Figure 5�. Number of CTS cases in California by type of activity or exposure, 1998. (Source: SENSOR [California Department of Health Services 1999].)

Nearly 18,000 tendinitis cases recorded in SOII in 1997 required days away from work. Women accounted for more than 60% of those cases, and the upper extremities were affected in more than 70% of cases. Most cases occurred in the manufacturing (45%) and services (20%) industries (Figure 5�) among operators, fabricators, and laborers (47%) and technical, sales, and administrative personnel (17%) (Figure 5�). Worker motion or position was the event or exposure accounting for 73% of cases.

Figure 5�. Number and distribution of tendinitis cases with days away from work in private industry by industry division, 1997. (Source: SOII [1999].)

Figure 5�. Number and distribution of tendinitis cases with days away from work in private industry by occupational group, 1997. (Source: SOII [1999].)

A SENSOR program to protect workers from noise-induced hearing loss was initiated in Michigan in 1992. The case definition for occupational noise-induced hearing loss under the program requires audiometric findings consistent with noise-induced hearing loss and a history of noise exposure at work sufficient to cause hearing loss. This case definition includes (1) workers with standard threshold shifts reported by company hearing conservation programs and (2) workers with a permanent noise-induced hearing loss diagnosed by a clinician. From 1992 to 1998, there were 13,177 cases of noise-induced hearing loss reported by companies, audiologists, otolaryngologists, the Bureau of Workers' Compensation, and hospitals. Companies accounted for 85.2% of these cases (Figure 5�). The SENSOR program interviews workers identified with permanent hearing loss by clinicians. In 1998, most of these cases were associated with manufacturing (Figure 5�). Within the manufacturing sector, 60% of cases were associated with transportation manufacturing, which includes automobile manufacturing.

According to patient interviews, 25% to 76% of companies in major industry divisions did not test hearing at the time the worker was exposed to noise (Figure 5�). Patients with hearing loss reported by companies (more than 85% of the reports) tended to be younger than patients whose hearing loss was reported by health professionals (Figure 5�). Of the cases in which sex was listed, 89% were men.

Figure 5�. Number and distribution of noise-induced hearing loss cases in Michigan by source of reports, 1992�98. Total number of cases was 13,177. (Source: SENSOR [Rosenman and Reilly 1999].)

Figure 5�. Number and distribution of permanent hearing loss cases reported by clinicians by industry division, 1998. (Source: SENSOR [Rosenman et al. 1999].)

Figure 5�. Percentage of companies within major industry divisions that did not test hearing at the time the worker was exposed to noise, as reported by patient interviews, 1992�98. (Source: SENSOR [Rosenman et al. 1999].)

Figure 5�. Distributions of noise-induced hearing loss cases by age range of patients and by company and noncompany reports, 1998. Age was unknown for 31 workers reported by company medical departments and 12 workers reported by noncompany hearing health professionals. (Source: SENSOR [Rosenman et al. 1999].)

Skin diseases or disorders accounted for 13% (57,900) of all illness cases reported in SOII in 1997. These disorders include allergic and irritant dermatitis, skin cancer, and other conditions. Manufacturing accounted for 45% of the skin diseases or disorders in private industry in 1997 (Figure 5�). The highest reported incidence rate was in the canned and cured fish and seafoods industry (181 cases per 10,000 workers). Other industries with the highest rates of occupational skin disease or disorder were meat packing plants (104 cases per 10,000 workers), ball and roller bearings (92 cases per 10,000 workers), and leather tanning and finishing (86 cases per 10,000 workers). Dermatitis, a subcategory of skin diseases and disorders, was associated with nearly 6,600 cases involving time away from work in 1997. A median number of 3 days away from work was associated with dermatitis. Exposures to chemicals and chemical products accounted for 53% of job-related dermatitis cases. The manufacturing and service industry divisions accounted for the most dermatitis cases with days away from work (29% each) (Figure 5�). Occupational groups that experienced most dermatitis conditions were operators, fabricators, and laborers (36%) and precision production, craft, and repair personnel (18%) (Figure 5�).

Figure 5�. Number (thousands) and distribution of skin disease or disorder cases in private industry by industry division, 1997. (Source: SOII [1999].)

Figure 5�. Number and distribution of dermatitis cases with days away from work in private industry by industry division, 1997. (Source: SOII [1999].)

Figure 5�. Number and distribution of dermatitis cases with days away from work in private industry by occupational group, 1997. (Source: SOII [1999].)

Dust diseases of the lungs accounted for less than 1% (2,900) of the nonfatal occupational illness cases recorded in SOII in 1997. These diseases include silicosis, asbestosis, and coal workers' pneumoconiosis (CWP). The most cases of occupational dust diseases of the lungs occurred in the manufacturing (33%) and service (27%) industries in 1997 (Figure 5�). The highest dust disease incidence rates occurred in aluminum sheet, plate, and foil manufacturing (33 per 10,000 workers), anthracite mining (30 per 10,000 workers), and ship building and repairing (12 per 10,000 workers).

Figure 5�. Distribution of occupational cases of dust diseases of the lungs in private industry, by industry division, 1997. Total number of cases was 2,900. (Source: SOII [1999].)

The prevalence and severity of CWP are examined in Coal Workers' X-Ray Surveillance Program (CWXSP). CWP is defined as having X-ray evidence of lung abnormalities (grade 1/0 or higher) using the International Labour Organization (ILO) Guidelines for the use of ILO International Classification of Radiographs of Pneumoconioses [ILO 1980]. Among workers with 25 or more years of underground tenure, the prevalence of CWP category 1/0 or greater decreased from more than 28% during 1970�73 to less than 10% during 1992�95 (Figure 5�). In the same tenure group, the prevalence of the more severe CWP category 2/1 or greater decreased from more than 10% during 1970�73 to less than 2% during 1992�95 (Figure 5�). Decreases in prevalence are also apparent in groups with less tenure in underground mining (Figures 5� and 5�).

Figure 5�. Prevalence of examined miners with CWP category 1/0 or greater by tenure in mining, 1970�95. (Source: CWXSP [1999].)

Figure 5�. Prevalence of examined miners with CWP category 2/1 or greater by tenure in mining, 1970�95. (Source: CWXSP [1999].)

From 1993 to 1995, seven States participated in the SENSOR silicosis program. Together these States identified 604 cases of silicosis, mostly through hospital reports (64%), reports by health care professionals (11%), and death certificates (9%) (Figure 5�). The cases originated mostly in manufacturing industries (75%), construction (9%), and mining (7%) (Figure 5�). Operators, fabricators, and laborers represented the majority of cases (61%) (Figure 5�).

Among silicosis patients who were interviewed, most had chronic disease with onset of symptoms 10 or more years after exposure. Exposure to high airborne concentrations of silica can cause disease within a few years, and acute silicosis (much less common) may result in death within months of intense occupational exposure. Although most of the interviewed workers had been occupationally exposed for more than 20 years, 8% had fewer than 10 years of exposure.

Figure 5�. Number and distribution of silicosis cases in all seven reporting States by source of report, 1993�95. (Source: SENSOR [NIOSH 1999].)

Figure 5�. Number and distribution of silicosis cases in all seven reporting States by industry division, 1993�95. (Source: SENSOR [NIOSH 1999].)

Figure 5�. Number and distribution of silicosis cases in all seven reporting States by major occupational category, 1993�95. (Source: SENSOR [NIOSH 1999].)

Respiratory disorders attributable to toxic agents in the work environment accounted for 5% (20,300) of the illness cases recorded in SOII in 1997. These disorders include allergic and irritant asthma, chronic bronchitis, and reactive airways dysfunction (an asthma-like syndrome). The industry divisions reporting the most cases in 1997 were manufacturing (37%) and services (34%) (Figure 5�). SOII reported the highest industry incidence rates in leather tanning and finishing (77 per 10,000 workers), motorcycles, bicycles, and parts (50 per 10,000 workers), ammunition, except for small arms not elsewhere classified (n.e.c.) (36 per 10,000 workers), ship building and repairing (36 per 10,000 workers), and musical instruments (34 per 10,000 workers).

Figure 5�. Number (thousands) and distribution of respiratory disorder cases attributed to toxic agents in private industry by industry division, 1997. (Source: SOII [1999].)

Workers' prevalence rates for asthma and chronic obstructive pulmonary disease (COPD) (such as chronic bronchitis and emphysema) are recorded in NHANES III (Figures 5� and 5�). These conditions may be caused or exacerbated by workplace exposures, but no particular attribution to workplace factors is made in NHANES III. Variations in prevalence rates among workers in different industries (particularly among nonsmokers) may suggest an occupational association in some cases.

Figure 5�. Estimated prevalence rates (and 95% confidence intervals [CIs]) for asthma among workers who are nonsmokers, by usual industry of workers' employment桿.S. residents aged 17 and older, 1988�94. (Source: NHANES III [1999].)

Figure 5�. Estimated prevalence rates (and 95% CIs) for COPD among workers who are nonsmokers, by usual industry of workers' employment桿.S. residents aged 17 and older, 1988�94. (Source: NHANES III [1999].)

Four States桸ew Jersey, Michigan, Massachusetts, and California梙ad active SENSOR programs during the years for which data are included in this report (1993�95). California relies on the first reports filed by physicians seeking reimbursement through the State workers' compensation system. The three remaining States rely primarily on more active physician reporting. In all four States, 90% of the 1,101 occupational asthma cases were identified through physician reports (Figure 5�). Most cases occurred in manufacturing (42%) and services (31%) (Figure 5�) among operators, fabricators, and laborers (32%) and technical, sales, and administrative support personnel (21%) (Figure 5�). The categories of agents most frequently associated with occupational asthma cases were all isocyanates (toluene diisocyanate, methylene diisocyanate, and other diisocyanates) (9%), indoor environments (8%), and mineral and inorganic dusts not otherwise specified (n.o.s.) (7%) (Figure 5�).

Figure 5�. Number and distribution of occupational asthma cases for all four reporting States by source of report, 1993�95. (Source: SENSOR [NIOSH 1999].)

Figure 5�. Number and distribution of occupational asthma cases for all four reporting States by industry division, 1993�95. (Source: SENSOR [NIOSH 1999].)

Figure 5�. Number and distribution of occupational asthma cases for all four reporting States by occupation, 1993�95. (Source: SENSOR [NIOSH 1999].)

Figure 5�. Number and distribution of occupational asthma cases for all four reporting States by most frequently associated agents, 1993�95. (Source: SENSOR [NIOSH 1999].)

Poisoning represented 1% (5,100) of all nonfatal occupational illness cases recorded in SOII in 1997. Poisoning cases include exposures to heavy metals (including lead), toxic gases (such as carbon monoxide and hydrogen sulfide), organic solvents, pesticides, and other substances (such as formaldehyde). Manufacturing accounted for 55% of poisoning cases reported in private industry (Figure 5�). The highest incidence rates occurred in the production of storage batteries (120 cases per 10,000 workers) and costume jewelry (78 cases per 10,000 workers), and in the secondary smelting and refining of nonferrous metals (62 cases per 10,000 workers).

Figure 5�. Number (thousands) and distribution of poisoning cases in private industry by major industry division, 1997. (Source: SOII [1999].)

ABLES monitors elevated blood lead levels (BLLs) in adults (persons aged 16 and older). Twenty-seven States participated in this program in 1998 by collecting BLLs from local health departments, private health care professionals, and private and State reporting laboratories (Figure 5�). During that year, a total of 10,501 adults in 25 of those States were reported to have BLLs of 25 礸/dL or greater. Prevalence rates for BLLs of 25 礸/dL or greater (based on all persons reported in a given year) do not reveal an obvious trend for the period 1993 through 1998, nor do the incidence rates (based on new cases reported in a given year) (Figure 5�). However, prevalence and incidence rates for BLLs of 50 礸/dL or greater in 10 ABLES States decreased from 1993 to 1998 (Figure 5�). 

Figure 5�. States (shaded) participating in the ABLES program in 1998. (Source: ABLES [1999].)

Figure 5�. Prevalence and incidence rates of adults aged 16 to 64 with BLLs greater than 25 礸/dL, 1993-1998. (Source: ABLES [1999].)

Figure 5�. Prevalence and incidence rates for BLLs equal to or greater than 50 礸/dL in adults aged 16 to 64 from 10 States (California, Connecticut, Iowa, Maryland, Massachusetts, New Jersey, New York, Oregon, Texas, Utah), 1993�98. (Source: ABLES [1999].)

Several surveillance systems track acute occupational illness and injury related to pesticides. Two systems are national, and several additional systems cover individual States. The Toxic Exposure Surveillance System (TESS) is maintained by the American Association of Poison Control Centers. Between 1993 and 1996, about 81% of the U.S. population was covered by a participating poison control center. During those years, more than 6,300 pesticide poisonings that occurred in the workplace were documented in TESS. Most of the poisonings were associated with insecticides (Figure 5�). Among those cases, 41% involved organophosphates, and 29% involved pyrethrins/pyrethroids.

SOII collects information about pesticide poisonings associated with lost workdays. Between 1992 and 1996, the annual number of nonfatal occupational illnesses and injuries related to pesticides ranged from 504 to 914 (Figure 5�). Most of those illnesses were associated with exposure to insecticides. Because SOII records only cases that result in lost work time, illnesses may be more severe than those recorded by other surveillance systems.

Thirty-one States have reporting requirements for pesticide-related illness and injury, but only eight States conduct surveillance for this condition. In California, Florida, New York, Oregon, and Texas, surveillance activities for acute occupational illness and injury related to pesticides are conducted in a SENSOR program supported in part by the U.S. Environmental Protection Agency (EPA). Besides tabulating case reports, these systems perform in-depth investigations for case confirmation, conduct screening of other workers at a patient's worksite, and develop targeted interventions. Over a 5-year period (1992�96), the annual number of cases in New York, Oregon, and Texas ranged from 72 to 170 (Figure 5�). Most cases involved exposures to insecticides. In addition, 33% of the cases involved agricultural exposures, including pesticide mixing, loading, and application.

Pesticide-related illness has been a reportable condition in California since 1971. The California Department of Pesticide Regulation (CDPR) has responsibility for collecting and evaluating these reports. Between 60% and 75% of cases are identified from workers' compensation reports. Most of the remainder are reported by physicians. The annual number of acute occupational illnesses and injuries related to pesticides in California ranged from 656 to 979 (Figure 5�). Insecticides were responsible for the largest proportion of cases. Among insecticides, insecticide combinations and organophosphates were most commonly responsible (Figure 5�). More than half of the reported cases occurred in agriculture (56%); services and public administration together contributed 28% (Figure 5�).

Figure 5�. Number of acute occupational illnesses related to pesticides by pesticide category (excludes antimicrobials), 1993�96. (Source: TESS [1998].)

Figure 5�. Number of occupational pesticide-related illnesses with days away from work in private industry by pesticide category, 1992�96. (Source: SOII [1999].

Figure 5�. Number of occupational illnesses related to pesticides in New York, Oregon, and Texas by pesticide category, 1992�96. (Source: SENSOR [New York State Department of Health 1999; Oregon Health Division 1999; PEST 1999].)

Figure 5�. Number of occupational illnesses related to pesticides in California by pesticide category (excludes antimicrobials and unknown agents), 1991�96. (Source: CDPR [1999].)

Figure 5�. Number of occupational illnesses related to insecticides in California by insecticide category, 1991�96. (Source: CDPR [1999].)

Figure 5�. Number and distribution of occupational illnesses related to pesticides (excluding antimicrobials and unknown agents) in California, by industry division, 1991�96. (Source: CDPR [1999].)

Between June 1995 and October 1999, 60 participating NaSH hospitals reported 6,983 cases of exposure to blood or body fluids. Most of these cases occurred in nurses (43%) and physicians (29%) (Figure 5�). The largest number of exposures to blood or body fluids occurred in inpatient (30%) and operating/procedure room settings (29%) (Figure 5�). The major route of exposure was percutaneous (puncture/cut injury) (Figure 5�).

Figure 5�. Number and distribution of reported health care worker exposures to blood or body fluids in 60 participating hospitals by occupational group, June 1995 to October 1999. (Source: NaSH [1999].)

Figure 5�. Number and distribution of reported health care worker exposures to blood or body fluids in 60 participating hospitals by work location, June 1995 to October 1999. (Source: NaSH [1999].)

Figure 5�. Number of reported health care worker exposures to blood or body fluids in 60 participating hospitals by exposure type, June 1995 to October 1999. (Source: NaSH [1999].)

VHSP and the Sentinel Counties Study of Acute Viral Hepatitis indicate a 93% decline in hepatitis B viral infections in health care workers over a 10-year period梖rom approximately 12,000 cases in 1985 to 800 cases in 1995 (Figure 5�). Infections also declined among the general population during this time, but not as dramatically. The greater decline among health care workers may be attributed to the adoption of universal precautions against exposure to body fluids and vaccinations against hepatitis B.

Figure 5�. Estimated number of hepatitis B infections among U.S. health care workers, 1985�95. (Source: VHSP [1999]; NCID [1999].)

Hepatitis C virus infection is the most common chronic bloodborne infection in the United States. Although the prevalence of hepatitis C virus infection in health care workers is similar to that in the general population (1% to 2%), health care workers have an increased occupational risk from needlestick injuries. The number of health care workers who have acquired hepatitis C infections occupationally is not known. But approximately 2% to 4% of acute infections in the United States occurred among health care workers exposed to blood in the workplace. Most workers exposed to hepatitis C were physicians or nurses (Figure 5�).

Figure 5�. Number and distribution of health care workers exposed to hepatitis C virus by occupational group, June 1995 to October 1999. (Source: NaSH [1999].)

Fifty-five cases of documented and 136 cases of possible occupational HIV transmission were recorded in HARS through June 1999. Among the documented cases of HIV seroconversion following occupational exposure, 85% resulted from percutaneous exposure and 93% involved exposure to blood or visibly bloody fluid. Most documented cases of occupational HIV transmission occurred among nurses (42%) and laboratory workers (35%) (Figure 5�). 

Figure 5�. Number and distribution of health care worker cases with documented occupational transmission of HIV by occupation through June 1999. (Source: HARS [CDC 1999].)

Health care workers have long been at risk of contracting TB. This risk increased in the 1980s with the resurgence of TB in the United States and the subsequent development of drug-resistant TB bacteria during the AIDS epidemic. From 1994 through 1998, there were 2,732 cases of TB in health care workers reported to the Centers for Disease Control and Prevention (CDC) through staffTRAK朤B from the 50 States, the District of Columbia, and Puerto Rico. Incidence rates in health care workers are shown in Figure 5� for each year from 1994 through 1998. These rates are not associated specifically with occupational exposure because that information is not available. Cases in health care workers constituted 3% of all TB cases.

Figure 5�. Incidence rates of TB in health care workers, 1994-1998. (Source: staffTRAK朤B [1999].)

Disorders attributable to physical agents represented 4% (16,600) of all nonfatal occupational illness cases recorded in SOII in 1997. Disorders attributable to physical agents include heatstroke, sunstroke, heat exhaustion, and other effects of environmental heat; freezing and frostbite; effects of ionizing radiation (isotopes, X-rays, radium); and effects of nonionizing radiation (welding flash, ultraviolet rays, microwaves, and sunburn). Illnesses from toxic exposures are excluded. Among industry divisions, manufacturing accounted for 55% of the disorders attributable to physical agents in private industry in 1997 (Figure 5�). Among individual industries, the highest illness rates occurred in metal sanitary ware (294 cases per 10,000 workers), primary aluminum (89 cases per 10,000 workers), ship building and repairing (79 cases per 10,000 workers), and plumbing and heating, except electric (73 cases per 10,000 workers).

Figure 5�. Number (thousands) and distribution of disorders attributable to physical agents in private industry by major industry division, 1997. (Source: SOII [1999].)

Nearly 5,300 cases of anxiety, stress, or neurotic disorders with time away from work were recorded in SOII in 1997. These represent 1% of all reported nonfatal occupational illness cases. Women accounted for more than 60% of all occupational anxiety, stress, and neurotic disorder cases with time away from work. Half of all such disorder cases required 23 or more days away from work, and more than 40% of workers with these disorders required more than 31 days away from work. The industry divisions accounting for most cases were services (35%), wholesale and retail trade (20%), and manufacturing (20%) (Figure 5�). The occupational groups most frequently experiencing these disorders were technical, sales, and administrative personnel (47%) and operators, fabricators, and laborers (18%) (Figure 5�). The exposures most frequently associated with anxiety, stress, or neurotic disorders were harmful substances (30%) and assaults or violent acts (13%) (Figure 5�).

Figure 5�. Number and distribution of anxiety, stress, and neurotic disorder cases with days away from work in private industry by industry division, 1997. (Source: SOII [1999].)

Figure 5�. Number and distribution of anxiety, stress, and neurotic disorder cases with days away from work in private industry, by occupational group, 1997. (Source: SOII [1999].)

Figure 5�. Number and distribution of anxiety, stress, and neurotic disorder cases with days away from work in private industry, by event or exposure, 1997. (Source: SOII [1999].)

All other nonfatal occupational illnesses represented 12% (50,400) of all illness cases recorded in SOII in 1997. This category captures illnesses such as anthrax, brucellosis, hepatitis B and C, HIV disease, malignant and benign tumors, food poisoning, histoplasmosis, and coccidioidomycosis. The largest percentages of such cases in 1997 occurred in services (41%) and manufacturing (29%) (Figure 5�). Industries reporting the highest incidence rates were luggage (163 cases per 10,000 workers), secondary smelting and refining of nonferrous materials (120 cases per 10,000 workers), prefabricated metal buildings (66 cases per 10,000 workers), and iron and steel forgings (61 cases per 10,000 workers).

Figure 5�. Number (thousands) and distribution of all other occupational illnesses in private industry by major industry division, 1997. (Source: SOII [1999].)

 Updated on 06/25/02

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