SAI-068-82-531
STUDY OF CANCER MORTALITY IN
CHRYSOTILE ASBESTOS MINING COUNTIES
Final Report
By
Richard Zlskind
Daniel Smith
Daniel Baxter
Gary Spivey
Energy-Environment Systems Division
SCIENCE APPLICATIONS, INC
Los Angeles, California 90067
EPA Contract Number
68-02-3443
Project Officer
John Acquavella
Epidemiology Branch
HERL, US EPA
Research Triangle Park, N.C. 27711
7 April 1982
Health Effects Research Laboratory
Office of Research and Development
U.S. Environmental Protection Agency
Research Triangle Park, N.C. 27711
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TABLE OF CONTENTS
PAGE
1.0 INTRODUCTION-HISTORY-SUMMARY 1
2.0 BACKGROUND REVIEW PROTOCOL ELEMENTS AND DATA GATHERING 5
2.0.1 Health Risks 5
2.0.2 Determination of Air and Water Ambient
Asbestos Levels6
2.0.3 Case and Control Selection 19
2.0.4 Case and Control Matching System 29
2.0.5 Quality Assurance of Death Certificate
Abstraction and Coding29
2.1 DETERMINATION OF STANDARDIZED MORTALITY RATIOS (SMR'S) 32
REFERENCES
APPENDIX A Description of Electron Microscopy
APPENDIX B Abstracting Forms and Codes
APPENDIX C SMR Data Bases for Calaveras and Tuolumne Counties
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ABSTRACT
The purpose of this study was to implement key data gathering tasks
of an epidemiological study protocol formulated as part of the intial program
phase. These activities included the asbestos analysis of air and water
samples and the identification and development of a study subject data base.
Initially, the ultimate objective of this program was formulated as
the evaluation of the hypothesis:
Deaths due to respiratory tract cancer, mesothelioma,
and cardiovascular disease are associated with the
length of residence proximal to asbestos mining
activities after controlling for the effects of
cigarette smoking, occupation, and .genetic susceptibility.
California death record tapes were secured for the period 1969
through 1978 for the two counties with the most extensive deposits of asbestos
bearing serpentine mineral formations. County residents were subdivided
according to cause of death as given by the three and four digit ICDA codes.
Case and control groups were defined in order to investigate whether the
geographical distribution of residence associated with particular categories
(case group) differed from that of the control causes. Three case groups were
developed for males and females with two controls for each case. Causes of
death known to be associated with occupational asbestos exposure were
generally taken as case categories whereas controls were selected with
precisely the opposing criterion. Case groups were digestive tract cancer,
respiratory tract cancer and heart disease with hypertension. Control groups
were reproductive cancers, heart disease without hypertension and general
categories.
In order to asssociate an inhalation and ingestion exposure index
with each individual's residential history, ambient concentrations of asbestos
were determined for airborne and waterborne pathways. The California Air
Resources Board made available their archive of cellulose high volume air
sampler filters from the early 1970 time period. Twenty two filters were
selected for electron microscopic analysis. These encompassed the
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DISCLAIMER
This report has been reviewed by the Health Effects Research Laboratory, U.S.
Environmental Protection Agency, and approved for publication. Approval does
not signify that the contents necessarily reflect the views and policies of
the U.S. Environmental Protection Agency, nor does mention of trade names or
commercial products constitute endorsement or recommendation for use.
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geographical area of importance including the adjacent counties with areas
outside the serpentine mineral formations. All samples were analyzed for
chrysotile content by scanning electron microscope and several by transmission
electron microscope as a quality assurance measure. In the serpentine area
53 63
fiber counts all exceeded 1.0x10 /m and ranged to 3.7x10 /m (12 samples
6.7x10 average). In the non-serpentine areas all fiber counts were less
5 3 43
than 1.0x10 /m and averaged 4.9x10 /m.
Water samples were gathered throughout the area and analyzed for
chrysotile concentration. Eight samples contained chrysotile concentrations
above the detectable limit of approximately 0.4x10 fibers/liter. The highest
concentration measured was approximately 20x10 fibers/liter.
Examination of air and water asbestos concentration findings
permitted the assignment of an air exposure index-high, medium, low- to each
residence community. Water asbestos were insufficiently elevated and
geographically coherent to support the definition of an exposure index.
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Acknowledgements
The authors wish to expressly acknowledge the cooperation of a
number of Individuals and agencies who provided us key support during the
study. Dr. Gregg Wilkinson and Mr. John Acquavella, formerly of the
Epidemiology Branch EPA/RTP, provided technical guidance and resources which
were critical to the conduct of the program. Ms. Susan Twlss of the State of
California Air Industrial Hygiene Laboratory and Ms. Judy Hodgklns, California
A1r Resources Board, researched and obtained the archived air sampler filters
which were analyzed for asbestos. Mr. Roger Smith of the California
Department of Health Services coordinated and expedited our obtaining computer
tapes containing death records. Dr. James Mlllette of the Exposure Evaluation
Branch, Epidemiology Division, EPA/CINC supervised the turbidity and asbestos
analysis of water samples. Discussions with technical staff at Union Carbide
Corporation (Dr. H.B. Rhodes and Mr. John Meyers) and Calaveras
Asbestos (Mr. Michael Dell'Orto and Mr. Robert Hoylman) were quite helpful.
We further acknowledge the assistance of the local water districts
throught out Calaveras and Tuolumne counties as well as the regional air
quality managment district. Staff was provided quality assistance from the
following individuals - Mr. Alan Miller and Richard Miller for data
abstracting and coding, Mr. David Barsky for data base management and
programming, Ms. Melanie Nelson for manuscript word processing.
Finally we extend our thanks to Dr. Carl Hayes for his assistance in
project oversight during its final stages.
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1.0 INTRODUCTION-HISTORY-SUMMARY
This report documents the second phase of a research effort
concerning the association between ambient asbestos and cancer mortality.
This segment was primarily a data gathering activity and consisted of air and
water sampling for asbestos in the Calaveras and Tuolumne counties of
California; collection and coding of certain categories of mortality data for
the period 1969-1978; and asssignment of asbestos exposure indices to the
study subjects. In addition standardized mortality ratios (SMR's) were
calculated for somewhat broader mortality categories in the two counties for
three years 1969-1971. These SMR values were compared with the expected
number of deaths for each cause based upon three-year California rates.
In 1978 the U.S. Environmental Protection Agency performed an
in-house study of age adjusted mortality rates in asbestos mining counties
across the United States. The results showed increased mortality ratios for
buccal and pharyngeal cancer, respiratory cancer, urinary tract cancer and
deaths from hypertensive heart disease. Relative risks for these causes of
death ranged from 1.2 and 5.6.
One of the limitations of this study was that the exposure to
asbestos was defined not on the basis of environmental measurements in the
communities, but by census Information on mining. The investigators concluded
that further investigation was needed and EPA decided to contract
(competitively) to fund a case/control study that would include measurements
of ambient asbestos exposures. SAI was awarded the procurement in September
1979. The first steps of the program included selecting the most suitable
counties for study (resulting in Calaveras and Tuolumne), designing the
epidemiological protocol, and developing an air and water sampling and
analysis plan. Calaveras and Tuolumne counties were selected for several
reasons: A rich and extensive asbestos bearing serpentine formation traverses
the western portion of both counties. These counties are rural and
individuals tend to be exposed to fewer confounding hazardous emissions. The
exposure of this population to asbestos was hypothesized to be significantly
elevated in localized portions of the counties while at low background levels
in other parts of the counties.
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Computer tapes of mortality data were obtained from the office of
the State Registrar of Vital Statistics for the two counties for the time
period 1969-1978. The data were sorted into computer files according to cause
of death (ICDA code), sex, age, and county of residence.* The epidemiologic
protocol design was to identify three case groups each of males and females.
Each case group consisted of a selected set of causes of death known or
suspected of being associated with occupationally related exposure to
asbestos. Two control groups were identified for each case group with their
selected causes of death categories known to be unrelated to asbestos
exposure.
The overall approach thus for each case subject is to identify by
age and sex matching, two control group members and associate with each an
asbestos exposure index based upon their residence location.
In order to investigate whether air and water ambient levels of
asbestos were elevated and to determine their gradients across the county a
sampling and analysis approach was designed based upon knowledge of the water
distribution systems, populations, and air quality monitoring stations. It
was predicted that roughly half the population in these two counties might
have been exposed to elevated concentrations of asbestos in the air and/or
water.
In September 1980 EPA approved the study protocol and SAI was issued
a new contract to collect the mortality and exposure data. This report
documents that contract.
The California Air Resources Board provided assistance to SAI in
this study phase by making available their archives of high volume air sampler
filters for the earliest time period still retained i.e. 1972 through 1974.*
Twenty-two cellulose filters were selected for electron microscopic analysis.
These encompassed all geographical areas of importance. Results were clear-
3
cut. In the serpentine area fiber counts all exceeded 100,000 f1bers/m ,
ranged to 3,700,000 and averaged 675,000 for 12 samples. In the
non-serpentine areas all samples (10) had fiber counts less than 100,000
* As opposed to county of death.
* It is most desirable to obtain past asbestos concentration information since
this more closely reflects the exposure the subject popuation recieved
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fibers/m and averaged 49,000. Blanks and duplicates were run as quality
assurance measures.
Since no archived water samples were available, twenty four were
gathered from throughout the two counties in order to comprehensively
characterize the asbestos content in each distinct water distribution system.
Eight samples contained chrysotile concentrations above the detectable limit
of approximately 400,000 fibers/liter. The highest concentration value
measured was approximately 20 x 10 fibers/liter which may have been a local
phenomenon associated with cement asbestos pipe transport. Unlike the
airborne case, waterborne levels were neither significantly elevated nor
geographically coherent to support the development of an exposure index.
In summary the airborne levels of asbestos found in communities in
the serpentine formation areas are significantly elevated over non-serpentine
areas and are more illustrative of occupational environments although the
fiber sizes distribution is biased toward the fines. Importantly, of course,
those exposed is a non-occupational population which is typically less hardy.
The following case and control groups with identifying cause of
death codes (ICD, 8th revision) are being utilized for males and females:
Case
Groups
Corresponding
Control Groups
1. Trachea .Bronchus General Causes
and Lung Cancer (various ICD
(ICD 162.0-162.9) numbers)
Reproductive Cancers
(ICD 174, 185-187.9)
2. Digestive Tract
Cancer (ICD
150.0-159.9)
General Causes
Reproductive Cancers
3. Hypertensive Heart General Causes
Disease (ICD 400.0-
404.9, 410.0, 411.0,
412..1-412.2)
Non-Hypertensive
Heart Disease (ICD 410.9,
411.9, 412.3-412.4)
The total study population is 1382 individuals.
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The study group was developed from the State computer tapes
discussed above. In order to obtain the information necessary to support the
mortality analysis, the death certificate hard copy was located, information
abstracted, coded and placed on tape. The death certificate abstract form is
shown as Figure 2.1-2. All necessary information has been coded to initiate
the tracing of the surviving spouse or informant if that is ever needed.
Subsequent effort for this research would begin at this point. It
would be appropriate to perform the analysis of this data base and test for
associations between cause of death and the area of residence within the
counties. Specifically the correlation between a case group, e.g. the 85
males deceased from the categories of hypertensive heart disease, and their
airborne asbestos exposure based on residence history would be statistically
contrasted with the 85 age matched males deceased from general causes and
finally the 85 who died of non-hypertensive heart disease.
This approach was formulated as the most cost-effective procedure to
determine if any categories of mortality correlated with asbestos exposure and
to prioritize them.
The master plan for completion of the study, as envisioned by EPA,
would be to perform a next of kin survey to improve upon the information base
coded from the death certificate. A questionnaire was developed in the
initial EPA sponsored contract which primarily obtains or verifies information
on smoking, drinking and residence and occupational history. Next of kin
interviews would only be considered later for specific case group categories
where a convincing association with exposure was found.
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2.0 BACKGROUND REVIEW
2.0.1 Health Risks
Health effects due to the occupational exposure to asbestos has been
studied particularly in the mining, milling, textile, and construction
industries. In their review of findings, EPA researchers (Acquavella, et al.
1979) cited studies* of human cohorts implicating asbestos as a factor in
increased mortality from several types of malignancy: mesothelioma, lung and
laryngeal cancer (especially for smokers), and possibly 61 cancer. Mortality
from non-cancerous conditions of the respiratory and possibly cardiovascular
system has also been related to chronic occupational exposure (Mancuso, 1967;
McDonald, 1971).
Studies have examined the risk of increased mortality among
residents in neighborhoods proximal to asbestos processing faciltiies, in
areas with natural asbestos deposits, and in communities having identifiable
asbestos fibers in public drinking water. Historically such studies have been
equivocal. However, recently with the emergence of two key factors (electron
microsopy and cancer incidence registries) several studies undertaken have
identified and quantified a risk factor among communities with elevated
asbestos exposure to airborne and/or waterborne concentrations.
Specifically Graham (1977) demonstrated, through use of tumor
registry data, residents in several Quebec communities had risks from 1.5 to
8.1 times higher than control communities for 10 different cancer sites among
males and for seven sites among females. The most prominent excesses were
found for cancer of pleura, small intestine, salivary gland, peritoneum, lip
and tongue for males; and lip and pleura, salivary gland, kidney and melanoma
for females.
* Kleinfield, 1967; Mancuso, 1967; McDonald, 1971; McDonald, 1974; Miller,
1978.
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Kanarek et al. 1980, analyzed the asbestos content In the water
distribution systems supplying the San Francisco-Oakland Standard Metropolitan
Statistical Area (SMSA). The dependent variable of interest was cancer
Incidence adjusted for age, sex and race. The major independent variable was
chrysotlle asbestos fiber content. Kanarek showed elevated mortality from
cancers of the esophagus, stomach, gall bladder, and pancreas.
Acquavella et al., 1979 investigated the hypothesis that cancer as
well as respiratory and cardiovascular disease mortality would be 1n excess In
chrysotile asbestos mining counties across the country. Although national 1n
scope, California figured large in this study since it accounts for over 70%
of total U.S. asbestos production. Mortality data from the years 1969-1971
were obtained from the POPATRISK data base. Unfortunately this data base
coarsely groups respiratory and digestive tract cancers and does not allow
their subdivision into sub-groupings of more specific occupationally
asbestos-related sites. Two critical features of the study protocol were that
the county level was the smallest population breakdown and in a related
limitation a localized source of emissions such as a plant or region of
natural asbestos deposits could not be expected to affect the ambient air of
an entire county. Thus the study would overestimate the population at risk
and therefore dilute potential associations. The study protocol had no
mechanism for considering occupational exposure. Control counties were
matched according to population density. The results showed increased
mortality ratios for buccal and pharyngeal cancer, respiratory cancer, urinary
tract cancer, and deaths from hypertensive heart disease. Relative risk for
these causes of death ranged from 1.2 to 5.5.
2.0.2 Determination of Air and Water Ambient Asbestos Levels
SAI undertook research to follow-up on the EPA effort discussed
above. The purpose of the work was to design and execute an epidemiologic
study protocol to further evaluate the hypothesis that asbestos related health
effects have been observed among populations without occupational exposure.
Two distinct California areas with extensive asbestos bearing serpentine
formations were researched. One is associated with a deposit running through
the junction of Fresno and San Benito counties (New Idria Deposit). The
second is located throughout the western sections of Calaveras and Tuolumne
-------
counties (herein referred to as the Calaveras Deposit). The preferable study
area was determined to be that associated with the Calaveras Deposit.
Selection criteria were three-fold: greater population base, evidence of
elevated airborne and waterborne concentrations of asbestos, and the existence
of archives (CARB) of useful ambient air sampler filters dating back over
seven years.
Figure 2.0-1 illustrates the asbestos deposits in California. The
New Idria and Calaveras Deposits are among the richest and most extensive in
the state and contain the only active commercial sities. Figure 2.0-1 depicts
the general area of Calaveras and Tuolumne counties.
The oldest measured ambient levels of airborne asbestos taken in the
western county area was reported by the California Department of Health in
1965-1967 (California Department of Public Health, 1967). Ambient (upwind)
asbestos concentration was measured by dust sample collection through
impingers. Quantification was by optical microscopy. Ambient levels on two
separate occasions were made and ranged between 0.1 and 2 million particles
per cubic foot of air (mppcf). A federal study at about the same time of the
area "Environmental Survey of Asbestos Mining and Milling in California "
(December 1966, Public Health Service Division of Occupational Health)
suggests the equivalence 10 total fibers/cc = 1 mppcf by impinger. In the
cited ambient concentrations (from the NIOSH Recommended Asbestos Standards)
the levels across the country are summarized as generally <10ng/m with
3
occasional peaks as high as 100 ng/m (by electron microscopy). Using optical
microscopy, ambient levels are generally less than 0.01 fibers > 5 ym/cc with
peak values as high as 0.03 fibers >y5 m/cc. Using the Public Health Service
equivalence 6 fibers > 5 ym/cc, 1 mppcf by impinger yields the mine area
ambient (upwind) concentration range 0.6 - 12 fibers/cc.* Further using the
NIOSH suggested equivalent 20 fibers > u5 m in length (as determined by
optical microscopy) per nanogram of asbestos yields the mine ambient range 12
3
- 140 ng/m . Thus the ambient levels detected at upwind locations in the
vicinity of a Calaveras mine/mill are at the extreme high end of surveyed
range. A number of subsequent studies of the general area have confirmed that
quite elevated concentrations of airborne asbestos exist. The most recent, of
course, being the comprehensive analysis done of the area performed by SAI for
EPA in 1980.
* Note the current NIOSH recommended standard is 0.1 fiber/cc for an 8 hour
time-weighted average (as detected by optical microscopy).
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I
MAP OF
CALIFORNIA
SHOWING PRINCIPAL
ASBESTOS DEPOSITS
EXPLANATION
SlftPCNTlNC AM
A AHPNIIOLC A1ICSTOS
C CMKTSOTILC AticsTo*
x OCPOSITS OUTSIOC or
INC ARIAS
OPERATING ASBESTOS MINES
jtrrmoH LAW Astnmcnw
COALINCA AUCITOS ca
ATtAl eOOf
AtKiroi iQNOiNa ca
——'it«'co
Figure 2.0-1 Asbestos Deposits of California.
8
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Hox*5X biKtmv «•« •»«»•. y -~«i»jin^_..Jiini«ll
—£'/f*t1 t~\-^^f"~~"S'mtCiti <••"!*•'••-S
««•• Xf. u ***£) tamva ,,„.,,., v
H?i?cH "V^^^ B5™,! 3-a-- 4 IT..*.-, o "--aifcy^aB^
• ;..uj«ler( u«.^..>...-'a, Q'.^r.,,,),,, ;„. l^/,-..\ crowwiiaS iiy/^v-'-i . .J
.lT-/''.-rV,,w NVv-^BuHcllCorKj-ii^J,, «/"*"7^^\ r.'.JS
tK.STOCKTOrA^W'""- :Xl 1^ ® /"V««..I«oi»niat
-»< .01—\ "•^j"'y,r"T7ii v^rr1- y xl /•—
H--ii.,w\i-'7r:'> f. 3J ° A °^ vi; !li«'fayr^"l j.—J ^ ' " i"-
• / W^^-r^\fcWl".T^r^li^lr^xSS^te?^-' ^'
rk^^S^^^1^"''""^"0 ^ k"^
Figure 2.0-2 Serpentine Areas of Calaveras and Tuolumne Counties
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The California Air Resources board provided h1-vol sampler filters from
geographical areas of interest. Available samples went back to 1972.
Analysis of these filters provided an important basis for the determination of
airborne asbestos exposure to the study population.
Filter selection procedure was to obtain 22 filters accounting for
seasonal variation at significant single locations, coverage of the entire
geographical region, and representation of suspected high and low suspended
particulate values. In addition, all hi-vol filter flow traces were inspected
to confirm that regular flow rates occurred throughout the collection period
and that no data tampering was evidenced.
Table 2.0-1 summarizes the results of the scanning electron
microscope analyses. Fiber counts and other data should be read as follows
for SAI number 81-1101 there were 3,251,00 flbers/m3 in the fiber size range
of less than 5 microns length. Figure 2.0-3 and Table 2.0-2 can be used to
explicitly interpret all sample locations. As can be readily seen from Table
2.0-1 the first twelve readings (sites 55922, 55921 and 22741) are
significantly elevated over the remainder, i.e. serpentine deposit sites
compared to non-serpentine. Furthermore the serpentine area concentrations
must be assessed as extremely high by any measure and would be of note even in
an occupational environment.
In addition to analysis by scannning electron microscopy several
analyses were performed by TEM (transmission electron microscope) as a quality
assurance procedure. TEM Analysis was conducted using a Hitachi Model H-500
Scanning Transmission Electron Microsope equipped with both SAED and
Dispersive X-ray capabilities. Two grids for each sample were counted at a
magnification of 10.000X and the diameter measurements were made at
magnifications of lOO.OOOX or 200.000X. The magnifications were calibrated
using a carbon grating replica. Chrysotile fibers were identified according
to morphology and/or selected area electron diffraction. Comparison of TEM
and SEM analysis for 81-1116-2 (Sonora 55922 9/20/74) and 81-1235 (Van401ELO
09001 8/14/73) are summarized in Table 2.0-3.
The fiber counts for the TEM analysis are slightly higher due to
the higher resolving power of the TEM.
10
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Table 2.1-1
SUMMARY ASBESTOS ANALYSIS BY ELECTRON MICROSCOPY OF STUDY AREA HI-VOL FILTERS
SA| Mumbpr
81-1101
81-1097
81-1116
A31-1094
81-1120
fll-1099
81.1121
81-1118
81-1102
•81-1106
81-1110
81-1092
81-1231
81-1232
81-1235
81-1199
81-1204
81-1213
B1-1217I2
81-1218
81-1197
61-1196
Sample blank
Sample blank
Sample blank
Location Site
Sonora 55922
Sonora 55922
Sonora 55922
Sonora 55922
Sonora 55922
Sonora 55922
Sonora 55922
Sorrora 55922
Sonora 55921
Sonora 55921
Sonora 55921
Marlposa 22741
Cam 1 no 09663
Placervllle 09664
Van 401 ELD 09001
Modesto 50557
Stockton 39252
Leevinlng 26772
Hadera 20001
Hadera 20002
Bridgeport 26773
Van 201 ELD 09301
Collection Date
08-08-73
10-25-73
09-20-74
12-30-73
06-28-74
09-25-73 •
04-05-74
07-22-74
07-15-73
05-24-73
03-23-73
07-11-72
04-10-73
04-10-73
08-14-73
07-26-72
07-25-72
09-20-72
11-20-72
03-13-73
04-07-73
06-15-73
129 (same ashed blank dilution as sample
filters)
11 (10 fold ashed blank
sample filters)
12 (10 fold aerosol O.T
dilution as
. and filtered
flbers/m3
<5,.m(lo'')
3251
232
704
247H45
106
388
231
153
378
1031*253
86
417
7.5
29
14
66
29
46
79
10
18
0.0
7.0
0.0
flbers/m3,
>5imi (10"J)
448
24
12
44f_23
8.4
38
26
9.5
73
79160
14
31
0.0
13
0.0
16
0.0
1.9
B.3
3.4
0.0
0.0
0.8
0.0
mass/m3 .
<5,,m (10'J)
221
118
46
37+21
13
43
31
86
73
268*130
3.8
44
0.4
1.6
0.5
10
5.1
1.3
3.1
0.1
11
0.0
0.3
0.0
mass/nr
>5i.m (10'3)
147
15
18
24237133748
380
16
27
1461
202
4351214
103
7.2
0.0
7.5
0.0
160
0.0
11
2.8
39
0.0
0.0
3.4
0.0
Surface area/m
<5nm (10°)
2513
379
456
234*130
89
332
201
204
401
13051106
45
360
4.5
15
6.3
59
40
21
38
2.0
33
0.0
4.4
0.0
Surface area/nr
»5uro (ID'3)
1578
127
105
520516243
333
185
122
752
526
2100H83
216
104
0.0
61
0.0
232
0.0
37
23
74
0.0
0.0
9.6
0.0
water blank)
denotes filter variation within one sample filtration
denotes sample variation between I wo separately filtered samples
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Figure 2.0-3 Site Locations of Samples Analyzed for Asbestos
MAP OF
CALIFORNIA
SHOWING PRINCIPAL
ASBESTOS DEPOSITS
(XPLANATION
tt«M»Tme A*O «mootin
»«»»H8(.C llttlTO* .
CMHTSOTIkt ISICSTOf
OC'OJITJ OuTSIOf Of
12
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Table 2.0-2 Ambient Asbestos Samples-Site Designations
Site
Designation
1
2A
2B
3
4
5
6
7
8
9
10
11A
11B
Site
Location
Mariposa
Sonora Location #1
Sonora Location #2
Bridgeport
Camino
Placerville
Van 201
Van 401
Modesto
Stockton
Lee Vining
Madera #1
Madera #2
Sample
Date
7/11/72
3/23/73, 5/24/73, 7/15/73
8/8/73, 9/25/73, 10/25/73,
12/30/73, 4/15/74, 6/28/74.
9/20/74
4/7/73
4/10/73
4/10/73
6/15/73
8/14/73
7/26/72
7/25/72
9/20/72
11/20/72
3/13/73
13
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The surface area and mass values are slightly higher In the SEM
analysis which Is probably due to the apparently larger fiber diameters which
result either from gold coating the filters or problems with resolution above
magnifications of 50.000X.
Appendix A contains information on the procedures used for the
preparation and analysis of the electron microscopy effort. The microscope
facilities are described and additional remarks are made pertaining to the
results and conclusions.
Analysis of the turbidity and asbestos content of water samples was
conducted by the Exposure Evaluation Branch of the Epidemiology Division,
Health Effects Research Laboratory, EPA Cincinnati: Twenty three water
samples were gathered by SAI staff encompassing the population centers and
water distribution systems. Table 2.0-4 delineates the sampling sites and
Table 2.0-5 summarizes the analysis results. The water distribution system
location and types - both historic and current were discussed in the final
report from the initial contract (Zlskind, 1980). Ten samples contained
statistically significant amounts of chrysotile asbestos with three samples
over 1 million fibers per liter. The highest concentration measured was at
Grovel and (20 x 10 fibers/liter) and appears to be due to aggressive water
transport through asbestos cement pipe (Personal Communication B. Beaudreau,
General Manager, Grovel and Commercial Services District). The pH In the
Groveland system decreases to approximately 6.0 after gas chlorinatlon. Lime
treatment is planned to raise pH to greater than 9 which should reduce the
asbestos content in the water. In any event the system is localized and
fairly recent ( 16 years).
It was concluded that asbestos concentration in water was neither
particularly elevated nor distributed with a sufficient gradient to warrant
creating an exposure index for use in the epidemiologic protocol. It was
decided, on the other hand, that airborne concentration of asbesto fulfilled
both criteria (sufficiently elevated levels and geographic gradient) and
exposure indices were formulated. Categories of asbestos concentration areas
in the two counties were defined as either high, medium and low according to
whether they were less than 5 miles from deposits, between 6 and 10 miles, or
greater than 10 miles. Deposits were readily located on the area geological
maps and each community was labeled and coded for incorporation into the
14
-------
Table 2.0-4 ASBESTOS WATER SAMPLING SITES
57303
57304
57305
57306
57307
57308
57309
57310
57311
57312
57313
57314
57315
Residency
270 High School Street
San Andreas (Utility Sink)
Residency
151 Chestnut Street
Valley Springs (Garden)
Residency
8288 West Main
Mukelumne Hill (Garages)
Residency
Main Street
West Point (Garden)
Haags Store (Also Residency)
R.R. Flats Rd. (Well Water)
R.R. Flats (Bathroom Sink)
(No Filter)
Residency
429 Church
Murphys (Kitchen Sink - No Filter)
Murphy's Hotel
Murphy's (Bathroom Sink - No Filter)
Jackpot Gas
Main Street
Angels Camp (Bathroom Sink - No Filter)
Residency
1280 Bush
Angels Camp (Garden)
Gold Rush Mobile Homes
Parrott's Ferry Road
Columbia (Bathroom)
Old Tuolumne County Court House
Yaney Street
Sonora (Bathroom)
Residency
33 Bradford W.
Sonora (Garden)
Residency
514 Stewart
Sonora (Garden)
16
-------
57316
57317
57318
57319
57320
57321
57322
57323
57324
57325
Samples
Samples
Residency
18415 Gardner Ave.
Tuolumne (Garden)
(A little murky brown)
Residency (Apt. Bldg.)
22771 Twain Harte Drive
Twain Harte (Garden)
Strawberry Store (Gen. Store and residency)
Hwy 108
Strawberry (Garden)
The Square Nail Restaurant
18376 Bay Ave.
Tuolumne (Bathroom)
Yosemite Bank
Hwy 120
Grovel and (Bathroom)
Residency
121 (The Main Street)
Copperopolis (Garden)
Same as 57321
Same location as 57320
Same location as 57306
Black Bart Inn - Garden Faucet
55 St. Charles Street (Hwy 49)
San Andreas
57303 - 57322 were taken in October 1980
57323 - 57325 were taken in March 1981
17
-------
Table 2.0-5 Turbidity and Asbestos Results for California Samples
Chrysotile Concentration
Millions of Fibers/liter
Sample No. Description
57303
57304
57305
57306
57307
57308
57309
57310
57311
57312
57313
57314
57315
57316
57317
57318
57319
57320
57321
57322
57323
57324
57325
2551A
2551E
2552E
2562E
2561E
2581A
2601A
San Andreas
Valley Springs
McKellumme Hill
West point
Railroad Flats
Murphys
Murphy s
. Angels Camp
Angels Camp
Columbia
Sonora
Sonora
Sonora
Tuol umne
Twain Harre
Strawberry
Tuotumne
Grovel and
Copperopolis
Copperopolis
Grovel and
West Point
San Andreas
Blank
Blank
Blank
Blank
Blank
Blank
Blank
Turbidity
(JTU)
0.6
2.1
3.3
1.6
2.5
1.4
2.5
0.3
0.7
0.6
0.3
0.2
0.5
10.0
0.3
0.9
0.7
0.5
1.3
5.5
-
_
_
0.2
0.2
0.2
0.2
0.2
0.2
-
Cone. 95%Confidence Limits
Upper Lower
NSS (0.3)*
BDL (0.1)**
0.4
5.5
NSS (0.1)
0.6
0.6
NSS (0.1)
0.7
BDL (0.05)
0.5
NSS (0.2)
BDL (0.06)
NSS (0.4)
NSS (0.3)
NSS (0.06)
BDL (0.07
3.2
BDL (0.3)
BDL (0.3)
20.1
0.4
0.5
NSS (0.05)
BDL (0.05)
NSS (0.15)
BDL (0.05)
BDL (0.05)
NSS (0.05)
BDL (0.05)
0.5
.
0.8
6.9
0.4
1.1
0.9
0.3
1.0
-
0.8
0.4
-
1.0
0.5
0.2
-
4.2
-
-
-
_
_
0.2
.
0.4
-
-
0.2
-
0.05
-
0.05
4.0
0.09
0.1
0.3
0.02
0.4
.
0.2
0.01
-
0.3
0.05
0.05
-
2.3
-
-
-
_
_
0.05
-
0.09
-
-
0.05
—
* NSS - Non-significant. While concentrations based on less than five fibers
may show the presence of asbestos in the water, the actual value is not
considered very reliable.
** BDL - Below the detectable limit shown.
analysis.
No fibers were seen in the
18
-------
coding of the mortality data base. The flexibility was retained to assign
numerical values of fiber concentration to each area. In the serpentine areas
fiber counts exceeded 100,000 fibers/m , ranged to 3,700,000 and averaged
675,000. In the non-serpentine area (all greater than 10 miles distance) all
3
samples had fiber counts less than 100,000 fibers/m and averaged 49,000. In
addition to the residence of the deceased individual being recorded on the
death certificate their length of stay in the county and in the state are
recorded as denoted in Figure 2.0-3. Although without further investigation
it would not be possible to verify their residence history in the county
during that period, it does facilitate the elimination from the study of
individuals with less than a minimal period of residence in the county.
Furthermore it is thus possible to define an exposure index equal to the
product of length of stay in the county and average fiber concentration
in the area of residence.
2.0.3 Case and Control Selection
The study group was defined as those individuals who died in
Calaveras and Tuolumne Counties during the ten year period 1969 and 1978.
Approximately 4300 individuals, nearly all white, were found to be in that
population. It was predicted that approximately one half of the population
would have resided in the serpentine formation areas and therefore the
counties would provide a useful distribution of residence (exposure index) for
contrast among ICDA categories.
Both cases and controls were identified from the California state
death tapes. The tapes are compiled monthly alphabetically by county of
death. Thus it was necessary to obtain the complete tapes from Calaveras and
Tuolumne counties and those entries from throughout the state of residents of
Calaveras and Tuolumne counties who died elsewhere. These tapes have coded
the basic information from the death certificate including the full name, date
of death, sex, race, birthplace, date of birth, age, county of death and
residence cause of death (4 digit) and local (county) file number.
The listings were sorted into groups according to the International
Classification of Diseases (ICD) code for the underlying cause of death. A ten
year time interval (1969-1978) was selected in order to gain a sufficient
statistical base while not proceeding into the more distant past thereby
complicating the study by introducing earlier revisions of the ICD codes.
19
-------
Causes of death hypothesized as linked to asbestos exposure
(primarily based upon the occupational literature) were delineated and case
groups formed as follows:
20
-------
' ' ' "' Stiff >lLC NUMBE'ft
DECEDENT
PERSONAL
DATA
PLACE
OF
DEATH
USUAL
RESIDENCE
(IF DEATH OCCURRED IN
INSTITUTION ENTER
tHSIOENCE IEFORE
ADMISSION!
PHYSICIAN'S
OR CORONER S
CERTIFICATION
FUNERAL
DIRECTOR
AND
LOCAL
REGISTRAR
H CAUSE
o OF
jE DEATH
—t
4
UJ
X
0
•z.
_l
<
o
g INJURY
s INFORMATIOI
STATE
REGISTRAR
CERTIFICATE OF DEATH
STATE OF CALIfOHNIA— DLPAHIMtNl OF PUBLIC HLALIH '" LOCAL REGISIRATION'OISTRICT AND CERTIFICATE NUMDCR
NAME OF DECEASED — FIRST NAME j It. MIDDLE NAME
1
1
SEX 4 COLOR OR
RACE 5 BIRTHPLACE iSK!,c.?T '°*
NAME AND BIRTHPLACE OF f ATHER
CITIZEN OF WHAT COUNTRY II. SOCIAL SECURITY NUMBE
. LAST OCCUPATION
A. PLACE OF DEATH— NAME
So CITY OR TOWN
jlC LAST NAME
1
1
CI01< 6. DATE OF BIRTH
ZA DATE OF DEATH— MONIM DAY. TIAR J2t HOUR
1
1 M
7. AGE .lAllmliMWi. IF UNDER I CORPORATE noils
1 liSPECI" ICS OR NO'
1
1
1 YEARS Y''AHS
9A. USUAL RESIDENCE — STREET ADDRESS ifTREU AND NUMKR OR LOCATION i l|9t. INSIDE CITY CORPORATE LIMITS
llSPECIFY t(S OR HOI
1
1
9c. CITY OR TOWN
IA CORONER. '„"'.' KCMMO'AI'
N
:nMKif4*TM \iba\\r, ~ '
22A SPCCKt IURIAI. ENTOMBMENT
OR CREMATION
J19o. COUNTY
1
1
M9l STATE
1
20. NAME AND MAILING ADDRESS OF INFORMANT
EJ'2li. PHYSICIAN: 'IM"I'''o>J.C '."'!' '.",',"'',"£"""<,» 2lc PHYSICIAN OR CORONER— W.AIU.I ..DMCAII c. mil l2lo. DATE SIGNED
°" | FBOM 1 TO
I1'""" r'""
-i 1
|22l DATE 23. NA
1
25 NAME OF FUNERAL DIRECTOR IOR MRSON ACTING At SUCHI 26. ','„
29. PART 1. DEATH WAS CAU
CONDITIONS. IF ANY. WHICH
GAVE RISE TO THE IMMEDI-
ATE CAUSE IAI. STATING
THE UNDERLYING CAUSE
LAST
AND
ME OF CEMETERY OR CREMATORY
24. EMBALMER — SIGNATURE ur loot [MIAIMCDI LICENSE NUMBER
lltOBMOl
SCO BY: ENTER ONLY ONE CAUSE PER LINE FOR A. B AND C
IMMEDIATE CAUSE •"
,A, APPROHI.
DUE TO. OR AS A CONSEQUENCE OF
(B)
DUE TO. OR AS A CONSEOUENCC OF
(C)
30. PART II: OTHER SIGNIFICANT CONDITIONS — CO>I>IKIIW 10 MAI. m
33 SPECIFY ACCIDENT tUICIOI 0* HOMICIDE 34 PLACE OF INJURY £
0(1*1 tg>i»><*« lie *
INTERVAL
•« BETWEEN
ONSET
DEATH
*
ori«»m»
!•« M.«'AI*"INII°" 35 INJURY AT WORK
• t'ICi't *lt Ct 4O>
37A. PLACE OF INJURY IITAEIY AND NUMIER OR LOCATION AND CUY on TOWNI '37i. ^"""o'Jvm"'.' °*
1 • Ittplfcll III* It
| Mill]
36> DATE OF INJURY— m,.,im t« •!«• 36i HOUR
M
38- e« IOIK c**|»iCftit <»riciri *lto* 1O> 39 t^HI ru4 *ite<*0f
•MICi** lit U* %0>
A
B C.
D. E ' F
.,1. i.i tnro.. vr..n
n
m
73
H
2-n
n -••
m o
> i
H co
o
T
—J*
CU
-------
A. Case Groups (hypothesized associations with asbestos exposure)
1. Malignant Neoplasms of Digestive Organs and Peritoneum
ICD 150.0 to 159.9
2. Malignant Neoplasm of Trachea, Bronchus and Lung ICO 162.0 to 162.9
3. Hypertensive Heart Disease ICD 400,0 to 404.9, 410.0, 411.0,412.1 to 2.2
B. Control Groups (no hypothesized association with asbestos exposure)
1. Reproductive Neoplasms (matched to digestive and respiratory cancer
case groups)
Males: ICD 185.0 to 187.9 (Prostate, Testes, Other and Unspecified)
Females: ICD 174.0 to 174.9 (Breast)
2. Non-Hypertensive Heart Disease (matched to hypertensive heart disease
case group) ICD 410.9, 411.9, 412.3 to 412.4
3. General Causes of Death (Matched to digestive, respiratory and hypertensive
heart disease case groups). Includes all causes of Death, except:
a) Tuberculosis ICD 10.0 to 19.9
b) Malignant Neoplasms of Digestive Organs and Peritoneum
ICD 150.0 to 159.9
c) Malignant Neoplasms of Trachea, Bronchus and Lung
ICD 162.0 to 162.9
d) Malignant Neoplasms of Breast ICD 174.0 to 174.9
e) Malignant Neoplasms of Prostate, Testes, Other and Unspecified
Male Genital Organs ICD 185.0 to 187.9
f) Malignant Neoplasms Without Specification of Site ICD 199.0 to 199.9
g) Mental Disorders ICD 290.0 to 315.9
h) Hypertensive Disease ICD 400.0 to 404.9
i) Ischaemic Heart Disease ICD 410.0 to 412.9
j) Cerebrovascular Disease ICD 430.0 to 438.9
k) Diseases of the Respiratory System ICD 460.0 to 519.9
1) Diseases of the Digestive System ICD 520.0 to 577.9
m) Complications of Pregnancy, Childbirth and the Puerperium
ICD 630.0 to 678.9
Congenital Anomalies ICD 740.0 to 759.9
Causes of Perinatal Morbidity and Mortality ICD 760.0 to 779.9
p) Water Transport Accidents ICD 830.0 to 833.9
q) Other and Unspecified Accidental Falls ICD 887.0 to 887.9
r) Accidental Drowning and Submersion ICD 910.0 to 910.9
s) Accident Caused by Firearm Missiles ICD 922.0 to 922.9
Suicide and Self-inflicted Injury ICD 950,0 to 959.9
Homicide ICD 960.0 to 969.0
Legal Intervention ICD 970.0 to 978.9
Injury Undetermined Whether Accidentally or Purposely Inflicted
ICD 980.0 to 989.9
x) Injury Resulting from Operations of War ICD 990.0 to 999.9
n)
o)
t)
u)
v)
w)
22
-------
These categories were eliminated from the general control causes of death
because they included:
1. Other case or control categories (b, c, d, e, h, i)
2. Categories which could be associated with asbestos exposure and/or
the three case categories (a, f, j, k, 1)
3, Categories unlikely to contain records that would be age-matchable
to case records Cm, n, o)
4. Categories containing deaths due to recreational activities, which
could be related to length of stay in the county, or place of
residence within the county (p, q, r, s)
5. Categories containing deaths likely to present difficulties in ob-
taining information from survivors due to their sensitive nature
(g, t, u, v, w, x)
All case and control subjects chosen were white, recorded as residents of
either Calaveras or Tuolumne Counties, and died in years 1969 through 1978.
23
-------
In summary, three case groups were selected which have been cited 1n the
occupational or general epldemiologic literature as suspected of being
asbestos related. We have selected specific concomitant cancer or heart
disease control groups and a general control group. Table 2.0-6 provides the
breakdown on the case and control group sizes.
The general control group included all categories except 1) those
which could possibly be associated with asbestos exposure, e.g. digestive and
respiratory diseases, 2) those likely to present difficulties 1n obtaining
information from surviviors, e.g., suicides, 3) those likely to be poorly age
matched with case groups, and 4) those heavily locale specific, e.g.,
drowning.
Table 2.0-7 illustrates the age and year of death breakdown of male
case group II*. Each case subject was then age and year of.death matched with
two controls- one from control group VI and one from the appropriate
designated analog control group which in this case is group IV.
After all case and control subjects were identified, each
Certificate of Death was located, reviewed, abstracted, coded and placed on
tape. Figure 2.0-3 shows the California Certificate of Death. Additional
information abstracted from the Certificate includes material vital to
assigning asbestos exposure, e.g. residence and length of stay 1n the county;
assisting in Identifying confounding exposures, e.g. last occupation; useful
in locating surviving kin; and verifying critical data such as the ICD number.
Residence information was recorded and also coded according to the
distance from high asbestos deposit areas. Coding of occupation was performed
and occupations classified into asbestos exposure potential as: definite,
probable, possible and probably no exposure. Subsequent analysis of these
data will focus on residence in the area so the primary measure of exposure
and will treat occupational category as a covariate which will be stratified
or adjusted for. It is readily acknowledged that death certificate listing of
occupation is a poor measure. These other such confounding factors such as
* Numbers disagree with those above since a slightly different analysis was
being performed which utilized somewhat different ICD categories.
24
-------
Table 2.0-7
Male Deaths from Malignant Neoplasms of Respiratory System (ICD 160-163),
by Year and Age at Death,
Calaveras and Tuolumne Counties
AGE
ro
1969
1970
1971
1972
1973
1974
1975
1976
1977
TOTAL
16
13
13,
14
21
25
22
19
1978
LT 10
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
•JO-54
55-59
60-64
65-69
70-74
75-79
80-84
CE 85
0
0
0
0
0
0
1
0
0
0
3
1
2
4
2 '
i
0
0
. ::,. 0 ;••;,.
0
0
0
0
1
I)
3
. .;.- . 2
I
2
1
0
0
0
o
' •:• --,.'• 1 •••• '• =
0
0
0
0
1
0
2
2
3
1
2
1 '
0
0
0
0
'•: <• 0 •••••
0
0
0
0
0
1
1
0
2
1
0
1
1
o
:0
0
0
o •
0
0
0
0
0
0
5
5
3
1
0
0 .
o
0
0
0
(J
0
0
0
1
2
2
5
3 ••
0
4
2
2'
o "
0
0
0
0
0
0
0
I
5
2
4
' 4
4
0
4
' 1
0
0
0
0
0
0
1
0
0
1
3
4
3
5
1
2
2.
0
0
o •• tv-
. 0
0
0
0 •
0
0
2
• •• -;--:. 3 ;:v'-
2
6
1
2
0
3
0
0
?'/'. 0
0
u
0
0
0
1
1
1
1
2
3
2
1
0
12
-------
smoking and drinking could be accounted for at some future time by means of
next-of-kin interviews if the proposed analyses identified specific case
groups with a significant elevated risk and there was sufficient
interest to minimize additional possible confounding factors.
Figure 2.0-4 shows (in photo-reduced size) the computer generated
form developed to record the abstracted information. For each subject
decedent, data from the death tapes are filled in when the form is generated.
These data are:
o Social security number
o Name
o Data of death
o Birthplace and birthdate
o Age at death
o Marital status
o Counties of death and of residence
o Cause of Death
o Whether or not an autopsy was performed
o The qualifications of the certifier.
The data recorded by our abstractors from the hard copy death
certificate were entered in the appropriate blanks. These are:
o Identification Number
o Father's name and birthplace
o Mother's name and birthplace
o Name of surviving spouse
o Last occupation and years worked
o Name and address of hospital
The format for the death certificate abstract corresponding to
Figure 2.0-4 is described in Appendix B. Coding for birthplace, occupational
classification, occupational asbestos exposure, city codes (for exposure
indices), and county codes are all provided in Appendix B.
27
-------
in tiiii a:it, 7? 7U /9 30
CARD NO 0 3 ID NO LAST OCC YRS COMPANY KIND
01 02 03 04 05 06 07 00 09 10 11 12
NAME AND ADDRESS (IF HOSPITAL
CO OF DEATH LENGTH OF STAY IN CO IN CA USUAL RES CITY CO
13 14 15 16 17 IB- 19 20 21 22
NAME OF INF ADDRESS
23 24 25 26 27 28 2V 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 S3 54 55 56 57 58 59
CITY STATE CAUSE OF DEATH CUUE . AUTOPSY CEKT1FIER
60 61 62 63 64 65 66' 67 68 69 70 71 72 73 74 Tit /&
PHYSICIAN/CORONER NAME. ADDRESS PHYSICIAN LICENSE NUMUER
IMMEDIATE CAUSE(A) DUE TO(B) DUE TO(C)
OTHER SIGNIFICANT CONDITIONS
AIR ASBESTOS X 10 WATER ASBESTOS
77 7Q 79 BO
Figure 2.0-4 Death Certificate Abstract
-------
2.0.4 Case and Control Matching System
The system for matching control records to case records was
established as follows:
o Controls were matched to cases of the same sex.
o Cases were categorized into 5 year age groups (<5, 5-9, 10-14,
15-19...,80-84, <85), and listed by year of death (1969 through
1978)
o For each case of given sex, 5 year age group, and year of death a
control was chosen randomly from among all controls of the same
sex, age group, and year of death. If there were no controls
with the same year of death (or if the number of cases
out-numbered the controls for a given year of death), a control
was sought from the year of death nearest the case. All controls
were chosen from the same age group as the case.
o An effort was made to choose unused controls for each successive
case group. But if all controls in a given age range and year
(e.g. digestive cancer), controls were used again for another
case group (e.g. lung cancer).
For the Reproductive Neoplasms control group, the pool of subjects
was so small (only 115 decedents), nearly all had to be used twice to provide
matches for the Digestive and Respiratory cancer case groups.
Among controls taken from the General Causes pool, approximately 12%
of the male controls and 9% of the female controls had to be used for matches
twice.
The Non-Hypertensive Heart Disease pool was large enough that no
controls had to be used twice.
2.0.5 Quality Assurance of Death Certificate Abstraction and Coding
As each death certificate was abstracted, the certificate was quickly
check for (1) internal consistency, and (2) consistency with the information
as coded by the California Office of Vital Statistics on the computerized
records. Because of time limitations, this check could not be exhaustive, but
nevertheless several errors were detected.
1. Errors in the State Vital Statistics Coding of Residence.
We discovered several instances where the county of residence coded
on the state death tape was incorrect. One type of error was to assign either
the Calaveras code or the Tuolumne code to the county of residence when the
29
-------
city of residence actually lies in a different county. This error occurred
fifteen times in our series.
Number City of Residence Actual County
3 Stockton San Joaquin
2 Coulterville Mariposa
1 Knight's Ferry Stanislaus
1 Oakdale Stanislaus
1 Berkeley Alameda
1 Oakland Alameda
1 Acampo San Joaquin
1 Linden San Joaquin
1 Sutter Creek Amador
1 Santa Clara Santa Clara
1 San Francisco San Francisco
Since only decedents who were residents of Calaveras or Tuolumne
Counties were to be used in this study, all of the aabove out of county
residents were deleted.
Another error we discovered was the assignment of the Calaveras
County code to five decedents who were actually residents of Tuolumne County.
Number City Residence
3 Sonora
1 Columbia
1 Tuolumne City
We corrected the county of residence codes for these decedents, and
kept them in the study.
We should not one feature of this miscoding in the state records.
The decendents in our series were selected from the state tapes on the basis
of their residence being coded as Calaveras or Tuolumne. However, any actual
residents of Calaveras or Tuolumne who were miscoded as residents of other
counties would not have been included. In view of the coding errors displayed
above, this last type of misclassification probably did occur, although there
were probably few of these since only 20 total errors were detected in roughly
1000 records.
30
-------
We also found one instance where a coded age at death differed from
the death certified age at death by one year, and so this correction was made.
2. Errors in Death Certificate Entries
There were only two errors detected on the death certificates
themselves. One was an incorrect year of birth (inconsistent with the year of
death), and the other was an inconsistency of the length of stay in the county
with the length of stay in California. These erros could not be corrected,
since we do not know what the actual entries should be.
3. Errors in Vital Statistics Coding of the Cause of Death
The information abstracted from the death certificate included the
complete causes of death as well as the "other significant conditions". We
checked the causes of death on the certificate against the Office of Vital
Statistics 4 digit ICD code on a 10% sample. In a few instances, the death
certificates themselves were vague, and so the given ICD codes were
necessarily somewhat arbitrary. But no incorrect ICD codes were found, so we
feel confident accepting the codes as given.
4. Errors in Coding the Abstracted Data
For quality control of our own effort--namely the coding of the death
certificate data we abstracted—we recoded a 10% systemtatic sample of the
certificates.
One hundred and two records were checked, and 14 coding errors were
found. Since each certificate contains 6 variables to be coded*, this
translates into a rate of 2 coding errors per 100 variables. This was judged
to be acceptable, and the records were sent to be keypunched.
* The birthplace of the decedent, the birthplaces of the parents, the
occupation, the likelihood of occupational exposure, and the city of
residence.
31
-------
2.1 Determination of Standardized Mortality Ratios (SMR's)
Standardized mortality ratios were calculated as part of this study
utilizing the California State mortality tapes. The purpose of this effort
was to examine if the total observed number of deaths in the counties for
particular categories of ICD codes were at variance with the expected numbers
based on State of California rates. It should be noted that the exact
residence of each individual within the counties was not factored Into the
analysis. Therefore the analysis does not bear directly upon the key study
question of whether Individuals living in the vicinity of serpentine deposits,
i.e. experiencing elevated ambient airborne asbestos concentrations, have
different mortality patterns. Rather it examines the gross Incidence across
the counties In comparison to the State of California. Since the counties are
relatively rural in comparison to the significant state population centers
many factors differ and remain uncontrolled in this analysis.
In order to compare the mortality of Calaveras and Tuolumne Counties
to the experience of the State of California as a whole it is necessary to
take Into account the potentially confounding effects of age, race, and sex
differences. We have calculated standardized mortality ratios (SMR's),
adjusting for age, for whites only, separately for males and females.
The causes of death to be examined were grouped Into six categories
as follows:
A. Three categories of death from causes possibly associated with
asbestos exposure:
-Malignant neoplasms of digestive organs and peritoneum
(ICD 150-159*)
-Malignant neoplasms of the respiratory system
(ICO 160-163)
-Hypertensive heart disease and hypertensive heart and renal
disease (ICD 402-404)
B. In addition, two comparison groups of deaths were looked at,
32
-------
composed of deaths from causes that have no reported association
with asbestos exposure:
-Malignant neoplasms of the breast (used for females only)
(ICD 174)
-Malignant neoplasms of the genital organs
(ICD 180-187)
C. Finally, we examined the total number of deaths from all causes.
The ICD codes included in these categories are broader than the ICD codes used
to delineate the case and control groups. These categories had to be. used
because the only published source of age, sex, and race specific numbers of
deaths for California is the United States Vital Statistics,** and the causes
of death were tabulated in these broader categories. Ischaemic heart disease
deaths (ICD 410 to 412) were not included in the SMR calculations because the
published deaths were not separated into hypertensive and nonhypertensive.
The SMR is a ratio of an observed number of deaths to an expected
number. The observed number of deaths for each cause is the sum of the deaths
for that cause in Calaveras and Tuolumne Counties for three years, 1969, 1970,
and 1971. The expected numbers of deaths for each cause were calculated by
multiplying cause-specific three-year California rates (for whites, for each
sex, and for each 5 year age group) by the corresponding 1970 subpopulation of
Calaveras and Tuolumne Counties. The three year California rates used in the
calculations were derived by summing the State deaths in 1969, 1970, 1971, and
dividing by the 1970 population given by the U.S. Census.
The expected number of deaths in each 5 year age group were then
summed over all ages to give the total number of expected deaths in Calaveras
and Tuolumne counties for the three years in question.
* International Classification of Disease, 8th Revision
* Table 7-6 "Deaths from 69 Selected Causes, By Age, Color, and Sex, Each
State"
33
-------
The 95% confidence limits of the SMR's were calculated as outlined
In Rothman and Boice (1979), assuming the occurrence of events to be Polsson
distributed. For observed numbers less than 30, the upper and lower limits
were found from the table in Remington and Schork (1970) (p. 394). For SMR's
with observed values greater than 30, Byar's approximation given in Rothman
and Boice (1979) was used.
For males, all SMR's were less than 1.00, I.e., there were fewer
observed deaths than expected, based upon the experience of white males in
California. Even the mortality from all causes was depressed (686 deaths
observed vs. 728 expected), Indicating that (adjusting for age) white males in
Calaveras and Tuolumne had a lower overall mortality than males in California
for the years 1969 through 1971. The category of death that mosts nearly
approached the expected figure was malignant neoplasms of the respiratory
system.
None of the male SMR's was statistically significant at the &-0.05
level, since all confidence limits span the null value, 1.00.
For females, the picture is somewhat different. The all causes
mortality was increased to 1.05 times the expected. Among the conditions
suggested to be related to asbestos exposure, the SMR's were elevated above
unity for cancers of the digestive system (SMR»1.07) and hypertensive heart
disase (SMR»1.75). However, the number of observed deaths for respiratory
cancer was less than expected (6 to 10.18).
Among the "dummy" conditions not known to be related to asbestos
exposure, the malignant neoplasms of the genital organs among women showed an
elevated SMR of 1.34. This result was unexpected. However, the recent study
by Kanarek et al (1980) of asbestos in drinking water and cancer incidence in
the San Francisco-Oakland area found an elevated number of deaths from
uterine cancer.
Although none of the female death ratios reached statistical
significance at the a=0.05 level, the hypertensive heart disease SMR (1.75)
had the largest excess of observed over expected.
One difficulty with a community study of an environmental exposure
such as this one is that an observed excess mortality might not be caused by
ambient environmental exposures, but by occupational exposures. Examining
34
-------
deaths among males and females separately is one way to check for this
possibility. If asbestos related mortality were higher among men than among
women, exposure in the workplace might be the cause. In our data, however,
males have lower mortality ratios than females for most causes, including
total mortality.
The lower than expected overall mortality for males deserves some
comment. In studies of males in an occupational setting, this observation
has been called the "healthy worker effect." Occupational groups tend to be
selected for the healthier, more vigorous individuals in the population.
Consequently, even when adjusting for age, the overall mortality of a specific
industrial group may be less than expected, if the expected mortality is based
on the experience of all males in the general population.
It may be that the occupational and recreational activities
prevalent in these two rural counties (where timber and mining are dominant
industries) exert a small selective pressure on males, which accounts for a
male population with a lower than expected mortality. The fact that the
observed mortality was not lowered for females indicates that an occupational
selection might be involved. On the other hand, it may indicate the presence
of a factor which puts females at a higher risk.
One method to "adjust" for a possible healthy worker effect in
occupational studies has been suggested by Tabershaw and Gaffey (1974) ,
Kupper et al(1978), and others. This involves the calculation of a "relative"
standardized mortality ratio (RSMR) by dividing the cause-specific SMR by the
all causes SMR. This results in a measure of risk that takes into account the
lower underlying mortality of the study popuation..
Since for males the all causes SMR was 0.94, the calculation of an
RSMR increases all of the observed to expected ratios. All cause spcific
RSMR's tend to be closer to 1 than the SMR's, except respiratory system
cancers, where the RSMR=1.04. However, this adjusted SMR is not
statistically significant.
One reason for the general lack of statistical significance in this
analysis is that many of these SMR's are based upon small numbers. These two
counties combined had a 1970 white population of only 17,000 males and 16,000
females. Consequently, the number of deaths accruing in just three years is
35
-------
not large. Our data set contains all deaths from 1969 through 1978. However,
we have elected to use only deaths from 1969 to 1971, spanning the censal
year, 1n order to use the 1970 census population as a denominator. The lack
of age, sex, and race specific population figures during the middle and late
part of the decade prevents us from making full use of our mortality
data.
In order to use all of the observed county deaths during the 1970's,
it would be necessary to get population estimates for these years. This would
be possible by using the forthcoming 1980 census data. Intercensal
populations can be estimated using the 1970 annd 1980 figures and estimation
procedures, such as those given by Shryock, Siegel, et al (1976).
Finally, we must discuss the choice of a comparison population. The
indirect standardization technique measures the experience.of the two
counties against the experience of the entire state of California. We have
restricted the analysis to whites, compared males and females separately, and
adjusted for differences in age distribution between the counties and the
state by standardization. But there may be other factors that confound the
mortality comparisons. The expected values were derived from the death rates
of the state of California as a whole. The state death rates Include deaths
from urban areas such as Los Angeles and San Francisco. These urban areas may
have increased cancer mortality over rural areas by virtue of greater air
polluation, pollution of drinking water, occupational exposures, and smoking
levels in the population. In short, asbestos related mortality in Calaveras
and Tuolumne Counties may have been masked by comparing these counties to the
state population, which is composed of subpopulations exposed to several other
environmental insults that can produce the same effects.
A better comparison would be to use rural California counties near
Calaveras and Tuolumne, with similar population densities and industries, but
without serpentine deposits. This is not possible at this point in our study,
however. Such a comparison would require mortality data from the comparison
counties that are age, sex, race and cause specific. Data this detailed are
not available from the published California vital statistics. We would have
to identify selected comparison counties and access Calfornia death tapes the
same way the Calaveras and Tuolumne data were acquired.
36
-------
Table 2.1-1 and 2.1-2 present the SMR results for males and females
respectively. Appendix C provides the age specific mortality data for
Calaveras and Tuolumne counties from which the three year study interval,
1969-1971 was taken.
37
-------
Table 2.1-1
STANDARDIZED MORTALITY RATIOS - MALES
Observed deaths reflect Calayeras and Tuolumne County experience (1969-71)
Expected deaths are Based upon rates for California 0969-71)
Malignant Neoplasms
of Digestive Organs
and Peritoneum
(ICD 150-159)
Observed
Deaths
33
Expected
Deaths
36.53
SMR
(0/E]
0.90
SMR 95%
Conf. Limits
(0.62, 1.27)
Malignant Neoplasms
of Respiratory System
(ICD'160-163)
42
42.98
0.98
(0.70, 1.32)
Hypertensive Heart
and Renal Disease
(ICD 402,404)
3.06
0.33
(0.01, 1.82)
Malignant Neoplasms
of the Genital Organs
(ICD 180-187)
11
13.12
0.84
(0.42, 1.50)
Mortality from
All Causes
683
723.03
0.94
(0.87; 1.02)
38
-------
Table 2.1-2
STANDARDIZED MORTALITY RATIOS - FEMALES
Malignant Neoplasms
of Digestive Organs
and Peritoneum
(ICD 150-159)
Observed
Deaths
27
Expected
Deaths
25.32
SMR
(0/E)
1.07
SMR 95%
Conf. Limits
(0.70, 1.55)
Malignant Neoplasms
of Respiratory System
(ICD 160-163)
10.18
0.59
(0.22, 1.28)
Hypertensive Heart and
Renal Disease
(ICD 402, 404)
3.42
1.75
(0.64, 3.82)
Malignant Neoplasms
of the-Breast
(ICD 174)
13
18.18
0.72
(0.38, 1.22)
Malignant Neoplasms
of the Genital Organs
(ICD 180-187)
18
13.43
1.34
(0.79, 2.12)
Mortality from
All Causes
488
464.04
1.05
(0.96, 1.15)
39
-------
REFERENCES
Acquavella, J., Wilkinson, G., et al. (1979) "Pilot study of cancer and
cardiovascular disease mortality in asbestos mining counties." Paper
presented at the 107th annual meeting of the American Public Health
Association, Nov. 4th, 1979, New York, New York.
California Department of Public Health, (1967), Industrial Health Study Wells
Cargo, Inc., Pacific Asbestos Corporation Mine Copperopolls, California, A.E.
Lowe, California Department of Public Health, Study 2963, August 1967.
Environmental Protection Agency (1980) support document for Proposed Rule on
Friable Asbestos • Containing Material in School Buildings. EPA
560/12-80-003.
Flelss, J.L. (1973) "Statistical Methods for Rates and Proportions." J. Wiley
and Soncs, New York.
Graham, S., Blanchet, M., Rohrer, T. (1977) Cancer in Asbestos Mining and
Other AReas of Quebec. JNCI 59, 1139-1145.
Kanarek, M.S., Connforti, P.M., Jackson, L.A., Cooper, R.C., and Murchio,
J.C., (1980) Asbestos in drinking water and cancer incidence in the San
Francisco Bay area. American Journ. Epidemiol. 112(1): 54-72.
Kleinfield, M., Messite, J., Kooyman, 0. (1967) Mortality Experience in a
Group of Asbestos Workers. Archives of Environmental Health 15, 177-180.
Kupper, L.L., McMichael, A.J., Symons, M.J., and Most, B.M., (1978) On the
Utility of Proportionate Mortality Analysis. Journ. Chron. Diseases 31:15-22.
Mancuso, T., Al-Attar, (1967) A Mortality Pattern in a Cohort of Asbestos
Workers. Journal of Occupational Medicine 9, 4, 147-162.
McDonald, J., McDonald, A., G1bbs, G. (1971) Mortality in the Chrysotile
Asbestos Mines and Mills of Quebec. Archives of Environmental Health 22,
667-686.
McDonald J., Becklake, M., Gibbs, G., et al. (1974) The Health of Chrysotile
Mine and Mill Workers of Quebec. Archives of Environmental Health 28, 61-68.
Miler, A. Asbestos Fiber Dust and Gastrointestinal Malignancies Review of the
Literature with Regard to a Cause/Effect Relationship. (1978) J. Chronic D1s.
31, 23-33.
National Center for Health Statistics, "Vital Statistics of the United
States." Vol. II Mortality, Part B, 1969, 1970, 1971.
Remington, R.D., and Schork, M.A., (1970) "Epidemiologic Analysts with a
Programmable Calculator." National Institutes of Health Publication No.
79-1649, Washington.
40
-------
Rothman, K.J., and Boice, J.D. (1979) "Epidemlologic Analysis with a
Programmable Calculator" National Institutes of Health Publication No.
79-1649, Washington.
Tabershaw, R., and Gaffey, W.R., (1974) Mortality STudy of Workers in the
Manufacture of Vinyl Chloride and its Polymers. Journ. Occupat. Med.
16:509-18, 1974.
U.S. Public Health Service, 1966. An Environmental Survey of Asbestos Mining
and Milling in California, Principal Authors, J.R. l^nch and O.L. Johnson,
U.S. Department of Health, Education, and Welfare, Public Health Service,
Division of Occupational Health, Report SR-17, December.
Ziskind, R.A., D.F. Smith, J.L. Hahn and 6. Spivey, (1980), Determinants of
Cancer and Cardiovascular Disease Mortality in Asbestos Mining Counties of
California, SAI Report 068-81-514 1 May.
41
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Appendix A
Description of Electron Microscopy
A-l Description of Whatman #41 Cellulose Filters
The filters shipped to Science Applications, for analysis by Scanning
Electron Microscope were contained individually in glassine negative
storage envelopes and appeared to be in good condition. Some filters
appeared to have lost some material or were unevenly dispersed. These
filters were excluded from the analysis.
The filter dimensions were 8" x 10" with an effective filter surface
of 7" x 9" or 63in2 (406.5 cm2).
A-l
-------
A-2 Laboratory Procedures for Asbestos Measurement of Air Samples Collected
Collected on High Volume Whatman 41 Cellulose Filters
i
Cleaning of glassware and utensils
All utensils and glassware are cleaned in a sonic bath (Bransonic model
220) using 2 rinses of Milli-Q water (.2 ym filtered) and a final sonicated
rinse of reagent grade acetone. After cleaning, the glassware and utensils
are stored in sealed plastic bags. All water is prescreened using, the Scanning
Electron Microscope to avoid any asbestos contamination.
Procedure for ashing the filter samples:
Sections of filters no greater than 2" x 2" (1" x 2" is optimum) are excised
from the original 8" x 10" Whatman 41 high volume filter using precleaned
scissors and transferred into engraved precleaned glass vials (70 mm x 30 mm).
For almost all samples a 1" x 2" sample is excised. Each filter is placed in
the vial with the top surface of the filter against the inner surface of the
g'lass vial.
No more than 2 sample vials are ashed at the same time. The vials are
placed into the Low Temperature Asher (International Plasma Corp. Model PM 104C)
side by side and lying down with the top of the vial facing the door of the
ashing chamber. This will minimize any effect of sample cross-contamination.
After the samples are placed in the Low Temperature Asher, the power is turned on
and the chamber is placed in the slow evacuation mode. In approximately 5 minutes
the vacuum will reach 1 torr; at this time the chamber is switched into the fast
vacuum mode and will pump down to less than .1 torr in a matter of minutes. At
this point, the RF generator and oxygen flow are turned on and the ashing of the
filter begins.
The filters are ashed for 4 hours at a vacuum of 1 torr, oxygen meter
flow of 200, and an RF forward power of 20 watts. The reflecting power is
kept below 1 watt by the fine tuning on the instrument console. Once ashing
A-2
-------
is complete the RF power and oxygen are turned off and the vacuum value on
the instrument is turned to the off position. The purge for the sample chamber
is opened to allow the chamber to return to atmospheric pressure over a period
of 30 minutes (any shorter time could result in sample loss or contamination).
Before the samples are removed from the chamber, the power to the entire instru-
ment must be turned off to avoid turbulence caused by the instrument cooling
fans. The samples are removed carefully and capped.
Sample dilution procedures:
All filter handling and filtration were performed in a laminar flow bench
with a particle concentration at >_.5ym of less than 100 particles/cu. ft. A
Climet Model 208 particle counter was used to monitor particle levels.
The capped samples containing the ashed filter are transferred to the
laminar flow bench and the initial dilution is performed with the air fan
turned off so that the dry ashed sample is not blown out of the vial during
the first addition of aerosol O.T. dispersant. Exactly 20 ml. of .2ym
millipore filtered .1% Aerosol O.T. is carefully pipetted into the sample
vial. The vial is capped, shaken gently and then placed in a ultrasonic bath
(Bransonic Model 220) for 5 minutes. The sample is removed from the sonic
bath and exactly 2.00 ml of the solution is withdrawn 1 cm from the bottom of
the vial and transferred to a clean plastic 15 ml. test tube with a screw top
cap. Approximately 5 ml. of .2ym filtered deionized water is added to the
test tube and gently shaken for approximately 1 minute before pouring into
the filter assembly.
The 25 mm filter assembly (Nuclepore stock #410200) is made of borosilicate
glass with a sintered glass support and has a funnel volume of 20 ml. and an
o
effective filtered area of 2.14 cm .
The asbestos samples are collected on a .2pm pore size nuclepore filter which
is backed by a .45ym pore size millipore filter which aids in a more even
dispersal of particles.
-------
The sample contained in the plastic test tube is poured into the filter
assembly after 1 ml. of deionized water has been filtered through the funnel
to saturate the filter media. The test tube and cap are rinsed twice with
5 ml of deionized water into the filter funnel and a light vacuum is applied
to the filter to allow complete filtration within 30 seconds. When the
sample solution approaches approx. 1 cm in depth, the walls of the filter
funnel are carefully rinsed with 2-3 ml of filtered deionized water and allowed
to totally filter. 15 seconds after the sample solution has finished filtering
the pump is turned off and the filter is allowed to air dry for 30 minutes
before removal from the funnel assembly. The sample filter and the backing
filter are removed together with clean polyethylene forceps and transferred
to a clean plastic petri dish with a depth no less than 1 cm and taped in
place. The filter is ready for sectioning for the Scanning Electron Microscope
or the Transmission Electron Microscope analysis.
FILTER PREPARATION FOR THE SCANNING ELECTRON MICROSCOPE
Using a clean razor blade, excise a portion of the taped filter section
from the filter by pressing evenly downward on the filter and backing filter
(it is not advisable to pull the blade across the filter as this may result in
particle loss and filter distortion). Carefully remove the cut section and
transfer to a clean sheet of 2" x 2" leucite or plexiglass (keeping the backing
filter in place aids in transferring the filter section without warping). The
backing filter is removed by carefully sliding the nuclepore sample filter
laternally off the backing filter using a sharp needle. 4 mm x 4 mm sections are
cut using a new razor and pressing with a downward motion only. The softness
of leucite or plexiglass provides for a very even undisturbed cut. The razor
blade and the 2" x 2" plastic are discarded after each filter is cut. The
filter sections are transferred to aluminum specimen mounts backed with #465
scotch transfer tape and only the edges of the filter are gently pressed down
and evened out using a sharp needle.
The samples are coated with gold using an ISI P-SI Sputter Coater Set
at 40 ma, 2.5 kV, a vacuum of .1 torr, and coated for 2.5 minutes.
A-4
-------
FILTER PREPARATION FOR THE SCANNING TRANSMISSION ELECTRON MICROSCOPE
The filters sections remaining in the petri dishes after SEM sample
preparation are transferred to a vacuum evaporator and coated with 40 to 50 mm
of carbon in bursts on the order of 5 seconds to avoid polymerization of the
nuclepore filter.
3 mm x 3 mm sections are excised from the filter pad as described in the
SEM filter preparation procedure and placed carbon side down over a carbon
stabilized formvar coated copper grid (200-300 mesh).
The copper grids to be extracted by the Jaffe wick method (EPA 600/2-77-178)
are placed on top of a section of Whatman #42 ash!ess filter paper that is over
a square of polyethylene foam that has been triple washed and ultrasonicated in
acetone. The entire extraction arrangement is contained in a precleaned
100 mm x 15 mm precleaned glass petri dish. Four grids for each sample are pre-
pared in the following manner. Approximately 10 yfc of reagent grade chloroform
is pipetted onto each 3 mm x 3 mm filter section using a syringe and the petri
dish is carefully filled with chloroform to a level approaching the top of the
foam support. The petri dishes are covered and placed inside a bell jar to
maintain a high chloroform atmosphere and reduce evaporation. Each filter
grid is allowed 48 hours for dissolution of the nuclepore filter. The grids
are then transferred to a clean covered petri dish to dry before analysis by
the Transmission Electron Microscope.
FILTER ANALYSIS BY SCANNING ELECTRON MICROSCOPY
The total counts of two separate filter areas of each sample are analyzed
at a magnification of 10,OOOX in the slow scan rate mode with a beam current of
15 kV. The resolution of the ISI Super III-A Scanning Electron Microscope is
checked prior to each sample analysis using an asbestos standard sample con-
taining many fibrils with diameters of .02 to ,03ym. Actual sample analysis
proceed only when fibrils of .03ym in diameter can be clearly resolved using
the slow scan rate at a magnification of 20.000X.
A-5
-------
Each sample filter section (two for each sample) is analyzed for a minimum
total of 50 fields or 50 fibers (100 total) and the results are combined and
totaled in the computer analys.is. Chrysotile asbestos fibers are confirmed by
morphology and the presence of magnesium and silicon using a Kevex 5100c
dispersive X-ray system.
Fiber analysis for the purpose of this survey were placed into four
categories; chrysotile, amphibole, ambiguous, and non-asbestos. Confirmation
for chrysotile required both morphology and X-ray identification. Very small
fibers (<.l urn diameter) which do not readily yield strong X-ray peaks were
confirmed when their fiber diameters and length were very well defined or when
they were found in the same field as another larger fiber confirmed to be
Chrysotile by both morphology and X-ray spectra.
Amphiboles when present were confirmed by morphology and X-ray spectra.
X-ray spectra typical of an amphibole must be well defined otherwise the particle
will be listed as ambiguous.
The ambiguous classification contains all the fibers which have a
questionable morphology or an ambiguous X-ray spectrum. The most common example
in this category is a fiber which exhibits a silicon peak but no magnesium peak.
The non asbestos fiber category includes all fibers defined as having an
aspect ratio of 3:1 but not having an asbestiform morphology. The second criterion
includes all fibers greater than .1pm in diameter that exhibit no X-ray spectrum
or no silicon peak.
3 3
The final reporting of data includes fibers/meter , mass/meter (nanograms)
3 2
and surface area/meter (ym ) expressed as total fibers, fibers <5ym, and fibers
>5pm.
A-6
-------
It is very important to emphasize the instrument parameters used in
the analysis.
The accelerating voltage on the SEM was set at 15 kV for a number of
reasons. Beam penetration at a higher kV range is much greater and decrease
the ability to resolve individual fibers with diameters below .1 m. 15 kV is
also the optimum energy range for X-ray analysis. The peak to background
ratio for Magnesium Aluminum and Silcon is much higher at 15 kV than 20 kV or
25 KV also due to beam penetration (less area below the fiber is being
excited). The working distance of the SEM was calibrated and maintained at a
working distance of 8 mm and a stage tilt of 15°. This provided for maximum
resolution without compromising X-ray yield. The samples were prepared on
.2 m pore size Nuclepore filters (particles on the shiny side) primarily
because of their smooth background as compared to .1 m pore size or even the
.45 m pore size filters.
-------
A-3 Microscopy Facilities
SAI's electron microscopy lab contains a scanning electron micro-
scope equipped with a dispersive X-ray spectrometer and a dedicated micro-
computer for rapid and tailored data reduction of particle field counts, parti-
cle density and size distributions, and elemental abundances. The microscope
is equipped with both a high angle back-scatter detector for atomic number
contrast and a low angle back scatter detector for high resolution surface
detail.
Adjacent to the SEM laboratory is a trace particle clean room
which has been tailored for the handling and preparation of ambient air
samples for asbestos and trace metals (see Figure A-l). The room is equip-
ped with a HEPA filtered air system producing a variable laminar flow inside
the room as well as a positive pressure throughout both the main lab and the
anteroom. This eliminates any possible outside contamination for trace metal
or asbestos samples. In addition to the ceiling HEPA filter system, the room
is equipped with a laminar flow bench.
Through a formal agreement with Scripps Institution of Oceano-
graphy, SAI utilizes the scanning transmission electron miscroscope facility
located less than 2 miles away. This instrument is an Hitachi Model H-500
with a magnification range of 500,000x and a resolution of 1.4 A°, and is
equipped with both Selected Area Electron Diffraction and computerized dis-
persive X-ray capabilities.
Instrumentation
SAI:
Model ISI Super IIIA Scanning Electron Microscope 70A° resolution
magnification range 12-200,OOOx
A-8
-------
scale 1" » 4'
1. Semi-clean transfer room
(positive pressure to the
outside exit).
2. Ceiling Hepa filter.
3. Floor exhaust with dampered
control for variation in laminar
flow over bench #4 and the posi-
tive pressure of the room.
4. Clean work tabU.
5. Bench for Oaffe-Wick prepara-
tion of filters.
6. Vented clean box for chloroform
extraction of filters.
7. Laminar flow bench for filter
sectioning and filtration.
8.. Polyethylene sink.
9. Particle tac mat.
FIGURE A-l TRACE PARTICULATE CLEAN ROOM.
A-S
-------
7-4
Standard secondary electron detector
High backscatter detector for atomic number contrast
Low angle backscatter detector (low loss) for high resolution
surface imaging and elevation measurement with a resolution
of 500A°. (Detector is used for measuring particle volume
and photographing biological and low atomic number surfaces.)
PS-I Sputter Coater
AuPd and Au target
Kevex 5100 c Dispersive X-ray System
2
30mm detector area
1.49 ev/channel resolution
Motorola 6800 Computer System with dual floppy disc
Scripps Institute of Oceanography:
Model Hitachi H-500 Scanning Transmission Electron. Microscope
Transmission Mode - resolution 1.4A°, magnification range to
500,000x equipped for Selected Area Electron Diffraction
Scanning Mode - resolution of 30A°; magnification range of 1000-
300,000 equipped with a Model 6230 Ortec dispersive X-ray system
which includes the computer and dual floppy disc.
Denton Carbon Evaporator
A-10
-------
A-4 Results & Conclusions
Viewing the concentration summaries for Sonora and Mariposa sites
(Table 2.0 - 1) reveals a minimum of at least one order of magnitude
differental in concentration for fibers/m3, mass/m3, and surface area/m3
in contrast to other sites assumed to be very low in concentration (Van 201 ELD,
Van 401 ELD, Camino).
Depending upon which parameter is viewed, large differentials can occur in
concentration when comparing two samples. For example, comparison of Sonora
sample 12-30-73 (SAI #81-1094) with Camino sample 04-10-73 (SAI #81-1231)
yields the following conentration effects:
Chrysotile
Total fibers/m3 Total mass/m3 Total surface area/m3
81-1094 Sonora
81-1231 Camino
291
7.5
24200
0.4
5450
4.5
Ratio: Sonora 39 60500 1200
Cami no
The fiber concentration in Sonora (81-1094) is 39 times higher, the mass
concentration is 60500 times higher and the surface area is 5450 times higher
This wide variation in concentration data should be considered carefully when
relating to any epidemiological data.
The usual reporting of data includes fiber and mass concentration without
reporting surface area. Theoretically mass and surface area do not differ in
ratio only when the size distribution of the asbestos population does not change.
A-ll
-------
In the real world situation the size distribution changes greatly in
chrysotile source rock areas with changes in meteorologic conditions. The
percent of chrysotile fibers >5ym in the Sonora County samples varied from
\
1 to 19 percent (Table A-l) This variation in the size distribution is
responsible for poor correlation between fibers/m3 and mass/m3.
In actuality, the correlation between fibers/m3 and surface area/m3
i
is a much better correlation (Table A-2). the correlation of all parameters
<5ym is fairly consistent with the correlation between fibers/m3 and surface
area/m3 (.98) being extremely good. Above 5ym none of the parameters correlate
and it is important to note how poor the correlation is between fibers/m3 and
mass/m3. It is recommended that some further investigation of surface area/m3
as an included parameter in the reporting of asbestos data be considered.
A-12
-------
TABLE A-l
Sample Variation in the Percentage
of "Occupational" Chrysotile Fibers
(<5pm) in Eleven Sonora County Samples
\l Sample #
81-1101
81-1097
81-1116
81-1094
81-1120
81-1099
81-1121
81-1118
81-1102
81-1106
81-1110
Collection
Date
08-08-73
10-25-73
09-20-74
12-30-72
06-28-74
09-25-73
04-05-74
07-22-74
07-15-73
05-24-73
03-23-73
%Chrysotile
fibers ^Sym
86
71
74
49
39
56
79
61
57
82
54
%Chrysotile
fibers >5ym
12
7
1
9
3
5
9
4
11
6
9
%Ratio of Chrysotile
fibers >5utn
14%
10%
1%
18%
8%
9%
11%
6%
19%
7%
17%
-------
TABLE A-2 ,
Correlation of Fibers/m3, mass/m3
and Surface Area/m3 for Sonora sites
Coefficient of Correlation
Compared parameters
Fibers/m3 (excluding 81-1094)
mass(ng)/m3
mass(ng)/m3 (excluding 81-1094)
surface area (vim2)/m3
Fibers/m3 (excluding 81-1094)
surface area ym2/m3
<5ym
.70
.83
.98
>5ym
-.13
.30
.59
total distribution
-.002
.22
.96
A-14
-------
Appendix B
DEATH CERTIFICATE ABSTRACT FORMAT
Variable Column Field
Number Location Type Description
1 01-02 F2.0 Card Number, 01
2 03-06 F4.0 Identification Number
3 07-15 F9.0 Social Security Number:999-99-9999-blan
4 16-45 7A4.A2 Decedent (Last, First, Middle)
5 46-47 F2.0 Date of Death, Year (last two digits)
6 48-49 F2.0 Date of Death, Month
7 50-51 F2.0 Date of Death, Day
8 52 Fl.O Sex: 1-Ma.le , 2-Female
9 53-54 F2.0 Birthplace (see State and Country Codes
10 55-57 F3.0 Date of Birth, Year (last three digits)
11 58-59 F2.0 Date of Birth, Month
12 60-61 F2.0 Date of Birth, Day
13 62 Fl.O Age Code: 0-100 years or over,1-years
14 63-64 F2.0 Age, years
B-l
-------
DEATH CERTIFICATE ABSTRACT
Variable
Number
15
16
17
18
19
20
21
Column
Location
01-02
03-06
07-26
27-28
29-48
49-50
51
22
52-80
Field
Type Description
F2.0 Card Number, 02
F4.0 Identification Number
5A4 Father's Name (First, Middle, Last if
different from decedent)
F2.0 Father's Birthplace (see State and
Country Codes)
5A4 Mother's Maiden Name (First, Middle, Las
F2.0 Mother's Birthplace (see State and
Country Codes)
Fl.O Marital Status: 1-Married; 2-Single,
Never Married; 4-Divorced; 5-Widowed;
9-Unknown/Not Stated
7A4,A1 Name of Surviving Spouse(First, Middle,
Last)
B-2
-------
DEATH CERTIFICATE ABSTRACT
Variable Column Field
Number Location Type Description
23 01-02 F2.0 Card Number, 03
24 03-04 F4.0 Identification Number
25 07-09 F3.0 Last Occupation (see Occupational Codes):
999-blank
26 10-11 F2.0 Number of Years in Last Occupation:
99-blank
27 12 Fl.O Kind of Occupation: 1-Definite Asbestos
Exposure; 2-Probable Exposure;
3-Possible Exposure;4-Probably No Exposure;
9-No Occupation (see exposure codes)
28 13-14 F2.0 County of Death (see County Codes)
29 15-16 F2.0 Length of Stay in County, years: 99-blank
30 17-18 F2.0 Length of Stay in California, years: 99-blank
31 19-20 F2.0 Usual Residence, City (see City Codes)
32 21-22 F2.0 Usual Residence, County (see County Codes)
33 23-40 4A4.A2 Name of Informant (First, Last, Middle)
34 41-59 4A4,A3 Address of Informant
35 60-68 2A4.A1 City of Informant
36 69-70 A2 State of Informant
37 71-74 F4.1 Cause of Death, ICD 8th Revision Code
38 75 Fl.O Autopsy: 1-No Autopsy; 2-Autopsy, results
used; 3-Autopsy, results not used;
4-Autopsy, unknown if results used;
5-Unknown if an autopsy
39 76 Fl.O Certifier: 1-Coroner; 2-M.D. or D.O.;
3-D.C.; 4-Unknown before 1975, Military
after 1975; 5-Unknown
B-3
-------
BIRTHPLACE
STATE CODES
01 - Alabama
02 - Alaska
03 - Arizona
04 - Arkansas
05 - California
06 - Colorado
07 - Connecticut
08 - Delaware
09 - District of Columbia
10 - Florida
11 - Georgia
12 - Hawaii
13 - Idaho
14 - Illinois
15 - Indiana
16 - Iowa
17 - Kansas
18 - Kentucky
19 - Louisiana
20 - Maine
21 - Maryland
22 - Massachusetts
23 - Michigan
24 - Minnesota
25 - Mississippi
26 - Missouri
27 - Montana
28 - Nebraska
29 - Nevada
30 - New Hampshire
31 - New Jersey
32 - New Mexico
33 - New York
34 - North Carolina
35 - North Dakota
36 - Ohio
37 - Oklahoma
38 - Oregon
39 - Pennsylvania
40 - Rhode Island
41 - South Carolina
42 - South Dakota
43 - Tennessee
44 - Texas
45 - Utah
46 - Vermont
47 - Virginia
48 - Washington
49 - West Virginia
50 - Wisconsin
51 - Wyoming
52 - Virgin Island
54 - Outlying Possessions
55 - United States, Place Unknown
B-4
-------
BIRTHPLACE
FOREIGN COUNTRY CODES
56 - Asia (inc. India, Israel, Korea, Lebanon, Pakistan
other Asia)
57 - Austria
58 - Belgium
59 - Central America (inc. British Honduras, Costa Rica, El Salvedor,
Guatemala, Honduras, Nicaragua, Panama)
60 - Canada
61 - China
62 - Czechoslavakia
63 - Denmark
64 - Eire (inc. Ireland, Northern Ireland)
65 - England
66 - Finland
67 - France
68 - Germany
69 - Greece
70 - Hungary
71 - Italy
72 - Japan
73 - Mexico
74 - Netherlands
75 - Philippine Islands
76 - Poland
77 - Portugal
78 - Rumania
79 - South America (.inc.Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador,
Paraguay, Peru, Uraguay, Venequela, other South American)
80 - Scotland
81 - Spain
82 - Norway, Sweden
83 - Switzerland
84 - USSR (inc. Russia, Ukrania)
85 - Wales
86 - West Indies (inc. Cuba, Dominican Republic, Haiti, Jamaica, West Indies
Federated, other West Indies)
B-5
-------
Page 2
Birthplace
FOREIGN COUNTRY CODES
87 - Yugoslavia
88 - All others (inc. Africa, Australia, Azores Islands, New Zealand,
other Pacific Islands
89 - Unknown Nativity
B-6
-------
OCCUPATIONAL CLASSIFICATION SYSTEM
Occupation Code:
Professional\ Technical, and
Kindred Workers
Occupations Code:
Professional, Technical, and
Kindred Workers - continued
001 Accountants 063
002 Architects 064
Computer specialists 065
003 Computer programmers 071
004 - Computer systems analysts 072
005 Computer specialists, n.e.c. 073
Engineer
006 Aeronautical § astroriautical eng. 074
007 Eng. not specified (4 yrs. college) 075
010 " Chemical engineers 076
Oil • Civil Engineers •
012 Electrical § electronic engineers 080
013 Industrial engineers (incl: gas
plant engineers) 081
014 Mechanical engineers 082
015 Metallurgical 3 materials eng.
020 Mining engineers 083
021 Petroleum engineers .
022 Sales engineers 084
023 Engineers, n.e.c 085
024 Farm Eanagement ' advisors
025 Foresters and conservationists
026 Home management advisors 086
Lawyers and judges 090
030 Judges
031 Lawyers . 091
Librarians, archivists, and curators 092
032 Librarians . 093
033 Archivists and curators . 094
X Mathematical specialists 095
034 Actuaries _ 096
035 Mathematicians
036 Statisticians 100
Life and physical scientists
042 Agricultural scientists 101
045 Atmospheric and space scientists
044 Biological scientists 102
045 Chemists 103
051 Geologists
052 Marine scientists 104
053 'Physicists and astronomers 105
054 Life and physical scientists, nee 110
055 Operations 6 systems researchers 111
and analysts 112
056 Personnel § labor relations workers 113
Physicians, dentists, 5 related 114
Practitioners . 115
061
062
Chiropractors
Dentists
116
120
Optometrists
Pharmacists
Physicians, medical and osteopathii
Podiatrists
Veterinarians
Health Practitioners, n.e.c.
Nurses, dieticians, ft therapists
Dieticians
Registered nurses
Therapists
Health technologists $ technicians
Clinical laboratory technologists
. technicians
Dental hygienists
Health record technologists $
technicians
Radiological technologists £
technicians, n.e.c.
Therapy assistants
Health technologists $ technicians
n.e.c.
Religious workers.
Clergymen
Religious workers, n.e.c.
Social Scientists
Economists
Political scientists
Psychologists
Sociologists
Urban $ regional planners
Social Scientists, n.e.c.
Social § recreation workers
Social workers (incl. juvenile
counseling)
Recreation workers
Teachers, college § university
Agriculture teachers
Atmospheric, earth, marine 5 spac
teachers
Biology teachers
Chemistry teachers
Physics teachers
Engineering teachers
Mathematics teachers
Health specialities teachers
Psychology teachers
Business 5 commerce teachers
Ecomonics teachers
History teachers
B-7
-------
Occupation Code:
Professional, Technical, and
Kindred Workers - continued .
121 Sociology teachers 191
122 Social science teachers, n.e.c. . 192
123 Art, drama, § music teachers .
124 Coaches 5 physical ed. teachers 193
125 Education teachers 194
126 English teachers
130 Foreign language teachers 195
131 Home economics teachers
132 Law teachers
133 Theology teachers
134 Trade, industrial § technical
135 Miscellaneous teachers, college § 201
university
140 Teachers, college § university, 202
subject not specified (incl. grad. 203
assistant) 205
Teachers, except college § university 210
141 Adult education teachers 211
142 Elementary school teachers 212
143 Prekindergarten teachers . 213
144 Secondary school teachers
145 Teachers, except college § univer- 215
sity, n.e.c.
146 Teachers, not specified 220
Engineering and science technicians 221
150 Agriculture § biological tech- 222
nicians, except health
151 Chemical technicians . 223
152 Draftsmen 224
153 Electrical § electronic engineering 225
technicians 226
154 Industrial engineering technicians 230
155 Mechanical engineering technicians 231
156 Mathematical technicians
161 Surveyors 233
162 . Engineering 5 science technicians, 235
•N n.e.c. (includes trainee) 240
Technicians, except health § engineer-
ing § science 245
163 Airplane pilots
164 Air traffic controllers 246
163 Embalmers .
1/0 •' Flight engineers
171 Radio operators
172 Tool programmers.numerical control 260
173 Technicians, n.e.c. 261
174 Vocational § educational counselors 262
Writers, artists, fi entertainers 264
175 Actors 265
180 Athletes 5 kindred workers
181 Authors 270
182 Dancers 271
133 Designers 280
184 Editors 6 reporters
185 Musicians § composers 281
190 Painters 5 sculptors
Photographers
Public relations men § publicity
writers '
Radio § television announcers
Writers, artists, § entertainers,
n.e.c.
Research workers, not specified
(incl. research director) .;•..
Management and Administrators, Except Farm
Assessors, controllers § treasurers;
local public administration
Bank officers § financial managers
Buyers § shippers, farm products
Buyers, wholesale § retail trade
Credit men
Funeral directors
.Health administrators
Construction inspectors, public
administration
Inspectors, except construction,
public administration
Office managers, n.e.c.
Officers, pilots § pursers; ship
Officials | administrators; public
administration, n.e.c. i
Officials of lodges, societies s—\
Postmasters § mail superintends,
Purchasing agents § buyers, n.e.c.
Railroad conductors
Restaurant, cafeteria § bar manager
Sales managers § department heads,
retail trade .
Sales managers, except retail trade
School administrators, college
School administrators, elementary 5
secondary
Managers § administrators, n.e.c. (
film producer, self employed)
Management trainee . ..
Sales Workers
Advertising agents § salesmen
Auctioneers
Demonstrators
Hucksters § peddlers
Insurance agents, brokers 6 under-
' writers (incl. insurance coordina-
Real Estate agents § brokers
Stock § bond salesmen
Salesmen § sales clerks, n.e.c. (i:
medical distributer, drugstor^.!
Sales associate
B-Q
-------
Clerical and Kindred Workers
301 Bank tellers (incl. banking,proofer) 384
302 Budgetary control 385
303 Billing clerks 390
305 Bookeepers (incl. accounting, auditing
clerk) 391
310 Cashiers . : 392
311 Clerical assistants, social welfare 394
312 Clerical supervisors, n.e.c. (incl.
det. head - office work, office 395
manager)
313 Collectors, bill 5 account 396
314 Counter clerks, except food .
315 Dispatcher § starters, vehicle
320 ' Enumerators $ interviewers
321 'Estimators § investigators, n.e.c. 401
(incl. costomer's representative) 402
323 Expediters § production controllers 403
325 File clerks (incl. filers, book 404
store sorting) 405
330 Library attendants § assistants 410
(incl. library clerk) 411
331 Mail carriers, post office 412
332 Mail handlers, except post office
. (incl. mail clerk) •. • ' 413
333 Messengers & office boys 415
334 Meter readers, utilities . 416
Office machine operators 420
341 Bookeeping $ billing machine oper- 421
ators - 422
342 . Calculating machine operators 423
343 Computer § peripheral equipment
operators . . 424
344 Duplicating machine operators 425
345 Key punch operators . 426
35P Tabulating machine operators 430
355 Office machine operators, n.e.c. 431
360 Payroll 5 timekeeping clerks 433
361 Postal clerks (incl. postal service) 434
362 Proofreaders .435
363 Real estate appraisers 436
364 Receptionists
Secretaries 440
370 Secretaries, legal 441
371 Secretaries, medical 442
372 Secretaries, n.e.c. 443
374 Shipping 5 receiving clerks 444
375 Statistical clerks 445
376 ' Stenographers 446
379 Administrative assistant 450
381 Stock clerks § storekeepers (incl.
inventory) 452
382 Teacher aides, exc. school monitors
(incl. school aide) 453
383 Telegraph messengers
Telegraph operators
Telephone operators
Ticket, station £ express agents
(incl. railroad station clerk)
Typists
Weighers .':.-. ' • •-..;•
Miscellaneous clerical workers (incl
service rep; general office worker)
Not specified clerical workers (incl
Volt, Kelly)
Other clerical •
Craftsmen and Kindred Workers
Automobile accessories installers
Bakers
Blacksmiths
Boilermakers
Bookbinders
Brickmasons § stonemasons
Brickmasons § stonemasons, apprentic
^Bulldozer operators (incl. tractor
driver)
Cabinetmakers
Carpenters
Carpenter apprentices
Carpet installers
Cement § concrete finishers
.Compositors 5 typesetters
Printing trades apprentices, exc.
pressmen (incl. print shop helper)
Cranemen, derrickmen, hoistmen
Decorators § window dressers
Dental laboratory technicians
Electricians
Electricians apprentices
Electric power linemen § cablemen
Electrotypers § stereotypers
•Engravers, exc. photoengravers
Excavating, grading 6 road machine
operators, exc. bulldozer
Floor layers, exc. tile setters
Foremen § hammermen
Forgemen and hammermen
Furniture £ wood finishers
Furriers
Glaziers
Heat treaters, annealers, 5 tempers
Inspectors, sealers, § graders;
log and lumber
Inspectors, n.e.c. (incl. telephont
investigation)
Jewelers fi watchmakers (incl. jewe
work)
B-9
-------
Operatives, Except Transport - cont'd
Laborers, Except Farm - continued
656 Punch § stamping press operatives
660 Riveters & fasteners
661 Sailors 5 deckhands
662 Sawyers
663 Sewers 5 stichers
664 Shoemaking machine operatives
665 Stationary firemen
Textile operatives
670 Carding, lapping § combing operatives
671 Knitters, loopers § toppers
672 Spinners, twisters 5 winders
673 Weavers
674 Textile operatives, n.e.c. (incl.
miller)
680 Welders & flame-cutters
681 Winding operatives, n.e.c.
690 Machine operatives, miscellaneous
specified (incl. pottery worker)
692 Machine operatives, not specified
694 Miscellaneous operatives (incl.
miscellaneous handywork)
695 Not specified operatives (incl.
baker's assistant, paper miller, pie
factory, auto factory, jewelry
factory, box assembler, aluminum
window plant, factory worker, made
barricades)
701 Boatmen § canalmen
703 Busdrivers
704 Conductors § motormen, urban rail
transit
705 Deliverymen S routemen
706 Fork lift 5 tow motor operatives
710 . Motormen; mine, factory, logging
camp, etc.
711 Parking attendants
712 Railroadbrakemen
713 Railroad switchmen
714 Taxicab drivers § chauffeurs
715 Truck drivers
762 Stock handlers (incl. box boy,
clerk, stock girl)
763 Teamsters
764 Vehicle washers § equipment cleaners
770 Warehousemen, n.e.c.
780 Miscellaneous laborers •
785 Not specified laborers (incl. factoti
786 Sanitation man, sanitizer
787 Maintenance man, n.s.
Farmers and Farm Managers
801 Farmers (owners and tenants)
802 Farm managers . .
Farm Laborers and Farm Foremen
821 Farm foremen
822 Farm laborers, wage workers (incl.
farm hand, farm work)
823 Farm laborers, unpaid family workers
824 _Farm service laborers, self-employed
825 Civilian Conservation Corp
Service Workers, Exc. Private Household :
Laborers, Except Farm
740 Aninal caretakers, exc. farm
750 Carpenters' helpers
751 Construction laborers, exc. carpenters'
helpers
752 Fishermen § oystermen
753 Freight 6'. material handlers (incl.
furniturs mover)
754 Garbage collectors
7S5 Gardeners § groundskeepers, exc. farm
760 Longshoremen § stevedores
761 Lumbermen, raftsmen § woodchoppers
(incl. lumber)
Cleaning service workers
901 Chambermaids § maids, except privi
household
902 Cleaners § charwomen
903 Janitors § sextons (incl. custodi
Food service workers
910 Bartenders
911 Busboys . •
912 Cooks, except private household (:
cook, director, chef)
913 Dishwashers
914 Food counter 5 fountain workers
915 Waiters (incl. barmaid) • •
916 Food service workers, n.e.c., exc
private household
917 Restaurants, n.s.
918 Hostess
Health service workers
921 Dental assistants
922 Health aides, exc. nursing (incl
asst., nuclear research lab wor);
923 Health trainees
924 Lay midwives
925 Nursing aides, orderlies 5 attend
926 Practical nurses
927 Health spa worker
B-ll
-------
Craftsmen and Kindred Workers - cont'd.
Craftsmen and Kindred Workers - cont'd
454 Job § die setters, metal
455 Locomotive engineers
456 Locomotive firement
461 Machinists
462 Machinist apprentices
Mechanics 5 repairmen
470 Air conditioning, heating $ refrig.
471 Aircraft
472 Automobile body repairmen
473 Automobile mechanics
474 Automobile mechanic apprentices
475 Data processing machine repairmen
480 • Farm implement
481 Heavy equipment mechanics (incl.
diesel, factory mech, meter)
482 Household appliance $ accessory
installers § mechanics (incl. re-
pairmen)
483 Loom fixers
484 Office-machine
485 Radio and television
486 Railroad § car shop
491 . Mechanic, exc. auto, apprentices
492 Miscellaneous mechanics § repairmen
495 Not specified mechanics § repairmen
501 ' Millers; grain, flour 5 feed
502 Millwrights
503 Molders, metal
504 Molder apprentices
SOS Motion picture projectionists
506 Opticians, § lens grinders § polishers
510 Painters, construction £ maintenence
(incl. contract)
511 Painter apprentices
512 Paperhangers
514 Pattern £ model makers, exc. paper
515 Photoengravers 5 lithographers
516 Piano § organ tuners § repairmen
520 Plasterers
521 Plasterer apprentices
522 Plumbers & pipe fitters
523 Plumber § pipe fitter apprentices
525 Power station operators
530 Pressmen 5 plate printers, printing
531 Pressmen apprentices
533 Rollers 5 finishers, metal
534 Roofers 5 slaters
535 Sheetmetal workers £ tinsmiths
536 Sheetmetal apprentices
540 Shipfitters .
542 Shoe repairmen
543 Sign painters 5 letterers
545 Stationary engineers
546 Stone cutters 5 stone carvers
B-10
550 Structural metal craftsmen (incl. ire
worker)
551 Tailors
552 Telephone installers g repairmen
554 Telephone linemen & splicers
560 Tile setters
561 Tool £ die makers
562 Upholsterers
571 Specified craft apprentices, n.e.c.
572 Not specified apprentices
575 Craftsmen § kindred workers, n.e.c.
580 Former members of the Armed Forces
Operatives, Except Transport
601 Asbestos 5 insulation workers
602 Assemblers
603 Blasters $ powdermen
604 Bottling § canning operatives
605 Chainmen, rodmen, 5 axmen; surveying
610 ' Checkers, examiners § inspectors;
•~~ • manufacturers
611 Clothing ironers § pressers
612 Cutting operatives, n.e.c.
613 Dressmakers § seamstresses, except
factory
614 Drillers, earth
615 Dry wall installers $ lathers
620 Dyers
621 Filers, polishers, sanders § bugger:
622 Fumacemen, -smeltermen 5 pourers
623 Garageworkers 5 gas station at tend a-
624 .Graders § sorters, manufacturing
625 Produce graders 5 packers, except
factory $ farm
626 Heaters, metal
630 Laundry § dry cleaning operatives,n.
631 Meat cutters § butchers, exc. manufr
turing ' • : . '• . •••••'
633 Meat cutters £ butchers, manufactur
624 Meat wrappers, retail trade
635 Metal platers
636 Milliners
640 Mine operatives, n.e.c.
641 Mixing operatives
642 Oilers f, greasers, exc. auto
643 Packers § wrappers, except meat 5
produce
644 Painters, manufactured articles
645 Photographic process workers
Precision machine operators
650 Drill press operatives
651 Grinding maching operatives
652 Lathe 5 milling machine operative
653 Precision machine operatives.n.e.
-------
Service Workers, Exc. Private Household, cont'd
Personal service workers
931 Airline stewardesses
932 Attendants, recreation § amusement
933 Attendants, personal service, n.e.c.
934 Baggage porters § bellhops
935 Barbers
940 Boarding $ lodging house keepers
941 Bootblacks
942 Child care workers, exc. private
household (incl. n.s., juvenile
detention)
943 Elevator operators
944 Hairdressers & cosmetologists
945 .Personal service apprentices
950 Housekeepers, exc. private household
952 School monitors
953 Ushers, recreation § amusement
954 Welfare service aides
Protective service workers
960 Crossing guards § bridge tenders
961 Firemen, fire protection
962 Guards § watchmen
963 Marshals $ constables
964 Policemen § detectives (incl. rail-
road traffic officer)
965 Sheriffs 5 bailiffs
966 Military .
980 Child care workers, private household
(incl. baby sitter)
981 Cooks, private household
982 Housekeepers, private household
983 Laundresses, private household
984 Maids § servants, private household
996 Occupation not specific enough to code
998 DX
B-12
-------
Occupational Asbestos Exposure Codes
Category
Definite asbestos exposure - decedent employed
by asbestos company
Probable exposure - including building, house
construction, plasterer, automobile mechanic,
cement worker
Possible exposure - including steel or metal
worker railroad workers, house painter,
longshoreman, PG & E laborer
Probably No exposure - including Farmer,
Rancher, lumber worker, office or clerical,
food service, health services.
B-13
-------
Calaveras and Tuolumne Counties
City Codes
I High Asbestos Areas: less than 5 miles from deposits
Calaveras County
Tuolumne County
11 - San Andreas
12 - Altaville
13 - Angels Camp, Carson Hill
14 - Melones
15 - Valley Springs, Double Springs
16 - Copperopolis, Salt Spring Valley
17 - Burson
18 - Calaveritas
19 - Campo Seco
20 - Sonora
21 - Chinese Camp
22 - Jamestown
23 - Grovel and
24 - Jacksonville
25 - Tuttletown
26 - Big Oak Flat, Moccasin
II Medium Asbestos Areas: 6 to 10 miles from deposits
Calaveras County
Tuolumne County
31 - Milton
32 - Jenny Lind
33 - Telegraph City
35 - Mokelumne Hill
36 - Mountain Ranch
37 - Murphys
38 - Douglas Flat
39 - Vallecito
40 - Columbia
B-14
-------
Ill Low Asbestos Area: More than 10 miles from deposits
Calaveras County
Tuolumne County
51 - West Point
52 - Railroad Flat
53 - Arnold, White Pines
54 - Camp Connell
55 - Avery, Hathaway Pines
56 - Sheep Ranch
57 - Glencoe
58 - Wilseyville
60 - Twain Harte
61 - Tuolumne, Bodenhamer
62 - Strawberry
63 - Long Barn, Sierra Village
64 - Soulsbyville
65 - Standard
66 - Mi-Wuk Village, Sugar Pine
B-I5
-------
CALIFORNIA COUNTY CODES
01 - Alameda
02 - Alpine
03 - Amador
04 - Butte
05 - Calaveras
06 - Co!usa
07 - Contra Costa
08 - Del Morte
09 - El Dorado
10 - Fresno
11 - Glenn
12 - Humboldt
13 - Imperial
14 - Inyo
15 - Kern
16 - Kings
17 - Lake
18 - Lassen
19 - Los Angeles
20 - Madera
21 - Marin
22 - Mariposa
23 - Mendocino
24 - Merced
25 - Modoc
26 - Mono
27 - Monterey
28 - Napa
29 - Nevada
30 - Orange
31 - Placer
32 - PIurnas
33 - Riverside
34 - Sacramento
35 - San Benito
36 - San Bernardino
37 - San Diego
38 - San Francisco
39 - San Joaquin
40 - San Luis Obispo
41 - San Mateo
42 - Santa Barbara
43 - Santa Clara
44 - Santa Cruz
45 - Shasta
46 - Sierra
47 - Siskiyou
48 - Solano
49 - Sonoma
50 - Stanislaus
51 - Sutter
52 - Tehama
53 - Trinity
54 - Tulare
55 - Tuolumne
56 - Ventura
57 - Yolo
58 - Yuba
98 - Out of State, Out of Country
B-16
-------
Appendix C
SMR Data Base for Calaveras and Tuolumne Counties
C-l
-------
Male Deaths from Malignant Neoplasms of the Digestive Organs
and Peritoneum (ICD 150-159), by Year and Age at Death,
Calaveras and Tuolumne Counties
YEAR
1969
1970
1971
1Q72
1973
1974
1975
1976
1977
AGE
o
f\>
TOTAL
1 1
13
12
13
11
8
17
1 1
1978
«
LT 10 1
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
GE 85
[ 0
0
0
O
0
0
0
0
0
0
1
1
1
3
3
1
1
o — •
0
0
0
0
0
0
0
o
0
1
0
2
2
2
1
1
o —
0
0
0
o
0
0
1
o
1
0
0
1
4
2
3
1
o -
0
0
0
0
0
0
0
.... 0 .._
0
0
4
5 '
1
1
I
0 ~
— o
0
0
0
a
0
1
0
3
2
1
2
2
2
0
0
0
0 •""
0
0
0
0
0
o •
0
0
1'
2
2
0.
2
1
2
' "1 '""
" 0
0
0
0
0
1
0
0
0
0
1
2
o —
1
0
2
_ ... j.
0
0
0
0
0
0
0
0
1
3
0
4
3
2'
0
4
0
0
0
0
0
0
0
0
0
1
0
0
0
3
3
1
1
2
0
0
0
0
0
0
0
0
1
0
2
3
6
4
2
2
0
20
-------
Male Deaths from Malignant Neoplasms of Respiratory System (ICD 160-163),
by Year and Age at Death,
Calaveras and Tuolumne Counties
AGE
o
I
u>
1969
1970
1971
1972
1973
1974
1975
1976
1977
TOTAL
16
13
'13,
14
21
25
22
19
1978
LT 10
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49 ~
IiO-54
55-59
60-64
65-69 "
70-74
75-79
80-84
GE 85"
0
0
0
0
0
0
1
0
0
0
3
1
2
2
4
2
I
0
0
0
0
0
0
1
0
3
2
1
2
1
2
1
0"
0
0
0
••• v '• 1
0
0
0
0
1
0
2
2
3
1
2
1
0
0
0
0
0
0
0
0
0
o
I
1
0
2
1
0
1
1
0
0
0
0
0
0
0
0
0
0
0
5
5
3
1
0
0 .
0
0
0
0
0
0
0
0
1
2
2
5
3
0
4
2
~ "2
0
O
0
0
0
0
0
0
1
5
2
4
' 4
4
0
4
1
0
0
0
0
0
0
1
0
0
1
3
4
3
5
1
2
2
0
•: ".,-.-. 0 • .-•
••-ov' :o r::
-••: ; 0 •"••
0
0
0
0
0
2
. - •••: 3 '•:••'.'•'•
•• ." 2 ' ; •
6
1
2
0
3
0
0
.:••;:. ::.- o
0
0
0
0
0
: 1
1
1
1
2
3
2
1
0
12
-------
Male Deaths from Hypertensive Heart and Renal
Disease (ICD 402, 404), by Year and Age at Death,
Calaveras and Wlumne Counties
AGE
o
i
LT 10
10-14
15-19
PO-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
GE 05
1969
0
0
0
0
0
0
0
0
0
0
0
0
0
O
0
o •
o •
YEAR
1<»70
0'
0
O
0
0
0
O
0
O
0
0
0
1
0
0
0
0
1971
"*
"0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 •
0 "
1972
0
0
0
0
0
0
0
o
0 '
0
0
o
o
0
0
0
0
1973
i .
O
o
0
0
0
0
0
0
o
0
0
0
0
1
0
0
" ' - 0
1974
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
1975
0
0
0
0
0
0
0
0
o
0
0
0
0
0
o
0
1
1976
0
0
0
0
0
0
0
0
0 '
0
0
0
0
0
0
0
0
1977
u
0
0
0
o
0
0
0
0
0
0
0
0
0
0
0
... . . 0 .-
1978
0
0
0
0
u
0
0
0
u
0
0
0
0
0
0
0
• " o
TOTAL
0
-------
Male Deaths from Malignant Neoplasms
of the Genital Organs (ICD 180-187), by Year and Age
at Death, Calaveras and Tuolumne Counties
AGE
o
i
tn
LT 10
10-14
15-19
20-?*
25-29
30-34
35-39
40-44
45-49 '
50-54
55-59
60-64
65-69
70-74
75-79
80-84
GE 85
OTAL
1969
0
0
O
0
0
0
0
0
0
0
0
0
0
0
1
0
1
I 2
YEAR
1970
i •
0"
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
I
3
1971
0 "
0
0
0
0
0
0
0
0
1
0
0
0
1
1
2
. 1 •
6
1972
O
0
0
0
0
1
0
0
... -. 0__
0
0
0
I
0
0
1
0
. '3
1973
O
0
0
0
0
0
0
0
._ 0 ...
0
0
0
4
0
3
1
I -
9
1974
0
0
0
0
0
0
0
0
0
0
0
0
o
2
I
3
."' "" 0 ""
6
1975
V f
0
0
0
0
0
0
0
0
- 0 "
0
0
0
•• ••' 1 • '•
0
3
1
- 2
7
1976
*' . *•
— — o
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
"0 "
2
I 977
0
0
0
0
0
0
0
0
0
0
0
2
1
2
1
2
0
8
1978
/
0
0
0
0
0
0
0
0
0
o
0
2
4 '
1
0
2
2
1 1
-------
Male Deaths from All Causes,
by Year and Age at Death,
Calaveras and Tuolumne Counties
"AGE
LT 10 1
10-14 ]
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
60-84
GC 85
1969
.•*
I " 6
0
4
3
0
1
2
6
4
9
22
23
• 2d '
43
42
22
22
YEAR
1970
3
0
3
5
4
3
0
1
4
11
16
16
34
29
29
22
28
1971
(
8 .....
0
3
5
1
2
5
5
12
9
13
25
38
31
26
32
26
1972
0
._. 3
1
5
5
,1
3
4
a
10
22
27
33
. 42
32.
26
22
1973
6
1
1
7
3
3
2
3
16
10
12
29
42 '-
39
21
24
" 26 "
1974
1
1
2
5
2
0
2
7
/
10
16
27
2B ,
25
30
37
24
1975
" 7
0
1
5
4
4
4
2
8
12
15
24
45
40
23
22
20
1976
2
1
4
8
_., -j „
4
3
1
8
16
16
37
42
46
31
25
16
1977
4
2
2
6
4
2
7
6
5
7
17
26
33
36
3O
28
38 "
1978
V
s
2
7
4
2.
7
I
3
6
13
12
34
43
4O
30
34
29
TOTAL
237
208
241
247
245
224
236
267
253
274
-------
Female Deaths from Malignant Neoplasms of the Digestive Organs
and Peritoneum (ICD 150-159), by Year and Age at Death,
Calaveras and Tuolumne Counties
AGE
• —
LT 10
10-14
15-19
20-24
25-29
30-3*
35-39
40-44
45-49
50-54
55-59
60-64
fc5-69
70-74
75-79
80-84
GE 85
1969
0
0
0
0
0
0
0
0
0
1
2
0
3
2
I '
3
I YEAR
1970
0
0
0
0
0
0
0
0
2
0
0
1
0
2
2
0
1
1971
o
0
0
0
0
0
0
0
0
0
1
0
0
1
1
3
0
1972
O
0
0
0
0
0
0
0
0
0
1
1
0
0
1
0
2 '
1973
O
0
0
0
0
0
0
0
0
0
1
1
2
4
1
0
2
1974
0 "
0
0
0
0
0
0
0
- o
1
0
0
1 ••
2
1
1
1
1975
._. ..... Q .
0
0
0
0
0
0
0
0
0
2
2
4
5
4
0
0
1976
0
0
0
0
0
0
0
0
u
1
2
3
1
1
1
I
2
1977
0 .
0
0
0
u
O
0
0
0
2
0
1
0
1
0
2
1
1978
u
0
0
0
u
0
0
0
u
1
0
1
1
0
1
3
I
TOTAL
13
8
11
17
12
-------
Female Deaths from Malignant Neoplasms, of Respiratory System (ICD 160-163),
by Year and Age at Death,
Calaveras and Tuolumne Counties
AGE
o
00
LT 10
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
GE 85
TOTAL
1969
" " 0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
o
YEAR
1970
0
0
0
0
0 "
0
0
0
0
0
2
0
0
0
0
0
o
1971
0
1
0
0
0
0
0
0
0
0
1
0
1
0
0
0 .
0
1972
ii • i •
0
0
0
0
•^~" 0
0
0
0
0
1
1
0
0
0
1
0
0
1973
0
0
0
0
o
0
0
0
0
0
0
2
~ 3
1
0
0
0
1974
• Mi •
— o
0
0
0
0
0
0
0
1
0
0
0
- • - o
0
1
0
0
1975
o
0
0
0
0
0
0
1
" 1
0
2
0
. .- - 0 _
2
2
1
'"- 0"
1976
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
1
1
1977
0
0
0
0
0
0
0
1
I
0
2
1
1
I
0
0
0
1978
0
0
0
0
o
0
0
o
0
1
2
5
1
1
2
1
0
13
-------
Female Deaths from Malignant Neoplasms
of the Breast (ICD 174), by Year and Age
at Death, Calaveras and Tuolumne
Counties
AGE "
o
i
•o
LT 10 "
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49 "
50-54
55-59
60-64
65-69
70-74
75-79
00-84
GE 65
1969
O
0
0
0
0
0
0
0
0
1
0
0
0
0
1
0 •
1
YEAR
1970
0
O
0
0
0
0
0
0
1
0
1
0
1
0
0
0
1
1971
0
0
0
0
0
0
0
1
0
0
0
3
0
1
0
0 .
1
1972
0
0
0
0
o
0
1
0
o
0
1
0
0
1
0
1
"0
1973
0
0
o
0
0
0
1
0
1
1
0
1
0
0
1
0
1
1974
0
0
0
0
0
0
0
0
0
0
1
0
1975
0
0
0
o
0
0
0
0
1
1
1
1
1
2
0
0
1
1976
0
0
0
0
0
0
0
0
0
0
1
1
1
0
0
0
._o _
1977
0
0
0
0
0
0
0
0
1
1
.. ••-. 2 -•
0
1
3
0
0
... . j ...
1978
0
0
v. 0
0
0
0
0
0
1
3
1
0
I
2
0
0
1
TOTAL
a
-------
Female Deaths from Malignant Neoplasms
of the Genital Organs (ICD 180-187),
by Year and Age at Death, '
Calaveras and Tuolumne Counties
AGE
o
i
LT 10
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-4 9
50-54
55-59
60-64
65-69
70-74
75-79
80-84
GE 85
1969
0
0
0
0
U
0
0
0
0
1
1
0
1
0
1
1
0
YEAR
1970
0
0
0
0
0'
0
0
0
0
0
1
2
i
I
0
1
0
1971
.•
--0- - -
0
0
0
0
0
0
0
1
0
0
2
0
1
2
1
— o
1972
0
0
0
0
0
0
0
1
' 0
0
0
2
1
0
2
0
„ 0
1973
O
0
o
0
U
0
0
0
..-_ . ._. . . 0
1
0
0
0
0
0
0
0
1974
"" 0
0
0
0
0
0
0
I
_. 0
1
1
2
•• o
0
0
0
I
1975
0
0
0
0
•• o "
0
O
o
o
2
0
1
0
0
0
0
0
1976
0
0
0
0
0
0
0
0
o "
0
2
0
2
0
0
1
0
1977
0
0
0
o
o
0
0
1
0
0
0
0
1
1
0
1
- o
1978
0
0
0
0
0
0
0
0
1
1
0
0
2.
0
0
o
l>
TOTAL
-------
Female Deaths from Hypertensive Heart and Renal
Disease (ICD 402, 404), by Year and Age at Death,
Calaveras and Tuolumne Counties
AGE
o
i
LT 10
10-14
15-19
20-24
25-29
30-34
35-39
40-<*4
45-49
50-54
55-5P
60-fc4
65-69
70-74
75-79
80-04
GE 85
1969
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
1
YEAR
1970
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
' 0
1971
o
0
0
0
0
0
0
0
0 "
1
1
0
o
0
0
1
o
1972
• "• o
0
0
0
0
0
0
0
o
0
0
0
0
0
o
0
__ 0 _
1973
o
0
0
0
o
0
0
0
0
0
0
0
0
0
0
0
1 -•
1974
o ' "
0
0
0
0
0
0
0
•~ ~ o
0
0
0
- ... ... 0 -
1
0
0
; """" "i
1975
... . Q
0
0
0
0
0
0
0
0
0
0
0
0
0
0
. 0
0
1976
"' " 0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
197.7
o -
0
0
0
0 '
0
0
0
0
0
0
0
0
0
0
0
0
1978
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
-------
Female Deaths from All Causes,
by Year and Age at Death,
Calaveras and Tuolumne Counties
YEAR
1969 1970
AGE LT 10
10-14
15-19
20-24
25-29
30-34
35-39
o 40-44
JL, 45-49
ro 50-54
55-59
60-64
65-69
70-74
75-79
80-84
4
3
1
1
0
0
0
0
3
5
1 1
10
18
18
22
24
GE 85 35
7
0
2
1
0
0
2
1
6
5
11
13
18
19
19
28
34
1971 1972
S
1
0
1
3
0
1
6
5
10
12
15
10
20
22
21
35
0
0
2
5
2
0
2
4
4
6
8
14
-- 9
10
20 .
11
36
1973 1974 1975
6
0
0
1
3
0
2
1
6
8
7
17
"" 18 ""•
23
21
25
38
5
1
1
0
0
1
1
3
4
8
12
15
19 ,
21
24
27
33 —
2
0
2
2
0
0
1
4
' 5
9
1 1
18
23
25
23
26
" 41
1976 1977
' " 3 '
0
1
1
0
2
1
6
5
9
10
16
20
15
20
22
~3l *
2
0
4
2
1
0
4
5
6
5
10
9
14
21
20
29
37
1978
6
0
3
3
1
1
1
2
11
6
14
16
21
23
23
52
TOTAL
155
166
167
133
176
175
192
162
169
166
-------
Female Deaths from All Causes,
by Year and Age at Death,
Calaveras and Tuolumne Counties
1969
ACE LT 10
10-14
15-19
20-24
25-29
30-34
35-39
o 40-44
;_, 45-49
ro 50-54
55-59
60-64
65-69
70-74
75-79
80-84
GE 85
4
3
1
1
0
0
0
0
3
5
1 1
to
18
18
22
24
35
YEAR
1970
7
0
2
1
0
0
2
1
6
5
1 1
13
18
19
19
28
34
1971
5
1
0
1
3
0
1
6
5
10
12
15
1C "
20
22
21
35
1972
0
O
2
5
2
0
2
4
4
6
8
14
9 ~
10
20 .
11
36
1973 1974
6
0
0
1
"3
0
2
1
6
8
7
17
18
23
21
25
38
5'
1
1
0
0
1
1
3
4
8
12
15
19 /
21
24
27
33
1975
2
0
2
2
0
0
1
4
' 5
9
1 1
18
23
25
23
26
41 "
1976
0
1
1
0
2
1
6
5
9
10
16
20
15
20-
22
"31
1977
2
0
4
2
1
0
4
5
'" 6
5
10
9
14
21
20
29
37
1978
6
0
3
3
1
1
1
2
' ' - 3
1 1
6
14
16
21
23
23
52
TOTAL
155
166
167
133
176
175
192
162
169
ld6
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