Daniel Lefkowitz

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.

Population-Based Surveillance of Amyotrophic Lateral Sclerosis in New Jersey, 2009-2011

Background: Limited epidemiological data exist about amyotrophic lateral sclerosis (ALS) in the United States (US). The Agency for Toxic Substances and Disease Registry maintains the National ALS Registry and funded state and metropolitan surveillance projects to obtain reliable, timely information about ALS in defined geographic areas. Methods: Neurologists submitted case reports for ALS patients under their care between January 1, 2009 and December 31, 2011 who were New Jersey residents. A medical record verification form and electromyogram (EMG) report were requested for a sample of case reports. Incidence rates were standardized to the 2000 US Standard Population. Results: The average crude annual incidence rate was 1.87 per 100,000 person-years, the average age-adjusted annual incidence rate was 1.67 per 100,000 person-years, and the point prevalence rate on December 31, 2011 was 4.40 per 100,000 persons. Average annual incidence rates and point prevalence rates were statistically higher for men compared with women; Whites compared with Blacks/African Americans and Asians; and non-Hispanics compared with Hispanics. Conclusions: The project findings contribute new, population-based, state-specific information to epidemiological data regarding ALS. The findings are generally consistent with previously published surveillance studies conducted in the US and abroad.

Utilizing United States Coast Guard Data to Calculate Incidence Rates and Identify Risk Factors for Occupational Fishing Injuries in New Jersey

ABSTRACT Commercial fishing has high rates of work-related injury and death and needs preventive strategies. Work-related fatal and nonfatal injury rates for New Jersey (NJ) commercial fishermen who suffered unintentional traumatic injuries from 2001 to 2007 are calculated using data from the United States Coast Guard (USCG) Marine Safety and Pollution Database and estimated denominator data. Fatalities were compared to those ascertained by the NJ Fatality Assessment Control and Evaluation (FACE) surveillance system. For the study years, 225 nonfatal injuries and 31 fatal injuries were reported. Among nonfatal injuries, the causes by frequency were fall onto surface, crushed between objects, struck by moving object, line handling/caught in lines, collision with fixed objects, fall into water, and other noncontact injuries. The distribution of fatal injuries differed, with the most frequent cause as crushed between objects. Falls into water and several noncontact injuries accounted for most of the other fatalities. The large majority (96%) of nonfatal injuries were contact injuries, whereas only 68% of fatalities were classified as contact. The overall incidence rate of nonfatal injuries was 1188 per 100,000 full-time equivalents (FTEs) per year. The rate varied considerably by year, from a low of 286 per 100,000 FTEs in 2001 and 2007 to 3806 per 100,000 FTEs in 2003. The overall occupational fatality rate over the period 2001–2007 was 164 per 100,000 FTEs per year. These results can aid in targeting the commercial fishing industry for injury prevention strategies and interventions, especially for falls, crushing injuries, and drownings.

Control of Respirable Dust and Crystalline Silica from Breaking Concrete with a Jackhammer

The Engineering and Physical Hazards Branch (EPHB) of the National Institute for Occupational Safety and Health (NIOSH) has been given the lead within NIOSH to study and develop engineering controls and assess their impact on reducing occupational illness. The objective of each of these studies has been to evaluate and document control techniques and to determine their effectiveness in reducing potential health hazards in a specific industry or for a specific process. The goal of the project reported in this article was to quantify the exposure reduction that could be achieved through the use of a water-spray attachment and two different tool-mounted local exhaust ventilation shrouds during concrete pavement breaking with jackhammers. In this case, the water-spray attachment consisted of a spray nozzle (of the type used with oil-burning furnaces) and associated hoses and fittings. Water was supplied by a pressurized tank mounted on the air-compressor trailer. The local exhaust ventilation (LEV) included an off-the-shelf shroud typically used with hand-held rock drills and a custom-made shroud. The same dust collector (one sold for use with the rockdrill hood) was used for both LEV attachments.

Effects of Demographic Factors on Survival Time after a Diagnosis of Amyotrophic Lateral Sclerosis

Background: The Agency for Toxic Substances and Disease Registry established surveillance projects to determine the incidence, prevalence, and demographic characteristics of persons with Amyotrophic Lateral Sclerosis (ALS) in defined geographic areas. There is a need to characterize and account for the survival and prognostic factors among a population-based cohort of ALS cases in the United States. Methods: A cohort of incident cases diagnosed from 2009-2011 in New Jersey was followed until death or December 31, 2013, whichever happened first. Survival was assessed using Kaplan-Meier curves and Cox proportional hazards regression was used to identify prognostic factors. Results: Sixty-four percent of incident cases died between 2009 and 2013, 93.7% specifically from ALS. Among the 456 cases studied in the survival analysis, the median survival from diagnosis was 21 months; 46% of cases survived longer than two years from diagnosis. Older age predicted shorter survival. While there is some indication of differences because of sex, race, and ethnicity, these differences were not statistically significant when accounting for age. Conclusions: New Jersey mortality data were queried to determine the vital status of a cohort of incident ALS cases and used to investigate relationships between demographic factors and survival. Results are consistent with other population-based studies. Older age was a strong predictor of shorter survival time. Additional follow-up time is needed to characterize longer-term survival.

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.

Survey of Current Lead Use, Handling, Hygiene, and Contaminant Controls Among New Jersey Industries

In 2003, a chemical handling and use survey was mailed to New Jersey employers identified as currently using lead in their industrial processes. This survey was used to ascertain characteristics about lead use, handling, and protection of employees during manufacturing operations. The survey included a diverse group of current lead users with a total lead use range from less than 1 pound to more than 63 million pounds of lead per year. The survey allowed for a comprehensive characterization of hazards and protective measures associated with this metal, still commonly used in many products and industrial processes. Forty-five surveys were returned by companies that are listed in the New Jersey Adult Blood Lead Registry, which is part of the New Jersey Adult Blood Lead Epidemiology and Surveillance (ABLES) program. This program records and investigates cases of adults with greater than 25 μ g/dL of lead in their blood; most cases are related to occupational exposures. This survey found that greater than 25% of these surveyed companies with significant potential for lead exposure did not employ commonly used and basic industrial hygiene practices. In addition, the survey found that 24% of these companies had not conducted air sampling within the last 3 years. Air sampling is the primary trigger for compliance with the Occupational Safety and Health Administration (OSHA) general industry lead standard. Only 17% of the companies have ever been cited for a violation of the OSHA lead standard, and only 46% of these companies have ever had an OSHA inspection. State-based surveillance can be a useful tool for OSHA enforcement activities. Elevated blood lead values in adults should be considered as a trigger for required compliance with an OSHA general industry lead standard.

Tree-Related Injuries Associated With Response and Recovery From Hurricane Sandy, New Jersey, 2011-2014:

Objectives: Extreme weather events require extensive tree removal and disposal, tasks associated with severe injury risks among workers and residents. To help understand the risks of such activities, we evaluated the impact of a large and destructive storm (Hurricane Sandy in 2012) on the incidence of tree-related injuries. Methods: We searched chief-complaint text fields for patients aged 18-65 from 2011-2014 emergency department visit records submitted by New Jersey hospitals through the state-based syndromic surveillance system. Tree-related keywords (eg, saw, branch, wood chip, woodchip, tree) identified possible injuries that we then reviewed to exclude unrelated cases and classify mechanisms of tree-related injury. We used Poisson regression analysis to evaluate changes in the rates of probable tree-related injuries, adjusting for total emergency department visits and seasonal variation. Results: We identified 698 probable tree-related injuries from 2011-2014 among patients aged 18-65, including 104 (14.9%) falls, 241 (34.5%) machine-related injuries, 311 (44.6%) struck-by injuries, and 42 (6.0%) other tree-related injuries. Tree-related injuries increased significantly in the quarter immediately after Hurricane Sandy (November 2012–January 2013) compared with the same quarter the year before (rate ratio [RR] = 1.67; 95% confidence interval [CI], 1.13-2.47) and the year after (RR = 2.47; 95% CI, 1.62-3.78) Hurricane Sandy, especially for struck-by injuries compared with the year before (RR = 2.74; 95% CI, 1.47-5.12) and the year after (RR = 4.17; 95% CI, 2.09-8.32) Hurricane Sandy. More than one-third of the injuries (33.4%) involved chainsaws. Conclusions: A major hurricane was associated with an increase in tree-related injuries in emergency departments, especially for mechanisms consistent with handling downed and damaged trees. Further research should confirm these findings and evaluate opportunities for preventing tree-related injuries.

Assessing Barriers to the Use of Fall Protection in Small Residential Construction Companies in New Jersey

Three focus groups were conducted with residential construction workers from local New Jersey labor organizations to characterize barriers to fall protection use among residential construction contractors who work for companies with fewer than ten employees. Thirty-six residential construction workers volunteered to participate, the average age was thirty-nine years, and twenty-four (67%) were of Hispanic origin. Twelve (33%) of the participants reported having fallen from greater than 6 ft at work and twenty (56%) of the participants had known someone who has fallen from greater than 6 ft. Sixteen (44%) had not been provided with fall protection equipment by their employer and eighteen (50%) reported their current employer had not provided workplace safety training. Factors that created barriers to use of fall protection equipment such as equipment availability, employee/employer relationships, cultural differences, and company size were identified. Results from this study confirm that falls remain a concern among residential construction workers in small companies.