John P. Sestito

Sentinel Health Events (occupational): a basis for physician recognition and public health surveillance.

A Sentinel Health Event(SHE)isa preventable disease, disability, oruntimely death whoseoccurrence serves asa warning signal thatthequality ofpreventive and/or therapeutic medical caremayneedtobeimproved. A SHE(Occupational) isa disease, disability, oruntimely death which isoccupationally related andwhoseoccurrence may:1)provide theimpetus forepidemiolog- icorindustrial hygiene studies; or2)serve asawarning signal that materials substitution, engineering control, personal protection, or medical caremayberequired. Thepresent SHE(O)list encom- passes 50disease conditions that arelinked totheworkplace. Only

Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.

Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey.

BACKGROUND Patterns of prevalence and work-relatedness of carpal tunnel syndrome (CTS) among workers offer clues about risk factors and targets for prevention. METHODS Data from an occupational health supplement to the 2010 National Health Interview Survey were used to estimate the prevalence of self-reported clinician-diagnosed CTS overall and by demographic characteristics. The proportion of these cases self-reported to have been attributed to work by clinicians was also examined overall and by demographic characteristics. In addition, the distribution of industry and occupation (I&O) categories to which work-related cases of CTS were attributed was compared to the distribution of I&O categories of employment among current/recent workers. RESULTS Data were available for 27,157 adults, including 17,524 current/recent workers. The overall lifetime prevalence of clinician-diagnosed CTS among current/recent workers was 6.7%. The 12-month prevalence was 3.1%, representing approximately 4.8 million workers with current CTS; 67.1% of these cases were attributed to work by clinicians, with overrepresentation of certain I&O categories. CONCLUSIONS CTS affected almost 5 million U.S. workers in 2010, with prevalence varying by demographic characteristics and I&O.

Hernia: is it a work-related condition?

BACKGROUND Development of hernias among active workers is a major occupational problem, however, the work-relatedness of hernias has not been well investigated. It is a difficult question for occupational and primary care physicians who must often address whether a worker with an inguinal hernia should be restricted from work requiring lifting of heavy objects. METHODS To evaluate the possible work-relatedness of inguinal hernias, a cross-sectional study was performed. The goal of the study was to determine hernia incidence according to occupation with the Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics in 1994. Hernia incidence rates (per 10,000 workers) for industry and occupation categories were calculated with the estimates of the number of hernias in males and the employed male workers from the Current Population Survey. Rate ratios (RR) of hernia incidence rates were calculated. RESULTS In 1994, an estimated 30, 791 work-related hernias in males were reported by US private establishments. The occupation groups with the highest RR were laborers and handlers (RR, 2.47; 95% confidence interval (CI), 2.14-2.80), machine operators (RR, 2.13; 95% CI, 1.81-2.44), and mechanics and repairers (RR, 1.72; 95% CI, 1.43-2.00). CONCLUSIONS Rate ratios for hernias vary considerably within industries and occupations, with the highest ratios found in industries and occupations involving manual labor. This provides support for the hypothesis that the hernias are work-related, especially in work involving strenuous, heavy manual labor. Am. J. Ind. Med. 36:638-644, 1999. Published 1999 Wiley-Liss, Inc.

Cancer mortality among laundry and dry cleaning workers.

A cancer mortality study of 8,163 deaths occurring among persons formerly employed as laundering and dry cleaning workers in 28 states is described. Age-adjusted sex-race cause-specific proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed for 1979 through 1990, using the corresponding 28-state mortality as the comparison. For those aged 15-64 years, there were excesses in black men for total cancer mortality (PMR = 130, 95% confidence interval (CI) = 105-159) and cancer of the esophagus 1 (PMR = 215, 95% CI = 111-376), and in white men for cancer of the larynx (PMR = 318, 95% CI = 117-693). For those aged 65 years and over, there were statistically nonsignificant excesses for cancer of the trachea, bronchus, and lung in black women (PMR = 128, CI = 94-170) and for cancer of other and unspecified female genital organs in white women (PMR = 225, CI = 97-443). The results of this and other studies point to the need for the effective implementation of available control measures to protect laundry and dry cleaning workers.

Fatalities in the landscape and horticultural services industry, 1992–2001

BACKGROUND Although landscape and horticultural services workers have high injury and illness rates, little is known about fatalities in this industry. METHODS Census of Fatal Occupational Injuries and Current Population Survey data were analyzed to determine fatality rates and causes of landscaping deaths from 1992 to 2001. RESULTS There were 1,101 fatalities during the 10-year period and the average fatality rate was 13.50 deaths per 100,000 full-time employees. In 2001, the landscaping fatality rate was 3.33 (95% CI 2.84-3.91) times the all industry rate. The leading causes of death were transportation incidents (27%), contact with objects or equipment (27%), falls (24%), exposure to harmful substances and environments (18%), and assaults and violent acts (4%). The fatality rate for African American landscapers was 1.51 (95% CI 1.25-1.83) times the rate for white workers. Fatalities were also common among self-employed, small business, and young landscapers. CONCLUSIONS Landscaping workers are at increased risk of fatal injury. Further research is needed to characterize industry hazards.

Mortality Among Members of a Truck Driver Trade Association

Previous studies report that truck drivers are at increased risk for illness and on-the-job mortality. It is unknown whether owner-operator truck drivers face the same risks as employee drivers, yet few studies have targeted owner-operators as a study population. This study examined the overall and cause-specific mortality ratios for a cohort with owner-operator truck drivers constituting 69% of the study population. Of the 26 major disease classifications and 92 specific causes of death examined, only mortality due to transportation accidents was significantly elevated (standardized mortality ratio=1.52, 95% confidence interval=1.36-1.70). Leading causes of death were ischemic heart disease and lung cancer, although risk was below that of the general population. Transportation accidents pose a particular hazard for members of the trade association. The absence of excess disease mortality deserves careful interpretation, and may be due to both a strong healthy worker effect and a short monitoring period.

Risk Factors, Health Behaviors, and Injury Among Adults Employed in the Transportation, Warehousing, and Utilities Super Sector

BACKGROUND The TWU super sector is engaged in the movement of passengers and cargo, warehousing of goods, and the delivery of services. The purpose of this study is to describe employee self-reported personal risk factors, health behaviors and habits, disease and chronic conditions, and employer-reported nonfatal injury experiences of workers in the TWU super sector. METHODS National Health Interview Survey (NHIS) data for 1997-2007, grouped into six morbidity and disability categories and three age groups, were reviewed. Demographic characteristics and prevalence estimates are reported for workers in the TWU super sector and the entire U.S. workforce, and compared with national adult population data from the NHIS. Bureau of Labor Statistics employer-reported TWU injury data from 2003 to 2007 was also reviewed. RESULTS An average of 8.3 million workers were employed annually in the TWU super sector. TWU workers 65 or older reported the highest prevalence of hypertension (49%) across all industry sectors, but the 20% prevalence is notable among middle age workers (25-64). TWU workers had the highest prevalence of obesity (28%), compared to workers in all other industry sectors. Female TWU workers experienced the highest number of lost workdays (6.5) in the past year across all TWU demographic groups. CONCLUSIONS Self-reported high proportions of chronic conditions including hypertension and heart disease combined with elevated levels of being overweight and obese, and lack of physical activity-particularly among TWUs oldest workers-can meaningfully inform wellness strategies and interventions focused on this demographic group. Am. J. Ind. Med. 56:556-568, 2013.

What is the true prevalence of carpal tunnel syndrome among US workers

By pooling data from six studies that participated in the Upper-Extremity Musculoskeletal Disorder Consortium (UEMSD), Dale et al’s recent publication “Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies” (1) provides an important contribution to the literature on carpal tunnel syndrome (CTS) among US workers. Although the main purpose of the UEMSD was not to estimate the national prevalence of CTS but rather to evaluate the relationship between workplace factors and upper-extremity health outcomes, Dale et al’s reported baseline prevalence rate of CTS (7.8%) might be considered one of the best estimates of the true prevalence of CTS among US workers performing hand-intensive activities. Another recently published estimate of the prevalence of CTS among US workers is based on data collected through an Occupational Health Supplement (OHS) to the 2010 National Health Interview Survey (NHIS) (2). The 2010 NHIS-OHS asked participants if a clinician had ever diagnosed them as having CTS, and, if so, whether they had CTS in the past 12 months. According to the 2010 NHIS-OHS, the 12-month prevalence of self-reported clinician-diagnosed CTS among current/recent workers is 3.1%, or 4.8 million workers. Clinicians attributed almost two thirds of these cases to work (2). There are several reasons why the 12-month prevalence estimate based on the 2010 NHIS-OHS is substantially lower than the baseline prevalence of CTS in the UEMSD study. Dale et al mention two of the main reasons: “While CTS rates depend on the physical exposures and other characteristics of the population under study, they are also affected by the study design and CTS case definitions used to define the disease.” The UEMSD study population was not designed to be representative of the US population but instead had a high proportion of participants employed in manufacturing and other hand-intensive jobs. However, the UEMSD study assessed all participating workers and used a rigorous case definition of CTS that was based on symptoms and electrodiagnostic studies. In contrast, the NHIS-OHS sample was designed to be representative of the US adult population. For this reason, the prevalence estimate based on the NHIS-OHS would be expected to be a more accurate national estimate. However, since the 2010 NHIS-OHS estimate is based on self-reported clinician diagnoses of CTS, it has several limitations including: (i) it did not capture workers with CTS who did not seek healthcare or were misdiagnosed; (ii) no information was available on how the clinician made the CTS diagnosis; and (iii) there was total reliance on the worker’s memory to accurately recall the CTS diagnosis. This comparison highlights the need to employ multiple methods to understand the true burden of common work-related disorders in the general population. The 2010 NHIS-OHS and UEMSD estimates probably bookend the true national prevalence of CTS among workers, as it likely lies somewhere between the 3.1% and 7.8% estimates from the 2010 NHIS-OHS and the UEMSD study, respectively.

Examining national trends in worker health with the National Health Interview Survey.

Objective: To describe data from the National Health Interview Survey (NHIS), both the annual core survey and periodic occupational health supplements (OHSs), available for examining national trends in worker health. Methods: The NHIS is an annual in-person household survey with a cross-sectional multistage clustered sample design to produce nationally representative health data. The 2010 NHIS included an OHS. Results: Prevalence rates of various health conditions and health behaviors among workers based on multiple years of NHIS core data are available. In addition, the 2010 NHIS-OHS data provide prevalence rates of selected health conditions, work organization factors, and occupational exposures among US workers by industry and occupation. Conclusions: The publicly available NHIS data can be used to identify areas of concern for various industries and for benchmarking data from specific worker groups against national averages.