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Occupational poison exposures reported to a poison center helpline, Colorado, 2000-2010
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-
2010
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
200
400
600
800
1000
1200
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
Total cases
Rate
Year
Nu
mb
er
of
calls
Rate
per
10
0,0
00
em
plo
yed
Occupational poison exposure calls by gender
59%
38%
2%MaleFemaleUnspecified
26.71/100,000
34.04/100,000
p<.0001
Occupational calls by gender and age group (N=8367)
The 25-34 age group had the greatest exposure
Source: Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)
16-19 20-24 25-34 35-44 45-54 55-64 65+ Un-known
Unknown 2 0 0 2 2 2 0 197
Female 226 430 743 595 397 151 35 625
Male 346 765 1264 898 562 225 56 844
250
750
1250
1750
2250
Age Group
Nu
mb
er
of
exp
osu
res
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
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
16-1920-2425-3435-4445-5455-6465+
Year
Rate
per
10
0,0
00
Age Group
Health outcomes by gender
MALES FEMALES0%
13%
82%
5%
DeathMajor effectModerate effectMinor effectUnable to follow
0.04% 1%
19%
72%
7%
Health management site and medical outcome of work-related poisoning exposures (N=8,367)
Source: Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)
0
500
1000
1500
2000
2500
3000
3500Minor
Moderate
Major
Death
Unable to follow
Healthcare Management Site
Fre
qu
en
cy
Work-associated exposure route & health effects
PathwayTop 10 clinical effects
{88%
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 5.63
Pesticides/Fertilizers 8.52 Cosmetics/Personal Care Products5.44
Other/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
