Occupational contact dermatitis I: Incidence and return to work pressures

Since the passage of the United States Occupational Safety and Health Act (OSHA) in 1970, there have been extensive changes in United States workplaces that should have served to enhance the prevention of occupational skin disease (OSD). Analysis of skin diseases reported to OSHA (OSHA recordables) shows that the number of OSDs declined steadily from 1974 to 1983 to about half the previous annual incidence. After 1984, there was a modest resurgence peaking in 1994, with a subsequent decline. A similar but somewhat greater decline in the late 1990s has been observed for occupational respiratory diseases, diseases caused by toxic agents and for poisonings. Likely explanations for the trends in OSD are discussed; the initial decline probably reflected an improvement in workplace conditions, the later resurgence and decline may have been attributable to changes in recording behaviors and in worker's compensation. The decline in recorded OSD since 1996 has been fairly uniform in most major industrial sectors but has been less marked in agriculture, forestry, and fishing so that this sector has replaced manufacturing in recording the highest incidence rate. In 1999, the incidence rate of recorded OSD was 0.49 per 1,000 workers, which appears to grossly underreport the true incidence. OSD now constitutes about 10% of all occupational disease cases. Currently, there is increasing emphasis in corporate and occupational medicine on reducing costs and maintaining productivity as well as in preventing occupational injuries and diseases. This is shown by the trend for a greater proportion of workers with occupational conditions to return to modified duty positions rather than to be completely off work. Implications of this phenomena for management of OSD are discussed.