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Characteristic	Total Cohort	Lung Cancer Deaths
Number of Workers	17,345	808
Total Deaths, December 31, 2010	6,636	---
Percent Male	99.8%	100%
Percent Caucasian	99.2%	99.4
Age at Intake Exam (Mean, (SD))	57.4 (8.7)	61.2 (7.7)
Smoking Status at Intake Exam (No. (%))¹
___ Never Smoked	26.0%	6.6%
___ Past Smoker	48.6%	42.7%
___ Current Smoker	25.4%	50.7%
Smoking Pack-Years for Ever Smoked (Mean, (SD))	32.3 (22.4)	44.3 (24.4)
Years of Sheet Metal Trade Work (Mean, (SD))	31.9 (7.2)	33.5 (7.7)
Prevalence of Radiographic Parenchymal Changes²	10.4%	19.7%
Prevalence of Radiographic Pleural Changes³	21.7%	26.1%
¹ 24 workers missing smoking data ² ILO profusion of small irregular shadows in the lung parenchyma >= category 1/ 0 ³ Any notations of positive findings in sections 3A-D of the NIOSH ILO coding form

Cause of Death	Obs.	Exp.	SMR	95% CI Lower	95% CI Upper
All Causes	6636	7972.54	0.83**	0.81	0.85
All Cancers	2224	2221.73	0.98	0.94	1.02
__MN buccal & pharynx	31	38.33	0.81	0.55	1.15
____MN lip	1	0.45	2.23	0.06	12.45
____MN tongue	6	8.92	0.67	0.25	1.46
____MN other buccal	12	9.77	1.23	0.63	2.14
____MN pharynx	12	19.19	0.63	0.32	1.09
__MN digestive & peritoneum	475	540.23	0.88**	0.80	0.96
____MN esophagus	60	73.81	0.81	0.62	1.05
____MN stomach	51	51.82	0.98	0.73	1.29
____MN intestine	139	184.96	0.75**	0.63	0.89
____MN rectum	28	37.04	0.76	0.50	1.09
____MN biliary, liver, gall bladder	58	68.52	0.85	0.64	1.09
____MN pancreas	131	117.79	1.11	0.93	1.32
____MN peritoneum, other & unspecified sites	8	6.29	1.27	0.55	2.51
__MN respiratory	839	812.78	1.03	0.96	1.10
____MN larynx	15	23.21	0.65	0.36	1.07
____MN trachea, bronchus, lung	808	784.86	1.03	0.96	1.10
____MN pleura	11	1.48	7.42**	3.70	13.27
____MN other respiratory	5	3.23	1.55	0.50	3.62
__MN breast	5	3.07	1.63	0.53	3.80
__MN female genital organs	0	0.20	0.00	0.00	18.28
__MN male genital organs	179	225.30	0.79**	0.68	0.92
__MN urinary	110	132.48	0.83	0.68	1.00
____MN kidney	49	60.02	0.82	0.60	1.08
____MN bladder & other urinary site	61	72.46	0.84	0.64	1.08
__MN other & unspecified sites	350	291.14	1.20**	1.08	1.33
____MN bone	2	3.38	0.59	0.07	2.14
____MN melanoma	30	37.20	0.81	0.54	1.15
____MN other skin	14	13.22	1.06	0.58	1.78
____MN mesothelioma	85	11.58	7.34**	5.86	9.08
____MN connective tissues	7	11.57	0.60	0.24	1.25
____MN brain & other nervous	48	48.47	0.99	0.73	1.31
____MN eye	1	1.02	0.98	0.02	5.45
____MN thyroid	3	4.34	0.69	0.14	2.02
____MN other & unspecified sites	160	160.35	1.00	0.85	1.17
__MN lymphatic & hematopoietic	235	228.19	1.03	0.90	1.17
____Hodgkin's disease	5	4.21	1.19	0.39	2.77
____Non-Hodgkin's lymphoma	97	92.40	1.05	0.85	1.28
____Multiple myeloma	43	42.73	1.01	0.73	1.36
____Leukemia	90	88.86	1.01	0.81	1.24
Benign & unspecified nature neoplasms	18	27.05	0.67	0.39	1.05
Diseases blood & blood-forming organs	31	39.17	0.79	0.54	1.12
Diabetes mellitus	112	220.61	0.51**	0.42	0.61
Mental & psychiatric disorders	107	136.79	0.78**	0.64	0.95
Alcoholism	13	22.64	0.57*	0.31	0.98
Other mental disorders	94	114.15	0.82	0.67	1.01
Nervous system disorders	249	263.28	0.95	0.83	1.07
Heart diseases	1871	2486.51	0.75**	0.72	0.79
Other diseases of the circulatory system	509	645.79	0.79**	0.72	0.86
Diseases respiratory system	743	839.70	0.88**	0.82	0.95
__Acute resp. infection, except. flu, pneumonia	3	1.22	2.46	0.51	7.19
__Influenza	3	2.76	1.09	0.22	3.18
__Pneumonia	129	196.57	0.66**	0.55	0.78
__COPD	461	485.42	0.95	0.86	1.04
__Asthma	5	7.28	0.69	0.22	1.60
__Asbestosis	48	4.11	11.68**	8.61	15.48
__Silicosis	0	0.68	0.00	0.00	5.44
__Other pneumoconiosis	1	4.00	0.25	0.01	1.39
__Other respiratory diseases	93	137.67	0.68**	0.55	0.83
Diseases digestive system	194	267.43	0.73**	0.63	0.84
Diseases skin & subcutaneous	5	8.21	0.61	0.20	1.42
Diseases musculoskeletal & connective	14	23.02	0.61	0.33	1.02
Diseases genito-urinary system	109	162.66	0.67**	0.55	0.81
Symptoms & ill-defined conditions	39	59.32	0.66**	0.47	0.90
Transportation injuries	62	71.80	0.86	0.66	1.11
Falls	63	56.42	1.12	0.86	1.43
Other injury	56	75.67	0.74*	0.56	0.96
Violence	65	90.62	0.72**	0.55	0.91
Other & unspecified causes	164	206.96	0.79**	0.68	0.92

* Two-Sided P < 0.05 ** Two-Sided P < 0.01

Disease Category	Time Since Trade Entry (years)	Obs.	Exp.	SMR	95% CI Lower	95% CI Upper
Lung Cancer	20 to 29	31	28.18	1.10	0.75	1.56
	30 to 39	142	144.32	0.98	0.83	1.16
	40 to 49	309	307.80	1.00	0.90	1.12
	50+	326	304.47	1.07	0.96	1.19
MN Pleura	20 to 29	1	0.08	12.15	0.31	67.71
	30 to 39	1	0.32	3.10	0.08	17.25
	40 to 49	6	0.62	9.73**	3.57	21.17
	50+	3	0.46	6.51*	1.34	19.02
Mesothelioma	20 to 29	1	0.13	7.54	0.19	42.02
	30 to 39	7	1.09	6.43**	2.58	13.24
	40 to 49	36	3.66	9.84**	6.89	13.63
	50+	41	6.70	6.12**	4.39	8.31
COPD	20 to 29	7	11.67	0.60	0.24	1.24
	30 to 39	29	53.80	0.54**	0.36	0.77
	40 to 49	131	157.35	0.83**	0.70	0.99
	50+	294	262.54	1.12	1.00	1.26
Asbestosis	20 to 29	2	0.08	24.83**	3.01	89.69
	30 to 39	4	0.36	11.13**	3.03	28.50
	40 to 49	11	1.19	9.23**	4.60	16.52
	50+	31	2.48	12.51**	8.50	17.75

* Two-Sided P < 0.05 ** Two-Sided P < 0.01

Disease Category	Parenchymal Change Category	Obs.	Exp.	SMR	95% CI Lower	95% CI Upper
Lung Cancer	0/- to 0/1	649	693.46	0.94	0.87	1.01
	1/0 to 1/2	143	86.85	1.65	1.39	1.94
	2/1 to 2/3	14	4.28	3.27	1.79	5.48
	3/2 to 3/+	2	0.26	7.58	0.92	27.38
MN Pleura	0/- to 0/1	10	1.27	7.89	3.78	14.51
	1/0 to 1/2	1	0.20	4.92	0.12	27.40
	2/1 to 2/3	0	0.01	0.00	0.00	300.99
	3/2 to 3/+	0	<0.01	0.00	0.00	6087.99
Mesothelioma	0/- to 0/1	69	10.37	6.65	5.18	8.42
	1/0 to 1/2	16	1.16	13.85	7.91	22.49
	2/1 to 2/3	0	0.04	0.00	0.00	82.29
	3/2 to 3/+	0	<0.01	0.00	0.00	1050.38
COPD	0/- to 0/1	356	423.03	0.84	0.76	0.93
	1/0 to 1/2	92	58.90	1.56	1.26	1.92
	2/1 to 2/3	12	3.31	3.63	1.87	6.33
	3/2 to 3/+	1	0.18	5.52	0.14	30.74
Asbestosis	0/- to 0/1	27	3.58	7.54	4.96	10.96
	1/0 to 1/2	18	0.50	35.96	21.30	56.84
	2/1 to 2/3	3	0.03	116.75	24.08	341.20
	3/2 to 3/+	0	<0.01	0.00	0.00	2446.02

* Two-Sided P < 0.05 ** Two-Sided P < 0.01

Disease Category	Pleural Changes	Obs.	Exp.	SMW	95% CI Lower	95% CI Upper
Lung Cancer	No	597	585.39	1.02	0.94	1.11
	Yes	211	199.47	1.06	0.92	1.21
MN Pleura	No	7	1.05	6.66**	2.68	13.73
	Yes	4	0.43	9.25**	2.52	23.68
Mesothelioma	No	53	8.72	6.08**	4.55	7.95
	Yes	32	2.86	11.19**	7.65	15.79
COPD	No	287	349.36	0.82**	0.73	0.92
	Yes	174	136.06	1.28**	1.10	1.48
Asbestosis	No	21	2.94	7.15**	4.42	10.93
	Yes	27	1.17	23.03**	15.17	33.51

* Two-Sided P < 0.05 ** Two-Sided P < 0.01

Risk Predictor	Number in Model²	No. of Cancer Cases	Relative Risk²	95% CI Lower	>95% CI Upper
Profusion Categories⁴
0/- - 0/0	13066	526	1.00	Ref	Ref
0/1	1341	78	1.10	0.86	1.39
1/0 - 1/2	1559	131	1.48	1.22	1.80
2/1 - 2/3	95	12	2.83	1.59	5.04
3/2 - 3/+	7	2	3.96	0.98	16.05
Pleural Abnormalities
Negative	13997	635	1.00	Ref	Ref
Positive	2071	114	0.91	0.74	1.11
Years Since Last Sheet Metal Trade Work at Exam
<1	9880	366	1.00	Ref	Ref
1-5	2942	189	1.33	1.09	1.62
5-10	1884	102	1.21	0.91	1.60
>10	1362	92	2.00	1.43	2.79
Age³	16068	749	1.045	1.028	1.061
Smoking Pack-Years³	16068	749	1.026	1.021	1.031
Years in Sheet Metal Trade³	16068	749	1.026	1.01	1.042
¹ Cox proportional hazard analyses based on 16068 Caucasian males with 20 or more years in sheet metal trade and having data on other model covariates. ² Stratified Cox model with strata defined by smoking status (never, past, and current) and adjusted for pack-years of smoking (0, 1-19, 20-39, or ≥ 40 pack-years), age at start of follow-up (<50, 50-54, 55-59, 60-64, 65-69, 70-74, or ≥ 75 years), time since last work in the sheet metal trade at start of follow-up (<5, 5-9, or ≥ 10 years), years of sheet metal work beyond 20 years (20-24, 25-29, 30-34, or ≥ 35 years), presence of pleural abnormalities, and profusion category. A pleural abnormality was defined as bilateral pleural thickening or plaques, with or without calcification. ³ Age, pack-years of smoking, and years of sheet metal work entered as grouped continuous variables. ⁴ Test for trend across profusions categories, p<0.0001.

Risk Predictor	Number in Model²	No. of Cancer Cases	Relative Risk²	>95% CI Lower	95% CI Upper
FVC Percent Predicted⁴
>=80	7354	226	1.00	Ref	Ref
70-79	1159	66	1.16	0.92	1.65
60-69	471	43	1.54	0.94	2.50
<60	240	28	1.73	0.95	3.16
FEV₁ Percent Predicted⁴
>=80	7116	176	1.00	Ref	Ref
70-79	1020	70	1.58	1.13	2.22
60-69	47	556	1.38	0.88	2.17
<60	532	70	1.57	0.84	2.92
FEV₁/FVC⁴
>=80	3230	51	1.00	Ref	Ref
70-79	4110	137	1.44	1.03	2.00
60-69	1290	100	2.16	1.47	3.18
<60	594	75	2.79	1.69	4.63
Years Since Last Sheet Metal Trade Work at Exam
<1	6088	186	1.00	Ref	Ref
1-5	1510	93	1.50	1.13	2.00
5-10	973	43	1.12	0.74	1.70
>10	653	41	2.01	1.24	3.25
Age³	9224	363	1.033	1.009	1.057
Smoking Pack-Years³	9224	363	1.017	1.009	1.025
Years in Sheet Metal Trade³	9224	363	1.021	0.999	1.044
¹ Cox proportional hazard analyses based on 9224 Caucasian males with 20 or more years in sheet metal trade and having spirometry data and data on other model covariates. Only workers with spirometry meeting ATS reproducibility criteria were included. ² Stratified Cox model with strata defined by smoking status (never, past, and current) and adjusted for pack-years of smoking (0, 1-19, 20-39, or ≥ 40 pack-years), age at start of follow-up (<50, 50-54, 55-59, 60-64, 65-69, 70-74, or ≥ 75 years), time since last work in the sheet metal trade at start of follow-up (<5, 5-9, or ≥ 10 years), years of 1 sheet metal work beyond 20 years (20-24, 25-29, 30-34, or ≥ 35 years). Pleural abnormalities were not significantly associated with lung cancer in the adjusted model (p=0.38). ³ Age, pack-years of smoking, and years of sheet metal work entered as grouped continuous variables. ⁴ Test for trend across categories for percent predicted FVC (p=0.0472), FEV₁ (p=0.0971) and FEV₁/FVC (p<0.0001).

Risk Predictor	Number in Model¹	No. of Cancer Cases	Relative Risk²	95% CI Lower	95% CI Upper
Profusion Categories
< 1/0	14407	72	1.00	Ref	Ref
1/0	1661	17	1.77	1.03	3.05
Pleural Abnormalities
Negative	13997	67	1.00	Ref	Ref
Positive	2071	22	1.79	1.09	2.94
Age³	16068	89	1.063	1.034	1.092
¹ Cox proportional hazard analyses based on 16068 Caucasian males with 20 or more years in sheet metal trade and having data on other model covariates. Smoking (p=0.24), years of sheet metal work beyond 20 years (p=0.73), years since last sheet metal work (p=41), percent predicted FVC (p=0.16), and percent predicted FEV₁/FVC (p=0.19) were not significant predictors of mesothelioma mortality and were eliminated from the final model. ² An alternate model with pleural abnormalities defined as any indication of pleural change on the ILO recording form resulted in slightly greater risk (RR= 1.97, 95% CI=1.36-3.06). ³ Age entered as grouped continuous variables.

An error has occured:

ABSTRACT

KEY FINDINGS

BACKGROUND

MATERIALS AND METHODS

Cohort Definition

Cohort Mortality Analyses

Multivariate Modeling of Lung Cancer, Mesothelioma, and COPD Mortality Predictors

RESULTS

DISCUSSION

ACKNOWLEDGEMENTS

REFERENCES

TABLES

ABSTRACT

KEY FINDINGS

BACKGROUND

MATERIALS AND METHODS

Cohort Definition

Cohort Mortality Analyses

Multivariate Modeling of Lung Cancer, Mesothelioma, and COPD Mortality Predictors

RESULTS

DISCUSSION

ACKNOWLEDGEMENTS

REFERENCES

TABLES

ABSTRACT

KEY FINDINGS

BACKGROUND

MATERIALS AND METHODS

Cohort Definition

Cohort Mortality Analyses

Multivariate Modeling of Lung Cancer, Mesothelioma, and COPD Mortality Predictors

RESULTS

DISCUSSION

ACKNOWLEDGEMENTS

REFERENCES

TABLES

ABSTRACT

KEY FINDINGS

BACKGROUND

MATERIALS AND METHODS

Cohort Definition

Cohort Mortality Analyses

Multivariate Modeling of Lung Cancer, Mesothelioma, and COPD Mortality Predictors

RESULTS

DISCUSSION

ACKNOWLEDGEMENTS

REFERENCES

TABLES

ABSTRACT

KEY FINDINGS

BACKGROUND

MATERIALS AND METHODS

Cohort Definition

Cohort Mortality Analyses

Multivariate Modeling of Lung Cancer, Mesothelioma, and COPD Mortality Predictors

RESULTS

DISCUSSION

ACKNOWLEDGEMENTS

REFERENCES

TABLES

ABSTRACT

KEY FINDINGS

BACKGROUND

MATERIALS AND METHODS

Cohort Definition

Cohort Mortality Analyses

Multivariate Modeling of Lung Cancer, Mesothelioma, and COPD Mortality Predictors

RESULTS

DISCUSSION

ACKNOWLEDGEMENTS

REFERENCES

TABLES

ABSTRACT

KEY FINDINGS

BACKGROUND

MATERIALS AND METHODS

Cohort Definition

Cohort Mortality Analyses

Multivariate Modeling of Lung Cancer, Mesothelioma, and COPD Mortality Predictors