Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 1;183(9):991-998.
doi: 10.1001/jamainternmed.2023.3295.

Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California

Jane C Fazio  1   2   3 , Sheiphali A Gandhi  2   4 , Jennifer Flattery  2 , Amy Heinzerling  2 , Nader Kamangar  1   3 , Nawal Afif  3 , Kristin J Cummings  2 , Robert J Harrison  2
Affiliations

Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California

Jane C Fazio et al. JAMA Intern Med. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Gandhi reported grants from National Institutes of Health (NIH) National Cancer Institute (F32 CA265103) outside the submitted work. Ms Flattery reported grants from Centers for Disease Control and Prevention (CDC)/NIOSH during the conduct of the study. Dr Heinzerling reported grants from NIOSH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Yearly Case Counts for 52 Patients With Engineered Stone–Associated Silicosis in California, 2010-2022
There were no reported cases of silicosis associated with engineered stone in California prior to 2010.
Figure 2.
Figure 2.. Representative Chest Imaging From 2 Patients With Engineered Stone–Associated Silicosis in Different Stages of Disease
Noncontrast computed tomography chest images demonstrate a case of early simple silicosis with scattered micronodules (A and B) and a case of complicated silicosis with progressive massive fibrosis, indicative of advanced disease (C and D).
See this image and copyright information in PMC

Comment in

References

    1. Leung CC, Yu ITS, Chen W. Silicosis. Lancet. 2012;379(9830):2008-2018. doi: 10.1016/S0140-6736(12)60235-9 - DOI - PubMed
    1. Barnes H, Goh NSL, Leong TL, Hoy R. Silica-associated lung disease: an old-world exposure in modern industries. Respirology. 2019;24(12):1165-1175. doi: 10.1111/resp.13695 - DOI - PubMed
    1. Silicosis mortality, prevention, and control—United States, 1968–2002. Accessed April 27, 2023. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5416a2.htm - PubMed
    1. Harris K. Forty years of falling manufacturing employment: beyond the numbers. US Bureau of Labor Statistics. Accessed April 27, 2023. https://www.bls.gov/opub/btn/volume-9/forty-years-of-falling-manufacturi...
    1. Kramer MR, Blanc PD, Fireman E, et al. Artificial stone silicosis [corrected]: disease resurgence among artificial stone workers. Chest. 2012;142(2):419-424. doi: 10.1378/chest.11-1321 - DOI - PubMed

Publication types