Group medical claims as a source of information on worker health and potentially work-related diseases.

OBJECTIVE: To help address underrecognition of occupational illnesses and support planning of workplace health initiatives. METHODS: Data from Highmark Inc., a health care insurer headquartered in Pittsburgh and Camp Hill, Pennsylvania, was used to calculate age and gender-adjusted rates of 15 diseases by industry and broad industry sector. RESULTS: Significant industry differences in disease rates were observed, some corresponding to known differences in workplace risk factors. CONCLUSION: Group medical claims offer timely, relatively low cost, longitudinal data on rates of physician-diagnosed cases and costs of many diseases for large populations. Limitations of medical claims data include inaccuracies in industry coding, lack of occupation codes, and lack of key variables that affect health. Yet, some elevated industry rates suggest potential new targets for wellness programs and evaluation of possible workplace health risks.

Coal dust exposure and mortality from ischemic heart disease among a cohort of U.S. coal miners.

BACKGROUND: Particulate exposure from air pollution increases the risk of ischemic heart disease (IHD) mortality. Although coal miners are highly exposed to coal dust particulate, studies of IHD mortality risk among coal miners have had inconsistent results. Previous studies may have been biased by the healthy worker effect. METHODS: We examined the dose-response relationship between cumulative coal dust exposure, coal rank, and IHD mortality among a cohort of underground coal miners who participated in the National Study of Coal Workers' Pneumoconiosis. RESULTS: After adjusting for age, smoking, and body mass index, risk of IHD mortality increased at higher levels of coal dust exposure. Mortality risk was also associated with coal rank region. CONCLUSION: There was an increased risk of mortality from IHD associated with cumulative exposure to coal dust, and with coal rank. The effect of coal rank may be due differences in the composition of coal mine dust particulate. The association of risk of IHD mortality with cumulative particulate exposure is consistent with air pollution studies.

Noise exposure and hearing loss among sand and gravel miners.

The objectives of this study were to describe workplace noise exposures, risk factors for hearing loss, and hearing levels among sand and gravel miners, and to determine whether full shift noise exposures resulted in changes in hearing thresholds from baseline values. Sand and gravel miners (n = 317) were interviewed regarding medical history, leisure-time and occupational noise exposure, other occupational exposures, and use of hearing protection. Audiometric tests were performed both before the work shift (following a 12-hour noise-free interval) and immediately following the work shift. Full shift noise dosimetry was conducted. Miners' noise exposures exceeded the Recommended Exposure Limit (REL) of the National Institute for Occupational Safety and Health (NIOSH) for 69% of workers, and exceeded the Mine Safety and Health Administration's action level for enrollment in a hearing conservation program for 41% of workers. Significantly higher noise exposures occurred among employees of small companies, among workers with a job classification of truck driver, among males, and among black workers. Hearing protection usage was low, with 48% of subjects reporting that they never used hearing protection. Hearing impairment, as defined by NIOSH, was present among 37% of 275 subjects with valid audiograms. Black male workers and white male workers had higher hearing thresholds than males from a comparison North Carolina population unexposed to industrial noise. Small but statistically significant changes in hearing thresholds occurred following full shift noise exposure among subjects who had good hearing sensitivity at baseline. In a logistic regression model, age and history of a past noisy job were significant predictors of hearing impairment. Overall, sand and gravel workers have excessive noise exposures and significant hearing loss, and demonstrate inadequate use of hearing protection. Well-designed hearing conservation programs, with reduction of noise exposure, are clearly needed.