Burden, Need and Impact
There were approximately 15.4 million workers in Manufacturing in 2017, which is 10% of the workforce. This sector accounted for 5.8% of the fatalities for U.S. workers. It also had approximately 426,400 occupational injuries and illnesses, 12.5% of the total.1 Although injuries and illnesses are challenging to track and are frequently undercounted, this is the best estimate available at this time.2
Data related to some of the health outcomes of concern may be available in the NIOSH Worker Health Charts (WHC). WHC is a web application that uses data from various sources to visualize worker health data that may be difficult to find or not charted elsewhere. Note that some industries may not be represented in this tool due to small sample size.
NIOSH strives to maximize its impact in occupational safety and health. The Manufacturing Program identifies priorities to guide investments, and base those priorities on the evidence of burden, need and impact. In 2012, NIOSH published the Mortality and disability report among workers 18 and older in the Manufacturing Sector, 1997-2007.pdf icon Below are the priority areas for the Manufacturing Program.
Hazardous exposures in the workplace have been associated with serious chronic diseases. Despite the limitations of the data sources on chronic conditions, the burden of cancer, reproductive disorders, neurologic disorders and respiratory disorders has been defined to some extent. Hazards associated with such health outcomes have also been documented.
- Researchers have estimated that between 2-8% of all cancers worldwide are caused by exposures to carcinogens in the workplace. 1-4
- Occupational exposures likely play an important and perhaps under-recognized role in adverse reproductive outcomes, such as infertility, menstrual cycle changes, pregnancy loss, pregnancy complications, and congenital malformations in offspring.5-6
- Neurologic disorders that may be associated with occupational exposures include neurodegenerative diseases (such as the motor neuron diseases, Parkinson’s disease, dementias, and multiple sclerosis) and other conditions such as peripheral neuropathies and chronic toxic encephalopathies. Neurotoxic effects are the basis for exposure limits for about 40% of the agents considered hazardous by NIOSH.7
High priority agents for cancer studies within the manufacturing sector include nanomaterials (specifically, carbon nanoparticles) and welding fumes; emerging agents of concern related to occupational cancer among workers in this sector include plasticizers and flame retardants.
Toxicants with reported reproductive and developmental effects are in regular commercial use and thus present potential exposure to workers. High priority agents to which workers in the manufacturing sector may be exposed include heavy metals, organic solvents, and the large class of agents characterized as endocrine disrupters.
While no occupational agent has been identified that is responsible for a significant number of cases of occupational neurologic diseases compared to some other health outcomes, reflecting the “emerging” nature of the study, focused etiologic research could help to ascertain whether workplace exposures are contributing to this burden.
Chronic diseases including cancers, reproductive disorders and neurologic disorders that occur as a result of exposures in the workplace are preventable, if exposures to known or suspected risk factors can be reduced. Foundational studies to identify hazardous exposures and their health effectives are often done in the Manufacturing sector because the exposure is highest and the population of interest is the largest. Their impact goes far beyond Manufacturing. For example, 70-80% of the cancer evaluations conducted by the International Agency for Research on Cancer (across all working and non-working populations) incorporated NIOSH research studies into their findings. The National Toxicology Program’s Report on Carcinogens frequently relies on findings from NIOSH studies in its evaluation of potential carcinogens, and the Occupational Safety and Health Administration frequently cites NIOSH’s cancer epidemiology studies as the basis of its rulemaking pertaining to occupational carcinogens.
Research from NIOSH (coordinated by the Manufacturing and Cancer, Reproductive, Cardiovascular, and Other Chronic Disease Prevention programs) play an important role in furthering our understanding of the health effects of workplace exposures and towards the development and evaluation of control interventions for the prevention.
- Driscoll T, Takala J, Steenland K, Corvalan C, Fingerhut M . Review of estimates of the global burden of injury and illness due to occupational exposures. Am J Ind Med 48:491-502.
- Purdue MP, Hutchings SJ, Rushton L, Silverman DT . The proportion of cancer attributable to occupational exposures. Ann of Epi 25(3):188-192.
- Rushton L, Hutchings SJ, Fortunato L, Young C, Evans GS, Brown T, Bevan R, Slack R, Holmes P, Bagga S, Cherrie JW . Occupational cancer burden in Great Britain. Br J Cancer 107(Suppl 1):S3-7.
- Steenland K, Burnett C, Lalich N, Ward E, Hurrell J . Dying for work: the magnitude of US mortality from selected causes of death associated with occupation. Am J Ind Med 43(5):461–482.
- CDC . Update on overall prevalence of major birth defects–Atlanta, Georgia, 1978-2005. MMWR 57(1):1-5, https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a2.htm
- CDC . Reproductive health- infertility FAQs. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. https://www.cdc.gov/reproductivehealth/infertility/index.htm
- Pearce N and Kromhout H . Neurodegenerative disease: The next occupational disease epidemic? Occup Environ Med 71(9):594-595.
In 2015, among over 15 million U.S. manufacturing workers, traumatic injury incidents led to 353 fatalities and approximately 425,700 non-fatal injuries, of which 122,610 involved missed work days.1-3 One of the leading causes of fatal and non-fatal injuries was interaction with machines. The highest risk machines were: material and personnel handling machinery (e.g., conveyors and cranes); and metal, woodworking, and special material machinery. In addition to traditional machinery-related injuries, rapid advances in automation technologies (e.g., fixed robots, collaborative and mobile robots, and exoskeletons) have introduced additional, less understood sources of workplace hazards in manufacturing workplaces. Despite limited occupational surveillance data, 61 robot-related workplace fatalities were reported between 1992 and 2015.4
To reduce the number of injuries and fatalities due to contact with objects and equipment among workers in the manufacturing sector, NIOSH identified several needs, which include:
- Tracking and preventing injuries and fatalities among vulnerable groups or workers in non-standard work arrangements; and worker populations who utilize or interact with machinery for material handling (e.g., conveyors) and processing (e.g., metal or woodworking machines);
- Expanding U.S. occupational injury surveillance capabilities to better identify, monitor, and quantify the burden of fatal and non-fatal incidents involving robots (e.g., development of new source or event codes);
- Studying the impact of personal, environmental, and task-related risk factors on worker injuries associated with robots;
- Studying the effectiveness of interventions for robotics safety;
- Disseminating safe machine control and maintenance procedures, and translating evidence-based interventions into workplace practice.
In a coordinated effort between the NIOSH Manufacturing Program, the Traumatic Injury Prevention Programs, the Center for Occupational Robotics Research, new evidence will be generated to develop new safety procedures, safe equipment design and operations specific to the manufacturing industry. NIOSH scientists published a paper on recommendations for workplaces incorporating robot workersexternal icon, which updated information to occupational safety and health professionals. The potential for impact of new evidence involves motivating employers to maintain and improve safety initiatives, but it also can help them identify hazards to guide risk assessments, identify appropriate types of safety interventions and provide appropriate justification for safety interventions that prioritize risk mitigation efforts.
- BLS . TABLE A-4. Fatal occupational injuries by primary and secondary source of injury for all fatal injuries and by major private industry 1 sector, all United States, 2015. In: Census of Fatal Occupational Injuries, 2015. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshcfoi1.htm#2015external icon.
- BLS . Chart 4. Distribution of nonfatal occupational injuries and illnesses by private industry sector, 2015. In: 2015 Survey of Occupational Injuries & Illnesses Summary Estimates Charts Package. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/osh/os/osch0057.pdfpdf iconexternal icon.
- BLS . TABLE R65. Number and percent distribution of nonfatal occupational injuries and illnesses involving days away from work by industry and number of days away from work, and median number of days away from work, private industry, 2015. In: Case and Demographic Characteristics for Work-related Injuries and Illnesses Involving Days Away From Work. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshcdnew2015.htm#Resource_Table_categories-2015external icon.
- Division of Safety Research . Robot-related workplace fatality analyses: Census of Fatal Occupational Injuries Research File (provided to NIOSH by Bureau of Labor Statistics). Morgantown, WV: Division of Safety Research. Unpublished.
The incidence rate for musculoskeletal injuries resulting in days-away-from-work for the manufacturing sector was 33.4 per 10,000 equivalent full-time workers compared to an incidence rate of 29.8 for all private establishments in 2015.1 This translates to approximately 41,000 severe musculoskeletal injuries in Manufacturing. Work-related musculoskeletal disorders (MSDs) or overexertion 2016 BLS surveillance data1, Ohio Bureau of Workers’ Compensation2 , and Washington State Department of Labor and Industries3 offer evidence that the food, wood product, foundries, and transportation equipment manufacturing subsectors have the greatest burden. However, currently the available data for prioritizing industry burden by body region (e.g., low back, upper extremities) is limited. Rapid advances in robotics and other emerging manufacturing technologies are likely to present new risks or exacerbate existing risks due to lack of experience with robots in varied work settings, potential unforeseen hazards, and unanticipated consequences in the manufacturing industry.
To reduce the number and severity of MSDs among workers in the Manufacturing sector, NIOSH has identified the need for several activities:
- Identify risk factors among worker populations who utilize or interact with machinery for material handling (e.g., conveyors) or processing (e.g., metal or woodworking machines), as well as emerging industrial machines (e.g., robots, collaborative robots)
- Provide intervention tools and engineering controls to reduce the number and severity of musculoskeletal disorders among sector workers. Vulnerable workers and those with non-standard work arrangements are especially important populations to reach.
- Implement activities that move research into practice to prevent musculoskeletal disorders among Manufacturing sector workers.
The NIOSH Manufacturing Program coordinates efforts with the NIOSH Musculoskeletal Health, Center for Occupational Robotics Research, and Health Hazard Evaluations (HHE) programs. NIOSH conducts health hazard evaluations of MSD issues in manufacturing, and typical recommendations for addressing MSD risk factors include reducing the weight of the load lifted through engineering or administrative controls and using ergonomic guidelines to design work stations and work tasks. The program has also established a collaboration with the NIOSH Center for Worker’s Compensation Studies and the NIOSH Economic Research and Support Office for surveillance and intervention effectiveness research, which could help workers and employers identify effective interventions. Impact can be achieved by proposing and/or evaluating and programs designed to prevent and mitigate MSDs across different age groups. Work is under way to identify improved measurement methods, research findings and effectiveness and cost-benefit of injury prevention and mitigation program. Any progress made to lessen the incidence and severity of MSDs would significant improve workers’ health, well-being and could bring significant cost reductions to industry.
- BLS . Nonfatal cases involving days away from work: selected characteristics by detailed industry with musculoskeletal disorders, All U.S., All workers, Private industry, (2011-2015). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics.
- Meyers AR, Al-Tarawneh IS, Wurzelbacher SJ, Bushnell PT, Lampl MP, Bell J, Bertke SJ, Robins DR, Tseng C, Wei C, Raudabaugh JA, Schnorr TM . Applying machine learning to workers’ compensation data to identify industry-specific ergonomic and safety prevention priorities — Ohio, 2001–2011. Manuscript submitted for publication.
- Washington State Department of Labor & Industries .Aggregate Washington State workers’ compensation claims data by industry group, injury type, including work-related musculoskeletal disorders, 2011-2014. Unpublished Tableau Packaged Workbook.
Occupational hearing loss is caused by exposure at work to loud noise or chemicals that damage hearing. Prevention is key because hearing loss is permanent and can have a profound impact on quality of life. This burden that can be measured using disability-adjusted life years (DALYs). It is an approach that can be used to quantify the impact of hearing loss on critical intangibles, such as communication and mental health. NIOSH found that 2.7 healthy years are lost each year for every 10,000 workers in manufacturing.1 An estimated prevalence of noise exposed workers in the manufacturing sector is nearly 6 million workers (37%) based upon National Health and Nutrition Examination Survey (NHANES)2 data, while the burden for hearing loss among noise-exposed workers in the manufacturing sector was about 20%.3
To reduce the number and severity of hearing loss among workers in the manufacturing sector, NIOSH is undertaking several activities:
- Implement surveillance activities to identify and reduce sources of noise exposures, conduct longitudinal analyses of hearing outcomes, implement hearing protection usage guidance, and utilize proven effective engineering noise control solutions.
- Implement research and development activities for identifying effective noise controls, educational outreach, economic cost benefit examples, and quiet-by-design activities for controlling exposure through reducing the noise at the source.
- Implement research and development activities for personal hearing protection devices, effective means of fit-testing protectors, guidance, and educational materials for use of hearing protection in the workplace.
- Implement research activities to characterize hearing loss risk factors (impulsive noise, chemicals, etc.) in manufacturing.
- Implement research activities to develop metrics of intervention effectiveness for hearing loss prevention to validate consensus standards, and to publicize or assess the effectiveness of hearing conservation program.
The NIOSH Manufacturing Program coordinates efforts with the NIOSH Hearing Loss Prevention and Surveillance programs which allow for the estimation of the prevalence and incidence of hearing loss within manufacturing as well as in other various industries. While the general trend has been one of decline in the incidence of hearing loss in the manufacturing sector (a 2% reduction from 1986–2010), the rates remain high.3 NIOSH has also supported the audiometric component of the National Health and Nutrition Examination Survey (NHANES). The NHANES data have been utilized in the updated International Standards Organization acoustic standard, ISO 1999:2013. ISO 1999 allows estimation of expected hearing loss due to varying intensities and durations of noise exposure during employment.
NIOSH has created an award program, the Safe-In-Sound Excellence in Hearing Loss Prevention Awardexternal icon™, to identify and disseminate real-world examples of noise control and other hearing loss prevention practices and innovations. Recently, NIOSH also released a Sound Level Meter App that can help occupational safety and health professionals and workers can measure sound levels in real time and make adjustments as needed. Promoting and encouraging the evaluation of the effectiveness of interventions is expected to expedite progress and contribute to a decrease in the rates of hearing disorders in manufacturing.
- CDC . Hearing Impairment among Noise-Exposed Workers — United States, 2003–2012. MMWR 65:389–394. http://dx.doi.org/10.15585/mmwr.mm6515a2Externalexternal icon.
- Tak S, Davis RR, Calvert GM . Exposure to hazardous workplace noise and use of hearing protection devices among US workers — NHANES, 1999-2004. Am J Ind Med 52(5):358-371.
- Masterson EA, Deddens JA, Themann CL, Bertke S, Calvert GM . Trends in worker hearing loss by industry sector, 1981-2010. Am J Ind Med 58(4):392-401.
The Manufacturing program currently focuses on three respiratory conditions: dust-induced respiratory diseases, fixed airways diseases and work-related asthma.
Respiratory diseases such as dust-induced respiratory diseases, fixed airways diseases and asthma are a substantial problem in the manufacturing sector. For example, during 1990–1999, manufacturing accounted for 43.8% of all deaths due to silicosis, which was the largest percentage for any one industrial sector, and nearly twice as much as the next highest sector.1 Evidence also documents that workers in certain manufacturing subsectors are at increased risk for chronic obstructive pulmonary disease (COPD). Using data from 2004–2011, an estimated 3.2% of the average annual number of workers in the manufacturing sector (14.7 million) have chronic obstructive pulmonary disease (COPD), totaling about 470,000 people.2 Work-related asthma (WRA) encompasses occupational asthma (caused by work) and work-exacerbated asthma (existing asthma is made worse by work exposures). About 15% of the 750,000 manufacturing workers have asthma caused by work, totaling about 113,000 workers, when reported in 2009.3
To reduce respiratory disease among workers in the manufacturing sector, NIOSH is undertaking several activities:
- Better define risks and mechanisms of action of various chemical exposures. This would allow for better prediction of risk and prevention through design based on chemicals’ molecular structures, for example prediction of risk from various flavoring chemicals. It would also allow for development of biomarkers allowing better detection of health effects such as sensitization to isocyanates.
- Exposure assessment research, including direct-reading methods. This serves as a foundation for epidemiological research, which is needed to document exposure-response relationships. This can also support research to develop interventions to control respiratory exposures.
- Identification of potential health hazards of new and emerging agents such as nanomaterials, advanced manufacturing materials, and abrasive blasting agents.
- Surveillance research to develop novel approaches for health and hazard surveillance that will improve the ability to track the burden of hazardous exposures and work-related illnesses associated in particular with respirable crystalline silica, diacetyl, refractory ceramic fibers, asthmagens, among other respiratory hazards.
NIOSH identified in flavoring manufacturing workers and microwave popcorn workers who were occupationally exposed to diacetyl (2,3-butanedione) or butter flavorings containing diacetyl and developed obliterative bronchiolitis, an irreversible form of lung disease. The NIOSH Alert: Preventing Lung Disease in Workers Who Use or Make Flavorings recommends steps that companies and workers should take to prevent hazardous exposures. Most recently, NIOSH has conducted several Health Hazard Evaluations in coffee roasting and packaging facilities and provided guidance to employers to prevent hazardous exposures to Diacetyl (2,3-butanedione) and 2,3-pentanedione (acetyl propionyl).
- NIOSH . Work-Related Lung Disease Surveillance System (eWoRLD). 2008-128 Cincinnati, OH, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, http://wwwn.cdc.gov/eworld/Data/128
- NIOSH . Chronic obstructive pulmonary disease: Estimated prevalence by current industry, U.S. working adults aged 18 and over, 2004–2011. From: Work-Related Lung Disease Surveillance System (eWoRLD). 2014-492. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,National Institute for Occupational Safety and Health, https://wwwn.cdc.gov/eworld/Data/492, accessed 6/14/17.
- Torén K, Blanc PD . Asthma caused by occupational exposures is common – A systematic analysis of estimates of the population-attributable fraction. BMC Pulmonary Medicine 9.
1 National Institute for Occupational Safety and Health. (2015). Current U.S. Workforce Data by NORA sector. https://www.cdc.gov/niosh/topics/surveillance/default.html
2 Bureau of Labor Statistics. (2016). An update on SOII undercount research activities. https://www.bls.gov/opub/mlr/2016/article/an-update-on-soii-undercount-research-activities.htmexternal icon