To the Editor
Occupational skin diseases, including contact dermatitis, rank as the most commonly reported occupational injuries worldwide1. Skin injuries lead to decreased worker productivity, decreased worker self-esteem, and long-term complications including skin cancer2. Focusing on environmental sustainability and eco-friendliness, the new “green collar” workforce includes occupations that preserve or restore the environment3. The Green collar workforce encompasses a variety of industries and professions including organic farmers, renewable energy engineers, and recycling center attendants in addition to numerous other occupations4. We report the rates of dermatological conditions, work-related dermatological injuries, and skin treatment-seeking behaviors among the emerging green collar U.S. workforce.
Analysis was performed by linking data from the 2010 Occupational Health Supplement (OHS) of the National Health Interview Survey (NHIS) to the Occupational Information Network (O*NET). NHIS is a nationally representative, multistage household survey of the civilian, non-institutionalized U.S. population that includes unique OHS questions administered to adults who were employed within the past 12 months. O*NET is a national database with occupational classification based on respondent interviews. The linkage allowed us to classify the occupational class (green vs. non-green) of the NHIS respondents. Among the 1,110 occupational job families listed in O*NET, 169 occupations are classified as Green occupations.
The main study variables on occupational dermatological conditions were derived from three NHIS OHS questions: 1) “During the past 12-months, have you had dermatitis, eczema, or any other red, inflamed skin rash?”; 2) “Have you ever been told by a doctor or other health professional that your skin condition was probably work-related?”; 3) “Have you ever seen a doctor or other health professional for your skin condition?” Prevalence estimates of socio-demographic and dermatological variables were calculated using SUDAAN taking into account the NHIS complex sampling design.
Total study sample included 14,805 workers; 2,588 green collar (18.7%) and 12,217 (81.2%) non-green collar workers (Table 1). Green collar workers reported similar higher rates of dermatitis, eczema, or red inflamed skin conditions within the past year compared to non-green (9.7% vs. 9.5%). However, in terms of work-related dermatological conditions, non-green collar had higher rates than green collar workers (6.7% vs. 5.9%, respectively). Green and non-green workers had comparable rates of seeking medical treatment for their dermatological conditions (76.5% and 76.3%, respectively).
Table 1.
Socio-demographic characteristics and dermatological conditions of green and non-green collar workers: the 2010 National Health Interview Survey
| Total Worker Population | Green | Non-green | |||||||
|---|---|---|---|---|---|---|---|---|---|
| US Estimated Population | N | Percent [95% CI] | US Estimated Population | n | Percent [95% CI] | US Estimated Population | n | Percent [95% CI] | |
| Total | 131,296,970 | 14,805 | 100 | 24,614,939 | 2,588 | 18.7 (18.0–19.4) | 106,682,031 | 12,217 | 81.2 (80.5–81.9) |
| Gender | |||||||||
| Male | 69,814,890 | 7,306 | 53.1 (52.1–54.1) | 18,777,269 | 1,900 | 76.2 (74.5–78.0) | 51,037,621 | 5,406 | 47.8 (46.7–48.9) |
| Female | 61,482,080 | 7,499 | 46.8 (45.8–47.8) | 5,837,670 | 688 | 23.7 (21.9–25.4) | 55,644,410 | 6,811 | 52.1 (51–53.2) |
| Race | |||||||||
| White | 107,663,727 | 11,224 | 82 (81–82.9) | 20,600,991 | 2,018 | 83.6 (81.8–85.4) | 87,062,736 | 9,206 | 81.6 (80.7–82.5) |
| Black | 15,246,774 | 2,349 | 11.6 (10.8–12.3) | 2,621,791 | 365 | 10.6 (9.1–12.1) | 12,624,983 | 1,984 | 11.8 (11–12.5) |
| Other | 8,386,469 | 1,232 | 6.3 (5.8–6.9) | 1,392,157 | 205 | 5.6 (4.6–6.6) | 6,994,312 | 1,027 | 6.5 (5.9–7.1) |
| Age (Years) | |||||||||
| 18–24 | 16,733,678 | 1,559 | 12.7 (11.9–13.5) | 2,260,000 | 210 | 9.1 (7.7–10.6) | 14,473,678 | 1,349 | 13.5 (12.6–14.4) |
| 25–64 | 109,210,100 | 12,552 | 83.1 (82.3–84) | 21,453,941 | 2,279 | 87.1 (85.4–88.8) | 87,756,159 | 10,273 | 82.2 (81.3–83.2) |
| 65+ | 5,353,192 | 694 | 4.0 (3.7–4.4) | 900,998 | 99 | 3.6 (2.8–4.4) | 4,452,194 | 595 | 4.1 (3.7–4.5) |
| Ethnicity | |||||||||
| Non-Hispanic | 112,465,426 | 11,865 | 85.6 (84.8–86.4) | 21,076,884 | 2,110 | 85.6 (84.1–87.1) | 91,388,542 | 9,755 | 85.6 (84.8–86.4) |
| Hispanic | 18,831,544 | 2,940 | 14.3 (13.5–15.1) | 3,538,055 | 478 | 14.3 (12.8–15.8) | 15,293,489 | 2,462 | 14.3 (13.5–15.1) |
| Education | |||||||||
| HS+ | 85,961,694 | 9,479 | 65.6 (64.5–66.7) | 14,887,531 | 1,537 | 60.7 (58.2–63.2) | 71,074,163 | 7,942 | 66.7 (65.6–67.9) |
| HS | 32,367,120 | 3,574 | 24.7 (23.8–25.6) | 7,176,915 | 731 | 29.2 (27–31.5) | 25,190,205 | 2,843 | 23.6 (22.7–24.6) |
| <HS | 12,585,494 | 1,713 | 9.6 (9–10.2) | 2,440,156 | 310 | 9.9 (8.7–11.1) | 10,145,338 | 1,403 | 9.5 (8.8–10.2) |
| Health Insurance | |||||||||
| Not Insured | 22,946,866 | 2,899 | 17.5 (16.6–18.4) | 3,569,671 | 437 | 14.5 (12.9–16.2) | 19,377,195 | 2,462 | 18.2 (17.2–19.2) |
| Insured | 107,795,448 | 11,863 | 82.4 (81.5–83.3) | 20,934,477 | 2,142 | 85.4 (83.7–87) | 86,860,971 | 9,721 | 81.7 (80.7–82.7) |
| Worker Residence | |||||||||
| Northeast | 23,415,050 | 2,326 | 17.8 (16.7–18.9) | 4,458,522 | 407 | 18.1 (16.1–20.1) | 18,956,528 | 1,919 | 17.7 (16.6–18.9) |
| Midwest | 31,050,486 | 3,295 | 23.6 (22.4–24.8) | 5,971,088 | 608 | 24.2 (22.2–26.2) | 25,079,398 | 2,687 | 23.5 (22.2–24.7) |
| South | 46,202,248 | 5,456 | 35.1 (33.8–36.5) | 8,365,611 | 923 | 33.9 (31.8–36.1) | 37,836,637 | 4,533 | 35.4 (34–36.9) |
| West | 30,629,186 | 3,728 | 23.3 (22.1–24.5) | 5,819,718 | 650 | 23.6 (21.6–25.6) | 24,809,468 | 3,078 | 23.2 (21.9–24.5) |
| Dermatological Conditions | |||||||||
| DRMYR1 | |||||||||
| Yes | 23,305,971 | 2,641 | 10.1 (9.7–10.6) | 2,109,337 | 221 | 9.7 (7.8–12.0) | 10,302,780 | 1,132 | 9.5 (8.8 – 10.3) |
| DRMWKREL2 | |||||||||
| Yes | 848,934 | 98 | 7.0 (5.5–8.8) | 121,677 | 11 | 5.9† (3.2–10.9) | 551,417 | 67 | 6.7 (5.0 – 9.0) |
| DRMTRET3 | |||||||||
| Yes | 11,510,108 | 1,266 | 76.9 (74.3–79.3) | 1,549,711 | 162 | 76.3 (69.8–81.8) | 7,806,008 | 866 | 76.5 (73.1 – 79.6) |
Estimate does not meet National Center for Health Statistic’s standard of reliability or precision given the relative standard error was greater than 30%.
Variables DRMYR, DRMWKREL, DRMTRET from 2010 NHIS Occupational Health Questionnaire
DRMYR = During the past 12 months, have you had dermatitis, eczema, or any other, red, inflamed skin condition?
DRMWKREL = Have you been told by a doctor or other health professional that your skin condition was probably work-related?
DRMTRET = Have you ever seen a doctor or other health professional for your skin condition?
Green workers showed similar rates of dermatitis, eczema, or red inflamed skin conditions when compared to other occupational classes, while work-related dermatological injuries were higher for non-green workers. As the green industry expands, it is important to identify workforce sectors that are at greatest risk for occupational dermatological conditions. Green and non-green workers showed similar rates of medical treatment sought for dermatological conditions. Further research into socio-demographics subsets of both occupational classes and treatment seeking habits is necessary to identify groups that are potentially under-treated for dermatological injuries. This study is limited by the cross-sectional design, the NHIS self-reported data, and the broadness of the dermatological conditions assessed in the survey. This study is the first to report dermatological conditions in green collar workers. As the green industry becomes an increasingly ubiquitous component of the American workforce, identifying high-risk worker groups remains an important concern to public health dermatology.
Acknowledgments
Financial Support: Financial support for this study provided by the National Institute for Occupational Safety and Health (NIOSH) grant R03-OH010124.
Footnotes
Conflict of Interest Statement: All authors express there are no known conflicts of interest in this study or in the writing of the manuscript. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of NIOSH.
Author Contributions Statement: KJM and AJCM conceptualized the study design and analysis approach. CC, DJL, and WGM provided data management and analysis. LEF and DJL provided interpretation of data, drafting and revision of the manuscript. All authors reviewed and approved the final version of this letter.
References
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