American journal of industrial medicine最新文献

Background: In the United States, health insurance is strongly associated with healthcare access and health status. How health insurance source, healthcare access, and health status differ by occupation has received less attention.

Methods: We used responses to the 2022 and 2023 Behavioral Risk Factor Surveillance System to estimate the prevalence of primary health insurance source, healthcare access/unmet healthcare needs, and health status by demographic characteristics and major occupation among respondents employed for wages or self-employed. We generated prevalences and adjusted prevalence ratios (PRs) to examine healthcare access and self-reported health status for workers in each occupation and to understand the impacts of adjustment for demographic characteristics (age, sex, race/Hispanic ethnicity), health insurance source, and household income.

Results: Overall, being insured was associated with better healthcare access and self-reported health status. Workers with employer-sponsored insurance or non-group private insurance were least likely to report unmet healthcare needs or to rate their health status as fair or poor. The uninsured were most likely to report unmet healthcare needs. The four occupations with at least 25% of workers uninsured (Farming, Fishing and Forestry; Building and Grounds Cleaning and Maintenance; Food Preparation and Serving; and Construction and Extraction) had statistically significant unadjusted PR elevations for all unmet healthcare need measures and for fair or poor general health. After sequential adjustment for demographic covariates and then primary insurance source, statistically significant elevations remained for being unable to afford needed care and for reporting fair or poor general health in most low-wage occupations. Final adjustment, adding household income, eliminated these remaining elevations for most occupations.

Conclusions: Both healthcare access and health status vary by health insurance status and source, which are differentially distributed by occupation. Workers in lower-wage occupations may have trouble affording medical care, even if insured. Affordable, comprehensive health insurance coverage, along with wages adequate to cover needed care, could help ensure the health and continued employability of all workers.

Background: This study examined the longitudinal influence of psychosocial safety climate (PSC) on self-endangering work behavior (SEWB), considering working time flexibility (fixed vs. flextime arrangement).

Methods: A two-wave web-based longitudinal survey was conducted in Japan in November 2021 and May 2022. Responses from 826 full-time workers were analyzed. Fixed-effects model analyses were used to examine the within-person effect of PSC on SEWB and test the moderation effect of working time flexibility.

Results: The decrease in PSC was significantly associated with the increase in SEWB under the flextime arrangement, but not under the fixed-time arrangement, presenting the significant moderation effect of working time flexibility.

Conclusions: The findings highlight the heightened vulnerability of flextime workers to SEWB in a deterioration of PSC, emphasizing the need for organizations to maintain a healthy organizational climate when implementing flextime.

Objectives: Pilots may have an increased risk of prostate cancer, potentially linked to circadian rhythm disruptions from crossing time zones, prolonged sedentary work, and ionizing radiation. However, existing research on associations presents inconsistent findings, likely attributable to methodological limitations, such as using the general population as a reference group and reliance on mortality as the primary outcome measure. This study aimed to contribute to understanding of the incidence of prostate cancer in pilots.

Methods: This nested case-control study included 54 male prostate cancer cases diagnosed between 1990 and 2003, along with 1126 cancer-free male controls, selected from a large Danish military population. Comprehensive data on military service, occupational history, exposures, and socioeconomic status (SES) were collected through a structured questionnaire. Among the cases, 7 individuals had previously worked onboard aircraft.

Results: Adjusted results indicated a positive association between working onboard aircraft and the risk of prostate cancer (OR = 3.42, 95% CI: 1.28-9.11). The risk was even more pronounced among individuals working as pilots.

Conclusions: The findings from this study of Danish military personnel indicate that pilots may have an elevated risk of prostate cancer, even after adjusting for SES. Future large-scale studies are needed to investigate this association further, incorporating detailed, objective data on exposure factors such as circadian rhythm disruptions and potential confounders.

In India, some occupational diseases are notifiable under the Mines Act, 1952, and the Factories Act, 1948. Mesothelioma, primarily attributable to asbestos exposure, has been listed specifically as one of the notifiable diseases under the Mines Act, 1952, and is notifiable under the category of occupational cancer in the Factories Act, 1948. The total number of cases of mesothelioma notified to the Directorate General of Mines Safety under the mining safety law was zero from 2004 to 2024. Similarly, under the factory safety law, only one case of occupational cancer was notified in one state, in a country of 28 states and 8 union territories (mesothelioma being listed under occupational cancer and not a separate entry under the factories law). This is in sharp contrast to the medical literature, where a large number of cases have been published by researchers and doctors from Indian hospitals. The absence of notified disease may not automatically mean the absence of disease. Further, a parallel National Cancer Registry Program, which is not only for occupational cancers, but which may overlap with occupational cases, covers only 16% of the country's population. With clear lack of notification of cases and underreporting of occupational mesothelioma, and cancer not being declared as universally notifiable at the national level, disease surveillance in India may need to be invigorated so that easily preventable disease is reduced, load on the already strained healthcare infrastructure is decreased, and overall national medical costs are reduced in the future.

Background: Classified as carcinogenic to humans by the International Agency for Research on Cancer, aluminum production has been transitioning towards lower polycyclic aromatic hydrocarbon-emitting prebake smelters. This study explored the risk of cancer and mortality over 20 years follow-up among a cohort of aluminum prebake smelter workers.

Method: Time-weighted average estimated exposure to the following airborne contaminants was available: total fluoride, sulfur dioxide, asbestos, oil mist, inhalable dust, benzene (a) pyrene (BaP), and benzene soluble fraction (BSF). Data about diagnosed cancers were accessed from the Australian Cancer Database and deaths and cause of deaths from the National Death Index, updating a previous linkage 9 years earlier.

Results: The cohort included 4495 male smelter workers. Mesothelioma was associated with historic asbestos exposure. BaP/BSF exposure were found associated with stomach cancer (10-year lag RR = 2.89 (1.19-6.98) [BaP], 2.88 (1.21-6.87) [BSF]), liver and prostate cancers, and Alzheimer's disease mortality. Oil mist exposure was associated with chronic obstructive pulmonary disease (COPD) mortality. There was no association between any smelter exposure and incidence of either lung or bladder cancer.

Conclusion: In this updated linkage of aluminum prebake smelter workers' data, the association between respiratory cancer and fluoride, inhalable dust and BaP exposure (found in the 2002 linkage analysis) was not confirmed. There was also no increased incidence of bladder cancer. However, compared with the earlier linkage, a stronger association was found for stomach cancer and BaP/BSF exposure. The strong association between mesothelioma and asbestos exposure, found in earlier linkages, remains. Other associations identified will require further investigation.

Introduction: A growing body of research is focused on the association between employment quality (EQ) and health, yet few studies have explored how transitions between types of EQ impact health in the United States (U.S.). Moreover, unemployed individuals are frequently omitted from EQ studies. The objective of this study was to assess how transitions between different EQ states, including unemployment, are associated with health in the U.S.

Methods: Using U.S. Medical Expenditure Panel Survey data from 2008 to 2022 (n = 71,957; weighted n = 126,312,273), this study identified five unique EQ types for men: 1. Salaried-Intensive; 2. Standard Employment Relationship (SER)-like; 3. Standard but Economically Vulnerable; 4. Precarious; and 5. Unemployed, and four for women: 1. SER-like, Union; 2. SER-like, non-Union; 3. Precarious; and 4. Unemployed. The probability of transitioning between each EQ type was measured using latent transition analysis (LTA). The probability of reporting poor/fair self-rated health (SRH) and self-rated mental health (SRMH) within each EQ transition was measured descriptively and associations of poor/fair SRH or SRMH with each EQ type were measured using generalized estimating equations.

Results: Respondents transitioning to or from low-EQ arrangements (e.g., precarious employment or unemployment) reported poor/fair SRH and SRMH more frequently relative to high-EQ (e.g., SER-like) types. LTA results suggested some respondents cycled between precarious employment and unemployment, potentially compounding the effects of employment instability on health.

Conclusion: Improving employment conditions, particularly for those caught in cycles of precarious employment and unemployment, may be an avenue for improving population health in the U.S.