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Tuesday, 01 February 2011 17:55

CARDIOVASCULAR MORBIDITY AND MORTALITY IN THE WORKFORCE

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In the following article, the term cardiovascular diseases (CVDs) refers to organic and functional disorders of the heart and circulatory system, including the resultant damage to other organ systems, which are classified under numbers 390 to 459 in the 9th revision of the International Classification of Diseases (ICD) (World Health Organization (WHO) 1975). Based essentially on international statistics assembled by the WHO and data collected in Germany, the article discusses the prevalence of CVDs, new disease rates, and frequency of deaths, morbidity and disability.

Definition and Prevalence in the Working-Age Population

Coronary artery disease (ICD 410-414) resulting in ischaemia of the myocardium is probably the most significant CVD in the working population, particularly in industrialized countries. This condition results from a constriction in the vascular system that supplies the heart muscle, a problem caused primarily by arteriosclerosis. It affects 0.9 to 1.5% of working-age men and 0.5 to 1.0% of women.

Inflammatory diseases (ICD 420-423) may involve the endocardium, the heart valves, the pericardium and/or the heart muscle (myocardium) itself. They are less common in industrialized countries, where their frequency is well below 0.01% of the adult population, but are seen more frequently in developing countries, perhaps reflecting the greater prevalence of nutritional disorders and infectious diseases.

Heart rhythm disorders (ICD 427) are relatively rare, although much media attention has been given to recent instances of disability and sudden death among prominent professional athletes. Although they can have a significant impact on the ability to work, they are often asymptomatic and transitory.

The myocardiopathies (ICD 424) are conditions which involve enlargement or thickening of the heart musculation, effectively narrowing the vessels and weakening the heart. They have attracted more attention in recent years, largely because of improved methods of diagnosis, although their pathogenesis is often obscure. They have been attributed to infections, metabolic diseases, immunologic disorders, inflammatory diseases involving the capillaries and, of particular importance in this volume, to toxic exposures in the workplace. They are divided into three types:

  • dilative—the most common form (5 to 15 cases per 100,000 people), which is associated with the functional weakening of the heart
  • hypertrophic—thickening and enlargement of the myocardium resulting in relative insufficiency of the coronary arteries
  • restrictive—a rare type in which myocardial contractions are limited.

 

Hypertension (ICD 401-405) (increased systolic and/or diastolic blood pressure) is the most common circulatory disease, being found among 15 to 20% of working people in industrialized countries. It is discussed in greater detail below.

Atherosclerotic changes in the major blood vessels (ICD 440), often associated with hypertension, cause disease in the organs they serve. Foremost among these is cerebrovascular disease (ICD 430-438), which may result in a stroke due to infarction and/or haemorrhage. This occurs in 0.3 to 1.0% of working people, most commonly among those aged 40 and older.

Atherosclerotic diseases, including coronary artery disease, stroke and hypertension, by far the most common cardiovascular diseases in the working population, are multifactorial in origin and have their onset early in life. They are of importance in the workplace because:

  • so large a proportion of the workforce has an asymptomatic or unrecognized form of cardiovascular disease
  • the development of that disease may be aggravated or acute symptomatic events precipitated by working conditions and job demands
  • the acute onset of a symptomatic phase of the cardiovascular disease is often attributed to the job and/or the workplace environment
  • most individuals with an established cardiovascular disease are capable of working productively, albeit, sometimes, only after effective rehabilitation and job retraining
  • the workplace is a uniquely propitious arena for primary and secondary preventive programmes.

 

Functional circulatory disorders in the extremities (ICD 443) include Raynaud’s disease, short-term pallor of the fingers, and are relatively rare. Some occupational conditions, such as frostbite, long-term exposure to vinyl chloride and hand-arm exposure to vibration can induce these disorders.

Varicosities in the leg veins (ICD 454), often improperly dismissed as a cosmetic problem, are frequent among women, especially during pregnancy. While a hereditary tendency to weakness of the vein walls may be a factor, they are usually associated with long periods of standing in one position without movement, during which the static pressure within the veins is increased. The resultant discomfort and leg oedema often dictate change or modification of the job.

Annual incidence rates

Among the CVDs, hypertension has the highest annual new case rate among working people aged 35 to 64. New cases develop in approximately 1% of that population every year. Next in frequency are coronary heart disease (8 to 92 new cases of acute heart attack per 10,000 men per year, and 3 to 16 new cases per 10,000 women per year) and stroke (12 to 30 cases per 10,000 men per year, and 6 to 30 cases per 10,000 women per year). As demonstrated by global data collected by the WHO-Monica project (WHO-MONICA 1994; WHO-MONICA 1988), the lowest new incidence rates for heart attack were found among men in China and women in Spain, while the highest rates were found among both men and women in Scotland. The significance of these data is that in the population of working age, 40 to 60% of heart attack victims and 30 to 40% of stroke victims do not survive their initial episodes.

Mortality

Within the primary working ages of 15 to 64, only 8 to 18% of deaths from CVDs occur prior to age 45. Most occur after age 45, with the annual rate increasing with age. The rates, which have been changing, vary considerably from country to country (WHO 1994b).

Table 3.1 [CAR01TE] shows the death rates for men and for women aged 45 to 54 and 55 to 64 for some countries. Note that the death rates for men are consistently higher than those for women of corresponding ages. Table 3.2 [CAR02TE] compares the death rates for various CVDs among people aged 55 to 64 in five countries.

Work Disability and Early Retirement

Diagnosis-related statistics on time lost from work represent an important perspective on the impact of morbidity on the working population, even though the diagnostic designations are usually less precise than in cases of early retirement because of disability. The case rates, usually expressed in cases per 10,000 employees, provide an index of the frequency of the disease categories, while the average number of days lost per case indicates the relative seriousness of particular diseases. Thus, according to statistics on 10 million workers in western Germany compiled by the Allgemeinen Ortskrankenkasse, CVDs accounted for 7.7% of the total disability in 1991-92, although the number of cases for that period was only 4.6% of the total (table 3.3 [CAR03TE]). In some countries, where early retirement is provided when work ability is reduced due to illness, the pattern of disability mirrors the rates for different categories of CVD.

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Contents

Preface
Part I. The Body
Blood
Cancer
Cardiovascular System
Physical, Chemical, and Biological Hazards
Digestive System
Mental Health
Mood and Affect
Musculoskeletal System
Nervous System
Renal-Urinary System
Reproductive System
Respiratory System
Sensory Systems
Skin Diseases
Systematic Conditions
Part II. Health Care
First Aid & Emergency Medical Services
Health Protection & Promotion
Occupational Health Services
Part III. Management & Policy
Disability and Work
Education and Training
Case Studies
Ethical Issues
Development, Technology, and Trade
Labour Relations and Human Resource Management
Resources: Information and OSH
Resources, Institutional, Structural and Legal
Community level
Regional and National Examples
International, Government and Non-Governmental Safety and Health
Work and Workers
Worker's Compensation Systems
Topics In Workers Compensation Systems
Part IV. Tools and Approaches
Biological Monitoring
Epidemiology and Statistics
Ergonomics
Goals, Principles and Methods
Physical and Physiological Aspects
Organizational Aspects of Work
Work Systems Design
Designing for Everyone
Diversity and Importance of Ergonomics
Occupational Hygiene
Personal Protection
Record Systems and Surveillance
Toxicology
General Principles of Toxicology
Mechanisms of Toxicity
Toxicology Test Methods
Regulatory Toxicology
Part V. Psychosocial and Organizational Factors
Psychosocial and Organizational Factors
Theories of Job Stress
Prevention
Chronic Health Effects
Stress Reactions
Individual Factors
Career Development
Macro-Organizational Factors
Job Security
Interpersonal Factors
Factors Intrinsic to the Job
Organizations and Health and Safety
Part VI. General Hazards
Barometric Pressure Increased
Barometric Pressure Reduced
Biological Hazards
Disasters, Natural and Technological
Electricity
Fire
Heat and Cold
Hours of Work
Indoor Air Quality
Indoor Environmental Control
Lighting
Noise
Radiation: Ionizing
Radiation: Non-Ionizing
Vibration
Violence
Visual Display Units
Part VII. The Environment
Environmental Health Hazards
Environmental Policy
Environmental Pollution Control
Part VIII. Accidents and Safety Management
Accident Prevention
Audits, Inspections and Investigations
Safety Applications
Safety Policy and Leadership
Safety Programs
Part IX. Chemicals
Using, Storing and Transporting Chemicals
Minerals and Agricultural Chemicals
Metals: Chemical Properties and Toxicity
Part X. Industries Based on Biological Resources
Agriculture and Natural Resources Based Industries
Farming Systems
Food and Fibre Crops
Tree, Bramble and Vine Crops
Specialty Crops
Beverage Crops
Health and Environmental Issues
Beverage Industry
Fishing
Food Industry
Overview and Health Effects
Food Processing Sectors
Forestry
Hunting
Livestock Rearing
Lumber
Paper and Pulp Industry
Major Sectors and Processes
Disease and Injury Patterns
Part XI. Industries Based on Natural Resources
Iron and Steel
Mining and Quarrying
Oil Exploration and Distribution
Power Generation and Distribution
Part XII. Chemical Industries
Chemical Processing
Examples of Chemical Processing Operations
Oil and Natural Gas
Pharmaceutical Industry
Rubber Industry
Part XIII. Manufacturing Industries
Electrical Appliances and Equipment
Metal Processing and Metal Working Industry
Smelting and Refining Operations
Metal Processing and Metal Working
Microelectronics and Semiconductors
Glass, Pottery and Related Materials
Printing, Photography and Reproduction Industry
Woodworking
Part XIV. Textile and Apparel Industries
Clothing and Finished Textile Products
Leather, Fur and Footwear
Textile Goods Industry
Part XV. Transport Industries
Aerospace Manufacture and Maintenance
Motor Vehicles and Heavy Equipment
Ship and Boat Building and Repair
Part XVI. Construction
Construction
Health, Prevention and Management
Major Sectors and Their Hazards
Tools, Equipment and Materials
Part XVII. Services and Trade
Education and Training Services
Emergency and Security Services
Emergency and Security Services Resources
Entertainment and the Arts
Arts and Crafts
Performing and Media Arts
Entertainment
Entertainment and the Arts Resources
Health Care Facilities and Services
Ergonomics and Health Care
The Physical Environment and Health Care
Healthcare Workers and Infectious Diseases
Chemicals in the Health Care Environment
The Hospital Environment
Health Care Facilities and Services Resources
Hotels and Restaurants
Office and Retail Trades
Personal and Community Services
Public and Government Services
Transport Industry and Warehousing
Air Transport
Road Transport
Rail Transport
Water Transport
Storage
Part XVIII. Guides
Guide to Occupations
Guide to Chemicals
Guide to Units and Abbreviations