National Institute for Occupational Safety and Health Worker Health Chartbook, 2000 September, 2000 DHHS (NIOSH) Publication No. 2000-127

Executive Summary

Understanding and preventing occupational injuries and illnesses require focused efforts to identify, quantify, and track both health outcomes and their associated workplace conditions. Occupational safety and health surveillance activities provide the ongoing and systematic collection, analysis, interpretation, and dissemination of data needed for prevention. Current occupational safety and health surveillance data reveal the staggering human and economic losses associated with occupational injuries and illnesses. Much work remains to be done to reduce those losses, despite overall decreases in occupational injuries and illnesses in recent years.

Our ability to survey and assess the state of occupational safety and health has improved over time. However, occupational safety and health surveillance data remain fragmented—collected for different purposes by different organizations using different definitions. We continue to have substantial gaps in surveillance information. Each surveillance system has limitations, particularly those that attempt to quantify occupational illness. Nonetheless, the data provide useful information for targeting and evaluating prevention efforts.

To make these data more accessible, the National Institute for Occupational Safety and Health (NIOSH) has assembled this chartbook, which provides occupational safety and health surveillance information from different sources in a single volume. This initial work focuses on injury and illness outcomes rather than on exposures or hazards. Included are contributions from several Federal agencies. Little information is included on public-sector employees or from State-based surveillance systems. Future editions of the chartbook will target additional data sources to provide a more comprehensive picture of occupational injury and illness for the U.S. workforce.

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Trends Over Time

Recent overall decreases in occupational injuries and illnesses are apparent in the incidence rates for total recordable cases of injuries and illnesses in private industry reported by the U.S. Department of Labor in the Survey of Occupational Injuries and Illnesses (SOII). From 1973 to 1997, this rate declined from 11.0 to 7.1 cases per 100 full-time workers. The greatest change occurred among cases without lost workdays,* which decreased from 7.5 to 3.8 cases per 100 full-time workers over the same period. For 1988–1997, the rate of cases with days away from work declined 40%, but there was a 140% increase in the rate of cases with restricted work activity only.

Occupational injury fatality rates recorded by NIOSH in the National Traumatic Occupational Fatalities Surveillance System (NTOF) decreased substantially (43%) between 1980 and 1995, from 7.5 to 4.3 deaths per 100,000 workers. Injury fatality rates recorded by the U.S. Department of Labor in the Census of Fatal Occupational Injuries (CFOI) declined by 7% from 1992 to 1997.

Losses attributable to occupational illness over time are more difficult to describe. Although efforts have been made to estimate the burden of occupational disease in the United States, no surveillance system describes the magnitude of fatal occupational illnesses other than the pneumoconioses (dust diseases of the lung). These illnesses can be described because they are attributable entirely to occupation. Since 1968, more than 113,000 deaths have occurred with pneumoconiosis diagnosed as the underlying or contributing cause—mostly coal workers' pneumoconiosis (CWP). Deaths with CWP have decreased in recent years, whereas deaths with asbestosis increased from 1968 to 1996 (from fewer than 100 to nearly 1,200).

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Recent Data

Fatal Occupational Injuries

About 17 workers were fatally injured on the job each day during 1997. Of the 6,238 fatal occupational injuries that year, 42% (2,605) were associated with transportation, excluding incidents that occurred while traveling to or from work. Most motor-vehicle-related fatalities (nearly 1,400) resulted from highway crashes. Homicides were the second leading cause of death, accounting for 14% of the total. The leading causes of death varied by sex, with motor vehicles being the leading cause for men and homicide the leading cause for women. Workers aged 65 and older had the highest rates of occupational injury death. Workplaces with 1 to 10 workers had the highest fatality rate (8.6 deaths per 100,000 workers), and workplaces with 100 or more workers had the lowest fatality rate (2 deaths per 100,000 workers). The highest numbers of fatalities occurred in construction, transportation and public utilities, and agriculture, forestry, and fishing industries. The highest fatality rates occurred in mining, construction, and agriculture, forestry, and fishing. The fatality rate in mining was more than five times the national average for all industries.

Fatal Occupational Illnesses

Deaths from diseases other than the pneumoconioses are difficult to attribute to the workplace for several reasons. For example, many diseases appear the same with or without occupational exposures; and some have latency periods of many years between exposure and disease development. Furthermore, health care professionals may not identify or consider occupational risk factors when making a diagnosis. Statistically elevated death rates for several diseases have been observed in a variety of occupations, but the degree to which these elevated rates can be directly associated with the workplace is not clear. However, these studies help set priorities for intervention and prevention as well as for future investigation. For example, death rates for persons with pneumoconiosis as an underlying or contributing cause varied by occupation and type of pneumoconiosis. Mining machine operators had high mortality rates from CWP and other/unspecified pneumoconiosis, and insulation workers and related occupations had high mortality rates from asbestosis. Various metalworking, plastic processing, and mining occupations had high mortality rates from silicosis, and textile machine operators and repairers had high mortality rates from byssinosis.

Nonfatal Injuries

Approximately 5.7 million injuries were reported in SOII in 1997. Those injuries represent 93% of the 6.1 million injuries and illnesses documented by employer records in the private sector. The nonfatal injury rate declined steadily in the 1990s. Agriculture, construction, manufacturing, and transportation reported rates above the average of 6.6 per 100 full-time workers for all industries. Sprains, strains, and tears accounted for a disproportionately large share of cases with days away from work (nearly 800,000 cases in 1997). Nearly half of those cases involved the back. Overexertion accounted for more than 60% of back injuries.

According to the National Electronic Injury Surveillance System (NEISS), occupational injuries treated in hospital emergency departments numbered 3.6 million in 1998. Rates for those injuries were highest among men and workers under age 25. Lacerations, punctures, sprains and strains, contusions, abrasions, and hematomas accounted for 70% of all injuries treated in emergency departments.

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Nonfatal Illnesses

Nearly 430,000 nonfatal occupational illnesses were recorded in SOII in 1997. About 60% of those illnesses occurred in the manufacturing sector. The illness incidence rate for 1997 was 49.8 cases per 10,000 full-time workers. Illness incidence rates varied by industry, with the highest rate occurring in manufacturing. The rates in private industry increased with establishment size, with the highest rate occurring in establishments employing 1,000 or more workers.

Disorders related to repeated trauma (including carpal tunnel syndrome [CTS], tendinitis, and noise-induced hearing loss) accounted for 64% of the occupational illnesses recorded in SOII in 1997. CTS accounted for more than 29,000 cases with days away from work in 1997. Half of the CTS cases required 25 or more days away from work. Most noise- induced hearing loss cases with days away from work occurred in manufacturing.

Skin diseases or disorders represented 13% (approximately 58,000 cases) of work-related illnesses recorded in SOII in 1997. Dermatitis, a subcategory of skin diseases or disorders, resulted in more than 6,500 cases with time away from work. Half of these cases required 3 or more days away from work.

SOII relies on employer records to identify work-related injuries and illnesses. Illnesses reported to SOII are those most easily and directly related to workplace activity (e.g., contact dermatitis). Diseases that develop over a long period (e.g., cancers) or that have workplace associations that are not immediately obvious are overwhelmingly underrecorded in SOII. Consequently, other approaches and data sources have been developed to track occupational illnesses in a more active way. For example, the Sentinel Event Notification System for Occupational Risks (SENSOR) establishes a variety of simultaneous data sources to increase the chances of identifying a work-related illness in State surveillance systems. The California SENSOR program has specifically targeted surveillance of occupational CTS. Of the CTS cases identified in that program through physician first reports filed with the State compensation system in 1998, 30% occurred in the services industry and 17% occurred in manufacturing. Currently, the Michigan SENSOR program monitors noise-induced hearing loss. Manufacturing accounted for 51% of the noise-induced hearing loss cases reported by clinicians in 1998. Seven States have had active SENSOR programs for silicosis surveillance. From 1993 to 1995, 75% of silicosis cases occurred in manufacturing. In addition, four States have had active SENSOR programs for occupational asthma surveillance. The industry divisions accounting for the most cases from 1993 to 1995 were manufacturing (42%) and services (31%).

Other public and private programs describe toxic exposures, pesticide poisonings, X-rays of working underground coal miners, infections in health care workers, and self-reported respiratory diseases among nonsmokers by industry. For example, the Adult Blood Lead Epidemiology and Surveillance Program (ABLES) monitors elevated blood lead levels (BLLs) in persons aged 16 and older. In 1998, a total of 10,501 adults in 25 States had high BLLs (25 µg/dL or greater).

Conclusions

The data provided in this chartbook indicate encouraging decreases in the frequency of some occupational fatalities, injuries, and illnesses. Surveillance has helped identify new and emerging problems and trends such as occupational musculoskeletal disorders and asthma. Although our ability to monitor these outcomes has improved over time, this chartbook illustrates the continued fragmentation of occupational health surveillance systems as well as the paucity (or even total absence) of data for certain occupational disorders and groups. The data suggest a compelling need to improve, expand, and coordinate occupational safety and health surveillance activities to develop and augment the data needed to guide illness and injury prevention efforts. Working with government and nongovernment partners, NIOSH will continue efforts to enhance occupational health surveillance in the coming years.

Contents

FOREWORD

EXECUTIVE SUMMARY

ABBREVIATIONS

ACKNOWLEDGMENTS

1 INTRODUCTION 
 
  Chartbook Organization and Data Systems
  Demographics
  Overview of Occupational Injuries and Illnesses
       The Burden of Occupational Injuries and Illnesses
           Fatal Injury
           Fatal Illness
           Nonfatal Injury and Illness Combined
       Characteristics of Workers and of Injuries and  Illnesses Involving Days away from Work
           Workers
           Injuries and Illnesses

2 FATAL INJURY

  The Burden of Fatal Occupational Injuries
      Fatal Injuries by Age and Race
      Fatal Injuries by Leading Cause
      Fatal Injuries by Industry and Occupation
      Fatal Injuries by State
      Fatal Injuries by Establishment Size
  Special Topics in Fatal Occupational Injury
      Fatal Injuries among Truck Drivers
      Homicides
      Fatal Falls
      Fire Fighter Fatalities

3 FATAL ILLNESS

   Pneumoconiosis
      Pneumoconiosis Deaths by State
      Pneumoconiosis Deaths by Sex and Race
      Pneumoconiosis Deaths by Occupation
  Malignant Pleural Neoplasm
  Hypersensitivity Pneumonitis
  PMRs for Selected Occupations and Causes of Death

4 NONFATAL INJURY  
   
   Nonfatal Occupational Injuries by Industry and Cases with Lost Workdays
   Characteristics of Injury Cases with Days away from Work
       Sprain, Strain, and Tear Cases with Days away from Work, 1997
       Back, Spine, or Spinal Cord Cases with Days away from Work, 1997
       Bruise and Contusion Cases with Days away from Work, 1997
       Cut and Laceration Cases with Days away from Work, 1997
       Fracture Cases with Days away from Work, 1997
       Heat Burn and Scald Cases with Days away from Work, 1997
       Amputation Cases with Days away from Work, 1997

5 NONFATAL ILLNESS

   Incidence of Occupational Illness in Private Industry
   Repeated Trauma Disorders
         Carpal Tunnel Syndrome
              Cases Recorded by SOII
              Cases Identified by SENSOR
         Tendinitis
   Noise-Induced Hearing Loss
   Skin Diseases or Disorders
   Respiratory Disorders
         Dust Diseases of the Lungs
              Coal Workers' Pneumoconiosis
              Silicosis
         Respiratory Disorders Attributable to Toxic Agents
         Asthma and Chronic Obstructive Pulmonary Disease
              NHANES III
              SENSOR
   Poisoning and Toxicity
         Poisoning
         Lead Toxicity
         Pesticide and Insecticide Toxicity
   Infections in Health Care Workers
         Consequences of Bloodborne Exposures
              Hepatitis B Virus
              Hepatitis C Virus
              Human Immunodeficiency Virus
         Tuberculosis (TB)
   Physical Agents
   Anxiety, Stress, and Neurotic Disorders
   All Other Nonfatal Occupational Illnesses

6 FOCUS ON MINING

   Fatal Injuries
         Historical Perspective
         Fatal Injuries during 1988–1997
   Lost-Workday Injuries

REFERENCES

APPENDIX A: SURVEILLANCE SYSTEM DESCRIPTIONS

   Overview
   Bureau of Labor Statistics (BLS) of the U.S. Department of Labor
         Current Population Survey (CPS)
         Survey of Occupational Injuries and Illnesses (SOII)
         Census of Fatal Occupational Injuries (CFOI)
   Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services
         National Institute for Occupational Safety and Health (NIOSH)
               National Electronic Injury Surveillance System (NEISS)
               National Occupational Mortality Surveillance System (NOMS)
               National Surveillance System for Pneumoconiosis Mortality (NSSPM)
               Coal Workers' X-Ray Surveillance Program (CWXSP)
               National Traumatic Occupational Fatalities Surveillance System (NTOF)
               Sentinel Event Notification System for Occupational Risk (SENSOR)
               Adult Blood Lead Epidemiology and Surveillance Program (ABLES)
               Mining Injury and Employment Statistics 
         National Center for Health Statistics (NCHS)
               National Hospital Ambulatory Medical Care Survey (NHAMCS)
               National Health and Nutrition Examination Survey (NHANES)
               Multiple-Cause-of-Death Data
         National Center for Infectious Diseases (NCID)
               National Surveillance System for Hospital Health Care Workers (NaSH)
               Sentinel Counties Study of Acute Viral Hepatitis
               Viral Hepatitis Surveillance Program (VHSP)
         National Center for HIV, STD, and TB Prevention (NCHSTP)
               Surveillance of Health Care Workers with HIV/AIDS
               Surveillance for Tuberculosis Infection in Health Care Workers (staffTRAK–TB )
   References Cited 
   Bibliography

APPENDIX B: DESCRIPTION OF INDUSTRY AND OCCUPATION CODING SYSTEMS

   Overview
   North American Industry Classification System/Standard Industrial Classification (NAICS/SIC)
   Standard Occupational Classification (SOC)
   Bureau of the Census
   References Cited

GLOSSARY

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Ordering Information

To receive documents or more information about occupational safety
and health topics, contact the National Institute for Occupational
Safety and Health (NIOSH) at

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4676 Columbia Parkway
Cincinnati, OH 45226-1998

Telephone: 1-800-35-NIOSH (1-800-356-4674)
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