National
Institute for Occupational Safety and
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Fatal illness in the workplace has been of interest to the public health community since at least the 18th century, when Bernardino Ramazzini compiled the first systematic description of the diseases of workers [Ramazzini 1713]. Diseases are generally more difficult to link with work than injuries. Many diseases related to occupational exposures (e.g., tuberculosis [TB], cancers, central nervous system disorders, and asthma) are no different when encountered in the absence of occupational exposures. Work-related aspects of illness may go unrecognized for many reasons, including long latency periods between the exposure and development of some diseases and the failure of health care professionals to recognize work-related illnesses or to obtain information about work history. This chapter covers conditions generally accepted to be solely or predominantly related to work. Excluded, for example, is lung cancer, even though 16% to 17% of cases in men and 2% of cases in women are considered to be work-related.
The pneumoconioses are a class of respiratory diseases attributed solely to workplace factors. From 1968 through 1996, pneumoconiosis was an underlying or contributing cause of 113,519 deaths in the United States (see
Figure 1�). The largest number of pneumoconiosis deaths were attributed to coal workers' pneumoconiosis (CWP), but deaths from this disease have declined over the years (Figure 3�/A>). By contrast, asbestosis deaths increased from fewer than 100 in 1968 to nearly 1,200 in 1996 (Figure 3�/A>). Over the same period, silicosis deaths decreased (Figure 3�/A>), byssinosis deaths varied substantially each year from 1979 to 1996 (Figure 3�/A>), and unspecified and other types of pneumoconiosis decreased (Figure 3�/A>).Back to TopFigure 3�/b>. Number of
deaths recorded with CWP as an underlying or contributing cause on the death
certificate桿.S. residents aged 15 and older, 1968�96. (Source: NSSPM
[1999].)
To view, click on image
Figure 3�/b>. Number of deaths
recorded with asbestosis as an underlying or contributing cause on the death
certificate桿.S. residents aged 15 and older, 1968�96. (Source: NSSPM
[1999].)
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Figure 3�/b>. Number of deaths recorded with silicosis as an underlying or contributing cause on the death certificate桿.S. residents aged 15 and older, 1968�96. (Source: NSSPM [1999].)
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Figure 3�/b>. Number of deaths recorded with byssinosis as an
underlying or contributing cause on the death certificate桿.S. residents aged 15
and older, 1979�96. (Source: NSSPM [1999].)
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Figure 3�/b>. Number of deaths recorded with unspecified and other pneumoconiosis as an underlying or contributing cause on the death certificate桿.S. residents aged 15 and older, 1968�96. (Source: NSSPM [1999].)
Back to TopPneumoconiosis Deaths by State
Asbestosis mortality is highest in northeastern, southern, and west coast States (
Figure 3�/A>), and CWP mortality is highest in Appalachian mining areas (Figure 3�/A>). Silicosis mortality appears less concentrated by geographic region than asbestosis or CWP mortality (Figure 3�/A>). Byssinosis deaths are concentrated in textile-producing States (Figure 3�/A>). The pattern of mortality for unspecified and other pneumoconiosis most resembles that of CWP (Figure 3�).Figure 3�/b>. Number of
asbestosis deaths by State桿.S. residents aged 15 and older, 1987�96
(Source: NSSPM [1999].)
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Figure 3�/b>. Number of CWP deaths
by State桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM
[1999].)
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Figure 3�/b>. Number of silicosis
deaths by State桿.S. residents aged 15 and older, 1987�96. (Source:
NSSPM [1999].)
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Figure 3�/b>. Number of byssinosis deaths by State桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)
Back to TopFigure 3�. Number of unspecified and other pneumoconiosis deaths by State桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)
Pneumoconiosis Deaths by Sex and Race
The distribution of different types of pneumoconiosis deaths varies by sex (Figure 3�) and race (Figure 3�). Women accounted for 28% of byssinosis deaths and less than 5% of deaths with all other types of pneumoconiosis. Blacks accounted for 15% of silicosis deaths, 13% of byssinosis deaths, and less than 7% of deaths with all other types of pneumoconiosis.
Figure 3�. Distribution of types
of pneumoconiosis deaths by sex桿.S. residents aged 15 and older,
1987�96. (Source: NSSPM [1999].)
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Figure 3�. Distribution of types of pneumoconiosis deaths by race桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)
Back to TopPneumoconiosis Deaths by Occupation
Proportionate mortality ratios (PMRs) associating pneumoconiosis deaths with various occupations are presented in Figures 3� through 3�. A PMR above 1.0 indicates that more deaths occurred with the condition than expected in an occupation or industry. PMRs with lower 95% confidence limits that exceed 1.0 are statistically significant. PMRs calculated from a large subset of national data indicate that mining machine operators have extremely high relative mortality from CWP and from unspecified and other pneumoconioses (
Figures 3� and 3�). Insulation workers and related occupations had the highest PMRs for asbestosis (Figure 3�). Workers in metal and plastic processing, hand molding and shaping, and crushing and grinding in mining occupations had the highest PMRs for silicosis mortality (Figure 3�). Textile machine operators and repairers had significant PMRs for byssinosis (Figure 3�). Back to TopFigure 3�.
PMRs (and 95% CIs) for CWP by occupation桿.S.
residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)
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Figure 3�. PMRs (and 95% CIs)
for unspecified and other pneumoconioses by occupation桿.S. residents aged
15 and older, 1987�96. (Source: NSSPM [1999].)
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Figure 3�.
PMRs (and 95% CIs) for asbestosis by
occupation桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM
[1999].)
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Figure 3�. PMRs (and 95% CIs) for silicosis by occupation桿.S. residents aged 15 and older, 1987�96. (Source: NSSPM [1999].)
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image
Figure 3�.
PMRs (and 95% CIs) for byssinosis in textile
machine operators and repairers桿.S. residents aged 15 and older, 1987�96.
(Source: NSSPM [1999].)
Mortality due to malignant pleural neoplasm (cancer of the
lung lining) can serve as a surrogate for mortality due to malignant mesothelioma (often
a cancer of the lung lining) because no unique cause-of-death code is
currently available for mesothelioma. Asbestos exposure is by far
the leading cause of malignant mesothelioma. The number of deaths associated with malignant
pleural neoplasm increased during 1968�96 (
Malignant Pleural Neoplasm
Figure 3�. Number of deaths with
malignant pleural neoplasm recorded as an underlying or contributing cause on
the death certificate桿.S. residents aged 15 and older, 1968�96.
(Source: NCHS [1999].)
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Figure 3�. Number of deaths due
to malignant pleural neoplasm by State桿.S. residents aged 15 and older,
1987�96. (Source: NCHS [1999].)
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image
Figure 3�. Distribution and number of deaths due to malignant pleural neoplasm by sex桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)
Back to TopFigure 3�. Distribution and
number of deaths due to malignant pleural neoplasm by race桿.S. residents
aged 15 and older, 1987�96. (Source: NCHS [1999].)
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image
Figure 3�.
PMRs (and 95% CIs) for malignant pleural neoplasm by usual
occupation桿.S. residents aged 15 and older, 1987�96. (Source: NCHS
[1999].)
Hypersensitivity pneumonitis is a lung
disease that is often related to occupation. Examples of this disease are
farmers' lung, mushroom workers' lung, and bird fanciers' disease. The annual
number of deaths with hypersensitivity pneumonitis as an underlying or
contributing cause has generally increased since 1979 (
Hypersensitivity Pneumonitis
Figure 3�. Number of deaths
recorded with hypersensitivity pneumonitis as an underlying or contributing
cause on the death certificate桿.S. residents aged 15 and older,
1979�96. (Source: NCHS [1999].)
To view, click on
image
Figure 3�. Number of
hypersensitivity pneumonitis deaths by State桿.S. residents aged 15 and
older, 1987�96. (Source: NCHS [1999].)
To view, click on
image
Figure 3�. Distribution and
number of hypersensitivity pneumonitis deaths by sex桿.S. residents aged
15 and older, 1987�96. (Source: NCHS [1999].)
To view, click on
image
Figure 3�. Distribution and number of hypersensitivity pneumonitis deaths by race桿.S. residents aged 15 and older, 1987�96. (Source: NCHS [1999].)
Back to TopPMRs for selected occupations and fatal illnesses are presented in
Table 3�/A> using data from the National Occupational Mortality Surveillance System (NOMS). Deaths related to diseases other than the pneumoconioses and mesothelioma are difficult to link to the workplace. Therefore, any apparent excess of mortality for an occupation must be verified by more definitive studies. Statistically significant elevations of PMR do not necessarily indicate a causal relationship between an occupation and a fatal illness. Some PMRs may be elevated by chance, which is likely when a very large number of PMRs are tested for statistical significance. Other elevated PMRs may be associated more strongly with confounding factors such as cigarette smoking, alcohol use, or socioeconomic factors such as availability of health care and proper diet. The information in Table 3�/A> may be used to identify possible associations between fatal illnesses and occupations that warrant further study. The findings may also be used to describe, to evaluate the results of other studies, or to target occupational groups for health promotion activities. For additional discussion about the use of PMRs from NOMS, see Mortality by Occupation, Industry, and Cause of Death: 24 Reporting States (1984�88) [NIOSH 1997]. Additional information about lung diseases can be obtained from the Work-Related Lung Disease Surveillance Report (WoRLD) [NIOSH 1999].Table 3�/b>. PMRs for white and black men and women aged 18 to 90 for selected occupations and causes of death in 28 States, 1984�95
Updated on 06/25/02