Cost-effectiveness of hospital discharge records for reaching selected endpoints in the surveillance of silicosis.

BACKGROUND: The Sentinel Event Notification System for Occupational Risks (SENSOR) is a state/federal system for the surveillance and intervention of occupational conditions. The Ohio SENSOR program identifies silicosis cases from a number of data sources, although hospital discharge records have largely been considered the most successful means of carrying out SENSOR objectives. However, the cost-effectiveness of hospital discharge records has not been evaluated. Thus, a cost analysis was conducted to compare the effectiveness of hospital discharge records with other data sources for achieving prevention-related endpoints of silicosis surveillance. METHODS: Total costs of reaching three endpoints (obtaining case names, identifying work sites, and identifying silica problems in work sites) were estimated retrospectively and measured in 1996 dollars for four data sources: hospital discharge records, physician reports, workers' compensation claims, and death certificates. Total costs were then divided by output for each source/endpoint combination to produce estimates of average costs. RESULTS: The average cost per case was $30 for hospital records, $212 for physician reports, $19 for workers' compensation claims, and $7 for death certificates. However, for identifying problem work sites, hospital records were most expensive at $2,883 per work site, compared with $2,558 for physician reports, $1,318 for workers' compensation claims, and $1,310 for death certificates. CONCLUSIONS: Hospital discharge records were least cost-effective for accomplishing prevention-related goals of surveillance. A change in the mix of resources applied to silicosis surveillance and intervention under SENSOR, i.e., a shift away from follow-up of hospital records toward more cost-effective methods for identifying work sites with silica problems may result in more efficient use of public health resources devoted to the prevention of silicosis.

Work-related skin disease in the plastics industry.

In a survey of a representative sample of workers taken at each of four different plastics manufacturers, 122 completed self-administered questionnaires were obtained. Twenty-six respondents (21.3%) met the case definition for having a work-related skin disorder during the preceding year. Sixteen (61.5%) cases indicated that their skin problems were present for 11 or more days, and 50% reported that their normal daily activities were at least somewhat affected. Risk of disease was elevated for workers who reported skin contact with formaldehyde (OR = 3.30; 95% CI = 1.02-10.69) or with polyvinyl-chlorides (PVCs) or their precursors (OR = 4.08; CI = 1.19-14.06), used barrier creams (OR = 4.51; CI = 1.22-16.68), were female (OR = 5.42; CI = 0.97-30.22), were 35 or younger (OR = 4.65; CI = 1.53-14.19), and for each use of hand cleaner at work (OR = 1.22; CI = 1.05-1.41). These findings should be considered when designing programs to reduce the incidence of skin disease among workers in the plastics industry.

The relative effectiveness of sanctions applied to first-time drunken driving offenders.

We selected for study drivers who were sentenced either to jail or a certified driver intervention program (DIP) in Franklin County, Ohio, in 1987 after their first drunken driving (DUI) conviction. Because each drunken driving charge was assigned to one of a pool of 15 judges with widely varying sentencing patterns, there was no apparent bias in subject allocation to the two treatments. For the jailed (n = 124) and DIP (n = 218) cohorts, we compared the likelihood of subsequent impaired driving, as evidenced by rearrest for a new alcohol-related driving offense or involvement in a car crash after drinking in the 4 years following the study-selected event. After controlling for potentially important covariates, such as gender, age, race, blood alcohol concentration, additional charges filed at the time of arrest, and driving history, we derived logistic regression results indicating that DIP attendees had significantly lower rates of subsequent impaired driving. Drivers who had no prior history of at least one non-DUI alcohol-related offense were significantly more likely to display additional impaired driving when jailed as opposed to those enrolled in a DIP (odds ratio [OR] = 2.53, confidence interval [CI] = 1.44, 4.45), while those with previous alcohol-related offenses may have fared better in jail (OR = .56, CI = .11, 2.76). Drivers younger than 21 years of age were also at elevated risk for repeat offenses (OR = 2.46, CI = 1.13, 5.35). DIPs appear most effective when used for persons who have not had previous alcohol-related crashes or driving offenses.

Indoor air mercury concentrations following application of interior latex paint.

Mercury vapors are released from paint containing mercury compounds used to prolong the shelf-life of interior latex paint. To determine whether homes recently painted with paint containing mercury had elevated indoor-air mercury concentrations, we studied 37 Ohio homes. Twenty-one homes painted with mercury-containing paint a median of 86 days earlier were compared with 16 homes not recently painted with mercury-containing paint. Paint samples from the exposed homes contained a median of 210 mg Hg/L (range 120-610 mg/L). The median air mercury concentration was higher in the exposed homes (0.3 microgram/m3; range nondetectable--1.5 microgram/m3) than in the unexposed homes (nondetectable; range nondetectable--0.3 microgram/m3, P less than 0.0001). Among the exposed homes there were seven in which paint containing less than 200 mg/L had been applied. In these homes, the median air mercury concentration was 0.2 microgram/m3 (range nondetectable--1 microgram/m3). Six (33%) exposed homes had air mercury concentrations greater than 0.5 microgram/m3, the acceptable indoor concentration recommended by the Agency for Toxic Substances and Disease Registry. Elemental mercury was the form of mercury released into the air. These data demonstrate that potentially hazardous mercury exposure may occur in homes recently painted with paint that contains mercury concentrations less than 200 mg/L.