BACKGROUND: Hepatitis C virus (HCV) disproportionately affects among people who inject drugs (PWID) globally. Despite carrying a high HCV burden, little is known about transmission dynamics in low-and-middle income countries. METHODS: We recruited PWID from Nairobi and Coastal cities of Mombasa, Kilifi and Malindi in Kenya at needle and syringe programs. Next-generation sequencing data from HCV hypervariable region 1 were analyzed using Global Hepatitis Outbreak and Surveillance Technology (GHOST) to identify transmission clusters. RESULTS: HCV strains belonged to genotype 1a (n=64, 46.0%), 4a (n=72, 51.8%), and were mixed HCV/1a/4a (n=3, 2.2%). HCV/1a was dominant (61.2%) in Nairobi while HCV/4a was dominant in Malindi (85.7%) and Kilifi (60.9%); whereas both genotypes were evenly identified in Mombasa (45.3%, for HCV/1a and 50.9% for HCV/4a). GHOST identified 11 transmission clusters involving 90 cases. Strains in the two largest clusters (n=38 predominantly HCV/4a, and n=32 HCV/1a) were sampled from all four cities. CONCLUSION: Transmission clusters involving 64.7% of cases indicate an effective sampling of major HCV strains circulating among PWID. Large clusters involving 77.8% of strains from Nairobi and Coast suggest successful introduction of two ancestral HCV/1a and HCV/4a strains to PWID, with widely spread progeny. Disruption of the country-wide transmission network is essential for HCV elimination.

Background: Diseases and conditions related to the respiratory system contribute to work-related morbidity, mortality, and disability. Details on the causes and nature of work-related respiratory disease and the specific industries in which they occur are limited. This study identifies respiratory-related claims in the Ohio Bureau of Workers’ Compensation (OHBWC) system and describes claim and worker characteristics to inform public health surveillance. Methods: We developed a list of respiratory-related International Classification of Diseases Clinical Modification (ICD-CM) diagnosis codes and searched over 2 million claims filed between 2001 and 2018 in the OHBWC system for at least one of these codes. The claim characteristics, rates of claims by employer industry classification, and causes of claims from narrative text were determined for these respiratory-related claims. Results: Among the 23,015 respiratory-related claims (5.8 per 10,000 full-time equivalents [FTE]), 54.6% had at least one ICD-CM code for Allergic Reactions and 30.6% had at least one code for Toxic Effects of Substances Chiefly Non-medicinal as to Source. Claim causes from narrative text included Chemical Exposure (30.3%), Activity Suggesting Exposure (24.4%), and Vapors, Gases, Dusts, or Fumes (VGDF) Exposure (19.3%). The highest overall rates of respiratory-related claims among private employers were for the agriculture, forestry & fishing (11.4 per 10,000), public safety (ambulance services) (11.3), and manufacturing (10.7) industry sectors. Conclusions: Respiratory-related claims in the OHBWC system were often acute in nature and included allergic reactions. Narratives from these claims provide insight into the work-related exposures and events causing claims or the disease and symptom factors surrounding claims. © 2024

To end the largest known outbreak of Ebola virus disease (EVD) in West Africa and to prevent new transmissions, rapid epidemiological tracing of cases and contacts was required. The ability to quickly identify unknown sources and chains of transmission is key to ending the EVD epidemic and of even greater importance in the context of recent reports of Ebola virus (EBOV) persistence in survivors. Phylogenetic analysis of complete EBOV genomes can provide important information on the source of any new infection. A local deep sequencing facility was established at the Mateneh Ebola Treatment Centre in central Sierra Leone. The facility included all wetlab and computational resources to rapidly process EBOV diagnostic samples into full genome sequences. We produced 554 EBOV genomes from EVD cases across Sierra Leone. These genomes provided a detailed description of EBOV evolution and facilitated phylogenetic tracking of new EVD cases. Importantly, we show that linked genomic and epidemiological data can not only support contact tracing but also identify unconventional transmission chains involving body fluids, including semen. Rapid EBOV genome sequencing, when linked to epidemiological information and a comprehensive database of virus sequences across the outbreak, provided a powerful tool for public health epidemic control efforts.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted workers in certain industries and occupations. The infection risk for SARS-CoV-2 and future respiratory viruses in the workplace is a significant concern for workers, employers, and policymakers. The current study describes the differences in COVID-19 mortality by sex and industry/occupation among working-age U.S. residents in 49 states and New York City. METHODS: The 2021 National Vital Statistics System (NVSS) public use multiple-cause-of-death data for U.S. decedents aged 15‒64 years (working-age) with information on usual industry and occupation were analyzed in 2022. Age-standardized COVID-19 death rates for selected demographic characteristics and adjusted proportional mortality ratios (PMRs) were estimated by sex and by usual industry and occupation. RESULTS: In 2021, 133,596 (14.3%) U.S. decedents aged 15‒64 years had COVID-19 listed as the underlying cause of death; the highest COVID-19 death rate was among persons aged 55‒64 years (172.4/100,000 population) and males (65.5/100,000 population). Among males, American Indian or Alaskan Native and among females, Black or African American had the highest death rates. Hispanic males had higher age-adjusted death rates than Hispanic females. Working-age male decedents in the public administration (PMR=1.39) and management of companies & enterprises industries (PMR=1.39) and community and social services occupations (PMR=1.68) and female decedents in the utilities industry (PMR=1.20) and protective services occupation (PMR=1.18) had the highest PMRs. CONCLUSIONS: COVID-19 death rates and PMRs varied by sex, industry, and occupation groups. These findings underscore the importance of workplace public health interventions, which could protect workers and their communities.

Kurth L, Doney B, Halldin C. Short Report: Prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007–2010. Occup Environ Med 2016;73:482–6. | The title that reads: “Prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007–2010” should read “Prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007–2008”. | All references on page 482 to ‘the 2007–2010 National Health and Nutrition Examination Survey (NHANES)’ and/or ‘2007–2010 NHANES data’ should read ‘the 2007–2008 National Health and Nutrition Examination Survey (NHANES)’ and ‘2007–2008 NHANES data’. | The sentences on page 482 that read “The US population, 18–79 years, was studied using NHANES data from the combined cross-sectional 2007–2008 and 2009–2010 survey cycles. These were the most current NHANES cycles available with longest held occupation and spirometry data” should read “The US population, 18–79 years, was studied using NHANES data from the cross-sectional 2007–2008 survey cycle”. | The sentences on page 483 that read “In the 2007–2010 NHANES, 11 891 persons aged 18–79 years who provided interview data were eligible for the spirometry component of the physical examination. Of those, 1,867 were excluded from spirometry for safety reasons, health reasons, or other reasons, and 501 had poor quality spirometry data” should read “In the 2007–2008 NHANES, 5789 persons aged 18–79 years who provided interview data were eligible for the spirometry component of the physical examination. Of those, 1030 were excluded from spirometry for safety reasons, health reasons, or other reasons, and 246 had poor quality spirometry data”. | The sentence on page 483 that reads “During 2007–2010, 4,172 NHANES participants had valid spirometry, height, and longest held occupation data, and were included in the study” should read “During 2007–2008, 4,172 NHANES participants had valid spirometry, height, and longest held occupation data, and were included in the study”. | The sentence on page 483 that reads “We analyzed NHANES data from 2007 to 2010 and estimated that the prevalence of spirometry-defined airflow obstruction among ever-employed US adults aged 18–79 years was 13.7%” should read “We analyzed NHANES data from 2007 to 2008 and estimated that the prevalence of spirometry-defined airflow obstruction among ever-employed US adults aged 18–79 years was 13.7%”. | The following sentence on page 484 should be deleted: “Even by combining data from the NHANES 2007–2008 and 2009–2010 survey cycles to improve the reliability of prevalence estimates, the prevalence estimates for some occupation groups were unreliable. The inclusion of NHANES occupation data from the 2011–2012 survey cycle, once it is released, may help us compute reliable prevalence estimates for additional occupation groups”. | The sentence on page 484 that reads “The prevalence of spirometry-defined airflow obstruction among ever-employed US adults from 2007 to 2010 varied by demographic characteristics and occupational factors, and was generally…” should read “The prevalence of spirometry-defined airflow obstruction among ever-employed US adults from 2007 to 2008 varied by demographic characteristics and occupational factors, and was generally…”. | The title of Table 1 on page 483 that reads “Age-specific and age-standardised prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by smoking status for selected demographic characteristics and occupational factors––NHANES 2007–2010” should read “Age-specific and age-standardised prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by smoking status for selected demographic characteristics and occupational factors––NHANES 2007–2008”.

BACKGROUND: Pneumoconiosis is a group of occupational lung diseases caused by dust and fiber exposure. This study analyzes Medicare claims to estimate the burden of pneumoconiosis among fee-for-service (FFS; Medicare Parts A and B) Medicare beneficiaries during 1999-2019 in the United States. METHODS: Claim and enrollment information from 81 million continuously enrolled FFS Medicare beneficiaries were analyzed. Beneficiaries with any pneumoconiosis and cause-specific pneumoconiosis (e.g., asbestosis, silicosis) were identified using three case definitions (broad, intermediate, and narrow) with varying diagnostic criteria based on claim International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes and Healthcare Common Procedure Coding System codes. Results are presented as ranges of values for the three case definitions. RESULTS: The 21-year prevalence range for any pneumoconiosis was 345,383-677,361 (412-833 per 100,000 beneficiaries) using the three case definitions. The highest prevalence was among those ≥75 years of age, males, Whites, and North American Natives. Most claims (70.0%-72.5%) included an ICD-CM diagnosis code for asbestosis. The broad pneumoconiosis prevalence rate increased significantly (p < 0.001) during 2002-2009 by 3%-10% annually and declined significantly by 3%-5% annually starting in 2009. The average annual broad incidence rate declined significantly by 7% annually during 2009-2019. CONCLUSIONS: Despite the decline in rate for any pneumoconiosis among Medicare beneficiaries, which is primarily attributed to a decline in asbestosis, pneumoconiosis is prevalent among FFS Medicare beneficiaries.

BACKGROUND: Exposure to respirable coal mine dust can cause pneumoconiosis, an irreversible lung disease that can be debilitating. The mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by occupation, by geographic region) from surface coal mines and surface facilities at U.S. underground mines during 1982-2017 were summarized. METHODS: Mine Safety and Health Administration (MSHA) collected and analyzed data for respirable dust and a subset of the samples were analyzed for quartz content. We calculated the respirable dust and quartz concentration geometric mean, arithmetic mean, and percent of samples exceeding the respirable dust permissible exposure limit (PEL) of 2.0 mg/m3, and the average percent of quartz content in samples. RESULTS: The geometric mean for 288 705 respirable dust samples was 0.17 mg/m(3) with 1.6% of the samples exceeding the 2.0 mg/m(3) PEL. Occupation-specific geometric means for respirable dust in active mining areas were highest among drillers. The geometric mean for respirable dust was higher in central Appalachia compared to the rest of the U.S. The geometric mean for respirable quartz including 54 040 samples was 0.02 mg/m(3) with 15.3% of these samples exceeding the applicable standard (PEL or reduced PEL). Occupation-specific geometric means for respirable quartz were highest among drillers. CONCLUSION: Higher concentrations of respirable dust or quartz in specific coal mining occupations, notably drilling occupations, and in certain U.S. regions, underscores the need for continued surveillance to identify workers at higher risk for pneumoconiosis.

OBJECTIVES: Mesothelioma is a rare, aggressive cancer caused by exposure to asbestos fibres. Mesothelioma patients who receive trimodal therapy (chemotherapy, surgical resection and radiation) survive longer than those who receive two or fewer therapy modalities. This study analyses the 2016-2019 Medicare claims data to estimate the burden of malignant mesothelioma and describe therapy patterns (when available) among continuously enrolled fee-for-service (FFS; Medicare parts A and B) beneficiaries. METHODS: We analysed claims and enrolment information from 42 529 117 FFS Medicare beneficiaries using three mesothelioma case definitions (broad, intermediate and narrow) with varying levels of diagnostic requirements. Results are presented as ranges of values for the three definitions. RESULTS: Among FFS beneficiaries, 8213-19 036 beneficiaries with mesothelioma were identified depending on the case definition. The annual prevalence per 100 000 beneficiaries ranged from 8.8 in 2016 (narrow) to 31.3 in 2019 (broad) and annual incidence per 100 000 beneficiaries ranged from 4.5 in 2019 (narrow) to 12.6 in 2017 (broad). Depending on the mesothelioma case definition, 41.8%-81.5% had available therapy claim information indicating that 7.6%-11.3% received chemotherapy alone, 1.3%-1.5% received radiation alone, and 14.3%-27.0% underwent surgery only, with 4.6%-10.5% receiving all three therapy modalities. CONCLUSIONS: Mesothelioma was a prevalent disease among FFS Medicare beneficiaries during 2016-2019, and a limited proportion of beneficiaries received all three therapy modalities. Medicare data build on findings from cancer registry data to enhance our understanding of the mesothelioma burden and therapy patterns.

Healthcare facility staff use a wide variety of cleaning and disinfecting products during their daily operations, many of which are associated with respiratory or skin irritation or sensitization with repeated exposure. The objective of this study was to characterize the prevalence of cleaning and disinfection product use, glove use during cleaning and disinfection, and skin/allergy symptoms by occupation and identify the factors influencing glove use among the healthcare facility staff. A questionnaire was administered to the current employees at a midwestern Veterans Affairs healthcare facility that elicited information on cleaning and disinfection product use, glove use during cleaning and disinfection, skin/allergy symptoms, and other demographic characteristics, which were summarized by occupation. The central supply/environmental service workers (2% of the total survey population), nurses (26%,), nurse assistants (3%), and laboratory technicians (5%) had the highest prevalence of using cleaning or disinfecting products, specifically quaternary ammonium compounds, bleach, and alcohol. Glove use while using products was common in both patient care and non-patient care occupations. The factors associated with glove use included using bleach or quaternary ammonium compounds and using cleaning products 23 or 45 days per week. A high frequency of glove use (75%) was reported by workers in most occupations when using quaternary ammonium compounds or bleach. The use of alcohol, bleach, and quaternary ammonium compounds was associated with skin disorders (p < 0.05). These research findings indicate that although the workers from most occupations report a high frequency of glove use when using cleaning and disinfection products, there is room for improvement, especially among administrative, maintenance, and nursing workers. These groups may represent populations which could benefit from the implementation of workplace interventions and further training regarding the use of personal protective equipment and the potential health hazards of exposure to cleaning and disinfecting chemicals. 2022 by the authors.

Chronic obstructive pulmonary disease (COPD), a progressive lung disease, is characterized by long-term respiratory symptoms and airflow limitation (1). COPD accounts for most of the deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2020.* Workplace exposures and tobacco smoking are risk factors for COPD; however, one in four workers with COPD have never smoked (2-4). To describe COPD mortality among U.S. residents aged 15 years categorized as ever-employed (i.e., with information on their usual industry and occupation), CDC analyzed the most recent 2020 multiple cause-of-death data() from 46 states and New York City.() Among 3,077,127 decedents, 316,023 (10.3%) had COPD() listed on the death certificate. The highest age-adjusted** COPD death rates per 100,000 ever-employed persons were for females (101.3), White persons (116.9), and non-Hispanic or Latino (non-Hispanic) persons (115.8). The highest proportionate mortality ratios (PMRs)() were for workers employed in the mining industry (1.3) and in food preparation and serving related occupations (1.3). Elevated COPD mortality among workers in certain industries and occupations underscores the importance of targeted interventions (e.g., reduction or elimination of COPD-associated risk factors, engineering controls, and workplace smoke-free policies) to prevent COPD from developing and to intervene before illness becomes symptomatic or severe.

BACKGROUND: Emergency Department (ED) visits are common among adults with intellectual and developmental disabilities (IDD). However, little is known about how ED use has varied over time in this population, or how it has been affected by recent Medicaid policy changes. OBJECTIVE: To examine temporal trends in ED use among adult Medicaid members with IDD in eight states that ranged in the extent to which they had implemented state-level Medicaid policy changes that might affect ED use. METHODS: We conducted repeated cross-sectional analyses of 2010-2016 Medicaid claims data. Quarterly analyses included adults ages 18-64 years with IDD (identified by diagnosis codes) who were continuously enrolled in Medicaid for the past 12 months. We assessed change in number of ED visits per 1000 member months from 2010 to 2016 overall and interacted with state level policy changes such as Medicaid expansion. RESULTS: States with no Medicaid expansion experienced an increase in ED visits (linear trend coefficient: 1.13, p < 0.01), while states operating expansion via waiver had a much smaller (non-significant) increase, and states with ACA-governed expansion had a decrease in ED visits (linear trend coefficient: 1.17, p < 0.01). Other policy changes had limited or no association with ED visits. CONCLUSIONS: Medicaid expansion was associated with modest reduction or limited increase in ED visits compared to no expansion. We found no consistent decrease in ED visits in association with other Medicaid policy changes.

Exposures to dust, vapors, or fumes (DVF) are associated with chronic bronchitis (CB) and emphysema. The 2007-2012 National Health and Nutrition Examination Survey data were used to estimate age-standardized prevalence of CB and emphysema among ever-employed adults by exposure status and industry and occupation groups. Age-standardized CB and emphysema prevalence were 2.3% and 1.9%, respectively. Of the estimated 111 million U.S. workers exposed to DVF, 2.7% reported CB and 2.8% reported emphysema. Workers in the "accommodation, food services" industry and "food preparation, serving related" occupations were more likely to report CB and emphysema. Current findings indicate that workplace exposures may be associated with high prevalence of CB and emphysema in certain industry and occupational groups. Early diagnosis and identifying associated workplace exposures are important steps in CB and emphysema prevention efforts.

Objective: To assess healthcare utilization, lost work days, and bed days among workers with chronic obstructive pulmonary disease (COPD) by industry and occupation. Methods: The 2014-2018 National Health Interview Survey (NHIS) data were analyzed. Results: Among workers with COPD the highest odds of reporting an emergency room (ER) visit and lost work days were observed among workers aged &gt;=65 years, females, those with no health insurance, and current combustible tobacco users. Workers with COPD in the information industry and computer and mathematical occupation reported highest odds of an ER visit and utilities industry workers reported highest odds for lost work days. Conclusions: The high healthcare utilization and lost work days among workers with COPD in certain industries and occupations underscores the importance of continued surveillance and tailored interventions to reduce disease burden and improve worker health.

BACKGROUND: Workers' compensation claims among Medicare beneficiaries have not been described previously. To examine the healthcare burden of work-related injury and illness among Medicare beneficiaries, we assessed the characteristics, healthcare utilization, and financial costs among Medicare beneficiaries with claims for which workers' compensation was the primary payer. METHODS: We extracted final action fee-for-service Medicare claims from 1999 to 2016 where workers' compensation had primary responsibility for claim payment and beneficiary, claim type, diagnoses, and cost information from these claims. RESULTS: During 1999-2016, workers' compensation was the primary payer for 2,010,200 claims among 330,491 Medicare beneficiaries, and 58.7% of these beneficiaries had more than one claim. Carrier claims submitted by noninstitutional providers constituted the majority (94.5%) of claims. Diagnosis codes indicated 19.4% of claims were related to diseases of the musculoskeletal system and connective tissue and 12.9% were related to disease of the circulatory system. Workers' compensation insurance paid $880.4 million for these claims while Medicare paid $269.7 million and beneficiaries paid $37.4 million. CONCLUSIONS: Workers' compensation paid 74% of the total amount to providers for these work-related medical claims among Medicare beneficiaries. Claim diagnoses were similar to those of all workers' compensation claims in the United States. Describing these work-related claims helps identify the healthcare burden due to occupational injury and illness among Medicare beneficiaries resulting from employment and identifies a need for more comprehensive collection and surveillance of work-related medical claims.

A workshop "Electronic Health Records and Pulmonary Function Data: Developing an Interoperability Roadmap" was held at the American Thoracic Society 2019 International Conference. "Interoperability" is defined as is the ability of different information-technology systems and software applications to directly communicate, exchange data, and use the information that has been exchanged. At present, pulmonary function test (PFT) equipment is not required to be interoperable with other clinical data systems, including electronic health records (EHRs). For this workshop, we assembled a diverse group of experts and stakeholders, including representatives from patient-advocacy groups, adult and pediatric general and pulmonary medicine, informatics, government and healthcare organizations, pulmonary function laboratories, and EHR and PFT equipment and software companies. The participants were tasked with two overarching Aobjectives: 1) identifying the key obstacles to achieving interoperability of PFT systems and the EHR and 2) recommending solutions to the identified obstacles. Successful interoperability of PFT data with the EHR impacts the full scope of individual patient health and clinical care, population health, and research. The existing EHR-PFT device platforms lack sufficient data standardization to promote interoperability. Cost is a major obstacle to PFT-EHR interoperability, and incentives are insufficient to justify the needed investment. The current vendor-EHR system lacks sufficient flexibility, thereby impeding interoperability. To advance the goal of achieving interoperability, next steps include identifying and standardizing priority PFT data elements. To increase the motivation of stakeholders to invest in this effort, it is necessary to demonstrate the benefits of PFT interoperability across patient care and population health.

Peak exposures are of concern because they can potentially overwhelm normal defense mechanisms and induce adverse health effects. Metrics of peak exposure have been used in epidemiologic and exposure studies, but consensus is lacking on its definition. The relevant characteristics of peak exposure are dependent upon exposure patterns, biokinetics of exposure, and disease mechanisms. The objective of this review was to summarize the use of peak metrics in epidemiologic and exposure studies. A comprehensive search of Medline, Embase, Web of Science, and NIOSHTIC-2 databases was conducted using keywords related to peak exposures. The retrieved references were reviewed and selected for indexing if they included a peak metric and met additional criteria. Information on health outcomes and peak exposure metrics was extracted from each reference. A total of 1,215 epidemiologic or exposure references were identified, of which 182 were indexed and summarized. For the 72 epidemiologic studies, the health outcomes most frequently evaluated were: chronic respiratory effects, cancer and acute respiratory symptoms. Exposures were frequently assessed using task-based and full-shift time-integrated methods, qualitative methods, and real-time instruments. Peak exposure summary metrics included the presence or absence of a peak event, highest exposure intensity and frequency greater than a target. Peak metrics in the 110 exposure studies most frequently included highest exposure intensity, average short-duration intensity, and graphical presentation of the real-time data (plots). This review provides a framework for considering biologically relevant peak exposure metrics for epidemiologic and exposure studies to help inform risk assessment and exposure mitigation.

BACKGROUND: Coal miners with totally disabling pneumoconiosis are eligible for benefits through the Federal Black Lung Benefits Program (FBLP). We identify the causes of death among Medicare beneficiaries with a claim for which the FBLP was the primary payer and compare these causes of death to all deceased Medicare beneficiaries to better understand elevated death and disease among miners with occupational respiratory exposures. METHODS: From 1999 to 2016 Medicare data, we extracted beneficiary and National Death Index data for 28,003 beneficiaries with an FBLP primary payer claim. We summarized the International Classification of Diseases, Clinical Modification 10th revision-coded underlying causes of death and entity-axis multiple causes of death for 22,242 deceased Medicare beneficiaries with an FBLP primary payer Medicare claim and compared their causes of death to the deceased Medicare beneficiary population. RESULTS: Among deceased FBLP beneficiaries, the three leading underlying causes of death were chronic obstructive pulmonary disease, unspecified (J44.9, 10.1%), atherosclerotic heart disease (I25.1, 9.3%), and coal workers' pneumoconiosis (CWP) (J60, 9.2%). All diseases of the respiratory system combined (J00-J99) were the underlying cause of death for 29.1% of all beneficiaries, with pneumoconioses (J60-J64) as the underlying cause for 11.0% of all beneficiaries. CONCLUSIONS: Coal miners enrolled in Medicare with an FBLP primary payer claim were more likely to have specific respiratory and cardiovascular diseases listed as a cause of death than deceased Medicare beneficiaries overall, and were also more likely to die from CWP or any pneumoconioses.

Respiratory disease (e.g., silicosis, chronic obstructive pulmonary disease) prevalence can be estimated using health insurance information, such as U.S. Centers for Medicare & Medicaid Services (CMS) claims data (1–3). In previous surveillance studies, cases of respiratory disease were defined by the presence of specific International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis code(s) on health insurance claims (1–3). Defining respiratory disease cases without clinical information may lead to misclassification of disease status. To further explore this issue, the current study applies ICD-CM diagnosis-based case definitions to a subset of Federal Black Lung Benefits Program (FBLP) beneficiaries within Medicare data to determine the proportion with diagnosis codes for coal workers’ pneumoconiosis (CWP), pneumoconiosis, and other respiratory diseases.

Introduction: This study estimated the prevalence of spirometry-defined airflow obstruction and coal workers' pneumoconiosis (CWP) among never-smoking coal miners participating in the National Institute for Occupational Safety and Health (NIOSH) Coal Workers' Health Surveillance Program (CWHSP). Methods: Data were from working miners screened by a CWHSP mobile unit who had valid spirometry and chest radiography results. Spirometry-defined airflow obstruction was determined when the ratio of forced expiratory volume in the first second to forced vital capacity is less than the lower limit of normal. Chest radiographs were classified according to the International Labour Office system to identify pneumoconiosis, including the most severe form of pneumoconiosis, progressive massive fibrosis (PMF). Results: Prevalence of airflow obstruction among never- smoking coal miners in this sample was 7.7% overall, 16.4% among miners with CWP and 32.3% among miners with PMF. Airflow obstruction was significantly associated with CWP and PMF. Conclusions: There was a higher prevalence of airflow obstruction among never-smoking coal miners with pneumoconiosis compared with those without pneumoconiosis. these findings support prior research on airflow obstruction and smoking and show pneumoconiosis might present with an obstructive pattern regardless of smoking status.

INTRODUCTION: Existing asthma-specific job-exposure matrices (JEMs) do not necessarily reflect current working conditions in the USA and do not directly function with occupational coding systems commonly used in the USA. We initiated a project to modify an existing JEM to address these limitations, and to apply the new JEM to the entire US employed population to estimate quantitatively the extent of probable work-related asthma exposures nationwide. METHODS: We started with an asthma-specific JEM that was developed for northern Europe (the N-JEM) and modified it to function with the 2010 US Standard Occupational Classification (SOC-2010) codes and to reflect working conditions in the USA during the post-2000 period. This involved cross walking from the 1988 International Standard Classification of Occupations (ISCO-88) codes used in the N-JEM to the SOC-2010 codes, transferring the N-JEM exposure assignments to the SOC-2010 codes, and modifying those assignments to reflect working conditions in the USA. The new US asthma JEM (USA-JEM) assigns exposures to 19 agents organized into five categories. The USA-JEM and N-JEM were applied to the same sample of working adults with asthma to compare how they performed, and the USA-JEM was also applied to the entire 2015 US working population to estimate the extent of occupational asthma exposures nationally. RESULTS: The USA-JEM assigns at least one asthma-related probable exposure to 47.5% and at least one possible exposure to 14.9% of the 840 SOC-2010 detailed occupations, and 9.0% of the occupations have both probable exposure to at least one agent and possible exposure to at least one other agent. The USA-JEM has greater sensitivity for cleaning products, highly reactive disinfectants and sterilants, and irritant peak exposures than the N-JEM. When applied to the entire 2015 US working population, the USA-JEM determined that 42.6% of workers had probable exposure to at least one type of occupational asthma agent. DISCUSSION: A new asthma-specific JEM for application in the USA was developed. Additional work is needed to compare its performance to similar JEMs and, if possible, to exposure assessments generated on a case-by-case basis.

OBJECTIVE: To establish the burden of totally disabling respiratory impairment among coal miners, we identified the healthcare utilization and cost for Medicare claims where the Federal Black Lung Program (FBLP) was the primary payer. METHODS: We extracted FBLP claims from 1999-2016 institutional Medicare data along with beneficiary, comorbidity, and claim cost information. Healthcare utilization was evaluated and compared to the 2016 Medicare population. RESULTS: The FBLP was the primary payer on 75,690 claims from 19,700 beneficiaries and paid an increasing percentage of the total paid to providers annually. Claims decreased from 1999-2016 but cost per claim increased. Beneficiaries were hospitalized and visited the ER for respiratory and cardiovascular conditions. CONCLUSIONS: Medicare beneficiaries with FBLP primary payer claims have higher healthcare utilization and comorbidities compared to Medicare enrollees, indicative of increased financial and healthcare burden.

OBJECTIVE: To describe delivery of recommended HIV care and work satisfaction among infectious disease (ID) physicians, non-ID physicians, nurse practitioners (NPs), and physician assistants (PAs). DATA SOURCES: Medical Monitoring Project 2013-2014 HIV Provider Survey. STUDY DESIGN: Population-based complex sample survey. DATA COLLECTION/ANALYSIS METHODS: We surveyed 2208 HIV care providers at 505 US HIV care facilities and computed weighted percentages of provider characteristics, stratified by provider type. Rao-Scott chi-square tests and logistic regression used to compare characteristics of ID physicians with each other provider type. PRINCIPAL FINDINGS: The adjusted provider response rate was 64 percent. Among US HIV care providers, 45 percent were ID physicians, 35 percent non-ID physicians, 15 percent NPs, and 5 percent PAs. Satisfaction with administrative burden was lowest among non-ID physicians (27 percent). Compared with ID physicians, satisfaction with remuneration was lower among non-ID physicians and higher among NPs (37, 28, and 51 percent, respectively). NPs were more likely than ID physicians to report performing four of six services that are key to providing comprehensive HIV care, but more NPs planned to leave clinical practice within 5 years (19 vs 7 percent). CONCLUSION: Addressing physician dissatisfaction with remuneration and administrative burden could help prevent a provider shortage. Strengthening the role of NPs may help sustain a high-quality workforce.

BACKGROUND: This study summarized the mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by district, and by occupation) from underground coal mines during 1982-2017. METHODS: Respirable dust and quartz data collected and analyzed by Mine Safety and Health Administration (MSHA) were summarized by year, coal mining occupation, and geographical area. The older (before August 2016) 2.0 mg/m (3) respirable dust MSHA permissible exposure limit (PEL) was used across all years for comparative purposes. For respirable dust and quartz, geometric mean and percent of samples exceeding the respirable dust PEL (2.0 mg/m (3) or a reduced standard for samples with >5% quartz content) were calculated. For quartz samples, the average percent quartz content was also calculated. RESULTS: The overall geometric mean concentration for 681 497 respirable dust samples was 0.55 mg/m (3) and 5.5% of the samples exceeded the 2.0 mg/m (3) PEL. The overall respirable quartz geometric mean concentration for 210 944 samples was 0.038 mg/m (3) and 18.7% of these samples exceeded the applicable standard. There was a decline over time in the percent of respirable dust samples exceeding 2.0 mg/m (3) . The respirable dust geometric mean concentration was lower in central Appalachia compared to the rest of the United States. However, the respirable quartz geometric mean concentration and the mean percent quartz content were higher in central Appalachia. CONCLUSION: This study summarizes respirable dust and quartz concentrations from coal mine inspector samples and may provide an insight into differences in the prevalence of pneumoconiosis by region and occupation.

INTRODUCTION: This study examined the association of spirometry-defined airflow obstruction and self-reported COPD defined as self-reported doctor diagnosed chronic bronchitis or emphysema, with occupational exposure among ever-employed US adults. METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian US population. Reported current and/or longest held job were used to create prevalence estimates and prevalence odds ratios (PORs) (adjusted for age, gender, race, and smoking status) for airflow obstruction and self-reported COPD by occupational exposure, determined using both NHANES participants' self-reported exposures and eight categories of COPD job exposure matrix (JEM) assigned exposures. RESULTS: Significant PORs for airflow obstruction and self-reported COPD respectively were observed with self-reported exposure for >/=20 years to mineral dust (POR = 1.44; 95% confidence interval (CI) 1.13-1.85; POR = 1.69; 95% CI 1.17-2.43) and exhaust fumes (POR = 1.65; 95% CI 1.27-2.15; POR = 2.22; 95% CI 1.37-3.58). Airflow obstruction or self-reported COPD were also associated with COPD-JEM assigned high exposure to mineral dust, combined dust, diesel exhaust, vapor-gas, sensitizers, and overall exposure. CONCLUSION: Airflow obstruction and self-reported COPD are associated with both self-reported and JEM-assigned exposures.

BACKGROUND: Substance use is common among people living with HIV (PLWH) and a barrier to achieving viral suppression. OBJECTIVE: Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. DESIGN: Longitudinal cohort studySetting/participantsPLWH in clinical care at 8 HIV clinics or 5 clinical studies. MEASUREMENTS: We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. RESULTS: The number of PLWH who were using each drug at baseline ranged from n=568 (illicit opioids) to n=4272 (marijuana). Abstinence was associated with higher odds of viral suppression (OR 1.4-2.2) and lower relative VL (ranging from 21-42% by drug) for all four drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR 2.2, 1.6 respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38% respectively). LIMITATIONS: Observational data have limitations with causal inference. CONCLUSIONS: Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Findings highlight the impact of reducing substance use even when abstinence is not achieved and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.

INTRODUCTION: This study estimated the prevalence of spirometry-defined airflow obstruction by industry and occupation and chronic obstructive pulmonary disease (COPD) among ever-employed U.S. adults. METHODS: Data came from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian U.S. POPULATION: Data on respondent's current and/or longest held job were used to create prevalence estimates and adjusted prevalence odds ratios (PORs) for airflow obstruction and COPD. RESULTS: Among ever-employed U.S. adults, airflow obstruction prevalence was 12.40% and COPD was 3.47%. High airflow obstruction prevalence and significant PORs were reported in mining; manufacturing; construction; and services to buildings industries as well as extraction; bookbinders, prepress, and printing; installers and repairers; and construction occupations. CONCLUSION: Prevalence of airflow obstruction varies by industry and occupation. Industries and occupations with increased risk were identified using the most current NHANES data including detailed occupations and spirometry.

OBJECTIVE: The aim of this study was to describe a study of medical monitoring methods and lessons learned in detecting health outcomes in U.S. plants producing toluene diisocyanate (TDI). METHODS: A multidisciplinary team implemented a medical and environmental monitoring program in three TDI plants. RESULTS: Of 269 eligible workers, 197 (73%) participated and 42 (21%) met symptom and/or lung function criteria that would trigger evaluation for possible asthma over 5 years of data collection. Subsequent evaluation was delayed for most, and a web-based data collection system improved timeliness. CONCLUSION: Medical monitoring of TDI workers identified workers triggering further assessment per study protocol. Systems and/or personnel to ensure rapid follow-up are needed to highlight when triggering events represent potential cases of asthma needing further evaluation. Implementation of a research protocol requires resources and oversight beyond an occupational health program.

OBJECTIVE: This study examines asthma risk in facilities producing toluene diisocyanate (TDI). METHODS: A total of 197 workers were monitored from 2007 to 2012. TDI air concentrations were used to estimate exposures. RESULTS: The incidence of cases consistent with TDI-induced asthma was 0.009 per person-years (seven cases) or consistent with TDI-induced asthma or asthma indeterminate regarding work-relatedness was 0.012 (nine cases). Increased risk of cases consistent with TDI asthma was observed for cumulative (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures (OR = 1.18, 95% CI 1.06 to 1.32) (logarithm parts per billion). There was a weak association with cumulative and peak exposures for decline of short-term forced expiratory volume in one second (FEV1). Asthma symptoms were associated with workers noticing an odor of TDI (OR 6.02; 95% CI 1.36 to 26.68). CONCLUSIONS: There is evidence that cumulative and peak exposures are associated with TDI-induced asthma.

An outbreak of influenza A(H7N2) virus in cats in a shelter in New York, NY, USA, resulted in zoonotic transmission. Virus isolated from the infected human was closely related to virus isolated from a cat; both were related to low pathogenicity avian influenza A(H7N2) viruses detected in the United States during the early 2000s.

INTRODUCTION: Healthcare workers are at increased risk for respiratory disorders. The purpose of our respiratory health survey was to estimate the prevalence of current asthma and asthma-like symptoms and their association with workplace exposures and tasks among healthcare workers at a Veterans Administration (VA) Medical Center. MATERIAL AND METHODS: Information on respiratory health and work characteristics, including tasks performed, products used, and exposures, were collected by questionnaire from a convenience sample of workers employed at the VA Medical Center during 2012-2014. Associations of asthma and asthma-like symptoms with cleaning and disinfecting tasks and products as well as exposure to dampness and molds, and construction dust were evaluated using log-binomial regression. RESULTS: The prevalence of current asthma was 17.6% and almost half of all workers reported asthma-like symptoms. We observed elevated prevalence of current asthma among the VA healthcare workers compared to the U.S. general and working adult populations. Asthma and asthma-like symptoms were significantly associated with mold, dampness, and construction material exposures; cleaning and disinfecting products; and cleaning or disinfecting tasks. CONCLUSIONS: Workplace exposures and tasks associated with current asthma and asthma-like symptoms were identified but further research is needed to investigate the temporal association between workplace exposures and current asthma and asthma-like symptoms.