Previously undetected silicosis in New Jersey decedents

Background: Despite a reported decline in mortality and hospitalizations associated with silicosis [U. S. Department of Health and Human Services, 1999], this decline may be artifactual, stemming in part from underdiagnosis by physicians. Methods: This study estimates, through radiological confirmation, the prevalence of unrecognized silicosis in a group of silica-exposed New Jersey decedents whose cause of death was chronic obstructive pulmonary disease (COPD), tuberculosis, or cor pulmonale. Two expert readers re-evaluated the chest X-rays of this group to determine the presence or absence of silicosis. The study population was considered to be presumptively exposed to silica dust by virtue of their usual industry of employment as listed on the death certificate. Results: Radiographic evidence of silicosis was found in 8.5% of this population, and evidence of asbestosis was found in another 10. 7%, for a total of 19.2%. Conclusions: The existence of previously unrecognized silicosis and asbestosis in 19.2% of this study group suggests that occupational lung disease is under-recognized and, hence, undercounted.