Occupational epidemiology

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Occupational epidemiology is a subdiscipline of epidemiology that focuses on investigations of workers and the workplace. [1] [2] Occupational epidemiologic studies examine health outcomes among workers, and their potential association with conditions in the workplace including noise, chemicals, heat, or radiation, or work organization such as schedules.

Contents

The need for evidence to inform occupational safety regulations, workers' compensation programs, and safety legislation motivated the development of public health policy, occupational epidemiology methods, and surveillance mechanisms. [3] Occupational epidemiological research can inform risk assessments; development of standards and other risk management activities; and estimates of the co-benefits and co-harms of policies designed to reduce risk factors or conditions that can affect human health. Occupational epidemiology methods are common to methods used in environmental epidemiology. [4]

History

Occupational hazards have long been recognized. For Hippocrates recommended other physicians consider patients' vocational backgrounds when diagnosing and treating disease, and Bernardino Ramazzini in 1700 outlined many occupational diseases in his book De Morbis Artificum. There are several examples from the 19th century onwards of hazard recognition proceeding to systematic epidemiology studies. In one example, premature mortality was reported among gold and silver miners in the Erz Mountains in Germany as early as the 16th century. [5] It was initially thought to be the result of consumption, but it was subsequently determined to be silicosis, and studies from 1879 through the 1930s uncovered the association of miners' deaths with lung cancer and nonmalignant respiratory diseases. Other examples include cancer among chimney sweeps, asbestos-related diseases, and the variety of occupational diseases found among factory workers in the early 1900s. [5]

Occupational health risks were initially observed by case series reports of apparent disease excesses or clusters. Although the case series approach provided a good indicator of occupational hazards, they are not adequate on their own to assess a wide spectrum of health outcomes that may not be closely related to workplace exposure. The development of retrospective, cohort design allowed for a more comprehensive study of the cases. Desire to improve the cost-efficiency of studies led to the use of case-control studies. Other methods later used in occupational epidemiology include cross-sectional and longitudinal studies. [5]

Early disease of concern recognized in the workplace

Coal Workers' Pneumoconiosis

The classic and preventable lung disorder of the mining industry, pneumoconiosis is commonly known as “black lung disease” and due to long term exposure to coal dust. [6] This condition has been identified since 1775 and has been officially listed as an occupational disease since 1980 by the ILO List of Occupational Diseases. [7]

Coal Workers Pneumoconiosis (CWP) develops when coal dust accumulates over time in the respiratory system and creates dark spots of trapped coal dust particles called coal macules. [8] CWP typically takes at least 10 years to develop after initial exposure and as the scarring continues to worsen, oxygen may be prevented from reaching the blood which subsequently puts stress on other organs, such as the heart and brain. [8]

The CDC and NIOSH examined and assessed trends in premature mortality attributed to CWP from 1999 to 2016, which are the most recent years for which complete data is available and calculated years of potential life lost to life expectancy (YPLL). [7] From 1999 to 2016, people aged 25 and older with CWP lost more years of life relative to their life expectancy than expected. [7] This suggests that there has been increased CWP severity and rapid disease progression and highlights the importance of strengthening prevention measures to prevent premature CWP-associated mortality. [7]

The Coal Workers’ Health Surveillance Program (CWHSP) was established by the Federal Coal Mine Health and Safety Act of 1969. [9] The mission of this program is to detect lung disease early in coal miners to subsequently prevent progression to severe lung disease. [9] CWHSP provides U.S. coal miners with black lung screening opportunities at no cost to miners and are available when miners initially begin employment and at periodic intervals throughout their careers. [9] The Mine Safety and Health Administration (MSHA) announced that they will give coal miners with black lung disease the right to work in areas with lower dust levels without reduced pay, discrimination, or termination. [10] In 2014, MSHA landmark respirable dust rule went into effect with phase III in 2016, which decreased allowable exposure to respirable coal mine dust, which is the most effective means of preventing CWP caused by excessive exposure to such dust. [10]

Occupational Exposures

The ability to identify, measure and model workplace exposures is a key step in the prevention of occupational illness. [11] Occupational epidemiologists collaborate with industrial hygienists through field investigations that seek to identify and assess hazard exposures in the workplace. [12] [13] Depending on the type of work being done, many modes of exposure exist--droplet exposure through air, consumption, and injection are three occupational examples. [14] The exposures experienced by a miner would differ from a nurse, but both fall under the jurisdiction of occupational epidemiology. [14] Specific exposures associated with disease may be encountered in or near the workplace: compounds such as carbon monoxide leading to carbon monoxide poisioning [15] and pesticide molecules leading to pesticide poisoning are two. [12] After identifying such exposures, occupational epidemiologists use data analysis skills to create models illustrating a dose-response relationship. [16] This leads to an understanding of how much, if any, exposure is safe. [16] Data on both the amount of occupational disease and the level of exposure to a particular hazard will be collected and compared to discern whether there is a correlation. [16]

Types of studies

Case series

Typically occupational epidemiological investigations begin with the observation of an unusual number of cases of disease among a group of workers. When the investigation does not go further than what is referred to as identifying a disease cluster, the study is referred to as a case series report. [5]

Cohort studies

In a cohort design study, a population, or cohort, of workers is compared to a control group that was not exposed to the workplace hazards being investigated. This type of study is the most accepted in the scientific community because it most closely follows experimental strategy and observes the entire population rather than a sample. In a prospective cohort study, the group examined at the time of the study is compared to a follow-up with the same group in the future. The historical cohort study design begins with defining a cohort at a time in the past and following the cohort over historical time. [5] [17]

Asbestos Exposure to Former Workers

Asbestos is a common industrial hygiene concern and is the name given to a group of naturally occurring minerals. [18] What makes asbestos unique compared to other minerals is its resistance to fire and corrosion. [18] Asbestos exposure can occur in many different industries, the most common being construction, manufacturing products like textiles, and automotive brake and clutch repair.

In June of 2024, a retrospective cohort study was conducted to identify the results of health surveillance in Italy after asbestos was banned in 1992. Health surveillance – the systematic collection, analysis, and interpretation of health-related data – conducted for exposed workers was voluntary and consisted of two phases: general evaluation with an assessment of work and residential history followed by a physical examination with emphasis on the respiratory system. This study consisted of 4 birth cohorts and examined the results of several physical tests including spirometry, CAT scan, etc. Results identified decreased levels of lung function, damage to the lungs, and lung cancer associated with 3 decades of asbestos exposure in the workplace. [19]

Case-control studies

Case-control studies compare the past exposure of cases with the disease to the past exposure of cases that did not have the disease. Because cohort studies require the entire population, case-control studies are a more cost-effective approach, using only the sample of workers with the disease to compare to a control. [5] [17]

Hyperuricemia in Steelworkers

Hyperuricemia is a condition in which there are elevated levels of uric acid in the body. [20] Uric acid is created as a waste product when the body breaks down chemicals known as purines in food and drinks. Hyperuricemia can lead to other health conditions including but not limited to gouty arthritis, renal impairment, and coronary artery disease. [20]

A case-control study conducted by Chinese scientists in 2022 wanted to identify the relationship between occupational exposure in Ironworkers and hyperuricemia. Samples of heat, dust, and noise were taken and individuals included in the study were grouped based on sex, smoking status (non-smokers and former smokers), alcohol consumption, and physical activity at the workplace. Physical and laboratory examinations including blood samples were used to measure uric acid levels in individuals. Results from the study found that the incidence rate of hyperuricemia in Steelworkers was 17.3% and is higher in comparison to the average worker in China. [21]

Cross-sectional studies

A typical cross-sectional study involves the comparison of varying degrees of exposure and the prevalence of disease, symptoms, or physiological status. The main advantage of cross-sectional studies is that they allow collection of data on conditions which would not be recorded normally because other study designs focus on severe states of disease. This is also the biggest shortcoming of this study type because by using prevalence rather than incidence it cannot be used to make a causal inference. [5] [17]

Application

By contributing to reduction in exposure, occupational epidemiology helps reduce health risks among workers. Using occupational epidemiological methods can also have benefits for society at large. For example, recommendations for exposure limits to benzene developed by the Expert Panel on Air Quality Standards were based on occupational epidemiology. [17]

Using meta-analysis, many occupational epidemiology studies can be synthesized in order to help set occupational exposure limits and make other kinds of policy decisions. This can also can be applied in health risk assessments, which is a method of predicting health risk based on hypothetical exposure conditions. [5]

See also

Related Research Articles

Coal dust is a fine-powdered form of coal which is created by the crushing, grinding, or pulverization of coal rock. Because of the brittle nature of coal, coal dust can be created by mining, transporting, or mechanically handling it.

<span class="mw-page-title-main">Pneumoconiosis</span> Scarring of the lungs due to inhaling dust over long periods

Pneumoconiosis is the general term for a class of interstitial lung disease where inhalation of dust has caused interstitial fibrosis. The three most common types are asbestosis, silicosis, and coal miner's lung. Pneumoconiosis often causes restrictive impairment, although diagnosable pneumoconiosis can occur without measurable impairment of lung function. Depending on extent and severity, it may cause death within months or years, or it may never produce symptoms. It is usually an occupational lung disease, typically from years of dust exposure during work in mining; textile milling; shipbuilding, ship repairing, and/or shipbreaking; sandblasting; industrial tasks; rock drilling ; or agriculture. It is one of the most common occupational diseases in the world.

<span class="mw-page-title-main">Asbestosis</span> Pneumoconiosis caused by inhalation and retention of asbestos fibers

Asbestosis is long-term inflammation and scarring of the lungs due to asbestos fibers. Symptoms may include shortness of breath, cough, wheezing, and chest tightness. Complications may include lung cancer, mesothelioma, and pulmonary heart disease.

<span class="mw-page-title-main">Silicosis</span> Pneumoconiosis caused by inhalation of silica, quartz or slate particles

Silicosis is a form of occupational lung disease caused by inhalation of crystalline silica dust. It is marked by inflammation and scarring in the form of nodular lesions in the upper lobes of the lungs. It is a type of pneumoconiosis. Silicosis, particularly the acute form, is characterized by shortness of breath, cough, fever, and cyanosis. It may often be misdiagnosed as pulmonary edema, pneumonia, or tuberculosis. Using workplace controls, silicosis is almost always a preventable disease.

<span class="mw-page-title-main">Occupational hygiene</span> Management of workplace health hazards

Occupational hygiene or industrial hygiene (IH) is the anticipation, recognition, evaluation, control, and confirmation (ARECC) of protection from risks associated with exposures to hazards in, or arising from, the workplace that may result in injury, illness, impairment, or affect the well-being of workers and members of the community. These hazards or stressors are typically divided into the categories biological, chemical, physical, ergonomic and psychosocial. The risk of a health effect from a given stressor is a function of the hazard multiplied by the exposure to the individual or group. For chemicals, the hazard can be understood by the dose response profile most often based on toxicological studies or models. Occupational hygienists work closely with toxicologists (see Toxicology) for understanding chemical hazards, physicists (see Physics) for physical hazards, and physicians and microbiologists for biological hazards (see Microbiology, Tropical medicine, Infection). Environmental and occupational hygienists are considered experts in exposure science and exposure risk management. Depending on an individual's type of job, a hygienist will apply their exposure science expertise for the protection of workers, consumers and/or communities.

Chemical hazards are hazards present in hazardous chemicals and hazardous materials. Exposure to certain chemicals can cause acute or long-term adverse health effects. Chemical hazards are usually classified separately from biological hazards (biohazards). Chemical hazards are classified into groups that include asphyxiants, corrosives, irritants, sensitizers, carcinogens, mutagens, teratogens, reactants, and flammables. In the workplace, exposure to chemical hazards is a type of occupational hazard. The use of personal protective equipment may substantially reduce the risk of adverse health effects from contact with hazardous materials.

An occupational disease or industrial disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalent in a given body of workers than in the general population, or in other worker populations. The first such disease to be recognised, squamous-cell carcinoma of the scrotum, was identified in chimney sweep boys by Sir Percival Pott in 1775. Occupational hazards that are of a traumatic nature are not considered to be occupational diseases.

<span class="mw-page-title-main">Black lung disease</span> Human disease caused by long-term exposure to coal dust

Black lung disease (BLD), also known as coal workers' pneumoconiosis, or simply black lung, is an occupational type of pneumoconiosis caused by long-term inhalation and deposition of coal dust in the lungs and the consequent lung tissue's reaction to its presence. It is common in coal miners and others who work with coal. It is similar to both silicosis from inhaling silica dust and asbestosis from inhaling asbestos dust. Inhaled coal dust progressively builds up in the lungs and leads to inflammation, fibrosis, and in worse cases, necrosis.

The Safety and Health in Mines Convention, 1995 is an International Labor Organization Convention adopted at the 82nd International Labor Conference (ILC). The convention (C176) was developed and adopted to better recognize the inherent hazards of the mining workplace and the necessity of addressing these hazards on a global scale.

Occupational lung diseases comprise a broad group of diseases, including occupational asthma, industrial bronchitis, chronic obstructive pulmonary disease (COPD), bronchiolitis obliterans, inhalation injury, interstitial lung diseases, infections, lung cancer and mesothelioma. These can be caused directly or due to immunological response to an exposure to a variety of dusts, chemicals, proteins or organisms. Occupational cases of interstitial lung disease may be misdiagnosed as COPD, idiopathic pulmonary fibrosis, or a myriad of other diseases; leading to a delay in identification of the causative agent.

<span class="mw-page-title-main">Occupational hazard</span> Hazard experienced in the workplace

An occupational hazard is a hazard experienced in the workplace. This encompasses many types of hazards, including chemical hazards, biological hazards (biohazards), psychosocial hazards, and physical hazards. In the United States, the National Institute for Occupational Safety and Health (NIOSH) conduct workplace investigations and research addressing workplace health and safety hazards resulting in guidelines. The Occupational Safety and Health Administration (OSHA) establishes enforceable standards to prevent workplace injuries and illnesses. In the EU, a similar role is taken by EU-OSHA.

<span class="mw-page-title-main">Asbestos abatement</span> Removal of asbestos from structures

In construction, asbestos abatement is a set of procedures designed to control the release of asbestos fibers from asbestos-containing materials. Asbestos abatement is utilized during general construction in areas containing asbestos materials, particularly when those materials are being removed, encapsulated, or repaired. Abatement is needed in order to protect construction workers and members of the general public from the many negative health impacts of asbestos.

Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing systematic collection, analysis, and dissemination of exposure and health data on groups of workers. The Joint ILO/WHO Committee on Occupational Health at its 12th Session in 1995 defined an occupational health surveillance system as "a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programmes".

The Institute of Occupational Medicine (IOM) was founded in 1969 by the National Coal Board (NCB) as an independent charity in Edinburgh, UK and retains its charitable purpose and status today. The "Institute" has a subsidiary, IOM Consulting Limited, which became fully independent in 1990 and now celebrates its 25th year within the IOM Group as an independent consultancy and also the commercial part of the IOM organization. It specializes in asbestos surveys and services, occupational hygiene services, nanotechnology safety, laboratory analysis and expert witness consulting services. IOM is therefore one of the UK's major independent "not for profit" centres of science in the fields of environmental health, occupational hygiene and occupational safety.

A "B" reader is a physician certified by the National Institute for Occupational Safety and Health (NIOSH) as demonstrating proficiency in classifying radiographs of the pneumoconioses.

<span class="mw-page-title-main">Occupational safety and health</span> Field concerned with the safety, health and welfare of people at work

Occupational safety and health (OSH) or occupational health and safety (OHS) is a multidisciplinary field concerned with the safety, health, and welfare of people at work. OSH is related to the fields of occupational medicine and occupational hygiene and aligns with workplace health promotion initiatives. OSH also protects all the general public who may be affected by the occupational environment.

Occupational cancer is cancer caused by occupational hazards. Several cancers have been directly tied to occupational hazards, including chimney sweeps' carcinoma, mesothelioma, and others.

<span class="mw-page-title-main">Mine safety</span> Practice of controlling mining hazards

Mine safety is a broad term referring to the practice of controlling and managing a wide range of hazards associated with the life cycle of mining-related activities. Mine safety practice involves the implementation of recognised hazard controls and/or reduction of risks associated with mining activities to legally, socially and morally acceptable levels. While the fundamental principle of mine safety is to remove health and safety risks to mine workers, mining safety practice may also focus on the reduction of risks to plant (machinery) together with the structure and orebody of the mine.

<span class="mw-page-title-main">Occupational dust exposure</span> Occupational hazard in agriculture, construction, forestry, and mining

Occupational dust exposure occurs when small particles are generated at the workplace through the disturbance/agitation of rock/mineral, dry grain, timber, fiber, or other material. When these small particles become suspended in the air, they can pose a risk to the health of those who breath in the contaminated air.

<span class="mw-page-title-main">Health impact of asbestos</span>

All types of asbestos fibers are known to cause serious health hazards in humans. The most common diseases associated with chronic exposure to asbestos are asbestosis and mesothelioma.

References

  1. ↑ "Occupational Epidemiology". U.S. Occupational Safety and Health Administration . Retrieved 2016-06-13.
  2. ↑ Checkoway, Harvey; Pearce, Neil; Kriebel, David (2004). Research Methods in Occupational Epidemiology. New York, NY: Oxford University Press. ISBN   0-19-509242-2.
  3. ↑ Halperin, William; Howard, John (2011-10-07). "Occupational Epidemiology and the National Institute for Occupational Safety and Health". Morbidity and Mortality Weekly Report . 60 (4). U.S. Centers for Disease Control and Prevention: 97–103. PMID   21976172.
  4. ↑ Pell, S. (May 1993). "Epidemiologists in industry. Past achievements, unexplored opportunities, and future needs". Journal of Occupational Medicine. 35 (5): 485–492. ISSN   0096-1736. PMID   8515320.
  5. 1 2 3 4 5 6 7 8 Checkoway, Harvey; Pearce, Neil; Crawford-Brown, Douglas J. (1989). Research methods in occupational epidemiology . New York: Oxford University Press. pp.  5–8, 59, 61, 66, 72, 331. ISBN   9780195092424. OCLC   610965808.
  6. ↑ "Black lung | Coal Miners, Dust Exposure, Respiratory Illness | Britannica". www.britannica.com. Retrieved 2024-12-02.
  7. 1 2 3 4 Mazurek, Jacek M. (2018). "Coal Workers' Pneumoconiosis–Attributable Years of Potential Life Lost to Life Expectancy and Potential Life Lost Before Age 65 Years — United States, 1999–2016". MMWR. Morbidity and Mortality Weekly Report. 67. doi:10.15585/mmwr.mm6730a3. ISSN   0149-2195.
  8. 1 2 Association, American Lung. "Diagnosing and Treating Pneumoconiosis". www.lung.org. Retrieved 2024-11-16.
  9. 1 2 3 CDC (2024-10-30). "About Coal Workers' Health Surveillance Program". Coal Workers' Health Surveillance Program. Retrieved 2024-11-16.
  10. 1 2 "Respirable Dust Rule: A Historic Step Forward in the Effort to End Black Lung Disease". Mine Health and Safety Administration. Retrieved 2024-11-16.
  11. ↑ Bepko, Jennifer; Mansalis, Katherine (2016-06-15). "Common Occupational Disorders: Asthma, COPD, Dermatitis, and Musculoskeletal Disorders". American Family Physician. 93 (12): 1000–1006. ISSN   1532-0650. PMID   27304769.
  12. 1 2 CDC (2024-09-03). "Occupational Disease And Injury". Field Epidemiology Manual. Retrieved 2024-12-02.
  13. ↑ "Occupational Epidemiology and the National Institute for Occupational Safety and Health". www.cdc.gov. Retrieved 2024-11-17.
  14. 1 2 Lim, V. K. E. (June 2009). "Occupational infections". The Malaysian Journal of Pathology. 31 (1): 1–9. ISSN   0126-8635. PMID   19694307.
  15. ↑ "Houseboat-Associated Carbon Monoxide Poisonings on Lake Powell --- Arizona and Utah, 2000". www.cdc.gov. Retrieved 2024-12-02.
  16. 1 2 3 "Occupational Epidemiology and the National Institute for Occupational Safety and Health". www.cdc.gov. Retrieved 2024-11-30.
  17. 1 2 3 4 Agius, Raymond. "Occupational Epidemiology" . Retrieved 2017-07-30.
  18. 1 2 "Asbestos". Occupational Safety and Health Administration. 2014.
  19. ↑ De Maria, Luigi; Pentimone, Floriana; Cavone, Domenica; Caputi, Antonio; Sponselli, Stefania; Fragassi, Francesco; Dicataldo, Francesco; Luisi, Vito; Delvecchio, Giuseppe; Giannelli, Gianmarco; Cafaro, Francesco; Sole, Stefano; Ronghi, Claudia; Zagaria, Silvia; Loiacono, Giuseppe (2024-06-17). "Clinical investigation of former workers exposed to asbestos: the health surveillance experience of an Italian University Hospital". Frontiers in Public Health. 12. doi: 10.3389/fpubh.2024.1411910 . ISSN   2296-2565. PMC   11215018 . PMID   38952736.
  20. 1 2 George, Christina; Leslie, Stephen W.; Minter, David A. (2023-10-14), "Hyperuricemia", StatPearls [Internet], StatPearls Publishing, PMID   29083565 , retrieved 2024-11-16
  21. ↑ Chen, Yuanyu; Yang, Yongzhong; Zheng, Ziwei; Wang, Hui; Wang, Xuelin; Si, Zhikang; Meng, Rui; Wang, Guoli; Wu, Jianhui (2022-08-08). "Influence of occupational exposure on hyperuricemia in steelworkers: a nested case–control study". BMC Public Health. 22 (1): 1508. doi: 10.1186/s12889-022-13935-x . ISSN   1471-2458. PMC   9361698 . PMID   35941633.
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