Occupational poison exposures reported to a poison center helpline, Colorado, 2000-2010

transcript

Amanda Tran, MPH, Colorado School of Public Health

Occupational Health and Safety Surveillance Program, Colorado Department of Public Health and Environment

Poisoning, what is it?

Poisoning: unintended exposure toextrinsic substances that results in at least one related adverse clinical effect

SSA, ISW7 Poisoning Surveillance, 2011

Occupational poisoning surveillance sources, 2010

SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES (SOII)

NATIONAL POISON DATA SYSTEM (NPDS)

Occupational poisonings = 4.4% of all occupational injuries and illnesses nationwide(BLS SOII, 2010)

For every 1 poisoning exposure:• Median 4 days away from work

(BLS SOII, 2010)• ~ 578 cumulative person-years

lost in workplace productivity

No Colorado Data

Occupational poisonings = 1.6% of all national poison center exposure calls (AAPCC 2010 annual report)

Rocky Mountain Poison and Drug Center (RMPDC)• Occupational poisoning =

1.9% of Colorado exposure calls(NPDS 2010 data)

Significance True burden of occupational injuries in

the U.S. is estimated to be 3-5x higher than reported (Blanc, et al., Annals of Internal Medicine)• Healthcare costs• Lack of access to care• Reluctance to seek care or report an injury or

illness as being work-related• Long latency periods between exposure and

symptoms• Low specificity of symptoms

Significance No estimations on the burden of

occupational poison exposures in Colorado

No estimations on the burden of occupational exposures to all toxic substances

Specific Aims Describe the magnitude and

distribution of occupational poison exposures from all substances among Colorado’s employed from 2000-2010

Understand characteristics and risk factors associated with these exposures

Inform occupational health surveillance efforts

Methods Data Sources

Colorado 2000-2010 data

RMPDC data reported through the NPDS

Demographic & location variables Exposure descriptions Exposure substance Health effects

BLS Geographic Profile of Employment and Unemployment

MethodsCase definition

National Institute for Occupational Safety and Health (NIOSH) & Council of State and Territorial Epidemiologist (CSTE) guidelines for occupational health indicator (OHI) surveillance of work-related pesticide poisonings (NIOSH & CSTE)

Study inclusions

Source: Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)

MethodsAnalyses

Descriptive statistics• Rates and frequency by demographic and

exposure variables Chi-square Student’s t-test Geospatial mapping

Decrease in annual numbers & crude rates of work-related exposure, Age 16 years or older, Colorado, 2000-

Numerator : Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)

Denominator: Employed persons age 16 years and older as reported by the Bureau of Labor Statistics (BLS) Geographic Profile of Employment and Unemployment

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

50.00Total casesRate

Occupational poison exposure calls by gender

2% MaleFemaleUnspecified

26.71/100,00034.04/100,000

p<.0001

Occupational calls by gender and age group (N=8367)

The 25-34 age group had the greatest exposure

16-19 20-24 25-34 35-44 45-54 55-64 65+ Unknown0

Age Group

Younger age groups had higher crude rates of occupational poison exposure

Numerator : Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)

Denominator: Employed persons age 16 years and older as reported by the Bureau of Labor Statistics (BLS) Geographic Profile of Employment and Unemployment

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100.00

16-1920-2425-3435-4445-5455-6465+

Age Group

Health outcomes by gender

MALES FEMALES0%

5%DeathMajor effectModerate effectMinor effectUnable to follow

0.04% 1%

Health management site and medical outcome of work-related poisoning exposures (N=8,367)

3500MinorModerateMajorDeathUnable to follow

Healthcare Management Site

Work-associated exposure route & health effects

PathwayTop 10 clinical effects

Top 10 exposure substancesOccupational N=8,367

% of totalcases

Non-occupational N=70,665

% of total cases

Chemicals 17.44 Pharmaceuticals41.49

Fumes/Gases/Vapors 11.43 Cleaning Substances, Household 10.22

Cleaning Substances, Household

10.95 Pesticides/Fertilizers6.85

Hydrocarbons 9.02 Fumes/Gases/Vapors6.68

Pharmaceuticals8.80 Other/Unknown

Non-drug/Missing Substances 5.63Pesticides/Fertilizers 8.52 Cosmetics/Personal Care Products

5.44Other/Unknown Non-drug/Missing Substances

7.33 Hydrocarbons

5.29Other Industrial-use Substance

5.84 Chemicals3.88

Industrial Cleaners 5.29 Other Industrial-use Substance3.80

Other Miscellaneous Substance

3.63 Plant-based Substances2.39

Summary Decreasing trend in occupational poison

exposures from 2000-2010• Annual average rate of 32/100,000 employed

Males had higher rates and reported more severe health outcomes than females (p<.0001)

25-34 age group had the highest incidence(p<.001), but the 16-19 age group had the highest rate (p<.0001)

Summary ~80% of occupational exposures had

minor or moderate health outcomes• 40% of exposures were treated at the

workplace Most common substance exposures

• Chemicals• Fumes/gases/vapors• Household cleaning substances• Hydrocarbons

Strengths & Limitations NPDS is a near real-time database

Passive approach relying on self-reports

Underreporting Caller may not be the exposed worker Possibility of duplicate cases Reporting bias based on demographic groups

Conclusions NPDS may identify less severe poisonings that

are not reported to established surveillance programs

Males and young workers appear to be at higher risk• Requires further analyses of industries and occupations

associated with exposures in these groups

Additional or more focused steps need to be pursued to prevent exposure to common substances

Next Steps Report publication

http://www.cdphe.state.co.us/dc/OH/

Data linkage analysis between RMPDC’s center-level reports and established surveillance systems for lead and mercury toxicity• Explore underlying causes and circumstances of

workplace exposures reported to RMPDC• Evaluate and compare cases captured by the two

surveillance systems

Acknowledgments Colorado Department of Public Health

and Environment:• Meredith Towle, MPH• Amy Warner, MPH• Kirk Bol, MSPH

Rocky Mountain Poison and Drug Center• Alvin Bronstein, MD, FACMT

Questions?Contact:amanda.tran@ucdenver.edumeredith.towle@state.co.us

Phone: (303) 691-4938

Occupational poison exposures reported to a poison center helpline, Colorado, 2000-2010

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