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Disparities in the occurrence and outcomes of chronic kidney disease (CKD) are associated with individual and community socioeconomic (SES) risk factors. The pathways by which SES contribute to increased CKD risk are under active investigation and access to adequate health care appears to be an important contributor to these disparities. Changes in the US health system have eliminated barriers to access for end-stage renal disease care for most US citizens and reduced disparities in outcomes of care after the onset of renal replacement therapy. The purpose of this review is to summarize the empiric evidence for the association between SES and disparities in CKD occurrence and outcomes of care and to describe existing and planned interventions to reduce these SES-associated variations in CKD care. In particular, we describe a 10-state pilot project initiated by the Centers for Medicare and Medicaid Services in August of 2008 to reduce disparities and improve the detection and treatment of early diabetic kidney disease. This pilot project represents an important step in developing interventions to reduce CKD disparities in the US health care system.

In 1990, heart disease and stroke emerged as the leading causes of death worldwide and remain the first and third leading causes of death in the United States, respectively.1,2 Cardiovascular disease (CVD) in the United States is responsible for &40% of all deaths, more than the next 5 leading causes of death combined. CVD death rates have declined significantly over the past several decades as a result of decreased incidence of myocardial infarction and increased survival.3,4 Coronary heart disease is also a leading cause of premature and permanent disability in the US labor force.2 In addition, the economic consequences are grave. In 2004, total CVD costs in the United States were estimated to be $368.4 billion2; these costs are expected to increase 40% to 50% by the year 2010.5 Blacks, the poor, and residents of particular regions in the United States are examples of groups that shoulder a disproportionate burden of CVD.6 US health objectives, as presented in Healthy People 2010, have placed a national emphasis on the prevention of CVD and its risk factors.7 The Secretary of Health and Human Services recently released the Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan) to further the “Healthy People 2010 goal of improving cardiovascular health through the prevention, detection, and treatment of risk factors; early identification and treatment of heart attacks and strokes; and prevention of recurrent cardiovascular events.”8 A recent American Heart Association publication focused on the optimal community approach to the prevention of CVD and its complications.9 This report, from the AHA Expert Panel on Population and Prevention Science, is entitled The American Heart Association Guide for Improving Cardiovascular Health at the Community Level: A Statement for Public Health Practitioners, Healthcare Providers, and Health Policy …

Background Development of hernias among active workers is a major occupational problem, however, the work-relatedness of hernias has not been well investigated. It is a difficult question for occupational and primary care physicians who must often address whether a worker with an inguinal hernia should be restricted from work requiring lifting of heavy objects. Methods To evaluate the possible work-relatedness of inguinal hernias, a cross-sectional study was performed. The goal of the study was to determine hernia incidence according to occupation with the Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics in 1994. Hernia incidence rates (per 10,000 workers) for industry and occupation categories were calculated with the estimates of the number of hernias in males and the employed male workers from the Current Population Survey. Rate ratios (RR) of hernia incidence rates were calculated. Results In 1994, an estimated 30, 791 work-related hernias in males were reported by US private establishments. The occupation groups with the highest RR were laborers and handlers (RR, 2.47; 95% confidence interval (CI), 2.14–2.80), machine operators (RR, 2.13; 95% CI, 1.81–2.44), and mechanics and repairers (RR, 1.72; 95% CI, 1.43–2.00). Conclusions Rate ratios for hernias vary considerably within industries and occupations, with the highest ratios found in industries and occupations involving manual labor. This provides support for the hypothesis that the hernias are work-related, especially in work involving strenuous, heavy manual labor. Am. J. Ind. Med. 36:638–644, 1999. Published 1999 Wiley-Liss, Inc.

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.

In this study the authors describe the investigation of a 1992 outbreak of green tobacco sickness, a form of nicotine poisoning from dermal exposure, among 47 tobacco workers in a five-county region of central and south-central Kentucky. Cases were identified through medical record searches at participating hospitals, as well as from reports submitted to the Occupational Health Nurses in Agricultural Communities program. A case-control study was undertaken to assess risk factors for green tobacco sickness. In a 20-min telephone interview, 40 cases and 83 controls responded to questions contained in a questionnaire. In 1992, 47 persons (3 were under age 16 y) in the study region sought medical treatment for green tobacco sickness. Twelve persons were hospitalized and 2 required intensive-care treatment. The crude incidence in 1992 was 10.0/1,000 tobacco workers. In 1993, 66 cases (7 were under age 16 y) of green tobacco sickness were identified in the study region (i.e., annual incidence of 14.0/1,000). A case-control study demonstrated that ill workers were younger, and were more likely to have worked in wet conditions, compared with workers who were not ill. Green tobacco sickness is a common problem among tobacco workers that may be prevented by avoiding work in wet tobacco or by use of protective clothing. Children younger than 16 y of age represented 9% of the green tobacco sickness cases in 1992 and 1993. Current occupational safety and health laws do not address protection of tobacco workers with respect to green tobacco sickness.

1. The Occupational Health Nurses in Agricultural Communities (OHNAC) program is a national surveillance program to identify and prevent agriculturally related illnesses and injuries. Locally based nurses work closely with health departments, hospitals, physicians, and other providers to identify and report sentinel health events. 2. Through OHNAC, sentinel health events are assessed and evaluated to identify occupational risk factors that may be applicable to the larger community of agricultural workers. This information is then disseminated nationally, locally, and to the individual workers. 3. The surveillance and investigation information is used to develop programs to prevent agricultural illnesses and injuries. The use of case based surveillance and subsequent data driven interventions has broad applicability for occupational health nurses in other industrial sectors. Language: en

A case of Q fever in a sheep producer was detected by a surveillance system in North Dakota in 1993, when Q fever was not reportable. This is the first officially documented case in the state. To estimate the prevalence of Coxiella burnetii infection and identify associated risk factors, we conducted a study covering the whole state. A total of 17 cases were identified among 496 sheep producers, their family members, and hired helpers. The number of sheep raised was a good predictor of C. burnetii infection. Lambing outdoors and frequent physical contacts with sheep during lambing were associated with a higher risk, but petting dogs was correlated with a lower risk. We conclude that C. burnetii infection is prevalent among sheep producers in North Dakota. As the result, Q fever became a reportable disease in North Dakota.

In 1990, heart disease and stroke emerged as the US health objectives, as presented in Healthy leading causes of death worldwide and remain the first and third leading causes of death in the United States, respectively [1,2]. Cardiovascular disease (CVD) in the United States is responsible for 40% of all deaths, more than the next five leading causes of death combined. CVD death rates have declined significantly over the past several decades as a result of decreased incidence of myocardial infarction and increased survival [3,4]. Coronary heart disease is also a leading cause of premature and permanent disability in the US labor force [2]. In addition, the economic consequences are grave. In 2004, total CVD costs in the United States were estimated to be $368.4 billion [2]; these costs are expected to increase 40–50% by the year 2010 [5]. Blacks, the poor, and residents of particular regions in the United States are examples of groups that shoulder a disproportionate burden of CVD [6].

OCCUPATIONAL disease surveillance is a critical step in the prevention of work-related injury and illness. 1 Case reporting by health care providers to public health authorities is one way of identifying sources of exposure toward which control measures can be directed. Most health care providers are familiar with the existence of reporting requirements for infectious diseases such as tuberculosis and the sexually transmitted diseases; however, less attention has been paid by the medical community to recognizing and reporting occupationally related conditions. 2,3 The Department of Labor estimated that in 1978 approximately 1.9 million people were severely or partially disabled from occupationally related diseases, at an annual cost of $11.4 billion in lost wages alone. 4 The Bureau of Labor Statistics reported an incidence of occupational injury and illness for 1984 of 8.0 cases and 63.4 lost workdays per 100 full-time workers. 5 This is most likely an underestimate, especially for