Libby Asbestos Health Status Project
Table of Contents
National mortality surveillance of occupation-related respiratory diseases designates asbestosis as the leading pneumoconiosis recorded on death certificates from 1982-2000. While mortality rates decreased for other previously dominant occupational lung diseases, e.g., silicosis and coal worker pneumoconiosis, from 1968-2000, death attributed to asbestosis steadily increased from 77 deaths in 1968 to 1,493 in 2000 (annual age-adjusted death rate 0.54 per million and 6.88 per million respectively). National attention focused on Libby, Montana in November 1999 when increasing numbers of local residents were diagnosed with asbestos-related disease (ARD). From 1979-1998 asbestosis mortality in Libby was 40-80 times higher than expected compared to Montana and the United States. After extensive review, in February 2002, the United States Environmental Protection Agency (EPA) placed Libby on the National Priorities List and the area became a Superfund asbestos cleanup and removal site.
Asbestosis, one of several chronic illnesses commonly linked to asbestos exposure, is a progressive disease involving scarring of lung tissue as a result of exposure to microscopic asbestos fibers . Pleural fibrosis, lung cancer, other cancers, and mesothelioma, a rare cancer of the chest lining, are also caused by exposure to asbestos. Once exposed, the protracted disease trajectory includes a 15-20 year non-symptomatic phase followed by increasing respiratory compromise [8, 9]. Some call this type of occupational and environmental exposure a "slow motion technological disaster" and the worst occupational health disaster in U.S. history. A significant source of exposure to asbestos in the U.S. came from contaminated vermiculite ore mined in rural Libby, Montana and then distributed to over 200 regional processing and expanding plants in 30 states; shipments of material were sent to nearly every state in the U.S. In the years of operations, millions of tons of vermiculite were produced providing nearly 80% of the world's supply. It is estimated that the raw ore contained as much as 26% asbestos. LaDou refers to the worldwide distribution and use of asbestos as the "asbestos epidemic."
Unlike acute illnesses, chronic diseases such as asbestosis are unrelenting, rarely cured, and require persons to deal with the associated health challenges on a daily basis. Access to health care providers, especially health care specialists such as pulmonologists, is an ongoing challenge for rural dwellers. Only 10% of physicians in the U.S. practice in rural areas although nearly 21% of Americans live in these areas. Psychosocial response to chronic illness significantly impacts an individual's ability to manage illness. Although researchers have established the association between specific exposure pathways and radiographic abnormalities in occupationally exposed vermiculite workers, the slow-progressing, but far-reaching bio-psychosocial health effects and health care needs of persons exposed to asbestos have not been adequately described or studied.
The overall goal of this study is to establish a more comprehensive understanding of the bio-psychosocial health status and health service needs for persons exposed to asbestos. To accomplish this goal, the national Libby cohort will be studied to achieve the following aims:
- Describe the bio-psychosocial health status of persons exposed to Libby asbestos through an examination of the severity of chronic illness, depression, acceptance of illness, and stress.
- Explore the associations among severity of chronic illness, depression, acceptance of illness, and stress.
- Evaluate access, availability, convenience, and financial aspects of care among the national Libby cohort.
The widespread asbestos contamination in the Libby area and extensive vermiculite shipping history present a unique opportunity to explore the comprehensive and long-term health affects of ARD in a national cohort. Results of the study will provide direction for health policymakers and service providers. The proposed study is consistent with the goals of the federally mandated Healthy People 2010 which seeks to improve the health of the nation by realizing two overall goals: (a) increasing the quality and years of healthy life, and (b) eliminating health disparities among populations. To achieve these Healthy People 2010 goals, programs are being solicited that will help identify appropriate medical evaluation and follow-up for respiratory disease (24-1) , and efforts are being encouraged to eliminate health disparities based on geography, e.g., rural locations . By describing the bio-psychosocial health status and health service needs of persons with ARD, recommendations for effective health policy can be made to reduce the burden of chronic illness and enhance quality of life.