Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
Clin Toxicol (Phila). 2021 Dec;59(12):1259-1263. doi: 10.1080/15563650.2021.1892717. Epub 2021 Mar 11.
References listing common occupational poisons often include agents that were observed decades prior to the introduction of worker protective laws and regulations. Current causes of work-related acute poisonings have not been characterized. This study's primary objective was to describe the most common poisons and routes of exposure responsible for clinically significant occupational poisonings. A secondary objective was to determine the crude rate of clinically significant occupational poisonings and occupational poisoning-related deaths over the study period.
This was a retrospective cohort study using electronic data from the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS), and open source data from the United States Bureau of Labor Statistics (BLS). The NPDS was queried for all cases with exposure reason coded as "Unintentional-Occupational" for the period 1 January 2008 to 31 December 2018. A case of clinically significant occupational poisoning (CSOP) was defined as a case with moderate or severe clinical effects reported, to include fatal cases. A descriptive analysis was conducted using unadjusted odds ratios to assess the strength of association between main variables of interest and CSOP.
329,437 exposure cases were available for analysis. Of these, 54,254 were considered CSOP and included 196 deaths. The top five poisons responsible for occupational fatalities were hydrogen sulfide, ammonia, carbon monoxide, simple asphyxiants, and chlorines. Fatalities were 3.7 times (OR: 3.7; 95% CI: 2.2-6.4) more likely to be men and 5.7 times (OR: 5.7; 95% CI: 4.0-8.1) more likely to have had an inhalational exposure, compared to those workers with CSOP without fatality. The crude rate of occupational fatal poisoning reported to US poison centers was 11.3 deaths per 100,000,000 worker-years during the study period. The crude rate of clinically significant occupational poisoning was 3.1 per 100,000 worker-years. These rates remained generally stable over the study period.
Occupational poisonings continue to be a significant cause of morbidity and mortality in the workplace despite significant improvements in workplace chemical safety over the last four decades. Workplace education and proper preventive measures devoted to inhalational toxicants and respiratory protection are opportunities for improvement.
列出常见职业中毒物的参考文献通常包括在工人保护法规和条例出台前几十年观察到的制剂。目前尚未对与工作相关的急性中毒的原因进行描述。本研究的主要目的是描述导致临床显著职业中毒的最常见毒物和暴露途径。次要目标是确定研究期间临床显著职业中毒和与职业中毒相关的死亡率的粗率。
这是一项回顾性队列研究，使用美国毒物控制中心协会（AAPCC）国家毒物数据系统（NPDS）的电子数据和美国劳工统计局（BLS）的开源数据。NPDS 对 2008 年 1 月 1 日至 2018 年 12 月 31 日期间编码为“非故意职业”的所有暴露原因的病例进行了查询。临床显著职业中毒（CSOP）的定义为报告有中度或重度临床效应的病例，包括致命病例。使用未经调整的优势比进行描述性分析，以评估主要变量与 CSOP 之间的关联强度。
共有 329437 例暴露病例可供分析。其中，54254 例被认为是 CSOP，包括 196 例死亡。导致职业性死亡的五种最主要毒物是硫化氢、氨、一氧化碳、单纯窒息剂和氯。与没有死亡的 CSOP 工人相比，男性发生致命的可能性高 3.7 倍（比值比：3.7；95%置信区间：2.2-6.4），吸入暴露的可能性高 5.7 倍（比值比：5.7；95%置信区间：4.0-8.1）。在研究期间，向美国毒物中心报告的职业性致命中毒的粗率为每 1 亿工人年 11.3 例死亡。临床显著职业中毒的粗率为每 10 万工人年 3.1 例。这些比率在研究期间基本保持稳定。
尽管过去四十年间工作场所化学物质安全得到了显著改善，但职业中毒仍然是工作场所发病率和死亡率的一个重要原因。针对吸入性毒物和呼吸保护的工作场所教育和适当的预防措施是改进的机会。
