years ranked third, showing the dynamics of age in this process (NIOSH, n.d., 2008; Table 1 and Figures 2 and 3). Malignant Mesothelioma Malignant mesothelioma is a rare and aggres- sive cancer that results from asbestos exposure (Jain & Wallen, 2023; Moore et al., 2008; Pou- liquen & Kopecka, 2021). It has a long latency period of between 20 and 30 years follow- ing asbestos exposure (Cugliari et al., 2020). As with asbestosis, the rate of new malignant mesothelioma in the U.S. is highest in the age groups 75–84 years and ≥85 years from 1999– 2018 (National Center for Chronic Disease Prevention and Health Promotion, 2022). The average age at diagnosis is 72, and malignant pleural mesothelioma predominantly aects male patients (Jain & Wallen, 2023). The num- ber of deaths among U.S. residents from malig- nant mesothelioma was 15,379 and 27,284 for 1995–2004 and 2005–2014, respectively, with the highest mortality in the age group 75–84 years. The age groups 65–74 and 55–64 years were ranked second and third, respectively, for the number of deaths from malignant meso- thelioma, followed by the age group ≥85 years ranked fourth for 1995–2004, also showing the dynamics of age in the process. This trend was reversed for the 2005–2014 period: the age groups 65–74 and ≥85 years were ranked sec- ond and third, respectively, for the number of deaths from malignant mesothelioma, followed by the age group 55–64 years ranked fourth, which may be an indication of early detection or better therapeutic options (NIOSH, n.d., 2008; Table 1; Figures 2 and 3). Hypersensitivity Pneumonitis Hypersensitivity pneumonitis is an immune- mediated interstitial lung disease that results from the inhalation of antigens found in the environment in susceptible or sensitized individuals (Barnes et al., 2022; Churg, 2022; Costabel et al., 2020; Hamblin et al., 2022; Raghu et al., 2020). The number of deaths among U.S. residents from hypersensitivity pneumonitis was 540 and 978 for 1995– 2004 and 2005–2014, respectively, showing an increase in mortality over the years. The highest mortality was in the age group 75–84 years for 1995–2004, and there were 262 and 257 deaths for the age groups 75–84 and 65–74 years, respectively, for the 2005–2014 period, with age group ≥85 years ranked third
for both periods (NIOSH, n.d., 2008; Table 1; Figures 2 and 3).
which can occur at primary, secondary, and tertiary levels. Hence, surveillance is an important integrated part of the occupational healthcare chain, requiring an interdisciplin- ary approach in which healthcare profes- sionals, occupational hygienists, employers, employees, and authorities need to collabo- rate (Szram & Cullinan, 2013). Medical surveillance is increasingly rel- evant in today’s aging workforce and should be regarded as an excellent occupational health practice. Surveillance programs are aimed at specific health risks related to potential occupa- tional exposure. For work-related diseases with a long latency period—such as lung cancer that often occurs after retirement age—early detec- tion can be di©cult and as such, all eorts are better focused on primary prevention of expo- sure to the causative agents. For short-latency respiratory diseases (e.g., asthma), early detec- tion and intervention can prevent disease progression and help keep individuals in the workforce. Further, diagnostic modeling can help to select or exclude workers at high risk and thus can oset the drawbacks of screen- ing all workers and the resulting high number of workers with a negative result (Meijer et al., 2010; Suarthana et al., 2007). OSHA provides medical surveillance guide- lines in standards such as C.F.R. 1910.1043 Paragraph H for cotton dust exposure (Cotton Dust, 2024; OSHA, 1995), C.F.R. 1910.1053 Appendix B for respirable crystalline silica exposure (Respirable Crystalline Silica, 2024), and C.F.R. 1910.1001 Appendix H for asbestos non-mandatory (Asbestos: Medical Surveillance Guidelines, 2024) for employ- ers whose workers are exposed to hazards in occupational settings. Furthermore, NIOSH (2024) studies the causes and eects of coal dust-related respiratory conditions to reduce the burden of the disease. Occupational health surveillance is an important program for employers and employees, but without awareness and understanding of the important short- and long-term benefits, setting up, implement- ing, and evaluating surveillance programs remain challenging for all parties involved (De Matteis et al., 2017). Older Adult Health and the Work Environment The aging population in Western countries is changing the classical occupational respira-
Work-Related Asthma Asthma is a chronic and noncommunicable disease of the air passages characterized by inflammation and narrowing of the lower air- ways (Hashmi & Cataletto, 2024; Laditka et al., 2020; Mims, 2015). A review by Yáñez et al. (2014) showed that asthma-related visits to the emergency department, hospitalizations, near- fatal asthma events, higher hospital charges, longer hospital length of stay, and higher over- all mortality are higher among individuals ≥55 years compared with adults between 18 and 54 years. In a 2012 report by CDC in 22 states, 15.7% of ever-employed adults with cur- rent asthma had work-related asthma, and the highest number of work-related asthma was recorded in the age group 45–64 years (Mazu- rek et al., 2015). This finding suggests that age plays a vital role in the disease outcome of asthma, including work-related asthma. Chronic Obstructive Pulmonary Disease The aging of the population in the U.S. and throughout the developed world has been associated with increases in morbid- ity and mortality attributable to lung dis- ease, whereas morbidity and mortality from other prevalent diseases have declined or remained stable. For example, COPD has risen to become the fourth-leading cause of death worldwide (Kochanek et al., 2011) and the third-leading cause of death in the U.S. in the past decade (Budinger et al., 2017). There is a growing recognition that aging contributes to the pathogenesis of a number of chronic lung diseases; most lung diseases are either largely restricted to or more severe in older adults. For example in the U.S., the prevalence of COPD was estimated at 3.2% among individuals 25–44 years of age and 10.3% among individuals 63–74 years of age (Ford et al., 2013). Comorbidities are respon- sible for a significant proportion of deaths in older patients with COPD, particularly for the comorbidities of cardiovascular disease and lung cancer (Anecchino et al., 2007; Chatila et al., 2008; Mannino et al., 2006).
Disease Surveillance and Older Adults in the Workforce
The rationale for the surveillance of occu- pational respiratory diseases is prevention,
21
October 2024 • our6)l o. 6=1ro6me6;)l e)l;0
Powered by FlippingBook