Todd A. Stueckle, PhD*, (HELD/NIOSH); Nicole S. Olgun, PhD (HELD/NIOSH); Taylor Shockey, PhD (DFSE/NIOSH); Raquel Velazquez-Kronen, PhD (DFSE/NIOSH); Lauralynn McKernan, ScD (DFSE/NIOSH)

Understanding the global burden of occupational chronic diseases is necessary for recognizing occupational hazards and targeting intervention and prevention efforts in the workplace. The Cancer, Reproductive, Cardiovascular and Other Chronic Disease Prevention Program (CRC) within the National Institute for Occupational Safety and Health (NIOSH) provides leadership for the prevention of work-related diseases related to many types of cancer, reproductive health, and cardiovascular, renal, and neurologic diseases. The CRC works with partners in industry, labor, trade and professional associations, and academia, with a focus on preventing and reducing occupational cancer incidence, incidence of adverse reproductive outcomes (AROs), occupational cardiovascular disease (CVD) incidence, and occupational neurologic and renal disease incidence. By conducting research and collaborating on health studies, the CRC identifies and quantifies occupational chronic disease outcomes and their associated workplace factors or exposures. The CRC develops products on prevention for stakeholders, and communicates research findings and recommendations via manuscripts, videos, conference presentations and internet web pages.

Epidemiological studies have found elevated risks for cancer among workers when examining specific exposures and occupations; however, many carcinogens from work exposures are understudied, leading to unknown cancer risk. Health surveillance systems such as the National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and Behavioral Risk Factor Surveillance System (BRFSS) provide data for exploring occupation-related cancers. The NIOSH National Occupational Mortality Surveillance (NOMS) System has allowed researchers to examine cancer mortality in health and science technicians, laundry and dry-cleaning workers, and workers exposed to agents such as asbestos and silica. Cohort tracking and data on emerging hazards, such as poly- and perfluorinated alkyl substances, are continuously sought after by the CRC to evaluate for cancer risk. Exposure and biological mechanism(s) of adverse effects from studies of high-priority agents are provided for quantitative risk models and recommendations. Recent CRC work with cancer has identified shift work as a carcinogen, linked firefighter exposure to site-specific cancers, and routinely provided carcinogen data to the International Agency for Research on Cancer (IARC). Enrollment in the National Firefighter Registry will begin in 2022 to improve understanding and reduce cancer risk among firefighters.

Occupational exposures and their effects on reproductive health are also of public health concern, as there is a need to understand how these exposures can impact gestational outcomes. As more women are entering less traditional workplace settings, understanding how heavy metals, fluorinated compounds, and nanoparticles can impact fertility and reproductive outcomes in workers is necessary. If the correct measures are not taken to prevent unwanted maternal, paternal and/or fetal exposures, AROs as a result of workplace exposure will add to the medical, educational, psychological, and lost wages burden of healthcare. While recent advances in pre-natal screenings and technology and in reproductive health research methodology are improving researchers’ ability to overcome obstacles and reduce AROs, they are associated with significant parental and fetal cost implications.

CVD burden is well characterized globally, but there is minimal information on how industry, occupation, and workplace factors contribute to CVD risk and mortality. Workplace exposures can affect heart health, but the links between these occupational factors and disease development are unclear. For example, exposure to secondhand smoke is associated with CVD and for adults who do not smoke; the workplace is the largest source of secondhand smoke exposure. Additionally, use of e-cigarettes among workers has increased in recent years with much still unknown in relation to the health impacts. Epidemiological research with worker populations and collected biological specimens is needed to understand occupational factors contributing to CVD. Improved monitoring and measures of stress were recently shown to identify and improve understanding of key factors in the work environment contributing to CVD risk. The Buffalo Cardio-Metabolic Occupational Police Stress study has linked job-related stress to metabolic syndrome among female officers. Improved exposure assessment methodology, health outcome and behavior surveillance, and laboratory effects studies improve detection of exposure and health disparities among workers and identify sub-clinical effects on the cardiovascular system.

Neurotoxicity leading to clinical syndromes represents one of the leading occupational disorders in the U.S, with a large proportion of hazardous agents possessing potent neurotoxic effects. Occupational exposures, such as pesticide and welding fume exposures, are increasingly associated with neurodegenerative diseases, peripheral neuropathies, and chronic encephalopathies. Also, chronic kidney disease with unknown cause (CKDu) occurs globally in agricultural and other high workload industries. Heat stress, silica-containing dust, and pesticide exposures are suspected factors. Both exposure and chronic effects studies are needed that span across personal risk factors, job tasks, and chemical classes. Evidence-based interventions and surveillance programs are beginning to elucidate the level of neurological and CKDu burden and etiologic mechanisms in U.S. workers. The CRC continues to seek out collaborative partnerships in basic etiology, prevention, and translation research to reduce morbidity in affected occupational sectors.

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