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Hundreds of California workers who fabricated engineered-stone countertops have been diagnosed with silicosis, a serious and incurable lung disease, with dozens dying and scores requiring lung transplants, according to state data and a new analysis of the outbreak.
California Department of Public Health data currently shows 618 confirmed cases and 32 deaths among workers exposed to silica while fabricating engineered-stone products, often marketed as quartz.
An analysis published in NEJM Evidence, covering cases identified between January 2019 and June 2026, documented 592 cases by that point, including 31 deaths. The findings highlight the relatively young age of affected workers and the severity and speed at which the disease can progress.
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California Cases In Numbers
Researchers analyzed California's surveillance data on workers with engineered-stone silicosis and found that 65 of the 592 workers, or 11 percent, had undergone a lung transplant. A further 138 workers, or 23 percent, had been referred for transplantation, underscoring the severity of disease among a substantial share of identified patients.
Among 310 workers for whom information on age at diagnosis was available, the median age at diagnosis was 46, with half those cases falling between ages 41 and 52.
Workers have also died relatively young. Among the 31 people who had died by June, the median age at death was 52, with an interquartile range of 44 to 55.
The researchers said the California cases were notable for patients' "young age at diagnosis, short duration of exposure, severity and rapid progression of disease."
Exposure histories were available for 427 workers. They had experienced a median of 22 years of occupational silica-dust exposure, with the middle half ranging from 16 to 25 years.
Almost all of the identified patients were men. Of the 592 cases, 591 were male, while one was female.
The outbreak has also disproportionately affected Latino workers. 580 patients, or 98 percent, were Latino, according to the analysis. Eleven were classified as another race or ethnicity, while information was unavailable for one person.
What Is Silicosis?
Silicosis develops when workers inhale respirable crystalline silica dust, which can be generated while cutting, grinding or polishing stone products.
Engineered stone is produced using crushed natural quartz combined with other materials and can contain very high levels of crystalline silica. Fabrication work can therefore expose employees to fine silica particles capable of entering deep into the lungs.
What Are The Symptoms? Is There A Cure?
Common symptoms include a persistent cough, difficulty breathing, and pain in the chest or back. As the disease can also make it harder for the body to fight infections, some people may develop additional respiratory illnesses and experience fatigue, muscle weakness, unexplained weight loss, fever, night sweats and chest pain.
It is not curable as scarring and permanent damage caused to the lung tissue by silica dust cannot be reversed. Medical care focuses on ensuring the disease does not get any worse. Lung transplants can be offered, but only to prolong life, not to save it.
California's First Identified Case
California health officials identified the state's first known case involving a countertop-fabrication worker in January 2019. That worker had been diagnosed with silicosis at 32 years old and later died from respiratory failure at 38.
An investigation into his workplace subsequently identified two former employees who also had silicosis, including another worker who had died.
Officials then screened 43 current employees at the business and identified another five cases. California later expanded its surveillance efforts to draw on hospital discharge data, electronic case reporting and reports submitted directly by clinicians and other sources.
Those efforts have contributed to the steep increase in the number of known cases since the first worker was identified seven years ago.
Researchers Warn Case Count Is Likely an Undercount
Despite the hundreds of workers already identified, the researchers said the true scale of engineered-stone silicosis in California is probably larger.
They said surveillance continues to depend heavily on workers first being diagnosed and then reported to public health authorities. Screening is inconsistent, while cases can also be misdiagnosed, meaning workers with the disease may not be included in official totals.
The authors said hazardous exposures also continue to occur in California despite changes intended to strengthen protections for workers.
California has taken a series of regulatory steps in response to the outbreak, including making silicosis a reportable disease. Since June 2025, clinicians have been required to report identified or suspected cases to the appropriate local health department within seven days.
Researchers called for more active screening of workers, improved surveillance and greater awareness among clinicians so cases can be recognized earlier.
They also said further workplace and policy measures will be needed to prevent additional workers from developing the disease.
The state's current tally of 618 cases and 32 deaths indicates that diagnoses have continued to rise since the study's June 2026 cutoff.
Lawmakers Seek Extra Protections For Workers
California has already moved to strengthen protections for stone workers through SB 20, the Silicosis Training, Outreach, and Prevention Act, which was signed into law in 2025. The measure bans dry cutting and other high-exposure fabrication practices, requires employers to use safer wet methods and mandates worker training.
From July 2026, employers must also attest annually to Cal/OSHA that required training has been completed. The law also strengthens reporting and enforcement requirements when silicosis cases are identified.
A separate proposal, AB 2137, introduced in 2026, sought to create a state certification system for stone-fabrication businesses. Shops would have had to demonstrate compliance with workplace-safety rules, maintain workers' compensation coverage and carry out air-quality monitoring. Suppliers would eventually have been barred from selling slabs to uncertified businesses.
The bill was held in the Assembly Appropriations Committee in May 2026.
Contact Newsweek editors on this story: Rebecca Flood and Robert Greenall
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