Vascular diseases in employed males: a perspective on preventive and remedial programs in industry

Simple morbidity and mortality surveillance procedures have been applied at a large steel mill for several years. Analyses arising from these data are presented demonstrating, as a case in point, that vascular diseases are among the leading causes of absenteeism and are the leading cause of death among male employees. Furthermore, the strong association of hypertension with vascular mortality is clearly displayed. Finally, attempts to initiate treatment for hypertensive employees through referral to their family physicians met with rather disappointing success as only 22 of 200 referrals resulted in patient-physician interactions. Several suggestions and conclusions can be drawn from this work. First, simple surveillance procedures can be easily implemented in occupational settings and meaningful results derived. Industrial sites offer unique opportunities for epidemiologic studies. Second, vascular diseases have a devastating effect on working age males and it would appear that hypertension, as a controllable "risk factor", is a logical target for intervention programs. Third, while our information is rather limited, it would seem that traditional referrals of patients "at risk" to their family physicians is not an effective way to arrange for their treatment. For much the same reasons that industrial sites may be useful in epidemiologic studies, they may also provide a base for intervention programs for certain disease conditions. Before such programs are undertaken, however, research into their feasibility and effectiveness is required and we are hopeful that our own studies, now underway, will provide some insight in this area.