Exploring the association between occupational noise exposures and injuries

摘要 职业伤害对美国工人和雇主来说是一个巨大的负担;每年， 工人死亡，数百万人受伤，每年的总费用接近2 000亿美元。许多因素可能 有助于职业伤害的风险，但几个-噪音暴露，听力损失（HL），和使用听力 保护装置（HPD）尚未得到充分研究。数以千万计的工人暴露在 噪音高到足以保证使用听力保护器，超过1000万工人患有HL。我们提出 结合联合收割机噪声暴露估计，我们以前在我们的在线工作暴露矩阵（JEM）开发 职业噪声在美国和加拿大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与噪音之间的关系， 听力损失和使用HPD对这种关系的潜在影响。我们提出两个具体目标： ·我们将评估与职业噪音相关的非致命和致命职业伤害的风险 20年（1998 - 2018年）的风险暴露。我们将评估与全班工作相关的受伤风险 时间加权平均（TWA）噪声暴露在研究期间，调整职称和行业。 我们亦会计算噪音引致受伤的归因风险，并评估 存在阈值暴露水平，高于该阈值暴露水平，伤害风险显著升高。这个目标有一个 子目标：探讨不同的噪声指标，包括平均值，最大值， TWA水平的标准差和> 85 dBA和> 90 dBA的工作班次百分比，使用 美国和加拿大的测量标准。我们将把这些分析的结果添加到我们的噪声JEM中。 ·我们将使用已发表的HPD使用和HL估计值来评估这些因素对风险的贡献 非致命和致命的职业伤害。HPD使用和HL患病率估计值将从 每个职位和行业的文献和可用数据。然后，我们将修改我们的目标1模型， 包括这些特征，并评估其对估计伤害风险单独和联合影响，以及 潜在的互动。与目标1一样，我们将把估计的风险添加到噪声JEM中。 这项R2P研究涉及国家职业研究议程的一些优先事项，包括 预防创伤性损伤的跨部门议程，以及 建筑业、制造业和服务业议程。该提案还涉及NIOSH战略目标 6、提高工作场所安全，减少创伤性伤害。研究的结果将是出版物和噪音- 相关伤害风险估计，我们将添加到我们现有的噪音正义运动网站，让从业人员访问 可采取行动的信息。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解决，最终结果是减少 职业伤害和噪音诱发的HL。

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.