Occupational Disease Reporting

A Step Toward Safer Workplaces

Many of the 2.3 million persons working in Washington State encounter occupational hazards each work day. Each year, one of nine workers is injured on the job or develops an occupational illness severe enough to file a workers' compensation claim. Nationally, 350,000 new cases of occupational illnesses occur each year and cause an estimated 50,000 deaths. These conditions are all preventable, we should be learning from the circumstances of each injury and illness to prevent future cases. Public health surveillance systems have long enumerated selected communicable diseases (such as tuberculosis and sexually transmitted diseases) and more recently counted certain chronic diseases (as through cancer registries), but reliable information on the occurrence of occupational diseases remains unavailable. Occupational health surveillance focuses on the occurrence and trends of illnesses, injuries, or exposures to workplace hazards. Data are collected to assess variations in rates among industrial groups, geographic areas, and nine periods.

chemical worker
Earl Dotter Although several state and federal programs collect information on occupational conditions, the data have limited usefulness in planning, initiating, and evaluating prevention activities. For example, most serious workplace injuries find their way into workers' compensation claims or employer logs, but most illnesses (especially illnesses related to chemicals) do not. The data systems are incomplete for several reasons, especially for occupational illnesses. Many conditions are not reported to any system because disincentives exist to do so or because the patient, provider, or employer lacks awareness of the relationship between exposure and disease.

Illnesses of occupational origin are often not clinically distinct from diseases due to other causes. In cancer and other chronic disorders, a long latency period may elapse between a workplace exposure and the appearance of illness. Finally, no coordinated program systematically collects, analyzes, and responds to these conditions. Special surveillance systems, including disease reporting requirements for health providers or others, can help solve some of these problems. Thirty-seven states require such reporting for certain or 11 occupational diseases. With the exception of new systems for pesticide illness reporting and laboratory reporting of lead poisoning, Washington State has not applied the traditional public health concept of disease reporting to occupational conditions.

Legislative Action

In a bill concerning chemically related illness, the 1994 Washington State Legislature required that a report by the Department of Labor and Industries (L&I) and the Department of Health (DOH) include "a State Board of Health plan to make occupational diseases reportable conditions." The Board of Health, with the assistance of DOH and L&I, convened an advisory committee to develop a plan to make occupational diseases reportable. The committee included representatives from the business, labor, medical, and university communities and from state and local governmental agencies The committee assessed the ability of existing data sources to provide information on occupational illnesses and injuries in the state of Washington and concluded that the data sources were inadequate. The committee then decided that a newly organized surveillance program could capture data essential for prevention programs. This system should build on existing systems, take pains to avoid being unnecessarily burdensome, and start small to build on successes and learn from mistakes.

Components of the Plan

The committees plan was approved by the State Board of Health in May 1995 and submitted in a report to the Legislature in June. The plan proposes an occupational disease reporting system and specifies: (1) development of a list of specific occupational diseases to be reported, based on specific criteria (Table 1); (2) collection of occupational information in selected data sets; and (3) systematic analysis and appropriate response to the information, and periodic evaluation of the program by an expert advisory committee. Also, the available data sources will be critically reviewed for their ability to describe the magnitude and distribution of occupational disease. Regulations should establish the initial reportable conditions, create a supervisory committee, and give the state and local health departments the authority to collect information on reportable occupational diseases.

The requirements for reporting these conditions will be tailored to the specific disorder, irrespective of the source of the report. For some conditions, education of potential reporters will need to accompany a new reporting requirement. Collected information will only be used to identify persons at risk and to plan, initiate, and evaluate prevention activities. As with other surveillance systems, information identifying individual persons will remain strictly confidential.

The committee suggested an initial provision I reporting period of 36 months for each disease on the list of reportable conditions. This will allow evaluation of the usefulness of the reports of these diseases from the surveillance program and elimination of unnecessary and burdensome requirements.

Occupational Disease Report Another important part of the surveillance plan is to improve data consistency in the state's workers' compensation system. Workers' compensation claims contain some limited information on occupational diseases and can be a good source of data, especially for acute disorders however, the information collected about claims other than those on the State Fund (especially from self-insured employers) is not comparable to the State Fund claims. Approximately one-third of working Washingtonians are covered by workers' compensation plans other than the State Fund.
Surveillance reports and annual summaries will be sent to health care providers, laboratories, public health officials, company managers, union representatives, and other interested parties, and published in an annual report.
An integral component of the plan is evaluation of the effectiveness of the program. The plan recommends establishing a committee to periodically review the surveillance program.

Experts from medical, business, labor, and governmental organizations will review the criteria for making occupational diseases reportable, recommend additions, advise the Board of Health on the usefulness of the program, and recommend whether each disease should be provisionally reportable, removed from the list, or remain on the list. The committee will also recommend the reporting mechanisms and the sources of disease case reports.

Reportable Diseases:Initial Recommendations

The committee recommended that four occupational conditions be subject to mandatory reporting for a three-year period: work-related hospitalized burns, dermatitis, lead poisoning, and toxic hepatitis. Hospitalized burns were selected because their workrelatedness can be easily ascertained. The reporting burden is small because people with severe burns are treated in a few hospitals, and this condition is amenable to prevention.

Dermatitis is the second most often reported type of occupational disease (after musculoskeletal disorders) in workers' compensation claims, is the most commonly noted chemically related illness, and is already reported voluntarily by designated health providers in two counties. The reporting requirement would allow substantially improved surveillance.

Occupational lead poisoning's first three year provisional reporting period ended in May 1996, but has been renewed for an additional three years by the Board of Health. Workplaces with unidentified exposures and co-workers with elevated blood lead levels have been detected. This system has proven acceptable and effective; further refinements to this system will put eradication of this persistent disease within our reach.

Toxic hepatitis was chosen because it is serious and identifiable by biopsy, even though rare and difficult to ascertain as work related. Successful surveillance likely could be achieved by recruiting the aid of a few providers (e.g., gastroenterologists and occupational medicine physicians).

At this writing, DOH and the Board of Health are designing regulations to implement the plan. The eventual surveillance program likely will be a collaboration between the DOH Office of Epidemiology and the L&I Safety and Health Assessment and Research for Prevention (SHARP) program. The proposed surveillance plan will collect data that could help tell us the nature of our workplace health problems, where to direct resources, and how well our solutions have worked. By implementing this plan, the state takes an important step toward ensuring a safe and healthy workplace.

picture - man wearing latex gloves Latex gloves may cause skin rashes an other serious problems in health care workers. Skin conditions care, the second most often reported occupational disease in a worker's compensation claims, an the most commonly noted chemically related illness. Latex-related health problems are occurring more frequently as glove use becomes more commonplace.

Recommended Reading

Baker EL, Melius JM, Millar JD: Surveillance of occupational illness and injury in the United States: current perspectives and future directions. J Public Health Policy 1988; 9:198-221.

Committee on Government Operations: Occupational Illness Data Collection: Fragmented, Unreliable and Seventy Years Behind Communicable Disease Surveillance, Washington, DC: 1984. 60th Report by the Committee on Government Operations, House Report 98-114.

Freund E, Seligman PJ, Chorba TL, Stafford SK, Drachman JG, Hull HF: Mandatory reporting of occupational diseases by clinicians. JAMA 1989; 2b2:3041-3044.

Kaufman J, Burt J, Silverstein BA: Occupational lead poisoning: Can it be eliminated? Am J Indust Med 1994; 26:703-71 2.

Landrigan PJ, Baker DB: The recognition and control of occupational disease. JAMA 1991; 260: 676-680.

Pollack ES, Keimig DG (Eds): Counting Injuries an Illnesses in the Workplace: Proposals for a Better System. Washington, DC: National Academy Press, 1987.

Washington State Department of Health and Department of Labor and Industries. Final Inter-Agency Report on Chemically Related Illness (CRT), Pursuant to 1994 Engrossed Substitute House Bill 2696. Olympia, WA: Department of Labor and Industries, 1995. (Contains the full text of the Board of Health's Plan to Make Occupational Diseases Reportable)

Weeks JL, Levy BS, Wagner GR (Eds): Preventing Occupational Disease and Injury. Washington, DC: American Public Health Association, 1991.

Authors

Joel D. Kaufman, M.D., M.PH., is associate medical director for the SHARP Program (Safety and Health Assessment and Research for Prevention) of the Washington Department of Labor and Industries.

Alden K. Henderson, Ph.D., M.PH., is with the Health Studies Branch of Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta. He formerly was a toxicologist with the SHARP Program, Washington Department of Labor and Industries.

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Created: 2/28/97 Updated: 7/14/99