직업병 유소견자 및 요관찰자 추이 및 사후관리와의 관련성: 납 및 카드뮴 취급근로자를 중심으로

김남수 ( Nam-soo Kim ),김용배 ( Yong-bae Kim ) 한국산업보건학회 (구 한국산업위생학회) 2020 한국산업보건학회지 Vol.30 No.4

Objectives: This study identifies the trend of possible occupational disease and probable occupational disease in lead or cadmium workers. It is also required to check the usefulness of follow-up management in lead or cadmium workers by reviewing the relevance between the results of follow-up management and the trend of possible occupational disease and probable occupational disease. Methods: From 2009 to 2018, the results of the Ministry of Employment and Labor's special health-screening program for hazard agents for workers were used. The correlation between the ratio of possible occupational disease and probable occupational disease of lead or cadmium workers and the ratio of those who observed were and underwent observed follow-up management was analyzed to confirm the usefulness of follow-up management. Results: Over the past decade, the average annual proportion of possible occupational disease and probable occupational disease among lead workers has been on the decline. Among cadmium workers, it has generally shown a trend of increasing and decreasing. After the implementation of follow-up management, possible occupational disease in lead workers showed significant relevance to work prohibitions and restrictions, and probable occupational disease in lead workers showed significant relevance to the work prohibitions and restrictions, on-duty treatment, and boundary lines. However, there was no significant correlation between persons involved in cadmium workers. Conclusion: In this study, more active managements such as work ban and restrictions, on-duty treatment among follow-up management of possible occupational disease and probable occupational disease of lead worker and observers are related to a decrease in the ratio of those who have been diagnosed with possible occupational disease and probable occupational disease.

업무상질병 발생 근로자의 특성 : 1999년 업무상질병으로 요양승인된 사례분석

안연순,강성규,권현길,정호근 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.4

목적 : 이 연구는 1999년 근로복지공단에서 업무상질병으로 인정한 사례를 정밀분석하여 직업병의 종류와 특성을 밝힘으로써 직업병 예방사업이나 산업보건연구의 우선순위를 결정하는데 기초자료로 제공하기 위하여 실시하였다. 방법 : 근로복지공단 주전산망을 통하여 재해일자가 1999년 1월 1일부터 12월 31일까지인 근로자 중2000년 6월 30일까지 요양이 승인된 업무상 질병자2,333명을 파악하고 이 중 뇌심혈관계질환자 1,348명과 근골격계질환자 410명을 제외한 575명을 연구대상으로 하였다. 소속 사업장 또는 연구대상 근로자에 대하여 우편 또는 전화 면담조사를 실시하여 업무상 질병자의 성, 연령, 질병 관련 작업기간, 질병 인지경위, 업종, 직종, 질병종류, 사업장규모 등에 대한 조사를 실시 후 기술분석을 시행하였다. 결과 : 업무상 질병자 575명 중 남성이 511명(88.9%), 여성이 64명 (11.1%)이었다. 사망유무는 조사당시에 사망자가 56명(9.7%)이었고, 사망하지 않은 자가 519명 (90.3%)이었다. 연령별로는50~59세가 217명(37.7%)으로 가장 많았고, 질병관련 근무기간은 10년 이상 근무자의 비율이 49.0%로 가장 높았다. 질병인지경위는 소음성 난청, 진폐증, 이황화탄소 중독으로 인한 업무상 질병자를 제외하고 건강진단을 통하여 질병을 발견한 경우가 조 사자의 12.7%fl 불과하였다. 소속 사업장 규모는5인 미만 사업장이 26.1%로 1999년 당시 산재보험 임의가입 대상인 5인 미만 사업장에 소속된 근로자의 비율이 가장 높았다.질병별로는 호흡기질환이 211명(36.7%)으로 가장 많았고, 다음으로 소음성 난청(이명 1명 포함)149명 (25.9%), 감염성질환 69명(12.0%), 유기용제, 중금속, 가스 등에 의한 중독성질환 60명(10.4%) 순이었다. 기타 피부질환 29명, 암 17명,양성종양(성대결절) 8명, 간장질환 9명, 일사병 및열사병 6명, 신경정신질환 5명, 신경계질환 4명, 안질환 3명, 혈액 ·골수질환 2명, 신장질환 1명, 기타2명이었다. 유해인자별로 분류하였을 때, 분진 209건(36.3%), 물리적인자 157건(27.3%), 화학적인자 89건(16.3%), 생물학적인자 82건(14.3%),작업판련성인자 34건(5.9%), 분류불능 4건으로 분진에 의한 업무상질병의 비율이 가장 높았다.종사업종은 제조업이 262명(45.6%)으로 가장 많았고 다음으로 광업 174명(30.3%), 기타 각종 행정기관 일용직 종사업이 42명 (7.3%), 의료업이 28명 (4.9%)이었다. 직종별로는 기능원 및 관련기능종사자가 285명 (49.6%)으로 가장 많았고 다음으로 장치, 기계조작 및 조립종사자 139명 (24.2%), 단순노무종사자 72명 (12.5%), 전문가 28명 (4.9%), 사무종사자 IS명(2.6%), 기술공 및 준전문가14명(2.4%), 행정 및 경영관리자 8명(1.4%), 판매 및 서비스종사자 8명(1.4%), 미상 6명이었다. 결론 : 이 연구를 통하여 우리나라에서 업무상질병으로 인정받고 있는 사례들을 분석함으로써 기존 통계에서 알 수 없었던 내용을 전체적으로 파악할 수있었고, 인첫받는 사례의 상당부분이 산업의학적 관리의 주요 대상인 팡업이나 제조업 이외의 업종에서 발생하고, 근무조건이 열악한 일용직 근로자에서 발생한다는 사실을 파악하였다. 또, 소음성 난청과 진폐증을 제외하고 업무상질병 승인자의 약 90% 가산업안전보건법상의 건강진단을 통하여 질병을 발견하기보다는 개인적인 병원방문을 통하여 발견한다는 사실을 확인하였다 이것은 작업병을 발견하기 위한특수건강진단 목적중 하나가 제대로 기능을 할 수 없다는 사실을 입증한 것으로 특수건강진단제도이 대한대상자 확대, 검사 항목 확대 등 제도보완이 필요함을 시사하는 결과로 판단된다. 또, 병원근로자, 일용직 근로자 등 업무상질병 위험직종에 대한 업무상질병 예방대책도 조속히 수립되어야 할 것이다. Objectives : The purpose of this study is to analyze the characteristics of occupational diseases listed by Korea Labor Welfare Corporation (KLWC). Methods : Using the database of the KLWC, we collected 575 approved occupational disease cases occurring between 1 January and 31 December 1999 and approved by the thirtieth June in 2000. We investigated the characteristics (sex, age, occupational history, kinds of occupational disease, exposure material, type of enterprises, etc.) of occupational disease using a mail survey and telephone interviews. Results : Men accounted for 88.9 %(511 workers) of the approved cases. 56 cases(9.7 %) died of occupational disease. The most common age group was 50∼59 years of age(n=217, 37.7 %). The proportion of workers with grater than ten years disease related working condition exposure were 195 (49.0 %). The majority of diseases were respiratory problems(211 workers, 22.4%), occupational healing loss(149 workers, 25.9%), infectious disease(69 workers, 12.0%), intoxication(60 workers, 10.4%), skin disease(29 workers, 5.0%) and cancer(17 workers, 3.0%). The causal hazardous agents were dusts(209 cases, 36.3%), physical agents(157 cases, 27.3 %), chemical agents(89 cases, 16.3 %), biological agents(82 cases, 14.3 %) and work-related agents (34 cases, 5.9 %). The major types of enterprise were manufacturing(262 workers, 45.6 %), mining and quarrying(174 workers, 30.3 %), public administration(42 workers, 7.3 %) and the health care Industry(28 workers, 4.9 %). The kinds of job included craft and related trades workers(285 workers, 49.6 %), plant or machine operators and assemblers(139 workers, 24.2 %), elementary occupations(72 workers, 12.5 %) and professionals(28 workers, 4.9 %). Conclusions : We were able to elucidate the kinds of occupational disease and the characteristics of workers through this study. Many approved cases occurred among non-manufacturing and non-mining workers and the kinds of disease were varied. This suggests that management policy must be established to prevent occupational disease occurring among workers in the above type of industries.

1990년대 직업성 경견완 장애의 사회적 호명과 젠더

김향수(Kim, Hyang-Soo) 한국여성연구소 2016 페미니즘 연구 Vol.16 No.1

이 연구의 목적은 1990년대 직업성 경견완 장애와 관련한 각 주체들의 담론이 어떻게 생성되고 경쟁하고 있는지 비판적 담론분석 시각에서 분석해 보는 것이다. 연구 대상은 1980년대 후반부터 2000년까지 직업병으로 경견완 장애에 관해 다룬 기사와 문헌들을 분석 자료로 삼았다. 1990년대 직업병으로 경견완 장애는 ‘여성의 직업병’, ‘첨단병’, ‘선진국병’이라는 사회적 호명을 얻었다. ‘여성의 직업병’ 호명은 제조업과 사무직 여성 노동자의 직업병을 일컬으며 여성의 직업병을 문제화하는데 사용된 사회운동 담론이다. ‘첨단병’ 호명은 사무직 중 단말기 사용 (여성) 노동자의 직업병을 일컬으며 여성의 직업건강에서 ‘미래사회의 불안’을 드러내는데 사용된 미디어 담론이다. ‘선진국병’ 호명은 한국통신 여성 전화교환원의 직업병을 일컬으며 여성들을 ‘선진국 진입과 국가 발전의 기표이자 피해자’이며 ‘후진적’ 산업안전보건 시스템의 문제로 규정한 정치 담론이다. 세 번의 다른 호명으로 젠더 문제를 비롯한 사회적 맥락은 비가시화되었고 여성들은 피해자로 규정되었다. 본 논문은 여성의 직업건강을 다루는 과정에서 구부러진 빛을 살펴봄으로서, 노동조합과 사회운동, 국가 등 행위자들의 실천을 통해 직업병 문제를 구성할 수 있는 가능성과, 그 과정에서 젠더를 어떻게 고려할 것인가에 일정한 단초를 제공한다. Cervico-omo-brachial syndrome, emerged in the 1990s as occupational disease, acquired social appellation as ‘women’s occupational disease,’ ‘state-of-the-art disease,’ and ‘developed country disease.’ The first appellation, women’s occupational disease, referred to female occupational disease among manufacturing industry and office workers; its discourse, emerged as social movement discourse, was mobilized to problematize women’s occupational disease. The second, state-of-the-art disease, referred to female occupational disease among office workers, in particular those who worked with Visual Display Terminal; its discourse, emerged as media discourse, relied on women’s occupational health to reveal ‘the anxieties of the future society.’ The third, developed country disease, specifically referred to the telephone operators of Korea Telecom; its discourse, emerged as political discourse, claimed women as ‘signifiant and victims of the entry to the developed country and national development’ and the disease as a matter of ‘underdeveloped’ occupational safety and health system. These three differing appellations blinded the social context of the disease, its gendered nature in particular, and stigmatized female sufferers as major victims. This article looks at the diffracted dimension of how the society deals with women’s occupational health. In so doing, it seeks possibilities of constructing occupational disease through the practice of related actors, including labor union, social movements, and the state; it further sheds light on incorporating gender perspective to this process.

Historical review of the List of Occupational Diseases recommended by the International Labour organization (ILO)

Eun-A Kim,Seong-Kyu Kang 대한직업환경의학회 2013 대한직업환경의학회지 Vol.25 No.-

The list of occupational diseases established in the international and national legal system has played important roles in both prevention of and compensation for workers’ diseases. This report reviewed the historical development in the ILO list of occupational diseases and suggested implications of the trends. Since the first establishment of the ILO list of occupational diseases in 1925, the list has played a key role in harmonizing the development of policies on occupational diseases at the international level. The three occupational diseases (anthrax, lead poisoning, and mercury poisoning) in the first ILO list of occupational diseases, set up in 1925 as workmen’s compensation convention represented an increase of occupational diseases from the Industrial Revolution. Until the 1960s, 10 occupational diseases had been representative compensable occupational diseases listed in Convention No. 121, which implies that occupational diseases in this era were equated to industrial poisoning. Since 1980, with advancements in diagnostic techniques and medical science, noise-induced hearing loss, and several bronchopulmonary diseases have been incorporated into the ILO occupational list. Since 2002, changes in the structure of industries, emerging new chemicals, and advanced national worker’s compensation schemes have provoked the ILO to revise the occupational disease list. A new format of ILO list appended in Recommendation 194 (R194) was composed of two dimensions (causes and diseases) and subcategories. Among 50 member states that had provided their national lists of occupational diseases, until 2012 thirty countries were found to have the list occupational diseases having similar structure to ILO list in R194.

인천지역 직업성질환 감시체계 구축의 현실가능성 조사

임종한,홍윤철,박혜숙,하은희 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.2

The occurrence of occupational illnesses and injuries has been seriously underestimated in Korea. This underdiagnosis and underreporting of occupational illnesses and injuries subsequently contribute to difficulties in performing effective control of occupational hazards and implementing intervention programs to protect workers. An Inchon model for an occupational disease surveillance system was constructed using multiple data sources. Available data were obtained from medical providers' reports, hospital medical records, medical examination data of employees, and environmental measurement data. This Inchon model was constructed with the following procedure: 1. assembled multidisciplinary staff 2. geographic targeting was to Inchon 3. established community liaison 4. collected related data to establish the magnitude of problem 5. selected, recruited, and trained case reporters 6. developed mechanisms and guidelines for reporting 7. received, screened, and prioritized case reports 8. analyzed data from case reports and field investigations 9. made and disseminated recommendations 10. evaluated the feasibility of the system. An information system based on the Internet for the occupational disease surveillance was also constructed to support the case reporting of occupational diseases. 133 cases of occupational diseases were collected in Inchon from 1 January to 31 December 1998. These cases included cumulative traumatic disorder, occupational asthma, occupational contact dermatitis, allergic pneumonitis, occupational cancer, noise-induced hearing loss, and pneumoconiosis. These data were different from the previously reported data. The occurrence pattern of occupational diseases obtained from this surveillance system will be useful for preventing occupational hazards and for enforcing occupational disease prevention programs. Our experiences in establishing this surveillance system may be also used in other regional settings.

Characteristics of Occupational Skin Disease Reported by Surveillance System

Ahn, Yeon-Soon,Kim, Hyung-Ok,Lee, Jun-Young,Jung, Ho-Keun 가톨릭대학교 2000 Bulletin of The Catholic Research Institutes of Me Vol.28 No.-

This study was carried out to estimate the magnitude of skin disease related to occupation and to find out the characteristics of it. We collected and analyzed the cases of occupational skin disease reported by surveillance system composed of doctors and nurses in 150 enterprises with dispensary or attached hospital and physicians in 92 specific health examination institutes and 150 dematologists from May to November, 1998. Among members of surveillance system, 66 enterprises and 47 specific health examination institutes and 55 dermatologists reported 571 cases of occupational skin disease in 512 workers. Excepting 81 cases reported by dermatologists, We analyzed 490 cases reported by enterprises and specific health examination institutes. Among 490 cases, contact dermatitis was most common(368 cases, 75.1%) and the second was hyper or hypopigmentation(36 cases, 7.3%). When we analyzed the characteristics of workers with occupational contact dermatitis, male workers were 281(79.2%) and female were 74(20.8). 165 workers(64.5%) had chronic skin disease with repeated cure and relapse. 245 workers(72.5) answered positively that their coworkers had similar skin disease. 27 workers(8.7%) experienced absence due to contact dermatitis related to occupation. To analyze the type of industries of workers with occupational contact dermatitis, automobile and trailer manufacturing industry was most common(105 cases, 29.6%) and the second was manufacturing industry for image, sound and communication equipment(55 cases, 15.5%). Organic solvent(183 cases, 46.7%) was the most common treating material of workers with contact dermatitis and the second was various kinds of chemicals(59 cases, 15.1%). This is the first study using nationwide surveillance system to collect data of occupational skin disease. We found that many workers had skin disease related to occupation and characteristics of occupational skin disease were chronic and clustering. Therefore, we had to establish counterplan to manage occupational skin disease and to operate suveillance system to identify trends of occupational skin disease, continuously. (Korean Journal of Preventive Medicine 32(2):130-140, 1999)

감시체계를 통하여 보고된 직업성 피부질환의 특성에 관한 연구 - 사업장, 특수건강진단기관, 피부과의사의 보고사례를 중심으로 기술 -

김형옥,이준영,정호근,안연순,Kim, Hyoung-Ok,Lee, Jun-Young,Jung, Ho-Keun,Ahn, Yeon-Soon 대한예방의학회 1999 예방의학회지 Vol.32 No.2

Objectives: This study was carried out to estimate the magnitude of skin disease related to occupation and to find out the characteristics of it. Methods: We collected and analyzed the cases of occupational skin disease reported by surveillance system composed of doctors and nurses in 150 enterprises with dispensary or attacked hospital and physicians in 92 specific health examination institutes and 150 dermatologists from May to November, 1998. Results: Among members of surveillance system, 66 enterprises and 47 specific health examination institutes and 55 dermatologists reported 571 cases of occupational skin disease in 512 workers. Excepting 81 cases reported by dermatologists, We analyzed 490 cases reported by enterprises and specific health examination institutes. Among 490 cases, contact dermatitis was most common(368 cases, 75.1%) and the second was hyper or hypopigmentation(36 cases, 7.3%). When we analyzed the characteristics of workers with occupational contact dermatitis, male workers were 281 (79.2%) and female were 74(20.8%). 165 workers(64.5%) had chronic skin disease with repeated cure and relapse. 245 workers(72.5%) answered positively that their coworkers had similar skin disease. 27 workers(8.7%) experienced absence due to contact dermatitis related to occupation. To analyze the type of industries of workers with occupational contact dermatitis, automobile and trailer manufacturing industry was most common(105 cases, 29.6%) and the second was manufacturing industry for image, sound and communication equipment(55 cases, 15.5%). Organic solvent(183 cases, 46.7%) was the most common treating material of workers with contact dermatitis and the second was various kinds of chemicals(59cases, 15.1%). Conclusions: This is the first study using nationwide surveillance system to collect data of occupational skin disease. We found that many workers had skin disease related to occupation and characteristics of occupational skin disease were chronic and clustering. Therefore, we had to establish counterplan to manage occupational skin disease and to operate surveillance system to identify trends of occupational skin disease, continuously.

Occupational Skin Diseases in Korea

Yeon-Soon Ahn,Min-Gi Kim Korean Academy of Medical Science 2010 Journal of Korean medical science Vol.25 No.S

Skin disease is the most common occupational disease, but the reported number is small in Korea due to a difficulty of detection and diagnosis in time. We described various official statistics and data from occupational skin disease surveillance system, epidemiological surveys and cases published in scientific journals. Until 1981, 2,222 cases of occupational skin disease were reported by Korean employee's regular medical check-up, accounting for 4.9% of the total occupational diseases. There was no subsequent official statistics to figure out occupational skin diseases till 1998. From 1999, the Korea Occupational Safety and Health Agency (KOSHA) published the number of occupational skin diseases through the statistics of Cause Investigation for Industrial Accidents. A total of 301 cases were reported from 1999 to 2007. Recent one study showed the figures of compensated occupational skin diseases. Many of them belonged to daily-paid workers in the public service, especially forestry workers. Also, it described the interesting cases such as vitiligo and trichloroethylene-induced Stevens-Johnson Syndrome. Skin diseases are still important though the number of cases has decreased, and therefore it is recommended to grasp the status of occupational skin diseases through continuous surveillance system and to make policy protecting high-risk group.

업무상 질병으로 요양 승인된 의료기관 종사자 및 질병의 특성

임현술,안연순 大韓産業醫學會 2003 대한직업환경의학회지 Vol.15 No.2

목적: 의료기관 종사자는 다양한 위험 요인에 노출되어 있지만 지금까지 의료기관 종사자에 대한 건강장해에 대한 관심은 적었다. 본 연구는 의료기관 종사자가 업무상질병으로 요양 승인된 질병 사례를 검토하여 의료기관 종사자의 업무상질병의 종류와 특성을 파악하고자 하였다. 방법: 근로복지공단에서 1999년과 2000년 업무상질병자 또는 기타 재해자로 입력된 전산 자료를 한국산업안전공단 전산망에 연결하여 자료를 다운받아 업무상질병을 재분류한 후 2001년 6월 30일까지 요양 승인된 업무상질병자 5,460명을 파악하였다. 이들 중 의료기관 종사자인 근로자 142명을 대상으로 하여 성별, 연령, 진단명 및 직종을 파악하여 기술역학적 분석을 시행하였다. 결과: 업무상질병자 중에서 의료기관 종사자의 점유율은 1999년과 2000년 각각 2.6%이었다. 질병별 분포는 감염성 질환이 61명(43.0%), 뇌·심장혈관계 질환이 60명(42.3%), 근육골격계 질환이 18명(12.6%), 기타 3명(2.1%)이었다. 성별 분포는 남성 59명(41.5%), 여성 83명(58.5%)으로 여성이 많았다. 연령별 질병별 분포는 20대가 64명(45.1%)으로 가장 많았고, 30대 30명(21.1%), 40대 25명(17.6%), 50대 17명(12.0%), 60대 6명(4.2%)의 순으로 감소하였다. 직종별 질병별 분포는 간호사 및 간호조무사가 64명(45.1%)으로 가장 많았고, 의사 19명(13.4%), 사무직 18명(12.7%), 조리실 10명(7.0%), 영선부 5명(3.5%), 임상병리사 5명(3.5%), 환경미화원 4명(2.8%)의 순이었다. 질병별 분포는 1999년 감염성 질환은 결핵이 21명, 간염은 B형 간염 3명, C형 간염 2명, 수두 1명이었다. 뇌·심장혈관계 질환은 뇌출혈 14명, 뇌경색 7명, 심근경색증 7명이었다. 근육골격계 질환은 좌완관절전위 1명, 요추부 추간판탈출증 2명, 좌측견관절 상부관절 와순파열 및 감입증후군 1명이었다. 2000년 감염성 질환은 결핵이 23명, 간염 5명, 수두 3명, 홍역 3명이었다. 뇌·심장혈관계 질환은 뇌출혈 14명, 뇌경색 4명 심근경색증 12명 심실세동 1명, 중심망막동맥폐쇄 1명이었다. 근육골격계질환은 경추부 추간판탈출증 4명, 요추부 추간판탈출증 4명, 주관절 내상과염 1명, 견관절 극상근 건초염 1명, 수지 활액낭염 1명, 주관절 염좌 1명, 견괄절 충돌증후군 1명, 근막통증 증후군 1명이었다. 결론: 의료기관 종사자의 승인된 업무상질병은 감염성 질환, 뇌·심장혈관계 질환 및 근육골격계 질환이 대부분을 차지하고 있었다. 앞으로 의료기관 종사자의 유해 환경 노출 실태 및 업무상질병 여부를 파악하고 의료기관 종사자를 제도적으로 보호할 수 있는 산업보건 정책이 강구되어야 한다. Objectives: This study was carried out to analyze the characteristics of occupational diseases among health care workers in Korea. Methods: Using the database of the Korea Labor Welfare Corporation (KLWC), 5,460 approved occupational disease cases, between Jan 1, 1999 and Dec 31, 2000, and approved by the Jun 30, 2001, were collected. Of these, the 142 health care worker cases were investigated. Results: The proportion of health care workers among the total cases reported in 1999 and 2000 was 2.6%, respectively. The diseases were infectious in 61(43.0%), cerebro-cardiovascular in 60(42.3%)and musculoskeletal in 18 cases(12.6%). The distributions of the occupational diseases by sex were 59(41.5%)and 83 cases(58.5%), in males and females, respectively. The distributions of the occupational diseases by age were 64(45.1%), 30(21.1%), 25(17.6%) and 17 cases(12.0%), in their 20s, 30s, 40s and 50s, respectively. For the cases of infectious diseases by age there were 48(78.7%) in their 20s and 12(19.7%)in their 30s, for the cases of cerebro-cardiovascular diseases by age there were 17(28.3%)in their 40s, 16(26.7%)in their 50s and 12(20.0%)in their 20s, and for the cases of musculoskeletal diseases there were 7(38.9%)in their 30s and 4(22.2%)in their 20s. The distributions of the cases of occupational diseases by department were 64(45.1%), 19(13.4%), 18(12.7%), and 10(7.0%)in the nursing, doctors, officers, and food services departments, respectively. Conclusions: The major occupational diseases of health care workers, as approved by the KLWC, were the infectious, cerebro-cardiovascular and musculoskeletal diseases. A special management policy must be considered to prevent occupational diseases of health care workers in Korea.

직업성 만성폐쇄성폐질환의 업무관련성 심의 사례들과 산업의학적 평가에 대한 고찰

이화평,고동희,이의철 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.1

목적 많은 연구들을 통하여 만성폐쇄성폐질환의 직업성 원인에 대한 역학적 근거들이 제시되고 있지만 산재로 인정받는 경우는 아직 적은 편이다 본 연구에서는 산업안전보건연구원에서 근로복지공단의 의뢰를 받아 시행한 업무관련성 여부에 대한 심의 사례들을 조사하였으며 만성폐쇄성폐질환의 직업성 원인에 대한 근거들을 함께 고찰하여 직업성 만성폐쇄성폐질환에 대한 산업의학적 평가의 시행에 도움을 주고자 하였다 방법 1998년부터 2007년까지 10년간 산업안전보건연구원에서 이루어진 업무상 질병 여부에 대한 심의 기록들을 담고 있는 전산자료에서 만성폐쇄성폐질환을 진단명으로 하는 13건의 사례들을 수집하였다 이들 13건의 기록들로부터 질병명 병력 직업력 흡연력 해당 유해인자 사업장의 작업환경측정 기록 업무관련성 평가에 대한 심의 결과를 파악하였다 결과 총 13건의 사례들 중에서 업무관련성이 높다고 평가된 4건의 사례들은 다음과 같다 1) 도로상 미세 분진과 일반쓰레기 분진에 노출된 비흡연자인 환경미화원 2) 카드뮴 흄에 의해 폐손상을 입은 용접공 3) 방적공장의 면 분진에 의해 발생한 천식이 장기노출에 의해서 만성화되면서 비가역적으로 폐기능이 저하된 공조기 공기필터 관리작업자 4) 개인보호장구와 국소배기장치 없이 작업한 흡연력이 있는 주물공장 사상공 다음의 9건의 사례는 업무관련성이 낮은 것으로 평가되었다 1) 직업성 요인보다는 흡연에 의한 만성폐쇄성폐질환으로 판단된 경우 4례 2) 기존 질환(심한 결핵)의 악화에 의한 질병 발생의 가능성이 큰 경우 1례 3) 잘못 진단된 경우 1례 4) 작업 환경상 유해인자에 대한 노출의 정도가 너무 낮은 경우 2례 5) 유해인자에 노출되기 이전에 이미 발병한 경우 1례 흡연력이 있고 진폐가 없는 사상공의 경우 2006년에는 업무관련성이 낮은 것으로 평가되었으나 2007년에는 높은 것으로 평가되었다 결론 만성폐쇄성폐질환의 산업의학적 평가에 필요한 요소들은 다음과 같다 1) 폐기능 검사와 방사선학적 검사를 통한 만성폐쇄성폐질환의 정확한 진단과 다른 질환들의 배제 2) 해당 유해인자와 질병 발병 사이의 인과관계에 대한 충분한 근거 확보 3) 노출의 정도에 대한 평 가 4) 흡연으로 인한 발병가능성의 평가 산업의는 이러한 요소들을 충분히 고려하여 직업성 여부를 평가하여야한다 또한 환자가 흡연자라고 할지라도 직업성 유해인자에 의한 폐기능의 감소가 평균수명 혹은 건강수명의 실질적인 단축을 가져왔는가라는 문제를 충분히 고려하여 만성폐쇄성폐질환의 직업성 여부를 평가하여야 할 것이다 Objectives To analyse the characteristics of occupational COPD (Chronic obstructive pulmonary disease) cases that were evaluated by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety & Health Agency (KOSHA) Methods Using the OSHRI database from KOSHA we collected 13 cases of occupational COPD that had been evaluated from 1998 to 2007 Results Four cases had been evaluated as occupational COPD 1) a nonsmoking road sweeper exposed to automobile exhaust gases and trash dust 2) an oxygen welding worker exposed to cadmium fumes 3) a cotton mill air conditioner cleaning worker exposed to cotton dust and 4) a foundry grinding worker exposed to dust gases vapors and fumes Nine cases had been evaluated as non-occupational COPD 1) 4 cases in which smoking was determined to be the main cause rather than occupational expo sure, 2) 1 case that was evaluated as another respiratory disease (severe tuberculosis sequelae) 3) 1 case that had been misdiagnosed as COPD 4) 2 cases in which the exposure levels in the workplace environments were too low and 5) 1 case that had developed before the employment Among these 13 cases a shipyard grinding worker had been evaluated in 2006 as having had a low occupational hazard but a similar case (a foundry grinding worker) was evaluated as having had a high hazard in 2007 Conclusions Proper evaluation of occupational COPD demands an accurate diagnosis of COPD itself and also the exclusion of other respiratory diseases that have similar symptoms an investigation of the relevant occupatioonal hazards and the amount of the exposure and a consideration of smoking history The evaluation should also take into account any substantial loss of life due to occupational hazards as well as any disease-free periods