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1 Final Report to the Legislature Minnesota This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp FINAL REPORT TO THE LEGISLATURE MINNESOTA TACONITE WORKERS HEALTH STUDY DATE: November 24, 2014 TO: Sen. David Tomassoni, chair Senate Jobs and Economic Growth Committee 317 Capitol Sen. Tony Lourey, chair Senate Health and Human Services Finance Division 120 Capitol Sen. Kathy Sheran, chair Senate Health, Human Services and Housing Committee 120 Capitol Rep. Tim Mahoney, chair House Jobs and Economic Development Finance & Policy Committee 591 State Office Building Rep. Sheldon Johnson, chair House Labor, Workplace and Regulated Industries 549 State Office Building Rep. Tom Huntley, chair Health and Human Services Finance Committee 585 State Office Building Rep. Tina Liebling, chair House Health and Human Services Policy Committee 367 State Office Building FROM: John R. Finnegan, Jr., dean and professor (E-mail: [email protected]; Phone: 612 625 1179) Jeffrey Mandel, associate professor, principal investigator (E-mail: [email protected]; Phone: 612 626 9308) COPIES: Iron Range Legislative Delegation Rep. David Dill Rep. Mary Murphy Sen. Tom Bakk Rep. John Persell Rep. Tom Anzelc Sen. Tom Saxhaug Rep. Carly Melin Rep. Jason Metsa 1 November 24, 2014 Dear Legislators: We are pleased to present the final report on our research regarding the health status of taconite workers. This report covers the assessments made by the University of Minnesota School of Public Health (SPH). The Natural Resources Research Institute will be submitting a separate report on the environmental characterization work that they have been doing. This report contains the SPH’s efforts in occupational exposure, mortality and cancer incidence, case-control studies and the respiratory health survey of taconite workers and spouses. The final NRRI report will be submitted under separate cover. In some study areas, peer-reviewed papers have been published. Others are being prepared for journal submission and are available in the appendix of this report. We remain committed to open communication and transparency. We plan to hold at least one additional stakeholder meeting through the Minnesota Taconite Workers Lung Health Partnership on December 1, 2014 and will continue to update our website, www.taconiteworkers.umn.edu as studies become published. We would be delighted to discuss the report at a convenient time. We would like to thank those current and former workers who participated in our screening study. We’d also like to thank the companies and union officials for cooperating with several parts of this work. Finally, thank you for the opportunity to advance scientific knowledge on this critical issue facing Minnesota. John R. Finnegan, Jr., PhD Jeffrey H. Mandel, MD, MPH Professor and Dean Associate Professor Principal Investigator 2 FINAL REPORT TO THE LEGISLATURE MINNESOTA TACONITE WORKERS HEALTH STUDY Table of Contents Page Number Acknowledgement………………………………………………………………… .......4 Abbreviations Used in Report……………………………………………………...... 5-6 Overall Summary……………………………………………………………………..7-8 Executive Scientific Summary………………………………………………………8-14 Occupational Exposure Assessment Component Summary………………………..15-18 Mortality Study Component Summary……………………………………………..19-20 Cancer Incidence Study Component Summary…………………………………….21-22 Mesothelioma Case-Control Study Component Summary………………………....23-26 Lung Cancer Case-Control Study Component Summary………………………..…27-29 Respiratory Health Survey Component Summary………………………………….30-32 Appendices Listing and manuscript status……………………………………………..33 3 ACKNOWLEDGEMENT This project is the result of the concerted effort of the entire Lung Health Partnership. The list of contributors to this effort are many and include the University of Minnesota investigators, graduate students, study coordinators and professional staff, the Minnesota Department of Health, the company representatives from U.S. Steel, Cliffs Natural Resources and Arcelor-Mittal, the United Steel Workers Union representatives, the legislators involved in the initial funding of this undertaking, particularly the Iron Range delegation and the participants of the Respiratory Health Survey. Our gratitude is extended to all of the people from these groups who contributed to this effort and, in so doing, helped in the effort to improve the taconite mining industry of Minnesota. 4 ABREVIATIONS USED IN THIS REPORT ACGHI American Conference of Governmental Industrial Hygienist BMI Body Mass Index CVD Cardiovascular Disease CI Confidence Interval CF Conversion Factors EBSD Electron Back Scattered Diffraction EDS Energy Dispersive X-ray Spectroscopy EDXA Energy Dispersive X-ray Analysis EMP Elongate Mineral Particle ICD International Classification of Disease ISO International Standards Organization LTAS Life Table Analysis System MCE Mixed Cellulose Ester MCSS Minnesota Cancer Surveillance System MDH Minnesota Department of Health MIR Mesabi Iron Range MRHAP Mineral Resources Health Assessment Program MSHA Mine Safety and Health Administration NAAQS National Ambient Air Quality Standard NDI National Death Index NIOSH National Institute of Occupational Safety and Health NMRD Non-malignant Respiratory Disease NRRI Natural Resources Research Institute 5 OEL Occupational Exposure Limit PCM Phase Contrast Microscopy PEL Permissible Exposure Limit PIXE Proton Induced X-ray Spectroscopy PM Particulate Matter RHS Respiratory Health Survey SAED Selected Area Electron Diffraction SEG Similar Exposure Group SEM Scanning Electron Microscopy SMR Standardized Mortality Rate SSA Social Security Administration TEM Transmission Electron Microscopy TSP Total Suspended Particulate TWA Time Weighted Average TWHS Taconite Worker Health Study UMN University of Minnesota UMD University of Minnesota Duluth UMTC University of Minnesota Twin Cities 6 Taconite Workers Health Study: Final Report to the Minnesota Legislature I. Overall General Summary The following is a general summary of the Taconite Workers Health Study. Details may be found in the rest of the report and in the full component reports in the appendix. In 2008, the University of Minnesota School of Public Health, at the request of the Minnesota Legislature, launched the Taconite Workers Health Study. The request was prompted by the discovery of an unusual number of cases of mesothelioma, a rare cancer of the lung lining, in Minnesota taconite workers. The study asked three questions to assess occupational risks to taconite workers. The investigation has now concluded and below is a snapshot of its findings. 1. Is working in the taconite industry associated with mesothelioma and/or with other diseases, respiratory or non-respiratory? Taconite workers had higher than expected death rates from three diseases: mesothelioma, a cancer of the lining around the lung, lung cancer and heart disease, when compared to people in Minnesota. The vast numbers of other disease categories were not higher than expected or were not felt to have an occupational basis. 2. What factors, particularly dust from taconite operations, are associated with mesothelioma and other respiratory diseases? The length of time people worked in the industry was linked to higher levels of mesothelioma but not lung cancer. Exposure to a fiber-like mineral, referred to as elongate mineral particle (EMP), was linked to mesothelioma but not lung cancer. EMP exposure, as defined in this study, could be from either dust generated in mining and processing or from commercial asbestos exposure. Workers with above-average exposure to dust containing EMPs were twice as likely to develop mesothelioma as workers with below-average exposures. 3. Are workers at risk for common dust-related lung diseases and are their spouses at risk for the same diseases due to their partners working in the industry? A screening of current and former taconite workers and their spouses was conducted in 2010-11 and revealed x-ray evidence of dust-related scarring of the lung and lung lining (pleura) in workers. There was a link from EMP exposure in workers to scarring of the pleura. Spouses of taconite workers had comparable evidence of lung scarring on chest x-ray, to what’s been reported for the broader general public. Conclusions The studies identified links to mesothelioma from working in the taconite industry and exposure to EMPs. The role of a specific EMP type of exposure is not clear. The overall risk for mesothelioma is low compared to other disease frequencies. Taconite worker spouses, as a group, showed a low frequency of lung disease on chest x-ray, comparable to the general population. 7 The authors of this report have made recommendations for taconite workers, the mining companies, unions and the Iron Range health care community, designed to assist in the safeguarding of future worker health. The complete report may be found at www.taconiteworkers.umn.edu. You may direct questions about the study to 800-646-9255. 8 II. Taconite Workers Health Study Executive Scientific Summary The Taconite Workers Health Study (TWHS) was funded by the State of Minnesota and began in 2008. The study was conducted in response to earlier findings by the Minnesota Department of Health (MDH), which described an apparent excess of mesothelioma within a cohort of iron ore workers. The taconite cohort originated from work done at the University of Minnesota (UMN) in the 1980s. At that time, all workers in the iron ore industry were
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