Proportionate mortality among US migrant and seasonal farmworkers in twenty-four states.

BACKGROUND: US migrant and seasonal farmworkers may be exposed to potentially carcinogenic pesticides and other agents. Little epidemiologic research has been conducted on this population. METHODS: We examined the proportionate mortality of 26,148 subjects (14,631 white men (WM), 7,299 nonwhite men (NM), 1,081 white women (WW), and 3,137 nonwhite women (NW)) who were identified as farmworkers on death certificates from 24 US states during 1984-1993. RESULTS: Farmworkers had significantly elevated proportionate mortality from injuries, tuberculosis, mental disorders, cerebrovascular disease, respiratory diseases, ulcers, hypertension (NW), and cirrhosis (NW). There was significantly reduced mortality from infectious diseases (other than tuberculosis), endocrine disorders, nervous system diseases, pneumoconioses, arteriosclerotic heart disease (WM), and all cancers combined. Proportionate cancer mortality analyses found excess cancers of the buccal cavity, larynx, esophagus, stomach, skin (NW), and cervix, and deficits for cancers of the colon, breast, kidney, pancreas (NW), and lymphohematopoietic system. CONCLUSIONS: The excess deaths from injuries, respiratory disease, and stomach cancer, and the deficits of colon cancer and arteriosclerotic heart disease among farmworkers, are consistent with typical mortality patterns previously observed among farm owner/operators. The excess buccal, laryngeal, esophageal, and cervical cancers, and the deficits of breast cancer and lymphohematopoietic cancers have not generally been observed in studies of farm owner/operators.

Back pain prevalence in US industry and estimates of lost workdays.

OBJECTIVES: Back pain is the most common reason for filing workers' compensation claims and often causes lost workdays. Data from the 1988 National Health Interview Survey were analyzed to identify high-risk industries and to estimate the prevalence of work-related back pain and number of workdays lost. METHODS: Analyses included 30074 respondents who worked during the 12 months before the interview. A case patient was defined as a respondent who had back pain every day for a week or more during that period. RESULTS: The prevalence of lost-workday back pain was 4.6%, and individuals with work-related cases lost 101.8 million workdays owing to back pain. Male and female case patients lost about the same number of workdays. Industries in high-risk categories were also identified for future research and intervention, including those seldom studied. CONCLUSIONS: This study provides statistically reliable national estimates of the prevalence of back pain among workers and the enormous effect of this condition on American industry in terms of lost workdays.

Association of occupational and non-occupational risk factors with the prevalence of self-reported carpal tunnel syndrome in a national survey of the working population.

To compare the association of occupational versus personal, nonoccupational risk factors with the prevalence of carpal tunnel syndrome (CTS), data from the 1988 National Health Interview Survey, Occupational Health Supplement, were analyzed. When both occupational factors (bending/twisting of the hands/wrists [B/T] and use of hand-held vibrating tools) and personal nonoccupational factors (gender, race, age, body mass index [BMI], smoking, education, and family income) were included in a multivariate logistic regression model, adjusted odds ratios (AORs) of these factors for reporting medically called CTS (MC-CTS) were: exposure to B/T, 5.5; exposure to vibration, 1.9; white race, 16.7; female gender, 2.3; BMI > or = 25, 2.0; history of cigarette smoking, 1.6; age > or = 40, 1.2; education > 12 years, 1.2; and annual family income > or = $20,000, 1.5. Although both occupational and nonoccupational factors are associated with reporting of CTS, repetitive bending/twisting of the hands/wrists and use of vibrating tools remain important risk factors for work-related carpal tunnel syndrome.

Back pain among workers in the United States: national estimates and workers at high risk.

Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.

Prevalence of chronic diseases and impairments among US farmers, 1986-1990.

Farmers in the United States suffer disproportionately from certain chronic diseases and impairments. This analysis estimated the prevalence of selected diseases among farmers and compared these rates with those for other US workers. Five years (1986-1990) of National Health Interview Survey data on white male workers were combined to provide a basis for estimating the prevalence of selected conditions and impairments among this subgroup. Crude prevalence rates were significantly elevated for farmers compared with other workers for cardiovascular diseases, arthritis, skin cancer, hearing loss, and amputations. These elevations persisted when farmers were compared with blue-collar workers. The crude prevalence of orthopedic impairments and chronic respiratory diseases was not elevated among farmers, but the age-adjusted prevalence ratios for cardiovascular diseases, arthritis, and amputations were significantly elevated for farmers as compared with other workers. The prevalence of hearing loss was significantly higher only for farmers older than 65 years. This method of pooling data holds promise for studying disease rates in other small segments of the US population.

Cigarette smoking prevalence by occupation in the United States. A comparison between 1978 to 1980 and 1987 to 1990.

We analyzed data from 1987 to 1990 National Health Interview Surveys and compared them with 1978 to 1980 National Health Interview Surveys data to determine changes in cigarette smoking prevalence by occupation. During this period, cigarette smoking prevalence declined from 31.7% to 24.2% among white-collar workers, from 43.7% to 39.2% among blue-collar workers, and from 37.2% to 34.5% among service workers. For occupational groups, the largest significant declines in smoking prevalence occurred among male sales workers (10.5 percentage points), female and male managers and administrators (9.9 and 8.7 percentage points), female professional and technical workers (8.0 percentage points), and male transportation equipment operatives (7.5 percentage points). Analyses of 1987 to 1990 detailed occupation codes revealed that roofers (57.8%) and crane and tower operators (57.6%) had the highest prevalences of cigarette smoking, whereas physicians (5.4%) and clergy (6.5%) had the lowest smoking prevalences. Since 1978 to 1980, the differences in smoking prevalence by occupation have widened, providing further evidence that smoking has moved from a relatively common behavior practiced by most segment of society to one that has become more concentrated among selected subpopulations. Health professionals need to play an important role in encouraging smoking cessation among workers and in advising management and labor about the benefits of strong work-site smoking policies.

Trends in cigarette smoking among US physicians and nurses.

OBJECTIVE: To determine trends in cigarette smoking prevalence among physicians, registered nurses, and licensed practical nurses since 1974. DESIGN: Analyses of data on smoking prevalence among persons 20 years of age and older using combined National Health Interview Survey data sets from 1974, 1976, and 1977; 1978, 1979, and 1980; 1983 and 1985; 1987 and 1988; and 1990 and 1991. MAIN OUTCOME MEASURES: Prevalence of cigarette smoking and average annual change in smoking prevalence. RESULTS: Based on the data for 1990 and 1991, there were an estimated 18,000 physicians, 322,000 registered nurses, and 128,000 licensed practical nurses who smoked cigarettes in the United States. Compared with 1974, 1976, and 1977, by 1990 and 1991 cigarette smoking prevalence had declined from 18.8% to 3.3% among physicians (average annual decline of 1.15 percentage points); from 31.7% to 18.3% among registered nurses (average annual decline of 0.88 percentage point); and from 37.1% to 27.2% among licensed practical nurses (average annual decline of 0.62 percentage point). CONCLUSION: Since 1974, cigarette smoking has declined most rapidly among physicians, at an intermediate rate among registered nurses, and at a lower rate among licensed practical nurses. Because of their important roles as exemplars and health educators, persons in these occupations should not smoke.

Visual assessment of facial elastosis using photographs as a measure of cumulative ultraviolet exposure.

Because solar ultraviolet (UV) exposure is ubiquitous, it is difficult to quantify in human populations. We developed a method to index cumulative UV damage, based upon visual manifestations of facial actinic elastosis. Four photographic slides were taken of each subject's facial skin. These slides were projected on a screen and graded by consensus of 2 raters using a 5-point relative severity scale. Rating disagreements were resolved by a skilled dermatologist who acted as adjudicator. High photographic quality was maintained by standardization of camera settings, lighting, and photographic techniques. Inter- and intrarater variability in grading was minimized by training using standard slides and by practice. This index has been tested in 2 large epidemiologic studies. The method proved highly reliable and, within categories of age and tanning ability, a valid measure of cumulative UV exposure. In addition, this method appeared superior to others in speed, ease of use and cost.

An analysis of potential carcinogenic risk from formaldehyde.

Formaldehyde was recently shown to be carcinogenic in the nasal cavities of rats and mice following chronic inhalation at vapor concentrations which were cytotoxic. The epidemiological, physiological, and toxicological data on formaldehyde are evaluated as they pertain to the analysis of carcinogenic risk. It is concluded that humans are likely to be less susceptible than test rodents to potential carcinogenic effects and that the risk at low-level exposure would not be linearly related to that observed at the higher levels which were found to be carcinogenic in animals. Risk assessment procedures and risk management decisions should incorporate all of the relevant biological information, such as that discussed, rather than rely solely on a mathematical approach which is likely to yield inaccurate and misleading conclusions.