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Current Trends Use of Workers' Compensations Claims for
Surveillance of Work-Related Illness -- New Hampshire, January
1986-
March 1987
As part of a surveillance program for occupationally related
health events, the New Hampshire Division of Public Health Services
(NHDPHS) routinely reviews case reports submitted by health-care
providers and identifies work-related sentinel health events from
death certificates (1,2). Despite the use of multiple data sources,
however, surveillance of work-related disease remains incomplete
(3).
In a further effort to improve surveillance, the NHDPHS recently
completed an epidemiologic analysis of workers' compensation claims
filed in the state for the 15-month period January 1986-March 1987.
Workers' compensation claims were provided by the New Hampshire
Department of Labor. Information on the sex, age, occupation, and
place and town of employment of the claimant; the date of the
claim;
and the diagnosis were abstracted manually from all claims for
disease
or illness. Data were analyzed to determine the demographic
characteristics of claimants and to determine the distribution of
work-related illness within particular industries. The proportions
of
diagnoses in each industrial category were compared with the
proportions observed for all claims. Statistical testing was
performed
using a chi-square distribution with 1 degree of freedom.
Nearly 78,000 claims were filed during the study period. Of
these,
76,856 (98.6%) involved work-related injuries, and 1,103 (1.4%)
involved illnesses or diseases. Fifty-two percent of illness and
disease claims were filed by males. Claimants ranged in age from 16
to
76 years, with a mean of 35 years. Three hundred eighty-six (35%)
of
reported conditions were attributable to the inhalation of gases,
fumes, or vapors; 288 (26%) were attributable to skin disorders;
226
(20%), to carpal tunnel syndrome or other repetitive trauma
disorders;
and 109 (10%), to exposure to an infectious agent. The latter
claims
were filed primarily by health-care workers, firefighters, and
police
officers, who alleged exposure to hepatitis (38%), tuberculosis
(19%),
pertussis (17%), chickenpox (7%), meningitis (6%), and AIDS (4%).
The distribution of diagnoses by industrial category was also
analyzed. Notable findings included elevated proportions of claims
due
to carpal tunnel syndrome among employees working with rubber
(relative risk (RR) = 2.33) and employees in retail sales (RR =
1.93);
dermatitis among workers in the metals and electronics industries
(RR
= 1.99 and 1.42, respectively); and chemical burns resulting from
the
use of caustic cleaning substances by food and restaurant workers
(RR
= 6.80). Fewer than 1% (7) of illness claims involved chronic
diseases: five cases of asbestosis, one of mesothelioma, and one of
pancreatic cancer.
Comparison of the distribution of claims filed during the study
period with that observed in an earlier review of 1976 claims
revealed
a change in the pattern of illnesses (4). The proportion of claims
for
respiratory diseases and for carpal tunnel syndrome and repetitive
trauma disorders had increased markedly; it had decreased
considerably for skin disorders (Table 1). Similar nationwide
changes
have been reported by the Bureau of Labor Statistics (5).
Reported by: E Schwartz, MD, MPH, State Epidemiologist, and staff,
New
Hampshire Dept of Health and Welfare. Office of the Director,
National
Institute for Occupational Safety and Health, CDC. Editorial Note
Editorial Note: Surveillance of occupationally related diseases
provides critical data necessary for targeting and evaluating
prevention and control activities. State-based surveillance often
relies on the analysis of data derived from multiple sources,
including physician reports, death certificates, hospital discharge
records, and workers' compensation claims. Because each data set
has
different inherent limitations, many states use complementary
sources
of data to estimate the occurrence of occupational disease more
accurately.
Workers' compensation systems vary widely among states in
eligibility but commonly are administered by state labor
departments
to provide no-fault insurance for work-related injuries (6). The
New
Hampshire law covers occupational diseases as well as injuries and
applies to all workers except federal employees, longshoremen,
railroad workers, and agricultural workers. Members of certain
other
exempted groups, such as the self-employed, may participate on a
voluntary basis (7). Despite an estimated 8 million claims filed
annually in the United States, fewer than 20% of workers who
thought
they had been severely disabled because of their jobs have ever
applied for workers' compensation (8,9). In New Hampshire, as in
most
states, nearly all claims involve work-related traumatic injuries
(10). This pattern occurs partly because the causal association
between workplace exposure and a resulting illness is often
obscured
by 1) the often multicausal nature of many chronic diseases, 2) the
generally long latent period between first exposure to workplace
agents and the time a chronic condition becomes clinically
apparent,
and 3) physicians' failure to recognize and diagnose occupational
disease. Since workers' compensation claims contain allegations of
injury, illness, or disease that may be subject to dispute, cases
identified through compensation claims may be considered suspected
rather than confirmed. Even so, as with infectious disease,
suspected
cases can be valuable for surveillance purposes.
Despite these limitations in workers' compensation claims, the
New
Hampshire data suggest that ongoing analysis of such data may be a
useful method for surveillance of trends in occupational illness,
as
demonstrated by the shift in the distribution of claims from 1976
to
1986. Some of this shift may indicate a true change in the
incidence
of these conditions, but the magnitude of the increases in claims
for
respiratory and repetitive trauma disorders suggests that much of
the
shift can be attributed to improved physician recognition and
reporting of these conditions as work-related. In addition, because
10% of disease claims in New Hampshire alleged exposure to an
infectious agent, analysis of these claims could enhance
surveillance
of occupationally related communicable disease as well.
Furthermore,
epidemiologic surveillance of workers' compensation claims offers
an
opportunity to identify companies and industries with unusual
patterns
of work-related illness or injury. Such identification can provide
a
basis for targeting industrial hygiene evaluations and for more
thorough epidemiologic investigations that will lead to
interventions.
In addition to the use of workers' compensation records for
surveillance, the National Institute for Occupational Safety and
Health continues to recommend that states develop primary
intervention
and prevention activities based also upon targeted provider-based
case
reporting and analyses of other data sources. References
CDC. Use of death certificates for surveillance of work-related
illnesses--New Hampshire. MMWR 1986;35:537-40.
Rutstein DD, Mullan RJ, Frazier TM, Halperin WE, Melius JM,
Sestito JP. Sentinel health events (occupational): a basis for
physician recognition and public health surveillance. Am J
Public
Health 1983;73:1054-62.
Sundin DS, Pedersen DH, Frazier TM. Occupational hazard and
health
surveillance. Am J Public Health 1986;76:1083-4.
New Hampshire Department of Labor. New Hampshire--Occupational
Injuries and Illnesses Survey, 1976. Concord, New Hampshire:
New
Hampshire Department of Labor, 1978.
Bureau of Labor Statistics. Towards improved measurement and
reporting of occupational illness and disease. Washington, DC:
US
Department of Labor, Bureau of Labor Statistics, 1987:78.
Larson A. Workmen's compensation for occupational injuries and
deaths. New York: Matthew Bender, 1985.
New Hampshire Revised Statutes Annotated 281; Workers'
compensation law. (Supp. 1986).
Shor GM. Workers' compensation: subsidies for occupational
disease. J Public Health Policy 1980;1:328-41.
US Department of Labor. An interim report to Congress on
occupational diseases. Washington, DC: US Department of Labor,
1980:66.
Barth PS, Hunt HA. Workers' compensation and work-related
illnesses and diseases. Cambridge, Massachusetts: MIT Press,
1980:256.
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