ChartBook-Introduction

National Institute for Occupational Safety and Health
Worker Health Chartbook, 2000
September, 2000
DHHS (NIOSH) Publication No. 2000-127

1 Introduction

More than 131 million people are employed in the United States. As we enter the new millennium, the U.S. workforce will be older and more diverse and will continue to shift from traditional heavy industry to services. Alternative work arrangements such as job sharing, part-time scheduling, and temporary or contingent work will become more common in response to rapid technological and economic changes. These changes will present new challenges to assuring the safety and health of Americans in the workplace.

Preventing occupational injuries and illnesses depends on our ability to quantify and track them. Through occupational safety and health surveillance, we can provide ongoing and systematic collection, analysis, interpretation, and dissemination of data for the purposes of prevention. Surveillance increases the effectiveness of prevention activities by targeting them to industries, workplaces, and occupations that have the greatest needs. Surveillance also expands knowledge about which prevention programs are effective.

Current occupational safety and health surveillance efforts indicate that 6.1 million injuries and illnesses were recorded in 1997 in private-sector establishments in the United States. During the same year, 6,238 workers died of occupational injuries. Since 1968, more than 113,000 worker deaths have been attributed to pneumoconioses (dust diseases of the lung). This number represents only a small portion of the total deaths attributable to occupational lung disease. Workplace injuries and illnesses also take a toll on workers' ability to earn a living and on economic productivity overall. From 1973 to 1997, the number of lost-workday cases* rose from 1.9 million to 2.9 million per year. During this period, there was a decrease in the number and rate of cases with actual days away from work and an increase in the number and rate of cases with restricted work activity only. Taken together, the surveillance data indicate that the human and economic losses associated with occupational injuries and illnesses are staggering. Much work remains to reduce those losses, but some improvements have been observed in recent years.

Our ability to survey and assess the state of occupational safety and health has improved over time. Publications such as the Work-Related Lung Disease Surveillance Report, 1999 (WoRLD) [NIOSH 1999], fatality summaries from the National Traumatic Occupational Fatalities Surveillance System (NTOF) [NTOF 1999], and the annual series of occupational safety and health data publications from the Bureau of Labor Statistics (BLS) provide periodic updates on occupational injuries and illnesses. Despite these efforts, occupational safety and health surveillance data are fragmented and have substantial gaps, making it difficult to characterize the overall health of working America. To make existing data more accessible, the National Institute for Occupational Safety and Health (NIOSH) has assembled this chartbook to provide a variety of occupational safety and health surveillance information in a single volume. The book includes contributions from several Federal agencies that collect data relevant to occupational safety and health. These agencies include BLS; the National Center for Health Statistics (NCHS); the National Center for Infectious Diseases (NCID); the National Center for HIV, STD, and TB Prevention (NCHSTP); the National Cancer Institute (NCI); the U.S. Environmental Protection Agency (EPA); the Mine Safety and Health Administration (MSHA); and the Consumer Product Safety Commission (CPSC). We hope this chartbook will be useful to anyone interested in workplace safety and health, including researchers, legislators and policy makers, health care professionals, educators, and occupational safety and health practitioners in labor, management, and consulting environments. NIOSH and the contributing agencies invite everyone to use the information provided here to see where we have been, where we are, and where we might go toward our common goal of protecting the safety and health of American workers.

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Chartbook Organization and Data Systems

This is the first edition of the Worker Health Chartbook, which will be an ongoing effort to assemble and integrate occupational safety and health surveillance information. The document is organized into sections on occupational fatal injuries, fatal illnesses, nonfatal injuries, and nonfatal illnesses. The Focus on Mining section describes safety and health in the mining industry. Topics in this section will change in future editions to summarize available data about other high-risk industries (e.g., agriculture and construction) or special populations (e.g., women and working adolescents).

The information presented here was obtained from several data systems maintained by a variety of Federal agencies. Each system has strengths and limitations. The systems may use different definitions, recording approaches, and sample populations, so they may produce different results for the same topic. For example, some of the reported values represent estimates based on statistical samples of populations, whereas others represent actual counts of cases. Some systems concentrate on workers only, and others report on all U.S. residents aged 15 and older. In addition, most data are restricted to private-sector workers. Public-sector workers (i.e., Federal, State, and municipal workers) may be included in some data systems such as fatality surveys and case-based surveillance systems, but the coding may not permit exact numbers to be determined. Consequently, public workers, a large segment of the U.S. workforce, are not described adequately. Appendix A and the Glossary describe the surveillance systems and terms used throughout this book.

Data on fatal injuries were obtained from NTOF and from the Census of Fatal Occupational Injuries (CFOI). These systems record rates and numbers of fatal injuries by industry and occupation, changes over time, and rates for high-risk industries and occupations. Information about fatal occupational illness was taken from the National Occupational Mortality Surveillance System (NOMS), the National Surveillance System for Pneumoconiosis Mortality (NSSPM), and the Vital Statistics, Mortality, and Multiple-Cause-of-Death data files from the National Center for Health Statistics (NCHS). NOMS presents an overview of the risk of death from several chronic diseases, whereas NSSPM is restricted to the pneumoconioses. The NCHS multiple-cause-of-death data provide information about mortality due to malignant neoplasms of the pleura and hypersensitivity pneumonitis. Data on nonfatal occupational injuries were obtained from the BLS annual Survey of Occupational Injuries and Illnesses (SOII), the National Electronic Injury Surveillance System (NEISS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS). Data on nonfatal occupational illnesses were taken from SOII, the Sentinel Event Notification System for Occupational Risk (SENSOR), the California Department of Pesticide Regulation (CDPR), the Adult Blood Lead Epidemiology Surveillance System (ABLES), the Coal Workers' X-Ray Surveillance Program (CWXSP), the third National Health and Nutrition Examination Survey (NHANES III), the National Surveillance System for Hospital Health Care Workers (NaSH), the Toxic Exposure Surveillance System (TESS), the Viral Hepatitis Surveillance Program (VHSP), the Sentinel Counties Study of Acute Viral Hepatitis, Surveillance for Tuberculosis Infection in Health Care Workers (staffTRAK–TB), and the Centers for Disease Control and Prevention (CDC) national HIV/AIDS Reporting System (HARS).

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Demographics

In 1998, approximately 131 million people were employed in the United States; 54% were male. By race/ethnicity, 84% of these workers were white, 11% were black, and 10% were Hispanic (of any race). These distributions vary by industry division (Table 1–1) and occupation (Table 1–2). In the 15-year period from 1983 to 1998, the largest increases in employment occurred in the services industry division (Figure 1–1) and in the executive, administrative, and managerial occupations and the professional specialty occupations (Figure 1–2). Future employment trends are projected from 1983 to 1998 changes. By 2008, 20 occupations (of 500 listed by the BLS) are projected to gain the largest number of jobs—about 8 million, or 39% of growth (Figure 1–3). Four occupations from this list also appear on the list of fastest growing occupations (Figure 1–4): computer engineers, computer support specialists, computer systems analysts, and personal care and home health aides.

The distribution of the labor force is projected to change by age, with workers aged 45 and older increasing from 33% to 40% of the workforce, and those aged 25 to 44 decreasing from 51% to 44% (Figure 1–5). From 1998 to 2008, the number of women in the labor force will increase by 15% compared with 10% for men and 12% overall. Women's total share of the workforce is projected to increase from 46% in 1998 to 48% in 2008. The share of labor force by race/ethnicity also is projected to shift, with decreases for whites, little or no change for blacks, and increases for Hispanics (of any race), Asians, and other races (Figure 1–6).

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Table 1–1. Persons aged 16 and older employed in the United States in 1998, by major industry, sex, and race/ethnicity. (Source: BLS [1999].)

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Table 1–2. Persons aged 16 and older employed in the United States in 1998, by major occupation, sex, and race/ethnicity. (Source: BLS [1999].)

Figure 1–1. Employment by major industry division, 1983 and 1998. (Source: BLS [1999].)

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Figure 1–2. Employment by major occupational category, 1983 and 1998. (Source: BLS [1999].)

Figure 1–3. Employment growth in occupations gaining the largest number of jobs, projected for 1998–2008. (Source: BLS [2000].)

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Figure 1–4. Employment growth in the fastest growing occupations, projected for 1998–2008. (Source: BLS [2000].)

Figure 1–5. Distribution of the civilian labor force by age group, 1998 and projected for 2008. (Source: Fullerton [1999].)

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Figure 1–6. Civilian labor force share by race/ethnicity, 1998 and projected for 2008. (Source: Fullerton [1999].)

Overview of Occupational Injuries and Illnesses

The Burden of Occupational Injuries and Illnesses

Injuries are generally easier than illnesses to categorize as occupationally related because their occurrence at the workplace or during work activities is usually obvious. Designating illnesses as occupational in origin is not as straightforward because illnesses often take a long time to develop and may be influenced by nonoccupational factors such as age, family history, or lifestyle habits such as tobacco use or avocational noise exposure. For example, a cancer appearing in old age may be very difficult to associate with work performed many years earlier. No single data system describes deaths from all occupational illnesses, but several data systems describe deaths from all occupational injuries. Therefore, the burden of occupational injuries is more apparent than the burden of occupational illnesses.

Fatal Injury

About 17 workers were fatally injured each day in 1997, yielding a total of 6,238 deaths that year; this total is about the same as that for 1992 (Figure 1–7) according to CFOI. Data from NTOF suggest that the overall rate of traumatic occupational fatalities declined during the 1980s and was stable in the early 1990s (Figure 1–8). CFOI fatality estimates exceeded those of NTOF by 1,000 or more for years reported in both surveillance systems (1992–1995).

Fatal transportation incidents accounted for 42% of all occupational injuries in 1997 (Figure 1–9), with highway crashes being the most frequent cause of death. Other frequent transportation incidents included crashes on the side of the road, jackknifings, and overturns. Assaults and other violent acts, including suicide, were the second most common fatal occupational events in 1997, accounting for 18% of total cases (Figure 1–9). Most violent acts were homicides, the second single leading type of fatality. Eighty percent of the homicides resulted from shootings, and most (85%) occurred during a robbery or another crime.

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Figure 1–7. Number of fatal work injuries, 1992–1997. (Source: CFOI [1999].)

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Figure 1–8. Number and annual rate of traumatic occupational fatalities, 1980–1995. (Source: NTOF [1999].)

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Figure 1–9. Number and distribution of fatal occupational injuries in 1997, by event and exposure. An additional 21 fatalities were attributed to other events and exposures, including bodily reaction and exertion. (Source: CFOI [1999].)

No surveillance data exist for most fatal occupational illnesses. One reason for this lack of data is that most occupational illnesses can be caused by factors other than workplace exposures. Lung diseases such as asthma, tuberculosis (TB), respiratory cancers, and chronic obstructive pulmonary disease (COPD) are examples of these diseases. However, the pneumoconioses, a small subset of lung diseases, are among the few illnesses attributable entirely to occupation. Since 1968, more than 113,000 fatalities have occurred with pneumoconiosis listed as an underlying or contributing cause of death (Figure 1–10). The number of deaths declined from a maximum of more than 5,400 in 1972 to slightly more than 3,100 in 1996. Coal workers' pneumoconiosis (CWP) deaths accounted for more than 50% of those deaths. Among the pneumoconioses, only asbestosis deaths have continued to increase.

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Figure 1–10. Number of deaths with pneumoconiosis listed as an underlying or contributing cause, U.S. residents aged 15 and older, 1968–1996. The stacked bars slightly overstate the numbers because some deaths are associated with more than one type of pneumoconiosis. The actual numbers are shown above the bars. (Source: NSSPM [1999].)

Nonfatal Injury and Illness Combined

Injuries accounted for 5.7 million (93%) of the 6.1 million injuries and illnesses reported by SOII for private-sector employers in 1997. The percentage of injuries in the combined count of illness and injury cases varied by industry division according to SOII. In manufacturing, 87% of all cases were injuries; in construction, almost 99% of the cases were injuries (Figure 1–11).

Incidence rates for total recordable cases of injuries and illnesses decreased from 11.0 to 7.1 cases per 100 full-time workers between 1973 and 1997 (Figure 1–12). The greatest change occurred among cases without lost workdays, which decreased from 7.5 in 1973 to 3.8 in 1997. In cases with lost workdays, the incidence rate in 1997 (3.3) was similar to that in 1973 (3.4) despite the fact that the total number of lost-workday cases rose from 1.9 million in 1973 to 2.9 million in 1997.

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Figure 1–11. Number of nonfatal occupational injury and illness cases in private industry, by industry division, 1997. Injuries as the % of total cases for each industry division are shown in parentheses. (Source: SOII [1999].)

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Figure 1–12. Incidence rates for occupational injury and illness cases in private industry, 1973–1997. (Cases without lost workdays and lost-workday cases are subsets of total cases.) (Source: SOII [1999].)

As noted earlier, lost-workday cases include cases with days away from work and cases with restricted work activity only (i.e., cases in which workers report to their jobs for limited duty). From 1988 to 1997, there was a decrease in the rate of cases with days away from work and an increase in the rate of cases with restricted work activity only (Figure 1–13).

One factor contributing to the decline in overall injury and illness incidence rates is the shift in hours worked from a sector with a high rate of injuries (manufacturing) to other sectors with lower rates of injury. Manufacturing hours decreased from 35% of all hours worked in 1973 to 17% of all hours worked in 1997. Hours worked in the service industries increased from 18% to 23% during that period. Actual injury and illness incidence rates from 1973 to 1997 are compared with incidence rates based on the 1973 industry distribution of hours worked (i.e., adjusted rates) in Figure 1–14. In all years, the rates would be higher if the number of manufacturing hours worked was as high as in 1973. However, the decrease over time is still apparent, suggesting that the shift away from work in manufacturing does not account completely for the decrease in injury and illness incidence rates. The results of a similar analysis performed on incidence rates for lost-workday cases are shown in Figure 1–15. Again, the rates would be higher if the number of manufacturing hours worked was as high as in 1973. However, no decrease over time is apparent in Figure 1–15 in either the actual or the adjusted rates.

Incidence rates in 1997 by State for total nonfatal occupational injuries and illnesses in private industry (not available for some States) ranged from a low of 4.4 cases per 100 full-time workers in New York to a high of 10.0 cases per 100 full-time workers in Wisconsin (Figure 1–16). The national rate was 7.1 cases per 100 full-time workers. Rates of nonfatal occupational injury and illness cases with days away from work ranged from 1.4 cases per 100 full-time workers in Georgia to 3.5 cases per 100 full-time workers in Alaska (Figure 1–17). The national rate for lost workdays was 2.1 cases per 100 full-time workers. For nonfatal occupational injuries and illnesses with restricted work activity only, rates ranged from 0.3 cases per 100 full-time workers in New York to 2.3 cases per 100 full-time workers in Maine (Figure 1–18). The national rate of cases with restricted work activity only was 1.2 per 100 full-time workers.

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Figure 1–13. Incidence rates of lost-workday cases associated with nonfatal occupational injuries and illnesses in private industry, 1976–1997. (Cases with days away from work and cases with restricted work activity only are subsets of lost-workday cases.) (Source: SOII [1999].)

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Figure 1–14. Total injury and illness incidence rates in private industry: actual rates compared with rates adjusted to 1973 hours series, 1973–1997. (Source: SOII [1999].)

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Figure 1–15. Incidence rates of lost-workday injury and illness cases in private industry: actual rates compared with rates adjusted to 1973 hours series, 1973–1997. (Source: SOII [1999].)

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Figure 1–16. Incidence rates of nonfatal occupational injury and illness cases per 100 full-time workers in private industry, by State, 1997. National rate was 7.1. (Source: SOII [1999].)

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Figure 1–17. Incidence rates of nonfatal occupational injury and illness cases with days away from work per 100 full-time workers in private industry, by State, 1997. National rate was 2.1. (Source: SOII [1999].)

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Figure 1–18. Incidence rates of restricted-workday cases of nonfatal occupational injury and illness cases per 100 full-time workers in private industry, by State, 1997. National rate was 1.2. (Source: SOII [1999].)

Characteristics of Workers and of Injuries and Illnesses Involving Days away from Work

Workers

Men constituted 55% of the employed workers covered by SOII in 1997, but they accounted for 67% of the 1.8 million occupational injury and illness cases with days away from work (Figure 1–19). Workers aged 25 to 44 constituted 53% of the employed workers covered by SOII in 1997 and accounted for 59% of injuries and illnesses involving days away from work (Figure 1–20).

Ten occupations accounted for nearly one-third of the 1.8 million injuries and illnesses involving days away from work in 1997 (Figure 1–21). Truck drivers, nonconstruction laborers, and nursing aides and orderlies each accounted for more than 90,000 job-related injuries and illnesses involving days away from work. Injuries and illnesses in these three groups represent almost 19% of the total cases with days away from work in 1997. The five occupational groups with the largest numbers of injuries involving days away from work during 1993–1997 are shown in Figure 1–22. Truck drivers accounted for the largest number of lost-time injuries each year.

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Figure 1–19. Employment in private industry and distribution of nonfatal occupational injury and illness cases with days away from work, by sex of worker aged 16 and older, 1997. Excludes cases in which sex of worker was not reported. Total number of injury and illness cases with days away from work was 1,833,380. (Source: BLS [1999]; SOII [1999].)

Figure 1–20. Employment in private industry and distribution of nonfatal injury and illness cases with days away from work, by age of worker, 1997. Excludes cases in which age of worker was not reported. Total number of injury and illness cases with days away from work was 1,833,380. (Source: BLS [1999]; SOII [1999].)

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Figure 1–21. Ten occupations with the most injuries and illnesses involving days away from work, 1997. Total number of injuries and illnesses involving days away from work was 1,833,380. (Source: SOII [1999].)

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Figure 1–22. Number of occupational injuries and illnesses involving time away from work, for selected occupations, 1993–1997. (Source: SOII [1999].)

Injuries and Illnesses

Thirty-one percent of nonfatal injuries and illnesses involving days away from work in 1997 occurred among new workers (i.e., workers having less than 1 year of service with their employer). The percentages for new workers were even higher in mining (44%), agriculture, forestry, and fishing (43%), construction (41%), and wholesale and retail trade (34%) (Figure 1–23). Nearly two-thirds of injury and illness cases with days away from work occurred among workers with 5 or fewer years of service with their employer. Sprains and strains were by far the most frequent disabling conditions, accounting for 799,012 cases (43.6%) with days away from work. Bruises accounted for 165,800 cases (9.0%), and cuts and punctures accounted for another 156,700 cases (8.5%) (Figure 1–24). The back was the body part most often affected by disabling work incidents (Figure 1–25). Bodily reaction and exertion, contact with objects and equipment, and falls were the most frequent events or exposures leading to work injury or illness that involved days away from work (Figure 1–26).

Severity of illness or injury can be estimated from the number of days away from work. Five days was the median number of days away from work for all types of injury and illness. Carpal tunnel syndrome (CTS), fractures, amputations, tendinitis, multiple injuries, and sprains and strains had median days away from work greater than the 5-day median for all injuries and illnesses combined (Figure 1–27).

Figure 1–23. Distribution of nonfatal injuries and illnesses involving days away from work within selected private industry divisions, by length of service with employer, 1997. (Source: SOII [1999].)

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Figure 1–24. Distribution of injury and illness cases with days away from work in private industry, by nature of injury or illness, 1997. Total number of injury and illness cases with days away from work was 1,833,380. (Source: SOII [1999].)

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Figure 1–25. Distribution of injury and illness cases with days away from work in private industry, by part of body affected, 1997. Total number of injuries and illnesses involving days away from work was 1,833,380. (Source: SOII [1999].)

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Figure 1–26. Distribution of occupational injuries and illnesses involving days away from work in private industry, by type of event or exposure, 1997. Total number of injuries and illnesses involving days away from work was 1,833,380. (Source: SOII [1999].)

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Figure 1–27. Median days away from work due to selected types of nonfatal occupational injury or illness in private industry, 1997. (Source: SOII [1999].)

Updated on 06/25/02

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