Burden, Need and Impact: An Evidence-Based Method to Identify Worker Safety and Health Research Priorities.

The importance of research and recommendations to address workforce safety and health derives from the continuing toll from worker fatalities, injuries, and illnesses. Estimates of the societal cost of work-related fatalities, injuries, and illnesses range up to $2.2 trillion in the USA from 2007 to 2015, which may be an underestimate of total societal costs. The ongoing changes in the nature of work, the workforce, and the workplace in the USA challenge old paradigms of worker safety and health research and require new decision criteria that are more solution oriented than observational and that result in interventions that can be readily applied to new occupational hazards and exposures. As public funding for science research programs becomes more constrained, and the demand for increased accountability of government spending grows, the need to demonstrate the impact or return on taxpayers' investment becomes a necessity for research agencies. The National Institute for Occupational Safety and Health has developed an evidence-based method that uses the criteria of 'burden', 'need', and 'impact' to identify research priorities and aid in the evaluation of the taxpayers' investment in research. This approach, named the BNI method, may be useful to other public and private sector research agencies or entities that need a systematic way to set research priorities and allocate increasingly scarce resources for research while ensuring the maximal return on investment.

Applying Machine Learning to Workers' Compensation Data to Identify Industry-Specific Ergonomic and Safety Prevention Priorities: Ohio, 2001 to 2011.

OBJECTIVE: This study leveraged a state workers' compensation claims database and machine learning techniques to target prevention efforts by injury causation and industry. METHODS: Injury causation auto-coding methods were developed to code more than 1.2 million Ohio Bureau of Workers' Compensation claims for this study. Industry groups were ranked for soft-tissue musculoskeletal claims that may have been preventable with biomechanical ergonomic (ERGO) or slip/trip/fall (STF) interventions. RESULTS: On the basis of the average of claim count and rate ranks for more than 200 industry groups, Skilled Nursing Facilities (ERGO) and General Freight Trucking (STF) were the highest risk for lost-time claims (>7 days). CONCLUSION: This study created a third, major causation-specific U.S. occupational injury surveillance system. These findings are being used to focus prevention resources on specific occupational injury types in specific industry groups, especially in Ohio. Other state bureaus or insurers may use similar methods.

Development of methods for using workers' compensation data for surveillance and prevention of occupational injuries among State-insured private employers in Ohio.

BACKGROUND: Workers' compensation (WC) claims data may be useful for identifying high-risk industries and developing prevention strategies. METHODS: WC claims data from private-industry employers insured by the Ohio state-based workers' compensation carrier from 2001 to 2011 were linked with the state's unemployment insurance (UI) data on the employer's industry and number of employees. National Labor Productivity and Costs survey data were used to adjust UI data and estimate full-time equivalents (FTE). Rates of WC claims per 100 FTE were computed and Poisson regression was used to evaluate differences in rates. RESULTS: Most industries showed substantial claim count and rate reductions from 2001 to 2008, followed by a leveling or slight increase in claim count and rate from 2009 to 2011. Despite reductions, there were industry groups that had consistently higher rates. CONCLUSION: WC claims data linked to employment data could be used to prioritize industries for injury research and prevention activities among State-insured private employers. Am. J. Ind. Med. 59:1087-1104, 2016. © 2016 Wiley Periodicals, Inc.

Occupational health and safety surveillance and research using workers' compensation data.

OBJECTIVE: Examine uses of US workers' compensation (WC) data for occupational safety and health purposes. METHODS: This article is a summary of the proceedings from an invitational workshop held in September 2009 to discuss the use of WC data for occupational safety and health prevention purposes. RESULTS: Workers' compensation data systems, although limited in many ways, contain information such as medical treatments, their costs and outcomes, and disability causes that are unavailable from national occupational surveillance sources. CONCLUSIONS: Despite their limitations, WC records are collected in a manner consistent with many occupational health and safety surveillance needs. Reports are available on the use of WC data for surveillance and research purposes such as estimating the frequency, magnitude, severity, and cost of compensated injuries. Inconsistencies in WC data can limit generalization of research results.

Occupational injuries, illnesses, and fatalities among workers in the services sector industries: 2003 to 2007.

OBJECTIVE: Provide descriptive statistics and discuss priorities for injury and fatality risks among services sector workers. METHODS: Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses and Census of Fatal Occupational Injuries data for 2003 to 2007 were analyzed to identify occupational injury and fatality risks for services sector industry groups. RESULTS: Many services sector industry groups experienced, on average, greater than one occupational fatality per week, and survey of occupational injuries and illnesses days-away-from-work rates in excess of those for all US workers. Overall, transportation incidents and homicides are leading factors contributing to fatalities. CONCLUSIONS: These results indicate the need for adoption of safety and health prevention practices in numerous industry groups. For groups that experience elevated injury and fatality rates, priorities for research and intervention can be identified through these data.

Mortality and exposure response among 14,458 electrical capacitor manufacturing workers exposed to polychlorinated biphenyls (PCBs).

BACKGROUND: We expanded an existing cohort of workers (n = 2,588) considered highly exposed to polychlorinated biphenyls (PCBs) at two capacitor manufacturing plants to include all workers with at least 90 days of potential PCB exposure during 1939-1977 (n = 14,458). Causes of death of a priori interest included liver and rectal cancers, previously reported for the original cohort, and non-Hodgkin lymphoma (NHL), melanoma, and breast, brain, intestine, stomach, and prostate cancers, based on other studies. METHODS: We ascertained vital status of the workers through 1998, and cumulative PCB exposure was estimated using a new job exposure matrix. Analyses employed standardized mortality ratios (SMRs; U.S., state, and county referents) and Poisson regression modeling. RESULTS: Mortality from NHL, melanoma, and rectal, breast, and brain cancers were neither in excess nor associated with cumulative exposure. Mortality was not elevated for liver cancer [21 deaths; SMR 0.89; 95% confidence interval (CI), 0.55-1.36], but increased with cumulative exposure (trend p-value = 0.071). Among men, stomach cancer mortality was elevated (24 deaths; SMR 1.53; 95% CI, 0.98-2.28) and increased with cumulative exposure (trend p-value = 0.039). Among women, intestinal cancer mortality was elevated (67 deaths; SMR 1.31; 95% CI, 1.02-1.66), especially in higher cumulative exposure categories, but without a clear trend. Prostate cancer mortality, which was not elevated (34 deaths; SMR 1.04; 95% CI, 0.72-1.45), increased with cumulative exposure (trend p-value = 0.0001). CONCLUSIONS: This study corroborates previous studies showing increased liver cancer mortality, but we cannot clearly associate rectal, stomach, and intestinal cancers with PCB exposure. This is the first PCB cohort showing a strong exposure-response relationship for prostate cancer mortality.

Tenth revision U.S. mortality rates for use with the NIOSH Life Table Analysis System.

OBJECTIVE: The objective of this study was to update rate files for the NIOSH Life Table Analysis System for Personal Computers (PC LTAS) reflecting the newly adopted tenth revision changes to the International Classification of Diseases. METHODS: PC LTAS allows researchers to conduct comparative mortality and morbidity analyses for the purpose of identifying disease-exposure associations using person-time-at-risk for age, race, sex, and calendar time-specific reference rates from 1940. Previously available through 1998, files for the United States and individual states were updated through 2004 using uncensored population data. Tenth revision causes were added if compatible with earlier NIOSH death categories, based on revisions 5 through 9. A few new cause categories were added. RESULTS: The resulting NIOSH categories are described for two new U.S. rate files: 1960 through 2004 and 1940 through 2004. CONCLUSION: The new U.S. rate files are available online or on request.

Polychlorinated biphenyls and neurodegenerative disease mortality in an occupational cohort.

BACKGROUND: Production of polychlorinated biphenyls (PCBs) ended in the United States in the 1970s, but PCBs persist in the environment and are detectable in the blood of approximately 80% of Americans over age 50. PCBs decrease dopamine levels in rats and monkeys. Loss of dopamine is the hallmark of Parkinson disease, a neurodegenerative disease. There are no epidemiologic studies of PCBs and neurodegenerative disease. METHODS: We conducted a retrospective mortality study of 17,321 PCB-exposed workers to determine whether mortality from Parkinson disease, dementia, and amyotrophic lateral sclerosis was elevated compared with the U.S. population. All workers had a least 90 days employment in 1 of 3 electrical capacitor plants using PCBs from the 1940s to the 1970s. PCB serum levels from a sample of these workers in the 1970s were approximately 10 times the level of community controls. RESULTS: We found no overall excess of Parkinson disease, amyotrophic lateral sclerosis, or dementia in the PCB-exposed cohort (standardized mortality ratios [SMRs]-1.40, 1.11, and 1.26, respectively, and number of deaths-14, 10, and 28 respectively). However, sex-specific analyses revealed that women had an excess of amyotrophic lateral sclerosis (SMR-2.26; 95% confidence interval [CI] = 1.08-4.15; 10 deaths). Furthermore, among highly exposed women (defined by a job-exposure matrix), we found an excess of Parkinson disease (SMR-2.95; 95% CI = 1.08-6.42; 6 deaths) and dementia (SMR-2.04; 95% CI = 1.12-3.43; 14 deaths). CONCLUSIONS: Our data are limited due to small numbers and reliance on mortality rather than incidence data, but are suggestive of an effect of PCBs on neurodegenerative disease for women. The literature does not offer an explanation for why women would be more affected than men by PCB exposure for these outcomes.

Paternal occupational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin and birth outcomes of offspring: birth weight, preterm delivery, and birth defects.

Agent Orange is a phenoxy herbicide that was contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). We studied pregnancy outcomes among wives of male chemical workers who were highly exposed to chemicals contaminated with TCDD and among wives of nonexposed neighborhood referents. For exposed pregnancies, we estimated serum TCDD concentration at the time of conception using a pharmacokinetic model. The mean TCDD concentration for workers' births was 254 pg/g lipid (range, 3-16,340 pg/g). The mean referent concentration of 6 pg/g was assigned to pregnancies fathered by workers before exposure. A total of 1,117 live singleton births of 217 referent wives and 176 worker wives were included. Only full-term births were included in the birth weight analysis (greater than or equal to 37 weeks of gestation). Mean birth weight among full-term babies was similar among referents' babies (n = 604), preexposure workers' babies (n = 221), and exposed workers' babies (n = 292) (3,420, 3,347, and 3,442 g, respectively). Neither continuous nor categorical TCDD concentration had an effect on birth weight for term infants after adjustment for infant sex, mother's education, parity, prenatal cigarette smoking, and gestation length. An analysis to estimate potential direct exposure of the wives during periods of workers' exposure yielded a nonstatistically significant increase in infant birth weight of 130 g in the highest exposure group (TCDD concentration > 254 pg/g) compared with referents (p = 0.09). Mothers' reports of preterm delivery showed a somewhat protective association with paternal TCDD (log) concentration (odds ratio = 0.8; 95% confidence interval, 0.6-1.1). We also include descriptive information on reported birth defects. Because the estimated TCDD concentrations in this population were much higher than in other studies, the results indicate that TCDD is unlikely to increase the risk of low birth weight or preterm delivery through a paternal mechanism. Key words: birth defects, birth weight, congenital anomalies, dioxin, occupation, paternal exposure, preterm birth, TCDD.

An occupational reproductive research agenda for the third millennium.

There is a significant public health concern about the potential effects of occupational exposure to toxic substances on reproductive outcomes. Several toxicants with reported reproductive and developmental effects are still in regular commercial or therapeutic use and thus present potential exposure to workers. Examples of these include heavy metals, organic solvents, pesticides and herbicides, and sterilants, anesthetic gases, and anticancer drugs used in health care. Many other substances are suspected of producing reproductive or developmental toxicity but lack sufficient data. Progress has been limited in identifying hazards and quantifying their potencies and in separating the contribution of these hazards from other etiologic factors. Identifying the causative agents, mechanisms by which they act, and any potential target populations, present the opportunity to intervene and protect the reproductive health of workers. The pace of laboratory studies to identify hazards and to underpin the biologic plausibility of effects in humans has not matched the pace at which new chemicals are introduced into commerce. Though many research challenges exist today, recent technologic and methodologic advances have been made that allow researchers to overcome some of these obstacles. The objective of this article is to recommend future directions in occupational reproductive health research. By bridging interdisciplinary gaps, the scientific community can work together to improve health and reduce adverse outcomes.

Feasibility issues in reproductive biomonitoring of female flight attendants and teachers.

Flight attendants (FAs) may be at risk of adverse reproductive outcomes. We investigated the feasibility of biomonitoring studies in this mobile workforce. Forty-five female FAs and 26 female teachers (referents) collected daily urine and saliva samples for one menstrual cycle, provided daily diary data for approximately three months, and wore a wrist monitor to measure sleep disruption. A transport system enabled FAs to store samples while traveling. Overall, participation rates were low (37%) but of those recruited, over 90% of FAs and teachers completed the biomonitoring cycle. Data collection and sample integrity were not diminished by travel. Study methods resulted in good compliance and high quality data. It is possible to conduct studies of menstrual cycle function, sleep disruption, and circadian rhythm disruption in a mobile workforce potentially exposed to reproductive hazards.