Follow-back study of oldest workers with emergency department-treated injuries

The aging of the U.S. workforce highlights the need to address issues affecting older workers specifically. Telephone surveys were conducted with injured workers identified through a surveillance system based in a sample of emergency departments in the United States. The 176 interviewed cases correspond to a national estimate of 8.263 (s.e. = 1,258) injuries to workers aged 63 years and older during May 15-September 30, 1993. Five percent reported limitations in the types or amount of work they could perform prior to the injury. Ninety-four percent reported familiarity with the task resulting in injury. Fifty-one percent returned to work without missing any workdays, however, 69% required return visits to a health care provider. Thirty-four percent reported receiving training in injury prevention. Twenty percent of the injured workers were self-employed and 43% worked for small businesses. Data from this study provide insight into routinely collected statistics and have implications for future research and intervention efforts. Am. J. Ind. Med. 31:609–618, 1997. © 1997 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Working lifetime risk of occupational fatal injury

Estimates of risk accumulated over a working lifetime are used to assess the significance of many workplace health hazards. Utilizing data from the National Traumatic Occupational Fatalities (NTOF) surveillance system, estimates of the risk of work-related fatal injuries are provided for the 50 industries and the 50 occupations having the highest risks. Cause-specific risk estimates are provided for the six occupations at the greatest risk of occupational fatal injuries. Results suggest that the risks of certain work-related fatal injuries in some occupations (e.g., loggers being struck by falling objects) are of the same magnitude as risks previously identified for specific occupational illness exposures (e.g., lung cancer among uranium miners exposed to ionizing radiation). Assuming a 45-year working lifetime, cause-specific fatal injury risks reported in this paper range from a predetermined minimum of 1 death per 1,000 lifetime workers to 36.4 deaths per 1,000 lifetime workers. These results suggest that risk assessment for traumatic causes of death should be considered equally with risk assessments for health exposures, such as potential carcinogens. Am. J. Ind. Med. 31:459–467, 1997. © 1997 Wiley-Liss, Inc.

1 This article is a US Government work and as such, is in the public domain in the United States of America.

     

Proportionate mortality among unionized construction operating engineers

This report presents the results of proportionate mortality ratios (PMR) and proportionate cancer mortality ratios (PCMR) among 15,843 members of the International Union of Operating Engineers who had died between 1988–1993. Operating engineers represent one of the 15 unions in the Building and Construction Trades Department and are responsible for the operation and maintenance of heavy earthmoving equipment used in the construction of buildings, bridges, roads, and other facilities. Using U.S. proportionate cancer mortality as the referent, statistically significant elevated mortality was observed for cancers of the lung (PCMR = 1.14, 95% confidence interval (CI) = 1.09–1.19) and bone (PCMR = 2.14, CI = 1.19–3.52). Using U.S. proportionate mortality as the referent, statistically significant elevated mortality was observed for other benign and unspecified neoplasms (PMR = 1.54, CI = 1.09–2.13), emphysema (PMR = 1.37, CI = 1.20–1.55), other injuries (PMR = 1.43, CI = 1.20–1.70) (which included crushing under/in machinery, tractor rollover, run over by crane), and suicide (PMR = 1.22, CI = 1.06–1.40). The PMR for leukemia and aleukemia (PMR = 1.19, CI = 1.02–1.37), but not the PCMR (1.07, CI = 0.92–1.24), was also significantly elevated. Some of the occupational exposures that may have contributed to these excesses include diesel exhaust, asphalt and welding fumes, silica dust, ionizing radiation, and coal tar pitch. The present study underscores the need to control airborne exposures to these substances and for injury prevention efforts aimed at operating engineers in the construction industry. Am. J. Ind. Med. 32:51-65, 1997. © 1997 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Identifying high-risk small business industries for occupational safety and health interventions

BACKGROUND: Approximately one-third (32%) of U.S. workers are employed in small business industries (those with 80% of workers in establishments with fewer than 100 employees), and approximately 53 million persons in private industry work in small business establishments. This study was performed to identify small business industries at high risk for occupational injuries, illnesses, and fatalities. METHODS: Small business industries were identified from among all three- and four-digit Standard Industrial Classification (SIC) codes and ranked using Bureau of Labor Statistics (BLS) data by rates and numbers of occupational injuries, illnesses, and fatalities. Both incidence rates and number of injury, illness, and fatality cases were evaluated. RESULTS: The 253 small business industries identified accounted for 1,568 work-related fatalities (34% of all private industry). Transportation incidents and violent acts were the leading causes of these fatalities. Detailed injury and illness data were available for 105 small business industries, that accounted for 1,476,400 work-related injuries, and 55,850 occupational illnesses. Many of the small business industries had morbidity and mortality rates exceeding the average rates for all private industry. The highest risk small business industries, based on a combined morbidity and mortality index, included logging, cut stone and stone products, truck terminals, and roofing, siding, and sheet metal work. CONCLUSIONS: Identification of high-risk small business industries indicates priorities for those interested in developing targeted prevention programs.     

Women in the U.S. construction industry: An analysis of fatal occupational injury experience, 1980 to 1992

Analysis of 139 deaths to U.S. female construction workers identified from a death certificate-based surveillance system during 1980–1992 showed that female workers in transportation and material moving had 59 and 85% higher mortality rates than male construction workers in the same occupation from motor vehicles (the leading cause of occupational injury death for women, 43.2%) and machinery (the second leading cause of occupational injury death for women, 15.8%), respectively. Female handlers, equipment cleaners, helpers, and laborers had 73% higher mortality rates than their male counterparts from motor vehicles. Two-thirds of women in construction killed by motor vehicles were pedestrians, compared with an average of 19.2% of women in all industries. Half the female pedestrian decedents in construction were flaggers, compared with 3.4% of construction men killed by motor vehicles. Construction women had higher cause-specific years of potential life lost (to age 65 years) than construction men from motor vehicles (33 vs. 24.8), machinery (29 vs. 24.8), homicide (26.1 vs. 24.6), and falls (31.9 vs. 24.7). Over half (53.2%) the female fatalities occurred before age 35 years, compared with 46% for males. The average fatality rate of 1.80 per 100,000 workers for female construction workers was higher than the rate for women in any other industry. The average rate per 100,000 workers for all industries was 0.77. Further studies are required to explore factors contributing to differences in leading causes of death between female and male construction workers. Development and evaluation of prevention measures, such as effective traffic control in highway construction work zones, fall protection training, and machinery-operation training, could reduce the risks for fatal occupational injuries for construction workers, regardless of gender. Am. J. Ind. Med. 33:256–262, 1998. © 1998 Wiley-Liss, Inc.     

Respiratory health services reported by U.S. mining facilities in the National Occupational Health Survey of Mining (1984–1989)

This report describes the involvement of mine management personnel at U.S. mines in providing environmental and medical services related to respiratory health. The data were obtained by means of a questionnaire that was administered to mine management personnel at 491 mines and mills during May 1984 to August 1989. The data indicate that 62% of U.S. miners worked at facilities that provided at least a portion of workers with chest X-rays, and 41% worked at facilities that provided at least a portion of workers with pulmonary function tests. Eighty-five percent of miners worked at facilities in which the company required a medical examination of all new employees; the majority were required by company policy to have a medical examination before returning to work after an illness. However, only 2% of miners were required by company policy to have an exit medical examination when their employment ended. This report underscores the need for respiratory health to remain a primary concern of all persons who provide occupational health services to miners. © 1996 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Traumatic occupational fatalities in South Carolina, 1989-90.

Death certificates for South Carolina for 1989 and 1990 were examined to identify deaths resulting from injury incurred in the workplace. There were 277 deaths in that category in the 2-year period, an average yearly rate for traumatic occupational fatalities of 8.84 per 100,000 workers. The groups of industries with the highest fatality rates were transportation-communication-utilities, construction, and agriculture-fishing-forestry. The leading causes of death were injuries from motor vehicle crash, homicide, and falls. The traumatic occupational fatality rate for men was about 13 times greater than that for women; however, a much higher proportion of women died from homicide on the job. The findings in general reflect trends reported in other studies. The death rates for workers in South Carolina for 1989-90, however, were higher than national averages for 1980-88. National data for 1989-90 were not available for comparison. The data suggest that more effective injury prevention efforts need to be applied to such causes of on-the-job injury as motor vehicle crash, homicide, and falls. Those three categories accounted for more than 56 percent of all traumatic occupational fatalities in South Carolina in 1989 and 1990. Motor vehicle crash prevention efforts particularly are needed in the transportation-communication-utilities industries. The findings show that particular efforts need to be directed to the retail trade category for prevention of homicide and to the construction industry for prevention of falls.     

Job tasks,potential exposures,and health risks of laborers employed in the construction industry

Construction laborers have some of the highest death rates of any occupation in the United States. There has been very little systematic research focused exclusively on “laborers” as opposed to other workers in the construction industry. We reviewed the English language literature and various data bases describing the occupational tasks, exposures, and work-related health risks of construction laborers. The sources of information included 1) occupational mortality surveillance data collected by the states of California and Washington and the National Institute for Occupational Safety and Health (NIOSH); 2) National Occupational Exposure Survey; 3) national fatality data; 4) cancer registry data; and 5) case reports of specific causes of morbidity. While the literature reported that construction laborers have increased risk for mesothelioma, on-the-job trauma, acute lead poisoning, musculoskeletal injury, and dermatitis, the work relatedness of excess risks for all-cause mortality, cirrhosis, cerebrovascular disease, chronic obstructive pulmonary disease, ischemic heart disease, and leukemia is less clear. Furthermore, while laborers are known to be potentially exposed to asbestos, noise, and lead, and the NIOSH Job Exposure Matrix describes other potential hazardous exposures, little research has characterized other possible exposures and no research has been found that describes the exposures associated with specific job tasks. More advanced study designs are needed that include a better understanding of the job tasks and exposures to construction laborers, in order to evaluate specific exposure-disease relationships and to develop intervention programs aimed at reducing the rate of work-related diseases. © 1993 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Work-Related Injury Surveillance in Vietnam: A National Reporting System Model

Developing nations bear a substantial portion of the global burden of injury. Public health surveillance models in developing countries should recognize injury risks for all levels of society and all causes and should incorporate various groups of workers and industries, including subsistence agriculture. However, many developing nations do not have an injury registration system; current data collection methods result in gross national undercounts of injuries, failing to distinguish injuries that occur during work. In 2006, we established an active surveillance system in Vietnam’s Xuan Tien commune and investigated potential methods for surveillance of work-related injuries. On the basis of our findings, we recommend a national model for work-related injury surveillance in Vietnam that builds on the existing health surveillance system.Given the International Labor Organization’s estimate that work-related injuries kill 335 000 people each year (a worldwide rate of 14.0 deaths per 100 000 workers), with developing nations having the highest injury fatality rates,1–3 the lack of detailed health statistics on work-related injuries from developing countries is striking. In Vietnam injuries have grown to be a leading cause of mortality, and in 1996 the Vietnam Ministry of Health (MOH) established a national policy that recognized injuries as a public health problem and resolved to implement community programs centered on localized injury prevention.4 The MOH noted the difficulty in obtaining a comprehensive picture of injury determinants, including workplace injuries, from official statistics. Without accurate data to differentiate injury causes (e.g., traffic vs workplace), the burden of injuries on Vietnam’s economy and their influence on the long-term health and well-being of the country’s residents are largely hidden.We established an active injury surveillance system in the Xuan Tien commune of Vietnam in 2006 that allowed us to assess a number of potential improvements in surveillance of work injuries. We collaborated with and received the support of numerous levels of health care and government in Vietnam throughout the project (commune, district, province, ministry). The success of these relationships was dependent on the continuous efforts of the research staff at Vietnam’s National Institute for Occupational and Environmental Health. The results of the surveillance project showed that overall injury incidence rates were well in excess of those identified in any prior study in Vietnam, and a large majority of injuries (80%) were judged to be work related. More detailed information on the project is available elsewhere.5–9Here we apply our findings from the Xuan Tien study to make recommendations on how to improve the means by which existing national health reporting systems in Vietnam track work-related injuries. We use the active surveillance data we collected to examine the likely improvements in data quality that can be realized with incremental changes in the existing health surveillance system. Specifically, we propose adding some of the injury reporting elements we developed in Xuan Tien to the national system and enhancing standard hospital reports to allow more comprehensive collection of data on work-related injuries and their determinants. We describe possible improvements in the sensitivity of data collection on work-related injuries, including collection of information on industries, occupations, and populations at risk; types and causes of injuries; and measures of severity and burden.     

Factors related to the frequency of citation of epidemiologic publications

Background

Previous studies have demonstrated that the frequency with which a publication is cited varies greatly. Our objective was to determine whether author, country, journal, or topic were associated with the number of times an epidemiological publication is cited.

Methods

We used outcome-based sampling and investigated one public health issue – child injury prevention, and one clinical topic – coronary artery disease (CAD) prevention. Using the Institute for Scientific Information's (ISI) Web of Science^® databases, we limited searches to full articles involving humans published in English between 1998 and 2004. We calculated the citation rate and, after frequency-matching on year of publication, selected the 36 most frequently cited and 36 least frequently cited articles per year, for a total of 252 highly-cited and 252 infrequently-cited articles per topic area (child injury prevention and CAD prevention).

Results

Highly-cited articles in both CAD and child injury prevention were more likely to be published in medium or high impact journals or in journals with medium or high circulations. They were also more likely to be published by authors from U.S. institutions. Among articles examining CAD prevention, the highly-cited articles often involved risk factors, and the association between topics and frequency of citation persisted after adjusting for impact factor. Among articles addressing child injury prevention, topic was not statistically associated with citation.

Conclusion

Journal and country appear to be the factors most strongly associated with frequency of citation. In particular, highly-cited articles are predominantly published in high-impact, high-circulation journals. The factors, however, differ somewhat depending on the area of research the journals represent. Among CAD prevention articles, for example, topic is also an important predictor of citation whereas the same is not true for articles addressing injury prevention.

Condensed Abstract

Our objective was to determine whether author, country, journal, or topic were associated with the number of times an epidemiological publication is cited. We used outcome-based sampling and investigated one public health issue, child injury prevention, and one clinical topic, coronary artery disease (CAD) prevention. Using the Institute for Scientific Information (ISI) Web of Science^® databases, we limited searches to full articles involving humans published in English between 1998 and 2004. We calculated the citation rate and, after frequency-matching on year of publication, selected the 36 most frequently cited and 36 least frequently cited articles per year, for a total of 252 highly-cited and 252 infrequently-cited articles per topic area (child injury prevention and CAD prevention). Highly-cited articles in both CAD and child injury prevention were more likely to be published in medium or high impact journals or in journals with medium or high circulations. They were also more likely to be published by authors from U.S. institutions. Among articles examining CAD prevention, the highly-cited articles often involved risk factors, and the association between topics and frequency of citation persisted after adjusting for impact factor. Among articles addressing child injury prevention, topic was not statistically associated with citation.     

Suicides,homicides, accidents,and undetermined deaths in the U.S. military: comparisons to the U.S. population and by military separation status

Purpose

To compare rates of external causes of mortality among individuals who served in the military (before and after separation from the military) to the U.S. population.

Leading Causes of Unintentional Injury and Suicide Mortality in Canadian Adults Across the Urban-Rural Continuum

Objective

We examined the leading causes of unintentional injury and suicide mortality in adults across the urban-rural continuum.

Methods

Injury mortality data were drawn from a representative cohort of 2,735,152 Canadians aged ≥25 years at baseline, who were followed for mortality from 1991 to 2001. We estimated hazard ratios and 95% confidence intervals for urban-rural continuum and cause-specific unintentional injury (i.e., motor vehicle, falls, poisoning, drowning, suffocation, and fire/burn) and suicide (i.e., hanging, poisoning, firearm, and jumping) mortality, adjusting for socioeconomic and demographic characteristics.

Results

Rates of unintentional injury mortality were elevated in less urbanized areas for both males and females. We found an urban-rural gradient for motor vehicle, drowning, and fire/burn deaths, but not for fall, poisoning, or suffocation deaths. Urban-rural differences in suicide risk were observed for males but not females. Declining urbanization was associated with higher risks of firearm suicides and lower risks of jumping suicides, but there was no apparent trend in hanging and poisoning suicides.

Conclusion

Urban-rural gradients in adults were more pronounced for unintentional motor vehicle, drowning, and fire/burn deaths, as well as for firearm and jumping suicide deaths than for other causes of injury mortality. These results suggest that the degree of urbanization may be an important consideration in guiding prevention efforts for many causes of injury fatality.Injury is a leading cause of mortality in Canada, accounting for approximately 14,500 deaths each year.¹ Although the majority of injury deaths are unintentional (29.5 deaths per 100,000 inhabitants), intentional deaths due to suicide (11.6 deaths per 100,000 inhabitants) are also common. Research shows that adults in rural areas are disproportionately affected by injury mortality.^2–6 With populations of Western countries aging rapidly, particularly in rural areas,⁷ a better understanding of injury mortality in rural adults becomes increasingly important.Only a limited number of studies have examined the relative contribution of different unintentional and intentional causes to urban-rural differences in injury mortality, despite the potential of cause-specific data to uncover possible underlying mechanisms and pathways for prevention.^8,9 The few studies of unintentional injury that examined causes beyond motor vehicle collisions and falls were limited by dichotomous categorizations of urban and rural areas, which may decrease the ability to capture differences in injury mortality across the range of geographical areas typically present in Western countries. In fact, it has been proposed that a continuum-based approach of urban and rural areas better reflects social, economic, and geographic diversity and may enhance our understanding of health variation across areas.^2,10There is also very limited information on how method-specific suicide mortality varies across the urban-rural continuum. One study found elevated firearm suicide rates in less urbanized areas,¹¹ but data do not exist for more common causes of suicide, such as hanging or poisoning. In light of the identified research gaps, we sought to determine the relationship between the urban-rural continuum and leading causes of unintentional injury and suicide mortality in Canadian adults.     

Surveillance of traumatic occupational fatalities in Alaska--implications for prevention.

Data on occupational injury fatalities in Alaska for the period 1980-85 were complied from workers' compensation claims and death certificates. These data yielded 422 unique cases for the 6-year period, for an average annual fatality rate of 36.3 per 100,000 workers. This rate is 5 times higher than the Bureau of Labor Statistics estimate of 7.6 per 100,000 for the United States during the same period. The four industries with the highest fatality rates were the same for Alaska as for the nation (agriculture-forestry-fishing, construction, mining, and transportation-communication-public utilities). The leading causes of occupational fatalities in Alaska, however, were considerably different than for the United States as a whole. Nationally, motor vehicles and industrial equipment accidents are the leading causes of death. In Alaska, the leading causes of occupational injury mortality are aircraft crashes and drowning. These findings highlight the benefit of local surveillance in planning prevention strategies.     

SELF-REPORTED HEARING LOSS AMONG WORKERS EXPOSED TO INDUSTRIAL NOISE. ANALYSIS OF U.S. SURVEILLANCE DATA WITH REFERENCE TO THE AUSTRALIAN ENVIRONMENT

Aging and noise are the two main causes of hearing loss. To estimate the extent to which hearing loss is due to noise and is therefore preventable, an analysis was undertaken, using U.S. surveillance data, of the prevalence of hearing loss in workers in industries categorised according to the percentages of the workforce exposed to noise levels of 85 dBA or more. It was estimated that 13 per cent of the U.S. workforce was exposed to these noise levels, and that occupational noise exposure accounted for 20 per cent of self-reported hearing loss in the male workforce. Applying the industry-specific exposures to Australia, it is estimated that some 657,000 workers are exposed to noise levels of 85 dBA or more in this country. Australian Bureau of Statistics data indicate that constant noise accounts for 38 per cent of self-reported hearing loss in Australian adult males (although this figure would include hearing loss due to non-occupational noise). Data from both countries indicate that the prevalence of noise-induced hearing loss in females is negligible.     

Mental retardation in ten-year-old children in relation to their mothers' employment during pregnancy

We conducted a case-control study to examine relationships between potential risk factors in women's prenatal occupational histories and subsequent mental retardation in their 10-year-old children. Children with mental retardation (intelligence quotient less than 71) were identified from special education records maintained by the public school systems in the metropolitan Atlanta area and from records of various medical and social service agencies serving children with special needs. Control children were chosen from the rosters of 10-year-olds who were enrolled in regular education classes in the local public school systems. To obtain occupational histories, sociodemographic data, and other information, we interviewed 352 natural mothers (67%) of 525 case children and 408 natural mothers (64%) of 636 control children. We computed odds ratios for each of 25 selected occupation, industry, and agent categories controlling for maternal education, birth order, and race. Most comparisons yielded odds ratios that were not indicative of unusual risks, but we did find lower than expected risks among children of teachers and health-care professionals. We also found a strong, positive association between mental retardation and maternal employment in the textile and apparel industries. The findings are useful for planning the direction of future studies of childhood cognitive ability to focus on specific parental occupations or industries. © 1993 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Development and Validation of an Instrument to Assess Imminent Risk of Homelessness Among Veterans

Objectives

Veterans are overrepresented within the homeless population compared with their non-veteran counterparts, particularly when controlling for poverty. The U.S. Department of Veterans Affairs (VA) aims to prevent new episodes of homelessness by targeting households at greatest risk; however, there are no instruments that systematically assess veterans'' risk of homelessness. We developed and tested a brief screening instrument to identify imminent risk of homelessness among veterans accessing VA health care.

Methods

The study team developed initial assessment items, conducted cognitive interviews with veterans experiencing homelessness, refined pilot items based on veterans'' and experts'' feedback and results of psychometric analyses, and assigned weights to items in the final instrument to indicate a measure of homelessness risk.

Results

One-third of veterans who responded to the field instrument reported imminent risk of homelessness (i.e., housing instability in the previous 90 days or expected in the next 90 days). The reliability coefficient for the instrument was 0.85, indicating good internal consistency. Veterans who had a recent change in income, had unpaid housing expenses, were living temporarily with family and friends, needed help to get or keep housing, and had poor rental and credit histories were more likely to report a risk of homelessness than those who did not.

Conclusion

This study provides the field with an instrument to identify individuals and households at risk of or experiencing homelessness, which is necessary to prevent and end homelessness. In addition, it supports VA''s investment in homelessness prevention and rapid rehousing services for veterans who are experiencing or are at risk for homelessness.On one day in January 2013, 57,849 veterans in the United States were homeless (i.e., in shelters, transitional housing, and places not meant for human habitation).¹ Veterans comprise 12% of homeless U.S. adults, are overrepresented within the homeless population, and are at a particularly high risk of homelessness compared with individuals living in poverty.² The U.S. Department of Veterans Affairs (VA) is focusing efforts on ending chronic homelessness and preventing new episodes of homelessness. VA has allocated more than $1 billion toward homelessness prevention services through the Supportive Services for Veteran Families (SSVF) program during federal fiscal years 2011–2014.SSVF provides homelessness prevention and rapid rehousing services for veterans who are at imminent risk of or have recently experienced homelessness. To ensure the efficient use of limited resources, efforts must target veteran households most likely to become homeless. To target resources accurately, service providers must have an understanding of (1) how to identify at-risk individuals and households, (2) where these households come from, and (3) what causes their homelessness.³ There is little evidence regarding the most efficient way to target households for a homelessness prevention intervention; such decisions are often associated with a high false-positive rate, making homelessness prevention relatively inefficient.⁴ While communities across the U.S. use a number of measures to determine if a household is at imminent risk—including barriers to housing, eviction notice, and household''s level of self-sufficiency—few of these assessments have been tested for their effectiveness, and research has suggested that providing services based, at least in part, on empirical evidence can increase the efficiency of homelessness prevention.⁵We describe the process by which VA developed and evaluated the reliability and validity of a brief screening and risk assessment instrument to (1) identify veterans accessing VA health-care services who are at imminent risk of homelessness and (2) quantify their level of risk to determine the appropriate level of care within VA Homeless Programs.     

Deconstructing a disparity: explaining excess preterm birth among U.S.-born black women

Purpose

To determine components of excess preterm birth (PTB) rates for U.S.-born black women relative to both foreign-born black women and U.S.-born white women attributable to differences in observed sociodemographic, behavioral, and medical risk factors.

An approach to the characterization of silica exposure in U.S. industry

Quantitative evaluation of worker exposure to silica in nine Standard Industrial Classification (SIC) codes was conducted, using data derived from OSHA compliance inspections, in order to assess the silica exposure problem in the U.S. The nine SICs studied were those in which OSHA inspections were concentrated. They include: construction; chemical manufacture; stone, glass, and clay manufacturing; primary metal industries; metal fabrication; machinery; transportation; and miscellaneous manufacturing industries. High exposures to silica were documented in each industry, with the number of test samples over the permissible exposure limit ranging from 14% (aluminum foundries) to 73% (pottery). An estimation is made that 24,889 workers employed in ferrous and nonferrous foundries are at risk of silica-related pulmonary effects. The data developed in this analysis also indicate the need to investigate certain industries that had high exposures but few inspections. The limitations of the data base for estimating the scope of the silica problem, including lack of data on mining and milling, are discussed. We conclude that exposure to silica represents a continuing and significant problem in a number of U.S. industries.     

Availability and quality of cause-of-death data for estimating the global burden of injuries

Objective

To assess the availability and quality of global death registration data used for estimating injury mortality.

Methods

The completeness and coverage of recent national death registration data from the World Health Organization mortality database were assessed. The quality of data on a specific cause of injury death was judged high if fewer than 20% of deaths were attributed to any of several partially specified causes of injury, such as “unspecified unintentional injury”.

Findings

Recent death registration data were available for 83 countries, comprising 28% of the global population. They included most high-income countries, most countries in Latin America and several in central Asia and the Caribbean. Categories commonly used for partially specified external causes of injury resulting in death included “undetermined intent,” “unspecified mechanism of unintentional injury,” “unspecified road injury” and “unspecified mechanism of homicide”. Only 20 countries had high-quality data. Nevertheless, because the partially specified categories do contain some information about injury mechanisms, reliable estimates of deaths due to specific external causes of injury, such as road injury, suicide and homicide, could be derived for many more countries.

Conclusion

Only 20 countries had high-quality death registration data that could be used for estimating injury mortality because injury deaths were frequently classified using imprecise partially specified categories. Analytical methods that can derive national estimates of injury mortality from alternative data sources are needed for countries without reliable death registration systems.     

The impact of initial job assignment on formaldehyde exposure among African-American and white formaldehyde industry workers

We compared initial job assignments of African-American and white employees at eight worksites that used formaldehyde between 1940 and 1979. Unexposed workers were excluded. Median, ambient air formaldehyde, 8-hour, time-weighted average (TWA₈) exposure estimates were determined for each worksite. Job assignments with TWAs above the worksite's median TWA₈ were called high formaldehyde exposed (HFE). Job assignments with TWAs less than or equal to the worksite's median TWA₈ for the same period were called lower formaldehyde exposed (LFE). Two worksites assigned black workers to HFE jobs in significantly higher proportions than white workers in some decades. One worksite assigned white workers in significantly higher proportions than black workers to HFE jobs in some decades. One worksite assigned racial groups in nearly equal proportions from 1940 to 1969. The remaining sites showed insignificant assignment disproportions (α = 0.05; Chi-square ≤ 3.841, 1 degree of freedom) for any period. No major trend was apparent across all plants and decades. Am. J. Ind. Med. 34:57–64, 1998. Published 1998 Wiley-Liss, Inc.

1 This article was prepared by a group of United States government employees and non-United States government employees, and as such is subject to U.S.C. Sec. 105.