A state trauma registry as a tool for occupational injury surveillance.

The goal of occupational surveillance is to identify and determine the magnitude of work-related disease and injury and workplace hazards for the purposes of focusing prevention programs and tracking their effectiveness. There are a number of databases that collect information on pieces of the puzzle of workplace exposure and adverse health outcomes. Other than that for the fatalities, none of these datasets specifically describes the most severe occupational injuries or their attendant disability. The goal of this study was to evaluate the usefulness of the Illinois Trauma Registry (ITR) in the surveillance of occupational injuries. The entire dataset of the ITR was obtained from the Illinois Department of Public Health for the years 1993 and 1994. The occupational injuries were extracted and frequency distributions were determined for all demographic and health variables. Background population, employment, and death-rate data were obtained for the purpose of rate calculation and for comparison of raw data. Mean costs for acute occupational injuries were calculated. There were 5844 occupational cases, comprising 6.7% of the total group. The majority of injuries had occurred in males (86%), in urban settings (81%), and were of the "blunt" injury type. External cause (coded according to the International Classification of Diseases, 9th Revision, External Injury) categories for work-related injuries were "Cut/Struck," 39%; "Falls," 36%; "Transportation," 12%; "Environmental," 6%; "Violence," 3%; and the remainder, 5%. By definition, all cases were admitted to the hospital, with 62% classified as "minor," 28% "moderate," and the remaining 11% "severe" to "life threatening." Surgery was performed in 54%, and admission to a monitored bed or the intensive care unit occurred in 15%. Although 93% were discharged home, only 54% ambulated independently. Seven percent were not independent with regard to self-feeding status. The mean hospital charge was $10,802 (standard deviation, $31,438). A pyramidal model of the place of ITR cases in the universe of occupational injuries is presented. The ITR contains a unique set of variables that broaden our understanding of serious work-related injuries. It is recommended that these variables--"occupation," "type of industry," and "nature of injury"--be added to the ITR so that it may be linked with other databases to check its validity and completeness and to enhance its value in occupational surveillance.     

Comparison of fatal and severe nonfatal traumatic work-related injuries in Washington state.

OBJECTIVE: To compare fatal and hospitalized nonfatal work-related traumatic injuries by occupation and cause. METHODS: Fatal and hospitalized nonfatal injuries occurring from 1991-1995 were identified from Washington State workers' compensation claims data. Nonfatal injuries were classified as severe if they had at least one of the following criteria: a brain or spinal cord injury, an Injury Severity Score of >/=16, or were hospitalized for more than 7 days. The frequency and rate of fatal and severe nonfatal injuries were then described by industrial risk class and cause. RESULTS: The study identified 335 fatal injuries and 4,405 hospitalized nonfatal injuries, of which 1,105 were classified as severe. Tree topping and pruning, carnival work, roofing, and metal siding and gutters risk classes had several severe nonfatal injuries, but few, if any, fatalities. Causes of fatal and severe nonfatal injuries were notably different for the roofing, restaurant, and orchard workers risk classes. CONCLUSIONS: The inclusion of severe hospitalized injuries in occupational injury surveillance systems will provide a broader view of high-risk occupations and profile of injury causation with which to direct occupational injury prevention efforts.     

Hospitalized nonfatal injuries in the Alaskan construction industry

BACKGROUND: Construction industry workers are exposed to many hazards leading to fatal and nonfatal injuries. Information for nonfatal work-related injury surveillance may be vague and come from a variety of sources. METHODS: The Alaska Trauma Registry (ATR) is used as an injury surveillance tool to focus on hospitalized nonfatal injuries in the Alaskan construction industry. RESULTS: During 1991-1999, 717 workers in the Alaskan construction industry were hospitalized due to occupational injuries, with an average annual injury rate of 0.39 injuries/100 workers. Leading causes of injury included falls (48%) and machinery (15%). Thirty-four percent of the falls were from a building or structure, followed by falls from a ladder (24%). A fractured bone was the most common type of injury (57%). CONCLUSIONS: Information on hospitalized patients from the ATR focuses on the more severe and debilitating injuries, and provides valuable information for prioritizing injury prevention efforts in Alaska.     

Trends in rates of occupational fatal injuries in the United States (1983-92)

OBJECTIVES: An updated version of a national surveillance system of traumatic occupational fatalities was used to explore adjusted and unadjusted trends in rates of fatal injury. METHODS: Data from the national traumatic occupational fatalities surveillance system were combined with data on employment from the United States Bureau of Labor Statistics. Poisson regression was then used to examine trends in rates of occupational fatality injuries while controlling for demographic and workplace characteristics. RESULTS: Adjusted annual changes in rates of fatal injuries ranged from a decline of 6.2% for workers in technical and administrative support occupations--for example, health, science, and engineering technicians, pilots, computer programmers--to an increase of 1.6% in machine operators, assemblers, and inspectors. For industries, annual changes ranged from a decline of 5.3% for workers in public administration--for example, justice, public order, and safety workers--to an increase of 2.6% for workers in the wholesale trade. By comparison, the annual decline over all industries and occupations was 3.1%. In many industries and occupations, an effect modification of annual trends by the age of the worker was also found with the oldest workers experiencing either no decline or a significant increase in rates of fatal injuries. CONCLUSIONS: This general pattern of decline, adjusted for the effects of demographic characteristics of the worker population, is encouraging; however, increases in rates of fatal injuries found in particular industries and occupations, suggest appropriate targets for increased injury prevention efforts.

 

     

Medical, personal, and occupational outcomes for work-related amputations in Minnesota

BACKGROUND: The Minnesota Sentinel Event Notification System for Occupational Risks (SENSOR) surveillance system has collected data on the medical, personal, and occupational outcomes associated with work-related amputations since 1992. METHODS: SENSOR defined amputations as any finger amputation or the loss of any other body part; 832 workers were identified as having amputation injuries between 1994 and 1995 and 72% of these workers completed a telephone interview. RESULTS: Twenty percent of those injured required overnight hospitalization. Ninety-one percent of the cases reported having missed work, with 56% reporting missing ten or more days. Individuals working on their usual jobs at the time of injury were more likely to report less serious medical and occupational outcomes. CONCLUSIONS: Severe injuries were significantly associated with worse medical, personal, and occupational outcomes. Two groups of machines, material handling, and powered handtools were associated with a higher proportion of severe injuries.     

Differences in Patterns of Mortality Between Foreign-Born and Native-Born Workers Due to Fatal Occupational Injury in the USA from 2003 to 2010

This study assesses differences mortality patterns and relative hazard due to fatal occupational injuries between native and immigrant workers in the US. Fatal occupational injury data from 2003 to 2010 were examined using survival analysis based on proportional hazards models controlling for categorical variables of race, gender, occupation, and industry. Workers are stratified based on whether they are native to the US (n?=?31952) or born abroad (n?=?7096). Foreign-born workers are further stratified into region of birth. Foreign-born workers had an adjusted hazard ratio of 1.148 (95?% CI 1.109:1.189) relative to native workers. Stratifying foreign-born workers into region of origin revealed significantly higher adjusted risk of work fatality relative to native workers for most foreign regions. Of fatally injured workers, foreign-born workers have shorter survival before succumbing to traumatic injury during their time of occupational ‘exposure’ in the workforce. Native-born workers tend to incur fatal injuries at older ages after longer ‘exposure’.     

The potential for using a trauma registry for injury surveillance and prevention

Trauma registries are a potential source of data for local injury surveillance. Data from a trauma registry in a Level 1 trauma unit were collected for 1,412 admissions during a one-year period, and the characteristics of these severely injured patients and their injuries were examined. Three-quarters of the injuries were unintentional, and half were vehicle-related injuries. The availability of variables regarding medical cost, patient outcome, and insurance status permits a determination of the impact of these injuries on society in terms of both cost and quality of life. Since the trauma registry contains an account of the patient's hospital experience from admission to discharge and is available in electronic format, it can be a useful data source for establishing priorities and evaluating the effectiveness of injury prevention programs.     

Fatal occupational injuries--United States, 1980-1997

CDC monitors deaths from occupational injuries through the National Traumatic Occupational Fatalities (NTOF) surveillance system (1,2). This report provides an overview of traumatic occupational deaths among civilian workers from NTOF from 1980 through 1997, the most recent year for which data are available. The data presented in this report indicate a decrease in occupational deaths overthis period with mining, agriculture/forestry/fishing, and construction having the highest death rates; motor-vehicle crashes were the leading cause of injury-related deaths for U.S. workers. State health departments and others involved in prevention of occupational injuries can use the data to prioritize intervention programs.     

Surveillance for nonfatal work-related injuries in Alaska, 1991–1995

Historically, Alaska has had an occupational fatality rate five times greater than that for the United States. This article reports recent surveillance results for hospitalized nonfatal work-related injuries in Alaska, using the population-based Alaska Trauma Registry (ATR) from 1991 through 1995. The fishing, construction, and logging industries led with the highest number of reported cases in the ATR. Workers in the logging, water transportation, and wood product manufacturing industries had the highest injury rates. Cause, severity, type, and body region of injury were examined for each target industry. For industries with the highest numbers and rates of injuries, in most cases, falls were identified as a common cause of injuries. A fractured bone was the most common type of injury, and the extremities were the most common body region affected. The ATR has proved to be a reliable tool for work-related injury surveillance and will be helpful in planning research priorities and targeting injury prevention efforts. Am. J. Ind. Med. 34:493–498, 1998. © 1998 Wiley-Liss, Inc.     

Fatal occupational injury rates in southern and non-southern States, by race and Hispanic ethnicity

OBJECTIVES: We investigated fatal occupational injury rates in the United States by race and Hispanic ethnicity during the period 1990-1996. METHODS: Fatalities were identified by means of the national traumatic occupational fatalities surveillance system. Fatal occupational injury rates were calculated by race/ethnicity and region using US-census-based workforce estimates. RESULTS: Non-Hispanic Black men in the South had the highest fatal occupational injury rate (8.5 per 100000 worker-years), followed by Hispanic men in the South (7.9 per 100000 worker-years). Fatal injury rates for Hispanic men increased over the study period, exceeding rates for non-Hispanic Black men in the latter years of observation. CONCLUSIONS: These data suggest a change in the demographics of fatal occupational injuries in the United States. Hispanic men in the South appear to be emerging as the group with the nation's highest unintentional fatal occupational injury rate.     

Occupational injuries reported in a population-based injury survey in Vietnam

This analysis of data from the Household Injury Survey conducted in Viet Nam in 2004-2005 sought to characterize the patterns of work-related injuries in Viet Nam and to determine whether self-employed and artisanal workers had higher rates of injuries than formally employed workers. The annual incidence rate of work-related injuries in Viet Nam was 7.06 per 1,000 person-years. Daily alcohol consumption was strongly associated with work-related injuries. The highest burden of injuries was among farmers. Mechanical forces were the most common mechanism of injury. Self-employed workers had a rate of work-related injuries 26% higher than that of formally employed workers. Self-employed workers were younger, less educated, and more likely to be male. This population-based survey showed substantial underreporting of occupational injuries by existing surveillance mechanisms, which focus on formally employed workers. Priorities for future work include developing an integrated surveillance system for injuries and implementing further needs assessments to improve the prevention of occupational injuries.     

Comparison of fatal occupational injury surveillance systems between the European Union and the United States

BACKGROUND: Comparison of workplace injury statistics among countries is often problematic, mainly because work injury statistics are based on different national recording and notification systems. METHODS: Definitions of fatal work-related injuries, identification of the reference population, and rates of fatal work-related injuries, from 1995 to 1998, were compared between the European Statistics on Accidents at Work (ESAW) and the United States (U.S.) Census of Fatal Occupational Injuries (CFOI). RESULTS: Similar definitions for workplace fatalities were found, but CFOI is based on an active search, and ESAW on passive notification. Daily fatal occupational injury numbers were similar in both: about 17 workers die per day, but average annual work-related death rates were higher in the U.S. CONCLUSIONS: There are enough differences to allow direct comparisons between both systems. CFOI is likely to be more comprehensive than ESAW. It is conceivable that the true number of fatal occupational injuries in the European Union (E.U.) could be higher, and thus the apparent difference in U.S. and E.U. fatal injury rates may be an artifact of the different surveillance systems.     

Trauma in Hispanic Farm Workers in Eastern North Carolina

Abstract

Context: In spite of the attention directed at the problem of occupational injuries within the farm environment and at the general health status of migrant farm workers in the United States, there have been no studies focusing on the risk for traumatic injury in general for this disadvantaged group.

Purpose: Trauma affecting Eastern North Carolina Hispanic farm workers was quantified and certain risk factors were found.

Methods: Through chart review and retrieval of trauma registry information, patient occupational history, injury patterns, treatment variables as well as outcome and hospital charges were determined and compared with data for Hispanic construction workers and other service area males.

Findings: Two hundred fifty-six Hispanic farm workers were admitted to the trauma center from July1992 to June 2002, which is comparable to the risk (0.1%) of being admitted to the trauma center for an age-matched service area male. Only 5% of injuries occurred during farm work, 21% were penetrating injuries, and in 66% ofcases (compared to 51% for other age-matched males) alcohol was involved.

Conclusion: Most trauma affecting Hispanic farm workers in Eastern North Carolina is not directly occupational and happens in conjunction with recreational activity, where alcohol is an important risk factor. The human and financial cost resulting from such injuries is of such magnitude that it deserves consideration by everybody who is involved in shaping policies in agriculture, immigration and rural public health.     

Outcomes in work-related injuries: a comparison of older and younger workers

BACKGROUND: The "graying of the workforce" has generated concerns about the physical capacity of older workers to maintain their health and productivity on the job, especially after an injury occurs. There is little detailed research on age-related differences in work outcomes after an occupational injury. METHODS: A self-report survey about occupational, health, and financial outcomes, and related factors was administered 2-8 weeks post-injury to workers aged < 55 and > or = 55 who had lost time due to a work injury. RESULTS: Despite more severe injuries in older workers, most outcomes were similar in both age groups. In multivariate models, age was unrelated or inversely related to poor outcomes. Injury severity, physical functioning, and problems upon return to work were associated with adverse work injury outcomes. CONCLUSIONS: Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect.     

珠海市建筑行业职业伤害研究

目的:了解珠海市建筑行业职业伤害情况,并进行原因分析,提出相关预防措施。为职业伤害系统资料的建立提供本底资料,也为政府决策和制订相应管理策略,增进劳动者健康,充分提高劳动效率提供科学依据。方法:根据珠海市劳动和社会保障局1 990～2 0 0 3年间的职业伤害(工伤)认定的资料进行分析。结果:1 990～2 0 0 3年间珠海市建筑行业职业伤害(工伤)人数为35 9人,以男性为主,占96 . 4 %。75 . 2 1 %的职业伤害者年龄<4 0岁。职业伤害者中30 . 6 4 %为四川籍,2 3 .6 8%为广东籍,1 4 .2 1 %为湖南籍。1 990年至2 0 0 3年间轻伤、重伤和死亡的构成比分别为2 8. 4 2 %、4 9 .30 %和2 2 . 2 8%。职业伤害主要类型为高坠(2 6 . 1 2 %)、碰撞伤(1 8. 82 %)和挤压(1 0 .39%)。职业伤害的主要部位为下肢(2 8. 70 %)、上肢(2 0 . 89%)和面部(1 2 . 5 3%)。职业伤害的主要原因为防护装置缺陷(30 . 92 %)、违反操作规程(2 5 . 0 7%)和缺乏安全操作知识(1 4 . 2 1 %)。结论:建筑业是珠海地区的高危险行业,建议改善工作场所安全设施和加强工人的安全教育和培训,从而有助于减少或杜绝建筑业职业伤害的发生。     

Use of employer administrative databases to identify systematic causes of injury in aluminum manufacturing

BACKGROUND: Employer administrative files are an underutilized source of data in epidemiologic studies of occupational injuries. METHODS: Personnel files, occupational health surveillance data, industrial hygiene data, and a real-time incident and injury management system from a large multi-site aluminum manufacturer were linked deterministically. An ecological-level measure of physical job demand was also linked. This method successfully created a database containing over 100 variables for 9,101 hourly employees from eight geographically dispersed U.S. plants. RESULTS: Between 2002 and 2004, there were 3,563 traumatic injuries to 2,495 employees. The most common injuries were sprain/strains (32%), contusions (24%), and lacerations (14%). A multivariable logistic regression model revealed that physical job demand was the strongest predictor of injury risk, in a dose dependent fashion. Other strong predictors of injury included female gender, young age, short company tenure and short time on current job. CONCLUSIONS: Employer administrative files are a useful source of data, as they permit the exploration of risk factors and potential confounders that are not included in many population-based surveys. The ability to link employer administrative files with injury surveillance data is a valuable analysis strategy for comprehensively studying workplace injuries, identifying salient risk factors, and targeting workforce populations disproportionately affected.     

Self-reported occupational injuries among industrial beef slaughterhouse workers in the Midwestern United States

Although workers in meatpacking facilities in the U.S. experience high rates of occupational injury, their injury experiences have received limited research attention. Prior research indicates underreporting in injury rates in this industry as well significant variation in injury rates among facilities. To add detail to the rates and circumstances surrounding occupational injury among meatpacking workers, we conducted a cross-sectional study of workers employed at an industrial beefpacking plant in Nebraska (n = 137) and interviewed workers about recent injury experiences. We assessed frequency, cause and nature of self-reported injury. We estimated annual incidence rates of self-reported injuries using the OSHA formula and compared these rates to industry-wide data. We also evaluated psychological distress in this workforce as measured by the Kessler-6 scale to assess whether distress was associated with recent occupational injury. In this study, 15.1% of workers experienced occupational injuries that required time off work, job transfer, or restriction during the past three months. The estimated annual incidence rate was 15.2 injuries per 100 full-time workers for these injuries at this plant. Rushing was identified as the cause of nearly 50% of injuries, and repetitive work as the cause of an additional 20% of injuries. Use of metal mesh sleeves (POR: 0.10 (p = 0.008)) and metal mesh gloves (POR: 0.41 (p = 0.05) were associated with reduced risk of injury. Use of a carbon steel for knife sharpening (POR: 5.2 (p = 0.02)) was associated with elevated risk of moderate and severe injury. There were no associations between self-reported occupational injury and overall measures of psychological distress. Self-reported incidence rate of severe injury in this plant was more than twice official industry estimates. Worker self-reports may illustrate key areas for injury prevention.     

Prevalence of traumatic dental injury in grade 8 children in six Ontario communities

OBJECTIVES: To determine the prevalence of traumatic injury to the anterior dentition in Grade 8 children in six Ontario communities. METHODS: Clinical examination of 3,010 children attending a stratified random sample of 66 schools in the communities served by 6 Ontario Public Health departments. Trauma to the hard tissues was classified according to the Trauma Index. RESULTS: Damage to the anterior dentition was observed in 18.5% of those examined. Unrestored fractures of the enamel were present in 13.0%, with more severe damage or damage sufficiently severe to have been treated being present in 5.9%. Of those with the more severe injuries, 20% had not received treatment. The prevalence of injury was higher in males than in females (21.3% vs. 13.4%: p < 0.0001) and varied across the six communities studied (10.7-29.4%: p < 0.01). There was an association between dental decay experience and traumatic dental injury. Those with more severe injuries had higher mean Decayed, Missing and Filled Teeth (DMFT) scores and were less likely to have a DMFT score of zero than those without injury (p < 0.01). DISCUSSION: The prevalence of traumatic dental injury in this Ontario child population was similar to those reported in national surveys in the US and UK. The association between injury and dental decay may reflect the fact that a subgroup of children live within environments or are prone to behaviours that place them at greater risk of multiple oral disorders. In order to provide a basis for prevention, further research needs to be undertaken to identify the causes of and the personal and environmental risk factors for such injuries in Ontario children.     

Occupational cancer mortality in Illinois white and black males, 1979-1984, for seven cancer sites

A death certificate mortality odds ratio study of seven cancer sites was conducted by using 1979-1984 data on Illinois deaths in white and black males. Cancer sites selected include stomach, pancreas, lung, prostate, bladder, brain, and non-Hodgkin's lymphomas. This surveillance study was undertaken to detect occupational associations that might suggest further avenues of research. Some of the occupations and industries found to have elevated cancer risks and that are consistent with previous studies include: brickmasons and stonemasons (stomach); metal workers (pancreas, lung); photoengravers and lithographers (pancreas); butchers (lung); locomotive operators and truck drivers (lung); farmers (prostate, brain, non-Hodgkin's lymphoma); mechanics and repairers, especially auto mechanics (prostate); physicians (brain); glass products manufacturing workers (brain); and communications industry (brain) and chemical plant workers (non-Hodgkin's lymphomas). It was also noted that for black males, the death certificate occupational data are of limited usefulness due to the high percentage of missing or inexact information. The Division of Vital Records in the State of Illinois should make an effort to improve the reporting of this data through additional training of the funeral directors and hospital clerks who collect this information and by follow-up of incomplete or missing data.