Background
Since 2010, thousands of cases of silicosis in workers who fabricate countertops have been reported worldwide. Workers in this industry can be exposed to respirable crystalline silica dust when working in or near areas where countertops are being cut or finished. Exposure to silica places them at risk for silicosis, a severe, incurable lung disease.
Workers who make countertops from engineered stone, a popular material with very high crystalline silica content, are at particularly high risk of silicosis. This material is also known as artificial stone, and the countertops are commonly called “quartz countertops.” A global epidemic of silicosis related to engineered stone is underway, with cases documented in many countries.
Since 2019, CDPH has conducted statewide multi-source surveillance for silicosis and has identified 432 cases of confirmed silicosis associated with engineered stone as of November 13, 2025. At least 25 California workers have died, many of whom were in their 30s and 40s. At least 48 California workers have received lung transplants.
The table below shows case counts by county. State and county case counts likely underestimate the true burden of disease among countertop workers in California. For updated information, consult the CDPH Silicosis Dashboard.
Table. Confirmed engineered stone silicosis case counts for counties with at least 10 cases, as of November 13, 2025.
The workers with silicosis identified so far in California are characterized by:
- History of cutting and finishing stone countertops, particularly engineered stone or “quartz countertops”
- Relatively young age (median age at diagnosis is 46 and median age of death is 48)
- Primarily immigrant men, predominantly from Mexico and Central America
- Symptoms of cough and shortness of breath, but can also be asymptomatic
- Under- or uninsured, often with initial presentation to the emergency department or urgent care
- Delayed diagnosis
- Common alternative initial diagnoses: pulmonary infections (pneumonia, tuberculosis (TB), non-TB mycobacterial infections), asthma, sarcoidosis
- Accelerated disease course, including severe impairment and need for supplemental oxygen, referral for lung transplantation, and/or death, sometimes within several years of diagnosis.
While silicosis is a serious disease, it is preventable. The Division of Occupational Safety and Health (Cal/OSHA) requires that employers control silica dust, including applying wet methods when cutting engineered stone, conducting prompt dust clean-up, having employees use powered air-purifying respirators (PAPRs), and conducting regular silica dust monitoring. However, it is very difficult for most employers to implement the dust control methods needed to protect workers because of the expense and technical expertise necessary to acquire and maintain sophisticated equipment. Furthermore, even when shops use mandated controls like wet methods, they are not always effective at lowering silica exposures enough to prevent disease.
Given these challenges to controlling silica dust from engineered stone, in July 2024, Australia became the first country to ban the use of engineered stone after hundreds of countertop workers there were found to have silicosis. Identifying and reporting cases in California helps CDPH assess where workers are at risk and safeguard worker health.
Recommendations
Active surveillance by healthcare providers
- Identify countertop workers by asking patients about their current and previous occupations (“Have you done work cutting or finishing countertops or worked in a shop that does these tasks?").
- Consider silicosis in both asymptomatic and symptomatic at-risk workers.
- Make the diagnosis using imaging (chest X-ray, chest CT) and pulmonary function tests (spirometry, diffusing capacity).
- Refer early to pulmonary and occupational medicine physicians for diagnosis and coordination of care.
- Share educational resources about workplace safety with all at-risk patients and advise them that:
- Inhaling any silica dust is dangerous; workers can help protect themselves by always using copious amounts of water to cut or grind countertops, using special vacuums to clean dust, and wearing the appropriate respirator.
- Employers are required under Cal/OSHA’s silica regulation to reduce silica dust to keep workers safe. If a worker has concerns about workplace safety, they can contact Cal/OSHA for assistance.
- Silicosis is a reportable disease (PDF) in California as of June 2025. Report identified or suspected cases within 7 calendar days to the local health department in the jurisdiction where the patient resides.
Dissemination of Information and Case Reporting by Local Health Departments
- Disseminate information, such as this CAHAN and educational resources listed below to:
- Healthcare providers in your community; primary care, urgent care, and emergency healthcare providers are often the first to evaluate workers with undiagnosed silicosis once they become symptomatic.
- Health plans that can help disseminate information to their provider networks, particularly Medi-Cal managed care plans.
- Report cases to CDPH via CalREDIE or alternate established mechanism.
- Senate Bill 20, which goes into effect in January 2026, requires CDPH to report silicosis cases related to engineered stone to Cal/OSHA for investigation and allows CDPH to share case information with the local health officer for the purposes of surveillance, investigation, or case management.
Resources
For more information, including educational resources for employers and workers on how to reduce silica exposures during countertop fabrication, and references for local health departments and providers, please visit the CDPH Occupational Health Branch website.
References