Toni Alterman, PhD Senior Health Scientist National Institute for Occupational Safety and Health

Toni Alterman, PhD Senior Health Scientist National Institute for Occupational Safety and Health

Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS) Leslie MacDonald, Sc.D. Sangwoo Tak, Sc.D. Aaron Sussell, Ph.D. (photographer) Division of Respiratory Disease Studies (DRDS) Eva Hnizdo, Ph.D.

Occupational risk factors for CVD and COPD Work organization and psychosocial risk factors Changes in work Impact on health behaviors Value of industry and occupation data for CVD/COPD surveillance and prevention

CVD is the leading cause of death in US 6-18 % of all CHD deaths attributed to occupation (noise, job control, shift work and environmental tobacco smoke)

Stress at work Sedentary job Chemicals Shift work Heavy lifting Thermal stress (extreme heat and cold) Chronic noise exposures

Environmental tobacco smoke Carbon disulfide (viscose rayon workers) Carbon monoxide (bridge and tunnel officers) Exhaust emissions (motor vehicle examiners) Nitroglycerin (munitions workers)

Work in high risk industries increases prevalence of Air Flow Obstruction (AO) in U.S. About 15-20% of cases in U.S. ages 30-75 assoc. with employment in high risk industries. Industries with highest prevalence (NHANES III) Rubber, plastics, leather manufacturing Utilities Office building services Textile products manufacturing

Dusts Mineral (e.g. coal dust, silica, asbestos) * Organic (e.g. grain, wood, cotton) Fumes Metals (e.g. vanadium, osmium) Bleaching chemicals, formaldehyde, ozone Irritant gases (sulfur dioxide SO 2, chlorine (Cl), chlorine dioxide CLO 2 : paper pulp industries *Mineral and cotton dusts are most serious

Bridge and tunnel repair Automotive repair Photos by Aaron Sussell, Ph.D. NIOSH

Work-family conflict (flexitime, flexiplace) Effort-reward imbalance Emotional strain Decision latitude (low decision authority) Psychological job demand (quantitative work load)

Work engagement Work intensification Work schedules (overtime, long work hours) Shift work/sleep problems

Social support (family, co-workers, superiors) Social strain (discrimination, bullying) Job insecurity Organizational change

More contingent and non-standard work arrangements (e.g. contract workers) Intensification and reorganization of work Shift away from manufacturing to services Changes in work organization to increase productivity lean production Decreased unionization, work benefits, and job security.

Physical activity Smoking Diet Alcohol consumption Substance abuse

Information on organizational and individual level risk factors for CVD/COPD is not currently collected in the US. Occupation specific/class exposures and risk factors have been delineated Homogeneity of exposure within I/O Heterogeneity within I/O Opportunities for targeted prevention

I/O needs to be included in electronic medical and health records Identify occupational exposures Direct prevention efforts Example: Medical claims data is being used to compute ischemic heart disease rates and costs by industry (PI: Tim Bushnell, PhD, NIOSH)

There are known physical, chemical, work organization, and psychosocial risk factors for both CVD & COPD Capturing industry & occupation is important for: Linkage across datasets and to electronic health records Targeting prevention & intervention programs Informing translational & etiologic research NIOSH staff can provide assistance in integrating I/O into any surveillance system developed

Talterman@cdc.gov Centers for Disease Control and Prevention 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 24 Hours/Every Day cdcinfo@cdc.gov The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health. And should not be construed to represent any agency determination or policy.

Supplemental slides

Obtain current and historical occupational information to characterize the cohort's exposure to adverse working conditions Administer survey to 25,000 active participants during routine biennial follow-ups. Data will help inform social and environmental determinants of CVD and direct prevention efforts. Leslie MacDonald, Sc.D. (PI, NIOSH)

Demographic statistics Economic trend data Occupational safety and health statistics As a measure of SES for health studies Exposure imputation

What is (was) the title of your principal job for this company? (For example, electrical engineer, stock clerk, farmer)? What are (were) the most important duties of this job? (For example, typing, selling cars, finishing concrete, keeping account books, machining parts)

What is the company name for whom you work? What kind of business or industry is this? (For example, shoe store, farm, real estate agency). What is (was) the principal product manufactured or services provided by this company? (For example, automobile parts, fast food, health care).

CDC/NIOSH has expertise in coding I/O NIOSH is developing computer software to code text for occupation and industry (2012) Occupational Coding systems SOC, DOT, Census Industry Coding systems NAICS, SIC Crosswalks exist Between NAICS and SIC Between SOC, DOT, and Census