Current Trends Use of Workers' Compensations Claims for Surveillance of Work-Related Illness -- New Hampshire, January 1986- March 1987

As part of a surveillance program for occupationally related health events, the New Hampshire Division of Public Health Services (NHDPHS) routinely reviews case reports submitted by health-care providers and identifies work-related sentinel health events from death certificates (1,2). Despite the use of multiple data sources, however, surveillance of work-related disease remains incomplete (3). In a further effort to improve surveillance, the NHDPHS recently completed an epidemiologic analysis of workers' compensation claims filed in the state for the 15-month period January 1986-March 1987.

Workers' compensation claims were provided by the New Hampshire Department of Labor. Information on the sex, age, occupation, and place and town of employment of the claimant; the date of the claim; and the diagnosis were abstracted manually from all claims for disease or illness. Data were analyzed to determine the demographic characteristics of claimants and to determine the distribution of work-related illness within particular industries. The proportions of diagnoses in each industrial category were compared with the proportions observed for all claims. Statistical testing was performed using a chi-square distribution with 1 degree of freedom.

Nearly 78,000 claims were filed during the study period. Of these, 76,856 (98.6%) involved work-related injuries, and 1,103 (1.4%) involved illnesses or diseases. Fifty-two percent of illness and disease claims were filed by males. Claimants ranged in age from 16 to 76 years, with a mean of 35 years. Three hundred eighty-six (35%) of reported conditions were attributable to the inhalation of gases, fumes, or vapors; 288 (26%) were attributable to skin disorders; 226 (20%), to carpal tunnel syndrome or other repetitive trauma disorders; and 109 (10%), to exposure to an infectious agent. The latter claims were filed primarily by health-care workers, firefighters, and police officers, who alleged exposure to hepatitis (38%), tuberculosis (19%), pertussis (17%), chickenpox (7%), meningitis (6%), and AIDS (4%).

The distribution of diagnoses by industrial category was also analyzed. Notable findings included elevated proportions of claims due to carpal tunnel syndrome among employees working with rubber (relative risk (RR) = 2.33) and employees in retail sales (RR = 1.93); dermatitis among workers in the metals and electronics industries (RR = 1.99 and 1.42, respectively); and chemical burns resulting from the use of caustic cleaning substances by food and restaurant workers (RR = 6.80). Fewer than 1% (7) of illness claims involved chronic diseases: five cases of asbestosis, one of mesothelioma, and one of pancreatic cancer.

Comparison of the distribution of claims filed during the study period with that observed in an earlier review of 1976 claims revealed a change in the pattern of illnesses (4). The proportion of claims for respiratory diseases and for carpal tunnel syndrome and repetitive trauma disorders had increased markedly; it had decreased considerably for skin disorders (Table 1). Similar nationwide changes have been reported by the Bureau of Labor Statistics (5). Reported by: E Schwartz, MD, MPH, State Epidemiologist, and staff, New Hampshire Dept of Health and Welfare. Office of the Director, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: Surveillance of occupationally related diseases provides critical data necessary for targeting and evaluating prevention and control activities. State-based surveillance often relies on the analysis of data derived from multiple sources, including physician reports, death certificates, hospital discharge records, and workers' compensation claims. Because each data set has different inherent limitations, many states use complementary sources of data to estimate the occurrence of occupational disease more accurately.

Workers' compensation systems vary widely among states in eligibility but commonly are administered by state labor departments to provide no-fault insurance for work-related injuries (6). The New Hampshire law covers occupational diseases as well as injuries and applies to all workers except federal employees, longshoremen, railroad workers, and agricultural workers. Members of certain other exempted groups, such as the self-employed, may participate on a voluntary basis (7). Despite an estimated 8 million claims filed annually in the United States, fewer than 20% of workers who thought they had been severely disabled because of their jobs have ever applied for workers' compensation (8,9). In New Hampshire, as in most states, nearly all claims involve work-related traumatic injuries (10). This pattern occurs partly because the causal association between workplace exposure and a resulting illness is often obscured by 1) the often multicausal nature of many chronic diseases, 2) the generally long latent period between first exposure to workplace agents and the time a chronic condition becomes clinically apparent, and 3) physicians' failure to recognize and diagnose occupational disease. Since workers' compensation claims contain allegations of injury, illness, or disease that may be subject to dispute, cases identified through compensation claims may be considered suspected rather than confirmed. Even so, as with infectious disease, suspected cases can be valuable for surveillance purposes.

Despite these limitations in workers' compensation claims, the New Hampshire data suggest that ongoing analysis of such data may be a useful method for surveillance of trends in occupational illness, as demonstrated by the shift in the distribution of claims from 1976 to 1986. Some of this shift may indicate a true change in the incidence of these conditions, but the magnitude of the increases in claims for respiratory and repetitive trauma disorders suggests that much of the shift can be attributed to improved physician recognition and reporting of these conditions as work-related. In addition, because 10% of disease claims in New Hampshire alleged exposure to an infectious agent, analysis of these claims could enhance surveillance of occupationally related communicable disease as well. Furthermore, epidemiologic surveillance of workers' compensation claims offers an opportunity to identify companies and industries with unusual patterns of work-related illness or injury. Such identification can provide a basis for targeting industrial hygiene evaluations and for more thorough epidemiologic investigations that will lead to interventions. In addition to the use of workers' compensation records for surveillance, the National Institute for Occupational Safety and Health continues to recommend that states develop primary intervention and prevention activities based also upon targeted provider-based case reporting and analyses of other data sources. References

1. CDC. Use of death certificates for surveillance of work-related illnesses--New Hampshire. MMWR 1986;35:537-40.

2. Rutstein DD, Mullan RJ, Frazier TM, Halperin WE, Melius JM, Sestito JP. Sentinel health events (occupational): a basis for physician recognition and public health surveillance. Am J Public Health 1983;73:1054-62.

3. Sundin DS, Pedersen DH, Frazier TM. Occupational hazard and health surveillance. Am J Public Health 1986;76:1083-4.

4. New Hampshire Department of Labor. New Hampshire--Occupational Injuries and Illnesses Survey, 1976. Concord, New Hampshire: New Hampshire Department of Labor, 1978.

5. Bureau of Labor Statistics. Towards improved measurement and reporting of occupational illness and disease. Washington, DC: US Department of Labor, Bureau of Labor Statistics, 1987:78.

6. Larson A. Workmen's compensation for occupational injuries and deaths. New York: Matthew Bender, 1985.

7. New Hampshire Revised Statutes Annotated 281; Workers' compensation law. (Supp. 1986).

8. Shor GM. Workers' compensation: subsidies for occupational disease. J Public Health Policy 1980;1:328-41.

9. US Department of Labor. An interim report to Congress on occupational diseases. Washington, DC: US Department of Labor, 1980:66.

10. Barth PS, Hunt HA. Workers' compensation and work-related illnesses and diseases. Cambridge, Massachusetts: MIT Press, 1980:256.

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