Occupational Health: The Facts

Occupational Health: The Facts

Introduction

The approximately 110 million workers in this country are exposed to a wide variety of occupational hazards that can pose significant risks to their health. The National Institute for Occupational Safety and Health (NIOSH) developed the following list of the 10 leading work-related diseases or injuries based on frequency of occurrence, severity to the individual and amenability to prevention:

  1. Occupational lung diseases: asbestosis, byssinosis, silicosis, coal workers pneumoconiosis, lung cancer, occupational asthma;
  2. Musculoskeletal injuries;
  3. Occupational cancers (other than lung): leukemia, mesothelioma, cancers of the bladder, nose and liver;
  4. Severe occupational traumatic injuries: amputations, fractures, eye loss, lacerations, and traumatic deaths;
  5. Cardiovascular diseases: hypertension, coronary artery disease, acute myocardial infarction;
  6. Disorders of reproduction: infertility, spontaneous abortion, teratogenesis;
  7. Neurotoxic disorders: peripheral neuropathy, toxic encephalitis, psychoses, extreme personality changes (exposure-related);
  8. Noise-induced loss of hearing;
  9. Dermatologic conditions: dermatoses, burns and scaldings, chemical burns, contusions and abrasions;
  10. Psychologic disorders: neuroses, personality disorders, alcoholism and drug dependency.

Prevalence

Occupational Injuries

NIOSH estimates that each year at least 10 million persons suffer traumatic injuries on the job, including 3 million severe injuries and 10,000 fatalities.

In 1984, 5.3 million occupational injuries were reported to the Bureau of Labor Statistics, yielding a job-related injury rate of 7.8 per 100 full-time workers.

Workplaces with 100 to 249 employees recorded the highest injury rate of 11.1 injuries per 100 workers, compared to the rate of 5.4 for establishments with more than 2,500 workers, or the rate of 3.6 for establishments with less than 20 workers.

A Bureau of Labor Statistics study showed that in 1977, 60% of work-related injuries occurred to workers under age 35.

Throughout all industries, injury rates for men and for women performing the same job are not significantly different according to a Bureau of Labor Statistics study.

The National Safety Council estimated that in 1984, 1.9 million disabling work injuries (requiring absence from work for 1 or more days) occurred. It is estimated that 70,000 of those injuries resulted in some permanent impairment.

The most frequently injured body part according to the above-mentioned National Safety Council study was the trunk with 32% of disabling injuries, followed by fingers, 14%; legs, 13%; arms, 9%; head (except eyes), 6%; eyes, 5%; hands, 5%; feet, 4%; toes, 2%; and general, 10%.

The Bureau of Labor Statistics reported that approximately 1 million workers sustained back injuries in 1980. In 1983, back injuries accounted for 23.0% of all worker disability cases. Back problems alone cost American industries an estimated $14 billion per year.

An estimated 21,000 workers suffered amputations in 1982. 93% of these amputations were of fingers and 4% were of hands and toes. Machine operators had the largest proportion of occupational amputations (8%).

An estimated 400,000 work-related fractures occurred in 1982. Fractures occurred most frequently among truck drivers (5%), miscellaneous laborers (4%) and construction laborers (3%).

An estimated 2.25 million work-related lacerations occurred in 1982, representing 24% of all job-related injuries treated in hospital emergency rooms.

Occupational injuries occur at a rate (as measured per million exposure hours) twice that of injuries in the home or in public places.

Workers in the following occupational categories filed the most claims for workers'' compensation in 1983: (1) truck drivers, 4.1%; (2) miscellaneous laborers, 2.9%; (3) miscellaneous operatives, 2.8%; (4) miscellaneous machinists, 2.7%; and (5) construction laborers, 2.7%.

According to the National Safety Council, in 1984, occupational injuries cost the nation an estimated $33.0 billion, or $320 per worker, and resulted in 80 million lost workdays.

Occupational Illnesses

In 1984,124,900 occupational illnesses were recorded by the Bureau of Labor statistics. Skin diseases accounted for the highest proportion with 42,600 cases (or 34.1%), followed by disorders due to repeated trauma with 34,700 cases (or 27.8%). Other causes of occupational illness included respiratory conditions from exposure to toxic agents: 8.6%; disorders due to physical agents: 7.3%; poisoning: 3.7%; dust diseases of the lungs: 1.4%; and all other occupational illnesses: 17.2%.

In 1984, occupational illnesses and injuries resulted in 63.4 lost workdays for every 100 full-time workers. However, numbers of workdays lost per 100 workers were much higher among miners (160.2) and construction workers (128.1), than among workers in finance, insurance and real estate (13.6).

The 78,983,800 private sector employees working in 1984 lost 1,061,900 workdays to job-related illnesses, and 41,921,900 work-days to job-related injuries.

Asbestosis

According to NIOSH, 2.75 million Americans may have been exposed to asbestos between 1940 and 1979. By 1981, 8,200 asbestos cancer deaths had been reported.

Of the 2.75 million workers exposed to asbestos from 1940-1979, 27.3% worked in construction trades, 23.3% in automobile maintenance, 15.6% in ship building and 33.8% in other industries.

Longitudinal studies of groups of asbestos insulation workers and shipyard workers have revealed that 10%-18% may be expected to die of asbestosis.

Byssinosis

A 1977 congressional report estimated that 560,000 workers were exposed to cotton dust, which will cause an expected 83,600 cases of byssinosis.

An estimated 35,000 current and retired textile workers have been disabled by severely impaired lung function as a result of byssinosis.

Coal Workers'' Pneumoconiosis

An estimated 4.5% of currently employed coal miners have coal workers'' pneumoconiosis (CWP) or black lung disease. Approximately 0.2% of coal workers have been diagnosed as having progressive massive fibrosis, the most severe form of CWP. About 4,000 deaths each year are attributed to CWP.

The underground mine labor force was estimated at 150,000 in 1980. The Coal Workers'' Health Surveillance Program has shown that as many as 29% of miners with 35 years of experience have X-ray evidence of black lung disease.

Silicosis

Of the estimated 1 million workers exposed to silica in mines, foundries, abrasive blasting operations, and stone, clay and glass manufacturing industries, nearly 60,000 may be expected to suffer some degree of silicosis.

Cancer

NIOSH estimated in 1978 that 3 million to 9 million workers were exposed to agents recommended by NIOSH for control as carcinogens.

288 chemicals, industrial processes and complex mixtures are known to be carcinogenic in animals. 30 chemicals or chemical mixtures and 9 industrial processes have been shown to be carcinogenic in humans. An additional 63 chemicals or mixtures of chemicals and 5 industrial processes are classified as probably carcinogenic in humans.

Estimates of the proportion of all cancers in the U.S. related to occupational exposures range from less than 4% to over 20%. The lower estimate attributes 17,000 cancer deaths per year to exposures at the workplace.

Up to 11% of workers exposed to asbestos may ultimately develop mesothelial tumors. In one group of workers distilling beta-morphylarn-ine who had more than 5 years of exposure, all reportedly developed tumors of the bladder.

Although the single most important cause of lung cancer is tobacco smoke, numerous occupational agents are also associated with lung cancer, including arsenic, asbestos, chloroethers, chromates, ionizing radiation, nickel and polynuclear aromatic hydrocarbons. Tobacco smoke interacts synergistically with some agents (e.g., asbestos) to increase the risk. As many as 6,000 asbestos-related lung cancers may occur annually.

Cardiovascular Disease

The NIOSH Registry of Toxic Effects of Chemical Substances identified 1,466 chemicals with possible cardiotoxic effects.

According to an updated analysis of the Framingham heart study in 1980, women employed in clerical jobs had rates of coronary heart disease that were nearly two times the rate among housewives.

Reproductive Disorders

At least 50 chemicals in widespread use in industry have been shown to impair reproductive function in animals. These chemicals include heavy metals such as lead and cadmium, glycol ethers, organhalide pesticides and organic solvents.

Studies of occupational reproductive hazards have shown increased rates of spontaneous abortions among laboratory and chemical workers and among workers exposed to lead, ethylene oxide, and anesthetic gases.

Neurotoxic Disorders

It is estimated that 7.7 million workers are exposed to one or more of the over 850 potentially neurotoxic chemicals found in the workplace.

Psychologic Disorders

An estimated 8-10% of the workforce is suffering disabling emotional or physiologic ill health.

Stress-related symptoms contribute to absenteeism, lost productivity, and company health care expenses at an estimated cost of $50 to $75 billion annually.

Dermatologic Conditions

Occupational skin disorders may affect as many as 1.5 million workers annually. Skin disorders are the most common occupational illness reported to the Bureau of Labor Statistics, accounting for 34.1% of all reported occupational illnesses.

Noise-Induced Hearing Loss

The Occupational Safety and Health Administration (OSHA) reported that 9,400,000 U.S. production workers either now work or have worked in industrial locations with noise-exposure levels of 80 decibels (dB) or higher. As a result of their occupational exposure, 17% of these workers have mild hearing loss, (hearing threshold higher than 15 dB at 1,000-3,000 Hz), 11% have material hearing impairment (hearing threshold higher than 25 dB) and 5% have moderate to severe hearing impairment (threshold higher than 40 dB).

An estimated $835 million will be paid in workers'' compensation claims for occupational hearing impairment for the 10-year period 1978-1987.

Occupational Mortality

The National Safety Council estimates 11,500 occupational fatalities in 1984 based on data compiled from the National Center for Health Statistics, State Vital Statistic Departments and State Industrial Commissions.

The Bureau of Labor Statistics estimates that in 1984 there were 3,740 work-related deaths in private industry establishments of 11 or more employees. The work-related fatality rate was 6.4 per 100,000 full-time workers.

The construction industry, employing 5% of the total U.S. workforce, accounted for 18% of the fatalities; transportation/public utilities, with 7% of the total U.S. workforce, accounted for 20% of the fatalities; mining, with 1% of the workforce, accounted for 10% of the fatalities; and agriculture, with 1% of the total U.S. workforce, accounted for 3% of the fatalities.

Causes of job-related mortality among all private sector industries for 1983 and 1984 included: highway vehicles, 27% of all occupational deaths; heart attacks, 12%; industrial vehicles or equipment, 11%; falls, 11%; electrocutions, 10%; accidents involving objects other than vehicles or equipment, 8%; assaults, 4%; explosions, 4%; aircraft crashes, 3%; gas inhalation, 3%; plant machinery operations, 2%; fires, 1%; and all others, 4%.

A Bureau of Labor Statistics study shows that in 1983-84, highway vehicles were listed as the leading cause of death for every industry, except for construction (in which falls were the leading cause of death) and mining (in which industrial vehicles or equipment were the leading cause of death).

National Safety Council data for the years 1971-1982 show that occupational fatalities occurred at a rate almost twice that of home injury fatalities.

Public Awareness Data

In a 1985 National Health Interview Survey (NHIS), 36% of workers stated their present job exposed them to substances (e.g., chemicals, dusts, fumes or gases) that could endanger their health.

37% of workers in NHIS survey responded that their jobs exposed them to work conditions (e.g., loud noise, extreme heat or cold, physical or mental stress or radiation) that could endanger their health.

41% of workers in the same 1985 survey stated their job exposed them to risks of accidents or injuries.

A 1984 survey of chemical workers revealed that 60.8% of respondents reported little or no co-worker knowledge about cancer hazards at the worksite, and 37.0% reported little or no co-worker overall knowledge of occupational health and safety.

The same survey indicated that the proportion of respondents who felt co-workers sometimes, rarely or never adhere to recommended or required safety behaviors for respirators was 41.9%; for safety glasses; 16.8%; and for protective clothing, 34.2%.

In the same survey, the following percentages of respondents felt that personal protective equipment at the worksite was not adequate: 25.2%, respirators; 9.1%, protective glasses; 10.6%, gloves; 18.3%, protective clothing; and 20.4%, emergency eyewash/showers.

Service Delivery

Workers'' compensation claims for 1982 resulted in $11.325 billion being paid out for income benefits and $4.820 billion for medical costs, according to the Social Security Administration.

The National Safety Council estimates that work accident costs totaled $33.0 billion in 1984, including $15.4 billion in direct costs (wage loss, medical expense, insurance and administrative costs), $15.4 billion in indirect costs (money value of time lost by workers and costs of investigating accidents) and $2.2 billion in fire costs. Each worker in the U.S. must produce $320 of goods or services annually to offset this cost of work injuries.

Participation of working miners in the Coal Workers'' Health Surveillance Program steadily decreased from 50% in 1970-73 to 32% in 1978-81.

Significant Trends

Occupational Injuries

The total number of occupational injuries increased 11.7% in 1984, although worksite hours rose by only 6.6%. This represents the largest single-year increase in occupational injuries since passage of the Occupational Safety and Health Act of 1970.

Occupational Illnesses

The 124,800 occupational illnesses reported by the Bureau of Labor Statistics in 1984 represents a 37.7% reduction from the 200,400 occupational illnesses reported in 1974. However, since the all-time low of 105,600 occupational illnesses recorded in 1982, there have been 2 years of increases in occupational illnesses.

Special Issues

Workforce Aging

By 1995, the population of people 35 years of age and older will exceed those under 35 years of age.