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Mark R. Cullen, MD; Martin G. Cherniack, MD, MPH

Arch Intern Med. 1989;149(7):1621-1626.

Abstract
• The inability to characterize the extent of occupational disease in the United States limits clinical diagnosis and public health interventions. We present an 8-year (1979 to 1987) experience with clinic-based reporting in Connecticut. Altogether, 3566 cases were sequentially coded for demographics, diagnoses, workplace identification, and exposures at two academic occupational medicine clinics. The lungs were the principal organs of diagnosed effect, with asbestos-related disorders predominating, whereas the urinary tract, endocrine organs, and cardiovascular systems were rarely involved. Of all diseases, 64.8% were diagnosed as chronic and irreversible. Three common disorders, lead intoxication (acute and chronic), asbestosis, and occupational asthma were selected for illustration. Patients with lead poisoning and asbestosis, although collectively numerous (40 and 504, respectively), came from a small number of worksites and industries. Occupational asthma was more variable: 141 diagnosed cases came from 56 different trades and industries and were caused by 28 recognized agents. While we recognize that clinic-based reporting suffers from obvious problems with referral bias and misclassification, our experience shows that it provides an important index of disease burden. Our data document the effects of legislation and litigation on lead poisoning and asbestosis, and correspondingly helps characterize diseases that will respond to broad intervention. On the other hand, occupational asthma is more pervasive and would require a more specialized, partially clinical approach.

(Arch Intern Med. 1989;149:1621-1626)

Author Affiliations
From the Yale-New Haven Occupational Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.

Footnotes
Accepted for publication February 17, 1989.

Reprint requests to Occupational Medicine Program, 333 Cedar St, New Haven, CT 06510 (Dr Cullen).

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