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ForewordSurveillance is the cornerstone of prevention: It helps us identify new and emerging problems, track and monitor issues over time, target and evaluate the effectiveness of intervention efforts, and anticipate future needs and concerns. Those who have long struggled with these issues in the occupational setting will share my enthusiasm for this first edition of the Worker Health Chartbook. I am grateful to the authors and contributors for accomplishing what has not been accomplished before—bringing together the patchwork of systems that monitor occupational illness and injury into one comprehensive and comprehensible guide. One of the primary goals in compiling the chartbook was to create a resource that could be used by anyone interested in workplace safety and health, including occupational safety and health practitioners, legislators and policy makers, health care providers, educators, researchers, and workers and their employers. In an attempt to reach the widest possible audience, we have made the chartbook available in printed and electronic form. Several Federal agencies worked together to organize the surveillance data sources required to produce this document. This is an important step toward identifying and filling significant gaps in occupational illness and injury information. The success of this initial effort has provided a framework for increased surveillance coordination between NIOSH and our partners in the future. The Worker Health Chartbook serves NIOSH and the occupational safety and health community well by placing surveillance in the hands of those who work to prevent occupational injuries and illnesses. The forethought and collaborative spirit that made all of this possible are commendable and bode well for future efforts to integrate Federal, State, and private-sector surveillance information.
Linda Rosenstock, M.D., M.P.H. Executive SummaryUnderstanding and preventing occupational injuries and illnesses require focused efforts to identify, quantify, and track both health outcomes and their associated workplace conditions. Occupational safety and health surveillance activities provide the ongoing and systematic collection, analysis, interpretation, and dissemination of data needed for prevention. Current occupational safety and health surveillance data reveal the staggering human and economic losses associated with occupational injuries and illnesses. Much work remains to be done to reduce those losses, despite overall decreases in occupational injuries and illnesses in recent years. Our ability to survey and assess the state of occupational safety and health has improved over time. However, occupational safety and health surveillance data remain fragmented—collected for different purposes by different organizations using different definitions. We continue to have substantial gaps in surveillance information. Each surveillance system has limitations, particularly those that attempt to quantify occupational illness. Nonetheless, the data provide useful information for targeting and evaluating prevention efforts.
To make these
data more accessible, the National Institute for Occupational Safety and
Health (NIOSH) has assembled this chartbook, which provides occupational
safety and health surveillance information from different sources in a
single volume. This initial work focuses on injury and illness outcomes
rather than on exposures or hazards. Included are contributions from several
Federal agencies. Little information is included on public-sector employees
or from State-based surveillance systems. Future editions of the chartbook
will target additional data sources to provide a more comprehensive picture
of occupational injury and illness for the U.S. workforce.
Trends Over TimeRecent overall decreases in occupational injuries and illnesses are apparent in the incidence rates for total recordable cases of injuries and illnesses in private industry reported by the U.S. Department of Labor in the Survey of Occupational Injuries and Illnesses (SOII). From 1973 to 1997, this rate declined from 11.0 to 7.1 cases per 100 full-time workers. The greatest change occurred among cases without lost workdays,* which decreased from 7.5 to 3.8 cases per 100 full-time workers over the same period. For 1988–1997, the rate of cases with days away from work declined 40%, but there was a 140% increase in the rate of cases with restricted work activity only. Occupational injury fatality rates recorded by NIOSH in the National Traumatic Occupational Fatalities Surveillance System (NTOF) decreased substantially (43%) between 1980 and 1995, from 7.5 to 4.3 deaths per 100,000 workers. Injury fatality rates recorded by the U.S. Department of Labor in the Census of Fatal Occupational Injuries (CFOI) declined by 7% from 1992 to 1997. Losses
attributable to occupational illness over time are more difficult to
describe. Although efforts have been made to estimate the burden of
occupational disease in the United States, no surveillance system describes
the magnitude of fatal occupational illnesses other than the pneumoconioses
(dust diseases of the lung). These illnesses can be described because they
are attributable entirely to occupation. Since 1968, more than 113,000
deaths have occurred with pneumoconiosis diagnosed as the underlying or
contributing cause—mostly coal workers' pneumoconiosis (CWP). Deaths with
CWP have decreased in recent years, whereas deaths with asbestosis increased
from 1968 to 1996 (from fewer than 100 to nearly 1,200). Recent DataFatal Occupational InjuriesAbout 17 workers were fatally injured on the job each day during 1997. Of the 6,238 fatal occupational injuries that year, 42% (2,605) were associated with transportation, excluding incidents that occurred while traveling to or from work. Most motor-vehicle-related fatalities (nearly 1,400) resulted from highway crashes. Homicides were the second leading cause of death, accounting for 14% of the total. The leading causes of death varied by sex, with motor vehicles being the leading cause for men and homicide the leading cause for women. Workers aged 65 and older had the highest rates of occupational injury death. Workplaces with 1 to 10 workers had the highest fatality rate (8.6 deaths per 100,000 workers), and workplaces with 100 or more workers had the lowest fatality rate (2 deaths per 100,000 workers). The highest numbers of fatalities occurred in construction, transportation and public utilities, and agriculture, forestry, and fishing industries. The highest fatality rates occurred in mining, construction, and agriculture, forestry, and fishing. The fatality rate in mining was more than five times the national average for all industries. Fatal Occupational IllnessesDeaths from diseases other than the pneumoconioses are difficult to attribute to the workplace for several reasons. For example, many diseases appear the same with or without occupational exposures; and some have latency periods of many years between exposure and disease development. Furthermore, health care professionals may not identify or consider occupational risk factors when making a diagnosis. Statistically elevated death rates for several diseases have been observed in a variety of occupations, but the degree to which these elevated rates can be directly associated with the workplace is not clear. However, these studies help set priorities for intervention and prevention as well as for future investigation. For example, death rates for persons with pneumoconiosis as an underlying or contributing cause varied by occupation and type of pneumoconiosis. Mining machine operators had high mortality rates from CWP and other/unspecified pneumoconiosis, and insulation workers and related occupations had high mortality rates from asbestosis. Various metalworking, plastic processing, and mining occupations had high mortality rates from silicosis, and textile machine operators and repairers had high mortality rates from byssinosis. Nonfatal InjuriesApproximately 5.7 million injuries were reported in
SOII in 1997. Those injuries represent 93% of the 6.1 million injuries and
illnesses documented by employer records in the private sector. The nonfatal injury rate
declined steadily in the 1990s. Agriculture, construction, manufacturing, and transportation
reported rates above the average of 6.6 per 100 full-time workers for all industries.
Sprains, strains, and tears accounted for a disproportionately large share of cases
with days away from work (nearly 800,000 cases in 1997). Nearly half of those
cases involved the back. Overexertion accounted for more than 60% of back injuries. According to
the National Electronic Injury Surveillance System (NEISS), occupational
injuries treated in hospital emergency departments numbered 3.6 million in
1998. Rates for those injuries were highest among men and workers under age
25. Lacerations, punctures, sprains and strains, contusions, abrasions, and
hematomas accounted for 70% of all injuries treated in emergency
departments. Nonfatal IllnessesNearly 430,000 nonfatal occupational illnesses
were recorded in SOII in 1997. About 60% of those illnesses occurred in the manufacturing
sector. The illness incidence rate for 1997 was 49.8 cases per 10,000 full-time workers.
Illness incidence rates varied by industry, with the highest rate occurring in
manufacturing. The rates in private industry increased with establishment size, with the
highest rate occurring in establishments employing 1,000 or more workers. Disorders
related to repeated trauma (including carpal tunnel syndrome [CTS],
tendinitis, and noise-induced hearing loss) accounted for 64% of the
occupational illnesses recorded in SOII in 1997. CTS accounted for more than
29,000 cases with days away from work in 1997. Half of the CTS cases
required 25 or more days away from work. Most noise- induced hearing loss
cases with days away from work occurred in
manufacturing. SOII relies on employer records to identify work-related injuries and illnesses. Illnesses reported to SOII are those most easily and directly related to workplace activity (e.g., contact dermatitis). Diseases that develop over a long period (e.g., cancers) or that have workplace associations that are not immediately obvious are overwhelmingly underrecorded in SOII. Consequently, other approaches and data sources have been developed to track occupational illnesses in a more active way. For example, the Sentinel Event Notification System for Occupational Risks (SENSOR) establishes a variety of simultaneous data sources to increase the chances of identifying a work-related illness in State surveillance systems. The California SENSOR program has specifically targeted surveillance of occupational CTS. Of the CTS cases identified in that program through physician first reports filed with the State compensation system in 1998, 30% occurred in the services industry and 17% occurred in manufacturing. Currently, the Michigan SENSOR program monitors noise-induced hearing loss. Manufacturing accounted for 51% of the noise-induced hearing loss cases reported by clinicians in 1998. Seven States have had active SENSOR programs for silicosis surveillance. From 1993 to 1995, 75% of silicosis cases occurred in manufacturing. In addition, four States have had active SENSOR programs for occupational asthma surveillance. The industry divisions accounting for the most cases from 1993 to 1995 were manufacturing (42%) and services (31%). Other public and private programs describe toxic exposures, pesticide poisonings, X-rays of working underground coal miners, infections in health care workers, and self-reported respiratory diseases among nonsmokers by industry. For example, the Adult Blood Lead Epidemiology and Surveillance Program (ABLES) monitors elevated blood lead levels (BLLs) in persons aged 16 and older. In 1998, a total of 10,501 adults in 25 States had high BLLs (25 µg/dL or greater). ConclusionsThe data provided in this chartbook indicate encouraging decreases in the frequency of some occupational fatalities, injuries, and illnesses. Surveillance has helped identify new and emerging problems and trends such as occupational musculoskeletal disorders and asthma. Although our ability to monitor these outcomes has improved over time, this chartbook illustrates the continued fragmentation of occupational health surveillance systems as well as the paucity (or even total absence) of data for certain occupational disorders and groups. The data suggest a compelling need to improve, expand, and coordinate occupational safety and health surveillance activities to develop and augment the data needed to guide illness and injury prevention efforts. Working with government and nongovernment partners, NIOSH will continue efforts to enhance occupational health surveillance in the coming years.
Updated on 06/25/02
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