10. HEALTH RISKS IN THE OCCUPATIONAL ENVIRONMENT AND THEIR CONSEQUENCES |
10.1 Organization of monitoring activities
This subsystem includes the follow-up of factors in working conditions and the working environment significant from the viewpoint of employee health and consequent health impairment. Subsystem 7 is subdivided as follows:
10.2 Monitoring exposure following from job categorization and health data on occupational diseases
10.2.1 Monitoring exposure to the individual factors in working conditions on the basis from job and workplace categorization
In the course of 2005 there has continued the processing of new recommendations on the categorization of jobs and workplaces submitted by employers, and the publishing of decisions by the public health organs legalizing those recommendations. The recommendations on the one hand followed from newly introduced jobs, and on the other, from jobs newly categorized due to changes in regulations. In the year 2005, there has been observed an increase in the number of persons at the individual workplaces, but that was not as big as in previous years. That goes to show that categorization is getting into a stabilized stage and that it is gradually incorporating an ever larger section of really existing jobs. There has occurred a decline in the number of people working in category 4, i.e. performing work under the greatest risk. As far as this trend shall be confirmed for the future, it will certainly be an important piece of knowledge.
On the basis of analyses acquired in the Job Categorization Information System it follows that as of May 17, 2006 (Tab. 10.1a), there have been included in categories 2, 2R, 3, 4 overall 1,763,548 persons, i.e. 37.5% of all employees, that being 19,001 per 100 ths employees. In jobs at risk (2R, 3, 4) there have been classified 423,068 persons, that being 4,560 per 100 ths employees (Fig. 10.1a, 10.1b). In category 4, that being high-risk workplaces, in the Czech Republic there have been classified 18,610 persons, i.e. 200 per 100 ths employees of which 1,756 are females (Tab. 10.1a).
The greatest number of exposed employees in under-risk categories is in the Moravian-Silesian Region – 73,301, followed by the Central Bohemian Region – 45,086, the Ústí nad Labem Region – 40,359, the South Moravian Region – 33,666, and Prague – 32,107. In relative figures, i.e. calculated per 100 ths employees, the nationwide average of 4,560 employees is not exceeded in only three regions, namely Prague, Karlovy Vary Region and the South Moravian Region (Fig. 10.1a, 10.1b).
The greatest number of exposed employees (2, 2R, 3,4) is filed under the factor Physical load – 821,831 subjects, Working position – 676,302 subjects, Mental load – 675,082 subjects, and Noise – 666,297 subjects (Fig. 10.1c). On the other hand, at work under risk (i.e. 2R, 3, 4) the greatest number of registered employees is under risk of Noise – 249,109, Particulate matter – 67,554, Physical load – 64,534, Vibrations – 52,023, Mental load – 44,666, and Biological agents – 43,877 (Tab. 10.1b).
At work, employees can be exposed even to more than one factor. In Table 10.1c there are presented quite interesting data on the numbers of persons exposed according to the number of factors, namely to 1, 2, 3 or 4, and to more than 4 factors. From those figures it follows that about one-third of employees (27.5 %) are exposed to more than one factor, and 7.7 % are exposed to more than four factors.
It can be stated that of the overall number of 4,706,600 employees (Czech Statistical Yearbook 2005) there are registered under categories 2, 2R, 3, and 4 – 37.5 %, and in jobs at risk, i.e. 2R, 3, and 4 – 9 % of those persons. The numbers presented should be considered as being preliminary in as registration has not been finalized yet, and in the following period those data have to be checked and erroneous ones amended.
10.2.2 Monitoring of health effects – the National Register of Occupational Diseases
In the year 2005 there have been reported in the Czech Republic in 1,317 employees a total of 1,400 profession-linked diseases (817 in males and 583 in females) of which 1,340 were occupational diseases and 60 were occupational disease threats. In comparison with the year 2004 there has increased the overall number of diagnosed profession-linked diseases by 12, i.e. by 0.9 % cases. The incidence of profession-linked diseases, as against the year 2004, has decreased from 31.6 down to 31.5 cases per 100,000 insured (Tab. 10.2a, Fig. 10.2a).
The greatest numbers of profession-linked diseases were reported in the Moravian-Silesian and Central Bohemian Regions (272 and 181, i.e. 19.4 % and 12.9 % of all cases, respectively), see Tab. 10.2b and Fig. 10.2b. The most numerous frequent of occupational diseases in the Moravian-Silesian Region were affections caused by physical factors (Chapter II – 169 cases). In question were mainly affections of the peripheral nerves due to long-term excessive unilateral load on the extremities peripheral nerve affections due to vibrations (54 and 46 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 – 86 cases). Those were foremost diseases caused by the action of particulate matter containing free crystalline silicon dioxide (38 cases), disease caused by asbestos (25 cases), and lung cancer due to radioactive substances (19 cases).
Just as in the four 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 – 215, i.e. 15.4 % of cases). The sector of metal constructions and metal products production (OKEČ DJ28) and the sector of coal, lignite and peat mining (OKEČ CA10) with 152 and 125 (10.9 % and 8.9 %) cases were in second and third place, respectively.
In 2005, a total of 594 (42.4 %) cases of occupational diseases have been caused by physical factors (Chapter II). That was followed by infectious and parasitary diseases (Chapter V – 278 cases), affections of the skin (Chapter IV – 249 cases), respiratory tract and lung diseases (Chapter III – 243 cases), diseases caused by chemical agents (Chapter I – 33 cases), diseases caused by other factors and agents (Chapter VI – 3 cases). The distribution of occupational diseases according to the List of Occupational Diseases is depicted in Fig. 10.2c.
Among the occupational diseases there have been diagnosed most frequently profession-linked dermatoses (item 4.1 – 249 cases, i.e. 18.6 %) followed by peripheral nerve affections due to overburdening of the extremities and due to vibrations (items 2.10 and 2.7 – 181 and 164 cases, i.e. 13.5 % and 12.2 %, respectively). Of occupational disease threats there have been reported most frequently peripheral nerve affections due to vibrations (item 2.7 – 12 cases, i.e. 20.0 %) and hearing disturbances due to noise (item 2.4 – 10, i.e. 16.7 % of cases).
10.2.3 The Register of Profession-linked Exposures to Carcinogens – REGEX
The updating of the database in 2005 (as of Dec. 31, 2004) continued in the Regional Public Health Institutes in Ústí nad Labem, České Budějovice, Karlovy Vary, Hradec Králové, Pardubice, Jihlava, Zlín, Olomouc, and Ostrava. In the year 2005 the Public Health Institute of the Liberec Region accepted the program and the placing of data into the database. Data from the Public Health Institute of the Central Bohemian Region remain without updating, i.e. as of December 31, 2002. The Public Health Institute of the South Moravian Region has signed up for the system, however, in the year being assessed it has not begun work on the database, and is thus the last Region that is not represented in the REGEX database.
The number of exposed people registered in the central register at the NIPH has reached 5,499 persons in the period under assessment (4,326 persons in the previous year) with 10,395 entries (6,223 entries in the previous year). The difference from the number of persons in the register represents the number of persons repeatedly entered in the updated lists. Over the 1st quarter of the year 2006 there have been checked data from the regions and errors removed, uniting them in a unified central data series.
There has been carried out an analysis of morbidity and mortality due to malignant neoplasm in persons registered up to the end of 2003 when there have been registered 4,160 people contributing to the overall duration of follow-up of 12,713 person-years in the case of morbidity and 12,965 years in the case of mortality. In the course of follow-up in this cohort there have been enrolled 88 cases of malignant neoplasm and a total of 44 deaths of which 18 were due to a malignant neoplasm. The observed index of overall mortality standardized for age, gender and calendar year was SMR = 80.59 %, 95% CI – (59.23–106.96) and the standardized index of mortality due to neoplasm was SMR = 75.63 %, 95% CI = (46.42–116.96). However, the observed standardized index of morbidity due to malignant neoplasm reached the value of SMR = 147.65 %, 95% CI = (119.17–180.99) (P = 0.001) which indicates a higher occurrence of neoplasms than would correspond to the Czech general population.
The observed excessive morbidity due to malignant neoplasm can be also expressed as the difference between the observed incidence (IR = 692.2/100,000 person-years) and the expected incidence (IR = 468.8/100,000 person-years). The difference in incidences is IR = 223.4/100,000 person-years. This figure can then be used for calculating the increment risk (cumulative incidence) associated with the various durations of occupational exposure. The estimated life-long risk of occurrence of malignant neoplasm on life-long exposure (70 years) is 1.563 x 10-1 or more realistically on an expected 40-year exposure, 8.939 x 10-2 (223.4/100,000 person-years x 70 years (or 40 years). Both estimates of the occupational risk are by several orders higher than the acceptable risk at 10-5–10-4.
A preliminary analysis of the data thus points to the serious impact of occupational exposure to carcinogens on the health of the working population in whom the occurrence of malignant neoplasm is by 50 % higher than in the corresponding Czech general population. The corresponding increment in the appearance of a malignant neoplasm in an occupationally exposed person is estimated at 1.563 x 10-1–8.936 x 10-2. These results clearly confirm the need for a reliable system of surveillance over the quality of the working environment, as well as the importance of REGEX as one of its substantial components.
Work on the database was accompanied by problems regarding the cooperation between the Public Health Institutes and the Regional Public Health Administrations in some regions; there continued to occur difficulties in relations with enterprise legal entities. There continues an overall legislative uncertainty concerning the legitimacy of the collecting of data for REGEX. Work shall continue with focus on stabilizing the system, on the gradual analysis of the data obtained with an aim to include all regions and to supplement the existing exposures in those regions that have not as yet been brought into the database, as well as on the improving the quality of data being included in the database.
10.3 Partial conclusions
In the course of 2005 there continued the processing of recommendations concerning the categorization of jobs and workplaces. As of May 17, 2006, in the Job Categorization Information System there have been registered in job categories 2, 2R, 3 and 4 overall 1,763,548 exposed subjects, i.e. 37.5 % of all employees. Approximately one third of the employees registered, are exposed to more than one factor. In jobs at risk (categories 2R, 3, 4) there have been registered 423,068 persons, that representing 4,560 per 100 ths employees. In category 4, that being workplaces under great risk, there have been included 18,610 subjects, i.e. 200 per 100,000 employees, of whom 1,756 are females.
In 2005 there have been reported in the Czech Republic 1,400 profession-linked diseases (1,340 occupational diseases and 60 occupational disease threats). In comparison with the year 2004, there has increased the overall number of diagnosed profession-linked diseases, their incidence in 2004 to the contrary having decreased. The majority of profession-linked diseases in 2005 were caused by physical factors. The greatest numbers of profession-linked diseases were reported in the Moravian-Silesian Region and in the Central Bohemian Region.
The number of persons occupationally exposed to carcinogens, registered in the central register at the NIPH over the period under assessment amounts to 5,499 persons (4,326 persons in the previous year) with 10,395 entries (in the previous year that having been 6,223 entries). Preliminary analysis of data obtained on morbidity and mortality in employees exposed to carcinogens points to the serious impact of occupational exposure on the health of the working population. There has been found an approximately 50 % higher incidence of neoplasm in the registered employees than could be expected in the Czech general population; the estimate of the occupational risk is by several orders greater than the acceptable risk.
Tab. 10.1a Number of employees exposed to risk factors in regions, as of May 2006
Region |
Category |
Category 2 |
Category 2R |
Category 3 |
Category 4 |
|||||
Total |
Females |
Total |
Females |
Total |
Females |
Total |
Females |
Total |
Females |
|
Capital City |
190,631 |
86,916 |
158,524 |
76,123 |
1,728 |
591 |
29,694 |
9,906 |
685 |
296 |
Central |
187,278 |
71,065 |
142,192 |
57,889 |
6,593 |
2,160 |
37,167 |
10,856 |
1,326 |
160 |
South |
113,108 |
46,287 |
83,185 |
37,933 |
755 |
399 |
28,044 |
7,861 |
1,124 |
94 |
Plzeň |
102,083 |
41,683 |
80,434 |
35,965 |
752 |
235 |
19,844 |
5,376 |
1,053 |
107 |
Karlovy Vary |
62,244 |
28,405 |
52,889 |
25,606 |
424 |
90 |
8,791 |
2,706 |
140 |
3 |
Ústí nad Labem |
177,296 |
70,780 |
136,937 |
57,706 |
4,502 |
1,509 |
34,975 |
11,465 |
882 |
100 |
Liberec |
83,204 |
35,092 |
63,194 |
27,878 |
1,319 |
602 |
17,982 |
6,482 |
709 |
130 |
Hradec Králové |
104,543 |
44,000 |
79,914 |
35,695 |
2,902 |
1,003 |
20,776 |
7,241 |
951 |
61 |
Pardubice |
82,976 |
33,447 |
60,844 |
27,186 |
4,218 |
925 |
17,112 |
5,153 |
802 |
183 |
Vysočina |
95,822 |
31,343 |
72,577 |
24,887 |
5,155 |
1,951 |
17,092 |
4,382 |
998 |
123 |
South |
178,067 |
72,435 |
144,401 |
62,073 |
2,383 |
990 |
30,146 |
9,274 |
1,137 |
98 |
Olomouc |
97,212 |
38,708 |
70,180 |
30,846 |
3,693 |
1,339 |
22,561 |
6,398 |
778 |
125 |
Zlín |
93,389 |
42,755 |
72,564 |
34,018 |
2,215 |
1,421 |
18,129 |
7,251 |
481 |
65 |
Moravian- |
195,695 |
68,450 |
122,645 |
54,517 |
4,633 |
1,772 |
60,873 |
11,950 |
7,544 |
211 |
Total |
1,763,548 |
711,366 |
1,340,480 |
588,322 |
41,272 |
14,987 |
363,186 |
106,301 |
18,610 |
1,756 |
Tab. 10.1b Number of exposed employees in categories of hazardous work (2R + 3 + 4) by factors, as of May 2006
Factor |
Females |
Males |
Total |
Noise |
43,043 |
206,066 |
249,109 |
Particulate matter |
9,954 |
57,600 |
67,554 |
Physical load |
30,078 |
34,456 |
64,534 |
Vibrations |
2,009 |
50,014 |
52,023 |
Mental load |
17,207 |
27,459 |
44,666 |
Biological agents |
32,449 |
11,428 |
43,877 |
Chemical substances |
9,143 |
21,056 |
30,199 |
Working position |
5,590 |
14,300 |
19,890 |
Heat load |
2,611 |
12,560 |
15,171 |
Non-ionizing radiation |
3,012 |
10,130 |
13,142 |
Selected jobs |
4,092 |
4,473 |
8,565 |
Visual load |
2,996 |
5,549 |
8,545 |
Cold load |
188 |
1,391 |
1,579 |
Ionizing radiation |
98 |
352 |
450 |
Tab. 10.1c Number of exposed employees with concurrently acting risk factors
No. of hazardous factors |
No. of exposed employees (work categories 2, 2R, 3, 4) |
1 |
607,834 |
2 |
485,573 |
3 |
313,341 |
4 |
184,272 |
More than 4 |
172,528 |
Total |
1,763,548 |
Tab. 10.2a Notified professional diseases in 1996–2005
|
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
Number of patients |
2,483 |
2,326 |
2,801 |
1,863 |
1,713 |
1,661 |
1,567 |
1,506 |
1,316 |
1,317 |
Professional diseases total |
2,541 |
2,376 |
2,111 |
1,886 |
1,751 |
1,677 |
1,600 |
1,558 |
1,388 |
1,400 |
– occupational diseases |
2,517 |
2,350 |
2,054 |
1,845 |
1,691 |
1,627 |
1,531 |
1,486 |
1,329 |
1,340 |
– threat of occupational disease |
24 |
26 |
57 |
41 |
60 |
50 |
69 |
72 |
59 |
60 |
Professional diseases – males |
1,563 |
1,551 |
1,261 |
1,192 |
1,104 |
1,034 |
977 |
972 |
826 |
817 |
Professional diseases – females |
978 |
825 |
850 |
694 |
647 |
643 |
623 |
586 |
562 |
583 |
Incidence rate |
55.2 |
49.1 |
44.1 |
41.1 |
38.7 |
37.4 |
35.8 |
35.1 |
31.6 |
31.5 |
Tab. 10.2b Professional diseases notified in regions
Region |
Chapter of Occupational Diseases Registry* |
Total |
|||||
I |
II |
III |
IV |
V |
VI |
||
Capital City Prague |
1 |
8 |
4 |
5 |
36 |
|
54 |
South Bohemian |
6 |
52 |
6 |
22 |
27 |
2 |
c115 |
South Moravian |
|
30 |
21 |
22 |
17 |
|
90 |
Karlovy Vary |
|
2 |
2 |
12 |
13 |
|
29 |
Hradec Králové |
|
23 |
17 |
22 |
12 |
|
74 |
Liberec |
2 |
21 |
3 |
9 |
19 |
|
54 |
Moravian-Silesian |
2 |
169 |
53 |
19 |
29 |
|
272 |
Olomouc |
|
88 |
11 |
20 |
7 |
|
126 |
Pardubice |
9 |
20 |
12 |
19 |
11 |
1 |
72 |
Plzeň |
7 |
81 |
12 |
24 |
20 |
|
144 |
Central Bohemian |
6 |
44 |
86 |
18 |
27 |
|
181 |
Ústí nad Labem |
|
19 |
5 |
25 |
33 |
|
82 |
Vysočina |
|
23 |
7 |
19 |
10 |
|
59 |
Zlín |
|
14 |
4 |
13 |
17 |
|
48 |
Total |
33 |
594 |
243 |
249 |
278 |
3 |
1,400 |
I – O. diseases caused by chemical substances
II – O. diseases caused by physical factors
III – O. diseases of respiratory tract, lungs, pleura and peritoneum
IV – O. diseases of the skin
V – Infectious and parasitary occupational diseases
VI – O. diseases caused by other factors and agents