| Overview | p. 1 |
| Introduction | p. 1 |
| Asbestos and Health | p. 1 |
| History of Asbestos | p. 4 |
| Epidemiological Discovery | p. 5 |
| Johns-Manville Corporation | p. 6 |
| Manville Trust | p. 6 |
| Manville Trust Litigation | p. 7 |
| Project History | p. 9 |
| Results | p. 11 |
| Organization of Monograph | p. 14 |
| Epidemiology of Asbestos-Related Diseases | p. 17 |
| Introduction | p. 17 |
| Design Issues in Studying Occupational Exposure | p. 18 |
| Measures of Risk | p. 19 |
| Design Issues | p. 22 |
| Studies of Health Risks of Occupational Exposures | p. 24 |
| Health Risks of a Cohort of Insulation Workers Occupationally Exposed to Asbestos | p. 25 |
| A Case-Control Study of Asbestos Risks in the United States and Canada | p. 35 |
| Short-Term Amosite Exposure Among Factory Workers in New Jersey | p. 37 |
| Effects of Chrysotile Exposure Among Miners and Millers in Quebec | p. 38 |
| Mesothelioma Risks Among World War II Shipyard Workers | p. 40 |
| Effects of Asbestos Exposure Among a Cohort of Retired Factory Workers | p. 42 |
| Increases in Disease Risk Associated with Exposure to Asbestos | p. 44 |
| Effects of Fiber Type on Disease Risks | p. 52 |
| Simian Virus 40 and Mesothelioma | p. 57 |
| Forecasts Based on Direct Estimates of Exposure | p. 61 |
| Introduction | p. 61 |
| Selikoff's Study: General Description | p. 61 |
| Data | p. 61 |
| Model and Methods | p. 62 |
| Selikoff's Six Tasks | p. 62 |
| Task 1: Identify the Industries and Occupations Where Asbestos Exposure Took Place | p. 63 |
| Task 2: Estimate the Number, Timing, and Duration of Employment of Exposed Workers | p. 67 |
| Task 3: Estimate Risk Differentials Among Occupations and Industries | p. 71 |
| Task 4: Estimate Dose-Response Models for Cancer Risks | p. 74 |
| Task 5: Project Future Asbestos-Related Cancer Mortality | p. 76 |
| Task 6: Estimate and Project Deaths Due to Asbestosis | p. 76 |
| Sensitivity of Selikoff's Projections | p. 79 |
| Alternative Projections of Health Implications | p. 81 |
| Forecasts Based on Indirect Estimates of Exposure | p. 89 |
| Introduction | p. 89 |
| Background | p. 89 |
| Walker's Study: General Description | p. 93 |
| Data | p. 93 |
| Model and Methods | p. 94 |
| Walker's Five Tasks | p. 94 |
| Task 1: Determine the Effective Number of Past Asbestos Workers | p. 95 |
| Task 2: Project Mesothelioma Incidence | p. 112 |
| Task 3: Project Lung Cancer Incidence | p. 115 |
| Task 4: Estimate Current and Future Asbestosis Prevalence | p. 119 |
| Task 5: Estimate the Amount of Asbestos-Related Disease Likely to Occur in Women | p. 124 |
| Asbestos-Related Disease Projections by Other Authors | p. 125 |
| Conclusions | p. 127 |
| Uncertainty in Forecasts Based on Indirect Estimates | p. 129 |
| Introduction | p. 129 |
| Qualitative Sources of Uncertainty in Walker's Projections | p. 129 |
| Uncertainties in Either Direction | p. 130 |
| Why Walker's Projections May Be Too Low | p. 132 |
| Why Walker's Projections May Be Too High | p. 133 |
| Sensitivity Analysis of Walker's Projections | p. 134 |
| Results for Single Parameters | p. 138 |
| Results for All Variables Jointly | p. 139 |
| Summary of Uncertainty Results | p. 142 |
| Further Sensitivity Analysis of Walker's Mesothelioma Projections | p. 143 |
| Projection Methodology | p. 145 |
| Alternative Scenarios | p. 147 |
| Results | p. 149 |
| Conclusions | p. 152 |
| Updated Forecasts Based on Indirect Estimates of Exposure | p. 155 |
| Introduction | p. 155 |
| Factors Considered | p. 155 |
| Assumptions | p. 160 |
| First-Stage Calibration: Overview | p. 165 |
| Data Preparation | p. 169 |
| Step 1: Nonmesothelioma Mortality Rates | p. 169 |
| Step 2: National Estimates of Mesothelioma Incidence Counts | p. 172 |
| Step 3: Distribution of Age and Date at Start of Asbestos Exposure for Mesothelioma Incidence Among Manville Trust Claimants | p. 174 |
| Step 4: Normalization of Exposure | p. 189 |
| Step 5: Intensity of Exposure | p. 190 |
| Model Estimation | p. 191 |
| Step 6: Stratification of National Estimates of Mesothelioma Incidence Counts, by Level of Asbestos Exposure | p. 191 |
| Step 7: Estimation of the IWE Population Exposed to Asbestos Prior to 1975 by Level of Asbestos Exposure | p. 192 |
| Step 8: Adjustments to Exposure During 1955-1974, by Level of Asbestos Exposure | p. 198 |
| Step 9: Adjustments to Reflect Improvements in the Workplace During 1960-1974, by Level of Asbestos Exposure | p. 198 |
| Step 10: Renormalization by Level of Asbestos Exposure | p. 199 |
| Model Projection | p. 200 |
| Step 11: Forward Projection of the At-Risk IWE Population by Level of Asbestos Exposure | p. 202 |
| Step 12: Forward Projection of Mesothelioma Incidence by Level of Asbestos Exposure | p. 202 |
| Nonparametric Hazard Modeling of Claim Filing Rates: CHR Model | p. 208 |
| Step 1: Distribution of 1990-1994 Claims by Attained Age, TSFE, and Disease/Injury | p. 208 |
| Step 2: Estimation of Claim Hazard Rates by Attained Age, TSFE, and Disease/Injury | p. 209 |
| Step 3: Claim Projections | p. 213 |
| Uncertainty in Updated Forecasts | p. 217 |
| Introduction | p. 217 |
| Analysis S1: Constant Age-Specific Claim Runoff | p. 222 |
| Analysis S2: Ratio Estimation of Nine Asbestos-Related Diseases - PTS Model | p. 223 |
| Analysis S3: Parametric Claim Hazard Rate Model | p. 224 |
| Analysis S4: Mesothelioma Incidence Function | p. 229 |
| Sensitivity to the b Parameter | p. 232 |
| Sensitivity to the k Parameter | p. 233 |
| Analysis S5: Adjustments to the IWE Exposed Population | p. 235 |
| Analysis S6: National Mesothelioma Incidence Counts | p. 236 |
| Analysis S7: Nonmesothelioma Mortality Rates | p. 237 |
| Analysis S8: Excess Mortality Among Insulation Workers | p. 239 |
| Analysis S9: Decline in Claim Filing Rates | p. 240 |
| Overall Sensitivity: Analyses S1-S9 | p. 241 |
| Analysis S10: Manville Trust Calibrations | p. 247 |
| Conclusions | p. 249 |
| Forecasts Based on a Hybrid Model | p. 251 |
| Introduction | p. 251 |
| Model Overview | p. 252 |
| First Stage | p. 252 |
| Second Stage | p. 254 |
| Data Preparation | p. 255 |
| Step 1: Nonmesothelioma Mortality Rates | p. 255 |
| Step 2: Occupation Groups with Significant Asbestos Exposure | p. 256 |
| Step 3: Distribution of Mesothelioma Claim Counts 1990-1994 by Attained Age at the Time of Claim and TSFE | p. 257 |
| Step 4: Distribution of Mesothelioma Claim Counts by Age at Start of Exposure and Date of First Exposure | p. 270 |
| Step 5: Normalization of Exposure | p. 273 |
| Model Estimation | p. 273 |
| Step 6: Estimation of the OSHA Model for Mesothelioma | p. 273 |
| Step 7: Estimation of the Population Exposed to Asbestos Prior to 1975 | p. 284 |
| Model Projection | p. 288 |
| Step 8: First-Stage Calibration | p. 288 |
| Step 9: Forward Projection of Mesothelioma Mortality | p. 288 |
| Second Stage: CHR Forecasting Model | p. 290 |
| Step 1: Distribution of Disease-Specific Claim Counts for 1990-1994 by Attained Age and TSFE | p. 290 |
| Step 2: Second-Stage Calibration | p. 290 |
| Step 3: At-Risk Population Projections | p. 294 |
| Step 4: Claim Projections | p. 298 |
| Conclusions | p. 308 |
| Uncertainty in Forecasts Based on a Hybrid Model | p. 311 |
| Introduction | p. 311 |
| Impact of Claim Filing Rules | p. 313 |
| Baseline Model: SDIS Criterion | p. 314 |
| Analysis S1: Validated Disease | p. 315 |
| Analysis S2: Multiple Diseases | p. 320 |
| Analysis S3: CHR Smoothing | p. 325 |
| Analysis S4: Exposure Smoothing | p. 327 |
| Analysis S5: Weibull k Parameter | p. 328 |
| Analysis S6: Relative Risks of Mesothelioma | p. 330 |
| Analysis S7: Duration of Exposure | p. 332 |
| Overall Sensitivity: Analyses S1-S7 | p. 334 |
| Conclusions | p. 336 |
| Conclusions and Implications | p. 345 |
| Introduction | p. 345 |
| Data | p. 347 |
| Comparisons of Original and Updated Data | p. 350 |
| Comparisons of Actual and Projected Numbers of Claims | p. 354 |
| Health and Vital Statistics Data, 1990-1999 | p. 359 |
| Conclusions | p. 374 |
| References | p. 377 |
| Index | p. 389 |
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