Utilizing hospital discharge data (HD) to compare fatal and non-fatal work-related injuries among Hispanic workers in New Jersey.

BACKGROUND: This study explores the utilization of Hospital Discharge (HD) data to obtain estimates of work-related non-fatal injuries rates in NJ to determine if Hispanics workers have an increased risk of specific work-related injuries. In addition, HD data are used to compare the rate ratios between fatal and non-fatal injuries in this population to demonstrate the effectiveness of using HD as a surveillance tool for monitoring injury trends and performing evaluations. METHODS: Several types of fatal and non-fatal injuries were modeled using Poisson regression with the following predictor variables: gender, ethnicity, and year. The estimated number of workers by ethnicity employed in NJ each year was obtained from the U.S. Census Bureau, DataFerrett, Current Population Survey, November 2006, a data mining tool which accesses CPS data. RESULTS: These analyses, utilizing estimates of working population at-risk, indicate that Hispanic workers have an increased risk of four particular work-related injuries compared with non-Hispanics, and Hispanics were injured at a younger age than non-Hispanics. In addition the rankings of the rate ratios from the comparison between non-fatal and fatal risk estimates were similar; indicating that occupational surveillance of non-fatal injuries is a viable component to be considered. CONCLUSIONS: HD data are effective for monitoring trends over time across ethnic groups and injury types. Therefore, non-fatal injury surveillance should be considered for targeting specific worker populations for interventions to reduce exposure to workplace hazards, and can be a valuable surveillance tool in efforts to reduce occupational injuries.

A descriptive study of work aggravated asthma.

BACKGROUND AND AIMS: Work related asthma (WRA) is one of the most frequently reported occupational lung diseases in a number of industrialised countries. A better understanding of work aggravated asthma (WAA), as well as work related new onset asthma (NOA), is needed to aid in prevention efforts. METHODS: WAA and NOA in the United States were compared using cases reported to the National Institute for Occupational Safety and Health (NIOSH) from four state Sentinel Event Notification Systems for Occupational Risks (SENSOR) surveillance programmes for 1993-95. RESULTS: A total of 210 WAA cases and 891 NOA cases were reported. WAA cases reported mineral and inorganic dusts as the most common exposure agent, as opposed to NOA cases, in which diisocyanates were reported most frequently. A similar percentage of WAA and NOA cases still experienced breathing problems at the time of the interview or had visited a hospital or emergency room for work related breathing problems. NOA cases were twice as likely to have applied for workers' compensation compared with WAA cases. However, among those who had applied for worker compensation, approximately three-fourths of both WAA and NOA cases had received awards. The services and manufacturing industrial categories together accounted for the majority of both WAA (62%) and NOA (75%) cases. The risk of WAA, measured by average annual rate, was clearly the highest in the public administration (14.2 cases/10(5)) industrial category, while the risk of NOA was increased in both the manufacturing (3.2 cases/10(5)) and public administration (2.9 cases/10(5)) categories. CONCLUSIONS: WAA cases reported many of the same adverse consequences as NOA cases. Certain industries were identified as potential targets for prevention efforts based on either the number of cases or the risk of WAA and NOA.

Evolution of a state occupational lead exposure registry: 1986-1996.

In the first 11 full years of operation (January 1, 1986, through December 31, 1996) of an adult lead registry in New Jersey, 23,456 reports of occupational lead toxicity (blood lead level > or = 1.21 mumol/L) in 4,011 workers, involving 496 workplaces, were received. The majority of the reports and workers were from the manufacturing and construction industries. Over the 11 years, the annual numbers of reports and workers declined, although the annual numbers of involved workplaces remained stable, as did the number of newly identified workers and workplaces. The decline occurred primarily in the manufacturing industry; the construction industry experienced an increase in reports and reported workers. For all years combined, 36% of reported workers had at least one blood lead level equal to or greater than 1.93 mumol/L, although in the most recent years the percentage dropped overall and in both the manufacturing and construction industries.

Does silicosis still occur?

A state-based surveillance system has identified 401 individuals with the diagnosis of silicosis for the years 1979 through 1987. The individuals identified were generally older men who began work before 1960 and had worked for 15 years or more in potteries, construction, foundries, or sand mines. Follow-up inspections at the identified companies indicated ongoing poorly controlled exposure to silica. Difficulties in distinguishing coal worker's pneumoconiosis from silicosis and inadequate attention to tuberculosis by the treating physicians were noted. Few workers applied for workers' compensation. Extrapolation of our results to the whole country suggests that the current national surveillance system for occupational illnesses markedly underestimates the true occurrence of silicosis.

Silicosis surveillance in New Jersey: targeting workplaces using occupational disease and exposure surveillance data.

To identify workplaces in New Jersey with potential for silica exposure, the New Jersey Department of Health compared four-digit Standard Industrial Classifications (SICs) identified by three different data sources: the National Occupational Exposure Survey (NOES), a new Jersey silicosis case registry, and regulatory agency compliance inspections in New Jersey. In total, the three data sources identified 204 SICs in New Jersey with potential for silica exposure. Forty-five percent of these SICs were identified by NOES only, 16% by registry cases only, 6% by compliance inspections only, and 33% by two or more sources. Since different surveillance sources implicate different SICs, this type of analysis is a useful first step in planning programs for prevention of silicosis.

Successful reduction of silica exposures at a sanitary ware pottery.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) conducted a joint survey with the New Jersey Department of Health (NJDOH) to measure crystalline silica exposures and evaluate the adequacy of the existing control measures for reducing these exposures at a sanitary ware pottery. This survey found that 95% of the personal and area samples from the Slip House, Casting, Glaze Spray, and Glaze Preparation Departments exceeded the NIOSH Recommended Exposure Level (87% exceeded the Occupational Safety and Health Administration Permissible Exposure Level) for crystalline silica. Three years later, a follow-up survey found statistically significant reductions in respirable crystalline silica exposures in two of four plant departments, and statistically significant reductions in area concentrations in all four plant departments. These reductions were accomplished through a combination of automating and enclosing the batching system in the Slip House and by replacing the mold parting compound with a nonsilica material, altering the method of dry sweeping, cleaning of castings while damp, improving exhaust ventilation at the spray booths, and improved housekeeping.

Silicosis surveillance--Michigan, New Jersey, Ohio, and Wisconsin, 1987-1990.

PROBLEM/CONDITION: Improved surveillance for silicosis is needed to target interventions to prevent this occupational lung disease caused by the inhalation of crystalline silica dust. REPORTING PERIOD COVERED: 1987-1990. DESCRIPTION OF SYSTEMS: State-based silicosis surveillance and intervention programs have been developed in Michigan, New Jersey, Ohio, and Wisconsin as part of the Sentinel Event Notification System for Occupational Risks (SENSOR) Program, initiated in 1987 by the National Institute for Occupational Safety and Health (NIOSH). RESULTS: From 1987 through 1990, the SENSOR program confirmed a total of 430 cases of silicosis reported from these four states. Overall, approximately 60% of these cases were in workers employed in primary metal industries, although the types of industries in which cases occurred varied by state. Some cases were attributable to relatively recent exposure, including new cases in seven persons first exposed since 1980 in New Jersey. Silicosis case reports have prompted measurement of respirable silica concentrations at 25 Michigan work sites, and 14 (56%) of these sites were found to have levels that exceeded the legally permissible exposure level. INTERPRETATION: The silicosis surveillance and intervention strategies piloted by state health departments in the NIOSH-funded SENSOR Program have demonstrated the feasibility and effectiveness of identifying specific silica-using work sites that need preventive intervention. ACTIONS TAKEN: On the basis of initial experience in these four states, NIOSH developed guidelines for state-based silicosis surveillance and awarded SENSOR cooperative agreements to three additional states where the applicability of these surveillance methods will be further evaluated.

Surveillance for silicosis, 1993--Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin.

PROBLEM/CONDITION: Silicosis is an occupational respiratory disease caused by the inhalation of respirable dust containing crystalline silica. Public health surveillance programs to identify workers at risk for silicosis and target workplace-specific and other prevention efforts are currently being field-tested in seven U.S. states. REPORTING PERIOD COVERED: Confirmed cases ascertained by state health departments during the period January 1, 1993, through December 31, 1993; the cases and associated workplaces were followed through December 1994. DESCRIPTION OF SYSTEMS: As part of the Sentinel Event Notification System for Occupational Risks (SENSOR) program initiated by CDC's National Institute for Occupational Safety and Health (NIOSH), development of state-based surveillance and intervention programs for silicosis was initiated in 1987 in Michigan, New Jersey, Ohio, and Wisconsin and in 1992 in Illinois, North Carolina, and Texas. RESULTS: From January 1, 1993, through December 2, 1994, the SENSOR silicosis programs in Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin confirmed 256 cases of silicosis that were initially ascertained in 1993. Overall, 185 (72%) were initially identified through review of hospital discharge data or through hospital reports of silicosis diagnoses; 188 (73%) were associated with silica exposure in manufacturing industries (e.g., foundries; stone, clay, glass, and concrete manufacturers; and industrial and commercial machinery manufacture). Overall, 42 (16%) cases were associated with silica exposure from sandblasting operations. Among the 193 confirmed cases for which information was available about duration of employment in jobs with potential exposure to silica, 37 (19%) were employed < or = 10 years in such jobs and 156 (81%) were employed > or = 11 years. A total of 192 primary workplaces associated with potentially hazardous silica exposures were identified for the 256 confirmed silicosis cases. Of these, nine (5%) workplaces were inspected by state health department (SHD) industrial hygienists, 19 (10%) were referred to the Occupational Safety and Health Administration (OSHA) for follow-up, and seven (4%) were routinely monitored by the Mine Safety and Health Administration. Of the 157 (82%) remaining workplaces, follow-up activities determined that 82 were no longer in operation, eight were no longer using silica, 18 were assigned a lower priority for follow-up, six were associated with building trades and could not be inspected because of the transient nature of work in the construction industry, and 43 workplaces were not inspected for other reasons. Fourteen (7%) of the 192 workplaces were inspected. At 10 of the 14 workplaces, airborne levels of crystalline silica were measured; in nine, silica levels exceeded the NIOSH-recommended exposure level of 0.05 mg/m, and in six, airborne silica levels also exceeded federal permissible exposure limits. ACTIONS TAKEN: Employee-specific and other preventive interventions have been initiated in response to reported cases. In addition, special silicosis prevention projects have been initiated in Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin. To facilitate the implementation of silicosis surveillance by other states, efforts are ongoing to identify and standardize core data needed by surveillance programs to describe cases and the workplaces where exposure occurred. These core variables will be incorporated into a user-friendly software system that states can use for data collection and reporting.