Causal effect of shifting from precarious to standard employment on all-cause mortality in Sweden: an emulation of a target trial.

BACKGROUND: We aimed at estimating the causal effect of switching from precarious to standard employment on the 6-year and 12-year risk of all-cause mortality among workers aged 20-55 years in Sweden. METHODS: We emulated a series of 12 target trials starting every year between 2005 and 2016 using Swedish register data (n=251 273). We classified precariously employed individuals using a multidimensional approach at baseline as (1) remaining in precarious employment (PE) (73.8%) and (2) shifting to standard employment (26.2%). All-cause mortality was measured from 2006 to 2017. We pooled data for all 12 emulated trials and used covariate-adjusted pooled logistic regression to estimate intention-to-treat and per-protocol effects via risk ratios (RRs) and standardised risk curves (the parametric g-formula). RESULTS: Shifting from precarious to standard employment decreases the 12-year risk of death by 20% on the relative scale (RR: 0.82, 95% CI: 0.73; 0.93), regardless of what happens after the initial shift. However, we estimated a 12-year risk reduction of 30% on the relative scale for workers shifting from precarious to standard employment and staying within this employment category for the full 12 years (RR: 0.71, 95% CI: 0.54; 0.95). CONCLUSIONS: This study finds that shifting from low to higher-quality employment conditions (ie, stable employment, sufficient income levels and high coverage by collective agreements) decreases the risk of death. Remaining in PE increases the risk of premature mortality. Our results emphasise the necessity of ensuring decent work for the entire working population to accomplish the 2030 Agenda for Sustainable Development.

Experiences of insecurity among non-standard workers across different welfare states: A qualitative cross-country study.

In recent decades, economic crises and political reforms focused on employment flexibilization have increased the use of non-standard employment (NSE). National political and economic contexts determine how employers interact with labour and how the state interacts with labour markets and manages social welfare policies. These factors influence the prevalence of NSE and the level of employment insecurity it creates, but the extent to which a country's policy context mitigates the health influences of NSE is unclear. This study describes how workers experience insecurities created by NSE, and how this influences their health and well-being, in countries with different welfare states: Belgium, Canada, Chile, Spain, Sweden, and the United States. Interviews with 250 workers in NSE were analysed using a multiple-case study approach. Workers in all countries experienced multiple insecurities (e.g., income and employment insecurity) and relational tension with employers/clients, with negative health and well-being influences, in ways that were shaped by social inequalities (e.g., related to family support or immigration status). Welfare state differences were reflected in the level of workers' exclusion from social protections, the time scale of their insecurity (threatening daily survival or longer-term life planning), and their ability to derive a sense of control from NSE. Workers in Belgium, Sweden, and Spain, countries with more generous welfare states, navigated these insecurities with greater success and with less influence on health and well-being. Findings contribute to our understanding of the health and well-being influences of NSE across different welfare regimes and suggest the need in all six countries for stronger state responses to NSE. Increased investment in universal and more equal rights and benefits in NSE could reduce the widening gap between standard and NSE.

Precarious employment and occupational injuries in Sweden between 2006 and 2014: a register-based study.

BACKGROUND: Precarious employment (PE) has been suggested as a risk factor for occupational injuries (OIs). However, several issues such as under-reporting and time at risk pose obstacles to obtaining unbiased estimates of risk OBJECTIVE: To investigate if PE is a risk factor for OIs in Sweden. METHODS: This register-based study included employed workers aged 18-65, resident in Sweden between 2006 and 2014. PE was operationalised as a multidimensional construct (score) and by its five items (contract insecurity, contractual temporariness, multiple jobs/multiple sectors, income level, collective bargaining agreement). Our outcome was OI in the following year. Pooled ORs for OIs in relation to PE and PE items were calculated by means of multivariate logistic regression models for women and men separately. RESULTS: Precarious workers were at lower risk of OIs as compared with non-precarious workers among both males and females (OR <1) also when applying weights for under-reporting and adjusting for time at risk (part-time work). Male agencies workers had a higher risk of OIs (OR 1.19, 95% CI 1.15 to 1.23), as did male and female workers in multiple jobs/sectors (OR 1.25, 95% CI 1.23 to 1.28 and OR 1.10, 95% CI 1.07 to 1.13 respectively), and female workers in the low-income groups (OR 1.11, 95% CI 1.09 to 1.12). Low coverage of collective bargaining agreements was associated with a lower risk of OIs for both men and women (OR 0.30, 95% CI 0.29 to 0.31 and OR 0.26, 95% CI 0.24 to 0.27, respectively). CONCLUSIONS: While several mechanisms may explain why precarious workers in Sweden present lower risks of OIs, several dimensions of PE such as temp agency work and multiple job-holding could be important risk factors for OIs and merit further research.

Non-Standard Employment and Unemployment during the COVID-19 Crisis: Economic and Health Findings from a Six-Country Survey Study.

The COVID-19 crisis is a global event that has created and amplified social inequalities, including an already existing and steadily increasing problem of employment and income insecurity and erosion of workplace rights, affecting workers globally. The aim of this exploratory study was to review employment-related determinants of health and health protection during the pandemic, or more specifically, to examine several links between non-standard employment, unemployment, economic, health, and safety outcomes during the COVID-19 pandemic in Sweden, Belgium, Spain, Canada, the United States, and Chile, based on an online survey conducted from November 2020 to June 2021. The study focused on both non-standard workers and unemployed workers and examined worker outcomes in the context of current type and duration of employment arrangements, as well as employment transitions triggered by the COVID-19 crisis. The results suggest that COVID-19-related changes in non-standard worker employment arrangements, or unemployment, are related to changes in work hours, income, and benefits, as well as the self-reported prevalence of suffering from severe to extreme anxiety or depression. The results also suggest a link between worker type, duration of employment arrangements, or unemployment, and the ability to cover regular expenses during the pandemic. Additionally, the findings indicate that the type and duration of employment arrangements are related to the provision of personal protective equipment or other COVID-19 protection measures. This study provides additional evidence that workers in non-standard employment and the unemployed have experienced numerous and complex adverse effects of the pandemic and require additional protection through tailored pandemic responses and recovery strategies.

Under-reporting of non-fatal occupational injuries among precarious and non-precarious workers in Sweden.

BACKGROUND: Under-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures. OBJECTIVE: To estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013. METHODS: Capture-recapture methods were applied using the national OIs register and records from a labour market insurance company. Employed workers 18-65 resident in Sweden in 2013 were included in the study (n=82 949 OIs). Precarious employment was operationalised using the national labour market register, while injury severity was constructed from the National Patient Register. Under-reporting estimates were computed stratifying by OIs severity and by sociodemographic characteristics, occupations and precarious employment. RESULTS: Under-reporting of OIs followed a dose-response pattern according to the levels of precariousness (the higher the precarious level, the higher the under-reporting) being for the precarious group (22.6%, 95% CI 21.3% to 23.8%), followed by the borderline precarious (17.6%, 95% CI 17.1% to 18.2%) and lastly the non-precarious (15.0%, 95% CI 14.7% to 15.3%). Under-reporting of OIs, decreased as the injury severity increased and was higher with highest level of precariousness in all groups of severity. We also observed higher under-reporting estimates among all occupations in the precarious and borderline precarious groups as compared with the non-precarious ones. CONCLUSIONS: This is the first register-based study to empirically demonstrate in Sweden that under-reporting of OIs is 50% higher among precariously employed workers. OIs under-reporting may represent unrecognised injuries that especially burden precariously employed workers as financial, health and social consequences shift from the employer to the employee.

Low-quality employment trajectories and risk of common mental disorders, substance use disorders and suicide attempt: a longitudinal study of the Swedish workforce.

OBJECTIVE: High-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories. METHODS: A longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005-2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010-2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories. RESULTS: We identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07-1.62) and substance use disorders (HR 1.05-2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08-1.76). CONCLUSIONS: Low-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex - especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.

Organisational factors and under-reporting of occupational injuries in Sweden: a population-based study using capture-recapture methodology.

OBJECTIVE: To estimate the magnitude of under-reporting of non-fatal occupational injuries (OIs) by different organisational factors in Sweden for the year 2013. METHODS: Capture-recapture methods were applied using two data sources: (1) the national OI register and (2) records from a labour market insurance company. To assure comparability of data sources, the analysis was restricted to the public sector and private companies with at least 50 employees. OIs were matched using personal identification number and reported injury dates (±7 days). Organisational factors were obtained from the national labour market register and injury severity (no healthcare/only outpatient/hospitalised) from the National Patient Register. Total number of OIs and ascertainment by data sources were estimated assuming data source independence. RESULTS: There were an estimated 98 493 OIs in 2013. Completeness of reporting OIs to the national register and to the insurance company was estimated at 73% and 43%, respectively. No report to either source was estimated at 15 000 OIs (~15%). Under-reporting to the national register differed by selected organisational factors, being higher among organisations in the public sector, those with more females, with a younger workforce and with a higher proportion of immigrants. Overall under-reporting was more common in agriculture (19.7%), other services (19.3%), commerce and hospitality (19.1%), health (18.4%) and education (18.4%). Under-reporting decreased as injury severity increased, with little variations across sectors of economic activity. CONCLUSIONS: Results suggest considerable under-reporting of OIs in Sweden and differential under-reporting by organisational factors. Results are relevant for official estimates of burden and for setting priorities for workplace safety and prevention.

The Contribution of Occupation-Specific Factors to the Deaths of Despair, Massachusetts, 2005-2015.

OBJECTIVES: In the USA, deaths from poisonings (especially opioids), suicides, and alcoholic liver disease, collectively referred to as 'deaths of despair', have been increasing rapidly over the past two decades. The risk of deaths from these causes is known to be higher among certain occupations. It may be that specific exposures and experiences of workers in these occupations explain these differences in risk. This study sought to determine whether differences in the risk of deaths of despair were associated with rate of occupational injuries and illnesses, job insecurity, and temporal changes in employment in non-standard work arrangements. METHODS: Usual occupation information was collected from death certificates of Massachusetts residents aged 16-64 with relevant causes of death between 2005 and 2015. These data were combined with occupation-level data about occupational injuries and illnesses, job insecurity, and non-standard work arrangements. We calculated occupation-specific mortality rates for deaths of despair, categorized by occupational injury and illnesses rates and job insecurity. We calculated trends in mortality according to changes in non-standard work arrangements. RESULTS: Workers in occupations with higher injury and illnesses rates and more job insecurity had higher rates of deaths of despair, especially opioid-related deaths. Rates of deaths of despair increased most rapidly for occupations with increasing prevalence of workers employed in non-standard work arrangements. CONCLUSIONS: The findings suggest occupational factors that may contribute to the risk of deaths of despair. Future studies should examine these factors with individual-level data. In the meantime, efforts should be made to address these factors, which also represent known or suspected hazards for other adverse health outcomes.

COVID-19 deaths by occupation, Massachusetts, March 1-July 31, 2020.

BACKGROUND: Exposure to COVID-19 is more likely among certain occupations compared with others. This descriptive study seeks to explore occupational differences in mortality due to COVID-19 among workers in Massachusetts. METHODS: Death certificates of those who died from COVID-19 in Massachusetts between March 1 and July 31, 2020 were collected. Occupational information was coded and age-adjusted mortality rates were calculated according to occupation. RESULTS: There were 555 deaths among MA residents of age 16-64, with usable occupation information, resulting in an age-adjusted mortality rate of 16.4 per 100,000 workers. Workers in 11 occupational groups including healthcare support and transportation and material moving had mortality rates higher than that for workers overall. Hispanic and Black workers had age-adjusted mortality rates more than four times higher than that for White workers overall and also had higher rates than Whites within high-risk occupation groups. CONCLUSION: Efforts should be made to protect workers in high-risk occupations identified in this report from COVID-19 exposure.

COVID-19 and Precarious Employment: Consequences of the Evolving Crisis.

The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis.

COVID-19: US federal accountability for entry, spread, and inequities-lessons for the future.

The United States (US) has been among those nations most severely affected by the first-and subsequent-phases of the pandemic of COVID-19, the disease caused by SARS-CoV-2. With only 4% of the worldwide population, the US has seen about 22% of COVID-19 deaths. Despite formidable advantages in resources and expertise, presently the per capita mortality rate is over 585/million, respectively 2.4 and 5 times higher compared to Canada and Germany. As we enter Fall 2020, the US is enduring ongoing outbreaks across large regions of the country. Moreover, within the US, an early and persistent feature of the pandemic has been the disproportionate impact on populations already made vulnerable by racism and dangerous jobs, inadequate wages, and unaffordable housing, and this is true for both the headline public health threat and the additional disastrous economic impacts. In this article we assess the impact of missteps by the Federal Government in three specific areas: the introduction of the virus to the US and the establishment of community transmission; the lack of national COVID-19 workplace standards and enforcement, and lack of personal protective equipment (PPE) for workplaces as represented by complaints to the Occupational Safety and Health Administration (OSHA) which we find are correlated with deaths 16 days later (ρ = 0.83); and the total excess deaths in 2020 to date already total more than 230,000, while COVID-19 mortality rates exhibit severe-and rising-inequities in race/ethnicity, including among working age adults.

Disparities in the Deaths of Despair by Occupation, Massachusetts, 2000 to 2015.

OBJECTIVE: To explore mortality rates and trends according to the occupation of workers who died from the deaths of despair (DoD). METHODS: Death certificates for deaths due to poisonings (including opioid-related overdoses), suicides, and alcoholic liver disease occurring in Massachusetts from 2000 to 2015 were collected and coded according to the occupation of the decedent. Mortality rates and trends in mortality were calculated for each occupation. RESULTS: DoDs increased by more than 50% between 2000 to 2004 and 2011 to 2015. There were substantial differences in mortality rates and trends according to occupation. Blue collar workers were at a particularly elevated risk for DoD and had elevated trends for these deaths, notably: construction and farming, fishing, and forestry workers. CONCLUSIONS: Interventions should be targeted to occupations with elevated mortality rates and trends. Occupational risk factors that may contribute to these disparities should be explored.

What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies.

Objectives The lack of a common definition for precarious employment (PE) severely hampers the comparison of studies within and between countries, consequently reducing the applicability of research findings. We carried out a systematic review to summarize how PE has been conceptualized and implemented in research and identify the construct's dimensions in order to facilitate guidance on its operationalization. Methods According to PRISMA guidelines, we searched Web of Science and Scopus for publications with variations of PE in the title or abstract. The search returned 1225 unique entries, which were screened for eligibility. Exclusion criteria were (i) language other than English, (ii) lack of a definition for PE, and (iii) non-original research. A total of 63 full-text articles were included and qualitative thematic-analysis was performed in order to identify dimensions of PE. Results We identified several theory-based definitions of PE developed by previous researchers. Most definitions and operationalizations were either an accommodation to available data or the direct result of qualitative studies identifying themes of PE. The thematic-analysis of the selected articles resulted in a multidimensional construct including the following three dimensions: employment insecurity, income inadequacy, and lack of rights and protection. Conclusions Despite a growing number of studies on PE, most fail to clearly define the concept, severely restricting the advancement of the research of PE as a social determinant of health. Our combined theoretical and empirical review suggests that a common multidimensional definition could be developed and deployed in different labor market contexts using a variety of methodological approaches.

Opioid-related overdose deaths by industry and occupation-Massachusetts, 2011-2015.

BACKGROUND: Thousands of people in the United States continue to die from opioid overdoses every year. Work-related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid-related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work-related factors that might contribute to these differences. METHODS: We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work-related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD. RESULTS: Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD. CONCLUSIONS: These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.

Precarious employment, business performance and occupational injuries: a study protocol of a register-based Swedish project.

INTRODUCTION: There is uncertainty regarding the trends in occupational injuries (OIs) in Sweden due to a significant and increasing problem with under-reporting to injury registers. Under-reporting, in general, is likely to be exacerbated by the rise in precarious employment (PE), a set of unfavourable employment characteristics that would benefit from formal definition and study. PE and global trends are believed also to affect companies and their commitment to health and safety. The present study attempts to bridge these knowledge gaps and presents a study protocol for planned studies, with three main objectives: first, to review the literature for definitions of PE emphasising those that are multidimensional and operationalise components in routinely collected register data; second, to estimate the under-reporting of OI in Swedish registers and third, using results from the first objective, to conduct large, register-based prospective studies, designed to measure effect sizes and interactions between PE, business performance and OI. METHODS AND ANALYSIS: First, a scientific literature review will be conducted, including scientific databases and grey literature. Second, data from two major OI registers will be used to estimate the magnitude of under-reporting using capture-recapture methodology. Finally, all residents aged 18-65 in Sweden with any registered income during 2003-2015 will be included. Data sources encompass Swedish population and labour market registers with linkage to both the main OI register with national coverage and hospital records. Trends in PE and OI will be explored, together with risk of OI associated with PE and business performance. ETHICS AND DISSEMINATION: The project has been approved by the Regional Ethics Committee, Stockholm (dnr: 2016/2325-31; 2017/2173-32). Dissemination of study results will include a series of peer-reviewed papers, at least one PhD thesis and one report in Swedish, engaging relevant stakeholders. Results will be presented in national and international conferences and through press releases to mass media.

Risk of sharps injuries among home care aides: Results of the Safe Home Care survey.

OBJECTIVES: Home care (HC) aides constitute an essential, rapidly growing workforce. Technology advances are enabling complex medical care at home, including procedures requiring the percutaneous use of sharp medical devices, also known as sharps. Objectives were to quantify risks of sharps injuries (SI) in a large HC aide population, compare risks between major occupational groups, and evaluate SI risk factors. METHODS: A questionnaire survey was administered to aides hired by HC agencies and directly by clients. One thousand one hundred seventy-eight aides completed questions about SI and potential risk factors occurring in the 12 months before the survey. SI rates were calculated and Poisson regression models identified risk factors. RESULTS: Aides had a 2% annual risk of experiencing at least 1 SI (95% confidence interval [CI], 1.1-2.6). Client-hired aides, men, and immigrants had a higher risk than their counterparts. Risk factors among all HC aides included helping a client use a sharp device (rate ratio [RR], 5.62; 95% CI, 2.75-11.50), observing used sharps lying around the home (RR, 2.68; 95% CI, 1.27-5.67), and caring for physically aggressive clients (RR, 2.82; 95% CI, 1.36-5.85). CONCLUSIONS: HC aides experience serious risks of SI. Preventive interventions are needed, including safety training for clients and their families, as well as aides.

Bayesian decision support for coding occupational injury data.

INTRODUCTION: Studies on autocoding injury data have found that machine learning algorithms perform well for categories that occur frequently but often struggle with rare categories. Therefore, manual coding, although resource-intensive, cannot be eliminated. We propose a Bayesian decision support system to autocode a large portion of the data, filter cases for manual review, and assist human coders by presenting them top k prediction choices and a confusion matrix of predictions from Bayesian models. METHOD: We studied the prediction performance of Single-Word (SW) and Two-Word-Sequence (TW) Naïve Bayes models on a sample of data from the 2011 Survey of Occupational Injury and Illness (SOII). We used the agreement in prediction results of SW and TW models, and various prediction strength thresholds for autocoding and filtering cases for manual review. We also studied the sensitivity of the top k predictions of the SW model, TW model, and SW-TW combination, and then compared the accuracy of the manually assigned codes to SOII data with that of the proposed system. RESULTS: The accuracy of the proposed system, assuming well-trained coders reviewing a subset of only 26% of cases flagged for review, was estimated to be comparable (86.5%) to the accuracy of the original coding of the data set (range: 73%-86.8%). Overall, the TW model had higher sensitivity than the SW model, and the accuracy of the prediction results increased when the two models agreed, and for higher prediction strength thresholds. The sensitivity of the top five predictions was 93%. CONCLUSIONS: The proposed system seems promising for coding injury data as it offers comparable accuracy and less manual coding. PRACTICAL APPLICATIONS: Accurate and timely coded occupational injury data is useful for surveillance as well as prevention activities that aim to make workplaces safer.

Occupational health of home care aides: results of the safe home care survey.

OBJECTIVES: In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. METHODS: HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides' OSH experiences. RESULTS: The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence. CONCLUSIONS: The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting.

Isocyanates and work-related asthma: Findings from California, Massachusetts, Michigan, and New Jersey, 1993-2008.

BACKGROUND: Isocyanates remain a leading cause of work-related asthma (WRA). METHODS: Two independent data systems were analyzed for the period 1993-2008: (1) State-based WRA case surveillance data on persons with isocyanate-induced WRA from four states, and (2) Occupational Safety and Health Administration (OSHA) Integrated Management Information System (IMIS) isocyanate air sampling results. RESULTS: We identified 368 cases of isocyanate-induced WRA from 32 industries and 678 OSHA isocyanate air samples with detectable levels from 31 industries. Seventeen industries were unique to one or the other dataset. CONCLUSION: Isocyanate-induced WRA continues to occur in a wide variety of industries. Two data systems uncovered industries with isocyanate exposures and/or illness. Improved control measures and standards, including medical surveillance, are needed. More emphasis is needed on task-specific guidance, spill clean-up procedures, skin and respiratory protection, and targeted medical monitoring to mitigate the hazards of isocyanate use.