ORIGINAL ARTICLE

An increased standardised mortality ratio for liver cancer among polyvinyl chloride workers in Taiwan

R-H Wong¹, P-C Chen¹, C-L Du², J-D Wang¹, T-J Cheng¹

¹ Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
² Institute of Occupational Safety and Health, Council of Labor Affairs, Executive Yuan, ROC

Correspondence to:
Correspondence to:
Dr T-J Cheng, Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan;
tcheng{at}ha.mc.ntu.edu.tw

Aims: To determine the standardised mortality ratio (SMR) corresponding to different causes of death in workers from polyvinyl chloride polymerisation factories in Taiwan.

Methods: Retrospective cohort study of workers from six polyvinyl chloride polymerisation factories in Taiwan. A total of 3293 male workers who had been employed for at least one year during the period 1 January 1950 to 31 December 1992, and were alive on 1 January 1985 were included for analysis. Using data acquired from Taiwan's National Mortality Registry, it was found that 144 of these workers died during the period 1985–97. The follow up rate was 99% with a total number of person-years at risk of 40 557.

Results: SMR for all causes of death was 0.78, indicating a possible "healthy worker" effect. The SMR for liver cancer decreased with increasing age of first exposure to vinyl chloride monomer. This association was more prominent for workers who were first employed in the industry prior to 1970 (SMR 4.82). Medical records indicated that most liver cancers in this study were hepatocellular carcinoma.

Conclusions: Polyvinyl chloride workers may experience a higher risk of developing liver cancer, particularly hepatocelluar carcinoma.

Keywords: occupational cohort; standardised mortality ratio; polyvinyl chloride; liver cancer; hepatocellular carcinoma

Abbreviations: AFP, fetoprotein; ASL, angiosarcoma of liver; BFD, blackfoot disease; BLI, Bureau of Labor Insurance; CT, computed tomography; HBsAg, hepatitis B virus surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus; HCC, hepatocellular cancer; IARC, International Agency for Research on Cancer; ICD, International Classification of Diseases; ID, identification number; MOR, morbidity odds ratio; NLI, National Labor Insurance; NMR, National Mortality Registry; PVC, polyvinyl chloride; SMR, standardised mortality ratio; VCM, vinyl chloride monomer

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