Duygu ACAR KARAGÜL, Elif ALTUNDAŞ HATMAN, Zeki KILIÇASLAN, Eliz KUMAN OYMAN, Kadir Onur ŞİMŞEK, Bahar TÜZÜN

Premature Deaths Due to Silicosis in Turkey, 2006–2017: A Twelve-Year Longitudinal Study

Background: Deaths due to epidemics of silicosis still continue to be reported both in developing and developed countries, and silica exposure from different sectors remains an important occupational health concern. Aims: To identify characteristics of silicosis cases by focusing on a developing country and evaluate the frequency of and factors related to premature deaths and also reveal preventable causes of premature deaths in silicosis. Study Design: Retrospective cohort. Methods: We reviewed the records of 9769 patients who were diagnosed with occupational diseases in İstanbul Occupational Diseases Hospital between 2006 and 2017. According to International Classification of Diseases (ICD)-10 codes, 1473 silicosis cases were detected. The sociodemographic characteristics, job characteristics, comorbidities, serological, functional, and radiological data, and follow-up time were obtained from the medical records. Mortality data were gathered from The National Death Notification System of Ministry of Health. Results: The study examined 9769 cases diagnosed with an occupational disease, and 15.0% (n = 1473) of them were diagnosed with silicosis. The median age of silicosis patients was 40.0 years, and 26.9% of them were child labor when they started to work in dusty industries. Child labor was mostly seen among dental technicians (57.7%), denim sandblasters (46.4%), and miners (37.0%). In the follow-up period, 26.3% of Teflon sandblasters, 11.1% of coal miners, 8.6% of denim sandblasters had died before their average life expectancy, and the years of loss of life was 26.0 ± 11.6 years all over the group. Premature death was associated with occupation [hazard ratio (Teflon sandblasting): 3.93, CI: 1.43-10.78; hazard ratio (marble production): 4.4, CI: 1.02-19.21]; large opacities in posterior anterior chest X-ray [hazard ratio: 2.14, CI: 1.18-3.86]; tuberculosis [hazard ratio: 2.60, CI: 1.42- 4.76]; and reduction in forced vital capacity (forced vital capacity% ≤80) during diagnosis [hazard ratio: 4.43, CI: 2.22-8.83]. Conclusion: More than a quarter of silicosis cases are those who start working in dusty industries at an early age. Factors associated with premature death in patients with silicosis are patient occupation, large opacities on chest X-ray, tuberculosis, and pulmonary function loss at diagnosis.

PDF

___

1. Centers for Disease Control and Prevention (CDC). Health Effects of Occupational Exposure Respirable Crystalline Silica [DHHS (NIOSH) Publication No. 2002-129]. Cincinnati, OH: The National Institute for Occupational Safety and Health (NIOSH); 2002.
2. Centers for Disease Control and Prevention (CDC). Preventing silicosis. Available at: https://www.cdc.gov/features/preventing-silicosis/index.html, Accessed June 13, 2019.
3. Jindal SK. Silicosis in India: past and present. Curr Opin Pulm Med. 2013;19(2):163- 168. [CrossRef]
4. De Matteis S, Heederik D, Burdorf A, et al. Current and new challenges in occupational lung diseases. Eur Respir Rev. 2017;26(146). [CrossRef]
5. Akgün M, Ergan B. Silicosis in Turkey: is it an endless nightmare or is there still hope? Turk Thorac J. 2018;19(2):89-93. [CrossRef]. Erratum in: Editorial Office Staff TTJ. Erratum. Turk Thorac J. 2018;19(3):158. [CrossRef]
6. Mannetje A, Steenland K, Attfield M, Boffetta P, Checkoway H, DeKlerk N. Exposure-response analysis and risk assessment for silica and silicosis mortality in a pooled analysis of six cohorts. Occup Environ Med. 2002;59(11):723-728. [CrossRef].
7. Greenberg MI, Waksman J, Curtis J. Silicosis: a review. Dis Mon. 2007;53(8):394- 416. [CrossRef]
8. Ng TP, Chan SL, Lee J. Predictors of mortality in silicosis. Respir Med. 1992;86(2):115-119. [CrossRef]
9. Wang W, Yu Y, Xiao J, et al. A novel variant of desmoplakin is potentially associated with silicosis risk. DNA Cell Biol. 2018;37(11):925-931. [CrossRef]
10. Centers for Disease Control and Prevention (CDC). Silicosis-related years of potential life lost before age 65 years–United States, 1968-2005. MMWR Morb Mortal Wkly Rep. 2008;57(28):771-775. Erratum in: MMWR Morb Mortal Wkly Rep. 2008;57(30):829.
11. Liu Y, Zhou Y, Hnizdo E, et al. Total and cause-specific mortality risk associated with low-level exposure to crystalline silica: a 44-year cohort study from China. Am J Epidemiol. 2017;186(4):481-490. [CrossRef]
12. Bilir N. Occupational Safety and Health Profile: Turkey. 1st ed. Ankara, Turkey: International Labour Organization (ILO); 2016.
13. De Vuyst P, Camus P. The past and present of pneumoconioses. Curr Opin Pulm Med. 2000;6(2):151-156. [CrossRef]
14. Turkish National Statistical Office. “Life expectancy at birth in European countries by sex, 2016” tables. 2017. Available at: http://www.tuik.gov.tr/UstMenu.do?metod= temelist, Accessed April 30, 2019.
15. International Labour Office (ILO). Global Estimates of Child Labour: Results and Trends, 2012-2016 [Report]. Geneva: ILO; 2017.
16. Akgun M, Araz O, Akkurt I, et al. An epidemic of silicosis among former denim sandblasters. Eur Respir J. 2008;32(5):1295-1303. [CrossRef]
17. Chiavegatto CV, Carneiro APS, Dias EC, Nascimento MS. Diagnosis of severe silicosis in young adults working in stone polishing and mining in Minas Gerais, Brazil. Int J Occup Environ Health. 2010;16(2):139-142. [CrossRef]
18. Blanco Pérez JJ, Arnalich Montiel V, Salgado-Barreira Á, et al. The 6-minute walk test as a tool for determining exercise capacity and prognosis in patients with silicosis [in Spanish]. Arch Bronconeumol. 2019;55(2):88-92. [CrossRef]
19. Jiang CQ, Xiao LW, Lam TH, Xie NW, Zhu CQ. Accelerated silicosis in workers exposed to agate dust in Guangzhou, China. Am J Ind Med. 2001;40(1):87-91. [CrossRef]
20. Hoy RF, Baird T, Hammerschlag G, et al. Artificial stone-associated silicosis: a rapidly emerging occupational lung disease. Occup Environ Med. 2018;75(1):3-5. [CrossRef]
21. Liu J, Feng LM, Tang HJ, et al. The epidemiological characteristics of silicosis cases in Tianjin from 2001 to 2015 [in Chinese]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2019;37(5):366-369. [CrossRef]
22. Xie LZ, Zhou L, Ding BM, et al. Analysis of occupational pneumoconiosis in Jiangsu Province from 2006 to 2017 [in Chinese]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2019;37(3):189-193. [CrossRef]
23. Fubini B, Hubbard A. Reactive oxygen species (ROS) and reactive nitrogen species (RNS) generation by silica in inflammation and fibrosis. Free Radic Biol Med. 2003;34(12):1507-1516. [CrossRef]
24. Vallyathan V, Shi XL, Dalal NS, Irr W, Castranova V. Generation of free radicals from freshly fractured silica dust: potential role in acute silica-induced lung injury. Am Rev Respir Dis. 1988;138(5):1213-1219. [CrossRef]
25. Bakan ND, Özkan G, Çamsari G, et al. Silicosis in denim sandblasters. Chest. 2011;140(5):1300-1304. [CrossRef]
26. Zhong Y, Li D. Potential years of life lost and work tenure lost when silicosis is compared with other pneumoconioses. Scand J Work Environ Health. 1995;21(suppl 2):91-94.
27. Akgun M, Araz O, Ucar EY, et al. Silicosis appears inevitable among former denim sandblasters. Chest. 2015;148(3):647-654. [CrossRef]
28. Barnes H, Goh NSL, Leong TL, Hoy R. Silica-associated lung disease: an old-world exposure in modern industries. Respirology. 2019;24(12):1165-1175. [CrossRef]
29. Arrouays D, McKenzie N, Hempel J, de Forges AR, McBratney BA. Global Soil Map: Basis of the Global Spatial Soil Information System. 1st ed. Boca Raton, FL: CRC Press; 2014.
30. Köksal N, Kahraman H. Acute silicosis in teflon-coated pan manufacturing due to metal sandblasting. Int J Occup Environ Health. 2011;17(3):210-213. [CrossRef]
31. Blackley DJ, Halldin CN, Laney AS. Continued increase in prevalence of coal workers’ pneumoconiosis in the United States, 1970-2017. Am J Public Health. 2018;108(9):1220-1222. [CrossRef]
32. Farazi A, Jabbariasl M. Silico-tuberculosis and associated risk factors in central province of Iran. Pan Afr Med J. 2015;20:333. [CrossRef]
33. Nasrullah M, Mazurek JM, Wood JM, Bang KM, Kreiss K. Silicosis mortality with respiratory tuberculosis in the United States, 1968-2006. Am J Epidemiol. 2011;174(7):839-848. [CrossRef]