graduate school of public health department of biostatistics center for occupational biostatistics...

Graduate School of Public Health Graduate School of Public Health Department of Biostatistics Center Department of Biostatistics Center for Occupational Biostatistics & Epidemiologyfor Occupational Biostatistics & Epidemiology PW_Phase 1 - PW_Phase 1 - 11

Presentation of Phase 1 ResultsPresentation of Phase 1 Results

September 18, 2008September 18, 2008

The Pratt & Whitney The Pratt & Whitney Epidemiology Study Epidemiology Study

Phase 1 (Cohort Mortality)Phase 1 (Cohort Mortality)


Purpose of the StudyPurpose of the Study

To investigate the earlier perception of an To investigate the earlier perception of an unusual occurrence of glioblastoma at the unusual occurrence of glioblastoma at the P&W North Haven facilityP&W North Haven facility


P&W Study HighlightsP&W Study Highlights

One of the largest and most comprehensive occupational cohort studies ever done

Phase 1 mortality study is complete and published. Much more work needs to be done (Phases 2 and 3)

Potential not only to learn more about health in the P&W workplace but also about possible causes of brain cancer


P&W Cohort Mortality StudyP&W Cohort Mortality Study

One of the Largest and One of the Largest and Most ComprehensiveMost Comprehensive

Occupational Cohort StudiesOccupational Cohort Studies


What information was used?The researchers looked at:

– Plant records of when and where people worked and their age, race and gender

– National and state records If workers were living or deceased Specific cause of death for deceased workersFocus on malignant brain cancer and benign brain tumors

The researchers compared:

– Numbers of deaths among workers to the number expected in the general populations of the US and CT


Very Large Cohort of WorkersVery Large Cohort of Workers

223,894 men and women that worked in one of 8 P&W 223,894 men and women that worked in one of 8 P&W sites during 1952 - 2001sites during 1952 - 2001

– North Haven (NH), East Hartford, Middletown, Rocky Hill, North Haven (NH), East Hartford, Middletown, Rocky Hill, Cheshire, Southington – Aircraft Rd, Southington – Newell St, Cheshire, Southington – Aircraft Rd, Southington – Newell St, Manchester FoundryManchester Foundry

– Includes work at plants in Maine, Florida & Georgia for Includes work at plants in Maine, Florida & Georgia for transferred employeestransferred employees

– 26,801 (12%) workers at NH only; 11,898 (5%) partial NH26,801 (12%) workers at NH only; 11,898 (5%) partial NH

Mortality evaluated 1952-2004 for all causes and CNS Mortality evaluated 1952-2004 for all causes and CNS cancer, 1976-2004 focus for CNS cancercancer, 1976-2004 focus for CNS cancer

– 68,701 total deaths identified 68,701 total deaths identified


Data Analysis StrategyData Analysis StrategyAll workers, 1952-2004All workers, 1952-2004

Work-related factorsWork-related factors

Plant group, pay typePlant group, pay type

Year of hire, age at hireYear of hire, age at hire

Duration of workDuration of work

Time since first workTime since first work

Non work-related factorsNon work-related factors

Race, sexRace, sex

Age group, time periodAge group, time period

North Haven workers by North Haven workers by study factorsstudy factors

Combined DataCombined Data

Study factors Study factors

Subgroups by study Subgroups by study factorsfactors


Phase 1 Findings Phase 1 Findings Accepted for Accepted for

Publication in Leading Publication in Leading Peer-Reviewed Peer-Reviewed

Journal (Oct 2008)Journal (Oct 2008)


Phase 1 - Results Phase 1 - Results

Total & Cause-Specific MortalityTotal & Cause-Specific Mortality(Excluding CNS Neoplasms)(Excluding CNS Neoplasms)


Total Cohort Level FindingsTotal Cohort Level Findings

Total cohort mortality rates, 1952-2004, for all Total cohort mortality rates, 1952-2004, for all causes combined, all cancers combined and causes combined, all cancers combined and most other cause of death categories examined most other cause of death categories examined were not elevated compared to US and CT were not elevated compared to US and CT populationspopulations


0

0.2

0.4

0.6

0.8

1

1.2

1.4

SM

R

US CT

Total Cohort Mortality Rates, 1952-2004, Not Elevated Total Cohort Mortality Rates, 1952-2004, Not Elevated Compared to US and CT PopulationsCompared to US and CT Populations


Subgroup Level FindingsSubgroup Level Findings

Only 3 of 63 disease categories revealed Only 3 of 63 disease categories revealed a greater than 25% statistically significant a greater than 25% statistically significant excess in deathsexcess in deaths

– Kidney cancer (30%) & non-malignant Kidney cancer (30%) & non-malignant respiratory disease (27%) in the “only North respiratory disease (27%) in the “only North Haven” plant groupHaven” plant group

– Bronchitis in hourly workers (28%)Bronchitis in hourly workers (28%)


Only Two Diseases Revealed a Greater than 25% Only Two Diseases Revealed a Greater than 25% Statistically Significant Excess by Plant GroupStatistically Significant Excess by Plant Group

0.86 0.86

0.98 0.96

0.87 0.84

1.301.27

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Kidney Cancer Other NM Respiratory Disease

SM

R-C

T

Only N. Haven

Partial N. Haven

Never N. Haven

Unspecified


Only One Disease Revealed a Greater than 25% Only One Disease Revealed a Greater than 25% Statistically Significant Excess by Payroll TypeStatistically Significant Excess by Payroll Type

0.72

1.28

0.82

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Bronchitis

SM

R-C

T

Salary

Hourly

Mixed


What do the results mean?What do the results mean?

No evidence of elevated mortality risks for:No evidence of elevated mortality risks for:– All causes combinedAll causes combined– All cancers combined All cancers combined – Most of the cause of death categories examinedMost of the cause of death categories examined

Not unusual in studies of workers:Not unusual in studies of workers:– Workers are generally healthier than people in the Workers are generally healthier than people in the

general populationgeneral population– Improved access to health careImproved access to health care– Improved quality of lifeImproved quality of life


What do the results mean (cont’d)?What do the results mean (cont’d)?

Findings for kidney cancer, bronchitis and non-malignant Findings for kidney cancer, bronchitis and non-malignant respiratory disease suggest that the excesses may be respiratory disease suggest that the excesses may be due to non-work factors or to work outside of P&W:due to non-work factors or to work outside of P&W:

– Mainly among short-term, hourly workersMainly among short-term, hourly workers

– No associations with available work-related factors, such as No associations with available work-related factors, such as duration of employment at P&Wduration of employment at P&W

These excesses will be evaluated further in Phases 2 These excesses will be evaluated further in Phases 2 and 3 of the studyand 3 of the study


Phase 1- Results Phase 1- Results

Mortality from CNS NeoplasmsMortality from CNS Neoplasms


Total Cohort Level FindingsTotal Cohort Level Findings Total cohort mortality rates, 1952-2004, for Total cohort mortality rates, 1952-2004, for all CNS all CNS neoplasmsneoplasms not elevated compared to US and CT not elevated compared to US and CT populationspopulations

– Same finding for malignant, benign and unspecified CNS Same finding for malignant, benign and unspecified CNS neoplasmsneoplasms

Total cohort mortality rates, 1976-2004, for Total cohort mortality rates, 1976-2004, for all brain all brain neoplasmsneoplasms not elevated compared to US and CT not elevated compared to US and CT populationspopulations

– Same finding for malignant, benign and unspecified brain Same finding for malignant, benign and unspecified brain neoplasmsneoplasms


Total Cohort Mortality Rates for CNS Neoplasms Total Cohort Mortality Rates for CNS Neoplasms Not Elevated Compared to US and CT PopulationsNot Elevated Compared to US and CT Populations

0.85 0.83

0.56

1.09

0.84 0.87

0.65

0.79

0

0.2

0.4

0.6

0.8

1

1.2

1.4

All CNSNeoplasms

Malignant CNS Benign CNS Unspecified CNS

SM

R

US CT

606606 462462 2323 121121


Subgroup Level FindingsSubgroup Level Findings

Not statistically significant excesses in deaths from all Not statistically significant excesses in deaths from all malignant brain neoplasms among NH workersmalignant brain neoplasms among NH workers

– 11% excess among only NH workers11% excess among only NH workers

– 4% excess among partial NH workers4% excess among partial NH workers

Malignant brain neoplasms in combined NH groupsMalignant brain neoplasms in combined NH groups

– Not statistically significant higher risks in salaried workers, older Not statistically significant higher risks in salaried workers, older hires and the most recent time periodhires and the most recent time period

– No association with duration of employment or time since first No association with duration of employment or time since first employmentemployment


Malignant Brain Rates Slightly Elevated in Malignant Brain Rates Slightly Elevated in Ever (Only + Partial) NH GroupEver (Only + Partial) NH Group

1.11

1.040.94

0.84

0

0.5

1

1.5

2

2.5

Malignant Brain Neoplams

SM

R-C

TOnly N. Haven

Partial N. Haven

Never N. Haven

Unspecified

# = observed deaths

4949 2424 251251 5757


Malignant Brain Rates Elevated for Malignant Brain Rates Elevated for Salary Workers in Ever NH GroupSalary Workers in Ever NH Group

0

0.5

1

1.5

2

2.5

Salary Hourly Mixed

SM

R-C

T

Only N. HavenPartial N. HavenNever N. HavenUnspecified

55 1212 5555 2727 4343 1010 2626 22 1515 44

SMR= 1.36SMR= 1.36# = observed deaths# = observed deaths

SMR= 1.08SMR= 1.08

181181 11

SMR = 1.91SMR = 1.91


Malignant Brain Rates Elevated for Malignant Brain Rates Elevated for 1995-2004 Time Period in Ever NH Group1995-2004 Time Period in Ever NH Group

0

0.5

1

1.5

2

2.5

1976-1984 1985-1994 1995-2004

SM

R-C

T

Only N. HavenPartial N. HavenNever N. HavenUnspecified

88 44 5353 1313 1313 99 2626 1111 100100 1818

SMR= 1.06SMR= 1.06

SMR = 1.50SMR = 1.50# = observed deaths# = observed deaths

SMR= 1.14SMR= 1.14

9898 2828


Malignant Brain Rates in Ever North Haven Group Malignant Brain Rates in Ever North Haven Group Not Related to Duration of Time Worked at PWNot Related to Duration of Time Worked at PW

# = Observed Deaths

1.30

1.11

0.85

1.11

0

0.5

1

1.5

2

2.5

< 1 year 1 - 4 5 - 19 20+

Time Worked (yrs)

SM

R-C

T

30 13 14 16


What do the results mean?What do the results mean?Total cohort mortality rates for CNS neoplasms and Total cohort mortality rates for CNS neoplasms and brain neoplasms (malignant, benign or unspecified) brain neoplasms (malignant, benign or unspecified) not elevated compared to US and CT general not elevated compared to US and CT general populationspopulations

Malignant brain excesses in certain subgroups of Malignant brain excesses in certain subgroups of workers from NH may be due to work outside of P&W, workers from NH may be due to work outside of P&W, non-work factors or workplace factors unique to NH non-work factors or workplace factors unique to NH not measured in the current phase of the studynot measured in the current phase of the study

These excesses will be further evaluated in Phases 2 These excesses will be further evaluated in Phases 2 and 3 of the studyand 3 of the study


P&W Epidemiology StudyP&W Epidemiology Study

Upcoming WorkUpcoming Work


What comes next?What comes next?

Phase 2Phase 2

– Examine the relationship between basic work Examine the relationship between basic work history factors and brain cancer history factors and brain cancer incidenceincidence

– Will enable evaluation of specific types of Will enable evaluation of specific types of brain cancer, such as glioblastomabrain cancer, such as glioblastoma


What comes next (cont’d) ?What comes next (cont’d) ?Phase 3Phase 3

– Re-evaluate total and cause-specific mortality in relation to Re-evaluate total and cause-specific mortality in relation to detailed work history and workplace exposure informationdetailed work history and workplace exposure information

– Re-evaluate brain cancer incidence in relation to detailed work Re-evaluate brain cancer incidence in relation to detailed work history and workplace exposure informationhistory and workplace exposure information

– Compare work and non-work related factors in the brain cancer Compare work and non-work related factors in the brain cancer cases and their matched controls cases and their matched controls

– Evaluate brain tissue samples from some workers with brain Evaluate brain tissue samples from some workers with brain cancer to see if patterns of genetic change are the same as in cancer to see if patterns of genetic change are the same as in brain cancer cases from the general populationbrain cancer cases from the general population


AcknowledgmentsAcknowledgmentsWe gratefully acknowledge the support, We gratefully acknowledge the support, cooperation and assistance of the following cooperation and assistance of the following groups without whose help this study would not groups without whose help this study would not be possible: be possible:

– The CT Dept. of Public HealthThe CT Dept. of Public Health– The Scientific Advisory CouncilThe Scientific Advisory Council– P&W HR and EHS personnelP&W HR and EHS personnel– The International Association of Machinists (IAM)The International Association of Machinists (IAM)– The Communications Facilitation Workgroup The Communications Facilitation Workgroup


Research TeamsResearch Teams

Univ. of Pittsburgh (Epidemiology)Univ. of Pittsburgh (Epidemiology)Gary Marsh, PhDGary Marsh, PhD

Jeanine Buchanich, PhDJeanine Buchanich, PhDAda Youk , PhDAda Youk , PhD

Frank Lieberman, MDFrank Lieberman, MDMike Cunningham, MSMike Cunningham, MS

Zb Bornemann, MSZb Bornemann, MS

Univ. of Illinois at Chicago (Exposure Assessment) Univ. of Illinois at Chicago (Exposure Assessment) Nurtan Esmen, PhDNurtan Esmen, PhDSteve Lacey, PhDSteve Lacey, PhD

Kathleen Kennedy, MSKathleen Kennedy, MSRoger Hancock, MCERoger Hancock, MCE


Questions?Questions?


P&W Phase 1 SummaryP&W Phase 1 SummaryVery large and comprehensive study

Phase 1 mortality study complete and published, Phases 2 & 3 analyses ongoing

Study will inform workers, companies and brain cancer research community about occupational health risks for brain cancer

Continue to encourage and promote participation in the case-control study


Contact InformationContact InformationGary M. Marsh, Ph.D., Principal Investigator for the University of Gary M. Marsh, Ph.D., Principal Investigator for the University of Pittsburgh Epidemiology component can be reached at Pittsburgh Epidemiology component can be reached at [email protected]

Nurtan A. Esmen, Ph.D., Principal Investigator for the University of Nurtan A. Esmen, Ph.D., Principal Investigator for the University of Illinois at Chicago Exposure Reconstruction component can be Illinois at Chicago Exposure Reconstruction component can be reached at reached at [email protected]

Frank S. Lieberman, M.D., Co-Investigator and neuro-oncologist can Frank S. Lieberman, M.D., Co-Investigator and neuro-oncologist can be reached at be reached at [email protected]

The researchers can also be reached:The researchers can also be reached:– by calling toll-free 1-866-621-1172by calling toll-free 1-866-621-1172– from their website (from their website (http://cobe.biostat.pitt.edu/))

Information and updates on the study are also available on the CTDPH Information and updates on the study are also available on the CTDPH website:website:– http://www.ct.gov/dph/cwp/view.asp?a=3140&q=387474http://www.ct.gov/dph/cwp/view.asp?a=3140&q=387474


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graduate school of public health department of biostatistics center for occupational biostatistics...

Documents

pw cohort mortality

cohort mortality slide

pw workplace

pw sites

pw study highlights

ct slide

pw north haven facility

results presentation