Are U.S. Companies That Use Isocyanates Providing Medical Surveillance?

Details

• Personal Author:
  Reilly MJ ; Rosenman, Kenneth D.
• Description:
  Research Purpose/Relevance: Patients with a prompt diagnosis of work-related asthma (WRA) and removal from ongoing exposure after the initiation of respiratory symptoms have the best prognosis, with fewer symptoms, need less asthma medication and have less loss of FEV1 over time. There is no requirement in the United States for employers to conduct medical surveillance for employees who work with isocyanates. However, the benefit of early diagnosis is justification for employers, who use substances that cause asthma, to institute periodic medical screening. We evaluated the percentage of companies using isocyanates that provided medical surveillance and the prevalence of symptomatic workers in companies with and without medical surveillance over a 24 year period. Methods/Analysis: Michigan has an active surveillance system for WRA based on records from the State Workers' Compensation Agency and regulations that require clinics, employers, health care practioners, hospitals and poison control centers to report all known or suspected work-related disease. Cases are confirmed through a standardized patient interview and review of medical records including pulmonary function testing. An OSHA enforcement inspection is initiated if the case or fellow workers are exposed to substance(s) that potentially could be better controlled. During inspections, the presence and content of any medical surveillance program is reviewed and workers from the same work area, including maintenance employees, complete a confidential self administered questionnaire during paid work hours. Results: Information was available from 142 Michigan OSHA enforcement inspections conducted from 1988 -2011 to follow up 404 cases of isocyanate asthma that occurred in these facilities. Only 29.6% of the companies provided periodic medical surveillance of which less than half included both a questionnaire and spirometry. Only 34.5% provided baseline medical testing of which less than half provided spirometry. The remaining 35.9% of companies provided no medical surveillance. There was no change in the percentage of companies providing medical surveillance over the 24 years. Results of 2051 worker interviews conducted during the inspections found that 19.5% had daily or weekly wheezing, shortness of breath or chest tightness in relationship to work, or new-onset asthma since beginning to work at the company. The percentage of symptomatic workers in companies that provided periodic medical surveillance was 15.5% vs. 21.3% in companies that did not (OR 0.68 (95% C.I. 0.52-0.88). Further analyses by industry type, company size and union status will be presented. Conclusion/ Implications: Only 30% of companies using isocyanates provided a medical surveillance program to their employees without any change in this percentage over a 24 year period. Those companies that do provide medical surveillance had 32% fewer workers with work-related lower respiratory symptoms or new-onset asthma in relation to work. Companies have not voluntarily instituted medical surveillance programs in the absence of a regulatory requirement to do so despite evidence of the benefit of early diagnosis and removal from exposure in reducing morbidity among individuals who develop isocyanate induced asthma. [Description provided by NIOSH]
• Subjects:
  Asthma, Occupational Delivery Of Health Care Isocyanates Lung Lung Diseases Occupational Health Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Exposure Assessment Lung Disorders Medical Care Occupational Asthma Respiratory Diseases Screening Programs Surveillance Programs
• Publisher:
  Work Wellness and Disability Prevention Institute (WWDPI)
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• Place as Subject:
  Maryland ; Michigan ; OSHA Region 3 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  90
• NIOSHTIC Number:
  nn:20054285
• Citation:
  Isocyanates & Health: Past, Present and Future, April 3-4, 2013, Potomac, Maryland. Vancouver, BC, Canada: Work Wellness and Disability Prevention Institute (WWDPI), 2013 Apr; :90
• Email:
  rosenman@msu.edu
• Federal Fiscal Year:
  2013
• Performing Organization:
  Michigan State University
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Isocyanates & Health: Past, Present and Future, April 3-4, 2013, Potomac, Maryland
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:aa2145ba68a6e712a89c97019105f55ceb2507d64a99efdc24dad9ad7881082bc936ea3dfeae3c5e00b48f6dff738572ea5c62107954c2a6c6f8ed20eeb7bf1e
• Download URL:
  https://stacks.cdc.gov/view/cdc/216879/cdc_216879_DS1.pdf
• File Type:
  [PDF - 704.58 KB ]