type of pneumoconiosis and whether complicated with tuberculosis. RESULTS: 41 papers were included for meta-analysis. The pooled total case fatality rate of pneumoconiosis was 31.2%. The pooled case fatality rate of pneumoconiosis patients of stage 1, 2 and 3 were 25.4%, 39.8%and 57.5%, respectively. The pooled case fatality rate of patients with silicosis, coal worker's pneumoconiosis, foundry worker's pneumoconiosis, asbestosis and cement pneumoconiosis were 35.8%, 32.4%, 24.7%, 35.1%and 5.5%, respectively. The complication with tuberculosis was a risk factor for the death of pneumoconiosis patients and the pooled RR was 1.82 (95%CI: 1.59∼2.08). CONCLUSION: There are significant differences in the case fatality rate of pneumoconiosis among different stages and different types of pneumoconiosis and whether complicated with tuberculosis.

Respiratory disease mortality among US coal miners; results after 37 years of follow-up.

OBJECTIVES: To evaluate respiratory related mortality among underground coal miners after 37 years of follow-up. METHODS: Underlying cause of death for 9033 underground coal miners from 31 US mines enrolled between 1969 and 1971 was evaluated with life table analysis. Cox proportional hazards models were fitted to evaluate the exposure-response relationships between cumulative exposure to coal mine dust and respirable silica and mortality from pneumoconiosis, chronic obstructive pulmonary disease (COPD) and lung cancer. RESULTS: Excess mortality was observed for pneumoconiosis (SMR=79.70, 95% CI 72.1 to 87.67), COPD (SMR=1.11, 95% CI 0.99 to 1.24) and lung cancer (SMR=1.08; 95% CI 1.00 to 1.18). Coal mine dust exposure increased risk for mortality from pneumoconiosis and COPD. Mortality from COPD was significantly elevated among never [corrected] smokers and former smokers (HR=1.84, 95% CI 1.05 to 3.22; HRK=1.52, 95% CI 0.98 to 2.34, respectively) but not current smokers (HR=0.99, 95% CI 0.76 to 1.28). Respirable silica was positively associated with mortality from pneumoconiosis (HR=1.33, 95% CI 0.94 to 1.33) and COPD (HR=1.04, 95% CI 0.96 to 1.52) in models controlling for coal mine dust. We saw a significant relationship between coal mine dust exposure and lung cancer mortality (HR=1.70; 95% CI 1.02 to 2.83) but not with respirable silica (HR=1.05; 95% CI 0.90 to 1.23). In the most recent follow-up period (2000-2007) both exposures were positively associated with lung cancer mortality, coal mine dust significantly so. CONCLUSIONS: Our findings support previous studies showing that exposure to coal mine dust and respirable silica leads to increased mortality from malignant and non-malignant respiratory diseases even in the absence of smoking.

Silica dust, radon and death from non-malignant respiratory diseases in German uranium miners.

OBJECTIVE: To quantify the relationship between death from non-malignant respiratory diseases (NMRD) and exposure to silica dust or radon in a cohort of 58,690 former German uranium miners. METHODS: In the follow-up period from 1946 to 2008, a total of 2336 underlying deaths from NMRDs occurred, including 715 deaths from chronic obstructive pulmonary diseases (COPD) and 975 deaths from silicosis or other pneumoconiosis. Exposure to respirable crystalline silica and radon was individually assessed by means of a comprehensive job-exposure matrix. Risk analyses were based on a linear Poisson regression model with the baseline stratified by age, calendar year and duration of employment. RESULTS: There was no increase in risk of death from COPDs or any other NMRDs in relation to cumulative exposure to silica (mean=5.9, max=56 mg/m(3)-years), except in the group of deaths from silicosis or other pneumoconiosis. Here, a strong non-linear increase in risk was observed. Cumulative radon exposure (mean=280; max=3224 Working Level Months) was not related to death from COPDs or any other NMRDs. CONCLUSIONS: The present findings do not indicate a relationship between mortality from COPD with silica dust or radon. However, validity of cause of death and lack of control for smoking remain potential sources of bias.

Long-term effects of aluminium dust inhalation.

OBJECTIVES: During the 1950s and 1960s, aluminium dust inhalation was used as a potential prophylaxis against silicosis in underground miners, including in Australia. We investigated the association between aluminium dust inhalation and cardiovascular, cerebrovascular and Alzheimer's diseases in a cohort of Australian male underground gold miners. We additionally looked at pneumoconiosis mortality to estimate the effect of the aluminium therapy. METHODS: SMRs and 95% CI were calculated to compare mortality of the cohort members with that of the Western Australian male population (1961-2009). Internal comparisons on duration of aluminium dust inhalation were examined using Cox regression. RESULTS: Aluminium dust inhalation was reported for 647 out of 1894 underground gold miners. During 42 780 person-years of follow-up, 1577 deaths were observed. An indication of increased mortality of Alzheimer's disease among miners ever exposed to aluminium dust was found (SMR=1.38), although it was not statistically significant (95% CI 0.69 to 2.75). Rates for cardiovascular and cerebrovascular death were above population levels, but were similar for subjects with or without a history of aluminium dust inhalation. HRs suggested an increasing risk of cardiovascular disease with duration of aluminium dust inhalation (HR=1.02, 95% CI 1.00 to 1.04, per year of exposure). No difference in the association between duration of work underground and pneumoconiosis was observed between the groups with or without aluminium dust exposure. CONCLUSIONS: No protective effect against silicosis was observed from aluminium dust inhalation. Conversely, exposure to aluminium dust may possibly increase the risk of cardiovascular disease and dementia of the Alzheimer's type.

[Analysis of state costs of the social security benefits provided to the insured presenting with lung cancer and pulmonary diseases caused by external factors]. / Ocena wielkosci obciazen panstwa swiadczeniami z systemu ubezpieczen spolecznych dla ubezpieczonych chorych na nowotwory ukladu oddechowego i choroby pluc wywolane czynnikami zewnqtrznymi.

UNLABELLED: Lung cancer and pneumoconioses constitute two serious problems of contemporary medicine and a public health system. THE AIM: To analyze the costs associated with social security benefits provided to the insured presenting with lung cancer and pulmonary diseases (including pneumoconioses) caused by external factors. MATERIAL AND METHODS: The analysis was based on the data obtained from the Department of Statistics and Actuarial Forecasts of the Social Insurance Institution (SlI) in Warsaw. Structural diversity of the costs of the separate benefits available within the national health insurance system has been considered. Based on the data available in Poland costs associated with the incidence of lung cancer and pneumoconiosis were assessed taking into account sex and age of the insured as well as the administrative division of Poland. Additionally, mortality rates from the selected pulmonary diseases were analyzed. RESULTS: Costs of the pensions paid to the insured presenting with lung cancer amount to 81.11% of the total social security costs associated with these diseases, while the sick leave money paid to the insured lung cancer patients equal to 15.5% of the total costs. In the insured women, costs of the pensions paid due to occupational pulmonary diseases (predominantly pneumoconioses) constitute 41.1% and in the insured men--11.5% of the total 'occupational' pensions. CONCLUSIONS: Although the maximal incidence of lung cancer occurs in both men and women above their retirement ages the costs of the work incapacity pensions paid to lung cancer patients still exceed 81% of the total social security costs associated with these diseases. In the insured women, the cost of pensions paid due to occupational pulmonary diseases, most of which are pneumoconioses, ranks first among the costs of 'occupational' pensions received by these subjects, while in the insured men the respective cost ranks third (after injuries plus intoxications and cardiovascular diseases) among their 'occupational' pensions. Moreover, the results of the performed analyses indicate that data on the social insurance money allow to comprehensively evaluate the health status of the insured men and women as well as their quality of life and therapeutical, rehabilitational and prophylactic needs. These data can and should, therefore, be utilized in both clinical practice and for accomplishment of the public health tasks.

Long-term exposure to silica dust and risk of total and cause-specific mortality in Chinese workers: a cohort study.

BACKGROUND: Human exposure to silica dust is very common in both working and living environments. However, the potential long-term health effects have not been well established across different exposure situations. METHODS AND FINDINGS: We studied 74,040 workers who worked at 29 metal mines and pottery factories in China for 1 y or more between January 1, 1960, and December 31, 1974, with follow-up until December 31, 2003 (median follow-up of 33 y). We estimated the cumulative silica dust exposure (CDE) for each worker by linking work history to a job-exposure matrix. We calculated standardized mortality ratios for underlying causes of death based on Chinese national mortality rates. Hazard ratios (HRs) for selected causes of death associated with CDE were estimated using the Cox proportional hazards model. The population attributable risks were estimated based on the prevalence of workers with silica dust exposure and HRs. The number of deaths attributable to silica dust exposure among Chinese workers was then calculated using the population attributable risk and the national mortality rate. We observed 19,516 deaths during 2,306,428 person-years of follow-up. Mortality from all causes was higher among workers exposed to silica dust than among non-exposed workers (993 versus 551 per 100,000 person-years). We observed significant positive exposure-response relationships between CDE (measured in milligrams/cubic meter-years, i.e., the sum of silica dust concentrations multiplied by the years of silica exposure) and mortality from all causes (HR 1.026, 95% confidence interval 1.023-1.029), respiratory diseases (1.069, 1.064-1.074), respiratory tuberculosis (1.065, 1.059-1.071), and cardiovascular disease (1.031, 1.025-1.036). Significantly elevated standardized mortality ratios were observed for all causes (1.06, 95% confidence interval 1.01-1.11), ischemic heart disease (1.65, 1.35-1.99), and pneumoconiosis (11.01, 7.67-14.95) among workers exposed to respirable silica concentrations equal to or lower than 0.1 mg/m(3). After adjustment for potential confounders, including smoking, silica dust exposure accounted for 15.2% of all deaths in this study. We estimated that 4.2% of deaths (231,104 cases) among Chinese workers were attributable to silica dust exposure. The limitations of this study included a lack of data on dietary patterns and leisure time physical activity, possible underestimation of silica dust exposure for individuals who worked at the mines/factories before 1950, and a small number of deaths (4.3%) where the cause of death was based on oral reports from relatives. CONCLUSIONS: Long-term silica dust exposure was associated with substantially increased mortality among Chinese workers. The increased risk was observed not only for deaths due to respiratory diseases and lung cancer, but also for deaths due to cardiovascular disease. Please see later in the article for the Editors' Summary.

[Survival analysis of patients with pneumoconiosis from 1956 to 2010 in Changsha].

OBJECTIVE: To investigate the survival rate and life expectancy of patients with pneumoconiosis and influence factors in Changsha from 1956 to 2010. METHODS: A total of 3685 patients with pneumoconiosis were diagnosed and reported from 1956 to 2010 in Changsha. The fatality rate and life expectancy were analyzed by life table and the cause of death was analyzed by Kaplan-Meier method and Cox regression model. RESULTS: The death rate increased obviously with age. Age and accumulation death probability showed linearity (Y=1.271+0.041X, r=0.989). The life expectancy was 60.12 years. The first cause of death was pulmonary tuberculosis in patients with pneumoconiosis. Ruling out the influence of pulmonary tuberculosis, pneumoconiosis, and lung source heart disease, the life expectancy of patients with pneumoconiosis averagely extended 0.83, 0.99, and 0.02 years. The death rate of pneumoconiosis-tuberculosis had significant difference with that of the pneumoconiosisnontuberculosis (P<0.01). Cox regression analysis revealed that the main risk factors for the survival of patients with pneumoconiosis included type of work (smashing worker), complication with tuberculosis, type of pneumoconiosis (silicosis). The death hazard ratio or relative risk caused by them was 1.927, 1.749, and 1.609, respectively. CONCLUSION: Prevention of pneumoconiosis should focus on smashing workers in Changsha, while its the treatment primarily attaches importance to complication of tuberculosis and lung infection.

[Comparing the therapeutic effect of lung transplantation with the therapeutic effect of whole lung lavage for the patients with end-stage pneumoconiosis].

OBJECTIVE: To explore the therapeutic effects of lung transplantation (LTx) and whole lung lavage (WLL) for patients with end-stage pneumoconiosis. METHODS: From June 2002 to February 2011, 5 cases with end-stage pneumoconiosis were treated with LTx and 12 cases with end-stage pneumoconiosis were treated with WLL. The clinical symptoms, pulmonary functions, pulmonary artery pressures, blood gas analysis, imagings of chest and survival status were retrospectively analyzed. RESULTS: In LTx group, the clinical symptoms (cough, sense of suppression in the chest), pulmonary functions and blood gas indicators were improved, pulmonary artery pressures decreased to normal levels, the imaging of chest showed that the implanted lung inflated well and was with clear lung markings. But the contralateral lungs without treatment appeared the progression of disease in the imaging of chest. In WLL group, the clinical symptoms in a half year after treatment were improved but the symptomatic relief rate declined with time, the pulmonary functions in half year after treatment were improved but decreased after 2 years, the pulmonary artery hypertension enhanced generally, as compared with that prior to WLL. The disease progression in the chest imaging examination was not found in a half year after WLL, but appeared in 1 ∼ 2 years after WLL. During following-up. the mean survival times in LTx and WLL groups were 40.5 and 21.4 months, respectively. In LTx group, one patient died of multiple organ dysfunctions (MODS) caused by primary graft dysfunction (PGD), one case died of severe infection in seven months after LTx. Up to now, other 3 cases have survived for 65, 41 and 29 months, respectively. In WLL group, 3 cases died of pulmonary infection, 2 cases died of respiratory failure, one case died of heart failure and one case died of encephalon vascular accident, the mean survival time of these 7 patients was (19.0 ± 8.7) months. So far other 5 cases have survived for 7, 9, 13, 18 and 26 months, respectively. CONCLUSION: LTx has greater risk of death during preoperative period, but patients after LTx may have long survival times with good quality of life. The clinical symptoms and pulmonary functions of patients can be improved temporarily after WLL, but the survival time of WLL is inferior to that of LTx.

Concurrent silicosis and pulmonary mycosis at death.

To examine risk for mycosis among persons with silicosis, we examined US mortality data for 1979-2004. Persons with silicosis were more likely to die with pulmonary mycosis than were those without pneumoconiosis or those with more common pneumoconioses. Health professionals should consider enhanced risk for mycosis for silica-exposed patients.

Cause-specific mortality in British coal workers and exposure to respirable dust and quartz.

OBJECTIVES: In the 1950s the Pneumoconiosis Field Research (PFR) programme was set up to study the health of British coal workers. Studies included regular health surveys, an intensive characterisation of workers' individual exposures, and entry to a cohort followed up to the present for cause-specific mortality. This study reports on analyses of cause-specific mortality in a cohort of almost 18 000 men from 10 British collieries. METHODS: External analyses used standardised mortality ratios (SMRs), comparing observed mortality with reference rates from the regions in which the collieries were situated. Causes investigated include lung and stomach cancers, chronic obstructive pulmonary disease and cardiovascular endpoints. Internal analyses used Cox regression models with time-dependent exposures adjusting for the confounding effects of age, smoking, cohort entry date and regional differences in population mortality rates. RESULTS: Several causes showed evidence of a healthy worker effect early in the follow-up, with a deficit in the SMR diminishing over time. For most of the causes there was a significant excess in the latter part of follow-up. Internal analyses found evidence of an association between increased risks of lung cancer and increased quartz exposure, particularly at a lag of 15 years. Risks of mortality from non-malignant respiratory disease showed increases with increased exposure to respirable dust. CONCLUSIONS: This paper adds to the evidence on the long-term effects of exposure to coalmine dust on mortality from respiratory diseases.

Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. METHODS: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. FINDINGS: In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9-584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8-7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578-4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), age-standardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. INTERPRETATION: Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. FUNDING: Bill & Melinda Gates Foundation.

Asbestosis mortality in the USA: facts and predictions.

BACKGROUND: Mortality trends in the USA show that deaths from asbestosis are increasing, while deaths related to other pneumoconiosis are declining. OBJECTIVES: To analyse the association between asbestos consumption and asbestosis mortality trends. METHODS: In an epidemiological time series study, we used a modern computer-intensive local regression method to evaluate the relationship between asbestos consumption per capita (1900-2006) as the predictor variable and number of deaths from asbestosis (1968-2004). The predictor variable was progressively lagged by annual increments from 30 to 60 years and the goodness of fit assessed for each lag period. The model having the smallest Akaike's Information Criteria was used to derive extrapolated estimates of future mortality based on more recent asbestos consumption data. RESULTS: Asbestos consumption per capita reached a peak in 1951 and gradually declined until 1973, when it started to drop rapidly. In 2006, it was 0.0075 kg/person/year. There were 25 564 deaths from asbestosis over the period 1968-2004. The best-fitting model (adjusted coefficient of determination (R(2)) = 99.7%) for 1968-2004 deaths from asbestosis used asbestos consumption per capita 48 years prior (1920-1956) and the log value of asbestos consumption per capita 43 years prior (1925-1961). This model predicts a total of 29 667 deaths (95% CI 19 629 to 39 705) to occur during 2005-2027 (an average of 1290 deaths per year). CONCLUSIONS: This study demonstrates a clear association between asbestos consumption and deaths from asbestosis and indicates that asbestosis deaths are not expected to decrease sharply in the next 10-15 years.

China's dusty lung crisis: Rural-urban health inequity as social and spatial injustice.

This paper examines rural-urban inequities in dusty lung (pneumoconiosis) deaths in China from 2002 to 2016 and possible causes for such inequities in the framework of social and spatial justice. The research reveals alarming results that have not been reported before. Dusty lung death rates for rural men increased twice as fast as those among urban men. The rural rates were particularly higher among middle-aged men, but lower in older age groups, as compared to urban rates. There were dramatic increases in death rates from 2011 to 2016 particularly among rural men aged 40-49 years old, who were many times more likely to die from dusty lung than urban men of a similar age. Chinese rural male victims also die at a younger age, compared to men in any of the seven countries or regions included in the study. For example, rural Chinese men aged 35-59 years old were many times more likely to die from dusty lung than their American, German, Polish, and Spanish counterparts. A possible explanation for the high death rates among middle-aged rural Chinese men is the tendency for rural migrant workers to be employed in unhealthy and unsafe working conditions in decent decades. Other explanations for the severe spatial injustice include the Hukou (household registration) system and the development policies that prioritize economic growth and urban development over occupational health and safety. The paper demonstrates the usefulness and weakness of the social and spatial justice concepts in understanding health inequity. Therefore, it proposes new definitions and models of social justice and spatial justice that combine the competing distribution and capabilities approaches and highlight interactions among multiple attributes.