Occupational injury mortality: New Mexico 1998-2002

BACKGROUND: The current study characterizes patterns of occupational injury fatalities in New Mexico for the 5-year period 1998-2002. METHODS: The study applied methods developed by the Council of State and Territorial Epidemiologists/National Institute for Occupational Safety and Health (CSTE/NIOSH) Occupational Health Indicator Work Group and compared the relative strength and weakness of two different datasets (CFOI and NMVRHS) for occupational injury fatality surveillance. RESULTS: Annual occupational injury mortality rates ranged from 4.4 to 7.6 per 100,000 employed persons aged 16 and over compared to annual US rates of 4.0-4.6 per 100,000. Risk factors for higher mortality rates included age over 65 years, self-employment, non-US citizenship, being African-American or Hispanic, and occurrence in rural counties. The top industry for fatality rate was mining followed by transportation, public utilities, agriculture, and construction. CONCLUSIONS: Applying CSTE/NIOSH Occupational Health Indicator protocol and using both CFOI and NMVRHS data improved the characterization of occupational injury mortality and the setting of priorities for prevention intervention.     

Comparison of death certificate occupation and industry data with lifetime occupational histories obtained by interview: variations in the accuracy of death certificate entries

This study compares usual and recent occupation and industry data from lifetime work histories obtained by interview with death certificate entries for occupation and industry for 2,435 persons diagnosed with cancer. Match rates are calculated as the percent of death certificate occupation and industry entries that were confirmed by interview data and are compared for exact 3-digit 1980 U.S. Census Bureau occupation and industry codes and for groups of these codes. The overall match rate for individual usual occupation codes was 47.9% and for exact usual industry codes it was 61.8%. Significant differences between the interview data for usual occupation or industry and the death certificate entry were observed by race and gender, marital status, number of years worked, and occupation and industry groups and by age for industry. Misclassification or overreporting of occupation and industry data on the death certificate ranged from 30 to 50% in this study. Our results suggest that the utility of death certificate data for investigations into the occupational risk factors for cancer may be quite limited.     

A comparison of analyses of occupational bladder cancer: Death certificate vs. population-based case-control interview data

The authors examined the utility of death certificate data for occupational health surveillance by comparing the ability of the data to identify high-risk occupations for bladder cancer with that of a population-based case-control study. Death certificate data for white males from 23 states for 1979–1987 were analyzed using proportionate mortality ratios. The case-control study used cancer registry cases for 1977–1978. Results were compared for 21 a priori suspect occupations. A broad definition of agreement resulted in agreement for 62% of the occupations; the death certificate study identified eight of 15 occupations identified by the case-control study and neither study identified five of the categories. While death certificate data have many limitations, our results indicate that death certificate data can provide clues to some potential occupational health problems. With the advantages of inexpensive data, large sample size, and industrial coverage, more refined analyses of the data should prove useful for occupational mortality surveillance and hypothesis generation. © 1994 Wiley-Liss, Inc.     

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.

     

Alaska's model program for surveillance and prevention of occupational injury deaths

The National Institute for Occupational Safety and Health (NIOSH) established its Alaska Field Station in Anchorage in 1991 after identifying Alaska as the highest-risk state for traumatic worker fatalities. Since then, the Field Station, working in collaboration with other agencies, organizations, and individuals, has established a program for occupational injury surveillance in Alaska and formed interagency working groups to address the risk factors leading to occupational death and injury in the state. Collaborative efforts have contributed to reducing crash rates and mortality in Alaska's rapidly expanding helicopter logging industry and have played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry (historically Alaska's and America's most dangerous industry). Alaska experienced a 46% overall decline in work-related acute traumatic injury deaths from 1991 to 1998, a 64% decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. Extending this regional approach to other parts of the country and applying these strategies to the entire spectrum of occupational injury and disease hazards could have a broad effect on reducing occupational injuries.     

Victoria M. Trasko: champion of state-based surveillance of occupational diseases in the United States, 1937 to 1971.

Victoria M. Trasko (1907-1979), a relatively unknown figure to many currently practicing occupational health specialists, was a pioneer in state-based surveillance of occupational diseases in the United States. To highlight her accomplishments during her career with the United States Public Health Service from 1937 to 1971, this report briefly reviews her publications on occupational disease surveillance. Her span of work includes guidelines for state industrial hygiene programs, numbers of workers in state occupational health programs, compilation of state and local laws related to industrial hygiene, proposals for standardized reporting of occupational disease, and analysis of trends in workers' compensation and mortality statistics for occupational diseases. She pilot tested the first state-based model system for occupational disease reporting in the United States. She documented the great difficulty experienced by states in getting physicians to report cases of occupational diseases, and pointed out that surveillance of other existing data sources was worthwhile, at least for some occupational diseases. She was the first to report on the distribution of silicosis cases in the United States by state, industry, and job title. She was the first to comment on mortality trends for the pneumoconioses and to document problems in comparability between different International Classification of Disease (ICD) periods.     

Occupational disease in New York State: a comprehensive examination

In order to obtain information on the current magnitude of occupational disease in New York State, four data sources were reviewed: Workers' Compensation records, disease registries maintained by the state department of health, data from the Bureau of Labor Statistics (BLS), and data from the California's physician reporting system. A proportionate attributable risk approach is used to develop estimates of mortality due to occupational diseases. The distribution of occupational hazards was assessed using data from the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the New York State Department of Environmental Conservation (NYDEC). Finally, econometric estimates of the direct and indirect costs of occupational illness were developed. The best available data indicate that 5,000 to 7,000 deaths are caused each year in New York State by work-related illnesses, and at least 35,000 new cases of occupational illness develop each year in the State. It is also estimated that between 150,000 and 750,000 workers in New York State are employed in the 50 most hazardous industries. OSHA standards regulating exposure to selected chemicals were found to have been violated frequently. The annual costs of occupational disease in New York State are approximately $600,000,000; only a small fraction is covered by workers' compensation insurance. Of the 52,000 physicians in New York State, only 73 are board-certified in occupational medicine. Most of these are involved in administrative, teaching, and research aspects of occupational medicine. Of the 300 industrial hygenists in New York State, two-thirds are employed by major corporations. Recommendations are described to improve the recognition of occupational disease in New York State and to reduce the burden of this disease. A statewide network of occupational health clinical services is proposed and has been funded by the New York State Legislature. Other recommendations are also given.     

Occupational injury mortality surveillance in the United States: an examination of census counts from two different surveillance systems, 1992-1997

BACKGROUND: The surveillance of occupational injury mortality in the United States has evolved over the last century. Currently there are two different data sources used for the study of occupational injury mortality. Each system varies in methodology, leading to different census counts. We provide an overview and analysis of similarities and differences in these two systems. METHODS: The National Traumatic Occupational Fatalities (NTOF) surveillance system and the Census of Fatal Occupational Injuries (CFOI) were examined for civilian deaths at work in the United States from 1992 to 1997. RESULTS: There were 31,643 occupational injury mortality cases according to NTOF and 37,023 from CFOI for civilian workers 16-years and older in the United States for the 6-year period of analysis. The annual average occupational injury mortality rates were 4.5 per 100,000 full time equivalent workers from NTOF and 5.2 from CFOI. The higher capture rate by CFOI was consistent across each of the 6 years. Similar patterns for demographics, industry, and occupation, and type of incident were seen for both systems. CONCLUSIONS: While NTOF provides more years of data dating back to 1980, CFOI (established in 1992) provides a more comprehensive capture of occupational injury mortality and provides greater detail of the mortality incidents. The overall injury mortality patterns, however, appear to be similar between the systems.     

Current knowledge of US metal and nonmetal miner health: Current and potential data sources for analysis of miner health status

Little is known about the current health status of US metal and nonmetal (MNM) miners, in part because no health surveillance systems exist for this population. The National Institute for Occupational Safety and Health (NIOSH) is developing a program to characterize burden of disease among MNM miners. This report discusses current knowledge and potential data sources of MNM miner health. Recent national surveys were analyzed, and literature specific to MNM miner health status was reviewed. No robust estimates of disease prevalence were identified, and national surveys did not provide information specific to MNM miners. Because substantial gaps exist in the understanding of MNM miners' current health status, NIOSH plans to develop a health surveillance program for this population to guide intervention efforts to reduce occupational and personal risks for chronic illness.     

The future of intervention research at NIOSH

The National Institute for Occupational Safety and Health (NIOSH) has recently made a commitment to increase both extramural and intramural support of control technology and intervention research. It is important for NIOSH to use intervention research more aggressively because it provides a mechanism to go beyond investigation, identification, and recommendations to actually determine if prevention has occurred. Intervention research can assess the effectiveness of the hierarchy of controls, workplace standards, and health and medical care, as well as provide important information on occupational disease and injury surveillance and health communication efforts. In pursuing intervention research, NIOSH will focus on enhancing its existing control technology and surveillance programs, seeking input from partners in industry and labor, pursuing interdisciplinary approaches, considering the cost and feasibility of controls, considering and integrating behavioral procedures, and widely disseminating the results. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

Summary of "Proposed national strategies for the prevention of leading work-related diseases and injuries, Part 1"

Strategies for the prevention of leading occupational health problems have been proposed by the National Institute for Occupational Safety and Health (NIOSH). NIOSH prepared these strategies following publication in 1983 of its suggested list of ten leading work-related diseases and injuries. At a national symposium in 1985, occupational health experts from academia, organized labor, management, professional associations, and voluntary organizations conducted an in-depth evaluation of the prevention strategies for the first five conditions on the list: occupational lung diseases, musculoskeletal injuries, occupational cancers, severe occupational traumatic injuries, and occupational cardiovascular diseases. The strategies were then revised to incorporate improvements suggested at the symposium and were published in booklet form. A summary of the revised strategies is provided.     

Malignant melanoma in the printing industry

In an occupational mortality surveillance study, cause-specific mortality patterns by occupation and industry, among Rhode Island residents who died during the period 1968-78, were examined using the age-standardized proportionate mortality ratio (PMR) method. A noteworthy finding was an elevated PMR for malignant melanoma among white males in the printing industry (PMR = 460, observed deaths = 6, p less than .01). When the results of other epidemiologic studies are reviewed in aggregate, they are consistent with this finding. A wide variety of chemicals, some of which are known or suspected human or animal carcinogens, are used in the printing industry. There is also potential exposure to ultraviolet radiation. The hypothesis of a relationship between malignant melanoma and occupational exposures in the printing industry should be investigated further.     

Adjustment for smoking, alcohol consumption, and socioeconomic status in the California Occupational Mortality Study.

This paper presents methods for adjusting for smoking, alcohol, and socioeconomic status in death certificate-based occupational mortality surveillance. The methods were applied in the California Occupational Mortality Study, a statewide study of rates based on 180,000 deaths and census estimates of occupations. For each occupation, levels of smoking, alcohol consumption, and socioeconomic status were estimated using National Health Interview Survey and U.S. Census data, and an empirical Bayes procedure was used to improve the stability of smoking and alcohol estimates for small occupations. Expected death rates for occupations were calculated by modeling rates as a function of age, smoking, alcohol, and socioeconomic status with Poisson regression. The effect of adjustment was usually moderate and in the expected direction, and the adjusted mortality ratios were generally closer to 1.0. Full data on agricultural occupations are presented for illustration.     

Geographic distribution of deaths due to sentinel health event (occupational) causes

This report describes the Compressed Mortality File available from the National Center for Health Statistics that can be used to easily and efficiently generate annual mortality rates for geographic areas as small as counties for any period from 1968 to 1985. Several ways of presenting geographic variation in mortality rates due to potentially work-related deaths and changes in these rates over time are discussed for the 15-year period from 1969 through 1983. Causes of death that are potentially work-related were identified using the sentinel health events (occupational) [SHE(O)] concept. Data are given for nine diagnostic groups of occupationally related disorders, and maps are presented for bladder cancer, acute myeloid leukemia, and pneumoconioses. Significant changes in age-adjusted mortality rates were noted for pneumoconioses and acute myeloid leukemia that could not be due to changes in the disease coding of death certificates. Racial differences in mortality rates due to pneumoconioses may be due to differences in employment patterns. The use of SHE(O) codes to search the Compressed Mortality File may be helpful in identifying areas for public health concern, even if only as a monitoring signal for subsequent time periods. This file also provides an easy way to generate reference population mortality rates for epidemiologic studies.     

Implementation of statutory occupational respiratory health surveillance

Health surveillance is required by UK regulations in certain circumstances, and is usually provided through an occupational health organization. Although there are studies assessing the provision of health surveillance across the country, there are no published studies addressing the practical application of legislation, guidelines and medical research to respiratory health surveillance programmes. An audit of a multidisciplinary health surveillance programme was carried out, using review of occupational health records, occupational hygiene reports and managers' risk assessments, to compare the implementation of health surveillance in different organizations and under different contractual relationships. Sixty-six per cent of National Health Service (NHS) and 56% of industrial workplaces were able to provide risk assessments but were unable to link these with appropriate health surveillance. Twenty-seven per cent of NHS employees potentially exposed to respiratory sensitizers had baseline surveillance, compared with 87% in industry. Fifty-five per cent of Medical Research Council questionnaires were inappropriately administered by the employee themselves, rather than an interviewer as recommended. Other follow-up questionnaires in use had not been formally validated. Non-regular lung function assessment using spirometry was the predominant tool used for follow-up surveillance. There was no overall strategic approach to respiratory health surveillance in the organization studied. Health surveillance programmes should focus on disease prevention without becoming a repetitious application of unvalidated tools. Clinical governance demands quality assurance standards that will effectively implement a coordinated approach to health surveillance.     

Occupational safety and health: progress toward the 1990 objectives for the nation

Occupational safety and health is 1 of 15 areas addressed in the Public Health Service's Objectives for the Nation. This area represents 104 million working men and women and the deaths, diseases, and injuries that result from exposures to hazards in their work environment. Characteristics of public health practice are compared with characteristics of occupational safety and health practice. The National Institute for Occupational Safety and Health (NIOSH), created by the Occupational Safety and Health Act, is discussed. NIOSH has developed a list of 10 leading work-related diseases and injuries. The list is headed by occupational lung diseases. Twenty Objectives for the Nation in the area of occupational safety and health are reviewed, and the status of NIOSH efforts toward their attainment is discussed. Five categories of objectives are covered: (a) improved health status, (b) reduced risk factors, (c) improved public and professional awareness, (d) improved service and protection, and (e) improved surveillance and evaluation. The potential for achieving these objectives is discussed, with special attention given to the lack of a data base for monitoring progress. A major conclusion is that surveillance in occupational safety and health needs to be strengthened.     

Using multiple cause of death coding in occupational mortality studies

Conventional occupational mortality analysis, using underlying cause of death coding, underestimates the contribution of those chronic diseases which are mentioned on the death certificate but which usually do not appear as underlying cause of death. Proportionate occupational mortality analysis, using all the mentioned causes on the Washington State male death records 1968-1984, identified an excess of rheumatoid arthritis in farmers, and asbestosis in plumbers, pipefitters, and steamfitters.     

Development of a National Occupational Exposure Survey and Database associated with NIOSH hazard surveillance initiatives

NIOSH pioneered hazard surveillance in the workplace by designing and conducting the 1972 to 1974 National Occupational Hazard Survey (NOHS), the 1981 to 1983 National Occupational Exposure Survey (NOES), and the 1984 to 1989 National Occupational Health Survey of Mining (NOHSM). The databases developed from these three on-site surveys represent unique resources for associating potential chemical, physical and biological agents with industries and occupational groups. The data have been a primary source of information for NIOSH, regulatory agencies, health professionals, researchers, and labor organizations in establishing priorities for prevention strategies that include medical and engineering interventions, development of occupational standards, and the identification of research needs. Recognizing that the data from these surveys are becoming dated, a multidisciplinary team comprising members from various NIOSH research divisions was established to develop a hazard surveillance strategy for the Institute, including options for a national hazard surveillance survey and database. The proposed new hazard survey builds on lessons learned from the previous surveys, seeks opportunities to incorporate existing data from other sources, expands the scope of industries and hazards, and takes advantage of advances in data gathering, processing and dissemination technology. This article presents current considerations and recommendations for a new hazard survey and database.     

Mortality surveillance and occupational hazards: the Solutia mortality experience 1980-94

OBJECTIVES—Several investigators argue that company wide mortalities for recent workers allow early identification of potential workplace hazards. Mortalities for recent workers were compared with published studies of workers with specific exposures in the same company to find whether mortality surveillance results could be used to identify previously unknown health effects from workplace hazards.
METHODS—Relative risks for causes of death in published substance specific studies at the plants were compared with the relative risks in the mortality surveillance of workers 20 or more years after first being employed.
RESULTS—As reported by other companies, low mortalities were found among workers in the mortality surveillance. The mortality surveillance reports often found no increased risk of disease at plants in which substance specific studies had found no effects. However, disease specific relative risks were not found by the mortality surveillance predictions of relative risks in the substance specific studies with increased risk.
CONCLUSION—Mortality surveillance is of limited use for identifying health effects from past workplace exposures to specific materials. The healthy worker and survivor effects, the failure to identify subsets of workers exposed to potentially toxic substances, the typically long induction period between exposure and disease, and the inability of recent mortality levels to reflect historical conditions all may make it difficult to use mortality surveillance to identify workplace hazards. Combining mortality surveillance with studies of workers with potentially toxic exposures helps identify occupational hazards.


Keywords: mortality surveillance; occupational cancer; bladder cancer; leukaemia     

Twenty-three years of hypersensitivity pneumonitis mortality surveillance in the United States

BACKGROUND: There are few population-based studies addressing hypersensitivity pneumonitis (HP) in the United States. The National Institute for Occupational Safety and Health (NIOSH) has nationally comprehensive longitudinal mortality data that can contribute to a better understanding of the epidemiology of HP. METHODS: The National Center for Health Statistics multiple cause-of-death data were analyzed for the period 1980-2002. Annual death rate was age-adjusted to the 2000 U.S. standard population. Death rate time-trends were calculated using a linear regression model and geographic distribution of death rates were mapped by state and county. Proportionate mortality ratios (PMRs) by usual industry and occupation adjusted for age, sex, and race, were based on data from 26 states reporting industry and occupation during 1985-1999. RESULTS: Overall age-adjusted death rates increased significantly (P < 0.0001) between 1980 and 2002, from 0.09 to 0.29 per million. Wisconsin had the highest rate at 1.04 per million. Among industries, PMR for HP was significantly high for agricultural production, livestock (PMR, 19.3; 95% CI, 14.0-25.9) and agricultural production, crops (PMR, 4.3; 95% CI, 3.0-6.0). Among occupations, PMR for HP was significantly elevated for farmers, except horticulture (PMR, 8.1; 95% CI, 6.4-10.2). CONCLUSIONS: These findings indicate that agricultural industries are closely associated with HP mortality and preventive strategies are needed to protect workers in these industries.