New York State Occupational Health Clinic Network Report 1988 - 2003

Chapter 4. Patient Exposures

  • Chapter 4 is also available as an individual Adobe Portable Document (PDF, 840 KB, 12pgs)

Patients seen by the NYS Occupational Health Clinic Network (OHCN) are evaluated to determine not only the medical diagnosis, but also the likely etiologic agents responsible for causing or exacerbating the disease. Appropriate identification of an etiologic agent can improve the treatment and management of a disease. Identification of workplace hazards can also be used to prevent occupational diseases through training and education of workers and companies; along with establishing effective workplace intervention programs.

This chapter provides data describing the exposures reported by the NYS OHCN patients. Putative exposures are identified by the clinicians based on the patient's diagnosis or reason for the visit. Up to two potential etiologic agents can be identified for each diagnosis. A patient may have one exposure associated with multiple diagnoses. The number of exposures is defined as one exposure per diagnosis per patient. Therefore, the number of exposures far exceeds the number of patients.

Exposure agents are classified using the coding scheme developed by the Association of Environmental and Occupational Clinics.1 Patients are represented by the first time an agent is suspected to be associated with a disease or a clinic visit. The suspected agents may change with subsequent visits due to further testing and presentation of symptoms. At least one percent of the NYS OHCN patient population reported exposures to agents in the following nine categories:

  • Mineral and inorganic dusts (010-012);
  • Metals and metalloids (020-024);
  • Miscellaneous inorganic compounds (040-042);
  • Hydrocarbons, NOS (170-171);
  • Miscellaneous chemicals & materials (320-327);
  • Pyrolysis products (330-331);
  • Physical factors (350-354);
  • Ergonomic factors (360-362); and
  • Microorganisms (390-391).

Because of the small number of patients (greater-then 1%) reporting exposures in the following categories, these groups were not analyzed:

  • Halogens (030);
  • Acids, bases, and oxidizing agents (050-052);
  • Aliphatic and alicyclic hydrocarbons (060-061);
  • Alcohols (070);
  • Glycols (080);
  • Glycol ethers (090-091);
  • Ethers (100);
  • Epoxy compounds (110);
  • Aldehydes and acetals (120);
  • Ketones (130);
  • Esters (140-142);
  • Carboxylic acids and anhydrides (150-151);
  • Aromatic hydrocarbons (160-161);
  • Phenols and phenolic compounds (180-181);
  • Halogenated aliphatic hydrocarbons (190-201);
  • Cyanides and nitriles (210-211);
  • Isocyanates (220-221);
  • Aliphatic and alicyclic amines (230-232);
  • N-Nitrosamines (240);
  • Aromatic nitro and amino compounds (250-252);
  • Aliphatic and miscellaneous nitrogen compounds (260-261);
  • Polymers (270-271);
  • Organochlorine pesticides (280);
  • Organophosphate and carbamate pesticides (290-292);
  • Organic phosphates (300);
  • Organic sulfur compounds (310);
  • Plant material (370-373); and
  • Animal material (380-382).

  • Figure 4.1 is available on page 50 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Mineral and Inorganic Dusts

The majority of exposures to mineral and inorganic dusts were associated with V-codes recorded in the medical records (n=8,083). Patients recorded with V-codes in their medical records by the NYS OHCN were patients who were not currently experiencing symptoms; they encountered the NYS OHCN for some specific purpose such as to receive prophylactic vaccinations or to be screened for conditions for which the patients were at high risk (such as Lyme disease, asbestos screenings, and lead screenings). Of these, 866 (11%) were related to the WTC disaster. Among the non-WTC-related dust exposures associated with V-codes (n=7,217), 80% were among group screening patients. Another 6,593 dust exposures were associated with diagnoses of diseases of the respiratory system, and 920 were associated with diagnoses of symptoms, signs and ill-defined conditions (data not shown).

  • Figure 4.2 is available on page 51 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Among the reported mineral and inorganic dust exposures related to the WTC disaster, there were 2,078 diagnoses of respiratory diseases. Among those, 1,296 (62%) were diagnosed with "other diseases of the upper respiratory tract" including 613 patients with chronic pharyngitis and 398 with chronic sinusitis (ICD-9-CM Codes 472 and 473, respectively). There were another 465 diagnoses (22%) of "chronic obstructive pulmonary disease and other conditions" of which 408 were asthma.

  • Figure 4.3 is available on page 52 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

<Non-specified Dusts or Asbestos

  • Figure 4.4 is available on page 53 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Metals and Metalloids

The majority of reported exposures to metals were associated with V-codes recorded in the medical records (n=3,268). Among these, 2,164 (66%) were group screening patients. Another 1,043 exposures were associated with diagnoses of injuries and poisonings of which 884 (85%) were toxic effects of lead and its compounds (ICD-9-CM Code 984). Of interest 374 (42%) of exposures associated with this diagnosis were not part of group screenings. Another 321 metals exposures were associated with diseases of the respiratory system (data not shown).

  • Figure 4.5 is available on page 54 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Miscellaneous Inorganic Compounds

  • Figure 4.6 is available on page 55 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Non-specified Hydrocarbons

  • Figure 4.7 is available on page 55 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Miscellaneous Chemicals and Materials

  • Figure 4.8 is available on page 56 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

  • Figure 4.9 is available on page 56 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Pyrolysis Products

  • Figure 4.10 is available on page 57 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Physical Factors

  • Figure 4.11 is available on page 58 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

  • Figure 4.12 is available on page 58 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Ergonomic Factors

  • Figure 4.13 is available on page 59 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Of those reported exposures to factors associated with stress, 48% were diagnosed with mental disorders. Exposures to repetitive motion were primarily associated with diagnoses of carpal tunnel syndrome (n=2,008), tenosynovitis of the hand or wrist including de Quervain,s disease (n=1,058), lateral or medial epicondylitis (n=950), and cubital tunnel syndrome (n=618) (data not shown).

  • Figure 1.14 is available on page 59 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

Exposures to Microorganisms

  • Figure 4.15 is available on page 60 of the complete Occupational Health Clinic Report (PDF, 6.77 MB, 110pgs)

References

  1. Association of Environmental and Occupational Clinics exposure coding system.