Early Diagnosis and Survival Outcomes in Silicosis: A Retrospective Cohort Study of 11,809 Patients in Guangdong Province, China (1956-2020)

Chunyue Fan¹Yuhao Wang²Jingjing Chen³Qiaoli Wei⁴Shijie Hu¹Lihua Xia^1*Jiawen Huang¹Weihui Liang¹Lin Wu⁵Xudong Li^6*

• ¹Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
• ²Guangzhou Center for Disease Control and Prevention, Guangzhou, China
• ³Clinical Data Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
• ⁴School of Public Health, Sun Yat-sen University, Guangzhou, China
• ⁵Department of Cardiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
• ⁶Guangdong Provincial Occupational Disease Prevention Hospital, Guangzhou, China

Silicosis, a progressive and irreversible occupational lung disease caused by exposure to silica dust, remains a significant global public health challenge due to the limited availability of effective therapeutic options. This retrospective cohort study,utilizing data from Guangdong's occupational disease monitoring systems and multi-sectoral registries, consolidated by provincial institutions, and managed nationally by the Institute of occupational health and poison control, examined the association between early diagnosis and survival outcomes among 11,809 silicosis patients in Guangdong Province, China, diagnosed between 1956 and 2020. After excluding cases with ambiguous diagnosis dates, pre-adolescent exposure, and missing variables (final adjusted sample: 11,809 from an initial 12,206), Cox proportional hazards models were employed to assess survival risks across diagnostic stages (I-III), stratified by radiological severity. A substantial proportion of patients (77.8%) were diagnosed at stage I, while fewer were identified at stage II (16.6%) and stage III (5.5%). Median survival times decreased significantly with advancing disease stages: 27 years for stage I, 20 years for stage II, and 11 years for stage III (P < 0.001). Adjusted mortality risks increased progressively; patients in stage II had a 42% higher risk (HR = 1.42, 95% , CI: 1.33-1.51) and those in stage III exhibited a 142% higher risk (HR = 2.42, 95% , CI: 2.17-2.70) compared to stage I. Early 2 diagnosis rates showed temporal variations, stabilizing after 2006. Subgroup analyses confirmed staging as an independent prognostic factor for survival across industries and exposure durations.These findings underscore the critical importance of early detection in reducing silicosis-related mortality, particularly within high-risk occupational groups. The study advocates for the systematic implementation of early screening protocols, such as high-resolution computed tomography (HRCT), to enhance diagnostic accuracy and enable timely interventions. By emphasizing early identification and promoting targeted occupational health policies, this research provides actionable insights to alleviate the global burden of silicosis.