Jacek M. Mazurek

Malignant Mesothelioma Mortality — United States, 1999–2015

Malignant mesothelioma is a neoplasm associated with occupational and environmental inhalation exposure to asbestos* fibers and other elongate mineral particles (EMPs) (1-3). Patients have a median survival of approximately 1 year from the time of diagnosis (1). The latency period from first causative exposure to malignant mesothelioma development typically ranges from 20 to 40 years but can be as long as 71 years (2,3). Hazardous occupational exposures to asbestos fibers and other EMPs have occurred in a variety of industrial operations, including mining and milling, manufacturing, shipbuilding and repair, and construction (3). Current exposures to commercial asbestos in the United States occur predominantly during maintenance operations and remediation of older buildings containing asbestos (3,4). To update information on malignant mesothelioma mortality (5), CDC analyzed annual multiple cause-of-death records† for 1999-2015, the most recent years for which complete data are available. During 1999-2015, a total of 45,221 deaths with malignant mesothelioma mentioned on the death certificate as the underlying or contributing cause of death were reported in the United States, increasing from 2,479 deaths in 1999 to 2,597 in 2015 (in the same time period the age-adjusted death rates§ decreased from 13.96 per million in 1999 to 10.93 in 2015). Malignant mesothelioma deaths increased for persons aged ≥85 years, both sexes, persons of white, black, and Asian or Pacific Islander race, and all ethnic groups. Despite regulatory actions and the decline in use of asbestos the annual number of malignant mesothelioma deaths remains substantial. The continuing occurrence of malignant mesothelioma deaths underscores the need for maintaining measures to prevent exposure to asbestos fibers and other causative EMPs and for ongoing surveillance to monitor temporal trends.

Respiratory Disease in Agricultural Workers: Mortality and Morbidity Statistics

ABSTRACT To quantify the respiratory disease burden among agricultural workers, we examined the 1988–1998 National Center for Health Statistics (NCHS) “Multiple Cause of Death Data” and the 1988–1994 Third National Health and Nutrition Examination Survey data (NHANES III). Proportionate mortality ratios (PMRs) were determined for 11 respiratory conditions among 6 agricultural groups: crop farm workers, livestock farm workers, farm managers, landscape and horticultural workers, forestry workers, and fishery workers. Prevalence ratios (PRs) were determined for 12 respiratory conditions among 3 agricultural groups: farm workers, farm managers, and other agricultural workers. Disease categories groups were based on the 9th International Classification of Diseases and the agricultural groups on the NCHS or NHANES III industry and occupation codes, respectively. Crop farm workers and livestock farm workers had significantly elevated mortality for several respiratory conditions, with mortality for hypersensitivity pneumonitis being 10 and 50 times higher than expected. Landscape and horticultural workers had significantly elevated mortality for abscess of the lung and mediastinum and chronic airways obstruction. Forestry workers had significantly elevated mortality for pulmonary tuberculosis, chronic airways obstruction, and pneumonia. Prevalence of wheeze was elevated for female farm workers, shortness of breath was elevated for farm workers who had ever smoked, and hay fever was elevated for black, non-Hispanic farm workers. Prevalence of asthma was elevated for other agricultural workers who had ever smoked. Farm workers had a PR of 173 for obstructive respiratory abnormality. Continued improvement in occupational health surveillance systems for agriculture is essential to help guide prevention efforts for respiratory disease.

Electronic Cigarette Use Among Working Adults — United States, 2014

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver a heated aerosol, which typically contains nicotine, flavorings, and other additives, to the user. The e-cigarette marketplace is rapidly evolving, but the long-term health effects of these products are not known. Carcinogens and toxins such as diacetyl, acetaldehyde, and other harmful chemicals have been documented in the aerosol from some e-cigarettes (1-3). On May 5, 2016, the Food and Drug Administration (FDA) finalized a rule extending its authority to all tobacco products, including e-cigarettes.* The prevalence of e-cigarette use among U.S. adults has increased in recent years, particularly among current and former conventional cigarette smokers (4); in 2014, 3.7% of all U.S. adults, including 15.9% of current cigarette smokers, and 22.0% of former cigarette smokers, used e-cigarettes every day or some days (5). The extent of current e-cigarette use among U.S. working adults has not been assessed. Therefore, CDC analyzed 2014 National Health Interview Survey (NHIS) data for adults aged ≥18 years who were working during the week before the interview, to provide national estimates of current e-cigarette use among U.S. working adults by industry and occupation. Among the estimated 146 million working adults, 3.8% (5.5 million) were current (every day or some days) e-cigarette users; the highest prevalences were among males, non-Hispanic whites, persons aged 18-24 years, persons with annual household income <

Work-related asthma, financial barriers to asthma care, and adverse asthma outcomes: asthma call-back survey, 37 states and District of Columbia, 2006 to 2008.

35,000, persons with no health insurance, cigarette smokers, other combustible tobacco users, and smokeless tobacco users. By industry and occupation, workers in the accommodation and food services industry and in the food preparation and serving-related occupations had the highest prevalence of current e-cigarette use. Higher prevalences of e-cigarette use among specific groups and the effect of e-cigarette use on patterns of conventional tobacco use underscore the importance of continued surveillance of e-cigarette use among U.S. working adults to inform public health policy, planning, and practice.

Silicosis mortality among young adults in the United States, 1968–2004

Background:Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. Objective:To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. Research Design:Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. Subjects:A total of 27,927 ever-employed adults aged ≥18 years with current asthma. Measures:Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. Results:Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43–1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22–1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39–1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41–2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36–1.75). After stratifying for financial barriers to asthma care, the associations did not change. Conclusions:Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.

Surveillance for Silicosis — Michigan and New Jersey, 2003–2011

BACKGROUND To describe silicosis deaths in young (aged 15-44) adults in the U.S. during 1968-2004. METHODS We analyzed the National Center for Health Statistics multiple cause-of-death records. RESULTS Compared with silicosis decedents aged >or=45 years (n = 15,643), young decedents (n = 237) were more likely to have silicosis listed as the underlying cause of death (74.3% vs. 48.2%, P < 0.001), to be female (9.3% vs. 2.2%, P < 0.001) and black (37.1% vs. 11.7%, P < 0.001). Twenty-nine young silicosis decedents had industry and occupation information available. Occupations in construction and manufacturing industries were associated with significantly elevated proportionate mortality ratios for young silicosis deaths. CONCLUSIONS Silicosis deaths occur among young adults. Because these deaths are likely to reflect more intense and recent exposures, the follow-back investigations into the work sites where these individuals were exposed to silica should be conducted.

Cigarette Smoking Trends Among U.S. Working Adult by Industry and Occupation: Findings From the 2004–2012 National Health Interview Survey

CDCs National Institute for Occupational Safety and Health (NIOSH), state health departments, and other state entities maintain a state-based surveillance program of confirmed silicosis cases. Data on confirmed cases are collected and compiled by state entities and submitted to CDC. This report summarizes information for cases of silicosis that were reported to CDC for 2003-2011 by Michigan and New Jersey, the only states that continue to provide data voluntarily to NIOSH. The data for this report were final as of January 8, 2015. Data are presented in tabular form on the number and distribution of cases of silicosis by year (Table 1), duration of employment in occupations with potential exposure to dust containing respirable crystalline silica (Table 2), industry (Table 3), and occupation (Table 4). The number of cases by year is presented graphically (Figure). This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (2).

Prevalence of Chronic Obstructive Pulmonary Disease in the U.S. Working Population: An Analysis of Data from the 1997–2004 National Health Interview Survey

OBJECTIVE To examine trends in age-adjusted cigarette smoking prevalence among working adults by industry and occupation during 2004-2012, and to project those prevalences and compare them to the 2020 Healthy People objective (TU-1) to reduce cigarette smoking prevalence to ≤12%. METHODS We analyzed the 2004-2012 National Health Interview Survey (NHIS) data. Respondents were aged ≥18 years working in the week prior to the interview. Temporal changes in cigarette smoking prevalence were assessed using logistic regression. We used the regression model to extrapolate to the period 2013-2020. RESULTS Overall, an estimated 19.0% of working adults smoked cigarettes: 22.4% in 2004 to 18.1% in 2012. The largest declines were among workers in the education services (6.5%) industry and in the life, physical, and social science (9.7%) occupations. The smallest declines were among workers in the real estate and rental and leasing (0.9%) industry and the legal (0.4%) occupations. The 2020 projected smoking prevalences in 15 of 21 industry groups and 13 of the 23 occupation groups were greater than the 2020 Healthy People goal. CONCLUSIONS During 2004-2012, smoking prevalence declined in the majority of industry and occupation groups. The decline rate varied by industry and occupation groups. Projections suggest that certain groups may not reach the 2020 Healthy People goal. Consequently, smoking cessation, prevention, and intervention efforts may need to be revised and strengthened, particularly in specific occupational groups.

Prevalence of lifetime asthma and current asthma attacks in U.S. working adults: an analysis of the 1997-2004 National Health Interview Survey data.

To estimate the prevalence and the population attributable fraction of chronic obstructive pulmonary disease (COPD) in the U.S. adult workers, we analyzed data obtained from the National Health Interview Surveys for the period 1997–2004. The overall COPD prevalence was 4.0% (95% confidence interval [CI] 3.9–4.1%). The prevalence was higher in females (5.4%, 95% CI 5.3–5.6%) than in males (2.8%, 95% CI 2.7–2.9%); in Whites (4.2%, 95% CI 4.1–4.3%) than in Blacks (3.4%, 95% CI 3.1–3.7%) and other races (2.4%, 95% CI 2.1–2.8%). Compared with insurance, real estate and other finance industry, the top three industries associated with significantly higher prevalence odds ratios (PORs) (adjusted for age, sex, race, and smoking) were other educational services (POR = 1.5, 95% CI 1.0–2.3); transportation equipment (POR = 1.4, 95% CI 1.1–1.8); and social services, religious and membership organizations (POR = 1.4, 95% CI 1.1–1.7). Compared with managers and administrators, except public administration occupation, the top three occupations with significantly higher PORs were health service (1.8, 95% CI 1.5–2.1), other protective service (POR = 1.6, 95% CI 1.2–2.2), and material moving equipment operators (POR = 1.6, 95% CI 1.1–2.3). The overall population attributable fraction for association of COPD with employment was 12.2% for industry and 17.4% for occupation. Further studies are needed to determine specific risk factors associated with COPD in industries and occupations with elevated prevalence and POR.

Characteristics associated with health care professional diagnosis of work-related asthma among individuals who describe their asthma as being caused or made worse by workplace exposures.

Objective: To estimate national prevalences of lifetime asthma and asthma attacks among workers by age, sex, race, occupation and industry, and estimate population attributable fraction to employment for asthma attacks in the United States. Methods: The 1997–2004 National Health Interview Survey data for currently working adults aged ≥18 years were analyzed. Results: Lifetime asthma prevalence was 9.2%; the social services religious and membership organizations industry and the health service occupation had the highest asthma prevalence. Asthma attack prevalence among workers with asthma was 35.4%; the primary metal industry and the health assessment and treating occupation had the highest attack prevalence. Approximately, 5.9% of cases reporting an asthma attack were attributed to employment when considering industries and 3.8% when considering occupations. Conclusions: Future studies and intervention strategies should address the higher prevalence of asthma in certain industries and occupations.