10. HEALTH RISKS IN THE OCCUPATIONAL ENVIRONMENT AND THEIR CONSEQUENCES

10.1 Organization of monitoring activities

This subsystem includes the follow-up of health impairment amongst the workforce as a consequence of harmful factors in the occupational environment. As against the year 2003 there has been removed from the subsystem the section concerning the monitoring of unilateral excessive load in relation to damage to the locomotor apparatus.

Subsystem 7 is comprised of two projects and their subdivisions, as follows:

10.2 Monitoring of health data on occupational diseases and job categorization

10.2.1 Monitoring of health effects – The Register of Occupational Diseases and Occupational Disease Threat

In the Czech Republic in the year 2004, there has been reported a total of 1,388 cases of profession-linked diseases (826 in males and 562 in females) in 1,316 employees, of which 1,329 were occupational diseases and 59 were occupational disease threats. On comparison with the years 1996–2003, there continued the decreasing trend in incidence as well as in the overall number of reported occupation-linked problems. As against the year 2003, the incidence of cases of profession-linked diseases dropped from 35.1 down to 31.6 cases per 100,000 insured employees, and the absolute number of profession-linked diseases decreased by 170 cases (i.e. by 10.9 %). The trends in notified occupational diseases in recent years are presented in Tab. 10.1a and Fig. 10.1a.

In the year 2004 the greatest numbers of cases of profession-linked diseases were caused by physical factors (Chapter II), namely 572 cases. The distribution by chapters of the List of Occupational Diseases is illustrated in Fig. 10.1b. In occupational diseases the most frequently diagnosed were profession-linked dermatoses (272, i.e. 20.5 % of cases), peripheral nerve affections due to excessive load and vibrations in the limbs (175 and 151, i.e. 13.2 % and 11.4 % of cases, respectively). In occupational disease threats there have been reported most frequently affections of the joints due to vibrations (14, i.e. 23.7 % of cases), as well as damage to the peripheral nerves by vibrations and excessive load in the extremities (12 and 11, i.e. 20.3 % and 18.6 % of cases, respectively).

The greatest numbers of profession-linked disease were reported in the Moravian-Silesian and Central Bohemian Regions (296 and 197, i.e. 21.3 % and 14.2 % of all cases, respectively). The most numerous category of occupational diseases in the Moravian-Silesian Region were affections caused by physical factors (Chapter II – 189 cases). In question were mainly affections of the peripheral nerves due to vibrations and excessive load on the extremities (62 and 56 cases, respectively). In the Central Bohemian Region there were predominant occupational diseases affecting the respiratory tract, lungs, pleura, as well as the peritoneum (Chapter III – 81 cases). Those were foremost diseases caused by the action of particulate matter containing free crystalline silicon dioxide (50 cases), disease caused by asbestos (14 cases), and lung cancer due to radioactive substances (11 cases). The distribution of profession-linked diseases in the regions by chapters in the List of Occupational Diseases is presented in Tab. 10.1b and illustrated in Fig. 10.1c.

Just as in the three previous years, most of the occupational diseases were reported from the sector of economic activities in medical and social care and in veterinary activities (OKEČ N85 – 185, i.e. 13.3 % of cases). The coal-mining sector (OKEČ CA10) with 181 (13.1 %) cases was in second place.

10.2.2 Monitoring of exposure to individual factors in the occupational environment, based on the categorization of jobs and workplaces

In the year 2004 there continued the processing of drafts for the categorization of jobs and workplaces submitted by employers, and the publishing of decisions by public health institutions that have legalized those drafts. The finalization of this phase of occupational categorization is expected to come off in the course of the year 2005.

Of the total number of 4,959,100 employees (Statistical Yearbook of the Czech Republic 2004) as of May 17, 2005, there have been registered in the Job Categorization Information System, in the job categories 2, 2R, 3, and 4 a total of 1,748,275 exposed subjects, i.e. 35 % of all employees (18,781 per 100,000 employees). In jobs at risk (categories 2R, 3, 4) there have been registered 401,233 persons representing 8 % of all employees in the Czech Republic (4,314 per 100,000 employees). In category 4, that being high-risk workplaces, there are 19,434 people, i.e. 209 per 100,000 employees, of whom 2,016 are females. The greatest numbers of employees in the categories of jobs at risk (2R, 3, 4) are in the Moravian-Silesian Region. The numbers of employees in categories of jobs at risk (2R, 3, 4), are presented by regions in Tab. 10.2a and Fig. 10.2a. In relative figures, i.e. calculated per 100,000 employees, the nationwide average of 4,314 employees exposed in jobs at risk is exceeded in all regions except for Prague, Zlín, Karlovy Vary, and Plzeň (Fig. 10.2b).

The greatest number of employees, out of all those registered, (job categories 2, 2R, 3, 4) were exposed to the factor of Physical load – 775,731 subjects, Mental load – 679,743 subjects, and Noise – 650,457 subjects. Relatively low is the number of employees exposed to Chemical substances, namely 141,082. On the other hand, in jobs at risk (i.e. categories 2R, 3, 4) the greatest number of employees were registered in the file of risk factor Noise. The numbers of employees exposed in jobs by factor are presented in Tab. 10.2b.

Approximately one third of registered employees is exposed to more than one factor; 7.7 % to more than four. Tab. 10.2c presents data on the numbers of employees (in categories 2, 2R, 3, 4) exposed to 1–4 factors and to more than four factors.

The data presented should be considered as being preliminary in as the registration of all jobs has not been finished yet.

10.3 Monitoring of selected parameters of exposure and health effects

10.3.1 The Register of Occupational Exposures to Chemical Carcinogens – REGEX

An updating of the 2003 database has been carried out by the Regional Public Health Institutes in Ústí nad Labem, České Budějovice, Karlovy Vary, Hradec Králové, Jihlava, Zlín, Olomouc, and Ostrava. Data from the Regional Public Health Institute Plzeň in the nationwide database have not been updated (data as of Dec. 31, 2002). Data from Region Pardubice and Region Central Bohemia have remained at the level that had been processed by the former Regional Public Health Center prior to the reorganization of the public health service. Data from the regions Liberec, Prague and South Moravian are not in the nationwide database yet. It still holds that the REGEX system shall be fully functional for application in preventive healthcare measures and for an analysis of the objective risk in profession-linked exposure to carcinogens, upon the inclusion of all the regions of the Czech Republic. It is expected that this objective shall be reached in the year 2005, including the limiting of filed personal health data, and the methodological guideline of the Chief Public Health Officer, on the cooperation of the NIPH and the Regional Public Health Institutes. There has also been prepared a draft on the temporarily minimal volume of data collection for regions newly joining in.

The number of exposed subjects registered in the central register REGEX as of Dec. 31, 2004, was 4,326 subjects (3,876 in the preceding year) with 6,223 entries (5,253 in the preceding year). The numbers of employees registered in the Register of Exposures to Carcinogens by regions as of Dec. 31, 2004, are presented in Fig. 10.3. The numbers of employees registered according to the most frequent exposure to carcinogens are presented in Tab. 10.3.

10.4 Partial conclusions

In the Czech Republic in the year 2004, in all, there have been reported 1,388 profession-linked health problems (1,329 occupational diseases and 59 occupational disease threats). There continues the decreasing trend in the incidence as well as in the overall number of reported profession-linked health problems. The greatest number of profession-linked affections in 2004 has been caused by physical factors. The greatest numbers of profession-linked affections were reported from the Moravian-Silesian Region and from the Central Bohemian Region.

In the course of 2004 there continued the processing of drafts for the categorization of jobs and workplaces. In the Job Categorization Information System, as of May 17, 2005, there have been registered in categories 2, 2R, 3 and 4 in all, 1,748,275 exposed subjects, i.e. 35 % of all employees (18,781 per 100,000 employees). Approximately one third of the employees registered, are exposed to more than one factor. In the categories at risk (2R, 3, 4), there have been registered 401,233 subjects, representing 8 % of all employees in the Czech Republic (4,314 per 100,000 employees). In category 4, i.e. workplaces under great risk, in the Czech Republic there have been included 19,434 subjects, i.e. 209 per 100,000 employees.

In the year 2004 there has not been finalized the involving of all regions in the inclusion of employees exposed to carcinogens in the Register of Profession-linked Exposures to chemical carcinogens, that being a prerequisite for its application in preventive healthcare measures, and for an analysis of the objective risk in profession-linked exposure to carcinogens.

Tab. 10.1a Notified professional diseases in 1996–2004

Professional diseases/calendar year

1996

1997

1998

1999

2000

2001

2002

2003

2004

Professional diseases total

2,541

2,376

2,111

1,886

1,751

1,677

1,600

1,558

1,388

  – occupational diseases

2,517

2,350

2,054

1,845

1,691

1,627

1,531

1,486

1,329

  – threat of occupational disease

24

26

57

41

60

50

69

72

59

Professional diseases – males

1,563

1,551

1,261

1,192

1,104

1,034

977

972

826

Professional diseases – females

978

825

850

694

647

643

623

586

562

Incidence rate
[number/100,000 employees]

55.2

49.1

44.1

41.1

38.7

37.4

35.8

35.1

31.6

Tab. 10.1b Notified professional diseases in regions, 2004

Region

Chapter of Occupational Diseases Registry

I

II

III

IV

V

VI

Total

Karlovy Vary

 

 

1

8

1

 

10

Liberec

 

20

2

13

16

 

51

Plzeň

2

28

11

11

3

 

55

Zlín

 

24

13

14

4

1

56

Ústí nad Labem

 

20

7

7

26

 

60

Vysočina

 

22

7

8

23

 

60

Prague

2

11

4

14

39

 

70

Hradec Králové

1

22

9

40

20

 

92

Pardubice

6

19

15

36

15

1

92

South Bohemian

2

59

6

21

10

 

98

South Moravian

 

29

43

21

22

 

115

Olomouc

1

67

14

37

17

 

136

Central Bohemian

11

62

81

25

18

 

197

Moravian-Silesian

1

189

69

17

20

 

296

CZ

26

572

282

272

234

2

1,388

I – O. diseases caused by chemical substances
II – O. diseases caused by physical factors
III – O. diseases of respiratory pathways, lung, pleura and peritoneum
IV – O. diseases of skin
V – O. diseases infectious and parasitic
VI – O. diseases caused by other factors

Tab. 10.2a Number of exposed employees in categories of hazardous work (categories 2R + 3 + 4) in regions, at May 17, 2005

Region

Females

Males

Total

Number/100,000 employees

Karlovy Vary

2,830

6,590

9,420

4,154

Zlín

7,226

11,144

18,370

4,146

Plzeň

4,499

14,374

18,873

4,225

Liberec

7,814

12,169

19,983

5,811

Vysočina

5,870

14,167

20,037

4,925

Pardubice

5,898

15,367

21,265

5,420

Olomouc

8,282

17,327

25,609

5,709

Hradec Králové

9,828

15,830

25,658

5,762

South Bohemian

9,122

22,077

31,199

6,161

Prague

12,119

21,661

33,780

1,409

South Moravian

12,378

21,840

34,218

3,698

Ústí nad Labem

12,937

27,288

40,225

7,128

Central Bohemian

13,504

30,075

43,579

5,447

Moravian-Silesian

11,568

45,271

56,839

5,958

CZ

124,866

276,367

401,233

4,314

Categories of work: 2R – potentially hazardous work, 3 and 4 – hazardous work.
Data stem from Information system of jobs and workplaces categorization.

Tab. 10.2b Number of exposed employees in categories of hazardous work (categories 2R + 3 + 4) by factors, at May 17, 2005

Factors

Total

Females

Males

Noise

225,403

42,240

183,163

Dust

61,787

10,085

51,702

Biological factors

53,855

40,248

13,607

Physical load

50,164

29,405

20,759

Psychical stress

47,337

19,049

28,288

Vibrations

41,741

1,674

40,067

Chemicals

30,121

9,734

20,387

Operating position

16,056

5,937

10,119

Thermal stress

15,181

2,589

12,592

Selected labours

11,663

5,678

5,985

Non-ionizing radiation and elmag. fields

10,531

2,646

7,885

Optical stress

6,579

1,981

4,598

Cool stress

1,635

155

1,480

Ionizing radiation

737

237

500

Tab. 10.2c Number of exposed employees with concurrently acting risk factors

No. of risk factors

No. of exposed employees (category of work 2, 2R, 3, 4)

1

604,919

2

457,678

3

384,316

4

165,518

More than 4

135,137

Total

1,748,275

Tab. 10.3 Number of employees in Registry of Occupational Exposures to Chemical Carcinogens, at Dec. 31, 2004 (according to carcinogen listed as the first)

Chemical substance, factor, workplace

No. of employees

Cytostatic agents, Cis-platine

870

Steel and iron foundry

494

Benzene

408

Coking plants

286

Formaldehyde

217

Cadmium and comp.

184

2-naphtylamine

179

Cytostatic agents, Ionizing radiation

176

Coal gasification

160

Ionizing radiation

142

Epichlorohydrine, Styrene, Formaldehyde

75

Vinylchloride

67

Benzene, PAHs

67

Ethylenoxide, Formaldehyde

58

Asbestos

55

Hardwood dust

53

Epichlorohydrine, Styrene

53

Styrene

52

Epichlorohydrine, Tetrachloroethylene, Tetrachloromethane, Hexachlorobenzene

51

Formaldehyde, Ionizing radiation

48

Nickel and comp.

27

Products of oil processing

26

Hydrazine

20


Fig. 10.1a Professional diseases, 1985–2004
Fig. 10.1b Distribution of occupational diseases by the Registry, 2004
Fig. 10.1c Occupational diseases in regions, 2004
Fig. 10.2a Number of employees exposed to risk factors in work categories 2R + 3 + 4 in regions, at May 17, 2005
Fig. 10.2b Number of employees exposed to risk factors in categories 2R + 3 + 4 per 100,000 employees, at May 17, 2005
Fig. 10.3 Number of employees in the Registry of Occupational Exposures to Chemical Carcinogens, at Dec. 31, 2004

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