Exploring the association between occupational noise exposures and injuries

摘要 职业伤害给美国工人和雇主带来了巨大的负担；每年，成千上万的 工人被杀，数百万人受伤，每年的总损失接近2000亿美元。许多因素可能 会导致职业伤害风险，但有几个因素--噪音暴露、听力损失(HL)和听力使用 保护装置(HPD)--尚未得到充分探索。数千万工人暴露在 噪音高到需要使用听力保护器，1000多万工人患有HL。我们建议 为了结合我们之前在在线工作暴露矩阵(JEM)中开发的噪声暴露估计值 对于美国和加拿大的职业噪声，以及来自这两个国家的国家职业伤害监测数据 国家。这项为期两年的研究将评估职业伤害和噪音之间的关系，并评估 听力损失和使用HPD对这种关系的潜在贡献。我们提出两个具体目标： ·我们将评估与职业噪音有关的非致命性和致命性职业伤害风险 在20年内(1998-2018年)暴露。我们将评估与全班工作相关的受伤风险 研究期间的时间加权平均(TWA)噪声暴露，根据职称和行业进行调整。 我们还将计算因接触噪音而受伤的归因风险，并评估 存在阈值暴露水平，超过该水平，伤害风险大大增加。这个目标有一个目标 子目标：探索不同的噪声测量方法来评估损伤风险，包括平均值、最大值和 TWA水平和轮班百分比的标准偏差&>85 dBA和&>90 dBA，使用这两种方法测量 美国和加拿大的衡量标准。我们将把这些分析的结果添加到我们的噪声JEM中。 ·我们将使用已公布的HPD使用率和HL估计值来评估这些因素对风险的贡献 非致命性和致命性职业伤害。HPD使用情况和HL患病率估计将从 每个职称和行业的文献和可用数据。然后，我们将修改我们的Aim 1模型以 包括这些特征，并评估其对估计伤害风险的单独和联合影响 潜在的相互作用。与目标1一样，我们将在噪声JEM中添加估计的风险。 这项R2P研究涉及国家职业研究议程的一些优先事项，包括 跨部门预防创伤性伤害议程，以及预防听力损失的目标 建筑业、制造业和服务业的议程。该提案还涉及NIOSH的战略目标 6、提高工作场所安全水平，减少创伤伤害。这项研究的成果将是出版物和噪音- 相关伤害风险评估，我们将添加到我们现有的噪音JEM网站，以允许从业者访问 可采取行动的信息。这项研究的中间结果将是噪声暴露、HL和 HPD的使用在伤害和听力损失预防计划中得到了解决，最终结果是减少 在职业性损伤和噪声所致的HL中。

ABSTRACT Occupational injuries represent a tremendous burden to US workers and employers; each year, thousands of workers are killed, and millions injured, with total costs approaching $200 billion annually. Many factors may contribute to occupational injury risk, but several – noise exposure, hearing loss (HL), and use of hearing protection devices (HPDs) – have not been adequately explored. Tens of millions of workers are exposed to noise high enough to warrant use of hearing protectors, and more than 10 million workers have HL. We propose to combine noise exposure estimates we have previously developed in our online Job Exposure Matrix (JEM) for occupational noise in the US and Canada with national occupational injury surveillance data from both countries. This 2-year study will evaluate the relationship between occupational injuries and noise, and to assess the potential contributions of hearing loss and use of HPDs on this relationship. We propose two specific aims: • We will assess the risk of nonfatal and fatal occupational injuries associated with occupational noise exposure over a 20-year period (1998-2018). We will estimate risks of injuries associated with full-shift Time-Weighted Average (TWA) noise exposures over the study period, adjusting for job title and industry. We will also calculate the attributable risk of injury due to noise exposure and evaluate whether a threshold exposure level exists above which injury risk is substantially elevated. This aim has one subaim: to explore different noise metrics for evaluation of injury risk, including mean, maximum, and standard deviation of TWA level and percent of workshifts >85 dBA and >90 dBA, measured using both US and Canadian measurement criteria. We will add the results of these analyses to our noise JEM. • We will use published estimates of HPD use and HL to evaluate the contributions of these factors to risk of nonfatal and fatal occupational injuries. HPD use and HL prevalence estimates will be gathered from literature and available data for each job title and industry. We will then modify our Aim 1 models to include these characteristics and assess their individual and joint impacts on estimated injury risk, as well potential interactions. As with Aim 1, we will add the estimated risks to our noise JEM. This R2P study addresses a number of priorities of the National Occupational Research Agenda, including the Cross-Sector agenda for Traumatic Injury Prevention, as well as hearing loss prevention goals of the Construction, Manufacturing, and Services sector agendas. This proposal also addresses NIOSH strategic goal 6, improve workplace safety to reduce traumatic injuries. The outputs of the study will be publications and noise- related injury risk estimates that we will add to our existing noise JEM website to allow practitioners access to actionable information. The intermediate outcomes of the study will be changes in how noise exposure, HL, and HPD use are addressed in injury and hearing loss prevention programs, and the end outcomes are reductions in occupational injuries and noise-induced HL.