Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage.

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Abstract
The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected (95% Confidence Limits 1.36, 2.62). Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant (odds ratios greater than 10). High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy.