Surveillance for Silicosis Deaths Among Persons Aged 15–44 Years — United States, 1999–2015

Jacek M. Mazurek, MD, PhD; John M. Wood, MS; Patricia L. Schleiff, MS; David N. Weissman, MD

Disclosures

Morbidity and Mortality Weekly Report. 2017;66(28):747-752. 

In This Article

Discussion

Among 55 deaths in young adults reported for 1999–2015 with ICD-10 code J62 assigned as either the underlying or a contributing cause of death, 13 were coded as subcategory J62.0, indicating exposure to talc dust, and in most of these cases, the underlying or contributing cause-of-death codes also indicated multiple drug use or drug overdose. These deaths likely represent nonoccupational pulmonary talcosis caused by illicit inhalation or intravenous administration of talc-contaminated drugs.[3,5–7] Eight of the 13 pneumoconiosis deaths attributed to talc dust were associated with multiple drug use and drug overdose occurred during 2010–2015, and coincided with the expanding epidemic of drug overdose deaths in the United States.[8]

The remaining two thirds of silicosis deaths were coded as J62.8. Among silicosis deaths reported for 1999–2013, manufacturing or construction industries, both of which are known to be associated with exposures to silica-containing dust, were frequently listed on death certificates for these decedents. Three decedents had a history of subcutaneous silicone injections and likely were erroneously assigned code J62.8 as the underlying cause of death.

The findings in this report are subject to at least five limitations. First, no information on silica exposure intensity or duration is listed on death certificates. Silicosis-associated deaths in young adults should be considered sentinel cases, potentially resulting from high exposures that cause short latency to disease onset and rapid disease progression. Second, lifetime occupational histories of decedents were not collected, and the usual industry and occupation listed on death certificates might not accurately represent the industry or occupation where the hazardous silica exposure occurred. However, there is a generally good agreement of industry and occupation information on death certificates compared with that from other sources.[9] Third, industry and occupation information was only available for 40 (83%) and 42 (88%) decedents, respectively, who were included in reports during 1999–2013. Fourth, pneumoconiosis as a cause of death might have been misclassified or under- or overreported. Finally, increased recognition of drug-related deaths, improvements in testing, and reporting of deaths involving drug use might have contributed to the high frequency of reported multiple drug use and drug overdose among pneumoconiosis deaths due to talc. The continuing occurrence of pneumoconiosis deaths due to other dust containing silica indicates the need for maintaining measures to limit workplace exposure to respirable crystalline silica. Primary prevention of pneumoconioses relies on elimination or effective control of exposures (https://www.cdc.gov/niosh/topics/hierarchy/). Effective silicosis prevention strategies for employers are available from the Occupational Safety and Health Administration (https://www.osha.gov/silica/) and CDC (https://www.cdc.gov/niosh/topics/silica). The occurrence of pneumoconiosis deaths due to talc associated with multiple drug use and drug overdose reinforces the need for a multifaceted, collaborative clinical, public health, public safety, and law enforcement approach to the drug overdose epidemic.[8] Examining detailed information on causes of death, including external causes, along with industry and occupation of decedents, is essential for identifying silicosis deaths associated with occupational exposures and reducing misclassification of silicosis mortality.

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