Occupational heat-related illness in Washington State: A descriptive study of day of illness and prior day ambient temperatures among cases and clusters, 2006-2021.

BACKGROUND: Insufficient heat acclimatization is a risk factor for heat-related illness (HRI) morbidity, particularly during periods of sudden temperature increase. We sought to characterize heat exposure on days before, and days of, occupational HRIs. METHODS: A total of 1241 Washington State workers' compensation State Fund HRI claims from 2006 to 2021 were linked with modeled parameter-elevation regressions on independent slopes model (PRISM) meteorological data. We determined location-specific maximum temperatures (Tmax,PRISM ) on the day of illness (DOI) and prior days, and whether the Tmax,PRISM was ≥10.0°F (~5.6°C) higher than the average of past 5 days ("sudden increase") for each HRI claim. Claims occurring on days with ≥10 HRI claims ("clusters") were compared with "non-cluster" claims using t tests and χ2 tests. RESULTS: Seventy-six percent of analyzed HRI claims occurred on days with a Tmax,PRISM ≥ 80°F. Claims occurring on "cluster" days, compared to "non-cluster" days, had both a significantly higher mean DOI Tmax,PRISM (99.3°F vs. 85.8°F [37.4°C vs. 29.9°C], t(148) = -18, p < 0.001) and a higher proportion of "sudden increase" claims (80.2% vs. 24.3%, χ2 [1] = 132.9, p < 0.001). Compared to "cluster" days, HRI claims occurring during the 2021 Pacific Northwest "heat dome" had a similar increased trajectory of mean Tmax,PRISM on the days before the DOI, but with higher mean Tmax,PRISM. CONCLUSIONS: Occupational HRI risk assessments should consider both current temperatures and changes in temperatures relative to prior days. Heat prevention programs should include provisions to address acclimatization and, when increases in temperature occur too quickly to allow for sufficient acclimatization, additional precautions.

Surveillance of work-related asthma including the emergence of a cannabis-associated case series in Washington State.

OBJECTIVE: We conducted surveillance for work-related asthma (WRA) in Washington State to identify the industry sectors and asthma exposures most commonly affecting injured workers and in need of prevention activities. METHODS: Using workers' compensation data as the primary data source, valid cases were classified as work-aggravated asthma (WAA) or new onset asthma that includes occupational asthma (OA) and reactive airways dysfunction syndrome (RADS). The source of exposure that caused the worker's asthma, their industry and occupation were determined. RESULTS: There were 784 valid work-related asthma cases identified for the period 2009-2016, WAA (n = 529) was most common followed by occupational asthma (n = 127) and RADS (n = 12). The Health Care and Social Assistance industry had the highest number of cases (n = 170) with 82% classified as WAA. The highest overall proportions of new onset asthma are occurring in Agriculture, Forestry, Fishing and Hunting (33% of work related asthma cases), Manufacturing (31%) and Construction (30%). The leading substances associated with new onset asthma across all industries include hop plant dust, wood and cedar dust, mineral and inorganic dust, mold, and cleaning materials. We describe ten cases of cannabis-associated asthma including seven from workers in the legalized cannabis industry, four of whom had OA. CONCLUSION: State-based work-related asthma surveillance is critical in identifying the workers and exposures associated with this occupational disease, including the detection of a case-series in the cannabis industry.

Improving Occupational Health Disparity Research: Testing a method to estimate race and ethnicity in a working population.

BACKGROUND: Race and ethnicity data are often absent from administrative and health insurance databases. Indirect estimation methods to assign probability scores for race and ethnicity to insurance records may help identify occupational health inequities. METHODS: We compared race and ethnicity estimates from the Bayesian Improved Surname Geocoding (BISG) formula to self-reported race and ethnicity from 1132 workers. RESULTS: The accuracy of the BISG using gender stratified regression models adjusted for worker age and industry were excellent for White and Latino males and Latino females, good for Black and Asian Pacific Islander males and White and Asian Pacific Islander females. American Indian/Alaskan Native and those who indicated they were "Other" or "More than one race" were poorly identified. CONCLUSION: The BISG estimation method was accurate for White, Black, Latino, and Asian Pacific Islanders in a sample of workers. Using the BISG in administrative datasets will expand research into occupational health disparities.

Workers' compensation claims not reported in the Survey of Occupational Injuries and Illnesses: Injury and claim characteristics.

BACKGROUND: Underreporting in the nation's primary source of non-fatal occupational injury and illness data are well documented, but worker-level characteristics of unreported cases have not been fully explored. METHODS: Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses (SOII) data were linked to Washington workers' compensation claims to identify injury and claim characteristics associated with unreported cases. Workers' compensation administrative date data were used to characterize timing of disability and SOII case eligibility. RESULTS: Based on claim date data, one in five lost time claims with an injury date in the survey year were likely ineligible for SOII case reporting during the survey year. Among SOII-eligible claims, those involving sprains or strains, employer protests, and those not eligible for work disability payments until months after the initial injury were least likely to be reported in SOII. CONCLUSIONS: SOII case capture is limited both by its cross sectional survey design and employer underreporting. Am. J. Ind. Med. 60:264-275, 2017. © 2017 Wiley Periodicals, Inc.

Employer reasons for failing to report eligible workers' compensation claims in the BLS survey of occupational injuries and illnesses.

BACKGROUND: Little research has been done to identify reasons employers fail to report some injuries and illnesses in the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII). METHODS: We interviewed the 2012 Washington SOII respondents from establishments that had failed to report one or more eligible workers' compensation claims in the SOII about their reasons for not reporting specific claims. Qualitative content analysis methods were used to identify themes and patterns in the responses. RESULTS: Non-compliance with OSHA recordkeeping or SOII reporting instructions and data entry errors led to unreported claims. Some employers refused to include claims because they did not consider the injury to be work-related, despite workers' compensation eligibility. Participant responses brought the SOII eligibility of some claims into question. CONCLUSION: Systematic and non-systematic errors lead to SOII underreporting. Insufficient recordkeeping systems and limited knowledge of reporting requirements are barriers to accurate workplace injury records.

Unreported workers' compensation claims to the BLS Survey of Occupational Injuries and Illnesses: Establishment factors.

BACKGROUND: Studies suggest employers underreport injuries to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII); less is known about reporting differences by establishment characteristics. METHODS: We linked SOII data to Washington State workers' compensation claims data, using unemployment insurance data to improve linking accuracy. We used multivariable regression models to estimate incidence ratios (IR) of unreported workers' compensation claims for establishment characteristics. RESULTS: An estimated 70% of workers' compensation claims were reported in SOII. Claims among state and local government establishments were most likely to be reported. Compared to large manufacturing establishments, unreported claims were most common among small educational services establishments (IR = 2.47, 95%CI: 1.52-4.01) and large construction establishments (IR = 2.05, 95%CI: 1.77-2.37). CONCLUSIONS: Underreporting of workers' compensation claims to SOII varies by establishment characteristics, obscuring true differences in work injury incidence. Findings may differ from previous research due to differences in study methods.

Occupational Hydrofluoric Acid Injury from Car and Truck Washing--Washington State, 2001-2013.

Exposure to hydrofluoric acid (HF) causes corrosive chemical burns and potentially fatal systemic toxicity. Car and truck wash cleaning products, rust removers, and aluminum brighteners often contain HF because it is efficient in breaking down roadway matter. The death of a truck wash worker from ingestion of an HF-based wash product and 48 occupational HF burn cases associated with car and truck washing in Washington State during 2001-2013 are summarized in this report. Among seven hospitalized workers, two required surgery, and all but one worker returned to the job. Among 48 injured workers, job titles were primarily auto detailer, car wash worker, truck wash worker, and truck driver. Because HF exposure can result in potentially severe health outcomes, efforts to identify less hazardous alternatives to HF-based industrial wash products are warranted.

Respiratory disease associated with occupational inhalation to hop (Humulus lupulus) during harvest and processing.

BACKGROUND: There is little published evidence for occupational respiratory disease caused by hop dust inhalation. In the United States, hops are commercially produced in the Pacific Northwest region. OBJECTIVE: To describe occupational respiratory disease in hop workers. METHODS: Washington State workers' compensation claims filed by hop workers for respiratory disease were systematically identified and reviewed. Incidence rates of respiratory disease in hop workers were compared with rates in field vegetable crop farm workers. RESULTS: Fifty-seven cases of respiratory disease associated with hop dust inhalation were reported from 1995 to 2011. Most cases (61%) were diagnosed by the attending health care practitioner as having work-related asthma. Seven percent of cases were diagnosed as chronic obstructive pulmonary disease, and the remaining cases were diagnosed as allergic respiratory disorders (eg, allergic rhinitis) or asthma-associated symptoms (eg, dyspnea). Cases were associated with hop harvesting, secondary hop processing, and indirect exposure. The incidence rate of respiratory disease in hop workers was 15 cases per 10,000 full-time workers, which was 30 times greater than the incidence rate for field vegetable crop workers. A strong temporal association between hop dust exposure and respiratory symptoms and a clear association between an increase in hop dust concentrations and the clinical onset of symptoms were apparent in 3 cases. CONCLUSION: Occupational exposure to hop dust is associated with respiratory disease. Respiratory disease rates were higher in hop workers than in a comparison group of agricultural workers. Additional research is needed before hop dust can be confirmed as a causative agent for occupational asthma.

Distribution of asthma by occupation: Washington State behavioral risk factor surveillance system data, 2006-2009.

OBJECTIVE: To estimate the prevalence of asthma in workers by occupation in Washington State. METHODS: Data from the 2006-2009 Behavioral Risk Factor Surveillance System (BRFSS) and the BRFSS Asthma Call-Back Survey (ACBS) in Washington State (WA) were analyzed. Using state-added and coded Industry and Occupation questions, we calculated prevalence ratios (PRs) for 19 occupational groups. RESULTS: Of the 41,935 respondents who were currently employed during 2006-2009, the prevalence of current asthma was 8.1% [95% confidence interval (CI) 7.8-8.5%] When compared with the reference group of executive, administration and managerial occupations, three occupational groups had significantly (p < 0.05) higher PRs of current asthma: "Teachers, all levels, and Counselors' (PR 1.3, 95% CI 1.1-1. 6%); 'Administrative Support, including Clerical" (PR 1. 5, 95% CI 1.2-1.9%); and "Other Health Services" (PR 1.5, 95% CI 1.2-1.9). Half of the 2511 ACBS respondent workers (55.1%) indicated that they believed exposure at work had caused or worsened their asthma, but only 10.7% had ever spoken with a health care professional about their asthma being work related. CONCLUSIONS: Some occupations have a higher prevalence of current asthma than other occupations. The systematic collection of industry and occupation data can help identify worker populations with a high burden of asthma and can be used to target disease prevention efforts as well as to aid clinician recognition and treatment. Workers indicated that work-related asthma exposures are not discussed with their health care provider and this communication gap has implications for asthma management.

Exploring the relationship between employer recordkeeping and underreporting in the BLS Survey of Occupational Injuries and Illnesses.

BACKGROUND: Little empirical data exist to identify the reasons for underreporting in the US Bureau of Labor Statistics (BLS) non-fatal occupational injury and illness data. METHODS: We interviewed occupational injury and illness record keepers from Washington State establishments that participated in the 2008 BLS Survey of Occupational Injuries and Illnesses (SOII). Qualitative and quantitative methods were used to explore recordkeeping and business practices that may explain SOII's incomplete case capture compared with WC claims data. RESULTS: Most participants (90%) did not comply with OSHA recordkeeping regulations. Other factors including using workplace injury data to evaluate supervisors' or SOII respondent's job performance, recording injuries for a worksite that operates multiple shifts, and failing to follow SOII instructions were more common among establishments with unreported WC claims. CONCLUSION: Business practices that incentivize low injury rates, disorganized recordkeeping, and limited communication between BLS and survey respondents are barriers to accurate employer reports of work-related injuries and illnesses.

Injury classification agreement in linked Bureau of Labor Statistics and Workers' Compensation data.

BACKGROUND: Estimates of select occupational injuries and illnesses often differ across data sources. We explored agreement in injury classifications and the impact of differences on case estimates among records reported to multiple data sources. METHODS: We linked cases reported in the Bureau of Labor Statistics (BLS) annual Survey of Occupational Injuries and Illnesses (SOII) to Washington State workers' compensation (WC) claims and evaluated agreement in injury characteristics coded in each data source according to the same occupational injury and illness classification system. RESULTS: Agreement between data sources was greatest for body part and lowest for event or exposure. Agreement on nature of injury varied by condition. WC-assigned injury codes estimated 94% more amputations than SOII-assigned codes while SOII-assigned codes estimated 34% more work-related MSD cases. CONCLUSIONS: Accounting for classification differences may improve case ascertainment within individual data sources and help align injury and illness estimates derived from different data sources.

Heat-related illness in Washington State agriculture and forestry sectors.

BACKGROUND: We sought to describe heat-related illness (HRI) in agriculture and forestry workers in Washington State. METHODS: Demographic and clinical Washington State Fund workers' compensation agriculture and forestry HRI claims data (1995-2009) and Washington Agriculture Heat Rule citations (2009-2012) were accessed and described. Maximum daily temperature (Tmax) and Heat Index (HImax) were estimated by claim date and location using AgWeatherNet's weather station network. RESULTS: There were 84 Washington State Fund agriculture and forestry HRI claims and 60 Heat Rule citations during the study period. HRI claims and citations were most common in crop production and support subsectors. The mean Tmax (HImax) was 95°F (99°F) for outdoor HRI claims. Potential HRI risk factors and HRI-related injuries were documented for some claims. CONCLUSIONS: Agriculture and forestry HRI cases are characterized by potential work-related, environmental, and personal risk factors. Further work is needed to elucidate the relationship between heat exposure and occupational injuries.

Obesity prevalence by occupation in Washington State, Behavioral Risk Factor Surveillance System.

INTRODUCTION: Data that estimate the prevalence of and risk factors for worker obesity by occupation are generally unavailable and could inform the prioritization of workplace wellness programs. The aims of this study were to estimate the prevalence of obesity by occupation, examine the association of occupational physical activity and a range of health behaviors with obesity, and identify occupations in which workers are at high risk of obesity in Washington State. METHODS: We conducted descriptive and multivariable analyses among 37,626 employed Washington State respondents using the Behavioral Risk Factor Surveillance System in odd numbered years, from 2003 through 2009. We estimated prevalence and prevalence ratios (PRs) by occupational groups adjusting for demographics, occupational physical activity level, smoking, fruit and vegetable consumption, and leisure-time physical activity (LPTA). RESULTS: Overall obesity prevalence was 24.6% (95% confidence interval [CI], 24.0-25.1). Workers in protective services were 2.46 (95% CI, 1.72-3.50) times as likely to be obese as workers in health diagnosing occupations. Compared with their counterparts, workers who consumed adequate amounts of fruits and vegetables and had adequate LTPA were significantly less likely to be obese (PR = 0.91; 95% CI, 0.86-0.97 and PR = 0.63; 95% CI, 0.60-0.67, respectively). Workers with physically demanding occupational physical activity had a lower PR of obesity (PR = 0.83; 95% CI, 0.78-0.88) than those with nonphysically demanding occupational physical activity. CONCLUSION: Obesity prevalence and health risk behaviors vary substantially by occupation. Employers, policy makers, and health promotion practitioners can use our results to target and prioritize workplace obesity prevention and health behavior promotion programs.

Effects of residential location and work-commuting on long-term work disability.

PURPOSE: Little is known about the independent effect of workers' residential location and work-commuting on their long-term disability due to work-related injuries. We examined 149,110 incident claims while adjusting for multiple risk factors in a large, population-based sample of Washington State workers' compensation State Fund claims during 2002-2008. METHODS: Claimants' residential addresses were geocoded with census tract and aggregated into four category classification of the Rural Urban Commuting Area Codes (RUCAs) which takes into account for tract-level work-commuting. We used logistic regressions to assess the association between RUCAs and whether or not a person was off work for more than 180 days due to injury; Quantile regressions to predict various percentiles of cumulative lost workdays by RUCAs. RESULTS: Compared to those who live in the Urban Core, workers in other areas experienced longer average paid time loss days due to work-related injury. The association between residential location and long-term disability was significant, odds ratio (OR) 1.19 (95 % confidence interval (CI) 1.11-1.27) for residents of Small Town and Isolated Rural and OR 1.17 (95 % CI 1.12-1.22) for those of Sub Urban, and persisted after controlling for injury nature, socio-demographic, employment-related, and claim administrative characteristics. The impact of residential location and work-commuting elevated as the duration of disability increased. CONCLUSIONS: This study shows that residential location and work-commuting has a significant and time-varying impact on duration of work disability. Workers living in Sub Urban and Small Town and Isolated Rural areas represent a particularly vulnerable group with respect to risk of long-term work disability.

Prevention guidance for isocyanate-induced asthma using occupational surveillance data.

Data from Washington State's work-related asthma surveillance system were used to characterize isocyanate-induced asthma cases occurring from 1999 through 2010. Injured worker interviews and medical records were used to describe the industry, job title, work process, workers' compensation cost, and exposure trends associated with 27 cases of isocyanate-induced asthma. The majority (81%) of cases were classified within the surveillance system as new-onset asthma while 19% were classified as work-aggravated asthma. The workers' compensation cost for isocyanate-induced asthma cases was $1.7 million; this was 14% of the total claims cost for all claims in the asthma surveillance system. The majority of cases (48%) occurred from paint processes, followed by foam application or foam manufacturing (22%). Nine of the asthma cases associated with spray application occurred during application to large or awkward-shaped objects. Six workers who did not directly handle isocyanates (indirect exposure) developed new-onset asthma. Two cases suggest that skin contact and processes secondary to the isocyanate spray application, such as cleanup, contributed to immune sensitization. Surveillance data provide insight for the prevention of isocyanate-induced respiratory disease. Key observations are made regarding the development of work-related asthma in association with a) paint application on large objects difficult to ventilate, b) indirect exposure to isocyanates, c) exposure during secondary or cleanup processes, and d) reports of dermal exposure.

Workers' Compensation Claims for Conditions Presumed to Be Occupational Diseases Among Firefighters in Washington State, 2000-2017.

OBJECTIVE: Occupational disease presumption laws for firefighters are common, yet little is known about the workers' compensation claims filed for them. METHODS: We identified Washington State's workers' compensation claims for conditions covered by presumption among firefighters during 2000 to 2017, and described them by disease type and claim characteristics. Claim rates for specific cancers were compared with statewide incidence rates using the Washington State cancer registry. RESULTS: Firefighters filed 330 claims for conditions covered by presumption (heart problems, 43%; cancer, 35%; respiratory disease, 15%; and infectious diseases, 8%), with acceptance rates varying by disease and insurer type. Cancer claims were associated with the highest claim costs and time loss. CONCLUSIONS: This study provides necessary baseline data to understand the impact of presumption laws on workers' compensation systems, and can inform future decisions presumption law expansions for firefighters.

Occupation and the prevalence of current depression and frequent mental distress, WA BRFSS 2006 and 2008.

BACKGROUND: Workers with depression and frequent mental distress (FMD) have lost work productivity. Limited systematic comparisons exist for the prevalence of depression and FMD across occupational groups. METHODS: Using a state-added question for occupation coupled to measures of depression and FMD on the Washington State (WA) 2006 and 2008 Behavioral Risk Factor Surveillance System survey, we estimated the prevalence and odds ratios (ORs) among the 20,560 WA workers. RESULTS: The prevalences of current depression and FMD were 5.2% and 7.5%, respectively. The prevalence varied considerably across occupations. Compared with Management occupation, Truck drivers had significantly increased odds for both current depression [OR = 6.18, 95% confidence interval (CI): 2.52-15.16] and FMD (OR = 1.85, 95% CI: 1.01-3.41). Cleaning/Building services (OR = 1.95, 95% CI: 1.11-3.40) and Protective services (OR = 1.97, 95% CI: 1.19-3.27) were associated with increased FMD. CONCLUSIONS: These findings demonstrate the need for research on possible sources of the differences for current depression and FMD across occupations.

Work-related asthma in Washington State.

OBJECTIVE: Asthma is a common and costly public health problem. Occupational exposures contribute to the burden of asthma. Identifying workplace exposures and industries and occupations at risk can lead to more effective prevention measures. METHODS: Data from Washington State's work-related asthma (WRA) surveillance program from October 2001 to December 2008 were analyzed. Workers' compensation records, physician reports, and telephone interviews were used to describe the occurrence of WRA during this time, in order to identify contributing exposure sources and industries and occupations that are associated with WRA in Washington. RESULTS: There were 1343 identified WRA cases in Washington State during this time. Of these, 1285 were workers' compensation claims, with a total medical cost for State Fund claims of approximately $3 million dollars. The top three sources identified were miscellaneous chemicals and materials, mineral and inorganic dusts, and plant material. Plant material claims proved to be widespread throughout various industries, were largely classified as new-onset asthma cases, and had higher median medical cost and higher median time loss days than cases associated with other exposure sources. CONCLUSIONS: Washington State has an abundance of plant-material-related WRA cases among US states conducting WRA surveillance. Washington State's industry mix might explain the higher prevalence of cases, particularly its logging and wood processing industries and as a world leader in hops production. In Washington, further WRA prevention efforts should emphasize workplaces working with plant materials.

Work-related amputations in Washington state, 1997-2005.

BACKGROUND: Work-related amputations are infrequent but devastating injuries. Attempts to more accurately estimate the burden of amputations and industries at risk have led the Washington State occupational surveillance program to explore new methods for case identification in Washington State workers' compensation data. METHODS: Two methods were utilized for case identification of work-related amputations. The first method used the ANSI Z16 nature code for amputation. An alternative method utilized medical, hospital, and claim administration coding of medical bills and bill payment systems. After identifying suspected amputation claims, a sample of the medical records associated with different case identification methods were reviewed to verify that an amputation likely occurred. RESULTS: From 1997 to 2005, 2,528 amputations were identified using the ANSI Z16 code for amputation (Nature = 100) and an additional 3,912 amputations were identified using the alternative method. There was an increasing trend of amputation injuries over the time period using the ANSI amputation definition; however, the trend in amputation injuries captured by the alternative method was decreasing. This may indicate a bias in estimating a trend due to misclassification of amputation injuries. The sectors with the highest amputation claims rates were Manufacturing; Construction; Agriculture, Forestry, Fishing and Hunting; Accommodation and Food Services; and Wholesale and Retail Trade. CONCLUSIONS: Current methods to identify work-related amputations in the workers' compensation data system underestimate the burden of amputations in Washington State. By utilizing alternative case identification methods, we estimate that there were about 150% more amputations in Washington State over the time period.