Occupational Medicine 2019;69:272–278 Advance Access publication on 23 May 2019 doi:10.1093/occmed/kqz067 © The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com Silicosis and pulmonary tuberculosis in deceased female South African miners N. Ndlovu 1 , G. Richards 2 , N. Vorajee 3,4 and J. Murray 1,3 1 School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa, 2 Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa, 3 National Institute for Occupational Health, National Health Laboratory Service, Johannesburg 2000, South Africa, 4 School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa. Correspondence to: N. Ndlovu, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, South Africa. Tel: +27 11 717 2311; e-mail: zodwa.ndlovu@wits.ac.za Background Implementation of South Africa’s 2002 Mining Charter increased women’s participation in under- ground mining. However, occupational lung diseases (OLDs) in female gold miners have not been studied. Aims To compare autopsy-diagnosed pulmonary silicosis, lymph gland silicosis (a precursor of pulmonary silicosis) and active pulmonary tuberculosis (PTB) in South African gold miners. Methods The law allows for autopsies on miners for OLD compensation. Information is stored on the Pathology Automation (PATHAUT) database. We selected records of deceased miners who had worked only in gold mines, started employment from 2002, and were autopsied between 2005 and 2015. Using descriptive statistics, we compared demographic and employment characteristics, and disease proportions by sex. Results The study comprised 847 gold miners: 68 women and 779 men. There were no statistically signif- cant differences in proportions of autopsy-diagnosed pulmonary silicosis [3 (4%) in women and 54 (7%) in men], lymph gland silicosis [11 (16%) and 171 (22%)] or PTB [29 (43%) and 254 (33%)]. Age and employment duration in women and men with disease were similar. Most miners with pul- monary silicosis had started employment from 2003 [315 (77%)] and worked for under 10 years. Conclusion It is important to report research fndings by sex. Proportions of silicosis and PTB were compar- able in women and men, suggesting similar exposures. Silicosis detection after short employment indicates inadequate dust control, particularly as most entered the industry after implementation of interventions to control silica dust in 2003. Key words Autopsy; lymph gland fbrosis; occupational lung disease; PATHAUT; silicosis; tuberculosis. Introduction South African gold miners are experiencing epidemics of silicosis and pulmonary tuberculosis (PTB). Silicosis is associated with high occupational exposures to crys- talline silica. Both silica and silicosis are risk factors for PTB [1]. In 2016, silicosis and PTB were diagnosed in 29 and 16% of gold miners who were autopsied at the National Institute for Occupational Health (NIOH) for compensation purposes [2]. Epidemiological studies in gold miners reported high silicosis prevalence (8–20% in active miners and 22–36% in former miners) and active PTB incidence (3000 per 100 000 persons) [1]. The mining industry is male-dominated. In South Africa, women were legally prohibited from working underground in 1911. Women continued to work in surface activities, mostly in asbestos mines where they comprised about half of the labour force and performed tasks such as sweeping, cobbing (processing) the ore and packing asbestos fbres for shipment [3]. Despite the re- moval of restrictions on underground mining in 1973 [4], women in the gold mining industry continued to occupy surface jobs (e.g. administration or cleaning). The Mining Charter of 2002, implemented in 2004, set a target to increase the participation of women in core mining activities to 10% by 2009. Core mining activities are jobs that are equivalent to those of men and include underground occupations, such as winch driving and drilling [5]. The employment of women in mining in- creased from <1% before 2002 to just >10% in 2013 [6]. Downloaded from https://academic.oup.com/occmed/article/69/4/272/5498019 by guest on 24 June 2022