Co-morbidities among silicotics at Shakarpur: A follow up study

CONTEXT Studies have revealed high morbidity and mortality among agate stone workers of Shakarpur due to silicosis. Besides the fatal disease, the workers also suffer from debilitating co-morbidities especially tuberculosis and under nutrition. AIMS The present study describes few co-morbidities and their influence in mortality in cases of silicosis that were followed for 30 months at Shakarpur. SETTINGS AND DESIGN Shakarpur, Khambhat of Gujarat. MATERIALS AND METHODS Spirometry for lung function, chest X-ray, anthropometry, body fat % measurement, record of tuberculosis status and ILO classification of pneumoconiosis were done among 53 chest symptomatic patients above 15 years of age who were followed for 30 months. RESULTS Out of 53 participants (35 men), with an average duration of exposure to free silica of 16.8 years, more than half of the male workers were underweight (BMI<18.5 kg/m(2)) at enrollment. Thirteen participants died in less than 3 years of follow up. While 11 of them were silicosis positive out of which 10 had tuberculosis. The odds ratio for association between silicosis and tuberculosis was 2.75. A majority (81.1%) of the 37 silicosis positive cases showed a mixed pattern in spirometry suggesting co-existence of restrictive and obstructive pathology. On regression analysis, TB and nutritional status were found to have strong influence on mortality. CONCLUSIONS Screening for early diagnosis of silicosis as well as co-morbid conditions and managing them would go a long way in prolonging the lives of the agate stone workers who are prone to die early due to silicosis.