1. Amanda Tran, MPH, Colorado School of Public Health Occupational Health and Safety Surveillance Program, Colorado Department of Public Health and Environment

2.  Poisoning: unintended exposure to extrinsic substances that results in at least one related adverse clinical effect SSA, ISW7 Poisoning Surveillance, 2011

3. 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)

4.  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

5.  No estimations on the burden of occupational poison exposures in Colorado  No estimations on the burden of occupational exposures to all toxic substances

6.  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

7.  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

8.  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)

9. Source: Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)

10.  Descriptive statistics Rates and frequency by demographic and exposure variables  Chi-square  Student’s t-test  Geospatial mapping

11. 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

13. Source: Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)

14. 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

15. MALESFEMALES

16. Source: Rocky Mountain Poison and Drug Center (RMPDC) data from the National Poison Data System (NPDS)

17. Inhalation Ocular Dermal Ingestion Multiple routes Unknown Parenteral Other Otic 1) Ocular irritation 2) Other 3) Dermal irritation 4)Headache 5) Nausea 6) Throat irritation 7) Cough/choke 8) Erythema 9) Vomiting 10) Burns Pathway Top 10 clinical effects 88%

18. Occupational N=8,367 % of total cases Non-occupational N=70,665 % of total cases Chemicals 17.44Pharmaceuticals 41.49 Fumes/Gases/Vapors 11.43Cleaning Substances, Household 10.22 Cleaning Substances, Household 10.95Pesticides/Fertilizers 6.85 Hydrocarbons 9.02Fumes/Gases/Vapors 6.68 Pharmaceuticals 8.80 Other/Unknown Non-drug/Missing Substances 5.63 Pesticides/Fertilizers 8.52Cosmetics/Personal Care Products 5.44 Other/Unknown Non-drug/Missing Substances 7.33Hydrocarbons 5.29 Other Industrial-use Substance 5.84Chemicals 3.88 Industrial Cleaners5.29Other Industrial-use Substance 3.80 Other Miscellaneous Substance 3.63Plant-based Substances 2.39

19.  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)

20.  ~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

21.  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

22.  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

23.  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

24.  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

25. Contact: amanda.tran@ucdenver.edu meredith.towle@state.co.us Phone: (303) 691-4938