Georgia occupational health surveillance report, 2006-2009

Georgia Occupational Health Surveillance Report
2006-2009

Acknowledgements
Georgia Department of Public Health Brenda Fitzgerald, MD, Commissioner Health Protection J. Patrick O'Neal, MD, Director Epidemiology Program Cherie L. Drenzek, DVM, MS, State Epidemiologist Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section A. Rana Bayakly, MPH, Chief Epidemiologist Occupational Health Surveillance Epidemiology Antionette Lavender, MPH, Epidemiologist
Graphic Design: Ginny Jacobs
Suggested citation: Lavender A., Bayakly A.R., Georgia Occupational Health Surveillance Report, 2006-2009. Georgia Department of Public Health, Epidemiology Program, September 2012. This publication was supported by Cooperative Agreement Number 1U60OH009870-03 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.
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Table of Contents
Executive Summary.......................................................................................................................................................................................................... 4 Profile of Georgia workforce, aged 16 years and older, 2006-2009................................................................................................................. 6 Indicator 1: Nonfatal work-related injuries and illnesses reported by employers.................................................................................... 9 Indicator 2: Work-related hospitalizations..............................................................................................................................................................11 Indicator 3: Fatal work-related injuries.....................................................................................................................................................................12 Indicator 4: Work-related amputations with days away from work reported by employer..................................................................14 Indicator 5: Workers' compensation claims for amputations with lost work time....................................................................................15 Indicator 6: Hospitalizations for work-related burns...........................................................................................................................................16 Indicator 7: Work-related musculoskeletal disorders with days away from work reported by employer........................................17 Indicator 8: Workers' compensation claims for carpal tunnel syndrome with lost work time..............................................................18 Indicator 9: Pneumoconiosis hospitalizations.......................................................................................................................................................19 Indicator 10: Pneumoconiosis mortality..................................................................................................................................................................20 Indicator 11: Acute work-related pesticide poisonings reported to Poison Control Centers...............................................................21 Indicator 12: Incidence of malignant mesothelioma..........................................................................................................................................22 Indicator 13: Elevated blood lead levels among adults.....................................................................................................................................23 Indicator 14: Workers employed in industries at high risk for occupational morbidity.........................................................................25 Indicator 15: Workers employed in occupations at high risk for occupational morbidity.....................................................................26 Indicator 16: Workers employed in occupations and industries at high risk for occupational mortality........................................27 Indicator 17: Occupational safety and health professionals.............................................................................................................................28 Indicator 18: Occupational safety and health administration (OSHA) enforcement activities............................................................30 Indicator 19: Workers' compensation awards........................................................................................................................................................31 Indicator 20: Work-related low back disorder hospitalizations.......................................................................................................................32 State Specific Indicator 1: Work-related asthma...................................................................................................................................................34 State Specific Indicator 2: Arthritis among employees.....................................................................................................................................36 State Specific Indicator 3: Workplace secondhand smoke exposure............................................................................................................37 References............................................................................................................................................................................................................................38 Data Sources and Limitations.......................................................................................................................................................................................39 Appendices..........................................................................................................................................................................................................................43
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Executive Summary
Over four million people aged 16 years and older make up Georgia's workforce. Almost half of a worker's lifetime is spent at work or commuting, which makes the workplace an important determinant of a person's health.1 Social factors, workplace procedures and design, chemical exposures, and chronic wear and tear are all facets of the workplace that may negatively impact workers' health.1,2,3 Some workers are employed in occupations or industries that may put them at higher risk of work related injuries or illnesses or being exposed to harmful substances. These injuries, illnesses, and exposures on the job can affect workers' health for the rest of their lives. Thus, the workplace provides unique opportunities for public health interventions.1
Work-related injuries and illnesses can be prevented, especially by controlling of occupational hazards and exposures. Resource allocation for prevention can be prioritized by focusing on industries and occupations that are at high risk for injury and illness.4 The Council of State and Territorial Epidemiologists (CSTE), in association with the National Institute of Occupational Safety and Health (NIOSH), has recommended that states conduct surveillance for a set of 20 occupational health indicators. These indicators serve as baseline measures of the occupational health status of a state's workforce and will allow states to track trends and guide prevention and intervention efforts.4 Each indicator falls under one of the five categories below:
Health Effect Indicators (13)--measures of injury or illness that indicate adverse effects from exposure to known or suspected occupational hazards
Exposure Indicator (1)--measures of markers in human tissue or fluid that identify the presence of a
potentially harmful substance resulting from exposure in the workplace Hazard Indicators (3)--measures of potential for worker exposure to health and safety hazards in the
workplace Intervention Indicators (2)--measures of intervention activities or intervention capacity to reduce
workplace health and safety hazards Socioeconomic Impact Indicator (1)--measure of the economic impact of work-related injuries and
illnesses4
Georgia has also elected to conduct surveillance for three state-specific occupational health indicators. These include work-related asthma, arthritis among workers, and workplace secondhand smoke exposure. A variety of sources were used to collect data for the 2006-2009 occupational health indicators. Due to limitations of the sources, most of the data provided are believed to be underestimates. The exact methods by which the indicators were calculated can be found in CSTE's guidance document entitled, Occupational Health Indicators: A Guide for Tracking Occupational Health Conditions and Their Determinants (at www.cste.org).
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While decreases were noted for most of the injuries and illnesses reported during 2006-2009, it is uncertain whether these decreases are due to the declines in employment observed in the state. The percent of unemployment increased from 4.6% in 2006 to 10.7% in 2010.5,6 Nevertheless, the data provided in this report estimates the burden of work-related injuries and illnesses and gives baseline measures of occupational health in Georgia during 2006-2009. At the time of this report, 2009 was the most current year of data available for many of the data sources used. The information in this report can be used to identify contributory factors and develop improved or new prevention strategies and regulations to protect the health of Georgia's workers.
Below are highlights of the findings in this report:
In 2009, private sector employers reported that an estimated 87,400 work-related injuries and illnesses occurred among workers in Georgia.
The 2009 incidence rate of total work-related injuries and illnesses involving days away from work was 800 per 100,000 full-time workers.
A total of 110 fatal work-related injuries were reported in Georgia during 2009. The five most frequent causes of fatal work-related injuries in Georgia were highway accidents,
homicides, falls, being struck by an object, and having contact with electric current. In 2009, there were 149 hospitalizations for burns reported in Georgia among workers aged 16 years
and older in which workers' compensation was the primary payer. The most frequent work-related musculoskeletal disorder in Georgia involves disorders of the back. The rate of work-related pesticide poisonings in Georgia during 2009 was 2.2 per 100,000 employed
persons, slightly higher than the national rate. About 72% of pneumoconiosis hospitalizations in Georgia were from asbestosis. In Georgia, the number of new cases of mesothelioma increased from 46 in 2006 to 61 in 2009. In 2009, Georgia had 147 prevalent cases of elevated blood lead levels of 25 g/dL or greater among
those aged 16 years and older. Over 500,000 Georgia workers were employed in occupations at high risk for occupational morbidities
in 2009. Workers' compensation benefits paid to Georgia workers with occupational injuries or illnesses
increased from approximately $1.2 billion in 2006 to $1.5 billion in 2009. The rate of occupational medicine physicians in Georgia is 0.02 per 1,000 employees, much lower than
the recommended rate of 1 per 1,000 employees. Among currently employed adults with work-related asthma, 36.4% say that their asthma is made
worse by their current job, and 18.4% say that their asthma is caused by their current job.
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Profile of Georgia Workforce, Aged 16 Years and Older, 2006-2010

An average of 4.5 million civilians were employed in Georgia during 2006-2010 (Table 1). Over this five-year period, unemployment increased from 4.6% in 2006 to 10.7% in 2010. Males made up over half of Georgia's workers. In 2010, 52.8% of the workforce was males and 96.2% of workers were between the ages of 18-64 years. About 68.5% of workers were white, 27.3% were black, and 4.2% were of other races. Additionally, 8.7% of the civilian workforce was of Hispanic origin. Georgia civilian employment demographics are compared to Georgia population demographics in Appendix 1.
About 68.7% of Georgia's workers spent 40 or more hours per week on the job and about 5.9% of workers were self-employed. Educational and health services (20.8%), wholesale and retail trade (15.1%), professional and business services (12.6%), manufacturing (9.3%), and leisure and hospitality (8.8%) were the top five employment industries in the state. The five most common occupations were professional and related occupations (20.3%), management, business, and financial operations (16.4%), service (16.4%), sales and related occupations (12.5%), and office and administrative support (12.5%). Table 2 shows the leading industries and occupations by sex and by race/ethnicity in Georgia during 2010.

Table 1. Demographic and employment characteristics, aged 16 years and older, Georgia, 2006-2010

Total number employed Civilian workforce unemployed Civilian self-employed Civilian employed part-time Civilian hours worked per week
<40 hours 40 hours 41+ hours Civilian employment by sex Male Female Civilian employment by age group 16-17 years 18-64 yeas 65+ years Civilian employment by race White Black Other* Hispanic origin*

2006 4,519,000
4.6% 5.8% 12.7%

2007 4,629,000
4.3% 6.1% 14.1%

2008 4,569,000
6.4% 6.2% 14.7%

2009 4,329,000
9.8% 6.4% 15.9%

2010 4,238,000
10.7% 5.9%
16.4%

26.2

26.4

28.7

32.6

31.3

48.4

48.0

45.8

43.4

44.9

25.5

25.5

25.5

24.1

23.8

53.1

53.3

53.7

53.4

52.8

46.0

46.7

46.3

46.6

47.2

1.1

1.0

0.9

0.7

0.5

96.1

96.2

96.0

95.9

96.2

2.7

2.9

3.2

3.3

3.3

68.0

67.7

68.2

67.8

68.5

27.4

27.9

27.3

27.7

27.3

3.7

4.4

4.6

4.6

4.2

8.0

7.2

7.4

8.2

8.7

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Table 1. Demographic and employment characteristics, aged 16 years and older, Georgia, 2006-2010

Education and health services Wholesale and retail trade Professional and business services Manufacturing Leisure and hospitality Construction Transportation and utilities Financial services Mining Public administration Other services Information Agriculture Civilian employment by occupation Professional and related occupations Management, business, and financial operations Service Sales and related occupations Office and administrative support Transportation and material moving Construction and extraction Production Installation, maintenance, and repair Farming, fishing, and forestry

2006 18.7 14.8 10.6
11.3 8.4 8.9 6.3 6.5 0.2 5.1 4.9 3.0 1.2
18.5
14.7
16.0 11.3 13.4
6.8
7.5 6.7 4.4
0.6

2007 19.3 14.6 10.7
11.0 8.1 8.6 6.6 7.3 0.2 4.8 4.7 3.2 1.0
20.0
14.6
14.9 12.3 13.4
6.8
6.6 6.7 4.3
0.3

2008 20.0 14.1 11.4
10.8 7.7 8.7 6.5 7.2 0.1 5.2 4.6 2.9 0.9
21.1
16.3
14.6 11.9 13.3
6.4
6.2 6.0 3.8
0.4

2009 20.7 14.7 11.9
9.1 8.2 8.1 7.1 6.7 0.1 4.9 4.9 2.5 1.3
21.4
16.0
15.8 12.5 12.3
6.9
5.6 4.8 3.9
0.6

2010 20.8 15.1 12.6
9.3 8.8 7.4 6.6 6.2 0.1 5.3 4.5 2.6 0.9
20.3
16.4
16.4 12.5 12.5
7.0
5.6 5.1 3.8
0.4

Source: U.S. Department of Labor, Bureau of Labor Statistics, Geographic Profile of Employment and Unemployment, 2006-2010 * Persons of Hispanic origin may be of any race (white, black, other) *Other includes Asians, American Indians, Alaskan Natives/Pacific Islanders

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Table 2. Leading industry and occupation employment by sex, race, and ethnicity, Georgia, 2010

Industry

Occupation

Male

Professional and business services Manufacturing Construction

14.4% Management, business, and financial 12.9% operations 12.4% Professional and related occupations
Service occupations

Female

Education and health services Wholesale and retail trade Professional and business services

33.9% Professional and related occupations 15.4% Office and administrative support 10.6% occupations
Service occupations

White

Education and health services Wholesale and retail trade Professional and business services

19.1% Professional and related occupations 14.6% Management, business, and financial 12.9% operations
Service occupations

Black

Education and health services

25.6% Service occupations

Wholesale and retail trade

16.1% Professional and related occupations

Professional and business services 10.8% Office and administrative support

Asian

Professional and business services Wholesale and retail trade Education and health services

20.8% Professional and related occupations 18.7% Management, business, and financial 18.1% operations
Sales and related occupations

Hispanic Construction Leisure and Hospitality Manufacturing

23.5% Service Occupations 14.7% Construction and extraction 13.9% Production occupations

Source: U.S. Department of Labor, Bureau of Labor Statistics, Geographic Profile of Employment and Unemployment, 2010

17.5% 15.8% 14.1%
25.3% 19.6% 19.0%
21.0% 18.5%
14.6% 21.8% 16.6% 14.9% 34.6% 14.6%
11.9% 26.7% 22.4% 11.0%

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Indicator 1: Nonfatal Injuries and Illnesses Reported by Employers, Georgia, 2006-2009
Data from the Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses (SOII) were used to estimate the incidence of non-fatal work-related injuries and illnesses in Georgia during 2006-2009. The SOII is an annual sample survey of employers conducted by the BLS. Employers are surveyed on all workrelated injuries and illnesses that resulted in one or more days away from work, death, loss of consciousness, restricted work, or medical treatment beyond first aid. Work-related injuries and illnesses include any injury or illness experienced by an employee while performing work-related activities on or off the worksite.1 Most injuries and illnesses that occur in the workplace are preventable. Monitoring and tracking of workplace injuries and illnesses can help guide priorities for prevention and intervention efforts.4
The employer-reported incidence of work-related injuries and illnesses in Georgia declined each year since 2006. In 2009, private sector employers reported an estimated 87,400 work-related injuries and illnesses occurring among workers in Georgia (Table 3). This corresponds to a rate of about 3,100 per 100,000 full-time workers who had a work-related injury or illness (Figure 1). About 26% (22,300) of these cases involved one or more days away from work, while about 11% (9,740) of these cases involved more than 10 days away from work. The 2009 incidence rate of total work-related injuries and illnesses involving days away from work was 800 per 100,000 full-time workers (Figure 2). The industries in Georgia with the highest number of non-fatal work-related injuries are listed in Table 4. There were 27,600 non-fatal injuries in the trade, transportation, and utilities industry, the highest number among all the industries. Public administration, education and health services (i.e. hospital, nursing and residential care, ambulatory care), and construction were the top three industries with the highest incidence rates of non-fatal injuries in Georgia during 2006-2009.

Table 3. Total number of work-related injuries and illnesses, Georgia, 2006-2009

Estimated total number of work-related injuries and illnesses
Estimated total number of cases involving days away from work
Estimated total number of cases involving more than 10 days away from work

2006 114,400

2007 101,800

2008 98,300

28,100

26,200 26,800

11,200

10,470 11,260

2009 87,400
22,300
9,740

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Table 4. Leading industries with non-fatal work-related injuries, Georgia, 2009

Number Non-Fatal Injuries Incidence Rate per 100,000

Public administration Education & health services Construction Trade, transportation, & utilities Manufacturing Leisure & hospitality Natural resources and mining

12,400 16,500
6,800 27,600 13,500
900 600

9,900 4,500 3,900 3,700 3,600 3,500 2,400

*Rates are the number of workers per 100,000 employed in the specific industry *Public administration industry includes justice, public order, and safety activities, police protection, correctional institutions, and security and international affairs

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Indicator 2: Work-Related Hospitalizations, Georgia, 2006-2009
Work-related hospitalizations represent some of the most severe and costly work-related injuries and illnesses. Work-related hospitalizations have the primary payer coded as workers' compensation. Since less than 10 percent of workers who receive workers' compensation are hospitalized, work-related hospitalizations underestimates the actual burden of injuries and illnesses. In addition, most individuals who are injured on the job do not file for workers' compensation.4 In 2008, Georgia had 3,726 work-related hospitalizations among workers age 16 years and older in which worker's compensation was the primary payer. Also, some workers may not be covered by workers' compensation, such as self-employed workers. Hospital discharge data, collected by the Georgia Hospital Association, were used to estimate work-related hospitalizations during 2006-2009. The number of work-related hospitalizations in Georgia declined during 2006-2009. There was a large number of work-related hospitalizations in 2006 (5,675 hospitalizations) compared to 2007 (3,923 hospitalizations), 2008 (3,726 hospitalizations), and 2009 (3,410 hospitalizations). The rate of work-related hospitalizations per 100,000 employed persons in Georgia was higher than the national rate in 2006. The rate decreased from 125.6 per 100,000 employed persons in 2006 to 78.8 per 100,000 in 2009 (Figure 3).
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Indicator 3: Fatal Work-Related Injuries, Georgia, 2006-2009

Fatal work-related injuries were determined using data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). The CFOI collects data from a variety of sources such as death certificates, Workers' Compensation records, police and medical examiner reports, news media, and Occupational Safety and Health Administration (OSHA) reports. Data for both intentional (i.e. homicides, suicides) and unintentional (i.e. falls, highway accidents, electrocutions) work-related deaths are collected.4 A total of 110 fatal work-related injuries in Georgia were reported to CFOI in 2009. This was a decrease from the number of fatal injuries that occurred in previous years (Table 5). Among these deaths, 103 (93.6%) were among men and 7 (6.4%) were among women. In 2009, workers aged 45-54 years had the highest number of fatal work-related deaths with 36 deaths. The rate of fatal work-related injuries for Georgia workers was 2.6 per 100,000 in 2009 and decreased annually since 2006. The work-related fatality rate in Georgia was lower than the U.S. rate in 2009 (Figure 4).

Five of the most frequent causes of fatal work-related injuries were highway accidents, homicides, falls, being struck by an object, and having contact with electric current. There were declines for each of these incidents in Georgia during 2009 compared to 2008. The number of fatal injuries in Georgia due to having contact with electric current remained the same from 2007 through 2009. Highway incidents were the primary cause of fatal work injuries (Figure 5).

In 2009, the majority of fatal work-related injuries among Georgia workers occurred in the transportation and utilities and construction industries (Table 6). The highest rate of fatal injuries occurred among workers in the agriculture, forestry, fishing, and hunting industry.

Table 5. Total number of fatal work-related injuries, Georgia, 2006-2009

Total Sex
Male Female Age Group (years) 16-17 18-19 20-24 25-34 35-44 45-54 55-64 65+ Race/Ethnicity White, non-Hispanic Black, non-Hispanic Hispanic Other

2006 201
174 27
0 3 15 37 46 51 28 20
119 41 35
6

2007 193
177 16
3 5 16 45 36 47 32 9
118 42 28
3

2008 182
170 12
0 5 11 32 38 53 24 15
100 48 26 6

2009* 110
103 7
0 0 8 20 19 36 13 12
79 17 10
3

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*Georgia mortality data for 2009 may be unreliable

Table 6. Leading industries with fatal work-related injuries, Georgia, 2009

Number of Fatal Injuries Fatality Rate per 100,000

Agriculture, forestry, fishing, and hunting Transportation and utilities Construction Professional and businesses services Public administration Wholesale and retail trade Leisure and hospitality

10

18.0

25

8.7

26

8.6

13

2.9

6

2.4

11

1.9

5

1.7

*Rates are the number of workers per 100,000 employed in the specific industry

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Indicator 4: Work-related Amputations with Days Away from Work Reported by Employers, Georgia, 2006-2009
Work-related amputations are serious and preventable injuries usually resulting from occupational hazards or improper use of equipment. Besides the economic burden, amputations also affect workers' productivity and ability to perform job functions.4 Data from the BLS Survey of Occupational Injury and Illness (SOII) was used to estimate the number of work-related amputations with days away from work in Georgia during 2006-2009. There were 180 work-related amputations in Georgia that involved days away from work in 2009. This was a decrease from the number of amputations observed in previous years (Table 7). All of the 180 amputations in 2009 were finger amputations, the majority of which resulted from use of machinery. Production and installation, maintenance, and repair occupations were the occupations reporting employers with work-related amputations in 2009. The annual incidence rate of work-related amputations in Georgia declined from 11.0 per 100,000 in 2006 to 6.0 per 100,000 in 2009 (Figure 6).

Table 7. Total number of work-related amputations with days away from work reported by employers, Georgia, 2006-2009

Estimated number of amputations

2006 320

2007 210

2008 190

2009 180

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Indicator 5: Workers' Compensation Claims for Amputations with Lost Work Time, Georgia, 2006-2009
State workers' compensation claims for amputations based on the National Council on Compensation Insurance (NCCI) codes were obtained from the Georgia State Board of Workers' Compensation, regardless of age, state of residence, or open or closed claim status. Cases were based on the date of injury. In Georgia, a lost work time claim is defined as an injury that results in seven or more days lost from work. In 2009, there were 134 amputation cases in Georgia resulting in seven or more lost workdays that were filed with workers' compensation. This is a decline from the number of claims for amputations filed in 2006, 2007, and 2008 (Table 7). The incidence rate of amputations filed was steady at 4.7 per 100,000 workers covered by workers' compensation in 2006 and 2007, and then it declined to 4.4 per 100,000 workers in 2008. The rate declined further in 2009 to 3.7 per 100,000 workers (Figure 7).

Table 7. Number of amputations with lost work time filed with workers' compensation, Georgia, 2006-2009

Annual number of amputations

2006 182

2007 182

2008 167

2009 134

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Indicator 6: Hospitalizations for Work-related Burns, Georgia, 2006-2009
It's estimated that about 30%-40% of burns are work-related, with the majority of cases occurring among males and younger workers.4 Burn hospitalizations can be devastating, painful, and costly to treat. Hospitalizations for work-related burns were estimated using data from the Georgia Hospital Association's Hospital Discharge Data. Hospitalizations for burns with workers' compensation coded as the primary payer were considered to be work-related. In 2009, Georgia had 149 hospitalizations for burns, among workers aged 16 years and older in which workers' compensation was the primary payer. This was a decline from the annual number of burns observed in previous years (Table 8). About 3.4 per 100,000 workers aged 16 years and older in Georgia were hospitalized due to work-related burns in 2009. As observed in Figure 8, the rate of work-related burn hospitalizations in Georgia is slightly higher than the national rate.

Table 8. N umber of hospitalizations for work-related burns, Georgia, 2006-2009

Annual number of work-related burns

2006 184

2007 186

2008 165

2009 149

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Indicator 7: Work-related Musculoskeletal Disorders with Days Away from Work Reported by Employers, Georgia, 2006-2009

The U.S. Department of Labor defines musculoskeletal disorders as injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs that are not caused by slips, trips, falls, motor vehicle crashes or similar events. Work-related musculoskeletal disorders are caused or aggravated by work activities.4 The BLS Survey of Occupational Injuries and Illnesses (SOII) was used to estimate the number and rate of work-related musculoskeletal disorders. In 2009, Georgia had 5,380 total musculoskeletal disorder cases reported by employers that involved days away from work. The total number of work-related musculoskeletal disorder cases in Georgia has been declining since 2006 (Table 9). Three categories of musculoskeletal disorders (MSDs) include neck/shoulder/upper extremities, carpal tunnel syndrome, and disorders of the back. The numbers of MSDs within each of these three categories occurring during 2006-2009 in Georgia are also shown in Table 9. The most frequent work-related MSD in Georgia involves disorders of the back. In 2009, there were 2,520 cases of work-related MSDs of the back reported in Georgia. In 2009, the incidence rate of all MSDs in Georgia was 194 per 100,000 full-time workers and the rate of MSDs of the back was 94 per 100,000 full-time workers (Figure 9).

Table 9. Total number of work-related musculoskeletal disorder cases reported by employers, Georgia, 2006-2009

Total number of work-related MSDs Number work-related MSDs of the back Number work-related MSDs of the neck/shoulder/ upper extremities Number work-related MSDs of carpal tunnel syndrome

2006 6,840 3,470 1,680

2007 6,310 3,100 1,770

2008 6,550 3,200 2,100

210

210

200

2009 5,380 2,520 1,400
150

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Indicator 8: Workers' Compensation Claims for Carpal Tunnel Syndrome with Lost Work Time, Georgia, 2006-2009
Carpal tunnel syndrome results when the median nerve that runs from the forearm to the palm of the hand is pressed or squeezed at the wrist, resulting in pain, numbness, or weakness in the hand and wrist and sometimes radiating up the arm. Carpal tunnel syndrome is common among people performing assembly line work, such as manufacturing, sewing, finishing, meat, poultry, or fish packing.7 Carpal tunnel syndrome ranks second behind back injuries as the leading cause of lost work-time diagnoses and claims.8 Carpal tunnel syndrome cases with seven or more days lost from work (lost work-time) filed with the Georgia State Board of Workers' Compensation during 2006-2009 were used to estimate the annual number and rate. Cases included were based on the date of injury and the National Council on Compensation Insurance (NCCI) codes for carpal tunnel syndrome, regardless of age, state of residence, or open or closed claim status. In 2009, there were 156 carpal tunnel syndrome cases in Georgia resulting in seven or more lost work days with claims filed with workers' compensation. This was a decrease from the numbers observed during 2006-2008 (Table 10). The rate of carpal tunnel syndrome cases with lost work-time filed with workers' compensation in Georgia during 2009 was 4.3 per 100,000 covered workers (Figure 10). Carpal tunnel syndrome can be prevented at the workplace by having workers take frequent breaks, perform stretching exercises, rotate job tasks, use correct posture and wrist position, and/or wear splints to keep wrists straight.

Table 10. Number of carpal tunnel syndrome cases with lost work time filed with workers' compensation, Georgia, 2006-2009

Annual number of carpal tunnel syndrome claims

2006 204

2007 175

2008 172

2009 156

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Indicator 9: Pneumoconiosis Hospitalizations, Georgia, 2006-2009
Pneumoconiosis is a class of non-malignant lung disease that includes asbestosis, coal workers' pneumoconiosis and silicosis. Nearly all cases of pneumoconiosis are caused by occupational exposures to mineral or metallic dust particles. Asbestosis results from inhalation of microscopic asbestos fibers. Coal workers' pneumoconiosis, also called "black lung disease," results from inhalation of coal dust. Silicosis results from inhalation of free crystalline silica. There is typically a long latency period for pneumoconiosis of about 10-15 years.4 Therefore, the current incidence presented in this report result may not be representative of the current exposures. Controlling occupational exposures to dust is the single most effective means of preventing pneumoconiosis.4 Data for pneumoconiosis hospitalizations were obtained from Georgia Hospital Discharge Data. In 2009, Georgia had 323 total hospitalizations for pneumoconiosis. The 2009 age-adjusted rate of total pneumoconiosis hospitalizations in Georgia was 50.1 per million residents. About 72% of the pneumoconiosis hospitalizations in 2009 were from asbestosis. There were 232 asbestosis hospitalizations, 35 coal workers' pneumoconiosis hospitalizations, 41 silicosis hospitalizations, and 15 hospitalizations for other and unspecified pneumoconiosis in Georgia during 2009. The age-standardized rates of pneumoconiosis hospitalizations per million Georgia residents for 2009 are shown in Figure 11. National rates of pneumoconiosis (all types) are generally higher than rates in Georgia. During 2006-2009, hospitalization rates for asbestosis declined from 43.7 per 100,000 residents to 36.4 per 100,000 residents. However, rates of coal workers' pneumoconiosis and silicosis in Georgia did not decrease (Figure 12).
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Indicator 10: Pneumoconiosis Mortality, 2008
Data for pneumoconiosis were obtained from the Georgia Office Vital Records. There were 28 deaths caused by pneumoconiosis among Georgia residents in 2008*. Of these deaths, 20 were due to asbestosis, five were from silicosis, less than five deaths from coal workers' pneumoconiosis, and less than five were due to other or unspecified pneumoconiosis. The age-standardized total pneumoconiosis death rate for 2008 was 4.6 per million Georgia residents. The age-standardized rate of deaths from asbestosis was 3.2 per million Georgia residents. The mortality rate for silicosis in Georgia during 2008 was similar to the national rate (Figure 13).
*Georgia 2009 mortality data were not available at time of this report.
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Indicator 11: Acute Work-Related Pesticide Poisonings Reported to Poison Centers, Georgia, 2006-2009
Pesticides are designed to kill and harm living organisms, particularly insects, plants, animals, or fungi. Workers who handle pesticides are at an increased risk for exposure, resulting in adverse health effects.4 The number of work-related pesticide poisonings is estimated from reported calls to Poison Centers and is obtained from the American Association of Poison Control Centers. In Georgia, 96 work-related pesticide poisonings were reported in 2009. The number of work-related pesticide poisonings has decreased in Georgia since 2006 (Table 11). The annual incidence rate of reported pesticide poisonings per 100,000 employed persons aged 16 years and older decreased in 2007 and 2008. However, the incidence rate of reported poisonings increased from 1.8 per 100,000 in 2008 to 2.2 per 100,000 in 2009. The rate of work-related pesticide poisonings in Georgia was slightly higher than the national rate during 2007-2009 (Figure 14).

Table 11. Annual number of reported work-related pesticide poisoning cases, Georgia, 2006-2009

Number of reported pesticide poisonings

2006 111

2007 92

2008 82

2009 96

21

Indicator 12: Incidence of Malignant Mesothelioma, Georgia, 2006-2009
Mesothelioma is a rare, but fatal, cancer of the mesothelial tissue lining the lung cavity, abdominal cavity, heart sac, and/or testis sac. It is estimated that 90% of mesothelioma cases are caused by exposure to asbestos and related fibers. Most cases of malignant mesothelioma are diagnosed at an already advanced stage of disease. With a latency period of 20-40 years, the incidence of malignant mesothelioma presented in this report is not indicative of current exposures. It may take many years before reductions in occupational exposure affect the incidence.4 In Georgia, the number of new cases of mesothelioma increased from 46 in 2006 to 61 in 2009 (Table 12). The age-standardized mesothelioma incidence rate per million Georgia residents increased from 7.1 in 2006 to 10.6 in 2008, and then decreased to 8.7 in 2009. The incidence rate of mesothelioma in Georgia was lower than the national rate during 2006-2008 (Figure 15).

Table 12. Number of incident mesothelioma cases, Georgia, 2006-2009

Number of mesothelioma cases

2006 46

2007 49

2008 71

2009 61

22

Indicator 13: Elevated Blood Lead Levels (BLL) among Adults, Georgia, 2006-2009
Lead is a toxic metal found both in the environment and the workplace. Exposure to lead can have adverse effects on multiple organ systems and cause permanent damage. Even exposure to low doses of lead have been associated with hypertension, cognitive dysfunction, adverse effects on renal function, and adverse effects on female reproductive outcomes. The blood lead level is a biological indicator of recent exposure to lead. Lead poisoning is mainly an occupational health issue for adults. Parents who unintentionally bring lead home from the workplace can expose their children to lead. It is estimated that 24,000 children in the United States have elevated blood lead levels of 10 g/dL or more from lead being brought home from work by their parents. Some of the adverse health effects from lead exposure experienced by children include neurologic damage, learning disabilities, and behavior problems.4 Industries with the highest risk of exposures to lead include battery manufacturing, secondary smelting refining of nonferrous metals, and painting and paper hanging.9 The federal Occupational Health and Safety Administration (OSHA) requires BLL monitoring for employees who meet certain exposure criteria. The average blood lead level for the general population is less than 2 g/ dL. Adult BLL is considered elevated at 25 g/dL, however, toxicity may occur at levels as low as 5 g/dL.4
In 2009, Georgia had 147 prevalent cases age 16 years and older with elevated blood lead levels of 25 g/dL or greater (120 of which were newly identified or incident cases) that were reported to the Georgia Adult Blood Lead Epidemiology Surveillance (ABLES) Program (Table 13). Of these cases, 16 residents had elevated blood lead levels of 40 g/dL or greater (15 incident cases). The annual number of elevated blood lead cases in Georgia varies each year. The number of reported incident cases of elevated BLL of 25 g/dL or greater decreased from 224 in 2006 to 120 in 2009. This resulted in an incident rate per 100,000 employed persons that decreased from 5.0 per 100,000 in 2006 to 2.8 per 100,000 in 2009 (Figure 16). Incident rates of elevated blood lead levels in Georgia were similar to the national rates in 2008 and 2009 (Figure 17).

Table 13. Number of incident cases of elevated* blood lead levels, Georgia, 2006-2009

Prevalent cases blood lead levels ( 25 g/dL) Incident cases blood lead levels ( 25 g/dL) Prevalent cases blood lead levels (40 g/dL) Incident cases blood lead levels ( 40 g/dL)

2006 262 224 35 33

2007 176 140 22 18

2008 191 151 25 20

2009 141 120 16 15

*Note: Elevated among persons aged 16 years or older

23

24

Indicator 14: Workers employed in industries and occupations at high risk for occupational morbidities, Georgia, 2006-2009
In 2009, the Bureau of Labor Statistics (BLS) reported an estimated injury and illness incidence rate of 3,600 cases per 100,000 full-time workers in the United States. Some industries have been identified as high risk for occupational morbidities based on having significantly higher injury and illness rates compared to the national average.4,10 These high risk industries are listed in Appendix 2 and include the average number of persons who were employed in these industries in Georgia during 2009. There were more than 200,000 workers employed in high risk industries in Georgia during 2009 (Table 14). This is a decrease from the numbers observed in years 2006 through 2008. The percentage of persons employed in high risk industries was 5.9% in 2009, a slight decrease from the previous year (Figure 18).

Table 14. Number of workers employed in industries at high risk industries for occupational injury and illness, Georgia, 2006-2009

Number of workers

2006 214,891

2007 219,698

2008 224,152

2009 200,601

25

Indicator 15: Workers employed in occupations at high risk for occupational morbidities, Georgia, 2006-2009
Risk of injuries and illnesses is also significantly higher in certain occupations compared to the national average.4 These high risk occupations are listed in Appendix 3 and include the average number of persons who were employed in these occupations in Georgia in 2009. More than 500,000 Georgia workers were employed in occupations at high risk for occupational morbidities in 2009 (Table 15). The percentage of employed persons who worked in high risk occupations in Georgia decreased from 18.3% in 2006 to 16.3% in 2009 (Figure 19).

Table 15. Number of workers employed in occupations at high risk for occupational morbidities, Georgia, 2006-2009

Number of workers

2006 622,502

2007 607,903

2008 541,561

2009 523,430

26

Indicator 16: Workers employed in occupations and industries at high risk for occupational mortality, Georgia, 2006-2009
Risk of occupational fatalities is significantly higher in certain industries and occupations compared to the national average.4,10 Between the years 2006-2009, an average of 172 workers in Georgia died as a result of injuries sustained on the job. These industries and occupations are listed in Appendix 4 and Appendix 5, respectively. In 2009, more than 600,000 workers in Georgia were employed in industries at high risk for occupational mortality. Almost 500,000 workers were employed in high risk fatality occupations in Georgia (Table 16). The percent of workers employed in these industries and occupations are presented in Figures 20 and 21.

Table 16. Number of workers employed in industries and occupations at high risk for occupational mortality, Georgia, 2006-2009

Number of workers in high fatality risk industries

2006 529,653

2007 674,804

2008 686,871

2009 632,352

Number of workers in high fatality risk occupations

572,012 541,457 494,467 490,528

27

Indicator 17: O ccupational Safety and Health Professionals, Georgia, 2006-2009
A sufficient number of trained occupational safety and health (OSH) professionals are needed to help prevent work-related injuries and illnesses. OSH professionals include occupational medicine physicians, occupational health nurses, industrial hygienists, and safety health professionals. These professionals provide primary, secondary, and tertiary occupational health preventive services, including workplace evaluations and safety assessments, onsite medical care, and treatment of injuries. The American Medical Association has recommended that there be at least one OSH physician per 1,000 employees.4 Rates of OSH professional are monitored within each state to determine the need for increased education or recruitment activities.2,4 Estimated numbers of OSH professionals in Georgia during 2006-2009 were obtained from current rosters and directories of each cited professional organization and are shown in Table 17. The number of board certified OSH professionals has increased since 2006 in Georgia, except for occupational health nurses. The number of occupational health nurses decreased from 217 in 2006 to 185 in 2009. Table 18 shows the rate of OSH professionals per 100,000 employed persons in Georgia. In 2009, there were approximately two occupational health physicians, four occupational health nurses, four industrial hygienists, and eight safety health professionals per 100,000 employees in Georgia. The rate of OSH physicians in Georgia per 1,000 employees is 0.02, which is much lower than the American Medical Association's recommended rate. Rates of OSH professionals in Georgia were slightly lower than national rates 2006-2009.

Table 17. Estimated number of occupational safety and health professionals, Georgia, 2006-2009

Board-certified occupational medicine physicians

2006

2007

2008

2009

88

97

96

102

Members of the American College of Occupational and Environmental Medicine (ACOEM)
Board certified occupational health nurses

113

104

103

101

217

185

183

185

Nurse members of the American Association of Occupational Health Nurses (AAOHN)
Board-certified industrial hygienists

302

268

238

218

142

144

149

154

Industrial hygienist members of the American Industrial Hygiene Association
Board-certified safety health professionals

232

218

199

189

318

330

336

345

Safety engineer members of the American Society of Safety Engineers (ASSE)

753

817

796

745

28

Table 18. Rate of occupational safety and health professionals per 100,000 employed persons Georgia and United States, 2006-2009

Board-certified occupational medicine physicians
Members of the American College of Occupational and Environmental Medicine (ACOEM)
Board-certified occupational health nurses
Nurse members of the American Association of Occupational Health Nurses (AAOHN)
Board-certified industrial hygienists

Georgia

United States

2006 2007 2008 2009 2006 2007 2008 2009

2.0 2.1 2.1 2.4 1.8 1.9 1.9 2.2

2.5 2.2 2.3 2.3 3.3 3.1 3.0 3.0

4.8 4.0 4.0 4.3 4.8 4.1 4.0 4.1 6.7 5.8 5.2 5.0 6.1 5.8 5.4 4.6

3.2 3.1 3.3 3.6 4.8 4.7 4.8 5.1

Industrial hygienist members of the American Industrial Hygiene Association
Board-certified safety health professionals
Safety engineer members of the American Society of Safety Engineers (ASSE)

5.2 4.7 4.4 4.4 7.2 6.2 6.1 5.9
7.1 7.1 7.4 8.0 7.5 7.6 7.9 8.6 16.8 17.6 17.4 17.2 22.0 21.5 22.0 21.5

29

Indicator 18: OSHA Enforcement Activities, Georgia, 2006-2009
The federal Occupational Safety and Health Administration (OSHA) was established in 1970 with the mission to "assure as far as possible every working man and woman in the nation safe and healthful working conditions."4 Some of OSHA's activities include standards development, enforcement, education, and compliance assistance. OSHA enforcement activities are measured through the number of inspections.4,10 OSHA conducts both referral (i.e. from outside health agency or media) and non-referral inspections at worksites. Data on the number of inspections and workers covered under OSHA jurisdiction in Georgia were obtained from the Region IV OSHA Office. The Bureau of Labor Statistics on Covered Employees and wages data were used to estimate the number of Georgia workers employed and establishments in the public and private sectors.
The number of establishments under OSHA jurisdiction in Georgia increased from 260,209 in 2006 to 268,871 in 2009 (Table 19). The number of Georgia establishments that were inspected by OSHA remained fairly stable (around 1,500 establishments) during 2006-2009. This represents about 0.6% of establishments under OSHA jurisdiction that were inspected. These percents remained lower than the national average during 2006-2009. The total number of employees covered under OSHA jurisdiction decreased during 2006-2009, however the number of employees whose work areas were inspected by OSHA increased from 49,461 to 75,104 (Table 20). This resulted in an increased percentage of Georgia employees under OSHA jurisdiction whose work areas were inspected by OSHA (from 1.2% in 2006 to 2.0%) in 2009. These percents were lower than the national average during 2006-2009.

Table 19. OSHA inspections among establishments, Georgia, 2006-2009

Number of establishments under OSHA jurisdiction

2006 260,209

2007 269,048

2008 273,604

Number of establishments inspected by OSHA

1,519

1,529

1,452

Percent of establishments under OSHA jurisdiction inspected by OSHA
National percent of establishments under OSHA jurisdiction inspected by OSHA

0.6% 1.3%

0.6% 1.2%

0.5% 1.2%

2009 268,871
1,500 0.6%
1.2%

Table 20. OSHA inspections among employees, Georgia, 2006-2009

Number of employees under OSHA jurisdiction (excluding miners and farm workers)
Number of employees whose work areas were inspected by OSHA
Percent of employees under OSHA jurisdiction whose work areas were inspected by OSHA
National percent of employees under OSHA jurisdiction whose work areas were inspected by OSHA

2006

2007

2008

4,003,673 4,056,604 4,012,043

49,461

50,380

57,512

1.2%

1.2%

1.4%

3.4%

3.3%

3.5%

2009 3,777,968
75,104
2.0%
3.9%

30

Indicator 19: Workers' Compensation Awards, Georgia, 2006-2009
In the event that an employee experiences a work-related injury or illness, medical expenses and some lost wages can be covered through workers' compensation benefits. All workers in Georgia are eligible for state workers' compensation, except for federal and self-employed employees. Workers' compensation awards can be used as a measure of the economic burden of occupational injuries and illnesses.4,10 The estimated amount of workers' compensation awards in Georgia during 2006-2009 were obtained from the National Academy of Social Insurance. Workers' compensation benefits paid to Georgia workers with occupational injuries or illnesses increased from approximately $1.2 billion in 2006 to $1.5 billion in 2009 (Table 21). This represents an average of $316 for every worker in Georgia who was eligible for workers' compensation in 2006 and $416 for workers eligible in 2009.

Table 21. Workers' compensation awards, Georgia, 2006-2009

Total amount of workers' compensation benefits paid
Average amount of workers' compensation benefits paid per covered worker

2006

2007

2008

2009

$1,214,622,000 $1,339,121,000 $1,601,604,000 $1,492,696,000

$316

$344

$418

$416

31

Indicator 20: Work-related low back disorder hospitalizations, Georgia, 2006-2009

Approximately two-thirds of all low back pain cases are attributed to work-related activities. Hospitalizations due to low back pain result in high medical costs, high absenteeism, major impairment and disability, and reduced work performance and productivity. Nearly 40% of workers' compensation costs are due to low back pain. The burden of low back disorder hospitalizations can be reduced through prevention efforts implemented for high-risk job activities.4 Hospital discharge data from the Georgia Hospital Association were used to estimate rates of low-back disorder hospitalizations among residents age 16 years and older during 2006-2009. In 2009, there were 763 low back disorder hospitalizations in Georgia for which workers' compensation was the primary payer. This was a decrease from the 965 low back disorder hospitalizations that occurred in 2006 (Table 22). The rate of hospitalizations per 100,000 employed persons decreased from 21.4 in 2006 to 17.6 in 2009 (Figure 22). Among the 763 low back disorder hospitalizations that occurred in 2009 in Georgia, 657 required surgery. The rate of surgical low back disorder hospitalizations per 100,000 employed persons decreased from 18.4 in 2006 to 15.2 in 2009. Rates of low back disorder hospitalizations in Georgia were similar to national rates in 2009 (Figure 23).

Table 22. Number of work-related low back disorder hospitalization, Georgia, 2006-2009

Low back disorder hospitalizations
Surgical low back disorder hospitalizations

2006 965
834

2007 770
669

2008 740
653

2009 763
657

32

33

State Specific Indicator: Work-Related Asthma, Georgia, 2006-2009

Work-related asthma (WRA) is an occupational lung disease that is preventable. Work-related asthma can be either existing asthma that is worsened by factors related to the environment of the workplace (work-exacerbated asthma) or a new onset of asthma attributed to the workplace environment (occupational asthma).11 Examples of some chemicals associated with WRA by industry/occupation are listed in Appendix 6. Identification of WRA provides direct opportunities for prevention and intervention activities. Data combined from the 2006-2009 Georgia Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Surveys were used to estimate the percent of ever-employed adults in Georgia who have been told by a health professional that their asthma was work-related. The proportion of adults reported to have work-related asthma is likely to be underestimated because work-related asthma is underdiagnosed in the United States.11 Overall, approximately 7.7% of adults in Georgia have doctor-diagnosed asthma. Among these adults, 11.3% of adults who were ever-employed and 8.8% (approximately 25,000 individuals) of adults who are currently employed have been told by a physician that their asthma was work-related (Figure 24). Among currently employed Georgia adults with WRA, 36.4% say that their asthma is made worse by their current job and 18.4% say that their asthma is caused by their current job (Figure 25). WRA is higher among current employees who are female, non-Hispanic black, aged 35-54 years, and who earn less than $25,000 annually (Table 17). Occupational conditions can be improved to reduce or prevent WRA among employees. Targeted strategies to reduce or eliminate workplace exposures for persons with WRA, such as substituting chemicals or engineering and administrative controls, will aid in the prevention of new onset asthma cases and slow the progression of work-exacerbated asthma.11

Table 17. P roportion (%) of currently employed adults with

work-related asthma, Georgia, 2006-2009

Overall

8.8%

Sex

Male

5.8%

Female

10.8%

Race/Ethnicity

White, non-Hispanic

8.4%

Black, non-Hispanic

11.1%

Age Group (years)

18-34

5.4%

35-54

11.8%

55+

7.0%

Income (annual)

$24,999

17.4%

$25,000-$49,999

7.4%

$50,000

7.9%

34

35

State Specific Indicator: Arthritis among Employees, Georgia, 2009

Arthritis is the most frequent cause of disability in the United States, affecting nearly 46 million adults. It is a painful condition consisting of approximately 100 diseases and is known to cause work limitations.12 Data from the 2009 Georgia Behavioral Risk Factor Surveillance System (BRFSS) was used to estimate the prevalence of employees in Georgia who had doctor-diagnosed arthritis (including osteoarthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia). An estimated 15.7% of employees in Georgia had doctor-diagnosed arthritis (approximately 715,000 individuals). About 18.2% of female employees were diagnosed with arthritis while about 13.5% of male employees were diagnosed with arthritis. Prevalence of arthritis increased with age; employees aged 45-54, 55-64, and 65+ were significantly more likely to be diagnosed with arthritis than employees in younger age groups. About 18.9% of non-Hispanic white employees were diagnosed with arthritis compared to 11.7% of non-Hispanic black employees and 10.5% of Hispanic employees. The burden of arthritis is higher among employees with an annual household income less than $50,000 (Table 18). About 23% (approximately 160,000 individuals) of employees said that arthritis or joint symptoms affects whether they work, the type of work they do, or the amount of work they do. This measure of arthritis-attributable work limitation shows that a considerable number of Georgia employees can benefit from interventions that include simple workplace accommodations such as flexible work schedules, ergonomic work stations, and efforts to promote maintaining a healthy weight and physical activity; all of which may help ease the pain of arthritis. As the workforce ages, due to employees working longer, it is increasingly more important to have arthritis interventions, such as arthritis-management education classes, available as well as health and disability insurance.13

Table 18. Prevalence (%) of currently employed adults with

arthritis, Georgia, 2009

Overall

15.7%

Sex

Male

13.5%

Female

18.2%

Race/Ethnicity

White, non-Hispanic

18.9%

Black, non-Hispanic

11.7%

Hispanic

10.5%

Age Group (years)

18-44

7.9%

45-54

22.2%

55-64

36.7%

65+

43.3%

Income (annual)

$24,999

17.1%

$25,000-$34,999

16.1%

$35,000-$49,999

17.9%

36

$50,000+

14.6%

State Specific Indicator: Workplace Secondhand Smoke Exposure, Georgia, 2009-2010

Secondhand smoke is a known major contributor to indoor air pollution and is known to cause lung cancer, chronic conditions, and diseases of the respiratory and cardiovascular systems.14,15 In 2006, the U.S. Surgeon General reported there is no safe level of secondhand smoke exposure.14 Although, there is much knowledge about the impact of secondhand smoke on the body, many non-smoking employees are still exposed to the dangers of secondhand smoke on the job. Data from the 2009-2010 National Adult Tobacco Survey (NATS) were used to estimate the percent of non-smoking employees in Georgia who were exposed to secondhand smoke at work (indoor or outdoor). Approximately 18.7% of non-smoking Georgia employees (approximately 488,000 individuals) were exposed to secondhand smoke at work during the past seven days prior to the survey. Exposure to secondhand smoke was higher among employees who were male, were between ages 18-34 years, or earned an annual income less than $70,000 (Table 19). Construction workers, blue collar workers, and service workers are among some of the groups who experience high levels of secondhand smoke exposure compared to other workers.15 "Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from secondhand smoke exposure. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings do not eliminate secondhand smoke exposure".14,15
Adoption of model smoke-free workplace policies can protect workers from the health effects of secondhand smoke exposure by prohibiting indoor smoking, smoking in company owned vehicles, and smoking at outdoor company worksites where two or more employees are working. Smoke free workplace policies also lead to more efficient work environments as they have been shown to reduce worker absenteeism, cleaning and maintenance costs, health insurance premiums, liability claims, and cigarette consumption.14,16

Table 19. Prevalence (%) of non-smoking employees exposed

to secondhand smoke at work , Georgia, 2009-2010

Overall

18.7%

Sex

Male

21.7%

Female

15.4%

Race/Ethnicity

White, non-Hispanic

20.4%

Black, non-Hispanic

17.8%

Hispanic

12.6%

Age Group (years)

18-34

27.1%

35-44

16.0%

45-54

11.7%

55+

11.9%

Income (annual)

$29,999

20.7%

$30,000-$49,999

23.0%

$50,000-$69,999

22.8%

$70,000+

12.4%

37

References

1. U.S. Department of Health and Human Services. (2012 Aug 22) Occupational Safety and Health--Healthy People 2020. Washington DC. Retrieved Aug 27, 2012, from http://www.healthypeople.gov/2020/topicsobjectives2020/overview. aspx?topicId=30.
2. O klahoma State Department of Health, Injury Prevention Service. Oklahoma Occupational Health Indicators, 2003-2007. September 2010.
3. Massachusetts Department of Public Health. Putting Data to Work: Occupational Health Indicators for Massachusetts. April 2011.
4. Council of State and Territorial Epidemiologists. Occupational Health Indicators: A Guide for Tracking Occupational Health Conditions and Their Determinants. June 2012.
5. U.S. Department of Labor Bureau of Labor Statistics. Geographic Profile of Employment and Unemployment, 2006. (2011 Oct).
6. U.S. Department of Labor Bureau of Labor Statistics. Geographic Profile of Employment and Unemployment, 2010. (2011 Aug).
7. National Institute of Neurological Disorders and Stroke (2012 July 20). Carpal Tunnel Syndrome Fact Sheet. Retrieved Aug 12, from http://www.ninds. nih.gov/disorders/carpal_tunnel/detail_carpal_ tunnel.htm#203513049.
8. Shuford H. and Restepo T. NCCI Research Brief: Carpal Tunnel Claims Rank Second among Major Lost Work Time Diagnoses. (2005 April).
9. Centers for Disease Control and Prevention. Adult Blood Lead Epidemiology and Surveillance--United States, 2008-2009. MMWR 2011; 26 (25), 841-845.

10. Florida Department of Health, Division of Environmental Health. Occupational Health Indicators, Florida, 2000-2007. 2011
11. Centers for Disease Control and Prevention. WorkRelated Asthma--38 States and District of Columbia, 2006-2009. MMWR 2012; 61 (20), 375-378.
12. Centers for Disease Control and Prevention. State-Specific Prevalence of Arthritis Attributable Work Limitations--United States, 2003. MMWR 2007; 56 (40), 1045-1049.
13. Caban-Martinez, A.J., et al. (September 2011). Arthritis, Occupational Class, and the Aging U.S. Workforce. American Journal of Public Health: 101 (9), 1729-1734.
14. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
15. Centers for Disease Control and Prevention (2012 March 1). Secondhand Smoke (SHS) Facts. Retrieved June 25, 2012 from, http://www.cdc. gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm.
16. Americans for Nonsmoker's Rights (March 2011). Model Policy for A Smokefree Workplace. Retrieved April 23, 2012 from, http://www.nosmoke.org/pdf/modelworkplacepolicy.pdf.

38

Data Sources and Limitations

Survey of Occupational Injuries and Illnesses
The Survey of Occupational Injuries and Illnesses (SOII) is an annual sample survey of employers conducted by the U.S. Department of Labor, Bureau of Labor and Statistics (BLS). Employers are surveyed on all employee work-related injuries and illnesses that resulted in one or more days away from work, death, loss of consciousness, restricted work, or medical treatment beyond first aid. The survey provides estimated numbers and incidence rates of work-related injuries and illnesses among private sector workers at the state and national levels. Limitations: The SOII uses a probability sample and is not a census of all employers. Therefore, it is subject to sampling error. In addition, employers are only required to report on up to 30 cases; which means all cases may not be reported if an employer has over 30 cases. The military, self-employed individuals, farms with fewer than 11 employees, and federal agencies are excluded from the survey.
Georgia Hospital Discharge Data
Records of patient discharges from all licensed nonfederal acute care inpatient facilities in Georgia are collected by the Georgia Hospital Association (GHA). Only discharges of Georgia residents who were seen in a Georgia facility are included. Information about patient demographics, diagnoses, and source of payment are included. Since the data does not include specific information about work-relatedness, the proxy of workers' compensation coded as the primary payer is used to indicate a work-related hospitalization. Limitations: The majority of individuals with work-related illnesses do not file for workers' compensation. Self-employed and federal employees are not covered by state workers' compensation. Individuals can be counted more than once if readmitted. Discharges include both people living and who have died.

Census of Fatal Occupational Injuries
The Census of Fatal Occupational Injuries (CFOI) is a federal-state cooperative program conducted by the U.S. Department of Labor, Bureau of Labor Statistics (BLS) in all 50 states and the District of Columbia that provides counts of fatal work injuries. In order for the fatality to be included in the census the person must have been working at the time of the incident, engaged in work activity, or present the incidents site as required by the job. CFOI covers private wage and salary workers, the self-employed, and public sector workers. To provide the most complete data as possible, CFOI uses multiple sources (including death certificates, workers' compensation reports, police and medical examiner reports, and news reports) to identify and verify fatal worker injuries. Some of the information collected includes occupation, equipment involved, and circumstances of the event. Limitations: CFOI publishes findings according to the Occupational Injury and Illness Classification (OIIC) system rather than the International Classification of Diseases (ICD) system. Thus, CFOI data may not be comparable to causes of death documented on death certificates. CFOI reports workrelated fatalities by the state in which the incident occurred, not by state of residence. Since the denominator data used to calculate rates are based on state of residence, state rates may be overestimated or underestimated, depending on whether incidents occur instate or out-of-state. Also, fatalities of people younger than 16 years may be included in the numerator but are not included in the denominator data.
Georgia Vital Records
Mortality data from the Georgia Department of Public Health's Office of Vital Records were used to determine numbers of pneumoconiosis deaths. The Vital Records Office maintains the death certificates of all deaths occurring in the state. Deaths of Georgia residents are included, regardless of the state in which the death occurred. Causes of death are coded according to the 10th revision of the International Classification of

39

Diseases (ICD-10). Limitations: Death certificates identify only a small percentage of people who have pneumoconiosis. The cause of death listed on the death certificate and coding of those causes may not be accurate. Also, the number of contributing causes of death listed on deaths certificates varies by the person completing the record. Persons whose death is due to a work-related illness or injury may not have been exposed in the state where the death occurred. Georgia mortality data were not available for 2009 due to data quality.
American Association of Poison Control Centers/Georgia Poison Control Center
Numbers of pesticide poisonings in the state were obtained from the American Association of Poison Control Centers (AAPCC), which administers the Toxic Exposure Surveillance System. The Georgia Poison Center (GPC) and all other state poison control centers report statewide data to the AAPCC. The Georgia Poison Center (GPC) has operated a 24-hour poison emergency treatment information service since 1970. The GPC provides assistance and expertise in the medical diagnosis and management of human and animal poisonings. GPC is one of the busiest and most up-todate front-line toxicology information centers in the nation. In 2009, the GPC received 115,669 calls into its emergency phone service lines (about 317 calls per day). Limitations: All poisonings are not reported to the poison center. Since the data in this report includes only persons who called the GPC, the number of pesticide poisonings reported may be underestimated.
Georgia Comprehensive Cancer Registry
The Georgia Comprehensive Cancer Registry (GCCR) was used to determine the incident number of malignant mesothelioma cases in the state. The GCCR is a statewide population-based cancer registry that collects all cancer cases newly diagnosed among Georgia residents. The Georgia Department of Public Health has designated the Georgia Center for Cancer Statistics

at the Rollins School of Public Health at Emory University as its agent for collecting and editing cancer data. Data collection for the GCCR began in 1995. GCCR participates in the National American Association of Central Cancer Registries (NAACCR), which provides ongoing development and cancer registries and the establishment of registry standards. GCCR is gold certified by NAACCR as high quality. An evaluation of GCCR showed that 100% of cancer cases are true cases. The cancer registry data also represents 98% of Georgia's population. Limitations: Since cancer is a disease of long latency, current incidence is not indicative of current exposures. The residence of the case may not have been the state of exposure. Not all cases of malignant mesothelioma are caused by occupational exposures.
Adult Blood Lead Epidemiology and Surveillance Program
The Georgia Adult Blood Lead Epidemiology and Surveillance (ABLES) program is a state-based surveillance program, funded through the CDC National Institute for Occupational Safety and Health (NIOSH),that collects clinical laboratory-reported adult blood lead levels of Georgia persons aged 15 years or older. The program collects and analyzes data to identify the incidence and prevalence of elevated blood lead levels in the adult population to measure trends in lead exposure and effectively intervene to prevent lead overexposures. Limitations: The elevated blood lead cases in this report are all report cases, which may include both occupational and non-occupational exposures. The rates reported may be overestimated if some cases were not due to occupational exposures. Some elevated blood-levels due to occupational exposures may not be captured. Though employers are required by the Occupational Health Safety Administration (OSHA) to provide blood lead testing for exposed workers, all employers do not provide testing. Also, individuals who are self-employed may not get tested.

40

Georgia Board of Workers' Compensation
The number of amputations and carpal tunnel syndrome claims filed through workers' compensation were obtained from the Georgia Board of Workers' Compensation (GBWC). Established by the Georgia legislature in 1920, more than 3.8 million Georgia workers are covered by the workers' compensation law which provides for specific benefits to be paid to employees who sustain work-related injuries or illnesses, such as replacement for a portion of lost wages, medical payments, vocational rehabilitation services, and other benefits. Georgia law requires that all employers, including public corporations and nonprofit organizations that have at least three full-time or part-time employees, to have workers' compensation insurance coverage. Limitations: Federal employees, railroad employees, farmers and farm laborers, self-employed individuals, and domestic servants are not covered by workers' compensation. Also, the majority of eligible workers who have a work-related injury or illnesses do not file for state workers' compensation.
Georgia Behavioral Risk Factor Surveillance System
The Georgia Behavioral Risk Factor Surveillance System (BRFSS) was used to estimate the prevalence of arthritis among employees and the BRFSS Asthma Call-back Survey (ACBS) was used to estimate the proportion of work-related asthma. Established by the Centers and Disease Control and Prevention (CDC) in 1984, the BRFSS is a cross-sectional random-digit-dialed telephone survey of non-institutionalized civilian adults age 18 years and older conducted annually in all 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. This state-based surveillance system collects information on health risk behaviors, preventive health practices, and healthcare access primarily related to chronic disease and injury. BRFSS respondents who said they work full-time, part-time, or have been out of work for less than a year and who said `yes' to having ever been told by a doctor or other health professional that they have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia

were considered employees with doctor-diagnosed arthritis. BRFSS respondents who said yes to ever being diagnosed with asthma are asked to participate in the ACBS. Administered since 2006, the ACBS collects detailed information on asthma, including symptoms, health-care utilization, medication use, knowledge of asthma, cost of asthma care, work-related asthma, comorbid conditions, and complementary and alternative medicine use for asthma. Limitations: Prevalence estimates of arthritis may be underestimates of the true burden because all employees with arthritis may not have been diagnosed. Also, the BRFSS is based on self-reported data; therefore, results may be subject to recall bias. The ACBS may be subject to self-selection bias, since ACBS participants are BRFSS respondents who agreed to be called-back. These participants may have more severe asthma or be more likely to attribute asthma to their work. Information on work-relatedness is not available in BRFSS for those who refused to participate.
National Adult Tobacco Survey
State-level data from the National Adult Tobacco Survey (NATS) was used to estimate the prevalence of employees exposed to secondhand smoke at work. The NATS, administered for the first time in 2009-2010, is a cross-sectional random-digit dialed telephone survey of non-institutionalized civilian adults age 18 years and older. The survey was designed with the purpose of obtaining representative data on key outcome indicators at state and national levels for monitoring and evaluating progress toward the goals of the CDC's National Tobacco Control Program. The NATS includes questions relating to general health, tobacco use, smoking cessation, smoke-free and tobacco-free policies, existing chronic conditions and diseases, and opinions and attitudes related to tobacco and policy. Limitations: The NATS is based on self-reported data; therefore, results may be subject to recall bias.
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42

Appendix 1

Georgia Population and Civilian Employment Demographics, Aged 16 Years and Older, 2010

Population

Civilian Employment

Total Number Sex
Male Female Age Group 16-17 years 18-64 years 65+ years Race White Black Other* Hispanic origin* Hispanic

7,383,453
48.4% 51.6%
3.8% 83.5% 12.7%
61.7% 29.6%
5.2%
7.6%

4,238,000
52.8% 47.2%
0.5% 96.2%
3.3%
68.5% 27.3%
4.2%
8.7%

* Persons of Hispanic origin may be of any race (white, black, other) *Other includes Asians, American Indians, Alaskan Natives/Pacific Islanders

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Appendix 2

Average Number of Employees in Industries at High Risk* for Morbidity, Georgia, 2009

NAICS Industry Title
Cotton Ginning Sugarcane Milling Fluid Milk Manufacturing Animal Slaughtering Except Poultry Rendering and Meat Byproduct Processing Seafood Canning Soft Drink and Ice Manufacturing Leather and Hide Tanning and Finishing Truss manufacturing Wood Container and Pallet Manufacturing All Other Wood Product Manufacturing Tire Retreading Porcelain Electrical Supply Manufacturing Concrete Pipe Manufacturing Other Concrete Product Manufacturing Rolling and Drawing of Purchased Steel Secondary Smelting and Alloying of Aluminum Foundries Forging and Stamping Kitchen Utensil, Pot, and Pan Manufacturing Architectural and Structural Metals Manufacturing Other Metal Container Manufacturing Other Fabricated Wire Product Manufacturing Precision Turned Product Manufacturing Industrial Pattern Manufacturing All Other Miscellaneous Fabricated Metal Product Manufacturing Agricultural Implement Manufacturing Sawmill and Woodworking Machinery Manufacturing Paper Industry Machinery Manufacturing Food Product Machinery Manufacturing

Average Number
600 0
750 1,750
560 10
1,685 60
970 1,624 2,732
375 10
270 2,291
368 175 946 1,755
0 11,351
60 448 788
60 1,239 4,857
99 127 845

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NAICS Industry Title

Average Number

Commercial Laundry, Dry Cleaning, and Pressing Machine Manufacturing Industrial and Commercial Fan and Blower Manufacturing Overhead Traveling Crane, Hoist, and Monorail System Manufacturing Light Truck and Utility Vehicle Manufacturing Heavy Duty Truck Manufacturing Motor Vehicle Body and Trailer Manufacturing Motor Vehicle Seating and Interior Trim Manufacturing Motor Vehicle Metal Stamping Ship and Boat Building Metal Household Furniture Manufacturing Institutional Furniture Manufacturing Beer, Wine, and Distilled Alcoholic Beverage Wholesalers Pet and Pet Supplies Stores Air Transportation Marine Cargo Handling

60 175
60 60 750 2,089 375 679 1,750 76 859 5,319 2,428 31,323 3,707

Other Support Activities for Transportation Couriers and Messengers Refrigerated Warehousing and Storage Veterinary Services Other Ambulatory Health Care Services Specialty Hospitals Except Psychiatric and Substance Abuse Nursing and Residential Care Facilities Spectator Sports Skiing Facilities Special Food Services Total

149 368
59 15,798
6,821 7,205 62,162 3,642
0 17,882 200,601

Data Source: U.S. Census Bureau County Business (CBP) Patterns. NAICS = North American Industry Classification System (NAICS) *High Risk Based on Bureau of Labor Statistics (BLS) "total reportable cases incidence rates" *Data in this table are limited to the private sector workforce only. Farms, self-employed, public administration, and state/federal government are not included.

45

Appendix 3

Average Number of Employees in Occupations at High Risk* for Morbidity, Georgia, 2009

2002 BOC Occupation Title
Athletes, coaches, umpires, and related workers Emergency medical technicians and paramedics Nursing, psychiatric, and home health aides First-line supervisors/managers of correctional officers Police and sheriff patrol officers Transit and railroad police Animal control workers Food servers, non-restaurant First-line supervisors/managers of landscaping, lawn service, and grounds keeping Janitors and building cleaners Maids and housekeeping cleaners Nonfarm animal caretakers Transportation attendants Reservation and transportation ticket agents and travel clerks Meter readers, utilities Forest and conservation workers Boilermakers Brick masons, block masons, and stonemasons Carpenters Construction laborers Pile-driver operators Glaziers Pipe layers, plumbers, pipefitters, and steamfitters Reinforcing iron and rebar workers Roofers Structural iron and steel workers Highway maintenance workers Miscellaneous construction and related workers Mining machine operators Roof bolters, mining Aircraft mechanics and service technicians Automotive glass installers and repairers

Average Number
10,356 4,144
37,534 0 0
1,189 0
2,208 1,632
32,595 39,375
3,752 15,478
1,618 2,906 1,066 1,269 1,441 33,350 51,961 1,001
0 7,696
0 10,809
294 1,737 1,022
0 0 10,705 778

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2002 BOC Occupation Title

Average Number

Automotive service technicians and mechanics Bus and truck mechanics and diesel engine specialists Heating, air conditioning, and refrigeration mechanics and installers Industrial and refractory machinery mechanics Telecommunications line installers and repairers Coin, vending, and amusement machine servicers and repairers Welding, soldering, and brazing workers Lay-out workers, metal and plastic Model makers and patternmakers, wood Sawing machine setters, operators, and tenders, wood Stationary engineers and boiler operators Cementing and gluing machine operators and tenders Cleaning, washing, and metal pickling equipment operators and tenders Cooling and freezing equipment operators and tenders Etchers and engravers Molders, shapers, and casters, except metal and plastic Paper goods machine setters, operators, and tenders Tire builders Helpers--production workers Production workers, all other Bus drivers Driver/sales workers and truck drivers Taxi drivers and chauffeurs Railroad conductors and yardmasters Subway, streetcar, and other rail transportation workers Sailors and marine oilers Hoist and winch operators Laborers and freight, stock, and material movers, hand Shuttle car operators Total

20,507 8,141
12,667 11,878 8,522
0 9,694
0 0 1,955 1,360 0 0 0 0 1,121 2,076 551 0 31,774 9,610 81,170 6,209 0 2,377 0 0 36,798 1,105 523,430

*Data Source: Bureau of Labor Statistics' Current Population Survey (CPS) *BOC = Bureau of Census Code *High Risk based on Bureau of Labor Statistics "days away from work" cases *Data in this table are limited to the private sector workforce only. Farms, self-employed, public administration, and state/federal government are not included.
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Appendix 4

Average Number of Employees in Industries at High Risk for Occupational Mortality, Georgia, 2009

2007 Census Industry Title
Crop Production Animal Production Forestry, Except Logging Logging Fishing, Hunting, Trapping Support Activities for Agriculture and Forestry Oil and Gas Extraction Coal Mining Metal Ore Mining Nonmetallic Mineral Mining and Quarrying Support Activities for Mining Construction Animal Food, Grain, and Oilseed milling Sugar and Confectionery Products Miscellaneous Petroleum and Coal Products Cement, Concrete, Lime, and Gypsum Product Mfg. Iron and Steel Mills and Steel Product Mfg. Nonferrous Metal Production and Processing (Except Aluminum) Foundries Ship and Boat Building Sawmills and Wood Preservation

Average Number
34,070 9,934 1,673 8,102 0 818 0 0 0 1,450 1,269
337,414 2,580 1,736 0 5,437 5,619 1,860 524 291 1,494

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2007 Census Industry Title
Veneer, Plywood, and Engineered Wood Product Mfg. Recyclable Material Wholesalers Farm Product Raw Materials Wholesalers Farm supplies wholesalers Wholesale Electronic Markets, Agents, and Brokers Rail Transportation Water Transportation Truck Transportation Taxi and Limousine Service Pipeline Transportation Scenic and Sightseeing Transportation Services Incidental to Transportation Sound Recording Industries Other Consumer Goods Rental Commercial, Industrial, and Other Intangible Assets Rental and Leasing Landscaping Services Waste Management and Remediation Services Drinking Places, Alcoholic Beverages Commercial and Industrial Machinery and Equipment Repair and Maintenance
Total

Average Number
656 0 0
816 1,162 16,219 1,006 71,452 9,849 1,487 1,660 33,817 1,905 6,543 2,896 42,682 8,799 5,845 11,286
632,352

*Data Source: Bureau of Labor Statistics' Current Population Survey (CPS) *High Risk based on the Bureau of Labor Statistics' Census of Fatal Occupational Injuries (CFOI) *Data in this table are limited to the private sector workforce only and includes self-employed workers

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Appendix 5

Average Number of Employees in Occupations at High Risk for Occupational Mortality, Georgia, 2009

2007 Census Occupation Title
Farmers and Ranchers Athletes, Coaches, Umpires, and Related Workers Announcers Fire Fighters Security Guards and Gaming Surveillance Officers Crossing Guards First-line supervisors/managers of landscaping, lawn service, & groundskeeping workers Pest Control Workers Grounds Maintenance Workers Tour and Travel Guides First-line Supervisors/Managers of Farming, Fishing, and Forestry Workers Miscellaneous Agricultural Workers Fishers and Related Fishing Workers Logging Workers First-line Supervisors/Managers of Construction Traders and Extraction Workers Boilermakers Brick masons, Block masons, and Stonemasons Cement Masons, Concrete Finishers, and Terrazzo Workers Construction Laborers Paving, Surfacing, and Tamping Equipment Operators Operation Engineers and Other Construction Equip. Ops. Electricians Glaziers Insulation Workers Painters, Construction and Maintenance Roofers Structural Iron and Steel Workers Helpers, Construction Trades Highway Maintenance Workers Miscellaneous Construction and Related Workers Derrick, Rotary Drill, and Service Unit Operators, Oil, Gas, and Mining Earth Drillers, Except Oil and Gas

Average Number
11,117 10,356
0 0 25,040 0 8,485
3,599 39,970
341 3,057 20,072
0 2,405 15,732
1,269 1,441
924 66,720
1,607 5,471 23,575
0 0 15,730 12,983 294 1,347 1,737 1,282 0 0

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2007 Census Occupation Title

Average Number

Mining Machine Operators Roustabouts, Oil and Gas Other Extraction Workers First-line Supervisors/Managers of Mechanics, Installers, and Repairers Bus and Truck Mechanics and Diesel Engine Specialists Heavy Vehicle and Mobile Equipment Service Technicians and Mechanics Maintenance and Repair Workers, General Maintenance Workers, Machinery Millwrights Electronic Power-line Installers and Repairers Riggers Molders and Molding Machine Setters, Operators, and Tenders, Metal Plastic Welding, Soldering, and Brazing Workers Chemical Processing Machine Setters, Operators, and Tenders Aircraft Pilots and Flight Engineers Driver/Sales Workers and Truck Drivers Taxi Drivers and Chauffeurs Motor Vehicle Operators, All Other Locomotive Engineers and Operators Railroad Brake, Signal, and Switch Operators Railroad Conductors and Yardmasters Sailors and Marine Oilers Ship and Boat Captains and Operators Ship Engineers Service Station Attendants Conveyor Operators and Tenders Crane and Tower Operators Industrial Truck and Tractor Operators Refuse and Recyclable Material Collectors Material Moving Workers, All Other Total

0 0 0 10,787 10,357 9,087 6,136 2,090 0 3,521 0 853
9,694 0
7,368 99,073 11,527
2,972 4,023
0 0 0 2,324 0 924 1,173 2,317 27,094 2,380 2,273 490,528

*Data Source: Bureau of Labor Statistics' Current Population Survey (CPS) *High Risk based on the Bureau of Labor Statistics' Census of Fatal Occupational Injuries (CFOI) *Data in this table are limited to the private sector workforce only and includes self-employed workers
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Appendix 6

Chemicals Associated with Occupational Asthma

Chemical Name

Alternate Name

Acrylates & Methacrylates Ethyl cyanoacrylate Methyl 2-cyanoacrylate Ethyl methacrylate Methyl methacrylate Ethoxylated bisphenol A diacrylate Metals Aluminum Chromium and compounds Cobalt

Ethyl-2-cyanoacrylate

Nickel and compounds Palladium Platinum Tungsten carbide Zinc chloride fume Aldehydes Formaldehyde Glutaraldehyde Amines Ethylenediamine Hexamethylene tetramine N,N-Dimethyl-1,3-propanediamine Triethylene tetramine EPO 60 Trimethylhexanediamine + Isophorondiamine 4-Methylmorpholine Piperazine dihydrochloride

Cidex 1,2-Diaminoethane DMAPA

p-Phenylene diamine Ethanolamine N,N-Dimethylethanolamine N-(2-hydroxyethyl) ethylenediamine Triethanolamine
52

2-Aminoethanol Aminoethylethanolamine

Occupation or Industry
Building airplane models Using adhesives Manicurist Nurse Autobody shop worker
Solderer Printer, plater, welder, tanner Hard metal grinder, diamond polisher Metal plating; welder Assembly line worker Platinum refinery Grinder Solderer
Hospital staff Hospital endoscopy unit
Shellac handler; photographer Lacquer handler Ski manufacturer Manufacturing aircraft filters Mold maker Floor covering material salesman
Manufacturing polyurethane foam Pharmaceutical and chemical manufacturing Fur dyeing Beauty culture Spray painter Solderer; cable jointer
Metal worker

Chemical Name
Acid Anhydrides Chlorendic anhydride Hexahydrophthalic anhydride Himic anhydride Maleic anhydride Methyltetrahydrophthalic anhydride Phthalic anhydride Pyromellitic dianhydride Tetrachlorophthalic anhydride Trimellitic anhydride Preservatives/Disinfectants Benzalkonium chloride 1,2-Benzisothiazolin-3-one Chloramine T

Alternate Name

Chlorhexidine

Hibiclens

Hexachlorophene

Isononanoyl oxybenzene sulfonate

Lauryl dimethyl benzyl ammonium chloride

Methylchloro-isothiazolinone

Isocyanates

Dicyclohexylmethane 4,4diisocyanate

Hydrogenated MDI

Hexamethylene diisocyanate

HDI

Isophorone diisocyanate

IPDI

Methylene bisphenyl isocyanate

MDI; Diphenylmethane diisocyanate

Naphthalene diisocyanate

NDI

Polymethylene polyphenyl

PPI

isocyanate

Toluene diisocyanate

TDI

Plastic & Rubber Dusts Azodicarbonamide Plexiglass (dust)
Polyvinyl chloride (heated)

1,1'-Azobisformamide
Lucite; Methyl methacrylate polymer;

Occupation or Industry
Mechanic Chemical worker Manufacturing flame retardant Manufacturing polyester resin Using curing agent
Producing resins Using epoxy adhesives Using epoxy resins Using epoxy resins
Using cleaning product Chemical manufacturing Chemical manufacturing; brewery; janitorial/cleaning Nurse Hospital staff Laboratory technician Using floor cleaner
Chemical manufacturing
Manufacturing polyurethane products Spray painter Spray painter Foundry
Rubber manufacturing Paint shop worker
Producing polyurethanes; floor varnisher
Rubber and plastic manufacturing Factory worker
Meat wrapper's asthma 53

Chemical Name

Alternate Name

Occupation or Industry

Polyvinyl chloride (dust)

Manufacturing bottle caps

Polyethylene (heated) Polypropylene (heated) Pyrolysis Products Rosin core solder
Zinc chloride fume Fungicides Bis(tri-n-butyltin)oxide

Rosin flux pyrolysis products Tributyltin oxide

Paper wrapper's asthma Manufacturing bags
Electronics worker; manufacturing solder flux Solderer; locksmith
Exposure to carpet deodorizer

Captafol

Difolatan

Chemical manufacturing

Chlorothalonil

Tetrachloroisophthalonitrile

Farmer

Other Chemicals Aluminum smelting
Ammonium persulphate Diazonium salt
Dioctyl-phthalate Drugs Ethylene Oxide

Yet to be identified substance or mixture (? aluminum, ? fluorides) that can cause "potroom asthma" in workers at electolytic reduction facilities
e.g., diazonium tetrafluoroborate and p-diethylaminobenzenediazonium chloride;

Potroom worker
Hairdresser Manufacturing photocopy paper; manufacturing fluorine polymer precursor PVC production worker Pharmacist; pharmaceutical worker Nurse

Furfuryl alcohol

Foundry mold making; wool dye house

Ninhydrin

Laboratory worker

Nitrogen chloride

Indoor pool lifeguards

Oil mist, mineral

Metalworking or machining fluids, Toolsetter and automobile plant cutting oils (may contain numerous additives and contaminants)

Styrene Sulfites Tetramethrin Tetrazene Textile dyes Triglycidyl isocyanurate

Plastics factory Water plant; food processor Exterminator Detonator manufacturing Textiles, dye manufacturing Spray painter

Urea formaldehyde

Kaurit S

Resin and foam manufacturing

54 Source: http://www.haz-map.com/OA1.html

55