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NIOSH Respiratory Diseases Research Program

Evidence Package for the National Academies' Review 2006-2007

NIOSH Programs > Respiratory Diseases > Evidence Package > 8. Surveillance Activities

8.1 Work-Related Lung Disease Surveillance Report and System

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 By the late1980s, RDRP became increasingly aware of the substantial lack of ORDS data. RDRP scientists and managers, our partners, news media, the general public, and others frequently requested information that could only be provided by ongoing surveillance. Recognition of this need led to the first of a series of six “WoRLD Surveillance Reports” in1991, with subsequent editions in 1992, 1994, 1996, 1999, and 2002 (A8-3)

The “WoRLD Surveillance Report” has proven itself as a landmark achievement, presenting serially updated data in a very accessible form to a very wide audience. The continuing challenge is not only to maintain and update existing content, but also to present content in more meaningful ways and add new sources of relevant, high quality data to the report. Effective dissemination is also critically important.


RDRP public health surveillance efforts have involved the identification and evaluation of existing data and, as appropriate, the analysis and effective presentation of those data in accessible format. This has required extensive partnering with other agencies, several of which have established data systems with data pertinent to occupational respiratory diseases. It has also required the establishment of surveillance data systems within RDRP to assure data quality and consistency and to make efficient use of available staff and funds.

Existing data systems routinely accessed and analyzed by RDRP include:

  • Coal Workers' X-Ray Surveillance Program data from RDRP
  • Multiple-cause-of-death data from NCHS
  • National Health Interview Survey (NHIS) data from NCHS
  • National Health and Nutrition Examination Survey data from NCHS
  • National Hospital Discharge Survey data from NCHS
  • Disability award data from the Social Security Administration and Department of Labor
  • SENSOR data on silicosis and WRA from cooperating state programs
  • Survey of Occupational Illnesses and Injuries data from BL
  • Occupational and environmental diseases data from AOEC
  • Industrial hygiene sampling data from OSHA and MSHA
  • Employment data from MSHA
  • Population data estimates from the Bureau of Census and CDC

Each edition of the “WoRLD Surveillance Report” contains a variety of tables, charts, and maps that provide summary statistics at the national, regional, state and sometimes county levels, for various respiratory diseases and occupational exposures that cause them. For the pneumoconioses, more detail is given, while for diseases that are much less attributable to occupational exposure (e.g. COPD and lung cancer), less information is provided, as appropriate.

In addition to disseminating hard copies of the Report and posting it to the NIOSH Web site’s “publications” repository, the highlights section of the Report is separately posted to the “ORDS” topic page on the NIOSH Web site. More importantly, an electronic version of the “WoRLD Surveillance Report” known as “eWoRLD” has recently been developed and posted to the Web.The user is offered quick access to all tables, figures, and maps in the Report (in three formats: html, gif, PDF) and underlying data (in CSV format).

 Outputs and Transfer

Hard copy surveillance report: NIOSH [2003] Work-Related Lung Disease Surveillance Report 2002. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2003-111 (A8-3). Nearly 9,000 hard copies of the two most recent editions of the “WoRLD Surveillance Report” have been distributed to the occupational safety and health community (previous editions were released in 1991, 1992, 1994, 1996, and 1999).

Electronic, Web-based surveillance report: “WoRLD Surveillance System (eWoRLD)” ( ) (A8-4)

An “ORDS” topic page was developed by RDRP and posted to the NIOSH Web site as an entry portal into RDRP electronic surveillance resources in 2004. This topic page organizes and provides links to a range of RDRP surveillance resources, including the eWoRLD Surveillance System discussed in this section and NORMS, a data-storage and interactive data-retrieval system described in the next section (chapter 8.2).

Intermediate Outcomes

A number of measures suggest that the WoRLD report has had important influence on other groups than RDRP.

RDRP has received numerous telephone and traditional mail contacts, as well as more than 200 email requests for information received at the “mailbox” since 2000. These requests were from other countries, other U.S. federal agencies, state and local health departments, university researchers and educators, practicing physicians, nurse, industrial hygienists, lawyers, insurance companies, unions, and non-governmental health agencies, among others.

Several journals and newsletters advertised publication of the “WoRLD Surveillance Report 2002,” often in the form of a note to the reader. Some include:

  • MMWR
    External link:
  • JAMA archive
    External link:
  • American Family Physician, August 2000
  • Business and Legal Reports, July 2003
  • American Lung Association Web site has an announcement for publication release of the “WoRLD Surveillance Report” and references in their Occupational Lung Disease Fact Sheet
  • Duke University Occupational and Environmental list serve
    External link:
  • UTNE magazine, in an article “The Human Ecologist,” Fall 2000

The “WoRLD Surveillance Report” or portions of the report are also directly linked from several state, federal and private sites. Some include:

In 2005, data on asbestosis from the “WoRLD Surveillance Report 2002” were cited by MSHA in a proposed revision of the asbestos standards for metal and nonmetal mines, surface coal mines, and surface areas of underground coal mines: Department of Labor, MSHA [2005]. Asbestos Exposure Limit; Proposed Rules. 30 CFR Parts 56, 57, and 71. Federal Register 2005; 70(145): 43950–43989 (A8-5).

In 1998, data from the“WoRLD Surveillance Report” was cited by OSHA in support of rulemaking on respiratory protection. ( [External link])

In 2002, surveillance data on asbestosis from the “WoRLD Surveillance Report” were used by Dr. Gregory R. Wagner, NIOSH Division Director, in a statement on Workplace Exposure to Asbestos before the Senate Committee on Environment and Public Works Subcommittee on Superfund, Toxics, Risk, and Waste Management (A8-6). ( [External link])

In 2001, surveillance data on asbestosis from the “WoRLD Surveillance Report” were used by Dr. Kathleen M. Rest, NIOSH Acting Director, in a statement at a hearing of the U.S. Senate Committee on Health, Education, Labor, and Pensions on Examining Workplace Safety and Asbestos Contamination (A8-7).

What’s Ahead

 An updated print version of the “WoRLD Surveillance Report” is being prepared, with an anticipated release in 2007.

“e-WoRLD” will be updated and enhanced annually. In its present form, it presents summary data as published in the “WoRLD Surveillance Report 2002,” but eWoRLD tables, charts, and maps are readily updated as new data become available. Also, in response to NIOSH researchers’ requests, eWoRLD will include data presentations by NORA industry sectors and occupations within those sectors. In addition, a new feature, an index, will be developed and employed to facilitate on-line search for specific information.