The New York State Department of Health (NYSDOH) Heavy Metals Registry was established in 1980 as a tool for the surveillance of adult exposures to arsenic, cadmium, lead, and mercury. Information is received from all clinical laboratories that test for any of these four metals in the blood or urine of adults who live or work in New York State. In 1992, legislation was enacted that required the reporting of all blood lead results, regardless of level. For mercury, arsenic and cadmium, only test results above specified limits are reportable to the NYSDOH.
This report presents statistics for the test results reported to the registry from 2000 through 2005. It is intended as a resource for programs providing preventive health care and for those concerned with reducing overall morbidity from heavy metals poisonings.
Only those adults (16 years of age and older) with reportable levels of arsenic, cadmium and mercury are added to the Heavy Metals Registry (See Appendix A for reportable levels). For this six year period, there were 899 adults with reportable levels of arsenic, 41 with reportable levels of cadmium and 7,952 with reportable levels of mercury. For lead, currently only blood lead levels of 10 micrograms per deciliter (µg/dL) or above are added to the Heavy Metals Registry. Overall, there were 12,522 adults with blood lead levels at or above 10 µg/dL.
NYSDOH staff routinely interview those adults with blood lead levels greater than or equal to 25 µg/dL (between 20 to 25 percent of all adults added to the Heavy Metals Registry for lead). Seventy-four percent of the people reported with blood lead levels greater than or equal to 25 µg/dL who were interviewed had an exposure that was occupational in origin. More than half of these occupational lead exposures were employed in the construction industry, and approximately 28 percent were employed in the manufacturing industry. Occupations reported in the Registry that had employees with higher blood lead levels included various construction trades, machine operators, laborers, precision production workers and assemblers. Due to high blood lead levels that have been reported to the Registry from employees in the scrap metal recycling industry, NYSDOH staff chose to examine this industry more closely. A study was conducted to identify and evaluate workers' exposures to lead and selected other hazardous metals in the scrap metal recycling industry. A summary of this study and recommendations to reduce workers' exposures are included in the Special Highlights section of this report.
Background
The New York State Department of Health (NYSDOH) Heavy Metals Registry (HMR) is a tool for the surveillance of adult exposures to arsenic, cadmium, lead and mercury. These metals are widely used in industry, and all have the potential to cause illness due to either acute or chronic exposure. Examination of the registry data can identify exposures in both communities and workplaces, thus allowing for early initiation of measures to help prevent exposures and potential illness.
The NYSDOH established the HMR in 1980 under Sections 22.6 and 22.7 of the State Sanitary Code (Appendix A), and reporting to the Registry began in 1982. All clinical laboratories, both in-state and out of NYS performing tests for arsenic, cadmium, lead and mercury on individuals residing or employed in NYS must report the results of the test to the NYSDOH. For mercury, cadmium and arsenic, only those tests above specified limits (shown in Appendix A) are required to be submitted to NYSDOH. From 1982 to 1986, blood lead levels of 40 micrograms per deciliter (µg/dL) or higher were reportable. In 1986, the reportable blood lead level was lowered to 25 µg/dL or higher. Then in 1992, as part of a major childhood lead poisoning prevention initiative, legislation was enacted to require the reporting of all blood lead results for all age groups, regardless of level. This legislative change has helped to identify elevated blood lead levels early and verify decreases in blood lead levels.
This report presents statistics for tests conducted from 2000 through 2005, and covers the four metals included in the HMR - arsenic, cadmium, lead and mercury. The number of adults reported since the inception of the Registry is presented for each metal. This report is intended as a resource for programs providing preventive health care and for public health officials concerned with reducing overall morbidity from heavy metals poisonings. Because of the change in the reporting requirement for lead in 1992 and because testing for lead exposure is much more common, lead tests account for approximately 78 percent of the tests added to the HMR each year. Therefore, the majority of this report focuses on the lead reports. The NYSDOH considers adult blood lead test results at or above 25 µg/dL to be indicative of an exposure to an identifiable source of lead, and conducts interviews on those adults.
This report also includes a Special Highlights section addressing lead exposure in the scrap metal recycling industry. This section discusses a study conducted by NYSDOH industrial hygiene staff that resulted in several recommendations for reducing lead and other heavy metal exposures for scrap metal recyclers.
Program Operation
Laboratories can report heavy metal test results electronically through the internet or manually on paper forms to the NYSDOH. All information reported to the registry is confidential, and records and computer files are maintained in accordance with NYSDOH regulations concerning medical data containing individual identifiers. Access to the data by anyone other than registry personnel is restricted and carefully monitored to ensure that confidentiality is maintained.
Registry staff contact all individuals reported to the registry with a reportable level of arsenic and cadmium. All individuals with reportable urine mercury levels are interviewed as well. Due to difficulty in identifying an exposure source for lower levels of blood mercury or lead and the absence of identifiable health effects at these levels, only those reports with blood mercury levels at or above 15 nanograms per milliliter (ng/mL) or with blood lead levels at or above 25 µg/dL are interviewed. Because of the large number of lead reports received each year, only those with blood lead levels greater than or equal to 10 µg/dL are added to the HMR. During an interview of a person reported to the HMR, the NYSDOH collects demographic information and information on the subject's work and home environments. This interview is used to determine the possible sources of exposure and to advise the person on appropriate control measures to limit future exposures. Subjects are provided with the local phone number of the NYS Occupational Health Clinic Network, for follow-up (Appendix B). When the exposure is work-related, information is gathered on the employer, work location, protective measures in place and whether coworkers are also potentially exposed.
Industrial hygiene staff provide consulting services to worksites with employees who have high or persistently elevated heavy metal levels. For situations where an employer has not previously had an employee who was reported to the HMR, an industrial hygienist contacts the company to determine the exposure circumstances, to learn whether coworkers are at risk, and to assess whether the company is taking appropriate measures to control exposures. With all contacts, the industrial hygienist protects the confidentiality of the individual reported. An important focus for these efforts is smaller businesses that do not have either full-time medical or industrial hygiene staff to evaluate their worksites. Between 2000 and 2005, there were 577 employers identified with at least one employee reported to the HMR with an occupational exposure to lead, 41 employers identified for occupational exposures to mercury, 11 for occupational exposures to arsenic and 2 for occupational exposures to cadmium.
NYSDOH staff make recommendations to employers on methods to reduce exposure to all heavy metals whenever feasible. The NYSDOH recommendations for exposures to heavy metals are guided by the federal Occupational Safety and Health Administration (OSHA) standards and the experience of the industrial hygienists in addressing similar exposures. The goal of the consultation is to identify site-specific exposure reduction techniques and to encourage monitoring to help assure that exposures have been reduced.
Arsenic
N
%
899
Male
535
59.5
Female
364
40.5
≤29 years
48
5.3
30-49 years
342
38.0
≥50 years
503
56.0
Unknown
6
0.7
Occupational
10
1.1
Non-Occupational
719
80.0
Both
8
0.9
Unknown
162
18.0
NYS w/o NYC
467
51.9
NYC
401
44.6
Cadmium
N
%
41
Male
26
63.4
Female
15
36.6
≤29 years
5
12.2
30-49 years
18
43.9
≥50 years
18
43.9
Occupational
12
29.3
Non-Occupational
11
26.8
Unknown
18
43.9
NYS w/o NYC
27
65.9
NYC
11
26.8
Lead
N
%
12,522
Male
10,021
80.0
Female
2,482
19.8
Unknown
19
0.2
<29 years
3,425
27.3
30-49 years
6,520
52.1
>50 years
2,537
20.3
Unknown
40
0.3
Occupational
3,720
29.7
Non-Occupational
452
3.6
Both
74
0.6
Unknown
8,276
66.1
NYS w/o NYC
6,771
54.1
NYC
4,447
35.5
-), only those tests greater than or equal to 40 µg/dL were required to be reported. From 1987 to 1993 (--), test results of 25 µg/dL and above were reportable. In 1992, a New York State regulation was enacted requiring the reporting of all blood lead results for all ages, regardless of level. This resulted in adding all reports with blood lead levels greater than or equal to 10 µg/dL to the HMR in 1994 (--). Another contributing factor resulting in the increase in testing was the enactment of the OSHA Lead in Construction standard in 1993 requiring biomonitoring for construction workers with lead exposure. Each new reporting requirement resulted in an increase in the number of reports received. However, the number of adults added to the HMR with blood lead levels of 10 µg/dL or greater has steadily decreased since 1996, following the national trends of decreasing blood lead levels in adults and children.
<Table 4. Total Number of Tested Adults Reported with Peak Blood Lead Levels ≥ 25 µg/dL to the Heavy Metals Registry, by Sex, Age, Exposure Source, Geographic Region, and Blood Lead Level, 2000 - 2005.
Peak Blood Lead Levels (µg/dL)
25-39
40-59
≥ 60
Total
N
%*
N
%*
N
%*
N
%*
2,161
564
76
2,801
Male
1,950
90.2
512
90.8
69
90.8
2,531
90.4
Female
211
9.7
51
9.0
7
9.2
269
9.6
Unknown
0
0
1
0.2
0
0
1
0.0
<29 years
493
22.8
116
20.6
15
19.7
624
22.3
30-49 years
1,243
57.5
330
58.5
41
53.9
1,614
57.6
>50 years
421
19.5
118
20.9
20
26.3
559
20.0
Unknown
4
0.2
0
0
0
0
4
0.1
Occupational
1,590
73.6
436
77.3
47
61.8
2,073
74.0
Non-Occupational
270
12.5
78
13.8
20
26.3
368
13.1
Both
44
2.0
12
2.1
5
6.6
61
2.2
Unknown
257
11.9
38
6.7
4
5.3
299
10.7
NYS w/o NYC
1,201
55.6
288
51.1
35
46.0
1,524
54.4
NYC
703
32.5
224
39.7
35
46.0
962
34.3
Out of NY
231
10.7
44
7.8
5
6.6
280
10.0
Unknown
26
1.2
8
1.4
1
1.3
35
1.2
*Note: Due to rounding, some percentage columns may not sum to 100.
Industry and Occupation
Table 5. Number of Tested Adults Reported with Occupational Exposures and Peak Blood Lead Levels ≥ 25 µg/dL, By Industry Type, 2000 - 2005
SIC Code SIC Descriptor
Peak Blood Lead Level (µg/dL)
25-39
40-59
≥60
Total
15
General Contractors
26
4
0
30
16
Heavy Construction
241
66
7
314
17
Special Trade Contractors
580
230
27
837
<847
<300
<34
<1,181
28
Chemicals and Allied Products
7
0
0
7
32
Stone, Clay, Glass and Concrete Products
79
9
0
88
33
Primary Metal Industries
160
15
1
176
34
Fabricated Metal Products
50
13
0
63
35
Industrial Machinery and Equipment
10
3
1
14
36
Electronic and Other Electrical Equipment
175
39
0
214
37
Transportation Equipment
3
1
0
4
38
Measuring, Analyzing and Controlling Instruments
3
0
1
4
<489*
<82*
<3*
<574*
48
Communications
9
2
0
11
49
Electric, Gas and Sanitary Services
40
4
2
46
50
Wholesale Trade - Durable Goods
21
4
0
25
55
Automotive Dealers and Service Stations
3
1
0
4
73
Business Services
8
0
1
9
75
Automotive Repair, Services, and Parking
10
0
0
10
76
Miscellaneous Repair Services
5
2
0
7
80
Health Services
4
0
0
4
87
Engineering and Management Services
7
2
0
9
92
Justice, Public Order and Safety
20
4
0
24
96
Administration of Economic Programs
22
1
0
23
99
Nonclassifiable Establishment
43
22
6
71
<205*
<46*
<10*
<261*
*Totals do not add up correctly because only those industries with more than 3 cases are shown in table. Note: Table does not include 11 individuals with a known occupational exposure, but who did not have an assigned SIC code.
Table 6. Number of Tested Adults Reported with Occupational Exposures and Peak Blood Lead Levels ≥ 25 µg/dL, by Selected Occupation, 2000 - 2005
Occupation
Blood Lead Levels (µg/dL)
25-39
40-59
≥60
Total
Executive, Administrative and Managerial
14
4
0
18
Professional Specialty
11
1
1
13
Technicians and Related Support
7
1
0
8
Sales
1
0
0
1
Administrative Support, Including Clerical
7
0
0
7
Service
40
8
1
49
Farming
2
0
0
2
Mechanics and Repairers
77
11
1
89
Construction Trades
688
244
31
963
Precision Production
58
13
1
72
Machine Operators and Tenders
158
39
1
198
Fabricators, Assemblers and Inspectors
62
13
1
76
Transportation and Material Moving
20
8
1
29
Handlers, Equipment Cleaners, Helpers and Laborers
136
35
7
178
<1281
<377
<45
<1703
Note: This table does not include 65 individuals with known occupational exposures, but who did not have an assigned occupation code
Table 7. Number of Tested Adults Reported with Non-Occupational Exposures and Peak Blood Lead Levels > 25 µg/dL, by Source of Exposure, 2000 - 2005
Blood Lead Levels (µg/dL)
Exposure Source
25-39
40-59
≥60
Total
Accidental Ingestion, Pica
31
9
3
43
Cookware
11
0
0
11
Environmental*
8
3
1
12
Casting
11
1
1
13
Folk Medicine
21
13
5
39
Hobby, Jewelry, Crafts
5
0
0
5
Bullet Embedded in Body
4
1
4
9
Residential Remodeling
68
22
3
93
Target Shooting
65
16
1
82
Unknown
46
13
2
61
<270
<78
<20
<368
*Environmental exposures are from lead in the environment around the household. These occurred outside of the United States.
Mercury
Mercury occurs naturally in the environment in several forms. A common form of mercury is called metallic or elemental. It is a silvery, odorless liquid that can evaporate at room temperature, becoming a vapor. Mercury can also combine with other chemicals to form inorganic or organic compounds. Urine and blood testing are the commonly accepted methods to assess mercury exposure for medical purposes. The type of test performed depends upon the nature of the suspected exposure. An elevated urine test for mercury indicates an elemental or inorganic source of mercury exposure. An elevated blood test for mercury indicates a recent exposure to a high concentration of mercury vapor or exposure to an organic mercury source (for example, methylmercury from a recent fish meal). Levels of mercury reportable to the Heavy Metals Registry are 5 ng/mL in blood and 20 ng/mL in urine.
Prior to 2000, all individuals reported to the HMR with blood mercury levels of 5 ng/mL or greater were interviewed. From those interviews, the NYSDOH determined that it is difficult to establish a source of exposure for blood mercury levels below 14 ng/mL and would find it difficult to provide advice and guidance on reducing or eliminating exposures. Also, in previous years, few adverse health effects were reported among those with blood mercury levels in this range. Therefore in 2000, the interview threshold was raised to those individuals with blood mercury levels of 15 ng/mL or higher. This level represents between 25 to 30 percent of all blood mercury test results received annually.
Interestingly, the number of reports attributed to known occupational exposures has been very low in recent years. In 2000, only 18 (3.7%) of the people tested for mercury had known occupational exposures, down from 11.3 percent in 1999 (data not shown). This number has decreased to only 2 individuals with occupational exposures (0.07%) in 2005. This reduction can primarily be attributed to fewer industries testing for mercury exposure rather than to a reduction in employee exposures. Since 2000, employees interviewed with occupational exposures to mercury worked in a variety of occupations, including dentists, laboratory workers/scientists, and public protection.
N
%
7,952
Male
4,070
51.2
Female
3,872
48.7
Unknown
10
0.1
<29 years
617
7.8
30-49 years
3,664
46.1
>50 years
3,643
45.8
Unknown
28
0.3
Occupational
63
0.8
Non-Occupational
1,889
23.8
Both
25
0.3
Unknown
5,975
75.1
NYS w/o NYC
3,507
44.1
NYC
4,163
52.4
Out of state
0
0
Unknown
282
3.5
<11,327
Special Highlights: Scrap Metal Recycling Industry Project
There were an estimated 5,785 metal recycling workers in New York State in 2000 (U.S. Census Bureau, County Business Patterns data http://censtats.census.gov/). Many of the materials or metals being recycled, such as ferrous and nonferrous scrap metals, vehicles and parts, communication cables, radiators, and batteries contain lead. From 1990 to 2000, the Heavy Metals Registry received reports of elevated blood lead levels (25 µg/dL or above) for 65 individuals working in metal recycling companies, one percent of the total estimated work force. Of those reported, 25 (38%) had blood lead levels above 40 µg/dL, and three (5%) had blood levels above 100 µg/dL. Based on these blood lead reports and the likelihood that the majority of the metal recycling workers may have not been tested, the true magnitude of the problem was unknown.
In order to learn more about the industry and the workers' lead exposures, the NYSDOH launched a Scrap Metal Recycling Industry project in 2000. The goals of the project were to collect information on metal recycling operations and processes from a representative survey population, to identify and evaluate workers' lead exposures in the scrap metal recycling industry, and to propose feasible and effective measures to reduce the exposures. NYSDOH worked with the Institute of Scrap Recycling Industries, Inc. (ISRI, a nationwide trade association for metal recycling companies) in developing the project. The project had two components - a mail survey and on-site industrial hygiene consultations; both were completed in 2001.
Mail Survey
A survey questionnaire was designed to gather information on company operations, potential employee lead exposures, and control measures being utilized, including personal protective equipment and biological monitoring programs. The survey population consisted of 224 establishments that were identified from statewide Yellow Pages' listings in the categories of "Scrap Metals", "Process & Recycle", "Scrap Metals & Iron (wholesale)", and "Steel-used". A total of 101 companies completed the survey, resulting in a response rate of 45 percent.
Industrial Hygiene (IH) On-site Consultations
On-site IH consultations were conducted by NYSDOH industrial hygienists at eight recycling operations that were representative of the entire sample based on the questionnaire findings. The industrial hygienists conducted a walk-through to observe recycling processes and employees' work activities and reviewed company lead safety programs at each facility. Personal breathing zone (PBZ) air samples were collected to measure employees' exposure to lead dust and fumes. These samples were collected during the performance of the various job tasks, such as sorting metal, driving forklifts, operating shears and balers, torch-cutting metal, and crushing cars. Surface dust wipe samples were also collected for the purpose of assessing the extent to which surfaces throughout the facility (e.g., non-production areas) were contaminated by lead and other metal dust. Areas sampled included surfaces in lunchrooms, bathrooms and locker rooms. Wipe samples were also collected from workers' hands.
Significant Findings and Discussion
Workers were exposed to lead when cutting not only painted scrap metal, but also unpainted and new steel.
The survey found that unpainted metal or even new steel can contain lead and workers may be exposed to airborne lead concentrations exceeding the Occupational Safety and Health (OSHA) PEL while torch cutting new steel. Lead can get into scrap metal in a number of ways: (1) as a contaminant in the base metal; (2) as an intended ingredient in some alloys; or (3) as a dust or chemical deposit on the surface rather than in the paint. A common misconception held by the metal recycling trade is that only painted or galvanized coatings contain lead. Unpainted metals are often mistakenly classified as "clean" or "lead free" by metal recyclers. Thus, many torch cutters working with unpainted or new steel do not use respiratory protection. Given the difficulty in predicting the specific and precise metal content of any piece of material, it is prudent to wear proper respiratory protection while torch cutting of any metal.
Surface lead contamination was widespread at metal recycling facilities and lead dust was found in employee bathrooms, lunchrooms, and on workers' hands prior to eating.
During the metal recycling process, lead dust is generated and dispersed through the air, eventually settling on surfaces both inside and outside of the work area, and on workers' exposed hair, skin, clothes and shoes. Lead dust that is tracked into lunchrooms and other non-work areas can pose an ingestion hazard. Workers can also inadvertently bring lead dust home, potentially exposing family members. The site visits found that even if air lead levels are fairly low, workers may still be exposed to lead through ingestion if the facility is not kept clean of lead dust. It is critical that workers wash their hands thoroughly before eating, drinking or smoking in order to minimize their risk of ingesting lead. A shower facility with separate "clean" and "dirty" lockers can help prevent cross contamination between the work and nonwork areas and the workplace and workers' homes.
Biological monitoring for lead was provided by only 15 percent of the companies surveyed.
According to the survey, 85% of the companies surveyed had not provided employees with biological monitoring (regular blood testing) for lead. Metal recycling workers are exposed to lead through both inhalation (i.e., airborne lead dust and fume generated by torch cutting) and ingestion. The site visits found that the surface lead dust contamination was wide spread in metal recycling facilities; it is prudent to assume that all the scrap metal handling areas and adjacent support areas, such as lunchrooms, bathrooms, and offices may have lead surface contamination. Personal air monitoring cannot assess the extent of the workers lead exposure through ingestion and the only method to assess exposure from both inhalation and ingestion is biological monitoring.
Companies tended to underestimate the degree and sources of lead exposure resulting in inadequate lead protection programs.
Our survey found that the greater the employer's awareness of workplace lead exposures, the greater the likelihood that the employer will conduct personal air monitoring and implement a biological monitoring program. However, at the time of the survey, 72% of the companies surveyed did not think that lead exposure was at least "possible" at their sites. This indicates that the owners of metal recycling companies may not realize the widespread nature of occupational lead exposures in their facilities. The information gathered through the survey indicates a need to educate employers within the metal recycling industry as to sources of lead exposure in scrap yard operations, risks of lead poisoning, and measures to prevent lead overexposure. Employers need to be aware of the requirements of the OSHA lead standard for general industry, and the importance of biological monitoring so they can take appropriate measures to protect their employees and to meet regulatory requirements.
Recommendations
The following recommendations were provided for scrap metal recyclers for their consideration:
Implement engineering controls to reduce workers' lead exposures in scrap metal recycling operations;
Provide employees with lead safety training;
Institute a biological monitoring program to assess employee exposures to lead;
Provide appropriate respiratory protection to workers who perform torch cutting, radiator disassembly, or any other tasks with the potential for significant airborne exposure;
Provide hygiene facilities, such as a clean lunch room, and a locker room with separate "clean" and "dirty" lockers and a shower facility;
Prohibit eating, drinking, and smoking in any area where lead contamination may occur, and require thorough hand washing before workers enter the lunch room, break area, or leave the facility; and
Perform routine housekeeping to reduce surface lead dust accumulation throughout the facility.
Outreach and Ongoing Initiatives
Additional educational materials from this project are being developed to provide guidance to the metal recycling industry. These materials will be disseminated in collaboration with ISRI and the metal recycling companies that participated in the project. The NYSDOH will continue to monitor metal recycling workers through the Heavy Metals Registry and to conduct follow-up intervention activities. The goals of these intervention activities are to provide direct assistance to individual companies as needed as well as to monitor trends and changes in the industry. Updates to the guidance materials will be developed and disseminated as needed.
-), test results of 25 µg/dL and above were reportable. In 1992, a New York State regulation was enacted requiring the reporting of all blood lead results for all ages, regardless of level. This resulted in adding all reports with blood lead levels greater than or equal to 10 µg/dL to the HMR in 1994 (-
-). Another contributing factor resulting in the increase in testing was the enactment of the OSHA Lead in Construction standard in 1993 requiring biomonitoring for construction workers with lead exposure. Each new reporting requirement resulted in an increase in the number of reports received. However, the number of adults added to the HMR with blood lead levels of 10 µg/dL or greater has steadily decreased since 1996, following the national trends of decreasing blood lead levels in adults and children.
