Coal workers' pneumoconiosis (CWP) is a preventable, progressive occupational lung disease caused by inhaling respirable coal mine dust, a complex mixture commonly containing coal, crystalline silica, and other silicate minerals. Early pneumoconiosis can be asymptomatic, but advanced disease often leads to disability and premature death. To describe CWP-associated mortality among U.S. residents aged ≥15 years by industry and occupation, CDC conducted an exploratory analysis of National Vital Statistics System multiple cause-of-death data for 2020-2023, the most recent years that include information on decedents' usual industry and occupation. During 2020-2023, CWP was listed on the death certificate of 1,754 decedents (age-adjusted CWP-associated death rate = 1.3 per 1 million). By industry group, the highest number of CWP-associated deaths occurred among workers in the mining industry (1,255). The highest proportionate mortality ratios (PMRs) were among persons employed in the mining industry (PMR = 50.0) and the construction and extraction occupations (6.2). Among workers employed in the mining industry, the highest PMR was among underground mining machine operators (164.6). The continuing occurrence of CWP-associated deaths underscores the potential value of a comprehensive prevention program (maintaining efforts to control occupational coal mine dust exposures, combined with early disease detection efforts and medical care) and supports potential benefits of ongoing surveillance.

ObjectiveDescribe work-related asthma (WRA) cases and associated exposures in the legalized cannabis industry.MethodsUsing data from four state-based surveillance systems (California, Massachusetts, Michigan, and Washington), WRA cases within the cannabis industry were identified and classified as new-onset asthma or work-aggravated asthma.ResultsFrom legalization dates (1996 in California, 2012 in Massachusetts, 2008 in Michigan, 1998 in Washington) through 2023, 30 WRA cases were identified. A majority were aged 18 to 34 years (66.7%) and were male (60%). Thirteen (52%) cases were new-onset asthma, and 12 (48%) were work-aggravated asthma, with two fatalities. The most frequently reported exposure was plant materials (40.4%), of which 94.7% were cannabis dust and/or marijuana plant. Most cases (69%) worked in indoor cultivation/processing.ConclusionsCannabis industry workers are at risk for WRA, emphasizing the need for interventions to address workplace respiratory hazards.

OBJECTIVE:Describe work-related asthma (WRA) cases and associated exposures in the legalized cannabis industry. METHODS:Using data from four state-based surveillance systems (California, Massachusetts, Michigan, and Washington), WRA cases within the cannabis industry were identified and classified as new-onset asthma or work-aggravated asthma. RESULTS:From legalization dates (1996 in California, 2012 in Massachusetts, 2008 in Michigan, 1998 in Washington) through 2023, 30 WRA cases were identified. A majority were aged 18 to 34 years (66.7%) and were male (60%). Thirteen (52%) cases were new-onset asthma, and 12 (48%) were work-aggravated asthma, with two fatalities. The most frequently reported exposure was plant materials (40.4%), of which 94.7% were cannabis dust and/or marijuana plant. Most cases (69%) worked in indoor cultivation/processing. CONCLUSIONS:Cannabis industry workers are at risk for WRA, emphasizing the need for interventions to address workplace respiratory hazards.

BACKGROUND:Work-related asthma (WRA), a preventable occupational disease, can result in adverse health outcomes and employment disability, including decreased productivity, lost workdays, and job loss. Early identification of WRA cases and avoidance of further exposures is crucial for optimal management. OBJECTIVE:We estimate WRA prevalence among US workers by selected sociodemographic characteristics, industry, and occupation groups and assess the differences in adverse health outcomes, preventive care, and lost workdays between persons with WRA and those with non-WRA. METHODS:The 2020 National Health Interview Survey (NHIS) data for working adults aged ≥18 years employed in the 12 months before the survey were analyzed. Prevalence, and adjusted prevalence ratios with 95% confidence intervals were estimated using multivariate logistic regression. RESULTS:Of the estimated 170 million US adults working in the past year, 13.0 million (7.6%) had asthma. Among workers with asthma, an estimated 896,000 (6.9%) had WRA. WRA prevalence was highest among males, workers aged ≥55 years, those with no health insurance, those living in the Midwest, and those employed in the accommodation, food, and other services industry, and in production, installation, transportation, and material moving occupations. Workers with WRA were significantly more likely to use preventive medication and rescue inhalers, and to experience adverse health outcomes and lost workdays than workers with non-WRA. CONCLUSION:Early identification of WRA cases, assessment of workplace exposures, and implementation of targeted interventions that consider the hierarchy of controls are critical to preventing future WRA cases and associated adverse health consequences.

BACKGROUND:Asthma, a chronic respiratory disease, is associated with high economic burden. This study estimates per-worker medical and incremental medical costs associated with treated asthma by socioeconomic and demographic characteristics, industries, medical events, and sources of payments for workers aged ≥18 years. METHODS:We analyzed Medical Expenditure Panel Survey data from 2018 to 2020 to assess medical costs for treated asthma among workers using the International Classification of Diseases, Tenth Revision, Clinical Modification code for asthma (J45). We used two-part regression models to estimate medical and incremental medical costs controlling for covariates. All results are adjusted for inflation and presented in 2022 US dollar values. RESULTS:An estimated annual average of 8.2 million workers out of 176 million had at least one medical event associated with treated asthma. The annualized estimated per-worker incremental medical costs for those with treated asthma was $457 and was highest among: those in the age group of 35-44 years ($534), in the western region ($768), of Hispanic ethnicity ($693), employed in the utility and transportation industries ($898), males ($650), and for inpatient admissions ($754). The total annualized medical costs of treated asthma was $21 billion and total of incremental medical costs was $3.8 billion. CONCLUSION:Findings of higher incremental medical costs for treated asthma among workers in certain socioeconomic, demographic, and industry groups highlight the economic benefit of prevention and early intervention to reduce morbidity of asthma in working adults. Our results suggest that the per-person incremental medical costs of treated asthma among workers are lower than that for all US adults.

BackgroundInhalation injuries due to acute occupational exposures to chemicals are preventable. National surveillance of acute inhalation exposures is limited. This study identified the most common acute inhalation exposure-related incidents by industry sector among US workers.MethodsTo characterize inhalation-related injuries and their exposures during April 2011-March 2022, state and federal records from the Occupational Safety and Health Administration (OSHA) Occupational Safety and Health Information System (OIS) accident database were analyzed. Industry-specific injury, hospitalization, and fatality rates were calculated.ResultsThe most frequent acute inhalation incidents investigated by OSHA were caused by inorganic gases (52.9%) such as carbon monoxide (CO) or acids, bases, and oxidizing chemical agents (12.9%) such as anhydrous ammonia. The largest number of fatal and nonfatal injuries were reported in the manufacturing (28.6%) and construction (17.2%) sectors.ConclusionsWorkers were affected by acute inhalation exposures in most industries. Using this surveillance, employers can recognize frequently-occurring preventable acute inhalation exposures by industry, such as inorganic gases in the manufacturing sector, and implement prevention measures. Training of workers on exposure characteristics and limits, adverse health effects, and use of protective equipment by exposure agent can prevent inhalation injuries.

ObjectivesAssess the prevalence of current asthma, asthma attacks/episodes, and asthma-related emergency room (ER) visits by industry and occupation and estimate the proportion of current asthma cases associated with employment during 2020-2021.MethodsThe 2020-2021 National Health Interview Survey data for persons aged >= 18 years who were employed at any time during the 12 months prior to the interview were analyzed.ResultsAn estimated 12.7 million US working adults had current asthma. Of those, 40% had an asthma attack/episode and 8.6% had an asthma-related ER visit. Prevalence varied by sociodemographic characteristics, industry, and occupation. Highest asthma prevalence was among workers in the administrative, support, waste management, and remediation industry and the community and social services occupation. Nearly half of workers with current asthma in the arts, entertainment, and recreation industry and arts, design, entertainment, sports, and media occupations reported having an asthma attack/episode. Workers in the accommodations and food services industry and food preparation and serving related occupation had the highest asthma-related ER visits. The proportion of current asthma cases attributable to employment was estimated to be 9.2% by industry and 12.2% by occupation.ConclusionAn estimated 1.2-1.5 million asthma cases among workers might be attributable to employment by industry and occupation. Disparities in asthma prevalence, asthma attacks/episodes and asthma-related ER visits among workers exist. These findings underscore the importance of early identification of asthma cases in relation to work and implementation of targeted interventions (including, training and education, personal protective equipment use, health surveillance, workplace policies), especially among workers employed in industries and occupations with elevated asthma prevalence.

INTRODUCTION:The COVID-19 pandemic has disproportionately impacted workers in certain industries and occupations. The infection risk for SARS-CoV-2 and future respiratory viruses in the workplace is a significant concern for workers, employers, and policymakers. This study describes the differences in COVID-19 mortality by sex and industry/occupation among working-age U.S. residents in 49 states and New York City. METHODS:The 2021 National Vital Statistics System public use multiple-cause-of-death data for U.S. decedents aged 15-64 years (working age) with information on usual industry and occupation were analyzed in 2022. Age-standardized COVID-19 death rates for selected demographic characteristics and adjusted proportional mortality ratios were estimated by sex and usual industry and occupation. RESULTS:In 2021, 133,596 (14.3%) U.S. decedents aged 15-64 years had COVID-19 listed as the underlying cause of death; the highest COVID-19 death rate was among persons aged 55-64 years (172.4 of 100,000 population) and males (65.5 of 100,000 population). Among males and females, American Indian or Alaskan Native and Black or African American, respectively, had the highest death rates. Hispanic males had higher age-adjusted death rates than Hispanic females. Working-age male decedents in the public administration (proportional mortality ratio=1.39) and management of companies and enterprises industries (proportional mortality ratio=1.39) and community and social services occupations (proportional mortality ratio=1.68) and female decedents in the utilities industry (proportional mortality ratio=1.20) and protective services occupation (proportional mortality ratio=1.18) had the highest proportional mortality ratios. CONCLUSIONS:COVID-19 death rates and proportional mortality ratios varied by sex, industry, and occupation groups. These findings underscore the importance of workplace public health interventions, which could protect workers and their communities.

Abstract Background Asthma-COPD overlap (ACO) is a respiratory condition with more severe respiratory symptoms, poorer quality of life, and increased hospital admissions compared with asthma or COPD alone. Objectives Estimate asthma, chronic obstructive pulmonary disease (COPD), and ACO prevalence among workers by industry and occupation and assess physical and mental health status, healthcare utilization, among workers with ACO. Methods The 2014–2018 National Health Interview Survey (NHIS) data for working adults aged ≥18 years employed (sample n = 99,424) in the 12 months prior to the survey were analyzed. Age-adjusted ACO, COPD and asthma prevalence and prevalence ratios adjusted for age, sex, race and smoking status were estimated. Results During 2014–2018, of the estimated 166 million (annual average) US workers, age-adjusted asthma, COPD, and ACO prevalence was 6.9%, 4.0%, and 1.1%, respectively. ACO prevalence was highest among workers aged ≥65 years (2.0%), females (1.6%), current smokers (1.9%), those living below the federal poverty level (2.3%), and workers in the accommodation and food services (1.6%) industry and personal care and service (2.3%) occupations. Workers with ACO had more frequent (p < 0.05) physician office visits, emergency department visits; and were more likely to be in poorer mental health, obese, have more lost workdays, more bed days, and comorbidities compared to workers with asthma alone and workers with COPD alone. Conclusion: Higher ACO prevalence among worker groups and increased healthcare utilization underscores the need for early identification of asthma and COPD, assessment of potential workplace exposures, and implementation of tailored interventions to reduce ACO among working adults.

In 2020, an estimated 21 million (8.4%) U.S. adults had current asthma. Despite improvements in asthma management and prevention efforts, asthma deaths still occur. Approximately 11%–21% of asthma deaths might be attributable to occupational exposures. To describe asthma mortality among ever-employed persons aged ≥15 years, by industry and occupation, the 2020 National Vital Statistics System mortality data with industry and occupation information collected from 46 states and New York City were analyzed. Decedents with asthma listed as the underlying cause of death were identified using International Classification of Diseases, 10th Revision codes J45 (asthma) and J46 (status asthmaticus). Decedents with information on their usual industry and occupation were considered to be ever employed. Death rates per 100,000 workers aged ≥15 years were age-adjusted using the 2000 U.S. Census standard population. Proportionate mortality ratios (PMRs) for asthma by industry and occupation were calculated. Among 3,077,127 ever-employed decedents, 3,625 (age-adjusted death rate 1.34 per 100,000 workers) had asthma listed on the death certificate as the underlying cause-of-death. The highest age-adjusted asthma death rates per 100,000 workers were for females (1.57), Blacks or African Americans (3.01), and non-Hispanics (1.43). The highest PMRs were for workers employed in the healthcare and social assistance industry (1.18; 95% confidence interval (CI) = 1.08–1.29) and in healthcare support occupations (1.30; 95% CI = 1.10–1.54). High asthma mortality among workers in certain industries and occupations underscores the importance of optimal asthma management and identification and prevention of potential workplace exposures.

Chronic obstructive pulmonary disease (COPD), a progressive lung disease, is characterized by long-term respiratory symptoms and airflow limitation (1). COPD accounts for most of the deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2020.* Workplace exposures and tobacco smoking are risk factors for COPD; however, one in four workers with COPD have never smoked (2-4). To describe COPD mortality among U.S. residents aged ≥15 years categorized as ever-employed (i.e., with information on their usual industry and occupation), CDC analyzed the most recent 2020 multiple cause-of-death data† from 46 states and New York City.§ Among 3,077,127 decedents, 316,023 (10.3%) had COPD listed on the death certificate. The highest age-adjusted** COPD death rates per 100,000 ever-employed persons were for females (101.3), White persons (116.9), and non-Hispanic or Latino (non-Hispanic) persons (115.8). The highest proportionate mortality ratios (PMRs)†† were for workers employed in the mining industry (1.3) and in food preparation and serving related occupations (1.3). Elevated COPD mortality among workers in certain industries and occupations underscores the importance of targeted interventions (e.g., reduction or elimination of COPD-associated risk factors, engineering controls, and workplace smoke-free policies) to prevent COPD from developing and to intervene before illness becomes symptomatic or severe.

INTRODUCTION:Asthma is associated with an increased risk for cardiovascular disease, and adults with persistent, severe asthma have a significantly higher risk of cardiovascular disease than adults with intermittent or no asthma.METHODS:The objective of this cross-sectional study was to assess the association between work-related asthma status and cardiovascular disease among ever-employed adults (aged 18-64 years) with current asthma using data from the 2012-2017 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia. Weighted prevalence ratios and 95% CIs, adjusted for age, sex, race/ethnicity, education, household income, smoking status, chronic obstructive pulmonary disease, diabetes, and BMI, were calculated. In addition, the associations of cardiovascular disease with adverse asthma outcomes and asthma control among adults with work-related asthma were examined. Analyses were conducted in 2021.RESULTS:Among an estimated annualized 14.8 million ever-employed adults aged 18-64 years with current asthma, adults with work-related asthma (prevalence ratio=1.5; 95% CI=1.2, 1.8) and possible work-related asthma (prevalence ratio=1.2; 95% CI=1.0, 1.5) were significantly more likely to have cardiovascular disease than adults with non-work-related asthma. Among adults with work-related asthma, those with very poorly controlled asthma (prevalence ratio=1.8; 95% CI=1.3, 2.5) and an asthma-related emergency room visit (prevalence ratio=1.5; 95% CI=1.1, 2.0) were significantly more likely to have cardiovascular disease.CONCLUSIONS:Adults with work-related asthma were more likely to have cardiovascular disease than those with non-work-related asthma. Primary prevention, early diagnosis, and implementation of optimal work-related asthma management are essential for workers' health. Cardiovascular disease should be considered where appropriate when diagnosing and recommending treatment and interventions for adults with work-related asthma.

In its introduction, this chapter presents on the general impact or burden of occupational asthma (OA) and on the distinction between impairment and disability by proposing distinct definitions of these two entities. Clinicians may mistakenly characterize impairment as "objective" and disability as "subjective," yet this dichotomization offers little useful insights. Impairment refers to a measured decrement in function. In contrast, disability reflects how much the impairment measured (for example, lung function impairment in respiratory disease) impedes or precludes altogether the individual's ability to perform expected daily-life activities, including work tasks. Asthma morbidity in relation to disability is discussed with covering of disability in adult asthma, OA, and work-exacerbated asthma (WEA). Works on quality of life in asthma and OA are then reviewed, with emphasis on a table that includes many studies. Psychological aspects related to asthma and OA are thereafter discussed with coverage on psychological stress and psychiatric morbidity. Various sociodemographic issues are presented: gender differences, burden of healthcare and asthma medication utilization, employment, unemployment, and work productivity. Considerations on the financial impacts and consequences for the workers are detailed. Finally, practical issues on the way to assess impairment and disability in the compensation process are discussed: purposes, impairment scales, how to consider disability in the assessment, etc.

Asthma affects 6.8% of working-age adults in the United States. Identification of workers with asthma that is caused or made worse by exposures in the workplace offers the opportunity for prevention. To estimate the proportion of potential work-related asthma (WRA) among workers in the healthcare and social assistance industry, data from 24 states that collected information from both the Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS) and the Industry and Occupation optional module during 2013–2017 among adults (≥18 years) with current asthma were analyzed. Persons with potential WRA were those who had ever been told by a physician their asthma was work-related or who indicated their asthma was caused or made worse by exposures in their current or previous job. The prevalence of current asthma among healthcare and social assistance industry workers was 9.8%. Overall, 43.8% of the healthcare and social assistance industry workers with current asthma had potential WRA (including 15.9% with physician-diagnosed WRA). Among healthcare and social assistance workers with potential WRA, 18.4% had very poorly controlled asthma, 56.0% had an asthma attack, 34.1% had urgent treatment for worsening asthma, and 17.5% had an emergency room visit in the 12 months prior to the interview. The proportion of healthcare and social assistance industry workers with current asthma who had potential WRA was highest among community and social services occupations (69.6%). The results of this cross-sectional study are consistent with previous reports showing that healthcare workers with current asthma have a high proportion of asthma that may be work-related.

Patients with asthma typically have chronic airway inflammation, variable airflow limitation, and intermittent respiratory symptoms; patients with chronic obstructive pulmonary disease (COPD) often have fixed airflow limitation and persistent respiratory symptoms. Some patients exhibit features suggesting that they have both conditions, which is termed asthma-COPD overlap. These patients have been reported to have worse health outcomes than do those with asthma or COPD alone (1). To describe mortality among persons aged ≥25 years with asthma-COPD overlap, CDC analyzed 1999-2016 National Vital Statistics multiple-cause-of-death mortality data* extracted from the National Occupational Mortality System (NOMS), which included industry and occupation† information collected from 26 states§ for the years 1999, 2003, 2004, and 2007-2014. Age-adjusted death rates per one million persons¶ and proportionate mortality ratios (PMRs)** were calculated. During 1999-2016, 6,738 male decedents (age-adjusted rate per million = 4.30) and 12,028 female decedents (5.59) had both asthma and COPD assigned on their death certificate as the underlying or contributing cause of death. The annual age-adjusted death rate per million among decedents with asthma-COPD overlap declined from 6.70 in 1999 to 3.01 in 2016 (p<0.05) for men and from 7.71 in 1999 to 4.01 in 2016 (p<0.05) for women. Among adults aged 25-64 years, asthma-COPD overlap PMRs, by industry, were significantly elevated among nonpaid workers, nonworkers, and persons working at home for both men (1.72) and women (1.40) and among male food, beverage, and tobacco products workers (2.64). By occupation, asthma-COPD overlap PMRs were significantly elevated among both men (1.98) and women (1.79) who were unemployed, had never worked, or were disabled workers and among women bartenders (3.28) and homemakers (1.34). The association between asthma-COPD overlap mortality and nonworking status among adults aged 25-64 years suggests that asthma-COPD overlap might be associated with substantial morbidity. Increased risk for asthma-COPD overlap mortality among adults in certain industries and occupations suggests targets for public health interventions (e.g., elimination of or removal from exposures, engineering controls, and workplace smoke-free policies) to prevent asthma and COPD in and out of the workplace.

Asthma and chronic obstructive pulmonary disease (COPD) are respiratory conditions associated with a significant economic cost among U.S. adults (1,2), and up to 44% of asthma and 50% of COPD cases among adults are associated with workplace exposures (3). CDC analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data to determine the medical expenditures attributed to treatment of asthma and COPD among U.S. workers aged ≥18 years who were employed at any time during the survey year. During 2011-2015, among the estimated 166 million U.S. workers, 8 million had at least one asthma-related medical event,* and 7 million had at least one COPD-related medical event. The annualized total medical expenditures, in 2017 dollars, were $7 billion for asthma and $5 billion for COPD. Private health insurance paid for 61% of expenditures attributable to treatment of asthma and 59% related to COPD. By type of medical event, the highest annualized per-person asthma- and COPD-related expenditures were for inpatient visits: $8,238 for asthma and $27,597 for COPD. By industry group, the highest annualized per-person expenditures ($1,279 for asthma and $1,819 for COPD) were among workers in public administration. Early identification and reduction of risk factors, including workplace exposures, and implementation of proven interventions are needed to reduce the adverse health and economic impacts of asthma and COPD among workers.

Objective: According to the National Asthma Education and Prevention Program (NAEPP), self-management education is an integral component of effective asthma care and should be offered to every patient with asthma. To estimate the proportion of persons with work-related asthma (WRA) who received asthma self-management education. Methods: A cross-sectional analysis of 2012-2014 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data was conducted among ever-employed adults (>= 18 years) with current asthma from 31 states and the District of Columbia. Results: Adults with WRA were significantly more likely than those with non-WRA to have ever taken a course to manage their asthma (15.7% versus 6.5%; PR = 2.1), been given an asthma action plan (43.5% versus 26.1%; PR = 1.7), shown how to use an inhaler (97.2% versus 95.8%; PR = 1.0), taught how to recognize early symptoms of an asthma episode (79.4% versus 64.1%; PR = 1.2), taught what to do during an asthma episode (86.4% versus 76.3%; PR = 1.1), taught how to use a peak flow meter to adjust daily medications (57.9% versus 41.7%; PR = 1.3), and advised to change things in home, school, or work (56.9% versus 30.4%; PR = 2.0). Moreover, targets for corresponding Healthy People 2020 respiratory disease objectives were met only among adults with WRA. Conclusions: Although adults with WRA were more likely to have received asthma self-management education, results suggest missed opportunities to provide asthma self-management education. Every healthcare visit should be used as an opportunity to discuss asthma self-management.

A subgroup of patients with overlapping clinical features of asthma and chronic obstructive pulmonary disease (COPD) has been associated with worse health outcomes than asthma or COPD alone. To describe the proportion of working adults who have been diagnosed with asthma-COPD overlap (ACO), the 2014–2018 U.S. National Health Interview Survey data for participants aged ≥18 years who were employed at any time during the 12 months prior to the interview were analyzed. Participants told by a doctor or other health professional that they had asthma and reported that they still have asthma were considered to have current asthma, and those told that they had COPD, emphysema, or chronic bronchitis were considered to have COPD. Participants with both current asthma and COPD had ACO. Data were weighted to produce nationally representative estimates. Among an estimated annual average of 166 million working adults, 5.9% had current asthma alone, 2.5% had COPD alone, and 1.1% had ACO. Prevalence of ACO was highest among those aged ≥65 years (2.0%); females (1.5%); those of black, non-Hispanic race (1.3%); with ≤high school education (1.3%); and current smokers (1.9%). Health care and social assistance (1.5%) industry and personal care and service (2.1%) occupations were associated with the highest ACO prevalence. Persons with ACO were more likely to have emergency department (prevalence ratio=6.1) and frequent physician office visits (prevalence ratio=2.0) than those who did not have ACO, current asthma, or COPD. Implementation of treatment according to the recommendations may lead to improved ACO burden and better patient outcomes. Continued surveillance is important to inform policy and intervention activities.