Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
Occupational Health Branch, California Department of Public Health, Richmond
Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California

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Sheiphali A. Gandhi Occupational Health Branch, California Department of Public Health, Richmond
Division of Occupational, Environmental, and Climate Medicine, University of California, San Francisco

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Jennifer Flattery Occupational Health Branch, California Department of Public Health, Richmond

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Amy Heinzerling Occupational Health Branch, California Department of Public Health, Richmond

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Nader Kamangar Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California

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Nawal Afif Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California

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Kristin J. Cummings Occupational Health Branch, California Department of Public Health, Richmond

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Robert J. Harrison Occupational Health Branch, California Department of Public Health, Richmond

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This article, which was published in 2023, is made available for a year to all subscribers of the AMA Guides Newsletter courtesy of the AMA JAMA Intern Med. The complete article is available from February 28, 2024, until February 27, 2025.

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Key Points

Question

What are the characteristics of patients in California with silicosis from occupational exposure to dust from engineered stone (quartz), a popular material that is high in silica content and that is used to fabricate countertops?

Findings

In this case series of 52 patients, the median age was 45 years at diagnosis, and nearly all were Latino immigrant men. Diagnosis was delayed in 58%, with 38% presenting with advanced disease (progressive massive fibrosis), and 19% died.

Meaning

In California, silicosis associated with occupational exposure to dust from engineered stone primarily occurred among young Latino immigrant men; many patients presented with severe disease, and some cases were fatal.

Abstract

Importance

Silicosis associated with inhalation of respirable crystalline silica among engineered stone countertop fabrication workers is an emerging health concern.

Objective

To describe clinical, socioeconomic, and occupational characteristics of patients diagnosed with silicosis associated with engineered stone in California.

Design, Setting, and Participants

This case series included reported cases of silicosis associated with fabrication of engineered stone countertops, as identified by statewide surveillance by the California Department of Public Health (2019–2022). Data analysis was performed from October 2022 to March 2023.

Exposures

Patient interviews and medical record abstractions were used to assess occupational exposure to respirable crystalline silica, including duration of work tenure and preventive measures undertaken.

Main Outcomes and Measures

Demographics, clinical characteristics, health care utilization, and clinical outcomes were obtained, including vital status, hypoxia, and lung transplant.

Results

This case series identified 52 male patients meeting inclusion criteria; median (IQR) age was 45 (40–49) years, and 51 were Latino immigrants. Ten (19%) were uninsured, and 20 (39%) had restricted-scope Medi-Cal; 25 (48%) presented initially to an emergency department. A delay in diagnosis occurred in 30 (58%) patients, most commonly due to alternative initial diagnoses of bacterial pneumonia (9 [30%]) or tuberculosis (8 [27%]). At diagnosis, 20 (38%) patients had advanced disease (progressive massive fibrosis) with severely or very severely reduced forced expiratory volume in 1 second in 8 (18%) and 5 (11%), respectively. Of the cases, 10 (19%) were fatal; median (IQR) age at death was 46 (38–51) years, and 6 patients (12%) were alive with chronic resting hypoxia. Eleven were referred for lung transplant: 3 underwent transplant with 1 fatality; 7 were declined transplant, with 6 fatalities; and 1 died prior to listing. Median (IQR) work tenure was 15 (10–20) years; 23 (45%) reported use of water suppression for dust mitigation, and 25 (48%) continued to fabricate stone after being diagnosed with silicosis.

Conclusions and Relevance

In this case series performed in California, silicosis associated with occupational exposure to dust from engineered stone primarily occurred among young Latino immigrant men. Many patients presented with severe disease, and some cases were fatal.

Contributor Notes

This article, which was published in 2023, is made available for a year to all subscribers of the AMA Guides Newsletter courtesy of the AMA JAMA Intern Med. The complete article is available from February 28, 2024, until February 27, 2025.

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