Friday, January 28, 2005

Chemicals and Work Related Mortality

A bad-guy regulatory deform idea [read OMB] was to require "comparative risk" analysis to support a public health intervention. Is it safer to work in an auto factory, or drive one of their cars? The recent National Safety Council initiative to refocus concerns from on-the-job to off-the-job injury is supported by claims that it's 10 times more dangerous at home.

BrooklynDodger tells people that 90% of identified work-related mortality arises from chronic disease caused by long term exposure to chemicals at work. The abstract quoted in full supports that claim, although this risk contrasts across sectors and job type.

The investigators estimate that 49,000 of 55,000 identifiable work related deaths are form illnesses. The investigators believe, and the Dodger concurs they have biased their estimate conservatively. This is certainly in the 90% ballpark the Dodger uses.

BrooklynDodger advances a few caveats, which would increase these estimates, certainly in some sectors.

First, the estimate across the entire work force underestimates the risk in certain sectors. For the 60% of the workforce who are white collar or professional, or the majority of the workforce in sectors like finance, chemical exposures at work are little different than exposures in the community.

Second, recent observations of respiratory, cardiovascular and carcinogenic risk associated with exposure to particles without special toxicity, imply that previously unrecognized environments put workers at risk.

Both these observations suggest a higher fraction impact of disease in manufacturing, construction and mining, although these are also high risk sectors for traumatic injury.

Thus, for preventing numbers of work related mortality, control of chemical exposures is far more important than traumatic injury prevention [although traumatic injury tends to have a younger age.]

Were cardiovascular effects of noise and work related job stress, and mortality due to depression arising from work related job stress recognized, the proportion of work related to total mortality would rise, although the fraction of work related mortality due to chemicals would fall.

Am J Ind Med. 2003 May;43(5):461-82.

Dying for work: The magnitude of US mortality from selected causes of death associated with occupation.

Steenland K, Burnett C, Lalich N, Ward E, Hurrell J.National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA.

BACKGROUND: Deaths due to occupational disease and injury place a heavy burden on society in terms of economic costs and human suffering.

METHODS: We estimate the annual deaths due to selected diseases for which an occupational association is reasonably well established and quantifiable, by calculation of attributable fractions (AFs), with full documentation; the deaths due to occupational injury are then added to derive an estimated number of annual deaths due to occupation.

RESULTS: Using 1997 US mortality data, the estimated annual burden of occupational disease mortality resulting from selected respiratory diseases, cancers, cardiovascular disease, chronic renal failure, and hepatitis is 49,000, with a range from 26,000 to 72,000. The Bureau of Labor Statistics estimates there are about 6,200 work-related injury deaths annually. Adding disease and injury data, we estimate that there are a total of 55,200 US deaths annually resulting from occupational disease or injury (range 32,200-78,200).

CONCLUSIONS: Our estimate is in the range reported by previous investigators, although we have restricted ourselves more than others to only those diseases with well-established occupational etiology, biasing our estimates conservatively. The underlying assumptions and data used to generate the estimates are well documented, so our estimates may be updated as new data emerges on occupational risks and exposed populations, providing an advantage over previous studies. We estimate that occupational deaths are the 8th leading cause of death in the US, after diabetes (64,751) but ahead of suicide (30,575), and greater than the annual number of motor vehicle deaths per year (43,501). Copyright 2003 Wiley-Liss, Inc.

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