Crystalline silica has been classified as a human carcinogen by the International Agency for Research on Cancer (Lyon, France); however, few previous studies have provided quantitative data on silica exposure, silicosis, and/or smoking. We investigated a cohort in China (in 1960-2003) of 34,018 workers without exposure to carcinogenic confounders. Cumulative silica exposure was estimated by linking a job-exposure matrix to work history. Cox proportional hazards model was used to conduct exposure-response analysis and risk assessment. During a mean 34.5-year follow-up, 546 lung cancer deaths were identified. Categorical analyses by quartiles of cumulative silica exposure (using a 25-year lag) yielded hazard ratios of 1.26, 1.54, 1.68, and 1.70, respectively, compared with the unexposed group. Monotonic exposure-response trends were observed among nonsilicotics (P for trend < 0.001). Analyses using splines showed similar trends. The joint effect of silica and smoking was more than additive and close to multiplicative. For workers exposed from ages 20 to 65 years at 0.1 mg/m(3) of silica exposure, the estimated excess lifetime risk (through age 75 years) was 0.51%. These findings confirm silica as a human carcinogen and suggest that current exposure limits in many countries might be insufficient to protect workers from lung cancer. They also indicate that smoking cessation could help reduce lung cancer risk for silica-exposed individuals.

In China, dust samplers were originally designed to collect 'total dust' for a short term during production, which is different from the widely adopted sampling strategy for dust. With the aim to provide the conversion factor from Chinese total dust to US and German respirable dust and to look at the influences on conversion factors from environment, production, and instruments, a comparative field study on the dust concentration measurements by different sampling methods was carried out in the same Chinese industries as in the 1989-1990 study and in some other factories. A supplemental experiment was also conducted in a wind tunnel. Dust concentration was measured with a parallel sampling strategy by using the following samplers: 10-mm nylon cyclone for US respirable dust (AR), FSP-Berufsgenossenschaftliches Institut für Arbeitssicherheit (BIA) cyclone for German respirable dust (GR), and samplers for Chinese total dust (CT). Totally, 1434 samples were collected (269 AR, 198 GR, and 967 CT), from which 429 matched sample pairs (249 pairs of AR/CT, 180 GR/CT) were available to calculate conversion ratios. Industry- and job-based conversion factors are presented in this study. The conversion factor of AR/CT was 0.38 for tungsten mines, 0.19 for copper/iron mines, 0.65 for tin mines, and 0.20 for pottery industry, while the factor of GR/CT was 0.69 for tungsten, 0.37 for copper/iron, and 0.52 for pottery. In the job category, AR/CT factors varied from 0.16 to 0.96 and GR/CT from 0.12 to 0.72. For the industries studied in 1988-1989, the AR/CT and GR/CT factors were 0.29 and 0.45, respectively. Both factors were definitely influenced by production, CT dust concentration, sample gain, and variation of dust concentration. Moreover, the respirable dust concentration by FSP-BIA was significantly higher than that by 10-mm cyclones, 63.27-73.10% more as showed also by the wind tunnel experiment. Meanwhile, the GR/CT ratio was significantly larger than the AR/CT in every industry or job with only few exceptions. The GR/CT estimates should be considered as independent ones. Following these results, there is a need to use 'ideal samplers' (consistent with the internationally accepted respirable fraction) in practice and to assess the existent samplers in order to homogenize the exposure data situation.

BACKGROUND: Human exposure to silica dust is very common in both working and living environments. However, the potential long-term health effects have not been well established across different exposure situations. METHODS AND FINDINGS: We studied 74,040 workers who worked at 29 metal mines and pottery factories in China for 1 y or more between January 1, 1960, and December 31, 1974, with follow-up until December 31, 2003 (median follow-up of 33 y). We estimated the cumulative silica dust exposure (CDE) for each worker by linking work history to a job-exposure matrix. We calculated standardized mortality ratios for underlying causes of death based on Chinese national mortality rates. Hazard ratios (HRs) for selected causes of death associated with CDE were estimated using the Cox proportional hazards model. The population attributable risks were estimated based on the prevalence of workers with silica dust exposure and HRs. The number of deaths attributable to silica dust exposure among Chinese workers was then calculated using the population attributable risk and the national mortality rate. We observed 19,516 deaths during 2,306,428 person-years of follow-up. Mortality from all causes was higher among workers exposed to silica dust than among non-exposed workers (993 versus 551 per 100,000 person-years). We observed significant positive exposure-response relationships between CDE (measured in milligrams/cubic meter-years, i.e., the sum of silica dust concentrations multiplied by the years of silica exposure) and mortality from all causes (HR 1.026, 95% confidence interval 1.023-1.029), respiratory diseases (1.069, 1.064-1.074), respiratory tuberculosis (1.065, 1.059-1.071), and cardiovascular disease (1.031, 1.025-1.036). Significantly elevated standardized mortality ratios were observed for all causes (1.06, 95% confidence interval 1.01-1.11), ischemic heart disease (1.65, 1.35-1.99), and pneumoconiosis (11.01, 7.67-14.95) among workers exposed to respirable silica concentrations equal to or lower than 0.1 mg/m(3). After adjustment for potential confounders, including smoking, silica dust exposure accounted for 15.2% of all deaths in this study. We estimated that 4.2% of deaths (231,104 cases) among Chinese workers were attributable to silica dust exposure. The limitations of this study included a lack of data on dietary patterns and leisure time physical activity, possible underestimation of silica dust exposure for individuals who worked at the mines/factories before 1950, and a small number of deaths (4.3%) where the cause of death was based on oral reports from relatives. CONCLUSIONS: Long-term silica dust exposure was associated with substantially increased mortality among Chinese workers. The increased risk was observed not only for deaths due to respiratory diseases and lung cancer, but also for deaths due to cardiovascular disease. Please see later in the article for the Editors' Summary.