Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California

Details

• Personal Author:
  Afif N ; Cummings, Kristin J. ; Fazio JC ; Flattery J ; Gandhi SA ; Harrison RJ ; Heinzerling A ; Kamangar N
• Description:
  Importance: Silicosis associated with inhalation of respirable crystalline silica among engineered stone countertop fabrication workers is an emerging health concern. Objective: To describe clinical, socioeconomic, and occupational characteristics of patients diagnosed with silicosis associated with engineered stone in California. Design, Setting, and Participants: This case series included reported cases of silicosis associated with fabrication of engineered stone countertops, as identified by statewide surveillance by the California Department of Public Health (2019-2022). Data analysis was performed from October 2022 to March 2023. Exposures: Patient interviews and medical record abstractions were used to assess occupational exposure to respirable crystalline silica, including duration of work tenure and preventive measures undertaken. Main Outcomes and Measures: Demographics, clinical characteristics, health care utilization, and clinical outcomes were obtained, including vital status, hypoxia, and lung transplant. Results: This case series identified 52 male patients meeting inclusion criteria; median (IQR) age was 45 (40-49) years, and 51 were Latino immigrants. Ten (19%) were uninsured, and 20 (39%) had restricted-scope Medi-Cal; 25 (48%) presented initially to an emergency department. A delay in diagnosis occurred in 30 (58%) patients, most commonly due to alternative initial diagnoses of bacterial pneumonia (9 [30%]) or tuberculosis (8 [27%]). At diagnosis, 20 (38%) patients had advanced disease (progressive massive fibrosis) with severely or very severely reduced forced expiratory volume in 1 second in 8 (18%) and 5 (11%), respectively. Of the cases, 10 (19%) were fatal; median (IQR) age at death was 46 (38-51) years, and 6 patients (12%) were alive with chronic resting hypoxia. Eleven were referred for lung transplant: 3 underwent transplant with 1 fatality; 7 were declined transplant, with 6 fatalities; and 1 died prior to listing. Median (IQR) work tenure was 15 (10-20) years; 23 (45%) reported use of water suppression for dust mitigation, and 25 (48%) continued to fabricate stone after being diagnosed with silicosis. Conclusions and Relevance: In this case series performed in California, silicosis associated with occupational exposure to dust from engineered stone primarily occurred among young Latino immigrant men. Many patients presented with severe disease, and some cases were fatal. [Description provided by NIOSH]
• Subjects:
  Dust Emigration And Immigration Lung Lung Diseases Occupational Health Quartz Respiratory System Respiratory Tract Diseases Safety Silicon Dioxide
• Keywords:
  Clinical Symptoms Crystalline Silica Immigrant Workers Lung Fibrosis Quartz Dust Respirable Dust Silicosis Stone Products
• ISSN:
  2168-6106
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  183
• Issue:
  9
• NIOSHTIC Number:
  nn:20068050
• Citation:
  JAMA Intern Med 2023 Sep; 183(9):991-998
• Contact Point Address:
  Jane C. Fazio, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, 43-229 CHS Box 951690, Los Angeles, CA 90095
• Email:
  jfazio@mednet.ucla.edu
• CAS Registry Number:
  Quartz (SiO2) (CAS RN 14808-60-7)
• Federal Fiscal Year:
  2023
• Performing Organization:
  Public Health Institute
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  JAMA Internal Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c890008f84d2a93b55dc85feb8630b5376e676b162eeb50d64ac41875d5e800266e2f755f3a029909447ff3f8bf7edafcb37cf2bb29205237c8f0c10cd42ed6f
• Download URL:
  https://stacks.cdc.gov/view/cdc/230271/cdc_230271_DS1.pdf
• File Type:
  [PDF - 862.81 KB ]