Respiratory Health Program: Economic and Surveillance Data
Input: Economic and Surveillance Data
Surveillance inputs for the RDRP have been catalogued in the WoRLD Surveillance Report since it was first published in 1991. These important data can now be accessed rapidly via the internet.
Work-Related Asthma (WRA)
Work-related asthma is the most common respiratory disease treated in occupational health clinics in the U.S. According to the American Thoracic Society (ATS) 15% of asthma among adults is attributable to work.1 RDRP researchers estimate that 23% of working asthmatics experience exacerbation at work. Extrapolated to all working asthmatics, this could affect 2.25 million Americans between the ages of 15 and 65. The economic impact of WRA has been estimated to be between $1.1 and $2.1 billion per year.2 3
Indoor Environmental Quality (IEQ)
Almost 70 percent of U.S. workers (approximately 89 million people) are employed in non-industrial, non-agricultural, indoor settings, referred to here as indoor work environments. Studies have associated some indoor environmental conditions with increased risks of nonspecific symptoms, respiratory disease (including asthma), and impaired performance. A report by the NORA Indoor Air Team suggested that improving building environments had the potential to result in health benefits for more than 15 million U.S. indoor workers, with estimated economic benefits of $5 to $75 billion annually.4A historical review of the NIOSH Health Hazards Evaluation (HHE) program showed that the proportion of IEQ requests since 1978 has increased 100-fold and currently accounts for approximately 52 percent of all requests. Building-related asthma was an issue in about a quarter of these indoor environmental quality requests. The majority of requests mentioning asthma as a health concern also mentioned mold or water damage as environmental exposure concerns.5
Chronic Obstructive Pulmonary Disease (COPD)
COPD is the fourth leading cause of death after heart diseases, cancer and cerebrovascular disease. It presents a large economic burden through high health care costs and loss of productivity. A review published by the ATS estimated that approximately 15% of COPD was attributable to occupation.7 Another ATS review published in 2003 estimated that the economic burden of work related COPD to the U.S. economy was approximately $3.3 – $6.6 billion per year.6 9
Coal Workers’ Pneumoconiosis (CWP)
Relative to the 1970s, there has been much progress towards the elimination of CWP, commonly referred to as “black lung.” However, the problem continues to exist. Recent surveillance outreach activities by RDRP staff using a mobile x-ray and examination unit documented a cluster of cases of advanced pneumoconiosis, including progressive massive fibrosis, in the Virginia/West Virginia/Kentucky tri-state area.7 RDRP continues this surveillance effort. Meanwhile over 102,000 beneficiaries and 18,000 dependents received coal mine worker compensation in 2004. The Black Lung Trust Fund paid out over $54 million for the diagnosis and treatment of miners for pneumoconiosis and almost $800 million in disability payments in fiscal year 2004.8
In the mid-1980s, NIOSH published estimates of 2.3 to 4.3 million workers at risk of occupational exposure to silica dust in myriad occupations, including: mining, sandblasting, surface drilling, stone cutting, construction, pottery making, silica flour milling, tunneling, and concrete cutting.9 Between 1968 and 2003, there were 15,714 deaths in the U.S. where the death certificate mentioned silicosis. Annual silicosis deaths decreased from 1,065 in 1968 to 179 in 2003,10 but recent estimates show that between 3,600 and 7,300 cases of silicosis are newly recognized each year.11 Also, OSHA and MSHA silica sampling data for 1999 indicate that 47 percent of samples from construction, 38 percent from manufacturing, and eight percent from mining exceeded the PEL for silica and over half of all such silica samples in construction and manufacturing exceeded NIOSH REL for silica (0.05 mg/m3). Thus, while there have been vast improvements in recent decades, silicosis is likely to continue to occur well into the future.
Inorganic Fibers and Asbestosis
Estimates of the total number of workers potentially exposed to all types of respirable fibers have not been made. However, summing available estimates for several types of fibers (asbestos, fibrous talc, fibrous glass, wollastonite and attapulgite fibers, and refractory ceramic fibers), nearly four million workers may be at risk.12 Asbestosis is the prototypical fiber-induced interstitial lung disease. This chronic lung disease is characterized by interstitial inflammation and subsequent scarring, leading to radiographic and functional abnormalities that can be disabling and fatal. Affected occupational groups largely reflect the historical major end user industries: shipbuilding/repair, construction materials, and other friction and insulation applications. But, because asbestos has been used in several thousand products with innumerable uses, risk has been widespread and, as recently as the 1980s, NIOSH estimated that 1,500,000 workers remained at risk for asbestosis. National death data distinguish asbestosis as the only major pneumoconiosis for which mortality is increasing in the U.S., from fewer than 100 deaths in 1968 to nearly 1500 in 2002, due in part to long latency between exposure and disease and perhaps also to improved recognition and diagnosis. However, OSHA and MSHA asbestos sampling data indicate substantial declines in exposure for manufacturing, construction, and mining over the past two decades. According to a RAND Corporation study, $54 billion had been paid out in asbestos-illness cases as of 2002 and as many as 2.4 million claims could be filed, costing businesses about $210 billion more.
Chronic Beryllium Disease (CBD)
Beryllium is a lightweight metal with many remarkable properties, such as heat resistance and conductance, electrical conductance, flexibility, formability, neutron moderation, x-ray transparency, and lubricity, among others. These properties enable many essential and/or unique applications in a variety of industries, including nuclear weapons and energy, medical devices, aerospace, and electronics. Beryllium’s use is steadily becoming more widespread and diverse. As many as 134,000 current U.S. workers may be exposed to beryllium and it is likely that many times that number have been exposed at some time in their working lives. Exposure to beryllium can lead to sensitization via a cell-mediated immune response, and cause CBD, an immunologic granulomatous lung disease. Chronic beryllium disease is incurable and can result in serious impairment and even death. Sensitization has been found in one percent to 10 percent of beryllium production workers in cross-sectional studies, with CBD diagnosed in 10 percent to 100 percent of the sensitized. In addition, beryllium-sensitization and CBD present a unique problem in that a known genetic component, certain forms of the HLA-DPB1 gene, is associated with susceptibility in workers exposed to beryllium. Although understanding the genetic underpinnings of CBD may eventually help to prevent beryllium-sensitization and CBD, genetic research in the workplace is a challenge because it invokes important ethical legal and social issues.
Occupational Infectious Diseases
Occupational respiratory infectious diseases can affect workers in a range of occupations and industries. The healthcare industry, which employs approximately 14 million people in the U.S.,13 is a particularly important area of concern. For example, in the case of SARS, more than 20 percent of all cases world-wide were healthcare workers.14 New, emerging infectious disease agents capable of causing respiratory infection in healthcare workers and others are also an important area of concern. These agents include drug-resistant forms of tuberculosis, avian and pandemic influenza, SARS, and bioterrorism agents such as anthrax.
Lung cancer is the most common malignancy in the U.S. and is ranked second only to bladder cancer in the proportion of cases thought to be due to occupational exposures.15 NIOSH has identified more than 150 chemical agents that are considered to be occupational carcinogens or potential occupational carcinogens.16 Based on 1996 data, it was estimated that approximately 9,000-10,000 men and 900-1,900 women developed lung cancer annually in the U.S. due to past exposure to occupational carcinogens. More than half of these lung cancers were attributed to asbestos.17
The U.S. Federal Government invests $1 billion each year in nanotechnology research and development (National Nanotechnology Initiative), and it is estimated that by 2015 the global nanotechnology market will be worth more than $15 billion. With the expected recruitment of 2 million nanotechnology workers worldwide, the potential for adverse respiratory exposure to materials engineered at a scale of less than 100nm is very real. Materials engineered at this scale exhibit unique physical, chemical and biological properties. Given experience of previous occupational exposures that have caused respiratory health problems, entering the nanotechnology era should be done with caution from a health and safety perspective.18
- American Journal of Respiratory & Critical Care Medicine. 167:787-797, 2003
- Asthma and Allergy Foundation of Americaexternal icon
- Chest. 121:264-272, 2002
- American Journal of Public Health. 92:1430-1440, 2002
- U.S. National Library of Medicine, Environmental Health and Toxicologyexternal icon
- National Center for Health Statistics (NCHS)
- Advanced Pneumoconiosis Among Working Underground Coal Miners – Eastern Kentucky and Southwestern Virginia, 2006
- U.S. Department of Labor, Division of Coal Mine Workers’ Compensationexternal icon
- Occupational Respiratory Diseases
DHHS (NIOSH) Publication No. 86-102 (September 1986)
- Occupational Respiratory Disease Surveillance
- Estimating the total number of newly-recognized silicosis cases in the U.S.
Am J Ind Med 44:141-147, 2003
- Criteria for a Recommended Standard: Occupational Exposure to Refractory Ceramic Fibers
DHHS (NIOSH) Publication No. 2006-123 (May 2006)
- NIOSH Health Care and Social Assistance Program Portfolio, Sector Description
- Annals of the Academy of Medicine, Singapore 35:374-378, 2006
- American Journal of Industrial Medicine 29:474-490, 1996
- NIOSH Carcinogen List
- American Journal of Industrial Medicine 43:861-862, 2003
- National Nanotechnology Initiative, Environmental, Health, and Safety Issuesexternal icon