Abstract Surveillance of Wo r k - related Diseases in Kumi Seong-Ah Kim, Jin-Seok Kim 1 ), Hae Ree Jeon 2 ), Sang Jae Jung, Sang Woo Kim, Chae-Yong Lee, Jung-O Ham 1 ), Jay-Young Yoo 1 ), Tae-Sung Choi 1 ), Ha Bong Goo 1 ), Min-Hwan Cho 3 ), Kuck-Hyun Woo 1 ) Department of Occupational and Environmental Medicine, Pochun CHA University, and Kumi CHA Hospital Department of Occupational and Environmental Medicine, Soonchunhyang Hospital 1 ) Department of Occupational and Environmental Medicine, Kumi Korye Hospital 2 ) Kumi Area Office, Korea Occupational Safety and Health Agency 3 ) O b j e c t i v e s: Area-based occupational disease surveillance in Kumi (KODS) was used to collect data on occupational diseases. The data was used to estimate the magnitude of the diseases, to analyze for their characteristics, and to find links for their intervention and prevention. M e t h o d s: Since January 2001, occupational physicians and nurses in Occupational Health Service (OHS) have reported six major occupational diseases; occupational musculoskeletal disorders of the upper extremities (MSDUE), occupational dermatoses, toxic hepatitis, occupational asthma (OA), hand-arm vibration syndrome (HAVS), and occupational cancer. For the respective diseases, a reporting sheet and operational diagnostic criteria were developed by the KODS. An analysis of the KODS data, collected over a certain period, was compared with data from the Korea Labor Workers Corporation (KLWC) and the Specific Health Examination (SHE), and the incidence rates of the diseases estimated. R e s u l t s: Between Jan 2001 and Apr 2002, 287 cases of the six major occupational disease were reported. Of these, there were 132 (46.0%), 100 (34.8%), 34 (11.8%), 16 (5.6%), and 5 (1.7%), cases of MSDUE, occupational dermatoses, toxic hepatitis, OA, and HAVS, respectively. But, there were no cases of occupational cancer. 33 (11.5%) of the incidence were reported via the OHS, 206 (71.7%) from health checkups, and the other 48(16.8%) from other routes. The synthetic fibers and electronic components manufacturing industries accounted for the greatest number of reported cases. With respect to occupation, the greatest numbers of incidence were reported from the elementary occupations, textile workers, assemblers, and cooks and food services worker, in that order. Of the MSDUE cases, carpal tunnel syndrome and epicondylitis were the two most common diseases. Most of the occupational dermatoses were due to contact dermatitis, with organic solvents (59%), nickel (6%), and epoxy resin (5%) accounting for the majority of these cases. All cases of toxic hepatitis were induced by dimethylformamide or dimethylacetamide, which were reported by a unique monitoring system. During same period, there were no cases claimed by workers to the KLWC, and only three cases from SHE, were identified. Using data from workers number and surveillance, the annual incidences of MSDUE, dermatoses, hepatitis, OA, and HAVS, per 100,000 workers were 63.6, 48.2, 17.9, 7.7, and 2.4, respectively. C o n c l u s i o n s: These results show that an area-based surveillance system can be very effective for the collection of data on work-related diseases, at least in Kumi. Key Words: Surveillance, Occupational diseases
Table 1. Occupational diseases reported by primitive surveillance system in Kumi, 2000 Disease Cases (%) Agent Toxic hepatitis 21 38.2 DMAC Contact dermatitis 18 32.7 Epoxy Resin, Solvents etc. MSDUE* 15 27.3 Occupational Asthma 1 0.0 Flux fume(rosin) Total 55 100.0 *; MSDUE, occupational musculoskeletal disorders of the upper extremities
Table 2. Results of diseases by reliability, sex, age, and reporting method MSDUE Dermatoses Toxic hepatitis Asthma HAVS Total Reliability Definite 33 (25.0) - 27 (79.4) - 2 (40.0) 62(21.6) Probable 81 (61.4) 96 (96.0) 7 (20.6) 11 (63.6) 2 (40.2) 197(68.6) Possible 18 (13.6) 4 ( 4.0) - 2 (12.5) 1 (20.0) 25(8.7) Suspected - - - 3 (18.8) - 3(1.0) Sex Male 54 (40.9) 48 (48.0) 24 (70.6) 13 (81.2) 5 (100.0) 144(50.2) Female 78 (59.1) 52 (52.0) 10 (29.4) 3 (18.8) - 143(49.8) Age < 20 3 (2.3) 7 (7.0) 4(11.8) - - 14( 4.9) 20~29 32 (24.2) 55(55.0) 7(20.6) 5 (31.3) - 99(34.5) 30~39 25(18.9) 29(29.0) 7(20.6) 9(31.3) 3(60.0) 73(25.4) 40~49 44(33.3) 6(6.0) 7(20.6) 2(12.5) 1(20.0) 60(20.9) 50~59 26(19.7) - 5(14.7) - - 31(10.8) > 60 2(1.5) 3(3.0) 4(11.8) - 1(20.0) 10( 3.5) Reporting method Medical checkup except mandatory checkup 105(79.6) 86(86.0) 5(14.7) 9(63.4) 1(20.0) 206(71.7) OEM clinic 2(1.8) - - 2(12.5) - 4( 1.4) OHS Doctor 3(2.3) 7(7.0) - 2(12.5) 3(60.0) 15( 5.2) RN 18(13.6) - - - - 18( 6.3) RN of workplace 4(3.0) 7(7.0) 1(2.9) 1*(6.3) - 13( 4.5) Other clinic - - - 2(12.5) 1(20.0) 3( 1.0) Monitoring - - 28(82.4) - - 28( 9.8) Total 132 (100) 100 (100) 34 (100) 16 (100) 5 (100) 287(100) *; reported case by non-medical person ; MSDUE, occupational musculoskeletal disorders of the upper extremities; HAVS, hand-arm vibration syndrome
Table 3. Distribution according to the Korean Standard Classification of Industry Type of industry Frequency Manufacture of synthetic fibers 76 Cotton spinning 10 Manufacture of other made-up textile articles 12 Manufacture of electronic components 59 Manufacture of other electronic components 30 Personnel supply services 12 Restaurants, bars, and canteens 17 Manufacture of rubber and plastic products 13 Others 58 Total 157 Table 4. Distribution according to the Korean Standard Classification of Occupation Type of occupation Frequency Elementary occupations 101 Textile fiber preparing and processing machine operators 57 Assemblers 37 Cooks and foods services workers 27 Office related clerks 13 Metal electroplating and cleaning machine operators 11 Others 41 Total 222
Table 5. Diseases of musculoskeletal disorders Disease Frequency Percentage for reported cases Carpal tunnel syndrome 42 31.8 Epicondylitis (lateral and medial) 39 29.5 Tendinitis (supra- & infra-spinatus, rotator cuff, etc.) 19 14.4 Ganglion 10 7.6 DeQuervain s disease 4 3.0 Myofacial pain syndrome 4 3.0 Ulnar nerve entrapment syndrome 3 2.2 Trigger finger 2 1.5 Others (shoulder pain, unclassified etc.) 21 15.9 Total 144 100.0 Table 6. Agents of occupational dermatoses Suggested agent Frequency % Solvents (DMAC, oil mist, alcohol, cutting oil, xylene, TCE etc.) 59 59.0 2,5-hexanedione 3 3.0 Nickel 6 6.0 Epoxy resin 5 5.0 Rubber glove 2 2.0 Graphite dust 1 1.0 Flux (rosin) 1 1.0 Paint(Urethan pigment) 2 2.0 Glass fiber 1 1.0 Physical irritation (mask, anti-dust clothes) 2 2.0 Chemicals(HCl, HF, NOx etc.) 4 4.0 Others( aroma oil, ciment, lamination resin etc.) 14 14.0 Total 100 100.0 Table 7. Agents of occupational asthma Suspected agent Frequency % MDI 3 18.8 Reactive dye 2 12.5 Grain dust 2 12.5 Flux 2 12.5 Others (Ceramic dust, Herb, Ciment, Solvent, Indoor dust, Paint, Natural rubber) 7 43.7 Total 16 100.0
Table 8. Latency period among toxic hepatitis Working duration (month) Frequency 1 10 1 ~ < 2 11 2 ~ < 3 9 3 ~ 6 4 Total 34 Table 9. Reported cases and annual rates calculated using 2001 LFS*data in Kumi Disease Reported cases during 16 months Annual incidence rate per 100000 workers MSDs of upper extremities 132 63.6(2.5) Dermatoses 100 48.2 Toxic hepatitis 34 17.9 Asthma 16 7.7 HAVS 5 2.4 Total 287 138.4 *; Labor Force Survey ; estimated annual incidence rate per 100000 workers using 1999 Korea Labor Welfare Corporation and data of Ahn et al s study(2002)
Table 10. Participation rate by classification of reporter Occupation of Expected No. of reporters Reporting Average report reporter number (1 & 2/1st quarter) rate No. per reporter Occupational physician* 11 9 (8/8) 82% 28 Clinical physician 10 3 (3/3) 30% 1 Nurse of OHS** 11 4 (3/0) 36% 4.5 Nurse of workplace 10 4 (4/3) 40% 3.3 Other 4 1 25% Total 46 21 46% *; including resident, ; non-medical person **; OHS, occupational health service
A. B. C. 1. 2. FEV1 or PEF 3. (, serial Methacholine Challenge Test) 4. 5. Definite Probable Possible Suspected A + B + C2 or C3 or C4 A + B + C1 or C5 A+B (C2 or C3 or C4). A. 1. 2. A1 B.,, 1. A, B, C,, 2. GOT,GPT2 ( w/o OT/PT Ratio <1 ) 3. B,, Definite Probable Possible Suspected A1 + B1 + B2 A1 + B2 + B3 A2 + B1 + B2 A2 + B2 + B3 A. (2000 - ) B.,,, C. D.,,.
Definite Probable Possible Suspected A, B, C, D (D: -,,, or NCV) A, B, C, D D(-) A & B, A.,, (,,,,, ). B.. C.,. D.. Definite Probable Possible Suspected A, B, C, D A, B, C, D D(-) A & B, A & C,,. - CTS(Carpal Tunnel Syndrome) A:,, CTS B: 1. (,, ) 2. C: ( ) 1) 2) 3) 4) Definite Probable Possible Suspected A, B(B1 & B2), C A, B(B1 or B2), C A B(B1 or B2)C A B(B1 or B2).
(, ) A: B:,,, C: Definite Probable Possible Suspected A, B, C.. A, B, C. A, B C B AC. A. - IARC: group 2A B.,, C.,,,, Definite Probable Possible Suspected A, B, C A, B. B, IARC group 2B. B