Research timeline: peer-reviewed studies on engineered-stone silicosis
The studies most often cited on the disease, from the first Israeli series to CDPH's 2026 surveillance report. Every citation was checked against its PubMed record; findings are taken from the published abstract.
Selection rule: a study is listed if it is a surveillance report from a public-health agency, a clinical series or cohort from an affected jurisdiction, an exposure study of fabrication workplaces, or a systematic review or professional-society statement. Findings are summarised from abstracts; the full papers were not all read by this project, and a clinician should be consulted on any medical question.
How to read the verification labels
- Verified: primary source
- Checked by this project against a court record, statute, agency publication or journal index.
- Verified: secondary source
- Checked against a major news organisation, professional body or university publication.
- Reported by an interested party
- Rests on a law-firm release, trade press or legal-marketing site. Treat figures as claims until independently confirmed.
- Unverified
- Listed for completeness; not yet checked against any source by this project.
Tier numbers next to sources (T1 to T4) follow the source hierarchy in the methodology: T1 primary records and agencies, T2 major news and professional bodies, T3 interested parties, T4 discovery-only.
Records
Silicosis among Workers Fabricating Engineered Stone ('Quartz') Countertops in California, 2019-2026
Heinzerling A, Flattery J, Cummings KJ, et al. NEJM Evidence, September 2026. DOI 10.1056/EVIDpha2600187. PMID 42584953.
Verified: primary source
- Type
- Public health surveillance report
- Jurisdiction
- California
- Key findings
- 592 cases identified January 2019 through June 2026; 65 lung transplants; 31 deaths
- Median age at diagnosis 46; 98% Latino; nearly all male; median 22 years of occupational silica exposure (per Healio's report of the paper)
- Why it matters
- Most complete published account of the California outbreak.
- Last checked
- 12 September 2026
Silicosis in the Artificial Stone Countertop Industry: An Official American Thoracic Society Workshop Report
Gandhi SA, Liu GY, Fazio JC, et al. Annals of the American Thoracic Society, 26 June 2026. DOI 10.1093/annalsats/aaoag176. PMID 42363709.
Verified: primary source
- Type
- Professional society workshop report
- Jurisdiction
- International
- Key findings
- Artificial-stone dust contains high silica plus resin-derived volatiles and trace metals; exposures routinely exceed limits despite wet methods, ventilation and respirators
- High rates of progressive massive fibrosis, autoimmune disease, infection and transplant need
- Why it matters
- Consensus statement of the leading US respiratory society.
- Last checked
- 12 September 2026
Silicosis Surveillance in California, 2019-2024: Tracking an Epidemic
Flattery J, Woolsey C, Fazio JC, et al. American Journal of Public Health, November 2025. DOI 10.2105/AJPH.2025.308225. PMID 40906995.
Verified: primary source
- Type
- Surveillance analysis
- Jurisdiction
- California
- Key findings
- 296 confirmed silicosis cases 2019-2024, 243 (82%) associated with engineered stone
- Engineered-stone cases younger, male, Latino and concentrated in Los Angeles County; 25% referred for transplant
- Why it matters
- Describes how CDPH's multisource surveillance works and its limits.
- Last checked
- 12 September 2026
The Rapid Rise of Silicosis in Victoria, Australia Associated With Artificial Stone Countertop Industry Work
Hoy RF, Tomic D, Gwini S, et al. American Journal of Industrial Medicine, April 2025. DOI 10.1002/ajim.23704. PMID 39829386.
Verified: primary source
- Type
- Compensation-claims and registry analysis
- Jurisdiction
- Victoria, Australia
- Key findings
- 536 silicosis compensation claims over 32 years, 90% of them in 2015-2022 (a 27-fold rise)
- Of 210 registry cases 2019-2022, 97% worked in the countertop industry and 89% were found through government screening
- Why it matters
- Shows how active screening surfaces cases that would otherwise go unrecognised.
- Last checked
- 12 September 2026
A review of silicosis and other silica-related diseases in the engineered stone countertop processing industry
Fazio JC, Viragh K, Houlroyd J, et al. Journal of Occupational Medicine and Toxicology, 17 March 2025. DOI 10.1186/s12995-025-00455-8. PMID 40098042.
Verified: primary source
- Type
- Narrative review
- Jurisdiction
- International
- Key findings
- Engineered stone is over 90% crystalline silica versus 40-50% for granite and under 10% for marble
- Disease diagnosed after 7-19 years of exposure; exposures often exceed limits even with wet saws and ventilation
- Why it matters
- Current clinical and regulatory overview.
- Last checked
- 12 September 2026
Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Fazio JC, Gandhi SA, Flattery J, et al. JAMA Internal Medicine, 1 September 2023. DOI 10.1001/jamainternmed.2023.3295. PMID 37486642.
Verified: primary source
- Type
- Case series (CDPH surveillance 2019-2022)
- Jurisdiction
- California
- Key findings
- 52 male patients, median age 45; 51 Latino immigrants; 19% uninsured
- Diagnosis delayed in 58%; 38% had progressive massive fibrosis at diagnosis; 19% fatal, median age at death 46
- Why it matters
- The paper most cited in coverage of the California outbreak.
- Last checked
- 12 September 2026
Elevated exposures to respirable crystalline silica among engineered stone fabrication workers in California, January 2019-February 2020
Surasi K, Ballen B, Weinberg JL, et al. American Journal of Industrial Medicine, September 2022. DOI 10.1002/ajim.23416. PMID 35899403.
Verified: primary source
- Type
- Exposure assessment from Cal/OSHA inspections
- Jurisdiction
- California
- Key findings
- 152 employees at 47 workplaces sampled; 25% of employees above the PEL (median 89.7 ug/m3, up to 670.7)
- 72% of workplaces cited for at least one RCS standard violation
- Why it matters
- Documents widespread overexposure in California shops before the 2023 emergency standard.
- Last checked
- 12 September 2026
Severe Silicosis in Engineered Stone Fabrication Workers: California, Colorado, Texas, and Washington, 2017-2019
Rose C, Heinzerling A, Patel K, et al. MMWR Morbidity and Mortality Weekly Report, 27 September 2019. DOI 10.15585/mmwr.mm6838a1. PMID 31557149.
Verified: primary source
- Type
- Case report series
- Jurisdiction
- United States (CA, CO, TX, WA)
- Key findings
- 18 cases including the first two US fatalities in the stone fabrication industry
- Several with progressive disease, autoimmune disease and latent tuberculosis
- Why it matters
- First CDC report of the US outbreak.
- Last checked
- 12 September 2026
Artificial Stone Associated Silicosis: A Systematic Review
Leso V, Fontana L, Romano R, et al. International Journal of Environmental Research and Public Health, 16 February 2019. DOI 10.3390/ijerph16040568. PMID 30781462.
Verified: primary source
- Type
- Systematic review
- Jurisdiction
- International
- Key findings
- Disease characteristics comparable to traditional silicosis but with gaps in exposure assessment and control in the artificial-stone sector
- Why it matters
- Early synthesis of the international literature.
- Last checked
- 12 September 2026
Artificial stone-associated silicosis: a rapidly emerging occupational lung disease
Hoy RF, Baird T, Hammerschlag G, et al. Occupational and Environmental Medicine, January 2018. DOI 10.1136/oemed-2017-104428. PMID 28882991.
Verified: primary source
- Type
- Case series
- Jurisdiction
- Australia
- Key findings
- Seven male workers, median age 44, all dry-cutting artificial stone in small shops
- Median 7 years' exposure before symptoms; six had progressive massive fibrosis with rapid lung-function decline
- Why it matters
- Australian series that preceded the national screening programme and ban.
- Last checked
- 12 September 2026
Artificial stone silicosis: disease resurgence among artificial stone workers
Kramer MR, Blanc PD, Fireman E, et al. Chest, August 2012. DOI 10.1378/chest.11-1321. PMID 22383661.
Verified: primary source
- Type
- Retrospective cohort
- Jurisdiction
- Israel
- Key findings
- 25 silicosis patients referred for lung transplant evaluation 1997-2010, all exposed by dry-cutting a high-silica artificial stone
- 10 underwent transplantation; observed transplant incidence 14.6 times the ISHLT-registry expectation
- Why it matters
- First major clinical series linking engineered stone to a silicosis outbreak.
- Last checked
- 12 September 2026
What the literature agrees on
- Engineered stone is typically more than 90% crystalline silica; granite is roughly 40 to 50% and marble under 10% (Fazio 2025 review).
- Disease appears after years, not decades, of exposure, and progresses quickly; progressive massive fibrosis, autoimmune disease, infection and transplant referral are common (Hoy 2018, Fazio 2023, ATS 2026).
- Exposures above the permissible limit have persisted despite wet methods, ventilation and respirators (Surasi 2022, ATS 2026).
- Active screening finds cases that would otherwise be missed (Hoy 2025, Victoria).
For the disease itself see symptoms, causes and treatment. For the outbreak numbers see the California overview.