Tuberculosis and silica exposure in South African gold miners.

Abstract:

AIMS:To examine the effect of silica exposure, in the absence of silicosis, on the prevalence of pulmonary tuberculosis (PTB), which is epidemic among South African gold miners. METHODS:Cross-sectional study of 520 gold miners over 37 years of age. Length of service, and cumulative and average dust and quartz exposure indices were derived for each miner. Chest radiographs were read for PTB by two NIOSH "B" readers. PTB was defined as a self-reported history of PTB or PTB on chest radiograph. Logistic regression was used to adjust for age, smoking, and silicosis. PTB effects of different exposure metrics for silica, scaled on their interquartile range (IQR), were compared. RESULTS:Means (ranges) were: age 46.7 (37.1-59.9) years; length of service 21.8 (6.3-34.5) years; average intensity of respirable quartz 0.053 (0-0.095) mg/m3. PTB prevalence was 19.4% (95% CI 16.0 to 22.8) on history alone, and 35.2% (95% CI 31.1 to 39.3) on history or on chest radiograph. Length of service was poorly predictive of PTB, while all exposure indices which included dust or quartz yielded prevalence odds ratios (PORs) of approximately 1.4 (95% CI approximately 1.1 to 1.8) for changes of one interquartile range in exposure. Controlling for silicosis--by adjustment or restriction--did not modify these results. Drillers and winch operators had the highest PTB prevalences and the highest dust and silica exposures. CONCLUSION:Older in-service gold miners in South Africa have a high prevalence of PTB, which is significantly associated with dust and silica exposure, even in the absence of silicosis. Limitations include a survivor workforce and the use of cumulative exposures based on current exposures. Dust control is an important component in control of the PTB epidemic in South African gold mines.

journal_name

Occup Environ Med

authors

teWaternaude JM,Ehrlich RI,Churchyard GJ,Pemba L,Dekker K,Vermeis M,White NW,Thompson ML,Myers JE

doi

10.1136/oem.2004.018614

subject

Has Abstract

pub_date

2006-03-01 00:00:00

pages

187-92

issue

3

eissn

1351-0711

issn

1470-7926

pii

63/3/187

journal_volume

63

pub_type

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