Women and Minorities Bear the Brunt of Medical Misdiagnosis
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Charity Watkins sensed something was deeply wrong when she experienced exhaustion after her daughter was born.
At times, Watkins, then 30, had to stop on the stairway to catch her breath. Her obstetrician said postpartum depression likely caused the weakness and fatigue. When Watkins, who is Black, complained of a cough, her doctor blamed the flu.
About eight weeks after delivery, Watkins thought she was having a heart attack, and her husband took her to the emergency room. After a 5½-hour wait in a North Carolina hospital, she returned home to nurse her baby without seeing a doctor.
When a physician finally examined Watkins three days later, he immediately noticed her legs and stomach were swollen, a sign that her body was retaining fluid. After a chest X-ray, the doctor diagnosed her with heart failure, a serious condition in which the heart becomes too weak to adequately pump oxygen-rich blood to organs throughout the body. Watkins spent two weeks in intensive care.
She said a cardiologist later told her, “We almost lost you.”
Watkins is among 12 million adults misdiagnosed every year in the U.S.
In a study published Jan. 8 in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.
In all, an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a study published in July in the BMJ Quality & Safety periodical.
Some patients are at higher risk than others.
Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, said David Newman-Toker, a professor of neurology at Johns Hopkins School of Medicine and the lead author of the BMJ study. “That’s significant and inexcusable,” he said.
Researchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.
Weakening of the heart muscle — which led to Watkins’ heart failure — is the most common cause of maternal death one week to one year after delivery, and is more common among Black women.
Heart failure “should have been No. 1 on the list of possible causes” for Watkins’ symptoms, said Ronald Wyatt, chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.
Maternal mortality for Black mothers has increased dramatically in recent years. The United States has the highest maternal mortality rate among developed countries. According to the Centers for Disease Control and Prevention, non-Hispanic Black mothers are 2.6 times as likely to die as non-Hispanic white moms. More than half of these deaths take place within a year after delivery.
Research shows that Black women with childbirth-related heart failure are typically diagnosed later than white women, said Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to further deteriorate, making Black women less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.
Watkins said the diagnosis changed her life. Doctors advised her “not to have another baby, or I might need a heart transplant,” she said. Being deprived of the chance to have another child, she said, “was devastating.”
Racial and gender disparities are widespread.
Women and minority patients suffering from heart attacks are more likely than others to be discharged without diagnosis or treatment.
Black people with depression are more likely than others to be misdiagnosed with schizophrenia.
Minorities are less likely than whites to be diagnosed early with dementia, depriving them of the opportunities to receive treatments that work best in the early stages of the disease.
Misdiagnosis isn’t new. Doctors have used autopsy studies to estimate the percentage of patients who died with undiagnosed diseases for more than a century. Although those studies show some improvement over time, life-threatening mistakes remain all too common, despite an array of sophisticated diagnostic tools, said Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.
“The vast majority of diagnoses can be made by getting to know the patient’s story really well, asking follow-up questions, examining the patient, and ordering basic tests,” said Singh, who is also a researcher at Houston’s Michael E. DeBakey VA Medical Center. When talking to people who’ve been misdiagnosed, “one of the things we hear over and over is, ‘The doctor didn’t listen to me.’”
Racial disparities in misdiagnosis are sometimes explained by noting that minority patients are less likely to be insured than white patients and often lack access to high-quality hospitals. But the picture is more complicated, said Monika Goyal, an emergency physician at Children’s National Hospital in Washington, D.C., who has documented racial bias in children’s health care.
In a 2020 study, Goyal and her colleagues found that Black kids with appendicitis were less likely than their white peers to be correctly diagnosed, even when both groups of patients visited the same hospital.
Although few doctors deliberately discriminate against women or minorities, Goyal said, many are biased without realizing it.
“Racial bias is baked into our culture,” Goyal said. “It’s important for all of us to start recognizing that.”
Demanding schedules, which prevent doctors from spending as much time with patients as they’d like, can contribute to diagnostic errors, said Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. “Doctors are more likely to make biased decisions when they are busy and overworked,” Spencer said. “There are some really smart, well-intentioned providers who are getting chewed up in a system that’s very unforgiving.”
Doctors make better treatment decisions when they’re more confident of a diagnosis, Spencer said.
In an experiment, researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women.
“If they were less certain, they were less likely to take action, such as ordering tests,” Spencer said. “If they were less certain, they might just wait to prescribe treatment.”
It’s easy to see why doctors are more confident when diagnosing white men, Spencer said. For more than a century, medical textbooks have illustrated diseases with stereotypical images of white men. Only 4.5% of images in general medical textbooks feature patients with dark skin.
That may help explain why patients with darker complexions are less likely to receive a timely diagnosis with conditions that affect the skin, from cancer to Lyme disease, which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more advanced disease, which can cause arthritis and damage the heart. Black people with melanoma are about three times as likely as whites to die within five years.
The covid-19 pandemic helped raise awareness that pulse oximeters — the fingertip devices used to measure a patient’s pulse and oxygen levels — are less accurate for people with dark skin. The devices work by shining light through the skin; their failures have delayed critical care for many Black patients.
Seven years after her misdiagnosis, Watkins is an assistant professor of social work at North Carolina Central University in Durham, where she studies the psychosocial effects experienced by Black mothers who survive severe childbirth complications.
“Sharing my story is part of my healing,” said Watkins, who speaks to medical groups to help doctors improve their care. “It has helped me reclaim power in my life, just to be able to help others.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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The Dirt Cure – by Dr. Maya Shetreat-Klein
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As we discussed in our article “Stop Sabotaging Your Gut”, there is indeed merit to living a little dirty, in particular when it comes to what we put in our mouths. Having the space of an entire book rather than a small article, Dr. Shetreat-Klein expands on this in great detail.
The subtitle mentions “growing healthy kids with food straight from the soil”; it’s worth noting that all the information here (with the exception of concerning breastfeeding etc) is equally applicable to adults too—so if it’s your own health you’re focused on rather than that of kids or grandkids, then that’s fine too.
You may be wondering: what more is there to say than “don’t scrub your vegetables as though you’re about to perform surgery with them”?
There’s a lot of background information on what things help or harm our bodies in the first place, most notably via our gut, and as an important extra consideration, the gut-brain axis. Incidentally, the author is a neurologist by professional background.
Then she gets more specific, into “include and exclude” recommendations. In this matter we have one criticism: she does recommend raw milk over pasteurized, and that is, by overwhelming scientific consensus, a terrible idea. Raw milk is an abundant source of pathogens and a breeding ground for even more. There is “living dirty” and there is “living dangerously”, and drinking raw milk is the latter. See also: Pasteurization: What It Does And Doesn’t Do
However, for the most part, the rest of her advice is sound, and there’s even a recipes section too.
The style is something of a polemic throughout, but the extensive venting does not take away from there being a lot of genuine information in here too.
Bottom line: please skip the raw milk, but aside from that, if you’d like to improve your diet to improve your gut and immune health, then this book can help with that.
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Are GMOs Good Or Bad For Us?
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Unzipping Our Food’s Genes
In yesterday’s newsletter, we asked you for your (health-related) views on GMOs.
But what does the science say?
First, a note on terms
Technically, we (humans) have been (g)enetically (m)odifying (o)rganisms for thousands of years.
If you eat a banana, you are enjoying the product of many generations of artificial selection, to change its genes to produce a fruit that is soft, sweet, high in nutrients, and digestible without cooking. The original banana plant would be barely recognizable to many people now (and also, barely edible). We’ve done similarly with countless other food products.
So in this article, we’re going to be talking exclusively about modern genetic modification of organisms, using exciting new (ish, new as in “in the last century”) techniques to modify the genes directly, in a copy-paste fashion.
For more details on the different kinds of genetic modification of organisms, and how they’re each done (including the modern kinds), check out this great article from Sciencing, who explain it in more words than we have room for here:
Sciencing | How Are GMOs Made?
(the above also offers tl;dr section summaries, which are great too)
GMOS are outright dangerous (cancer risks, unknown risks, etc): True or False?
False, so far as we know, in any direct* fashion. Obviously “unknown risks” is quite a factor, since those are, well, unknown. But GMOs on the market undergo a lot of safety testing, and have invariably passed happily.
*However! Glyphosate (the herbicide), on the other hand, has a terrible safety profile and is internationally banned in very many countries for this reason.
Why is this important? Because…
- in the US (and two out of ten Canadian provinces), glyphosate is not banned
- In the US (and we may hypothesize, those two Canadian provinces) one of the major uses of genetic modification of foodstuffs is to make it resistant to glyphosate
- Consequently, GMO foodstuffs grown in those places have generally been liberally doused in glyphosate
So… It’s not that the genetic modification itself makes the food dangerous and potentially carcinogenic (it doesn’t), but it is that the genetic modification makes it possible to use a lot more glyphosate without losing crops to glyphosate’s highly destructive properties.
Which results in the end-consumer eating glyphosate. Which is not good. For example:
❝Following the landmark case against Monsanto, which saw them being found liable for a former groundskeeper, 46 year old Dewayne Johnson’s cancer, 32 countries have to date banned the use of Glyphosate, the key ingredient in Monsanto’s Roundup weed killer. The court awarded Johnson R4.2 billion in damages finding Monsanto “acted with malice or oppression”.❞
Source: see below!
You can read more about where glyphosate is and isn’t banned, here:
33 countries ban the use of Glyphosate—the key ingredient in Roundup
For the science of this (and especially the GMO → glyphosate use → cancer pipeline), see:
Use of Genetically Modified Organism (GMO)-Containing Food Products in Children
GMOs are extra healthy because of the modifications (they were designed for that, right?): True or False?
True or False depending on who made them and why! As we’ve seen above, not all companies seem to have the best interests of consumer health in mind.
However, they can be! Here are a couple of great examples:
❝Recently, two genome-edited crops targeted for nutritional improvement, high GABA tomatoes and high oleic acid soybeans, have been released to the market.
Nutritional improvement in cultivated crops has been a major target of conventional genetic modification technologies as well as classical breeding methods❞
Source: Drs. Nagamine & Ezura
Read in full: Genome Editing for Improving Crop Nutrition
(note, they draw a distinction of meaning between genome editing and genetic modification, according to which of two techniques is used, but for the purposes of our article today, this is under the same umbrella)
Want to know more?
If you’d like to read more about this than we have room for here, here’s a great review in the Journal of Food Science & Nutrition:
Should we still worry about the safety of GMO foods? Why and why not? A review
Take care!
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Surviving with Beans And Rice – by Eliza Whool
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If you’d like to be well-set the next time a crisis shuts down supply lines, this is one of those books you’ll want to have read.
Superficially, “have in a large quantity of dried beans and rice” is good advice, but obvious. Why a book?
Whool gives a lot of advice on keeping your nutrition balanced while subsisting on the same quite few ingredients, which is handy.
More than that, she offers 100 recipes using the ingredients that will be in your long-term pantry. That’s over three months without repeating a meal! And if you don’t think rice and beans can be tasty and exciting and varied, then most of the chefs of the Global South might want to have a word about that.
Anyway, we’re not here to sell you rice and beans (we’re just enthusiastic and correct). What we are here to do is to give you a fair overview of this book.
The recipes are just-the-recipes, very simple clear instructions, one two-page spread per recipe. Most of the book is devoted to these. As a quick note, it does cover making things gluten-free if necessary, and other similar adjustments for medical reasons.
The planning-and-storage section of the book is helpful too though, especially as it covers common mistakes to avoid.
Bottom line: this is a great book, and remember what we said about doing the things now that future you will thank you for!
Get yourself a copy of Surviving with Beans And Rice from Amazon today!
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How much time should you spend sitting versus standing? New research reveals the perfect mix for optimal health
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People have a pretty intuitive sense of what is healthy – standing is better than sitting, exercise is great for overall health and getting good sleep is imperative.
However, if exercise in the evening may disrupt our sleep, or make us feel the need to be more sedentary to recover, a key question emerges – what is the best way to balance our 24 hours to optimise our health?
Our research attempted to answer this for risk factors for heart disease, stroke and diabetes. We found the optimal amount of sleep was 8.3 hours, while for light activity and moderate to vigorous activity, it was best to get 2.2 hours each.
Finding the right balance
Current health guidelines recommend you stick to a sensible regime of moderate-to vigorous-intensity physical activity 2.5–5 hours per week.
However mounting evidence now suggests how you spend your day can have meaningful ramifications for your health. In addition to moderate-to vigorous-intensity physical activity, this means the time you spend sitting, standing, doing light physical activity (such as walking around your house or office) and sleeping.
Our research looked at more than 2,000 adults who wore body sensors that could interpret their physical behaviours, for seven days. This gave us a sense of how they spent their average 24 hours.
At the start of the study participants had their waist circumference, blood sugar and insulin sensitivity measured. The body sensor and assessment data was matched and analysed then tested against health risk markers — such as a heart disease and stroke risk score — to create a model.
Using this model, we fed through thousands of permutations of 24 hours and found the ones with the estimated lowest associations with heart disease risk and blood-glucose levels. This created many optimal mixes of sitting, standing, light and moderate intensity activity.
When we looked at waist circumference, blood sugar, insulin sensitivity and a heart disease and stroke risk score, we noted differing optimal time zones. Where those zones mutually overlapped was ascribed the optimal zone for heart disease and diabetes risk.
You’re doing more physical activity than you think
We found light-intensity physical activity (defined as walking less than 100 steps per minute) – such as walking to the water cooler, the bathroom, or strolling casually with friends – had strong associations with glucose control, and especially in people with type 2 diabetes. This light-intensity physical activity is likely accumulated intermittently throughout the day rather than being a purposeful bout of light exercise.
Our experimental evidence shows that interrupting our sitting regularly with light-physical activity (such as taking a 3–5 minute walk every hour) can improve our metabolism, especially so after lunch.
While the moderate-to-vigorous physical activity time might seem a quite high, at more than 2 hours a day, we defined it as more than 100 steps per minute. This equates to a brisk walk.
It should be noted that these findings are preliminary. This is the first study of heart disease and diabetes risk and the “optimal” 24 hours, and the results will need further confirmation with longer prospective studies.
The data is also cross-sectional. This means that the estimates of time use are correlated with the disease risk factors, meaning it’s unclear whether how participants spent their time influences their risk factors or whether those risk factors influence how someone spends their time.
Australia’s adult physical activity guidelines need updating
Australia’s physical activity guidelines currently only recommend exercise intensity and time. A new set of guidelines are being developed to incorporate 24-hour movement. Soon Australians will be able to use these guidelines to examine their 24 hours and understand where they can make improvements.
While our new research can inform the upcoming guidelines, we should keep in mind that the recommendations are like a north star: something to head towards to improve your health. In principle this means reducing sitting time where possible, increasing standing and light-intensity physical activity, increasing more vigorous intensity physical activity, and aiming for a healthy sleep of 7.5–9 hours per night.
Beneficial changes could come in the form of reducing screen time in the evening or opting for an active commute over driving commute, or prioritising an earlier bed time over watching television in the evening.
It’s also important to acknowledge these are recommendations for an able adult. We all have different considerations, and above all, movement should be fun.
Christian Brakenridge, Postdoctoral research fellow at Swinburne University Centre for Urban Transitions, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Finding Peace at the End of Life – by Henry Fersko-Weiss
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This is not the most cheery book we’ve reviewed, but it is an important one. From its first chapter, with “a tale of two deaths”, one that went as well as can be reasonably expected, and the other one not so much, it presents a lot of choices.
The book is not prescriptive in its advice regarding how to deal with these choices, but rather, investigative. It’s thought-provoking, and asks questions—tacitly and overtly.
While the subtitle says “for families and caregivers”, it’s as much worth when it comes to managing one’s own mortality, too, by the way.
As for the scope of the book, it covers everything from terminal diagnosis, through the last part of life, to the death itself, to all that goes on shortly afterwards.
Stylewise, it’s… We’d call it “easy-reading” for style, but obviously the content is very heavy, so you might want to read it a bit at a time anyway, depending on how sensitive to such topics you are.
Bottom line: this book is not exactly a fun read, but it’s a very worthwhile one, and a good way to avoid regrets later.
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What is silicosis and what does research say about it?
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Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.
Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.
Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.
But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.
The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.
Silicosis in modern industries
Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.
The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.
The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.
A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.
An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.
Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.
In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.
In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.
However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.
A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.
The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.
Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”
Silicosis symptoms and treatment
Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.
Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.
There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.
Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.
Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.
In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.
Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.
Research roundup
Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.
Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.
However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”
The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.
The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.
“Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.
Silica-Related Diseases in the Modern World
Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.
The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m3 to 0.1 mg/m3, although the risk of dust exposure to workers still remains high at those levels.
The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.
“Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.
Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.
“Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.
A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.
These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.
The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.
“Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”
Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.
From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.
Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.
At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.
The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.
“It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”
Additional research
Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
Chandnee Ramkissoon, et al. Respirology, December 2023.Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
Patrick Howlett, et al. PLOS Global Public Health, September 2023.Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
P. Jamshidi, et al. Pulmonology, June 2023.From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.Silicosis After Short-Term Exposure
J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
Ryan F. Hoy, et al. Respirology, March 2022.The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
Antonio León-Jiménez, et al. Chest, September 2020.Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.Australia Reports on Audit of Silicosis for Stonecutters
Tony Kirby. The Lancet, March 2019.Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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