Mortality Follow-Up Through 1977 Of The White Underground Uranium Miners Cohort Examined By The United States Public Health Service

[Introduction] Since excess lung cancer mortality was first noted in the late 1800's among Joachimsthal-Schneeberg miners, there have been a number of studies of the long term health effects among various types of miners exposed to elevated levels of radon and its radioactive decay daughters. Substantial excesses of lung cancer have been noted among miners in the Joachimsthal mines (Sevc, 1976) , lead-zinc miners in Sweden (Axelson, 1979) , fluorspar miners in Canada (DeVilliers, 1971) , iron miners in Sweden (Renard, 1974) , uranium miners in Canada (Hewitt, 1976), and metal (Wagoner, 1963) and uranium miners in the United States (Lundin, 1971; Archer, 1976). The latter prospective cohort has also been shown to be at an excess risk of death due to tuberculosis, nonmalignant respiratory disease, and accidents when followed through September 30, 1974 (Archer, 1976). This report extends the followup of this cohort of miners through December 31, 1977 and expands the mortality analysis to investigate more cause-specific categories. [Methods] During the decade beginning with July, 1950, medical teams from the United States Public Health Service (USPHS) examined 3362 white and approximately 780 nonwhite males who had worked underground in uranium mines in the Colorado Plateau at least one month by January 1, 1964. Occupational, medical, and smoking histories were obtained during the examinations and often updated/confirmed during subsequent annual censuses of the miners conducted by the USPHS. The white miners now have been followed-up through December 31, 1977 using the Social Security Administration, Internal Revenue Service, direct telephoning and various other sources. Death certificates were obtained for the deceased and coded directly into the Seventh Revision of the International Classification of Diseases, Adapted, using the rules in effect at the time of death. Deceased miners for whom no certificate has yet been located were assumed dead on the date specified by the reporting agency, cause of death unknown. The uranium miners cohort was analyzed using a modified life-table system developed by the National Institute for Occupational Safety and Health (NIOSH). Person-years at risk of dying (PYAR) were calculated for each miner from his first USPHS medical examination date or date upon completion of one month of underground uranium mining if that was later. PYAR were calculated specific for five-year age groups, calendar periods, and periods after first underground uranium mining. The numbers of cause-specific observed deaths among the cohort occurring by December 31, 1977 were compared to the numbers of expected deaths. The expected deaths were calculated by multiplying the appropriate PYAR by the United States death rates for white males specific for five-year age groups, five-year calendar periods, and cause. The results were summed over the age and calendar period specific categories to obtain the total expected deaths for each cause. Standardized Mortality Ratios (SMR's) were calculated for each cause by dividing the observed number of deaths by the expected number of deaths and multiplying by 100. In some tables, two-sided 95% confidence intervals for the SMR's were computed using either Fisher exact confidence limits, if the observed frequency was less than eight, or approximate confidence limits, if the observed frequency was eight or greater, to indicate statistical significance. Because a priori hypotheses had been well established, one-sided lower confidence limits were used for tuberculosis, lung cancer, other nonmalignant respiratory disease (ONMRD), accidents, and total mortality. [Results] The cohort included 589 miners first examined in either 1950, 1951 or 1953; 753 first examined in 1954; 1235 first examined in 1957; 5 first examined in 1958; and 782 first examined in 1960. In Figure 1 the distribution of the cohort by first year of underground uranium mining indicates that 13.7% started before 1947 and would have thus had an opportunity to be followed beyond 30 years