Cardiovascular conditions,hearing difficulty,and occupational noise exposure within US industries and occupations

Background

The purpose of this study was to estimate the prevalence of occupational noise exposure, hearing difficulty and cardiovascular conditions within US industries and occupations, and to examine any associations of these outcomes with occupational noise exposure.

Methods

National Health Interview Survey data from 2014 were examined. Weighted prevalence and adjusted prevalence ratios of self‐reported hearing difficulty, hypertension, elevated cholesterol, and coronary heart disease or stroke were estimated by level of occupational noise exposure, industry, and occupation.

Results

Twenty‐five percent of current workers had a history of occupational noise exposure (14% exposed in the last year), 12% had hearing difficulty, 24% had hypertension, 28% had elevated cholesterol; 58%, 14%, and 9% of these cases can be attributed to occupational noise exposure, respectively.

Conclusions

Hypertension, elevated cholesterol, and hearing difficulty are more prevalent among noise‐exposed workers. Reducing workplace noise levels is critical. Workplace‐based health and wellness programs should also be considered.

     

Prevalence of hearing loss among noise‐exposed workers within the agriculture,forestry, fishing,and hunting sector, 2003‐2012

Background

The purpose of this study was to estimate the prevalence of hearing loss among noise‐exposed US workers within the Agriculture, Forestry, Fishing, and Hunting (AFFH) sector.

Methods

Audiograms for 1.4 million workers (17 299 within AFFH) from 2003 to 2012 were examined. Prevalence, and the adjusted risk for hearing loss as compared with the reference industry (Couriers and Messengers), were estimated.

Results

The overall AFFH sector prevalence was 15% compared to 19% for all industries combined, but many of the AFFH sub‐sectors exceeded the overall prevalence. Forestry sub‐sector prevalences were highest with Forest Nurseries and Gathering of Forest Products at 36% and Timber Tract Operations at 22%. The Aquaculture sub‐sector had the highest adjusted risk of all AFFH sub‐sectors (PR = 1.70; CI = 1.42‐2.04).

Conclusions

High risk industries within the AFFH sector need continued hearing conservation efforts. Barriers to hearing loss prevention and early detection of hearing loss need to be recognized and addressed.

     

Melanoma,thyroid cancer,and gynecologic cancers in a cohort of female flight attendants

Background

Flight attendants may have an increased risk of some cancers from occupational exposure to cosmic radiation and circadian disruption.

Methods

The incidence of thyroid, ovarian, and uterine cancer among ～6000 female flight attendants compared to the US population was evaluated via life table analyses. Associations of these cancers, melanoma, and cervical cancer with cumulative cosmic radiation dose and metrics of circadian disruption were evaluated using Cox regression.

Results

Incidence of thyroid, ovarian, and uterine cancer was not elevated. No significant, positive exposure‐response relations were observed. Weak, non‐significant, positive relations were observed for thyroid cancer with cosmic radiation and time zones crossed and for melanoma with another metric of circadian disruption.

Conclusions

We found little evidence of increased risk of these cancers from occupational cosmic radiation or circadian disruption in female flight attendants. Limitations include few observed cases of some cancers, limited data on risk factors, and misclassification of exposures.

     

Risk assessment for metalworking fluids and cancer outcomes

Background

Metalworking fluids (MWF) are complex mixtures with dermal and inhalation exposure. Published reports reveal excess cancer risk.

Methods

Using published findings exposure response was derived for each attributable cancer site. Aggregate excess lifetime risk was estimated by applying a lifetable calculation.

Results

Cancer sites contributing the most attributable cases were larynx, esophagus, brain, female breast, and uterine cervix. With constant workplace MWF exposure of 0.1 mg/m³ over a 45 years working life, the risk of attributable cancer was 3.7% or, excluding the less certain female cancers, 3.1%.

Conclusion

Substantial cancer risks occurred at 0.1 mg/m³ MWF, one fourth of the current NIOSH recommended exposure limit for MWF total particulate. Because ingredients in current MWF remain from earlier formulations, it is likely that some MWF carcinogenicity persists today. Although important changes have occurred, newer agents are being continually introduced with little or no knowledge of chronic health risks.

     

Cancer mortality update with an exposure response analysis among styrene‐exposed workers in the reinforced plastics boatbuilding industry

Background

There is sparse and inconsistent evidence of an association between styrene exposure and cancer.

Methods

This study examines mortality patterns in a previously studied cohort of 5201 workers employed in two Washington boat‐building facilities, extending follow‐up 5 years. Standardized mortality ratios (SMR) were calculated using state rates as referent. Cox regression calculated rate ratios (RR) per year employed in styrene‐exposed exposed jobs.

Results

No excess deaths from lymphohematopoietic cancers (LHCs) were observed (SMR: 0.99, 95%CI: 0.74‐1.30) when compared to the referent population; however, the relative risk increased with duration of employment in internal analyses. Conversely, lung cancer mortality was significantly elevated (SMR: 1.24, 95%CI: 1.08‐1.41), but there was no evidence of a dose‐response relationship.

Conclusion

We found evidence that occupational exposure to styrene was associated with increased LHC risk, while no such association was observed for lung cancer.

     

Occupational exposure to textile dust and lung cancer risk: Results from the ICARE Study

Background

To investigate the association of lung cancer with occupational exposure to textile dust and specifically to cotton dust in the population‐based case‐control study ICARE.

Methods

Lifelong occupational history of 2926 cases and 3555 controls was collected using standardized questionnaires, with specific questions for textile dust exposure. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using unconditional logistic regression models controlling for confounding factors including smoking and asbestos exposure.

Results

An inverse association between textile dust exposure and lung cancer was found among workers exposed ≥5% of their work time (OR = 0.80, 95%CI = 0.58‐1.09), more pronounced for distant exposures (40+ years; up to a 56% reduced risk, statistically significant). The OR of lung cancer was significantly decreased among workers exposed to cotton fibers (OR = 0.70, 95%CI = 0.48‐0.97).

Conclusions

Our results provide some evidence of a decreased risk of lung cancer associated with exposure to textile dust, particularly cotton.

     

Occupational exposure to flour dust and the risk of head and neck cancer

Background

To investigate the association between head and neck squamous cell cancer (HNSCC) risk and occupational exposure to flour dust in women and men, using data from ICARE, a French population‐based case‐control study.

Methods

The analysis included 2053 cases of HNSCC and 3507 controls. Lifelong occupational history was collected. A job‐exposure matrix was used to assess exposure to flour dust. Odds‐ratios (ORs) and 95% confidence intervals (CI), adjusted for smoking, alcohol drinking, and asbestos exposure, were estimated with logistic regression models.

Results

Ever exposure to flour dust was associated with elevated ORs in women (OR = 2.15, 95%CI: 1.01 4.55) and in men (OR = 1.55, 95%CI: 1.11 2.17). In women, the risk increased with the probability, the duration, and the cumulative level of exposure. No dose‐response relationships were observed in men.

Conclusions

Although the results were less conclusive in men than in women, overall, these findings provide some support to the hypothesis of a role of flour dust in the occurrence of HNSCC.

     

Prevalence of occupational exposure to asbestos and crystalline silica according to phenotypes of lung cancer from the CaProMat study: A case‐only study

Background

The objective of the study was to compare the prevalence of occupational exposure to asbestos and crystalline silica according to histological types of lung cancer and age at diagnosis.

Methods

CaProMat study is a pooled case‐only study conducted between 1996 and 2011. The current study consisted of 6521 lung cancer cases. Occupational exposure to asbestos and crystalline silica was assessed by two Job‐Exposure Matrices. A weighted prevalence of exposure was derived and compared according to histological types and age at diagnosis.

Results

There was no difference of weighted prevalence of exposure to asbestos and crystalline silica according to histological types of lung cancer. There was a statistically significant difference of weighted prevalence of exposure to asbestos and crystalline silica according to age at diagnosis.

Conclusions

Due to the limited clinical importance of the difference, neither the histological type, nor the age at diagnosis can be used as an indicator for the occupational exposure to asbestos or crystalline silica.

     

Workers’ compensation and the working poor

Background

The working poor are at highest risk of work‐related injuries and have limited access to occupational health care.

Objectives

To explore community health centers (CHCs) as a venue for accessing at risk workers; and to examine the experience, knowledge, and perceptions of workers’ compensation (WC) among the working poor.

Methods

Key informant interviews were conducted among patients in waiting rooms of rural and urban CHCs.

Result

Fifty‐one interviews of minority workers across sectors identified 23 prior work‐related injuries and mixed experiences with the WC system. Barriers to reporting and ways to overcome these barriers were elucidated.

Conclusions

Patients in CHCs work in jobs that put them at risk for work‐related injuries. CHCs are a good site for accessing at‐risk workers. Improving occupational healthcare and appropriate billing of WC insurance should be explored, as should best practices for employers to communicate WC laws to low wage workers.

     

Prison employment and post‐traumatic stress disorder: Risk and protective factors

Objectives

To examine the prevalence of Post‐Traumatic Stress Disorder (PTSD) in a sample of prison employees, investigate risk factors, and explore protective factors for PTSD.

Methods

We surveyed 355 Washington State Department of Corrections employees. The survey included the PTSD checklist for the DSM‐5 (PCL‐5), the Critical Incident History Questionnaire, and the Work Environment Inventory.

Results

We found 19% of the sample met the criteria for diagnosable PTSD. Several risk factors were associated with a higher PCL‐5 score, including exposure to critical incidents, and having greater ambiguity in the job role. Being happy with job assignments and having positive relationships with supervisors and coworkers were associated with decreased PCL‐5 score.

Conclusions

Prison employees have a PTSD rate equivalent to Iraq and Afghanistan war veterans and higher than police officers, suggesting the importance of developing programs for promoting resilience to stress, incorporating the knowledge gained on risk, and protective factors.

     

Dose‐response relationships between internally‐deposited uranium and select health outcomes in gaseous diffusion plant workers, 1948‐2011

Objective

To examine dose‐response relationships between internal uranium exposures and select outcomes among a cohort of uranium enrichment workers.

Methods

Cox regression was conducted to examine associations between selected health outcomes and cumulative internal uranium with consideration for external ionizing radiation, work‐related medical X‐rays and contaminant radionuclides technetium (⁹⁹Tc) and plutonium (²³⁹Pu) as potential confounders.

Results

Elevated and monotonically increasing mortality risks were observed for kidney cancer, chronic renal diseases, and multiple myeloma, and the association with internal uranium absorbed organ dose was statistically significant for multiple myeloma. Adjustment for potential confounders had minimal impact on the risk estimates.

Conclusion

Kidney cancer, chronic renal disease, and multiple myeloma mortality risks were elevated with increasing internal uranium absorbed organ dose. The findings add to evidence of an association between internal exposure to uranium and cancer. Future investigation includes a study of cancer incidence in this cohort.

     

Pleural abnormalities and exposure to elongate mineral particles in Minnesota iron ore (taconite) workers

Background

Iron ore (taconite) mining and processing are an important industry in northern Minnesota and western Michigan. Concerns around exposures have centered largely on exposure to non‐asbestiform amphibole elongate mineral particles (EMPs) found in the eastern portion of the Minnesota iron range.

Methods

A cross sectional survey was undertaken of current and former taconite workers and spouses along with a detailed exposure assessment. Participants provided an occupational history and had a chest radiograph performed.

Results

A total of 1188 workers participated. Potential exposures to non‐amphibole EMPs were evident across multiple jobs in all active mines. Pleural abnormalities were found in 16.8% of workers. There was an association of pleural abnormalities with cumulative EMP exposure that was not specific to the eastern portion of the range.

Conclusion

There was evidence of a mild to moderate increase in pleural abnormalities in this population of miners, associated with geographically non‐specific cumulative EMP exposure.

     

Sinonasal cancer in the Italian national surveillance system: Epidemiology,occupation, and public health implications

Background

Sinonasal cancer (SNC) is a rare tumor with predominant occupational etiology associated with exposures to specific carcinogens. The aim of this study is to describe SNC cases recorded in Italy in the period 2000‐2016.

Methods

Clinical information, occupational history, and lifestyle habits of SNC cases collected in the Italian Sinonasal Cancer Register were examined. Age‐standardized rates were estimated.

Results

Overall, 1529 cases were recorded. The age‐standardized incidence rates per 100 000 person‐years were 0.65 in men and 0.26 in women. Occupational exposures were predominant among the attributed exposure settings, primarily to wood and leather dusts. Other putative causal agents included chrome, solvents, tannins, formaldehyde, textile dusts, and pesticides. Many cases had unknown exposure.

Conclusions

Epidemiological surveillance of SNC cases and their occupational history is fundamental for monitoring the occurrence of the disease in exposed workers in industrial sectors generally not considered at risk of SNC as well as in non‐occupational settings.

     

The prevalence of exposure to high molecular weight asthmagens derived from plants among workers in Australia

Background

Limited information is available on exposure to high molecular weight (HMW) asthmagens derived from plants and on the main occupations and tasks that result in such exposure among workers.

Methods

Data were collected as part of the Australian Work Exposures Study—Asthma. We estimated adjusted prevalence ratios (aPR) using modified Poisson regression models to determine which factors were associated with exposure.

Results

A 12.8% of 4878 workers were exposed to HMW asthmagens derived from plants. The highest prevalence of exposure was found among farmers/animal workers, education workers, and food processing workers. The main circumstances of exposure were through handling flour, freesias, or through raising livestock. Exposure was more common among female workers (aPR = 1.26, 1.10‐1.43) than males, while it was lower among workers born overseas (aPR = 0.70, 0.57‐0.86) than those born in Australia.

Conclusion

Prevention of exposure to HMW asthmagens derived from plants requires a broad strategy targeting different tasks and occupations.

     

Violence against emergency medical services personnel: A systematic review of the literature

Background

Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel.

Methods

We examined literature from 2000 to 2016. Eligibility criteria included English‐language, peer‐reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies; 25 studies from nine countries met the inclusion criteria.

Results

The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk‐reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base.

Conclusions

EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.

     

Asbestos standards: Impact of currently uncounted chrysotile asbestos fibers on lifetime lung cancer risk

Background

Current regulations require that asbestos fibers are collected and examined using a light microscope. This method fails to enumerate fibers that are too short or thin to reliably count using a light microscope under normal conditions.

Methods

A cohort of 3054 workers employed at an asbestos textile plant was followed to ascertain causes of death. Exposure was almost entirely chrysotile. Fiber counts were quantified using light microscopy and electron microscopy. The g‐formula was used to estimate impacts on lung cancer of policies defined in terms of fiber counts quantified using light and electron microscopy.

Results

Given exposure at the current standard, the estimated lung cancer risk was 7.33%, comparable to the risk expected under a standard of 1 fiber/mL counted using electron microscopy (7.30%). The lifetime risk of lung cancer under a standard of 0.1 fiber/mL counted by electron microscopy was estimated to be 7.10%.

Conclusions

We identify policies defined in terms of electron microscopy‐based asbestos exposure metrics that yield comparable, or lower, lung cancer mortality than that expected under the current standard.

     

Occupational asthma risk from exposures to toluene diisocyanate: A review and risk assessment

Background

Toluene Diisocyanate (TDI) is a known respiratory sensitizer linked to occupational asthma (OA). To better manage worker risks, an appropriate characterization of the TDI‐OA dose‐risk relationship is needed.

Methods

The literature was reviewed for data suitable for dose‐response modeling. Previous study data were fit to models to derive prospective occupational exposure limits (OELs), using benchmark dose (BMD) and low‐dose extrapolation approaches.

Results

Data on eight TDI‐exposed populations were suitable for analysis. There were 118 OA cases in a population contributing 13 590 person‐years. The BMD‐based OEL was 0.4 ppb. The OEL based on low‐dose extrapolation to working lifetime extra risk of 1/1000 was 0.3 ppb.

Conclusions

This study synthesized epidemiologic data to characterize the TDI‐OA dose‐risk relationship. This approach yielded prospective OEL estimates below recent recommendations by the American Conference of Governmental Industrial Hygienists, but given significant study limitations, this should be interpreted with caution. Confirmatory research is needed.

     

Standardized morbidity ratios of four chronic health conditions among World Trade Center responders: Comparison to the National Health Interview Survey

Purpose

We conducted external comparisons for the prevalence of asthma, hypertension, diabetes, and cancer among World Trade Center (WTC) general responders using the National Health Interview Survey (NHIS) as the reference, along with internal comparisons for the incidence of asthma.

Methods

Standardized Morbidity Ratios (SMRs) were calculated for the prevalence of the health conditions, and risk ratios (RRs) for asthma incidence.

Results

Relative to the NHIS, asthma prevalence was in excess in responders over the study years (age‐adjusted SMRs = 1.3‐2.8). Hypertension prevalence began to exceed expected from 2006 while diabetes was lower than expected. An upward trend towards excess cancer prevalence was observed. Internal comparisons showed elevated asthma incidence among protective service and utility workers compared to construction workers; while those who arrived at the WTC site in the morning of 9/11 had a lower asthma risk than those who arrived in the afternoon.

Conclusions

The use of NHIS data as a reference population demonstrates and reconfirms several important patterns of excess risk in WTC responders. External comparisons are an alternative for disaster cohorts without an established comparison group.

     

Self‐reported musculoskeletal disorder pain: The role of job hazards and work‐life interaction

Background

Previous research identified an association between work‐family conflict and musculoskeletal pain. This study explores how the work‐life interface might affect pain experienced by residential aged care staff.

Methods

A cross‐sectional survey of 426 employees in residential aged care was analyzed to assess the impacts of workplace hazards, work‐family conflict, and work‐life balance on self‐reported musculoskeletal pain.

Results

Work‐family conflict acts as a mediator of the relationships between workplace hazards and the total number of body regions at which musculoskeletal pain was experienced. Work‐life balance only acts as a mediator for particular hazards and only if work‐family conflict is not taken into account.

Conclusions

Addressing work‐life interaction, and in particular work‐family conflict, warrants further investigation as a legitimate means through which musculoskeletal disorder risk can be reduced. Policies and practices to improve work‐life interaction and reduce work‐family conflict should be considered as integral components of musculoskeletal disorder risk management strategies.

     

Relationships of working conditions,health problems and vehicle accidents in bus rapid transit (BRT) drivers

Background

The aim of this study was to estimate accident risk rates and mental health of bus rapid transit (BRT) drivers based on psychosocial risk factors at work leading to increased stress and health problems.

Methods

A cross‐sectional research design utilized a self‐report questionnaire completed by 524 BRT drivers.

Results

Some working conditions of BRT drivers (lack of social support from supervisors and perceived potential for risk) may partially explain Bogota's BRT drivers’ involvement in road accidents. Drivers’ mental health problems were associated with higher job strain, less support from co‐workers, fewer rewards and greater signal conflict while driving.

Conclusions

To prevent bus accidents, supervisory support may need to be increased. To prevent mental health problems, other interventions may be needed such as reducing demands, increasing job control, reducing amount of incoming information, simplifying current signals, making signals less contradictory, and revising rewards.