Jul 19, 2023

Artificial Quartz Countertops Are Damaging the Lungs of Stone Workers

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Toxic dust generated from the machining of artificial stone countertop slabs is causing workers to develop silicosis, a new investigation has found. Published in the journal JAMA Internal Medicine, the study found that silicosis is frequently misdiagnosed, with many workers in this industry already displaying signs of advanced disease at the point of diagnosis.

Silicosis is a lung disease caused by inhaling high amounts of silica particulate. Silica is found naturally in most rocks and is known to be a health risk among stonemasons.

During the machining of stone, silica particles are released into the air. If insufficient protection is worn, workers can breathe in these particles. Over several decades, these particles will begin to build up in the lungs and cause permanent scarring, called pulmonary fibrosis.

This scar tissue makes it difficult to breathe while also increasing the risk of an individual developing other related health problems, such as tuberculosis, lung cancer and chronic bronchitis.

Silicosis cases were previously very rare in the United States, but in recent years case rates have risen. This is largely thought to be down to the use of artificial stone, which is a popular choice for kitchen countertops, but is also much more dangerous.

Synthetic stone tends to contain much higher levels of silica than naturally formed rock. In addition, such synthetic material often contains harmful polymer resins and dyes that could potentially present additional health concerns.

In this new study, researchers set out to investigate the group characteristics of silicosis patients in California who reported having worked with artificial quartz stone. According to the new investigation, this occupational hazard has been predominantly affecting young Latino immigrant workers, who are falling sick and, in some cases, even dying as a result of exposure.

In this investigation, researchers from the University of California San Francisco (UCSF) and the University of California Los Angeles (UCLA), in collaboration with the UCSF California Labor Laboratory and the California Department of Health, identified cases of silicosis in 52 male patients working in Calfironia’s engineered stone industry.

Of these 52 patients, 51 were Latino immigrants. Most of the group had been diagnosed between the years 2019 and 2022. The median age of the group was 45 years old, with an average work history spanning 15 years.

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From a series of patient interviews and medical record abstractions, it was determined that diagnosis had been delayed in 58% of patients, who were initially diagnosed with some kind of bacterial pneumonia or tuberculosis before they received a silicosis diagnosis. At the point of diagnosis, 20 patients showed severe or very severe disease progression.

Collectively, 10 of the patients identified in this case series passed away from silicosis and 11 were referred for a lung transplant, of which 3 actually received a transplant. One individual passed away after receiving a transplanted lung. Seven patients were declined a transplant – of which six passed away – and a further individual passed away prior to listing.

“Increasing case counts of silicosis among stone fabricators over the last 10 years and accelerated progression of disease transforms the paradigm of an all-but-previously-forgotten disease in the U.S.,” said Jane Fazio, MD, a pulmonary specialist at Olive View-UCLA Medical Center and co-author of the study. “Our study demonstrates severe morbidity and mortality among a particularly vulnerable group of young underinsured and likely undocumented Latino immigrant workers.”

In light of their case series, researchers are calling on public health officials and policymakers to implement more stringent protections for workers operating in environments where they may be exposed to silica dust. This could include better guidelines for diagnosing the disease or even banning synthetic stone products altogether, they say.

“Our paper raises the alarm,” said Sheiphali Gandhi, a UCSF pulmonologist and co-author of the study. “If we don’t stop it now, we’re going to have hundreds if not thousands of more cases. Even if we stopped it now, we’re going to be seeing these cases for the next decade because it takes years to develop.”

Early diagnosis and minimizing further exposure are two key areas where the researchers would like to see improvement. In the case series, 45% of patients continued working after their silicosis diagnosis. With the majority of patients in the case series being either uninsured or having restricted scope Medi-Cal (California’s state medical assistance program for low-income individuals or vulnerable groups), early interventions could also help to significantly ease the healthcare burden on vulnerable workers.

Reference: Fazio JC, Gandhi SA, Flattery J, et al. Silicosis among immigrant engineered stone (Quartz) countertop fabrication workers in California. JAMA Intern Med. 2023. doi: 10.1001/jamainternmed.2023.3295

This article is a rework of a press release issued by the University of California San Francisco. Material has been edited for length and content.