Evaluation of the characteristics of injured workers and employer compliance with OSHA's reporting requirement for work-related amputations.

INTRODUCTION: In 2014, the Federal Occupational Safety and Health Administration (OSHA) enacted a standard requiring employers to report work-related amputations to OSHA within 24 hours. We studied the characteristics of the injured workers and employer compliance with the regulation in Michigan. METHODS: Two independent data sets were used to compare work-related amputations from 2016 to 2018: employer reports to OSHA and the Michigan Multi-Source Injury and Illness Surveillance System (MMSIISS). We deterministically linked employer reports to OSHA with the MMSIISS by employee name, employer name, date, and type of amputation. RESULTS: We identified 1366 work-related amputations from 2016 to 2018; 575 were reported by employers to OSHA and 1153 were reported by hospitals to the MMSIISS. An overlap of 362 workers were reported in both systems, while 213 workers were only reported by employers to OSHA and 791 workers were only reported by hospitals. Employer compliance with the regulation was 42.1%. Employer compliance with reporting was significantly less in: agriculture, forestry, fishing, and hunting (14.6%); construction (27.4%); retail trade (20.7%); arts, entertainment, and recreation (7.7%); accommodation and food services (13.0%); and other services (27.0%). Large employers and unionized employers were significantly more likely (67.9% and 92.7%, respectively) and small employers were significantly less likely (18.2%) to comply with the reporting rule. Enforcement inspections at 327 workplaces resulted in 403 violations; of those, 179 (54.7%) employers had not corrected the amputation hazard before the time of inspection. DISCUSSION: Michigan employers reported less than half of the work-related amputations required by OSHA's reporting regulation. Noncompliance was greatest in small employers, and agriculture, forestry, fishing, and hunting; construction; arts, entertainment, and recreation; accommodation and food services; and retail and other service industries. Inspections found that over half of the employers had not corrected the hazard that caused the amputation at the time of the inspection's initial opening date; in these cases, abatement of any hazards identified would have occurred after the inspection. Improved compliance in employer reporting of work-related amputations will identify hazards posing a high risk of recurrence of injury to other workers from the same injury source. Greater compliance can also help target safety-related preventive and intervention efforts in industries that might otherwise be overlooked.

Non-Fatal Work-Related Farm Injuries Occurring to Michigan Adults and Youths.

Farming is one of the top industries in Michigan and has the highest fatality rate. National sources of non-fatal farm injuries underestimate the burden, especially among children. In this paper, we provide a more accurate estimate of non-fatal farm injuries in Michigan by using an ongoing multi-source surveillance system. Michigan's farm-injury surveillance system includes abstractions of hospital-based medical records, poison control center calls, ambulance runs, and workers' compensation claims for individuals with a farm-related injury. For this analysis, injury onset occurred in 2015 to 2021 and included all injuries regardless of age or occupation. We identified 4,306 injuries in adults and 336 injuries in youth. For those 0-13 years of age all but two were family members. For those 14-15 and 16-17 years of age, 19% and 45%, respectively were hired hands. For adults, 51% were owner/operators, 43% were hired hands, and 5% were family members. For all ages, the most frequent injury source was cattle. Lacerations/cuts/punctures were the most common type of injury for those < 14 years of age while for older individuals it was contusions/bruises. The plurality of injuries occurred in the summer months. Children working on a farm are in unique situation and tracking injuries and identifying injury sources provide necessary information to protect their health and well-being. Michigan's farm-injury surveillance system will continue to provide a comprehensive count of work-related injuries among Michigan's farming population. The information is used to direct public health intervention both at the individual and population level.

Mortality Among Individuals Diagnosed With Chronic Beryllium Disease and Beryllium Sensitization.

OBJECTIVE: The aim of the study is to investigate the cause of death among individuals diagnosed with chronic beryllium disease (CBD) or beryllium sensitization (BeS). METHODS: Vital status, cause of death, and standardized mortality ratios for the underlying cause of death were determined for a cohort of 354 individuals with CBD and 290 individuals with BeS. RESULTS: Among 216 deceased individuals, 153 had CBD and 63 had BeS. Nonmalignant respiratory deaths and other causes of death were significantly increased among those with CBD. No cause of death was significantly increased for BeS. Mortality from lung cancer was not increased. CONCLUSIONS: Individuals with CBD had an overall increased mortality risk due to increased respiratory mortality regardless of their duration of exposure to beryllium. Individuals with BeS did not have increased respiratory mortality. No increased risk of lung cancer was seen among this cohort.

Evaluation of the characteristics of workers injured on the job requiring hospitalization, and employer compliance with OSHA's reporting requirement for these work-related hospitalizations.

BACKGROUND: The Occupational Safety and Health Administration (OSHA) implemented a new standard in 2014 requiring employers to report nearly all work-related inpatient hospitalizations within 24 h of the event. We examined the characteristics of the injured workers who were reported and the compliance of Michigan employers with the regulation. METHODS: From 2016 to 2018, we compared reports of acute nonmotor-vehicle work-related injuries and illnesses from two independent datasets, employer reports to OSHA and the Michigan Multi-Source Injury and Illness Surveillance System (MMSIISS) which collects injured worker hospital records from the 134 hospitals in Michigan. We matched records from employer reports to OSHA with the MMSIISS by employee's first and last name, company name, date of injury/illness, and type of injury/illness. RESULTS: We identified 2887 workers hospitalized with severe injuries/illnesses from 2016 to 2018 in Michigan; 1260 workers were reported by employers to OSHA and 2238 workers were reported by hospitals to the MMSIISS. There was an overlap of 611 workers reported in both systems, while 649 workers were only reported by employers to OSHA and 1627 workers were only reported by hospitals to the MMSIISS. Employer compliance with the regulation over the 3 years showed a nonsignificant increase; from 42.0% to 43.6% to 45.0%. Fractures were the most frequent type of injury (1238, 42.9%), then head injuries, including skull fractures (470, 16.3%). The median length of hospital stay was 3 days. Manufacturing (709, 25.5%) and construction (563, 20.3%), accounted for the greatest number of hospitalizations. Employer-reported cases to OSHA significantly undercounted hospitalized workers in agriculture, forestry, fishing, and hunting; construction; finance and insurance; real estate and rental and leasing; administrative and support and waste management and remediation services; arts, entertainment, and recreation; accommodation and food services; and other services except public administration. Companies with 250 or more employees were significantly more likely to comply and small companies with 10 or fewer employees were significantly less likely to comply with the reporting rule. Enforcement inspections at 465 of the workplaces where a hospitalization had occurred resulted in $1,017,835 in fines and identified 608 violations. Of the 465 inspections, 246 (52.9%) of the employers had not corrected the hazard before the inspection. CONCLUSIONS: This study identified that workers sustained severe injuries and illnesses on the job and that over half of the companies where a worker suffered an injury/illness leading to hospitalization were not in compliance with OSHA's reporting regulation. Furthermore, at the time of an inspection 1-5 months later, 50% of the companies had not corrected the hazard causing the hospitalization. Improvement in the reporting of work-related injuries/illnesses that result in hospitalization will identify more ongoing hazards in the workplace and improve where to focus preventive actions.

Opioid prescriptions for individuals receiving workers' compensation in Michigan.

PURPOSE: We evaluated the prevalence of opioid prescriptions after injury and associated characteristics among workers receiving workers' compensation for a lost work time injury. METHODS: Injured workers identified in Michigan's Workers' Compensation records from 2016 to 2018 were linked to the opioid prescription history in the Michigan Automated Prescription System. RESULTS: Among the 46,934 injured workers with paid claims, the prevalence of receiving an opioid prescription, morphine milligram equivalents (MME) per prescription, number of opioid prescription and probability of receiving opioids prescription>90 days after injury decreased from 2016-2018. Despite the decrease over 50% of the injured workers received an opioid prescription. Being over 34 years, a male, having had an opioid prescription before the injury, working in construction or having an amputation or sprain/strain of the shoulder had a significantly higher probability of receiving an opioid prescription, a higher MME per prescription, a higher number of opioid prescriptions and a higher probability having opioids prescription >90 days after the injury. CONCLUSIONS: Even though opioid prescribing patterns generally decreased from 2016 to 2018 (64.5-52.8%), injured workers in Michigan had a higher prevalence of opioid prescription after injury, than those reported from other states.

HLA-DPB1 E69 genotype and exposure in beryllium sensitisation and disease.

OBJECTIVES: Human leukocyte antigen-DP beta 1 (HLA-DPB1) with a glutamic acid at the 69th position of the ß chain (E69) genotype and inhalational beryllium exposure individually contribute to risk of chronic beryllium disease (CBD) and beryllium sensitisation (BeS) in exposed individuals. This retrospective nested case-control study assessed the contribution of genetics and exposure in the development of BeS and CBD. METHODS: Workers with BeS (n=444), CBD (n=449) and beryllium-exposed controls (n=890) were enrolled from studies conducted at nuclear weapons and primary beryllium manufacturing facilities. Lifetime-average beryllium exposure estimates were based on workers' job questionnaires and historical and industrial hygienist exposure estimates, blinded to genotype and case status. Genotyping was performed using sequence-specific primer-PCR. Logistic regression models were developed allowing for over-dispersion, adjusting for workforce, race, sex and ethnicity. RESULTS: Having no E69 alleles was associated with lower odds of both CBD and BeS; every additional E69 allele increased odds for CBD and BeS. Increasing exposure was associated with lower odds of BeS. CBD was not associated with exposure as compared to controls, yet the per cent of individuals with CBD versus BeS increased with increasing exposure. No evidence of a gene-by-exposure interaction was found for CBD or BeS. CONCLUSIONS: Risk of CBD increases with E69 allele frequency and increasing exposure, although no gene by environment interaction was found. A decreased risk of BeS with increasing exposure and lack of exposure response in CBD cases may be due to the limitations of reconstructed exposure estimates. Although reducing exposure may not prevent BeS, it may reduce CBD and the associated health effects, especially in those carrying E69 alleles.

Evaluation of Silicosis, Asthma, and COPD Among Sand and Gravel and Stone Surface Mine Workers.

OBJECTIVE: Despite the large number of workers in surface sand and gravel mines, there are no previous studies on a cohort of these workers. METHODS: A cross-sectional study of Michigan surface mine workers included a questionnaire and for those who worked ≥15 years spirometry and chest x-ray. RESULTS: Questionnaires were completed by 1207 miners, 111 had an X-ray and 70 had spirometry. There were no silicosis cases. There were 117 with asthma, 22 COPD, 129 saw a doctor for shortness of breath (SOB), 125 with possible work-related asthma, and 26 abnormal spirometry results. CONCLUSIONS: Although, no cases of silicosis were identified, there was more current asthma; and an association of current asthma, COPD and seeing a doctor for SOB with time since first worked, and obstructive changes in some nonsmokers that suggested the potential for adverse respiratory effects.

A County-Level Program for the Evaluation of the Potential for Take-Home Lead Exposures Among Children in Michigan.

OBJECTIVE: Take-home lead exposure involves lead dust inadvertently carried from the worksite by employees that becomes deposited in their homes and vehicles. We piloted a program in 2 counties in Michigan to investigate the countywide potential for take-home lead exposures across industries. METHODS: During 2018-2020, we identified establishments through internet searches and industry-specific registries. We visited establishments with a physical storefront in-person; we attempted to contact the remaining establishments via telephone. We administered questionnaires at the establishment level to assess the presence of lead and the current use of practices meant to mitigate the potential for take-home lead exposures. We recruited workers for wipe sampling of lead dust from their vehicle floors to test for lead levels. RESULTS: We identified 320 establishments with potential lead use or exposures. Questionnaire responses revealed widespread worker exposures to lead and a lack of education and implementation of best practices to prevent lead from leaving the worksite. Dust samples (n = 60) collected from employee vehicles showed a ubiquitous tracking of lead out of the workplace, with a range of 5.7 to 84 000 µg/ft2 and a geometric mean of 234 µg/ft2. Of the sample results, 95.0% were above the lead dust clearance levels for homes established by the US Environmental Protection Agency. CONCLUSIONS: This work suggests that take-home lead exposures are widespread and may be important sources of lead exposure among children. It also demonstrates the feasibility of a program for the identification of establishments whose employees may be susceptible to taking lead dust home with them and whose children may subsequently be targeted for blood lead monitoring.

Ongoing risk of bladder cancer among former workers at the last benzidine manufacturing facility in the USA.

OBJECTIVE: To determine whether there is an ongoing risk of developing bladder cancer in a previously studied cohort of workers exposed to both benzidine and dichlorobenzidine or dichlorobenzidine only in the last benzidine manufacturing plant in the USA. METHODS: Workers (n=488) were identified from the quarterly 941 forms the employer was required to submit to the Social Security Administration from 1960 to 1977. Exposures were assigned based on dates worked and known benzidine/dichlorobenzidine production schedules. Incidence, vital status and cause of death were determined through 2014. Analyses were restricted to white men. RESULTS: Bladder cancer incidence and mortality were significantly increased (25 incident cases, standardised incidence ratio (SIR) 2.19, 95% CI 1.42 to 3.23, and 5 deaths, standardised mortality ratio (SMR) 3.79, 95% CI 1.23 to 8.84). There were significant increases in incidence and mortality in those exposed to both benzidine and dichlorobenzidine (SIR 3.11, 95% CI 1.97 to 4.67, SMR 4.10, 95% CI 1.12 to 10.50), but not among workers exposed to dichlorobenzidine only (two incident cases, SIR 0.89, 95% CI 0.11 to 3.23 and one death, SMR 2.90, 95% CI 0.07 to 16.15). Bladder cancer incidence and mortality were increased in individuals with >20 years since last exposure with >5 years worked (six observed, SIR 5.94, 95% CI 2.18 to 12.92 and two deaths, SMR 7.93, 95% CI 0.96 to 28.65). CONCLUSIONS: Incidence and mortality due to bladder cancer increased among workers exposed to benzidine but not among workers exposed only to dichlorobenzidine. The risk of incidence and death from bladder cancer remain elevated more than 20 years after last exposure to benzidine in those who worked >5 years.

Calls to a State Poison Center Concerning Cleaners and Disinfectants From the Onset of the COVID-19 Pandemic Through April 2020.

An increased use of disinfectants during the coronavirus disease 2019 (COVID-19) pandemic may increase the number of adverse health effects among people who apply them or among those who are in the area being disinfected. For the 3-month period from January 1 to March 30, 2020, the number of calls about exposure to cleaners and disinfectants made to US poison centers in all states increased 20.4%, and the number of calls about exposure to disinfectants increased 16.4%. We examined calls about cleaners and disinfectants to the Michigan Poison Center (MiPC) since the onset of the COVID-19 pandemic. We compared all calls related to exposure to cleaners or disinfectants, calls with symptoms, and calls in which a health care provider was seen during the first quarters of 2019 and 2020 and in relationship to key COVID-19 dates. From 2019 to 2020, the number of all disinfectant calls increased by 42.8%, the number of calls with symptoms increased by 57.3%, the average number of calls per day doubled after the first Michigan COVID-19 case, from 4.8 to 9.0, and the proportion of calls about disinfectants among all exposure calls to the MiPC increased from 3.5% to 5.0% (P < .001). Calls for exposure to cleaners did not increase significantly. Exposure occurred at home for 94.8%97.1% of calls, and ingestion was the exposure route for 59.7% of calls. Information about the adverse health effects of disinfectants and ways to minimize exposure should be included in COVID-19 pandemic educational materials.

Assessing the accuracy of the death certificate injury at work box for identifying fatal occupational injuries in Michigan.

BACKGROUND: Death certificates contain a box labeled "Injury at Work" which is to be marked "Yes" for all fatal occupational injuries. The accuracy of this box in Michigan is not fully characterized. METHODS: The accuracy of the Injury at Work box on the Michigan death certificate was compared to deaths identified from 2001 through 2016 by the Michigan Fatality Assessment and Control Evaluation multi-source surveillance system. The sensitivity was calculated across this time period, while specificity and positive and negative predictive values were derived for 2011-2016. Univariate and multivariate regression were used to examine differences in the sensitivity over time and across demographic variables, industry, and the type of death. RESULTS: We found a sensitivity for the Injury at Work box of 73.1% among 2156 deaths. The sensitivity showed a significant declining trend over the 17 years, from 79.8% to 63.1%. Sensitivity varied significantly across incident type (aircraft, animal-related, drug overdose, motor vehicle, and suicides having particularly lower sensitivities, and electrocutions, falls, and machine-related incidents having higher sensitivities), and industry sector (construction, manufacturing, public safety, transportation, and trade sectors having higher sensitivities, and agriculture and services sectors showing lower sensitivities). Across nearly all categories the sensitivity was significantly below 1. CONCLUSIONS: The Injury at Work box on the Michigan death certificate was often incorrectly completed and has become less accurate with time, though the degree of this inaccuracy varies by the industry of the victim and the type of incident.

Multisource surveillance for non-fatal work-related agricultural injuries.

Objectives: Development of a state-wide comprehensive surveillance system for non-fatal work-related farm injuries, since non-fatal injuries that occur to the self-employed (i.e., many farm owners/operators), family workers, federal government workers and small farms with fewer than 11 employees are not included in the Bureau of Labor Statistics employer-based survey used to produce the U.S. National statistics of work-related injuries.Methods: In 2015 and 2016, inpatient discharge summaries, emergency department, and hospital-based outpatient clinic records from all 134 of Michigan's hospitals with ICD-9 codes 989.0-.1, E827.0-.9, E849.1, E906.8, E919.0 or ICD-10 codesT65.0-.1, V80, Y92.7, W55.1-.4, W30 were reviewed to identify non-fatal work-related farm injuries.Results: We identified 1,559 non-fatal work-related farm injury incidents that occurred in 1,525 individuals, with 74% being among men. The most common parts of the body injured were an upper limb (38.2%) and a lower limb (23.7%). The most common types of injury were contusions (26.4%) and fractures (19.9%). Owners/operators accounted for 44.1% and hired hands for 42.9% of individuals injured. Injuries caused by cows were the predominant cause: 472 (31.5%) of all the injuries. Dairy farms accounted for 39.6% of all cases for which the farm type was recorded.Conclusion: A comprehensive system to identify non-fatal work-related farm injuries among all individuals who work on a farm, including owner/operators, family members and migrant and seasonal farm laborers, was implemented using hospital, emergency department and hospital-based outpatient clinic medical records. Such a system is important to be able to identify hazards and target prevention.

The Burden of Work-related Asthma in Michigan, 1988-2018.

Rationale: Exposure to a variety of substances in the workplace can cause new-onset asthma or aggravate preexisting asthma, both of which are considered work-related asthma (WRA). Understanding trends in the nature and causes of WRA can assist in the diagnosis and management of adult patients with asthma.Objective: To describe trends over 31 years of WRA surveillance in Michigan.Methods: Michigan law requires reporting of all known or suspected cases of occupational disease. WRA was confirmed by review of a standardized telephone interview and patient medical records. Enforcement inspections at the workplaces of the WRA cases included air monitoring and evaluation for asthma and asthma symptoms among coworkers.Results: The Michigan surveillance program identified 3,634 WRA cases from 1988 to 2018, including nine deaths. The cumulative incidence rate of WRA decreased from 3.5 to 2.0 cases per 100,000 workers. Cases most frequently worked in manufacturing (56%), health care (12%), and education (4%). The cumulative incidence rate of WRA decreased in each of those three industries, while increasing in retail trade and accommodations and food services. The most common exposures to known asthma inducers were to cleaning agents and isocyanates; the percentage exposed to cleaning agents increased from 5% to 20%, and the percentage exposed to isocyanates decreased from 20% to 7%. Fifty-one percent had not applied for workers' compensation benefits. Only 5% of the 571 workplaces where air sampling was performed were above the allowable exposure limit. Fifteen percent (1,622 of 10,493) of coworkers of the index cases reported onset of asthma since beginning to work at the facility or being bothered at work by daily or weekly chest tightness, shortness of breath, or wheezing.Conclusions: The industries and exposures where Michigan adults develop WRA have changed during the past 31 years. The identification of WRA cases, including WRA deaths, underscores the need for continued vigilance to monitor changes in where and how workers are exposed to asthma-causing agents, physician consideration of workplace exposures in new-onset or worsening adult asthma, and adoption of workplace standards that reduce exposure and require workplace medical monitoring to prevent and reduce the morbidity and mortality of WRA.

The Burden of Silicosis in Michigan: 1988-2016.

RATIONALE: Exposure to respirable crystalline silica causes silicosis, a preventable, progressive occupational lung disease. A more rigorous occupational health standard for silica could help protect silica-exposed workers. OBJECTIVES: To describe trends over 29 years of silicosis surveillance in Michigan. METHODS: Michigan law requires the reporting of silicosis. We confirmed the diagnosis of silicosis in reported cases using medical questionnaires, review of medical records, and chest radiographs. The Michigan Occupational Safety and Health Administration (OSHA) conducted enforcement inspections at the workplaces of the silicosis cases, including air monitoring for silica and evaluation of workplace medical surveillance programs. RESULTS: The Michigan surveillance program identified 1,048 silicosis cases from 1988 to 2016, which decreased from 620 during 1988-1997, to 292 during 1998-2007, to 136 during 2008-2016. The cumulative incidence rate of silicosis decreased from 3.7 to 1.4 to 0.7 cases per 100,000 men 40 years of age and older in Michigan over the same three periods. African Americans had a higher cumulative incidence rate of silicosis, with 6.0 cases per 100,000 African American men 40 years of age and older in Michigan compared with 1.2 cases per 100,000 white men 40 years of age and older in Michigan. The cases identified had severe disease; 59% had progressive massive fibrosis or category 2 or 3 small opacities per B-reading classification of the chest radiograph. Seventeen percent reported ever having active tuberculosis. On spirometry, 76% of ever smokers and 72% of never smokers demonstrated either a restrictive or an obstructive pattern. Most (65%) had not applied for workers' compensation benefits; the percentage who applied for benefits decreased from 42% to 28-16% over the three periods. Thirty-four of 55 (62%) workplace inspections found exposures above the new OSHA 50 µg/m3 respirable crystalline silica permissible exposure limit, and only 11% of inspected companies screened their workers for silicosis. CONCLUSIONS: Adults with confirmed cases of silicosis have advanced disease and morbidity. Most are not using workers' compensation to pay for their care. The new OSHA silica standard, which lowers the permissible exposure limit for silica and requires medical monitoring to identify workers with silicosis, will help reduce the burden of silica exposure. It is critical for pulmonologists to be vigilant to recognize and manage this preventable occupational lung disease.

Multi-source surveillance for work-related crushing injuries.

BACKGROUND: Work-related crushing injuries are serious but preventable. For 2013 through 2015, the U.S. Bureau of Labor Statistics' (BLS) Survey of Occupational Injuries and Illnesses (SOII) reported 1260 crushing injuries in Michigan. In 2013, Michigan initiated multi-data source surveillance of work-related crushing injuries. METHODS: Records from all 134 of Michigan's hospitals/emergency departments (EDs), the Workers Compensation Agency (WCA) and Michigan's Fatality Assessment Control and Evaluation (MIFACE) program were used to identify work-related crushing injuries. Companies, where individuals were hospitalized or had an ED visit for a crushing injury, potentially had an OSHA enforcement inspection conducted. RESULTS: From 2013 through 2015, there were 3137 work-related crushing injury incidents, including two fatalities. The Michigan OSHA program completed inspections at 77 worksites identified by the surveillance system. CONCLUSION: The Michigan multisource surveillance system identified two and a half times more crushing injuries than BLS and was useful for initiating case-based enforcement inspections.