The effect of rate denominator source on US fatal occupational injury rate estimates

BACKGROUND: The Current Population Survey (CPS) is often used as a source of denominator information for analyses of US fatal occupational injury rates. However, given the relatively small sample size of the CPS, analyses that examine the cross-classification of occupation or industry with demographic or geographic characteristics will often produce highly imprecise rate estimates. The Decennial Census of Population provides an alternative source for rate denominator information. We investigate the comparability of fatal injury rates derived using these two sources of rate denominator information. METHODS: Information on fatal occupational injuries that occurred between January 1, 1983 and December 31, 1994 was obtained from the National Traumatic Occupational Fatality surveillance system. Annual estimates of employment by occupation, industry, age, and sex were derived from the CPS, and by linear interpolation and extrapolation from the 1980 and 1990 Census of Population. Fatal injury rates derived using these denominator data were compared. RESULTS: Fatal injury rates calculated using Census-based denominator data were within 10% of rates calculated using CPS data for all major occupation groups except farming/forestry/fishing, for which the fatal injury rate calculated using Census-based denominator data was 24.69/100,000 worker-years and the rate calculated using CPS data was 19.97/100,000 worker-years. The choice of denominator data source had minimal influence on estimates of trends over calendar time in the fatal injury rates for most major occupation and industry groups. CONCLUSIONS: The Census offers a reasonable source for deriving fatal injury rate denominator data in situations where the CPS does not provide sufficiently precise data, although the Census may underestimate the population-at-risk in some industries as a consequence of seasonal variation in employment.     

Motor vehicle crash injury rates by mode of travel, United States: using exposure-based methods to quantify differences

The authors used traffic exposure data to calculate exposure-based fatal and nonfatal traffic injury rates in the United States. Nationally representative data were used to identify fatal and nonfatal traffic injuries that occurred from 1999 to 2003, and the 2001 National Household Travel Survey was used to estimate traffic exposure (i.e., person-trips). Fatal and nonfatal traffic injury rates per 100 million person-trips were calculated by mode of travel, sex, and age group. The overall fatal traffic injury rate was 10.4 per 100 million person-trips. Fatal injury rates were highest for motorcyclists, pedestrians, and bicyclists. The nonfatal traffic injury rate was 754.6 per 100 million person-trips. Nonfatal injury rates were highest for motorcyclists and bicyclists. Exposure-based traffic injury rates varied by mode of travel, sex, and age group. Motorcyclists, pedestrians, and bicyclists faced increased injury risks. Males, adolescents, and the elderly were also at increased risk. Effective interventions are available and should be implemented to protect these vulnerable road users.     

Fatal occupational injury rates: Quebec, 1981 through 1988.

OBJECTIVES. The purpose of the study was to estimate the death rates from occupational injuries in the province of Quebec for the period 1981 through 1988. METHODS. Worker's compensation files were used to ascertain numbers of deaths, which were used as the numerators in figuring the rates (it was estimated that these files reported 83% of the true number of deaths among men). Annual average estimates of the labor force were used as denominators. RESULTS. From 1981 through 1988, compensation was awarded for 1227 fatal work injuries. Among men (96% of the victims), rates declined from 1981 to 1988 (from 12.7 to 8.1 per 100,000); women's rates were stable (< or = 1.0 per 100,000). Compared with men, women had excess mortality from violent acts. Motor vehicle crashes accounted for 36% of all fatal injuries in 1984 and 1985 and declined thereafter. Fatal injury rates in forestry and mining rose to a 1987 maximum of 67.6 per 100,000. The construction sector had the largest number of deaths, despite a decline in rates from 1981 to 1988 (from 27.8 to 15.9 per 100,000). CONCLUSIONS. Except for construction and agriculture, reported fatal occupational injury rates in Quebec were similar to those in the United States. Motor vehicle crashes, falls, violent acts, and farming-related injuries were the most frequent causes of death.     

Temporal Patterns in Work-Related Fatalities Among Foreign-Born Workers in the US, 1992–2007

In the United States, approximately 20% of all workers who died on the job in 2007 were foreign-born. The objective of this study was to describe trends in occupational fatalities among foreign-born workers. An analysis of fatal injuries among foreign-born workers in the US occurring from 1992 through 2007 was conducted using the Bureau of Labor Statistics’ Census of Fatal Occupational Injuries. Individual characteristics, employment characteristics, injury events and industry employment were summarized and evaluated for trends. Both the number and proportion of foreign-born workers who died from a traumatic work-related injury increased substantially over the time period studied. The proportion who were men, aged 25–44 years, Hispanic, non self-employed, employed by business establishments with 10 or fewer employees, working at private residences and working in Construction and Services consistently increased throughout the time period. While some trends among foreign-born decedents are improving, others are worsening. More comprehensive research efforts are needed to address the occupational injury and safety issues among foreign-born workers, with a focus on Hispanics.     

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.     

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.     

Occupational injury and absence from work among African American, Hispanic, and non-Hispanic White workers in the national longitudinal survey of youth

OBJECTIVES: We examined how race and ethnicity influence injury and illness risk and number of days of work missed as a result of injury or illness. METHODS: We fit logistic regression and negative binomial regression models using generalized estimating equations with data from 1988 to 2000 on currently employed African American, Hispanic, and non-Hispanic White participants in the National Longitudinal Survey of Youth. RESULTS: Occupational factors-having a blue-collar occupation, working full-time, having longer tenure, working 1 job versus 2, and working the late shift-were associated with increased odds of an occupational injury or illness. Although racial/ethnic minority workers were no more likely than Whites to report an occupational injury or illness, they reported missing more days of work. African American and Hispanic men missed significantly more days of work than non-Hispanic White men, and African American women missed significantly more days of work than non-Hispanic White women. CONCLUSIONS: Factors associated with occupational health are multifaceted and complex. Our findings suggest that race/ethnicity influences the duration of work absence owing to injury or illness both indirectly (by influencing workers' occupational characteristics) and directly (by acting independently of occupational factors).     

COVID-19–Related Hospitalization Rates and Severe Outcomes Among Veterans From 5 Veterans Affairs Medical Centers: Hospital-Based Surveillance Study

BackgroundCOVID-19 has disproportionately affected older adults and certain racial and ethnic groups in the United States. Data quantifying the disease burden, as well as describing clinical outcomes during hospitalization among these groups, are needed.ObjectiveWe aimed to describe interim COVID-19 hospitalization rates and severe clinical outcomes by age group and race and ethnicity among US veterans by using a multisite surveillance network.MethodsWe implemented a multisite COVID-19 surveillance platform in 5 Veterans Affairs Medical Centers located in Atlanta, Bronx, Houston, Palo Alto, and Los Angeles, collectively serving more than 396,000 patients annually. From February 27 to July 17, 2020, we actively identified inpatient cases with COVID-19 by screening admitted patients and reviewing their laboratory test results. We then manually abstracted the patients'' medical charts for demographics, underlying medical conditions, and clinical outcomes. Furthermore, we calculated hospitalization incidence and incidence rate ratios, as well as relative risk for invasive mechanical ventilation, intensive care unit admission, and case fatality rate after adjusting for age, race and ethnicity, and underlying medical conditions.ResultsWe identified 621 laboratory-confirmed, hospitalized COVID-19 cases. The median age of the patients was 70 years, with 65.7% (408/621) aged ≥65 years and 94% (584/621) male. Most COVID-19 diagnoses were among non-Hispanic Black (325/621, 52.3%) veterans, followed by non-Hispanic White (153/621, 24.6%) and Hispanic or Latino (112/621, 18%) veterans. Hospitalization rates were the highest among veterans who were ≥85 years old, Hispanic or Latino, and non-Hispanic Black (430, 317, and 298 per 100,000, respectively). Veterans aged ≥85 years had a 14-fold increased rate of hospitalization compared with those aged 18-29 years (95% CI: 5.7-34.6), whereas Hispanic or Latino and Black veterans had a 4.6- and 4.2-fold increased rate of hospitalization, respectively, compared with non-Hispanic White veterans (95% CI: 3.6-5.9). Overall, 11.6% (72/621) of the patients required invasive mechanical ventilation, 26.6% (165/621) were admitted to the intensive care unit, and 16.9% (105/621) died in the hospital. The adjusted relative risk for invasive mechanical ventilation and admission to the intensive care unit did not differ by age group or race and ethnicity, but veterans aged ≥65 years had a 4.5-fold increased risk of death while hospitalized with COVID-19 compared with those aged <65 years (95% CI: 2.4-8.6).ConclusionsCOVID-19 surveillance at the 5 Veterans Affairs Medical Centers across the United States demonstrated higher hospitalization rates and severe outcomes among older veterans, as well as higher hospitalization rates among Hispanic or Latino and non-Hispanic Black veterans than among non-Hispanic White veterans. These findings highlight the need for targeted prevention and timely treatment for veterans, with special attention to older aged, Hispanic or Latino, and non-Hispanic Black veterans.     

Race,Medicaid Coverage,and Equity in Maternal Morbidity

BackgroundSevere maternal morbidity (SMM) affects 50,000 deliveries in the United States annually, with around 1.5 times the rates among Medicaid-covered relative to privately covered deliveries. Furthermore, large racial inequities exist in SMM for non-Hispanic Black women and Hispanic women with rates being 2.1 and 1.4 times higher than White women, respectively. This study aimed to compare the differences in SMM among women of different races/ethnicities and delivery insurance types. Quantifying the rates of SMM based on the intersection of race/ethnicity and insurance status can help to elucidate how multiple forms of oppression and racism may contribute to the substantial inequities in SMM among Black women.MethodsUsing hospital discharge data from the Healthcare Cost and Utilization Project National Inpatient Sample (years 2016 and 2017), we conducted multivariate logistic models to evaluate equity in maternal outcomes among women with different primary payers, overall and stratified by race/ethnicity.ResultsWe found a rate of SMM equal to 138.3 per 10,000 deliveries. Differences in the rate of SMM among non-Hispanic Black, non-Hispanic Asian, and Hispanic women relative to White women were lower among Medicaid-covered deliveries relative to deliveries of all payer types. For example, among all payers, Black women had 2.17 (221.3 vs. 102.1 per 10,000) times the rate of SMM compared with White women; however, among Medicaid-covered deliveries, Black women had 1.84 (227.3 vs. 123.2) times the rate. Despite increased risk associated with Medicaid coverage (adjusted odds ratio, 1.12; 95% confidence interval, 1.07–1.16), the risk was no longer significant in the stratified regression including Black women (adjusted odds ratio, 1.06; 95% confidence interval, 0.98–1.15).ConclusionsOur findings suggest that Black women with Medicaid do not have higher rates of SMM relative to Black women with private insurance. National and state policy efforts should continue to focus on addressing structural racism and other socioeconomic drivers of adverse maternal outcomes, including barriers to high-quality care among women with Medicaid coverage.     

Fatal agricultural injuries in North Carolina by race and occupation, 1977–1991

Medical examiner reports and death certificates were reviewed for all fatal agricultural injuries (n = 228) that occurred on-the-job in North Carolina between 1977 and 1991. Data were collected on the decedents' age, gender, race, date and time of injury, means of injury, and occupation. Annual workforce estimates were derived from the 1980 and 1990 US Census of the Population. Overall, 54% of the fatal injuries were due to tractors. Farmers who suffered fatal injuries tended to be older (median age = 56 years) and Caucasian (87%), while farm workers who died on the job were younger (median age = 35 years) and more often African-American (60%). The crude mortality rate for farmers was 38 per 100,000 worker-years; the crude rate for farm laborers was 16 per 100,000 worker-years. Age-adjusted fatal injury rates were 2.5 times higher among African-American farmers than among Caucasian farmers; furthermore, between 1977 and 1991 the rate of fatal injury among African-American farmers increased an estimated 14.7% per year. African-American farmers in North Carolina have experienced rising rates of fatal injuries at a time when employment in the industry is declining due to consolidation of farm ownership and foreclosures of African-American owned farms. In order to address the growing racial disparity in farm fatalities, efforts need to be made to improve the conditions under which African-American farmers are working. Am. J. Ind. Med. 31:452–458, 1997. © 1997 Wiley-Liss, Inc.     

Disparities in Sexually Transmitted Infection/HIV Testing,Contraception, and Emergency Contraception Care Among Adolescent Sexual Minority Women Who Are Racial/Ethnic Minorities

PurposeSexual minority women and racial/ethnic minority women in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. Yet, we know little about STI/HIV testing and contraceptive care among women who have sex with women only and women who have sex with both women and men, and who are racial/ethnic minorities. This study examined receipt of STI/HIV testing and contraceptive care among sexually active adolescent women by sex of sexual contact(s) and race/ethnicity.MethodsOur sample included 2,149 sexually active adolescent women from the National Survey of Family Growth (2011–2019). We examined receipt of sexual and reproductive health (SRH) services by sex of sexual contact(s) and race/ethnicity: STI and HIV testing, contraceptive counseling, contraceptive method, emergency contraception (EC) counseling, and EC method.ResultsService receipt was low for all adolescent women, with disparities by sex of sexual contact(s) and by race/ethnicity. Women who have sex with women only had the lowest rates across all services; women who have sex with both women and men had higher rates of STI and HIV testing and EC counseling than women who have sex with men only. Non-Hispanic Black women had higher rates of STI and HIV testing than non-Hispanic White peers, and non-Hispanic Black and Hispanic women had lower rates of contraception method receipt than their non-Hispanic White peers. Racial/ethnic disparities persisted when results were stratified by sex of sexual contact(s).DiscussionThere is an unmet need for improved SRH service delivery for all adolescent women and for services that are not biased by sex of sexual contact(s) and race/ethnicity.     

Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution

BackgroundDespite a lower percentage of primary cesareans than non-Hispanic White and Black women, Hispanic women in the United States had the highest rate of repeat cesarean deliveries (RCD) in 2016; it is unclear if reasons for differences are due to known risk factors. Our study examined the association between ethnicity/race and RCD among women with one previous cesarean and whether demographic (age, marital status, education, language, and delivery year), anthropomorphic (height, prepregnancy body mass index), obstetrical/medical (parity, gestational age, infant birth weight, gestational diabetes, labor induction or augmentation, vaginal birth after cesarean delivery history), or health system (delivery day/time, payer source, provider gender) factors accounted for any observed differences by ethnicity/race.MethodsOur retrospective cohort study used logistic regression to evaluate the relationship between ethnicity/race and RCD based on data from electronic delivery and prenatal records from 2010 to 2016, including 1800 births to Hispanic and non-Hispanic women with one previous cesarean at a District of Columbia hospital.ResultsStatistically significant differences by ethnicity/race were noted after adjustment for obstetric/medical factors, particularly parity and use of induction or augmentation methods. Hispanic (adjusted odds ratio, 2.48; 95% confidence interval, 1.03–6.01) and Black women (adjusted odds ratio, 2.83; 95% confidence interval, 1.67–4.81) had higher odds of RCD than White women.ConclusionsAdjustment for parity and use of induction or augmentation methods revealed higher odds of RCD for Hispanic and Black women than White women. Demographic and anthropometric factors did not alter these results. Our work is a first step in creating effective public health policy and programs that target potentially preventable RCD by highlighting the need to evaluate risk factors beyond those included in the literature to date.     

The Interactive Effects of Race and Ethnicity and Mother's Residence on the Adequacy of Prenatal Care

Abstract: Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal care use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, non metropolitan residence, poverty, low level of education, and no insurance were more strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.     

Deindustrialisation and the long term decline in fatal occupational injuries

Aims: To examine the extent to which deindustrialisation accounts for long term trends in occupational injury risk in the United States.

Methods: Rates of fatal unintentional occupational injury were computed using data from death certificates and the population census. Trends were estimated using Poisson regression. Standardisation and regression methods were used to adjust for the potential effect of structural change in the labour market.

Results: The fatal occupational injury rate for all industries declined 45% from 1980 to 1996 (RR (rate ratio) 0.55, 95% CI 0.52 to 0.57). Adjustment for structural changes in the workforce shifted the RR to 0.62 (95% CI 0.60 to 0.65). Expanding industries enjoyed more rapid reduction in risk (–3.43% per year, 95% CI –3.62 to –3.24) than those that contracted (–2.65% per year, 95% CI –2.88 to –2.42).

Conclusions: Deindustrialisation contributed to the decline of fatal occupational injury rates in the United States, but explained only 10–15% of the total change.

     

Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC,January 1–October 1, 2020

We examined disparities in cumulative incidence of severe acute respiratory syndrome coronavirus 2 by race/ethnicity, age, and sex in the United States during January 1–October 1, 2020. Hispanic/Latino and non-Hispanic Black, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander persons had a substantially higher incidence of infection than non-Hispanic White persons.     

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.     

National surveillance of occupational fatalities in agriculture

Agriculture is one of the most hazardous industries in the United States. Although estimates vary, all reporting agencies show agriculture having an occupational fatality rate three to five times higher than that of the general private sector. The National Institute for Occupational Safety and Health (NIOSH), Division of Safety Research's National Traumatic Occupational Fatalities (NTOF) data base monitors occupational fatal injuries in all industries in the United States through death certificates. Uniform case-selection criteria are applied nationwide. NTOF shows that for the years 1980 through 1985, agriculture had a work-related fatality rate of 20.7 deaths per 100,000 workers compared with 7.9 deaths per 100,000 workers for the private sector U.S. work force. Age-specific rates indicate that the risk of fatal occupational injury increases with age for agricultural workers. Workers over 64 years old have an average annual rate of 55.7 deaths per 100,000 workers. Other uses of the surveillance system, as well as its limitations, are discussed.     

Incidence of anal cancer in California: increased incidence among men in San Francisco, 1973-1999

BACKGROUND: Incidence of anal cancer has increased in the United States during the past 30 years. This report describes the incidence of this rare cancer in the diverse California population. METHODS: Age-adjusted incidence rates (AAIR) were calculated by gender, race/ethnicity, county, and year of diagnosis for over 2100 cases of cancer of the anus diagnosed between 1995 and 1999. Age-adjusted incidence rates by time period 1973-1999 were calculated for San Francisco County. RESULTS: Age-adjusted incidence was higher for women than for men (AAIR 1.5 vs 1.2) in California, but men under age 40 and those classified as non-Hispanic Black had higher rates than women, and men had higher rates in San Francisco County (AAIR=8.7). Rates were higher among non-Hispanic Blacks and Whites than among Hispanics and Asian/Pacific Islanders. For all of California, there was an average 2% annual increase among non-Hispanic White men between 1988 and 1999. Incidence of this cancer among White males residing in San Francisco County more than doubled between the 1984-1990 and 1996-1999 time periods. Rates rose especially dramatically for San Francisco men ages 40 to 64, from 3.7 cases per 100,000 in 1973-1978 to 8.6 cases per 100,000 in 1984-1990 and to 20.6 cases per 100,000 in 1996-1999. CONCLUSIONS: Elevated incidence of anal cancer among White men residing in San Francisco County is likely to be related to the high proportion of men who have sex with men. Rates of anal cancer in this high-risk population increased during the past decade.     

Necrotizing enterocolitis mortality in the United States, 1979-85.

The Multiple Cause of Death Mortality data from the National Center for Health Statistics were analyzed to describe epidemiologic characteristics and trends in deaths related to necrotizing enterocolitis (NEC) among infants in the United States from 1979 to 1985. The average annual mortality rate (multiple cause mortality) for NEC was 13.1 deaths per 100,000 live births. NEC annual mortality rates decreased significantly during the study period for White and Black infants, male and female infants, and infants in the Northeast, North Central, and South regions. Black infants were approximately three times more likely to die from NEC than White infants, and the NEC infant mortality rate was highest in the South.     

Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991-1999

OBJECTIVES: We identified risk factors for pregnancy-associated homicide (women who died as a result of homicide during or within 1 year of pregnancy) in the United States from 1991 to 1999. METHODS: Pregnancy-associated homicides were analyzed with data from the Pregnancy Mortality Surveillance System at the Centers for Disease Control and Prevention. RESULTS: Six hundred seventeen (8.4%) homicide deaths were reported to the Pregnancy Mortality Surveillance System. The pregnancy-associated homicide ratio was 1.7 per 100000 live births. Risk factors included age younger than 20 years, Black race, and late or no prenatal care. Firearms were the leading mechanism for homicide (56.6%). CONCLUSIONS: Homicide is a leading cause of pregnancy-associated injury deaths.