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Occupational Health Indicators
Guide to navigating this document: The 20 Occupational Health Indicators (OHI) are listed below. Each section includes a brief definition of the specific measures* of that OHI, the source(s) of the data used to calculate the indicator measures, a description of the public health significance of that indicator, and links to the data tables and figures. The tables and figures show OHI results by state and, when available, the U.S., from 2000 to 2010. Technical notes are included to explain important data issues involved in generating the indicators. *Some OHIs include more than one measure, for example, the pneumoconiosis OHI includes measures for specific kinds of pneumoconiosis including asbestosis and silicosis.
Indicators which are NOT conducive to state-to-state or state-national comparisons using Workers’ Compensation or Hospital Discharge Data:
  • Indicator # 2: Work-related hospitalizations
  • Indicator # 5: Amputations identified in state workers’ compensation systems
  • Indicator # 6: Hospitalizations for work-related burns
  • Indicator # 8: Carpal tunnel syndrome cases identified in state workers’ compensation systems
  • Indicator # 9: Pneumoconiosis hospitalizations
  • Indicator # 19: Workers’ compensation awards
  • Indicator # 20: Hospitalizations for low-back disorders
Please include the following note with presentation of these data: Workers’ compensation eligibility criteria and availability of data from workers’ compensation programs varies among states, prohibiting state-level data from being directly compared to other states or with national estimates.
Indicators which are NOT conducive to state-to-state or state-national comparisons using Survey of Occupational Injuries and Illnesses data:
  • Indicator #1: Non-fatal work related injuries and illnesses reported by employers
  • Indicator #4: Work-related amputations with days away from work reported by employers
  • Indicator #7: Work-related musculoskeletal disorders with days away from work reported by
    employers
Please include the following note with presentation of these data: Difference in industry concentration and sample size prohibit state-level data from being directly compared to other states or with national estimates.
 
Employment Demographics Profile
Data source(s)
Public health significance

As the United States moves into the twenty-first century, its workforce is more diverse than ever. This diversity in age, race, sex, ethnicity, and levels of employment in certain industries and occupations varies from state to state. State-to-state differences are important to consider because these workforce characteristics can impact rates of work -related injury and illness may explain some variability in injury and illness rates between states. The data within this section illustrate employment demographics from each of the participating states. This includes the percentage of workers by age, sex, race, Hispanic ethnicity, self-employment, part-time workers, hours worked per week, industry, and occupation.


Indicator 1: Non-Fatal Injuries and Illnesses Reported by Employers
Brief definition of measures
  • Estimated annual number and rate of work-related injuries and illnesses among private sector workers
  • Estimated annual number and rate of work-related injuries and illnesses involving days away from work
  • Estimated annual number of injuries and illnesses involving more than 10 days away from work
Data source(s)
Public health significance

Work-related injuries are generally defined as injuries that result from single events such as falls, being struck or crushed by objects, electric shocks, or assaults. Work-related illnesses, such as asthma, silicosis and carpal tunnel syndrome, typically occur as the result of longer-term exposure to hazardous chemicals, physical hazards (e.g., radiation, noise), or repeated stress or strain at work. Infectious diseases also can be caused by workplace exposures. It is more difficult to track work-related illnesses than injuries because many of the conditions also can be caused by non-occupational factors. Also, many work-related illnesses take a long time to develop and may not appear until many years after the individuals have left employment.

The Bureau of Labor Statistics’ (BLS) Annual Survey of Occupational Injuries and Illnesses (Annual Survey) provides yearly estimates of the numbers and incidence rates of work-related injuries and illnesses at national and state levels. Information is collected from a nationwide sample of employers on all work-related injuries and illnesses that result in death, lost work-time, medical treatment other than first aid, loss of consciousness, restriction of work activity, or transfer to another job.

While the Annual Survey is a valuable source of information about work-related injuries and illnesses, it is well recognized that it has a number of limitations and underestimates the full extent of the burden. Excluded from the national estimates provided by the Annual Survey are public sector workers, the self-employed, household workers, and workers on farms with fewer than 11 employees. Together these sectors comprise approximately 21% of the U.S. workforce.1 Occupational diseases are not well documented in the Annual Survey and there is evidence that injuries are underreported2,3. It is also subject to sampling error. Additional data sources used in generating other occupational health indicators in this report provide important supplementary information that, together with the Annual Survey, creates a more complete picture of occupational health in the states.

1 Leigh JP et al. An estimate of the US government’s undercount of nonfatal occupational injuries. J Occup and Environ. Med. 2004; 46 (No. 1)
2 Conway H, Svenson J. Occupational injury and illness rates,1992-1996: why they fell. Mon Labor Rev.1998; 121(11)36-58.
3 Azaroff LS, Levenstein C, Wegman DH. Occupational Injury and Illness Surveillance: Conceptual Filters Explain Underreporting. AJPH. 2002;92(9):1421-1429.


Indicator 2: Work-Related Hospitalizations
Brief definition of measures
  • Annual number and rate of hospitalizations of state residents 16 years or older with workers’ compensation reported as the primary payer
Data source(s)
Public health significance

Individuals hospitalized for work-related injuries and illnesses have some of the most serious and costly adverse work-related health conditions. It has been estimated that, nationwide, approximately 3% of workplace injuries and illnesses result in hospitalizations, and that hospital charges for work-related conditions exceed $3 billion annually. Most identified work-related hospitalizations are for treatment of musculoskeletal disorders and acute injuries.1

State hospital discharge data are useful for surveillance of serious health conditions. While these state data sets do not include explicit information about "work-relatedness” of the health conditions for which a patient is hospitalized, they do include information about the payer for the hospital stay. The designation of workers' compensation as primary payer is a good proxy for the work-relatedness of hospitalized injuries.2 It is not a sensitive measure of work-related illness.

1 Dembe AE, Mastroberti MA, Fox SE, Bigelow C, Banks SM. Inpatient hospital care for work-related injuries and illnesses. Am J Ind Med 2003; 44:331-342.
2Sorock GS, Smith E, Hall N. An evaluation of New Jersey's hospital discharge database for surveillance of severe occupational injuries. Am J Ind Med 1993; 23:427-437.


Indicator 3: Fatal Work-Related Injuries
Brief definition of measures
  • Annual number of fatal work-related injuries
  • Annual rate of fatal work-related injuries among persons 16 years or older
Data source(s)
Public health significance

A fatal work-related injury is an injury occurring at work that results in death. Since 1992 the Bureau of Labor Statistics (BLS) has conducted the Census of Fatal Occupational Injuries (CFOI), using multiple data sources to provide complete counts of all fatal work-related injuries in the nation and in every state. CFOI includes fatalities resulting from non-intentional injuries such as falls, electrocutions, and acute poisonings as well as from motor vehicle crashes that occurred during travel for work. Also included are intentional injuries (i.e., homicides and suicides) that occurred at work. Fatalities that occur during a person’s commute to or from work are not counted.

During the last ten years, on average, more than 5,800 workers died as a result of fatal work-related injuries each year in the U.S. – more than 16 workers per day. Overall, the fatal occupational injury rate declined from 4.8 deaths per 100,000 workers in 1996 to 4.0 deaths per 100,000 workers in 2005.
1992-2004 rate change data


Indicator 4: Amputations Reported by Employers
Brief definition of measures
  • Estimated annual number and rate of work-related amputations involving days away from work among private sector workers
Data source(s)
Public health significance

An amputation is defined as full or partial loss of a protruding body part – an arm, hand, finger, leg, foot, toe, ear, or nose. An amputation may greatly reduce a worker’s job skills and earning potential as well as significantly affect general quality of life.

The Bureau of Labor Statistics’ (BLS) Annual Survey of Occupational Injuries and Illnesses (Annual Survey) provides yearly state and national estimates of the numbers and incidence rates of work-related amputations that involve at least one day away from work.
The Annual Survey is based on data collected from a nationwide sample of employers. While it is a valuable source of information about work-related injuries, it has a number of limitations. Excluded from the estimates are public sector workers, the self-employed, household workers, and workers on farms with fewer than 11 employees. Together these sectors comprise approximately 21% of the U.S. workforce.1 In addition, there is evidence that injuries are underreported on the Occupational Safety and Health Administration (OSHA) logs that serve as the basis for the Annual Survey.2,3 The Annual Survey is also subject to sampling error. State workers’ compensation data used in Indicator 5 in this report are another source of information about work-related amputations in the states.

1 Leigh JP et al. An estimate of the US government’s undercount of nonfatal occupational injuries. J Occup and Environ. Med. 2004; 46 (No. 1)
2 Conway H, Svenson J. Occupational injury and illness rates,1992-1996: why they fell. Mon Labor Rev.1998; 121(11)36-58.
3 Azaroff LS, Levenstein C, Wegman DH. Occupational Injury and Illness Surveillance: Conceptual Filters Explain Underreporting. AJPH. 2002;92(9):1421-1429.


Indicator 5: Amputations Identified in State Workers’ Compensation Systems
Brief definition of measures
  • Annual number and rate of amputations identified in state workers’ compensation systems
Data source(s)
Public health significance

An amputation is defined as full or partial loss of a protruding body part – an arm, hand, finger, leg, foot, toe, nose, or ear. An amputation may greatly reduce a worker’s job skills and earning potential as well as significantly affect general quality of life.

Claims data from state workers' compensation systems were used as the data source for this occupational health indicator (OHI). Most state systems capture all claims filed while others include only claims that have been reviewed and accepted. There are also substantial differences among states in workers’ compensation claim coding systems, criteria for claim eligibility, reimbursement, and other administrative regulations (see Technical Notes). Therefore, differences among states in work-related amputations as defined in this OHI reflect variations in both workers’ compensation systems and amputation incidence. For this reason, this OHI should be used to monitor within-state trends in work-related amputations rather than to compare data/trends between states.

Cases were limited to amputations identified through "lost-time” claims. These are claims for which workers missed sufficient time from work to qualify for benefits to compensate for lost wages and/or functional impairments for time loss.


Indicator 6: Hospitalizations for Work-Related Burns
Brief definition of measures
  • Annual number and rate of hospitalized state residents 16 years or older with principal diagnosis of burn and primary payer coded as workers’ compensation
Data source(s)
Public health significance

Burns encompass injuries to tissues caused by contact with dry heat (fire), moist heat (steam), chemicals, electricity, friction, or radiation. Burns are among the most expensive work-related injuries to treat and can result in significant disability. Thermal and chemical burns are the most frequent types of work-related burn injury. A substantial proportion of burns occur in the service industry, especially in food service, often disproportionately affecting working adolescents. 1,2

Nationally, it has been estimated that 150,000 people with work-related burns are treated in emergency rooms annually.3 Approximately 30% to 40% of hospitalizations for burns among adults have been found to be work-related.2

The designation of workers' compensation payment as primary payer on hospital discharge records is a good proxy for the work-relatedness of hospitalized injuries.4

There are substantial differences among states in workers’ compensation eligibility, reimbursement, and other administrative policies. Therefore, differences among states in work-related burns as defined in this occupational health indicator (OHI) reflect variations in both workers’ compensation systems and work-related burn incidence. For this reason, this OHI should be used to monitor within-state trends in work-related hospitalized burns rather than to compare data/trends between states.

1Centers for Disease Control and Prevention. Occupational burns among restaurant workers – Colorado and Minnesota. MMWR. 1993; 42:713-716.
2Baggs J, Curwick C, Silverstein B. Work-related burns in Washington State, 1994-1998. J Occup Environ Med. 2002; 44:692-9.
3Rossignol AM, Locke JA, Burke JF. Employment status and the frequency and causes of burn injuries in New England. J Occup Med. 1989; 31:751-757.
4 Sorock GS, Smith E, Hall N. An evaluation of New Jersey's hospital discharge database for surveillance of severe occupational injuries. Am J Ind Med. 1993; 23:427-437.


Indicator 7: Musculoskeletal Disorders Reported by Employers
Brief definition of measures
  • Estimated annual number and rate of musculoskeletal disorders (MSDs) involving days away from work among private sector workers
  • Estimated annual number and rate of MSDs of the back involving days away from work among private sector workers
  • Estimated annual number and rate of MSDs of the upper extremities, neck, and shoulder involving days away from work among private sector workers
  • Estimated annual number and rate of carpal tunnel syndrome cases involving days away from work among private sector workers
Data source(s)
Public health significance

Work-related musculoskeletal disorders (MSDs) are injuries or disorders of muscles, tendons, nerves, ligaments, joints, or spinal discs that are caused or aggravated by work activities. Workplace risk factors for MSDs include repetitive forceful motions, awkward postures, use of vibrating tools or equipment, and manual handling of heavy, awkward loads. These disorders also can be caused by single, traumatic events such as falls.

This occupational health indicator is based on data collected by the Bureau of Labor Statistics (BLS) in the Annual Survey of Occupational Injuries and Illnesses (Annual Survey). The BLS definition of MSDs includes sprains, strains, pain, hurt back, carpal tunnel syndrome, and hernia in which the event leading to the condition is reported as overexertion, repetitive motion, or bending, reaching, or twisting. BLS excludes MSDs reportedly caused by single events such as slips and falls, and motor vehicle crashes.

MSDs are some of the most common and costly work-related health problems. These injuries can significantly impact the ability of workers to perform their jobs and affect quality of life both on and off the job. According to the Annual Survey, MSDs have consistently accounted for over one-third of all work-related injuries and illnesses involving days away from work reported by employers over the last decade.1 Direct workers’ compensation costs of work-related MSDs have been estimated at $20 billion annually in the U.S., and total costs of these injuries when including indirect costs, such as lost productivity, range as high as $54 billion.2

The Annual Survey is based on data collected from a nationwide sample of employers. While it is a valuable source of information about work-related injuries, it has a number of limitations. Excluded from these estimates are public sector workers, the self-employed, household workers and workers on farms with fewer than 11 employees. Together these sectors comprise approximately 21% of the U.S. workforce.3 In addition, there is evidence that MSDs are under-recorded on the Occupational Safety and Health Administration (OSHA) logs that serve as the basis for the Annual Survey.4,5 The Annual Survey is also subject to sampling error. Workers’ compensation data used in Indicator 8 in this report provide additional information about one type of MSD—carpel tunnel syndrome—in the states.

1 National Institute for Occupational Safety and Health. Worker Health Chartbook, 2004. Cincinnati OH: U.S. Department of Health and Human Services, Center for Disease Control and Prevention, DHHS (NIOSH) Publication No. 2004-146. 2004. Available: http://www.cdc.gov/niosh/docs/chartbook/pdfs/2004-146.pdf
2 Institute of Medicine and National Research Council, Musculoskeletal Disorders and the Workplace; Low back and Upper Extremities. National Academy Press, Washington, D.C. 2001, page 58.
3 Leigh JP et al. An estimate of the US governments’s undercount of nonfatal occupational injuries. J Occup and Environ. Med. 2004; 46 (No. 1)
4 Conway H, Svenson J. Occupational injury and illness rates,1992-1996: why they fell. Mon Labor Rev.1998; 121(11)36-58.
5 Azaroff LS, Levenstein C, Wegman DH. Occupational Injury and Illness Surveillance: Conceptual Filters Explain Underreporting. AJPH. 2002; 92(9):1421-1429.


Indicator 8: Carpal Tunnel Syndrome Cases Identified in State Workers’ Compensation Systems
Brief definition of measures
  • Annual number and rate of carpal tunnel syndrome cases identified in state workers' compensation systems
Data source(s)
Public health significance

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist. Symptoms range from a burning, tingling, or numbness in the fingers to difficulty gripping or holding objects. Workplace factors that may cause or aggravate CTS include direct trauma, repetitive forceful motions or awkward postures of the hands, and use of vibrating tools or equipment.1 CTS has the longest average disability duration among the top ten workers’ compensation conditions in the United States.2

Claims data from state workers’ compensation systems were used as the data source for this occupational health indicator (OHI). Most state systems capture all claims filed while others include only claims that have been reviewed and accepted There are also substantial differences among states in workers’ compensation claim coding systems, criteria for claim eligibility, reimbursement, and other administrative regulations (see Technical notes). Therefore, differences among states in work-related carpal tunnel syndrome as defined in this OHI reflect variations in both workers’ compensation systems and CTS incidence. For this reason, this OHI should be used to monitor trends in work-related carpal tunnel syndrome within states over time rather than to compare data/trends between states.

Cases were limited to those identified through "lost-time” claims. These are claims for which workers missed sufficient time from work to qualify for benefits to compensate for lost wages and/or functional impairments for time loss.


Indicator 9: Pneumoconiosis Hospitalizations
Brief definition of measures
  • Annual number and rate of hospitalizations with pneumoconiosis as a principal or secondary discharge diagnosis
Data source(s)
Public health significance

Pneumoconiosis is a term for a class of non-malignant lung diseases caused by the inhalation of mineral dust, nearly always in occupational settings. Most cases of pneumoconiosis develop only after many years of cumulative exposure; thus they are usually diagnosed in older individuals, often long after the onset of exposure. These diseases are incurable and may ultimately result in death.1

Pneumoconiosis includes: silicosis, asbestosis, coal workers’ pneumoconiosis (CWP), and, less commonly, pneumoconiosis due to a variety of other mineral dusts, including talc, aluminum, bauxite, and graphite. Byssinosis and several other dust-related lung diseases are sometimes grouped with "pneumoconiosis," even though they are caused by occupational exposure to organic (e.g., cotton) dust. Individuals with certain kinds of pneumoconiosis are at increased risk of other diseases, including cancer, tuberculosis, autoimmune conditions, and chronic renal failure.

State-based hospital discharge data are a useful population-based surveillance data source for quantifying pneumoconiosis even though only a small number of individuals with pneumoconiosis are hospitalized for that condition.
It is widely recognized that pneumoconiosis and other long latency diseases are very poorly documented in the Bureau of Labor Statistics’ Annual Survey (Annual Survey). Thus, hospital discharge data are an important source for quantifying the burden of pneumoconiosis, even though they capture only hospitalized cases.
1 Christiani DC, Wegman DH. Respiratory disorders, In: Occupational Health: Recognizing and Preventing Work-Related Disease (3rd ed.) Levy BS, Wegman DH (eds.) Little, Brown, 1995:427-454.


Indicator 10: Pneumoconiosis Mortality
Brief definition of measures
  • Annual number and rate of deaths with pneumoconiosis as the underlying or contributing cause of death
Data source(s)
Public health significance

Pneumoconiosis is a term for a class of non-malignant lung diseases caused by the inhalation of mineral dust, nearly always in occupational settings. Most cases of pneumoconiosis develop only after many years of cumulative exposure; thus they are often diagnosed in older individuals, long after the onset of exposure. These diseases are incurable and may ultimately result in death.1

Pneumoconiosis includes: silicosis, asbestosis, coal workers’ pneumoconiosis (CWP), and, less commonly, pneumoconiosis due to a variety of other mineral dusts, including talc, aluminum, bauxite, and graphite. Byssinosis is sometimes grouped with "pneumoconiosis," even though byssinosis is caused by occupational exposure to organic (e.g., cotton) dust. Individuals with certain kinds of pneumoconiosis are at increased risk of other diseases, including cancer, tuberculosis, autoimmune conditions, and chronic renal failure.

All states collect cause-of-death information on death certificates, including both the underlying and contributing causes of death. From 1990 through 1999, pneumoconiosis was an underlying or contributing cause of more than 30,000 deaths in the United States, for an overall age-adjusted annual mortality rate of 15.8 per million population among those age 15 and older. Pneumoconiosis was the underlying cause of death in approximately one-third of these deaths.2 Mortality from most kinds of pneumoconiosis has gradually declined over the past three decades with the exception of asbestosis, which has increased more than tenfold.

Deaths due to pneumoconiosis are undercounted on death certificates.3,4 Pneumoconiosis is likely to be under-recorded on the death certificate as a cause of death because it is under-recognized by clinicians for a number of reasons, including the long latency between exposure and onset of symptoms, and the non-specificity of symptoms. 1Christiani DC, Wegman DH. Respiratory disorders, In Occupational Health:Recognizing and Preventing Work-Related Disease (3rd ed.) Levy BS, Wegman DH (eds.) Little Borwn, 1995:427-454
2National Institute for Occupational Safety and Health. Work-related lung disease surveillance report 2002. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. DHHS (NIOSH) Number 2003-111. 2003.
3 Rosenman KD, Reilly MJ, Henneberger PK. Estimating the total number of newly recognized silicosis cases in the United States. Am J Ind Med. 2003; 44:141-147.
4 Goodwin S., Stanbury M, Wang, M-L, Silbergeld, E, Parker, JE. Previously undetected silicosis in New Jersey decedents. Am J Ind Med. 2003; 44:304-311.


Indicator 11: Acute Work-Related Pesticide Poisonings Reported to Poison Control Centers
Brief definition of measures
  • Annual number and rate of work-related pesticide poisonings reported to state Poison Control Centers
Data source(s)
Public health significance

A pesticide is a substance or mixture of substances used to prevent or control undesired insects, plants, animals, or fungi. In the U.S., approximately one billion pounds of pesticides are used annually, contained in more than 16,000 pesticide products.1 Although the value of pesticides in protecting the food supply and controlling disease vectors is well recognized, it is also recognized that pesticides can cause harm to people and the environment. Adverse health effects from exposure vary depending on the amount and route of exposure and the type of chemical used. Agricultural workers and pesticide applicators are at greatest risk for the more severe pesticide poisonings.

The U.S. Environmental Protection Agency (EPA) estimates that there are 20,000 to 40,000 work-related pesticide poisonings per year.2 National estimates of pesticide poisoning are not available from the Bureau of Labor Statistics. Poison Control Center (PCC) data are useful for monitoring pesticide poisonings nationally because PCCs service almost the entire U.S. population, even though calls to state and regional PCCs are estimated to capture only approximately 10% of acute occupational pesticide-related illness cases.3 A small number of states have active programs for occupational pesticide surveillance; seven of these states documented 1,009 individuals with acute occupational pesticide-related illness (including three deaths) in a two-year period, for an incidence rate of 1.2 per 100,000 full-time workers. 4
1 Calvert GM, Plate DK, Das R, Rosales R, Shafey O, Thomsen C, Males D, Beckman J, Arvizu, E, Lackovic M. Acute occupational pesticide-related illness in the US, 1998-1999: Surveillance findings from the SENSOR-pesticides program. Am J Ind Med. 2004; 45:114-23.
2 Blondell J. Epidemiology of pesticide poisonings in the United States, with special reference to occupational cases. J Occup Med. 1997;12:209-220.
3 Calvert GM, Mehler LN, Rosales R, Baum L, Thomsen C, Male D, Shafey O, Das R, Lackovic M, Arvizu E. Acute pesticide-related illnesses among working youths, 1988-1999. Am J Public Health. 2003; 93:605-610.
4 Blondell J. Epidemiology of pesticide poisonings in the United States, with special reference to occupational cases. J Occup Med. 1997;12:209-220.


Indicator 12: Incidence of Malignant Mesothelioma
Brief definition of measures
  • Annual number and rate of persons 15 years and older newly diagnosed with malignant mesothelioma
Data source(s)
Public health significance

Malignant mesothelioma is a rare but highly fatal cancer of the thin membranes surrounding the chest cavity (pleura) or abdominal cavity (peritoneum). Much less frequently, this tumor affects other anatomical sites (e.g., pericardium). The only well-established risk factor for mesothelioma is exposure to asbestos fibers. Prior asbestos exposure, primarily from exposure in the workplace, has been reported in 62 to 85 percent of all mesothelioma cases.1

Mesothelioma is a disease of long latency, typically with 20-40 years between exposure and onset of disease. The incidence of mesothelioma in the United States has risen steadily since the 1960s, reflecting high levels of asbestos use and occupational exposure to asbestos during World War II through the 1970s. In the 1970s, new Occupational Safety and Health Administration regulations limited workplace exposures and the Environmental Protection Agency began regulating asbestos uses. It has been projected that the mesothelioma incidence rate in the U.S. would begin to decline in 2004.2

Approximately 1.3 million workers continue to be exposed directly or indirectly to asbestos in many industries and activities.3 Environmental exposure to asbestos is also a continuing concern. Asbestos-containing materials are found in hundreds of thousands of schools and public buildings throughout the country, and asbestos continues to be used in many manufactured products.
1 Albin, M, Magnani, C, Krstev, S, Rapiti, E, and Shefer, I. Asbestos and cancer: An overview of current trends in Europe. Environ Health Perspect. 1999; 107(2): 289-298.
2 Price, B and Ware, A. Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003. Am J Epidemiol. 2004;159(2): 107-112.
3 U.S. Department of Labor. Program Highlights; Fact Sheet No. OSHA 92-06, 2004. Available at: www.pp.okstate.edu/ehs/training/oshasbes.htm


Indicator 13: Elevated Blood Lead Levels among Adults
Brief definition of measures
  • Annual numbers and rates (prevalence and incidence) of persons age 16 or older with blood lead levels greater than or equal to 25 micrograms per deciliter (µg/dL) and greater than or equal to 40 µg/dL
Data source(s)
Public health significance

Lead poisoning among adults is primarily due to occupational exposure. Lead adversely affects multiple organ systems and can cause permanent damage. Exposure to lead in adults can cause anemia, nervous system dysfunction, kidney damage, hypertension, decreased fertility, and miscarriage. Workers bringing lead dust home on their clothing can expose their children to lead.

The blood lead level (BLL) is the best biological indicator of recent lead exposure. A BLL of 25 micrograms per deciliter (µg/dL) or greater for adults is considered "elevated," and the Healthy People 2010 goal is to eliminate BLLs above this level.1 The federal Occupational Safety and Health Administration (OSHA) requires that employers regularly monitor the BLLs of workers where airborne lead in the workplace exceeds certain levels. When a worker's BLL is 40 µg/dL or greater, the employer is required to offer an annual medical exam and other medical interventions depending on the BLL. However, adverse health effects have been found with cumulative exposure at BLLs lower than 40 µg/dL2 and 25 µg/dL.3 The average BLL for the general population is less than 2 µg/dL.4
Many states, accounting for more than half of the U.S. population, participate in compiling data on laboratory reports of BLLs(1) in adults for the national Adult Blood Lead Epidemiology and Surveillance (ABLES) program.5,6 Reporting by clinical laboratories is mandatory in these states. ABLES programs are not always able to determine whether reported cases were exposed to lead at work or exposed in a non-occupational setting; several states have determined that occupational exposures account for approximately 90% of all reported cases.

1 U.S. Department of Health and Human Services. Healthy People 2010. 2nd edition. Washington DC. US Government Printing Office. November 2000. Objective 20-7.
2 Rosenman KD, Sims A, Luo Z, Gardiner J. Occurrence of lead-related symptoms below the current Occupational Safety and Health Act allowable blood lead levels. J Occup Environ Med. 2003; 45:546-555
3 Schwartz J. Lead, blood pressure and cardiovascular disease in men. Arch Environ Health. 1995; 50:31-37.
4 Centers for Disease Control and Prevention. Second National Report on Human Exposure to Environmental Chemicals. Atlanta, Ga: U.S Department of Health and Human Services. NCEH Pub. No. 03-0022, Lead CAS No. 7439-92-1. 2003. Available at: http://www.cdc.gov/exposurereport
5 Roscoe RJ, Ball W, Curran JJ, et al. Adult blood lead epidemiology and surveillance -- United States, 1998 - 2001. MMWR December 13, 2002; 51(No. SS11);1-10.
6 CDC. Adult Blood Lead Epidemiology and Surveillance – United States, 2003-2004. MMWR August 18, 2006; 55(32):876-879.


Indicator 14: Workers Employed in Industries with High Risk for Occupational Morbidity
Brief definition of measures
  • Number and percent of workers employed in industries with high risk for occupational morbidity
Data source(s)
Public health significance

Workers in certain industries sustain non-fatal injuries and illnesses at much higher rates than the overall workforce. The proportion of the workforce that is employed in these high-risk industries varies by state. This variation can help explain differences in injury and illness rates among states.

In 1999, the Bureau of Labor Statistics (BLS) estimated that nationally there were 5.7 million injury and illness cases within the private sector, which was equivalent to 6.3 cases per 100 full-time workers. Twenty-five industries had occupational injury and illness rates more than double the national rate.1 Workers in these industries made up 6% of the national private sector workforce, but 17% of the Occupational Safety and Health Administration (OSHA)-reportable injuries and illnesses. These 25 industries comprised the "high-risk” industries for this occupational health indicator (Appendix A). The list of high risk industries was developed based on 1999 BLS data from the Survey of Occupational Injuries and Illness.
1 United States Department of Labor, BLS Bulletin 2551. Occupational Injuries and Illnesses: Counts, Rates, and Characteristics, 1999. September 2002


Indicator 15: Workers Employed in Occupations with High Risk for Occupational Morbidity
Brief definition of measures
  • Number and percent of workers employed in occupations with high risk for occupational morbidity
Data source(s)
Public health significance

Workers in certain occupations sustain non-fatal injuries and illnesses at much higher rates than the overall workforce. The proportion of the workforce that is employed in these high-risk occupations varies by state. This variation can help explain differences in injury and illness rates among states.

In 1999, the Bureau of Labor Statistics (BLS) estimated that nationally there were 1.7 million injury and illness cases within the private sector that resulted in days away from work. This was equivalent to 1.9 cases per 100 full-time workers. Twenty-three occupations had injury and illness rates of more than 5 per 100 full-time workers  more than two-and-a-half times the overall rate. While workers in these occupations made up only 6% of the national private sector workforce, they accounted for 27% of cases with one or more days away from work. These 23 occupations comprised the "high-risk” occupations for this occupational health indicator (Appendix B). The list of high risk occupations was developed based on 1999 BLS data from the Survey of Occupational Injuries and Illness.

1 United States Department of Labor, BLS Bulletin 2551. Occupational Injuries and Illnesses: Counts, Rates, and Characteristics, 1999. September 2002


Indicator 16: Workers Employed in Industries and Occupations with High Risk for Occupational Mortality
Brief definition of measures
  • Number and percent of workers employed in industries and occupations with high risk for occupational mortality due to injuries
Data source(s)
Public health significance

Workers in certain industries and occupations sustain fatal injuries at much higher rates than the overall workforce. The proportion of the workforce that is employed in these high-risk industries and occupations varies by state. This variation can help explain differences in injury mortality rates among states.

In 1998, there were 6,055 work-related injury deaths in the United States, according to the Census of Fatal Occupational Injuries (CFOI), which is administered by the Bureau of Labor Statistics (BLS). This was equivalent to 4.5 deaths per 100,000 workers. Twenty-seven industries had injury fatality rates greater than 10 deaths per 100,000 workers in 1998. Workers in these industries comprised 14% of the private sector workforce, but sustained 58% of the fatal work-related injuries that year. Twenty-four occupations had fatality rates greater than 20 per 100,000. Workers in these occupations made up 6% of the private sector workforce, but sustained 45% of the fatalities. These 27 industries and 24 occupations comprised the "high-risk” groups for this occupational health indicator (Appendix C). The list of high risk industries and occupations was developed based on the 1998 CFOI data.


Indicator 17: Occupational Safety and Health Professionals
Brief definition of measures
  • Estimated number and rate of occupational safety and health professionals
Data source(s)
Public health significance

Occupational safety and health (OSH) professionals share the common goal of identifying hazardous conditions or practices in the workplace and helping employers and workers reduce the risks imposed by such conditions. It is important to assess the availability of such personnel to implement occupational health preventive services in the states. In a 2000 report, the Institute of Medicine estimated that approximately 75,000 to 125,000 Americans are active or eligible members of professional societies representing core OSH disciplines of occupational safety, industrial hygiene, occupational medicine, and occupational health nursing.1 The report concluded that "the continuing burden of largely preventable occupational diseases and injuries and lack of adequate OSH services in most small and many large workplaces indicate a clear need for more OSH professionals at all levels.” Previously, in 1989, the American Medical Association recommended a ratio of one OSH physician per 1,000 employees.

This occupational health indicator provides information about occupational safety and health professionals who are board-certified occupational medicine physicians, members of the American College of Occupational and Environmental Medicine (ACOEM), board-certified occupational health nurses, members of the American Association of Occupational Health Nurses (AAOHN), board-certified industrial hygienists, members of the American Industrial Hygiene Association (AIHA), board-certified safety professionals, and members of the American Society of Safety Engineers (ASSE).

1 Institute of Medicine. Safe Work in the 21st Century: Education and Training Needs for the Next Decade's Occupational Safety and Health Personnel. 2000


Indicator 18: Occupational Safety and Health Administration (OSHA) Enforcement Activities
Brief definition of measures
  • Total number of establishments under Federal/state OSHA jurisdiction
  • Annual number of establishments inspected by Federal/state OSHA
  • Annual number of employees whose work areas were inspected by Federal/state OSHA
  • Percent of establishments under Federal/state OSHA jurisdiction inspected by Federal/state OSHA
  • Percent of employees in establishments under Federal/state OSHA jurisdiction whose work areas were inspected
Data source(s)
Public health significance

The Occupational Safety and Health Act of 1970 was passed by Congress to assure safe and healthy working conditions for every working man and woman in the nation. Under the Act, the United States Department of Labor’s Occupational Safety and Health Administration (OSHA) is authorized to conduct worksite inspections to determine whether employers are complying with health and safety standards issued by the agency. OSHA may issue citations and impose fines on employers if violations are found.

OSHA inspects worksites in response to reports of fatal injuries or incidents resulting in multiple hospitalizations, worker complaints, and referrals from other agencies. OSHA also conducts programmed inspections aimed at specific high-risk industries, occupations or worksites with high injury rates. Federal OSHA jurisdiction includes Federal employment but does not extend to state and municipal government workplaces. However, under the OSHA Act, states may elect to administer their own safety and health programs that are at least as effective as federal OSHA programs. In these "state plan” states, public and private sector worksites are subject to occupational safety and health inspections conducted by state OSHA programs. In 2000, there were 25 states and territories in which OSHA protections extended to public sector workers. Farms with ten or fewer paid employees, while technically under federal OSHA jurisdiction, are exempt from federal OSHA inspections because of a congressional budgetary rider, unless they have a temporary labor camp. They are also exempt from inspections in most "state plan” states; although in California and North Carolina, small farms are not exempt. The mining industry is covered by a separate federal agency – the Mine Safety and Health Administration (MSHA).

Nationwide, almost eight million workplaces are covered by the OSHA Act. Federal OSHA and "state-plan” states have approximately 1,100 and 1,350 inspectors, respectively. Clearly only a small percentage of worksites can be inspected on an annual basis. The possibility of inspection and of subsequent penalties if violations are found is intended as a general deterrent to dissuade employers from violating health and safety standards.1 This occupational health indicator (OHI) provides a measure of the numbers and proportions of workers and worksites potentially benefiting directly from Federal/State OSHA inspection activity.

Federal OSHA and State plans also conduct a range of activities in addition to enforcement. They provide assistance in complying with legally binding standards and voluntary guidelines promulgated by Federal and State OSHA and support educational outreach and programs for employers and employees. In addition, OSHA funds a consultation program delivered by the states. This OHI does not measure these activities. Nor does this OHI measure the quality of OSHA inspections, such as the extent to which the worksite targeting activity has successfully identified workplaces where there are violations of worksite health and safety standards.

1 McQuiston TH, Zakocs RC, Loomis DL . The case for stronger OSHA enforcement – Evidence from evaluation research. Am J Public Health. 1998; 88:7.


Indicator 19: Workers’ Compensation Awards
Brief definition of measures
  • Annual workers’ compensation benefits paid and average amount paid per covered worker
Data source(s)
Public health significance

Workers’ compensation was first implemented in the United States in 1911 in nine states and in subsequent years by all states. This state-based social insurance program was developed to provide guaranteed compensation for workers with work-related injuries or illnesses while limiting the liability exposure of employers. Workers’ compensation provides benefits to partially replace lost wages and pay for medical expenses associated with a work-related injury or illness. In case of a death, the worker’s dependents are eligible for survivor benefits.

While the amount of benefits paid is an indicator of the direct financial cost of work-related injuries and illnesses, it does not reflect their true burden. Indirect costs to the employer and worker are not taken into account. In addition, some workers who are eligible for benefits do not file. Finally, several types of workers may not be covered by state workers’ compensation systems, including the self-employed, corporate executives, domestic and agricultural workers, federal employees, and railroad, long shore, and maritime workers.

There are substantial differences between states in wages and medical costs, in workers’ compensation eligibility, reimbursement, and other administrative regulations governing workers’ compensation. Therefore, differences among states in benefits paid could be due to a variety of factors other than injury and illness incidence. For this reason, this occupational health indicator should be used to monitor trends within states over time rather than to compare states.


Indicator 20: Work-related low back disorder hospitalizations
Brief definition of measures
  • Annual number and rate of work-related low back disorder hospitalizations for state residents age 16 years or older
Data source(s)
Public health significance

Each year 15-20% of Americans report back pain, resulting in over 100 million workdays lost and more than 10 million physician visits. National Health Interview survey data estimates that two-thirds of all low back pain cases are attributable to occupational activities. The cost of back pain is also disproportionate, as it represents about 20% of workers’ compensation claims, but nearly 40% of the costs. In 2003, 3.2% of the total U.S. workforce experienced a loss in productive time due to back pain. The total cost of this productive time lost to back pain is estimated to be in excess of $19.8 billion dollars.

Hospitalizations for work-related back disorders have serious and costly effects including: high direct medical costs, significant functional impairment and disability, high absenteeism, reduced work performance, and lost productivity. Well-recognized prevention efforts can be implemented for high risk job activities and reduce the burden of work-related low back disorders.

Hospital discharge records are only available for non-federal, acute care hospitals. Many individuals with work-related injuries do not file for workers’ compensation or fail to recognize work as the cause of their injury. Additionally, self-employed individuals such as farmers and independent contractors, federal employees, railroad or longshore and maritime workers are not covered by state workers’ compensation systems. The expected payer on hospital discharge records may not be accurate and reflect the actual payer. Data between states may not be comparable due to differences in benefit adequacy in states’ workers’ compensation programs. Trends in the use of outpatient surgical centers may limit the interpretation of this indicator. The indicator utilizes only the first seven diagnosis and four procedure code fields to include and exclude cases. Many states have more diagnosis and procedure code fields that could be used to include and exclude cases. The indicator excludes patients hospitalized outside their state of residence.


Indicator 21: Asthma Among Adults Caused or Made Worse by Work
 
Brief definition of measures
  • Weighted estimate of the number of ever-employed adults with current asthma who report that their asthma was caused or made worse by exposures at work
  • Estimated percent of ever-employed adults with current asthma who report that their asthma was caused or made worse by exposures at work
Data source(s)
Public health significance
Asthma is a chronic inflammatory disease of the airways that affects more than 18 million adults in the United States.1 Work-related asthma is a term used to describe asthma that has a temporal association between asthma symptoms and the work environment. 2,3 It has been estimated that approximately 36-58% of adult asthma is caused or made worse by workplace exposures, which translates to approximately 9.7 million adults in the United States.4-7 However, work-related asthma continues to be underdiagnosed.3,5,6 If diagnosed early, work-related asthma may be partially or completely reversible if exposures can be identified and properly stopped or controlled.3
The Asthma Call-Back Survey (ACBS) contains multiple questions related to the work-relatedness of a respondent’s asthma and these questions are administered to adults 18 years or older. Four of the questions ask about asthma caused or made worse by the respondent’s current or previous jobs. Two other questions ask about whether the respondent was told by or ever told their health care provider that their asthma was work related. The latter two questions require that the respondent both encountered a healthcare professional and that a discussion took place about work-relatedness of their asthma. This occurs in approximately 22-25% of respondents who report their asthma is caused or aggravated by work.7 The two questions on whether the respondent was told by or ever told their healthcare provider that their asthma was work related may also underestimate the true burden of work-related asthma because work-related asthma is often under-diagnosed. Physicians document asking about work-related asthma in only 15% of medical charts of asthma patients, suggesting under-diagnosis of work-related asthma.8 Additionally, the American Thoracic Society estimates that as much as 58% of asthma is attributable to work, a measure much closer to that which can be obtained by using the four questions on asthma caused or made worse by work.5
Work-related asthma is preventable but often goes undiagnosed by physicians. Research has shown that work-related asthma can have adverse effects on the worker, including increased morbidity, adverse socioeconomic impacts and difficulty getting and sustaining work. Estimating the burden of asthma caused or made worse by work can help target prevention programs and activities.
The data represents a population-based estimate of asthma caused or made worse by work and are subject to measurement, nonresponse and sampling errors. The indicator does not distinguish between new-onset asthma and work-aggravated asthma. The Asthma Call Back Survey began new weighting methods in 2011 and the wording and order of questions changed in 2012, therefore any trend analysis would need to be restricted to 2012 forward.
 
1 Current asthma prevalence, National Health Interview Survey (NHIS), National Center for Health Statistics, Centers for Disease Control and Prevention, 2010 (NHIS 2010).
2 Vandenplas O, Malo J-L. Definitions and types of work-related asthma: a nosological approach. Eur Respir J 2003; 21: 706–712.
3 Tarlo SM, Balmes J, Balkissoon R, et al. Diagnosis and Management of Work-Related Asthma: ACCP Consensus Statement. Chest 2008; 134: 1S-41S.
4 Knoeller GE, Mazurek JM, Moorman JE. Work-Related Asthma Among Adults with Current Asthma in 33 States and DC: Evidence from the Asthma Call-Back Survey, 2006–2007. Public Health Rep 2011; 126; 603-611.
5 American Thoracic Society Statement: Occupational Contribution to the Burden of Airway Disease. Am J Resp Crit Care Med 2003; 167: 787-797.
6 Henneberger PK, Redlich CA, Callahan DB, Harber P, Lemière C, Martin J, Tarlo SM, Vandenplas O. An Official American Thoracic Society Statement: Work-Exacerbated Asthma. Am J Resp Crit Care Med 2011; 184:368-378.
7 Lutzker LA, Rafferty AP, Brunner WM, Walters JK, Wasilevich EA, PhD, Green MK, Rosenman KD. Prevalence of Work-Related Asthma in Michigan, Minnesota and Oregon. J Asthma 2010; 47:156-161.
8 Milton DK, Solomon GM, Rosiello RA, Herrick RF. Risk and Incidence of Asthma Attributable to Occupational Exposure Among HMO Members. Am J Ind Med 1998; 33:1-10.

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