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Absence of Synergism between Exposure to Asbestos and Cigarette Smoking in Asbestosis'" JONATHAN Mo SAMET, GARY R. EPLER, EDWARD A. GAENSLER, and BERNARD ROSNER ~. / SUMMARY i,~ ~cuiscd for.I Jh~rch .,~, 1979) I,c-~lo~i~ i~ ui~ch'ar (5-9). i'll'el I~ of I'~]lll%lll't' Io ;1411'~lo~ .lult t it;ll l'l I~ ~lll(l~- i~I hi iil~ d~vl.lOl,lili.nl ill ;i~ht-~lO~i~. w~ i iii( [lf~. illllll~i~. I1) ll~li(';i, i lid ileal iiplllf ;llllior- lli:ilil)', iIt.tira~ed filllt'l[ ~'illil t;il~;l¢itb ;llill ilrlll-.l~l.il ~iil~h'-hlt';ilh 11il[ll~Tli~ ilill~cil) of lilt' hill~ [or (;O (OI.tu) (~. 10. 11), Thl' ill) lilll I ~ ill fh ill ~) lit1 ~i~111 Iwl t~TI:ll ( i~:il t'llt' ~liili~. ";I Prr~<nird ill |l.il t :It tile |ilh'lli.llillll;ll (']l)lif<ll liil ( }l.i II|llllillilli| ] .1111~ llkc.i~t'..~.ill Fi;lIK i~l O. (:,~1iI,, I chillLIl.% 'JT" .%l.ill II <7. 1{179. I Itt'lliic.q~ rill-i. |liiill.~ .~|kiiih| lit. ;illi|lr~¢l| io Edl~-;lld A. (;;t¢ll~l<i0 lliu.quii lliiiil-i~h)- .~cli.li| T107241949

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mine the independent altll nf e).p¢.sttrt- to ust-~ for FV~, D~o, and ikely Io lm related to the the ptobal~ility of their OC- ;IIISfIII tiled probabiliLy. d:ttlon to'~ient ~quared ability nf the imh'pcndcnt II O[ each "lltlt'pPIIt]l'll[ yar- d. ]n the tllotlei de~ribed, :t} tiller|tie the multiplica- Ill is picket|t, the fldl term imlicatcs the lllag. ~ig~dficatq. A ~lep-up bier- . which ctttercd it~diccs of ;till8 of the StatiMital Pack- wcte u~C (20). the rt'gl .ssiot~ ntotlel, the U,tlillll$ ,bt:dtwd horn 140 troup w~ tc as follows: ght- 0.t~23" age -2A3 l* height -O.Ii~ age ~ 1.50 his aClUal by ]liS predicted tk ~UbjtCt~ wele ~ah'd up- CIGARt-*{"I E $.Mf)K1NG AND I- XPOSURI-. "I 0 ASBE3 I OS 77 arid the r:tdiographic ~ore. The independent vari- ;d)lc.'~ (xl) illClllded (l) tilt" |t)g o[ li[etlme pack-)eats of dapcd nlnce first t-xp.sure, as an imk'x of exposure to test for a s)ncigislic ]xltetactiolL The h~arithmic t~a~tbftntnalitm of lifetimc pack-)ears of cigarettes plant ~ariation iu exposure was ;tctomplishvd by ere- aild h~tllcator vali;tbh.s for the plants. The plant-ex. posure illlelaetillll It'l Ills wcle t'lllt'icd dflcF the lilain poxt~lc-cigaret le interact|Ore The logistic model tt~vd f.r clubbing, talcs, and dyspnea regxcssed the logit tran~fotmallott ~d the probability of an ahtmrmality o. the iudcpendcnt ~.tr/ahles. As in linear multiple reg~es,iot~ anaiysis, the sigtfificance of Iho effect of each indt'l~cudettt xaz'- grt,u[ts wele ptmhxl. "rlle imlcpt'n,lent variahles were tqlteled hiera~chlcally, as hi the [lilt'at inulli]~le re- g)e~SiOll IlltKlel, with the ]ttgalilhln t)[ lifetime ciga- it'lle SlllOkillg and years si/lcc filet t-xpctMil'O piCOt'if- ]lie their iuteractlon tCltll ;tlid the pl:lllt-t'XJ~OSllle Results D;it:l x~cle ,ix:lil.lhh: fol .t(19 ~tllXt:)" subjt.(ts, ot whtlln ;~8~ Illlllt.'rW(.'IH tOlll},tl~l(2 ph~.q,ll(,glc test- hie. "|'h~: lllt',lll age :lllll Slll'll,illg Jlabith of the 4 st,~e-y grrmp,, were shnil:tr. ;is "was the l)rcva- lt"zttt" Of ]adiogtal)hit :d)tmtm:llit~ (tahle "l'he 2 qlipyaid gh,up~ had ~ttqaint.d nearly tory A w:h of ~hcH Itrr dulqtlEon Ih:lll that in fac- tor} ]L hut the t~tt'zttt ittunber Of )ears elapsed "I'he mtdtiple rcgrc~sion analyst's were first lmrh,tmvd ~epar;llCly |or (';if tt [dam. Both total to, tilts with regard to s)nclgi~nt were not vd I~y die ~}~oice of exposure index, o~d) the re- ,tilts obtained with ~t.,tl's since ill'St exposure are 1 eporl ed. A sigtfilicat~t cffctl ~d exposure It> ashcstos on FVC was fotmd ht huth ~ltil~;l~tls and factory B. whc~ca~ a s/gnifit:~nt cfle(t nf ~igarette ing was l~,'<'~t.nl rally iu slail)~,rd B (lahlt. 2). "the intcrat lion Imtwut.n f i~ar(.tl{' smoki~g was tlOI sign|fit:mr in an) ol Ihe ~urvo)" tltms. The r~:~c~sb.)n ~l)t.~fit icnts for exposure Io :~sl)u~los wcte itlcntital iu the ~ shipyard g~OUl~S (table ~). Cigarette stnokh~g was a~o- ti.~cd ~ith a tletrca~t.d DL~oin each of the gl~)ttl~ (t:~b[t: 3). All .tdditi~)nal effect of expo- stttC IO asJ)esto~ %%zls [t)llll([ ollly ill factory A fa(tor5 B. In fa(tt)ty IL whorl, ex}msute to asl)es. Ihe tt)nt~il)tttitm o| exl)o~ure to ;IbbebtOb tO W:t~ ncarly twite that u[ t igalCltt" ]'ABLE 1 CI IAI]AC I'FH ISTIC5 0 F STUDY SI..II~JE.C'I S Mealt dfl~, ~¢ 42 6 45 4 44.9 41.5 Pr*:se~}t GO bG 40 b2 P~st 30 27 ~2 30 ~J,~ver 10 0~0 0/1 ~9 1.0 1/2 ~ 2/1 10 5 13 12 T107241951

78 TABLE 2 REGRESSION* OF FORCED VITAL CAPACITY. EXPRESSED AS A PERCENTAGE OF THE PREDICTED VALUE. ON LIFETIME CIGARETTE CONSUMPTION. YEAFIS SINCE FIRST EXPOSURE TO ASBESTOS, AND THEIR INTERACTION Coef fic*ont A FI 2 Coef f~cien! A R2 Co~f f,c~enx at which all variables were s,gnlf~canto i'Not s,gnil~cant. :~p < 0.01 §p < o.o5. As with the FVC..',~'n=t.rgism between (:ig;lrette ('OllSt|llljJtiOll alld L'xJM)titllc tO aslle:,los Was llOt l)]escnt. Exl)o~ure to a~bestos was the prindpal dctc]minant o{ the radiogral)hic ~{ore, but ~mall .~(hliti~e ctlc(ts ()f tigarette smoking, without s)'ncrgism, were noted (tnble 4). In thrse ;ttlal)ntrs the contlil)tttiozl to R2 o[ the inlt'ra(li~n trrm was minimal (table 5). With the cx(,.pti,~n of d~e-FVC ~n factory A. ~calcd that none .tpl~.athed ~ignitic;m('e. In athliti(~n. Ihe tlilettion of elleel in(lic;ttcd I~y the sig. ol the rcgtcn~ion tutflit:ient wa~ not con- si~tcntlT Ihat antitipa~cd lot ~)ncrginm. When the .1 survey group were l)()oled, only additive effects on FVC. Dt.co. and radiographic score of dg;.ette smoking and cxp(~sttrc Io as- firm further the ulhcnce o[ ~)]lcrgi~m, the re- gression anal)ses dc~cribt'd wt'rc d.~ac separately withh} t igarcttc-smnking g~(~.ps. The icgl'c~siol} c t~( ff~(it.ztts ¢~t) exj,o.urc to asb('Sl()S for FVC and I)L( o t rn(lcd Io bc h ight-~l lit t ho~c who ]t~d ne~ cr ~mokrtl: they were ~1~. ~amc f.r lilt' ic ~(.l'C in these who ]l,l(I }lt'~el" sm~)ked and ]}a~t sm.kcrs (lahlc 6)..%h.mbc~s of tlt~' ~ riga- zcltv.sn.~king (.itt.~.]ic~ (lid nol (liftEr in znean job. The results ol the ].glt m.(Icl f()~ the TABLE 3 REGRESSION" OF DIFFUSING CAPACrI'Y OF rile LUNG FOR CO, EXPRESSED AS A PERCENTAGE OF 3HE PREDICTED VALUE, ON LIFETIME ClGARET1E CONSUMi:'IION, YEARS SINCF FIRST FXPOSUHE TO ASBESTOS, AND THEIR IN I f.'RACTION 0.01. 0 05. TI07241952

f;I~;ARF+.I IL SM~lklNG. A~II+ I-xr'¢ISURE I~) A~B}'vlOS )ASA ARETTE ~_STOS, Coellicienl NS NS NS NS ~an~ tn R2 I)t.co. and r;~diographic ng and t'x|~o~ute to Its not show:~). To con- e o[ ~)m:r~i,m. the re- .'d were donr ~cparatdy ~q~mp~. Th,.. rc~rr~ic, n t in tho~e who had never +tile lot the radi~,gr;iph- d uevcr ~tn< ked and in 31t:lllhrrs ol ~l~e ~ <iga- did ==ot differ in mean ,c~tos, t,r t)j)e ,,[ current git rondel fi}i the pres- EXPRESSED TIME RE TO NS his TABLE 4 REGRESSION" OF RADIOGRAPHIC SCORE ON LIFETIME CIGARETTE CONSUMPTION, YEARS SINCE FIRST EXPOSURE TO ASBESrOS, AND THEIR INTERACTION Coeff~clent ~.R2 Coef f=cient &R2 Cou/t,uierlt ShtDyard A 0.47t 0 09 0 03111" 0 27 NS¢ Shipyard B NS~ -- 0 0351" 0 16 NS Faclory A 0,36§ 0.07 0 034"~ 0 08 NS I:acloty B 0.24§ 003 0.045"~ 0 41 NS "[p < 0 01. ~Nol sigm flcant. §p ¢. 0.05 t't,t'c of r;,Ic~, chd,I}iug, ;rod dy',l,n<'a ]mr;llleled those of the multiple l'('glt'~iOll zn+,del ],resent- cd lncvi~+t=sly. Additive el[cots on each o[ these tlini¢:tl I,aramcle~s of both cigarette smoking and cxp¢~surc to .t~I)t'MOS wcrc touBd, whereas the i=Hr=action term was not significant in any u[ Ihc Discussion :~...,I.+c.',to:~ workers who ;if't" C[~;Ir(.tlc '-.tl~okers t+l~%'c :~tx in( ith'ute of hmg (;,l~tt'r fur h.,reatcr than i,t-clcd on Ihc b;~.~is ol .~,nuking ;t]-,ic (l, 3). Doll ('~) +'tnd m~rc rt.tct=tly, Sara¢~i (,t) and Rt~.~si- tt.r ;llld Bt.rry (8) h:lvc e~.;.nintd d+c ,,uit;d+il- it,. of :~dditive al=<l mt,llipllc;~tivc models o1 car- tit=tiBt.m.,,i,+ h+r dc+(.tlbing Ihi.,, t'~.¢e.,,~.. Ead~ has to~lehRlcd Ihat a muhi|+lit+,=tivc nt=+¢lel i+ most ton:,i,,tt.ut with tht: av;tilablc cphtctt/i,h>gic data; the itnl)l~,':ttiot+ o| d+is mutlel is that exposure dcntly Io ]}rtalucc hmg {.mcer btR are s}=~crgis- t;c in pcrs, ns ~.xl~o~ctl Io both (4). iIt+t I+t.cn tle,~rl) r~lal+li~hed (5). XVelm (6) purtcd an intreast.d lnex;drnt'e +ff radiograph fi[JlOSi~ ill ;tslJesto~ text+to W<+l'kers who smoked t ig.==t Itc~. "l'hi~ i~tt t.~t igat i+nt, hox+cvcr, int ludcd ++nl) 100 workers, did =.>1 n~c Ihe IhO da~silitatitm, ;=nd did ~,~t d+~ti.gui+h additive honl ~}nrrgi+tit rltctt+ ,+1 tiga~ctte M,rc lect.=~tl)', Wci++ +rod 'l'hc, d;ts (9) I'++t£nd a ~cl;~ti,~n~hip hetwt-ct~ ¢ig.+rc==e ~moking and ra. tlh~.qJhit }+lt=[t=~i+~t= in .IS .=+hc+tt=s wurkcr+ but Wt'lc ilil:II~]c 10 l('.,¢h ;iilx t~lillii~i()ll iil~utit TABLE 5 Rt:GRESSION COEFFICIENT (~). STANDARD ERROR ($E) OF AND CONTRIBUTION TO R2 OF THF INTERACTION TF.RM° FVC. % preo,cled /J 0.19 0.:21 0.67 0.017 SIS of ,6 0:22 0 24 0 37 0 17 .3. R2 0.01 0.01 0 04 0 00 Dr-CO, % t' *,diCl~d {I 0 24 1" 0+53 0 SF of ~ 0.41 0 56 0:25 -%R2 O.00 O.OI 0 02 JJ -7.GX 103 -2.8X 103 -1OOX lU-3 2.7x 10-3 51-" ofj~ 13 0X 10"3 120X 10 3 18 0 X 10.3 9)~ 10-3 ".3.R2 0 O0 0 00 0.O0 0.00 T!07241953

80 TABLE 6 REGRESSION COEFFICIENT" ON YEARS SINCE FIRST E×POSFO TO ASBESTOS OF PER CEN'£ PREDICTED FORCED VITAL CAPACITY |FVC)0 PER CENT PREDICTED OIFFUSING CAPACITY OF THE LUNG FOR CO (D/co}. AND RADIOGRAPHIC SCORE WITHIN SPECIFIC CIGARE] TE-SMOKING GROUPS Never (n 58| P~st (n - 118) Pr¢.~¢nt [n- 207) FVC, % pzed,cted -O B2"~ O 50"~" O DLCO. % pru(licteO -O 92~ -0 85~ R=¢Jiogtap~c ~core 0 042~ 0 042~ 0 O24~ pooled, ~p < 0.01. ing asbestos =cxllk. ~o~k~'=s :=ml shipy;~td ashes. ]~t.r[o=m~d. Although ~ot Sl~¢,tific,~ll) sou;hi by lh~ J~csligalors, lhc =c~ull~ of Mudic~ uf I,~-¢ mine aml mill ~orkers did uol (~6) ~ludicd wo~r~ at 2 ;~[~'~l,~ ¢¢~ ¢=u=~ man- ll~l~g Ilmclio~l did nol d~,l~lOll~ll~He SyllulgiMli, "I'hc pruscnl stud) provides [u~thur ~r.phiL inulu.iou (hfl)k'~ 3 5). I[ ill llt~ll~llloi,['r~, l']l~ ol,[~=J~il~ W.l~ A~ discussed =~'¢cndy b~ Bc{Ma~ (5), ~illl L" []I Sl ~'~l){~lil'~ ]iill L' I~¢'¢tl H~'HII ill Ihe); h;Iv~ [)fUll tl~t'd I~ ~i~slII~Cl "l'hc m.hlx,~ialt- t~'th~itluls u>ctl wt-rc ahle ICCl~ of l~¢=lll ('~I.~I=IC5 ~II PVC ,Hid l)l,co i~r~ hcqu~'nd) .h.~'~<'d 0.d.h'~ ~ aml 3). l:~r FVC, ~ ;tlill :~). ['lie l't ~l'{'~h~l~ ¢i~vlh¢ i~'lll tlll ~'~i~ (~9, :111) ha~ i,~i,,uq} dc,,,il,,'d :~n i~- T!07241954

ED TO F¥ IFVC), ~ OR CO ,ant (n = 207) -o.5~1 NSt 0 O241" I plants Bt-cklake (5), in the ~urcmcnts of dust to for eadl w.rker, the the mm~ber of years >n~hips. 'I'he~e indices ~cliabi]ky and with- Shnl]ar consklcrations cstima/c~ ol cigarette questionnaire as an ,rct*e smoke. The tell- adequate (27). and ~logic parameters cse indites ¢ff exposure agaiztsl the dclcctkm saltier'.,, u~ed ,~cre able exposure t, :,rooking. Additive ef- n FVC ~md D~o were Its ~ and 3). For FVC. o[ clgare'lle true fiK I)~ O (tables ~twf~£i¢.nl ot (ig~rene klngl~ ~mif~m~ in the 4 ~l~u cff¢'(Is ,,[ £igareue • no ~m,,k{ng ,m the M~o re,ted .tab]e 4). CICARI-.]'I I- NMOKI\f. A.XII t XI'O,~I.RE 1 (]' AS, IllS| OS 81 thaw lie)so .[ x=.n~m~)kcrs (32). ~Vhc[hcr tl~c ol)~c=vcd effect of ~mokix=g ¢,n the ]LO U/C l,~Ol,=sion rCl,rCscnts a ~c.,~i~ivity t¢, such ciga- reliC.]elated :dmm'ma]il;cs is unclear. A high i)lev:dt-me ,)[ hil:~l(.ra] fine Ires been ],rc~i,us]) (le~(.~il,ed in l,cr~,)n~ wilh lhci] picscn¢c m;~v b¢. an carl) indit~Hi(,n of dis- case (13). Bih==eral fine c~:~(kles arc also re- dHo~)ic obstru(tive pulmonar) dN('asc (I~). Our logh m~.h'l (.nf. mvd d~c huh'pendent eL l~'('tS O[ I]IC ~ ex]lo~lllt-s Ull lhc in¢:va]cn£c ol bilateral fin(" (~a(kh's. l))sl,nea ~md (l.bhing are n,~n~j,ecifit m;,nih'~l.*tions of l,ulm,>n;ff)' disease .,ml were a~+)¢i:Hed ~ith bt)th eXl)C,~tlres. :ts was .mlitilm~ed ..Xhh~n~g]~ these :m:dy~es do not demonstrate lilt} tlf)t~llllClll advvr+c t'ffc( t~ of each of these exl~osures. "]'h4".se re'stilts furthcr (.mj)hasize the m'cd for dc~rt'asing Ihc high prevalence of torte smoking (t;ibJe ]) in wolkers at risk of ,nt up;Hi<)ilal lung clist.ase. .'lrk;,ou'l< rlglnet~t 'l'ht' **litcrs that*k Dr. F*:mk E. Spciter for his ,.nr:,g,.men~ :rod for his rr~iew of ~his ma**uscript. References 1, St'likolt IJ, Hamm¢,nd FC, Churg J. Asbt'~tos t'Xl),:Stl~e. ~moki~l~ and m.,+plasia. JAMA 1968; 2. D,~I[ R. The agc di~t~ibtnion of ranter: ht~plica- B<qry (;, Nc~+h..~v MI+, "Furok M. C.mbim+d I.Ilily flora lung (ant'er Ju f:ttto)y workuls. I.~n- 8. ll.t~s~ilcr CE. Bcrpi." (;. The hitcraciilrlll cli" CXl),~sul-c :lilll stnokin~ ,m lebilil31Ui} henllh, ln- II-lil:iliilllal ~fil'lllilil Mcclillg, ~11 ill;ill. ~i'llll lulicI 1977. 9. IVt'i~> t1", Thl-lli];ll PA. Plculilpllllliillial)' ~lillOllg ;l~lit'Mill ~¢(,lkt'rs in iclallon Ill MliO[ilig ;iinl I)l)¢ ill i:xllll~lii~. J (ll'Cllp Med 107~; 70: :1.11 -5. ]0, ~Iilillll)" RI.tt ]i', Fl'lli~ fIG Jr, ~ii1~i'55 %%11 ll'~l£r J, O:it'li~k'r i~A, l~t'[l~ ill low i~llilll(Jlir lind i'phlelliiohllil lll)~l'i~:iliilll~ ~llil)l.ir(I pipe i'ol~rl'l'~ :ilill (lilill~]~, ~ [lill Ml-,I Hill: 7~5:1771 ~. I1. Mlillill)' RI.H It, {kit'llslt'r [A, Ri'ildin~ ~A, ris BG Jr. ~ls" exposure to asbestos: gas ex- ¢h:~ug¢ in ship pipe ,ox¢.re, s and ,,,n**ols. l:lll ii llll Ill':lhh 1972: 25:253-64. (:1t. 'l'he ~llliilil'~inl- ill il'~llh~lill) /3:333-J. nhiu~ for Ihc clinical iii~:,i~lii<t'lii~lil ol I~e ililhl~- l,i:,~, 3b,l 7. ~ (:lhi hill,~l i .... • 15, (;iivii~lcl ~A, ~iliilli ,4A. All:u'~lllCli~ [or ~illO. nil'Ill. (:l-M 10/3, Ii~: 1~8 18, UICC Cinlliiliilt'l~ UIC(~!Oh~chin:ill II.() tl]C I!1~1 lilll,llUlllona] ~l:i~[~flllllili 18. i)i;ipl.r ~1~, ~lnilh It. Alqllied i'¢,~l~,s~i~,l~ almly- 19, Arlnh.~e, P. S~alis[ic:d i~.~]~ls hi n~cdital re- ~'alch. ~ew Yolk: John Wih.y =nd S.~l~, 1971: ~h' ~!~. S~liMhal i~;i¢~a~c for Ihc ~,¢l;i} ~l ~. ~ ~, k: McCr;iw Ilill. 1976. hll J I'l~hh'nlkd 1971; 3. ~,, 61. 22. Fbh¢'r RA, Yal~'~ F. ~l.I I~ ical I;lblcs. 6111 ~'d. ~:l Me I)-..dd JC. Ih', Ll.,k~" M R. F-url~ier-M:ls~uy Ti07241955

996 l.~g:LOi.1_ Ii

Respiratory Disease Mortality in New Mexico's American Indians and Hispanics JONArl.tAN M. SAMF.T, MD, M~,, CH/',RLt:.S R. K.I:Y, MD, I'HD, L)ANIEL M. KUTVIR'r, BA, ,XNt) CHARLES L. WIGGINS, BS Abstract: To determine the effect of ethnic group on respiratory di.',ea.',e occurrence, average annual sex, ethnic, and di~ea.,,e specific mortality rates for the period of 1969 to 1977 were calculated for New Mexi- co's American India,i, Hispanic, and Anglo popu- lations. Incidence dala were available for respiratory tract cancer. "l'hi.,, study corroborates previous lind- ings of reduced mortality li'om lung cancer in Arneri- can Indians of both .',exes and in Hispanic males. American Indian mortality from tuberculosis and from influenza and pneumonia was hlgl~. Hispanic males and American Indians of both sexes .showed low mor- tality rates for chronic obstructive pulmonary disease (COPD). l)i!]_'t;rin~ cigaretle usage is tile mo~t obvious explanation for the variations in COPD Rind lung'can- cer occurrence with ethnic group. (Am J Publh" th,alth "~:492-497, 1980.) lntroduclion New Mexico's tricullurul populatitm of American In- dians, Hi,paints, .',nd Anglo.,, (non-Hispanic Whiles) pro- vides an opportunity Io ;ts.~es.~ disease occurrence in several distinct ethnic group.',. This report describes mortality result- ing from infectious respiratory diseases, from chronic res- piratory d~.',ea',e,,, and frofll cancer of Ihe respiralory Iract in New Mexico during the period 1969 to 1977. For cancer, the mortahty d;lla are supplemented by incidence data from the New Mexico Tumor Registry, a population-based cancer registry which cncompa',.,,es the entire slate. The.,,e observa- tions conlirm previou.,, rel~rts of redt,ced morlality from lung cancer m American Indians of bolh sexes and in Hi~- pa,dc male,,,t " Additionally, they docuumnt continued ex- cess morlulity from respintlory infcctio,t, both luberculous and nt~n-luberculuu.~, tit American Indian.,,, and reduced mortality fronl chtolllC ob.,,Iructive pulmonary disease (COPD) in Hi,,panic ntale~. Methods Background New Mexico i.,, the lifth largest state in area with a popu- lation of.,,hghtly over one million In the 1970 census. Accord- From the Department,, of Medicine and of Pathology. and the New Mexico Tumor RegP, try. t.lm,~e=~=ty of New Mexico Medical Center. Albuque=que. NM Addre',~ reprint requesl to Dr. Jonathan M. Samet. Ne'~. Mcx|t:t~ I'mn~J= RegP, try. 9041 ('amino de Salud. N Albuquerque, NM 1~717d I'h=s paper= submilted to the Journal July 20. 1979. was re,, =~ed and accepted for publication January I 492 ing to that census, approximately one-third of the state'.~ re.,,idents live in the Albuquerque metropolitan area. and the remainder in cities with fewer than 50,t100 inhabitants, ur in rural village~. The composition of New Mexico's popukttion, accord- ing to 1970 U.S. Census Bureau estimales," is 38 per cent Hispanic, 7 per cent American Indian, ;tail 3 per cent Black and "'other non-while," the renminmg 52 pet" cent are White, non-Hispanic and are locally termed "'Anglo". The Hispan- its comprise two distinct groups; those living in the southern part of the slate are primarily of rece=tl Mexican descent and ctdture, while tho.,,e residing in norlhern New Mexico trace their ancestry to the original Spanish conquistadores and colonists who setlled several cenluries ago,~'" The Ameri- can Indian population within New Mexico [uclude.,, the Nay- RiGs, Pueblo's, and Apaches. These delined pupulatton.~ are relalively isohttcd, both cttltulally and geographic:ally, fronl the stale's Anglo.,, and Hispanic.,,. Mortality Rates Average annual ethnic and sex.specilic mortality rates for the period 1969-1977 were ealcul:ded with dealh cerlili- c;tte information provided by the New Mexico Bureau of Vi- tal Slati.,4ic~. Becau.',e of small numbers, rates ftw Blacks were not calculated. The specitic cum, e of death was coded according to the E,ghlh Revi.,,ion International Classilicatton of Disease~,, adapled for use in the United States (.ICDA)."~ A dealh wa'~ ,tltr~butetl to (.'hro,uc ()b.-,truclive Puhnon:try l)i~- ease (COPI)I if due to chrome bronchttP, (ICDA 4911, 1o phy~ema IICDA 4'12k or to chronic obstructive Itmg di,,ea.',e (ICDA 519.31. Deaths due to bronch=ti~,, unqualilied (ICDA AJPH May 1980. Vol 70, No. b T107241957

SAME~ETAL TABLE 1--Age Dlllrlbutlona for New Mexlcc'a Hispanic, Anglo, and American Indian Popu- lations in 1973 and for th~ Standacd 1970 UoS. Population ~ (yrs} Hispanic Anglo Male Female Male Female % % % % 0-9 25 24 18 17 10-19 27 26 20 19 20-29 14 15 15 15 30-39 11 12 12 12 40-49 9 9 16, 13 50-59 7 7 IO 11 60-69 4 4 ; 8 ~70 3 3 $ 6 TOTAL POPULATION 205,345 210,704 278.502 285.638 Indian Male Female % % 1970 U S. 31 30 18 26 26 20 13 14 15 10 11 11 7 8 12 6 5 10 4 4 8 3 2 6 38,623 41,602 490) were excluded from the COPD category because ap- proximately one-third of the deaths were in children. Addi- tionally, only small numbers of deaths in the older age groups were placed in this group. Ethnic group was assigned by the New Mexico Bmeau of Vital Statistics. The death certilicale specilieation of race was used lbr American In- dians while Hispauics were idenlilied primarily by the sur- name of the deceased and that of the deceased's parents. For the rates" denominator, mid-period (1973) popu- lation estimates were derived by interpolalion of 1970 Cen- sus Bureau tigures and of 1975 county Iotal estimates pro- vided by the Universily of New Mexico's Bureau of Busi- ness and Economic Research. Census Bureau counts of "'Persons of Spanish surname or langugage'" were slightly adjusted to account for sampling errors and to subtract a number of PueblO) indians with Spanish surnames. The Cen- sus Bureau's data concerning the New Mexico Hispanic population were based on a 15 per cent sampling of surname and a .5 per cent sampling of language J" All rates were age standardized to the 1970 U.S. population, Cancer Incidence Rates Since 1969, the New Mexico Tnmor Registry, a parlici- pant in the National Cancer lnstitute's Surveillance, Epide- miology, and End Results I~'ogram, has recorded all incident cancer cases (exclusive of non-melanoma skin cancersl in the state. Average annual sex and ethnic group specilic in- cidence rales for 1969 to 1977 were calculated as described above for morlalily. Elhnicity was as,Jgned by lhe New Mexico Tumor Registry. American Indians were idenlitied chmtly by stated ethnicily on hospital charls or tm dealh cer- lificates. Hispanics were designated on lhe basis of identi- fiers m the record or by surname. Anglos were identified by record designation and by excluslou of other identiliable groups. Incidence rates were also age standardized to Ihe 1970 U.S. popahttion. Comparison R~ttes The 1973 U.S. total mortality rates were cho.~en for comparison with the New Mexico dataJ~ These U.S. rates were used without adjustmenl to Ihe 1971) U.S. popuhtlion because the population structure Of the relay;m( age groups was virtually unchanged from 1970 to 1973.~'' ~-' Cancer in- cidence in New Mexico was compared with thai reported liom Ihe Third Nalional Cancer Survey I't~r all races coln- bincd, age-adjusted Io the 1970 U.S. population.t~ R t'SldlS New Mexico's principal elhuic gronps have differing age slructures (Table I I. The Hispanic ;.uld American lndi:m pop- ulalious are younger than both the Anglo and the 1970 I.I.S. comparison populations. The latter two groups have identi- cal age compositions. Mortality rales vary markedly by elhnic group {'lrables 2 and 3). Total mort.'dity for American Indian,, exceeds that for the comparison populalions except for Ihe age groups above 711 years; Ihe exce,,s ft~r American Indian males is much greater than for American Indian females. For Hispanlcs of both sexes, morl;tlity from all cause.,, ts less than New Mexi- co Anglo and tolal U.S. rates. Respiratory di.,,ease specilic mortality rates also vary markedly by ethnic group {Tables 2 and 3). For the diseases due It) infectious .'~gcnts, ItlberculoMs, and influenza itlld pneumonia, inorla]ily rates for American Indians are in ex- cess of U.S. r:tle'-, and those Ibr othe~ New Me~.~co residents. This excess is ob.,,erved in nearly :dl age groups liar both dis- e;tses. Incrca.,,ed tuberculosis morlalily in AiiierlCall Jndi;.tns in greatest in Ihe older age groups, although |he excess roof tality :dso all'eels the yuunger grotlps. I:our deaths from tu- berculosis occurred among American Indiam, less Ihan 20 years of age wherca.', among both Hi,,pamcs and Anglos of Ihe same age order two deaths wele altribuled to tubercu- losis. The above paltern for respiratory disease-, resulting from infectious agent.~ contrasls sharply with that observed for did, eases assooaled with cigarelte .,,moknlg ('l'able.~ 2 and 3,). Mortality rate-, m American Indians of bulb ~exes are AJPH May 1980. VoL 70. No. 5 493 T107241958