Occupational Disease Reporting
Disease Reporting and Surveillance
Disease surveillance is a core function of public health and many diseases are reportable by law to health departments. Ongoing surveillance enables public health professionals to monitor rates and trends of disease and to identify outbreaks and unusual disease patterns that may require immediate investigation and intervention. In Minnesota, health care providers are required to report over 77 specific infectious diseases to the Minnesota Department of Health within specified time periods. In addition to these communicable diseases, other diseases or health conditions are also reportable to MDH under various state statutes and rules including cancers (MS 144.68), traumatic brain injuries and spinal cord injuries (MS 144.663), birth defects (MS 144.2216), and lead poisoning (MS 144.9502). Other conditions (such as worker deaths, gunshot wounds, and burns) are reportable to other government authorities.
The Council of State and Territorial Epidemiologists (CSTE) conducts an annual survey of states to identify disease reporting requirements. Detailed summaries of reportable diseases and health conditions for Minnesota and other states can be found at the CSTE web site:
- CSTE State Reportable Conditions (viewable only in Internet Explorer)
- CSTE State Reportable Conditions Assessment – Query Page (may be viewable only in Internet Explorer)
Occupational Disease and Injury Reporting
Fatal, serious, and multiple occupational injuries are reportable by employers to the Minnesota Department of Labor and Industry (DLI) within very specific time limits under MS 176.231. For OSHA-regulated industries, occupational injuries and illnesses are recorded in OSHA logs, which are utilized by the annual Survey of Occupational Injuries and Illnesses (SOII), comprised of a stratified sample of industries, conducted jointly by the US Bureau of Labor Statistics (BLS) and the states. Most occupational injuries are also reported to the Workers’ Compensation program at the DLI. Fatal occupational injuries are also identified and tracked by the BLS Census of Fatal Occupational Injuries.
Injury vs disease
Existing surveillance and reporting systems in Minnesota (SOII and Workers’ Comp) are much more complete for occupational injuries than for occupational diseases. While some work-related diseases (such as acute poisonings or dermatitis) are captured by these reporting systems, work-related diseases are generally not well reported or captured by these systems. Injuries are often acute events that occur in the current workplace. Disease related to occupation is usually much more difficult to identify since the disease often occurs many years – often many decades – after the exposure started. Individuals have often changed jobs or retired and are no longer exposed to the disease-causing agent when the disease is diagnosed. This long “latency” makes it difficult for the employee, employer, or health professional to associate the exposure and disease. In addition, many work-related diseases have multiple causes. For example, while asbestos, silica, arsenic, chromium, PAHs, and diesel exhaust are all known occupational risks for lung cancer, smoking is the overwhelming cause of lung cancer. Residential radon exposure, secondary tobacco smoke, and air pollution are additional causes of lung cancer.
Adult asthma is another disease with multiple risk factors. Although many workplace exposures have been associated with asthma and it has been estimated that about 15% of adult asthma is work-related, considerable effort and expense is required to identify asthma that is work-related. Consequently, there is no existing surveillance system that can routinely identify work-related asthma.
A few diseases are closely or almost uniquely associated with occupational exposures and can be readily identified through existing surveillance systems. Mesothelioma and the pneumoconioses (diseases associated with mineral dusts including asbestosis, silicosis, coal workers “black lung”) are diseases that are captured through hospital discharge data, cancer surveillance, and death certificate data. These diseases are overwhelmingly related to occupational exposures and have been included among the occupational health indicators (OHIs). Workers’ compensation data are not used for these indicators as a very small portion of these disease cases are captured by this data set.
Minnesota Statute 144.34: Investigation and Control of Occupational Diseases
Minnesota Statute 144.34 was established in 1939 and states “Any physician having under professional care any person whom the physician believes to be suffering from poisoning from lead, phosphorous, arsenic, brass, silica dust, carbon monoxide gas, wood alcohol, or mercury, or their compounds, or from anthrax or from compressed-air illness or any other disease contracted as a result of the nature of such a person shall within five days mail to the Department of Health a report….”.
While this statute has existed for over 70 years, systematic identification and reporting of occupational diseases entails many challenges, as noted above, and has not been implemented. Consequently, reporting of occupational diseases generally lags far behind reporting of occupational injuries.
Survey of state-based occupational disease reporting
Few states have the necessary resources to support an occupational disease reporting system. To examine the feasibility of implementing MS 144.34, a telephone survey was conducted in 2011 by Program staff of 12 states in which state statutes required some degree of reporting of occupational diseases/conditions. The purpose of the survey was to ascertain how other programs conduct and maintain their statewide occupational disease reporting systems. The survey indicated that the scope and ability of reporting systems to identify and report occupational diseases were largely dependent on both the legislative authority and the monetary support available. The survey also illustrated the necessary resources to create a comprehensive system, as well as methods that other states have utilized to supplement their systems when funding was unavailable or limited.
Electronic Health Records
To address the need for enhancing occupational disease surveillance, there has been a strong national initiative to include a person’s occupation and industry in electronic health records. As recommended in this Institute of Medicine report, inclusion of these items could be of great value for improving identification of work-related conditions by health care providers and for promoting electronic surveillance of occupational diseases. In addition, many states are now including questions on occupation and industry on their federally-funded Behavioral Risk Factor Surveillance System (BRFSS), which are annual randomized telephone surveys of state residents over 18 years of age covering a wide variety of health conditions and behaviors.