! ! 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! ! ! ERRATA April 6, 2015 Taconite Workers Health Study Final Report to Minnesota Legislature The final report had the following changes made and was posted to the website with these changes on April 6, 2015: 1) Typographical errors were found in connection with the term cumulative exposure. This was changed from EMP/cc/years to (EMP/cc)-years when needed throughout the document. Changes were also made for cumulative silica exposure when needed from mg/m3/year to (mg/m3)-years. 2) On page 15 of the report, in the 2nd paragraph, a footnote was added. This reads as follows: The NIOSH REL is intended for regulated asbestiform EMP and for their non-asbestiform analogs. 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 5! ! ! NRRI Natural Resources Research Institute 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$non9respiratory?! • Taconite!workers!had!higher!than!expected!death!rates!from!three!diseases:! mesothelioma,!a!cancer!of!the!lining!around!the!lung,!lung!cancer!and!heart!disease,! when!compared!to!people!in!Minnesota.! • The!vast!numbers!of!other!disease!categories!were!not!higher!than!expected!or!were! not!felt!to!have!an!occupational!basis.!!! 2.!What$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!fiberPlike!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!abovePaverage!exposure!to!dust!containing!EMPs!were!twice!as!likely!to! develop!mesothelioma!as!workers!with!belowPaverage!exposures.!!! 3.!Are$workers$at$risk$for$common$dust9related$lung$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!2010P11!and!revealed!xPray!evidence!of!dustPrelated!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!xPray,! 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 7! ! ! frequency of lung disease on chest x-ray, comparable to the general population. 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!