National Surveillance for Occupational Hearing Loss SangWoo Tak, ScD, MPH Geoffrey M. Calvert, MD, MPH Division of Surveillance, Hazard Evaluation, and Field Studies NIOSHCDC/DHHS

Chronology  2005 – National Academy of Science (Institute of Medicine) recommends national surveillance for OHL and noise exposure  2006 – NIOSH Prioritized OHL surveillance goals  2008 – OHL surveillance project proposed  2009 – NORA project awarded funding

Project goal To conduct surveillance research to track occupational hearing loss To develop the first ever national surveillance system on OHL

Where are the data?  NHCA – audiometric service providers across the US  In December 2007, a recruiting letter sent to all audiometric service provider members  Six providers gave a positive response  Received letters of support from five of these audiometric service providers

Hearing loss prevention programs Workers Audiometric Service Providers Employers NIOSH OHL Surveillance Analysis Incidence & Prevalence Interpretation By industry Collection National Data Repository Dissemination Preventive intervention Audiograms, Noise survey data Stakeholders Industry Labor unions State health departments Practitioners Scientific community

Specific aim 1 Collect audiometric data from audiometric testing service providers to develop an audiometric data repository Collect audiometric data from audiometric testing service providers to develop an audiometric data repository

Tasks Recruit 15 audiometric service providers across the country Recruit 15 audiometric service providers across the country  1 st year: 3  2 nd year: 5  3 rd year: 7 Retrieve historical data for those who were tested at lease once from 01/2003 to 12/2008 Retrieve historical data for those who were tested at lease once from 01/2003 to 12/2008 Identify a audiometric data repository system Identify a audiometric data repository system

Data elements Demographic characteristics of the worker 1) Unique identifier (will be assigned by data provider) 2) Gender 3) Date of birth Workplace variables 1) Workplace state 2) Unique identifier 3) Industry code and literals (NAICS 2002) Audiometric testing variables Audiometric testing variables 1) Date of test 2) Threshold for each pure tone frequency (500, 1K, 2K, 3K, 4K, 6K, and 8K).

Specific aim 2  Estimate the rate of occupational hearing loss and changes in hearing per year by industry using NAICS codes*  North American Industry Classification System

Tasks Data management Data management  Cleaning  Quality control  Protocol for data management Descriptive data analyses by industry Descriptive data analyses by industry Report dissemination Report dissemination

Specific aim 3 Identify specific industries associated with a high risk of occupational hearing loss in the construction and manufacturing industry sectors Identify specific industries associated with a high risk of occupational hearing loss in the construction and manufacturing industry sectors

Definitions OHL -- average hearing threshold of 25 dB or greater at frequencies of 0.5k, 2k, 3k, and 4k Hz in either ear OHL -- average hearing threshold of 25 dB or greater at frequencies of 0.5k, 2k, 3k, and 4k Hz in either ear Standard threshold shift (STS) -- average increase from baseline of 10 dB or more (pure tone test in the frequencies of 2k, 3k, and 4k Hz in either ear) Standard threshold shift (STS) -- average increase from baseline of 10 dB or more (pure tone test in the frequencies of 2k, 3k, and 4k Hz in either ear) NIOSH defines STS as shift from baseline of 15 dB or more at any test frequency in either ear NIOSH defines STS as shift from baseline of 15 dB or more at any test frequency in either ear

Tasks Comprehensive statistical analysis Comprehensive statistical analysis Risk ratios estimated for hearing loss (OHL and STS) Risk ratios estimated for hearing loss (OHL and STS) Multilevel analysis Multilevel analysis  industry level adjusted for individual factors (age & sex) Disseminate reports & at least one peer reviewed paper Disseminate reports & at least one peer reviewed paper

Outcome – 1 st year ( ) Initial contacts with 3 providers Initial contacts with 3 providers Data use agreement (between providers and NIOSH) Data use agreement (between providers and NIOSH) Industry coding Industry coding Established a secure web site for data upload/download Established a secure web site for data upload/download Data retrieval in progress Data retrieval in progress

Outcome – 2 nd year ( ) Recruit 5 more audiometric service providers Recruit 5 more audiometric service providers Design NIOSH OHL data repository Design NIOSH OHL data repository Continue audiometric data management Continue audiometric data management Begin analyzing audiometric data Begin analyzing audiometric data Produce reports Produce reports

Expected outcomes upon project completion This project is anticipated to: Measure incidence/prevalance of OHL Measure incidence/prevalance of OHL Identify industrial sectors with the highest rates of OHL Identify industrial sectors with the highest rates of OHL Set research priorities Set research priorities Guide workplace interventions Guide workplace interventions

Discussion -- Issues Data confidentiality is assured Data confidentiality is assured Audiometric data quality assurance Audiometric data quality assurance -- work in progress More participation is needed More participation is needed

Acknowledgement Mark Stephenson Mark Stephenson Theresa Schulz Theresa Schulz John Sestito John Sestito Scott Henn Scott Henn Christa Themann Christa Themann Thais Morata Thais Morata Chandran Achutan Chandran Achutan Kenneth Rosenman Kenneth Rosenman Contact ) Phone)