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      Mortality from asbestos-associated disease in Libby, Montana 1979–2011

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          Abstract

          Research on asbestos exposure in Libby, MT, has focused on occupational exposure in vermiculite mining and processing, but less attention has been paid to asbestos-related mortality among community members without vermiculite mining occupational history. Our study reports on asbestos-related mortality in Libby over 33 years (1979–2011) while controlling for occupational exposure. We calculated sex-specific 33-year standardized mortality ratios (SMRs) for Libby residents who died from 1979 to 2011 with an asbestos-related cause of death. Decedent address at time of death was geocoded to confirm inclusion in the Libby County Division. We controlled for past W.R. Grace employment by including and then removing them from the SMR analysis. Six hundred and ninety-four decedents were identified as having at least one asbestos-related cause of death and residing in our study area boundary. Statistically significant ( P<0.05) 33-year SMRs, both before and after controlling for W.R. Grace employment, were found for: male and female non-malignant respiratory diseases, female COPD, and asbestosis for both sexes combined. Eighty-five men and two women were matched to employment records. We observed elevated asbestos-related mortality rates among males and females. SMR results for asbestosis were high for both sexes, even after controlling for past W.R. Grace employment. These results suggest that the general population may be experiencing asbestos-related effects, not just former vermiculite workers. Additional research is needed to determine whether SMRs remain elevated after controlling for secondary exposure, such as living with vermiculite workers.

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          Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes

          Chronic obstructive pulmonary disease (COPD), one of the most common chronic diseases and a leading cause of death, has historically been considered a disease of men. However, there has been a rapid increase in the prevalence, morbidity, and mortality of COPD in women over the last two decades. This has largely been attributed to historical increases in tobacco consumption among women. But the influence of sex on COPD is complex and involves several other factors, including differential susceptibility to the effects of tobacco, anatomic, hormonal, and behavioral differences, and differential response to therapy. Interestingly, nonsmokers with COPD are more likely to be women. In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations. Women historically have had lower mortality with COPD, but this is changing as well. There are also differences in how men and women respond to different therapies. Despite the changing face of COPD, care providers continue to harbor a sex bias, leading to underdiagnosis and delayed diagnosis of COPD in women. In this review, we present the current knowledge on the influence of sex on COPD risk factors, epidemiology, diagnosis, comorbidities, treatment, and outcomes, and how this knowledge may be applied to improve clinical practices and advance research.
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            Vermiculite, Respiratory Disease, and Asbestos Exposure in Libby, Montana: Update of a Cohort Mortality Study

            Background Vermiculite from the mine near Libby, Montana, is contaminated with tremolite asbestos and other amphibole fibers (winchite and richterite). Asbestos-contaminated Libby vermiculite was used in loose-fill attic insulation that remains in millions of homes in the United States, Canada, and other countries. Objective This report describes asbestos-related occupational respiratory disease mortality among workers who mined, milled, and processed the Libby vermiculite. Methods This historical cohort mortality study uses life table analysis methods to compare the age-adjusted mortality experience through 2001 of 1,672 Libby workers to that of white men in the U.S. population. Results Libby workers were significantly more likely to die from asbestosis [standardized mortality ratio (SMR) = 165.8; 95% confidence interval (CI), 103.9–251.1], lung cancer (SMR = 1.7; 95% CI, 1.4–2.1), cancer of the pleura (SMR = 23.3; 95% CI, 6.3–59.5), and mesothelioma. Mortality from asbestosis and lung cancer increased with increasing duration and cumulative exposure to airborne tremolite asbestos and other amphibole fibers. Conclusions The observed dose-related increases in asbestosis and lung cancer mortality highlight the need for better understanding and control of exposures that may occur when homeowners or construction workers (including plumbers, cable installers, electricians, telephone repair personnel, and insulators) disturb loose-fill attic insulation made with asbestos-contaminated vermiculite from Libby, Montana.
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              Environmental exposure to Libby Asbestos and mesotheliomas.

              Thirty-one cases of mesothelioma resulting from exposure to Libby Asbestos have been identified from Libby, Montana. Eleven cases not previously reported are the subject of this report. These cases are in non-occupationally exposed people, appearing to have resulted from exposure to contamination of the community, the surrounding forested area, and areas in proximity to the Kootenai river and railroad tracks used to haul vermiculite. These exposures are considered to be of a low degree of magnitude, but are similar to those in Western Australia's crocidolite mine at Wittenoom Gorge. An epidemic of mesothelioma can likely be expected from this type of asbestos contamination over the next 20 plus years. Copyright 2008 Wiley-Liss, Inc.
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                Author and article information

                Journal
                J Expo Sci Environ Epidemiol
                J Expo Sci Environ Epidemiol
                Journal of Exposure Science & Environmental Epidemiology
                Nature Publishing Group
                1559-0631
                1559-064X
                March 2017
                30 March 2016
                : 27
                : 2
                : 207-213
                Affiliations
                [1 ]Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry , Atlanta, Georgia, USA
                [2 ]Office of Extramural Programs, National Institute for Occupational Safety and Health , Atlanta, Georgia, USA
                Author notes
                [* ]Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry , 4770 Buford Highway, Mailstop F-57, Atlanta, GA 30341, USA. Tel.: +1 770 488 3680. E-mail: SLNaik@ 123456CDC.gov
                Article
                jes201618
                10.1038/jes.2016.18
                5318660
                27025411
                58688f34-ac64-4139-8b88-4935bb574f4e
                Copyright © 2017 Nature America, Inc., part of Springer Nature.

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                : 23 October 2015
                : 13 February 2016
                Categories
                Original Article

                Occupational & Environmental medicine
                asbestos,asbestosis,libby,mesothelioma,mortality,vermiculite
                Occupational & Environmental medicine
                asbestos, asbestosis, libby, mesothelioma, mortality, vermiculite

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