Traumatic Occupational Fatalities -- United States, 1980-1984
To help fill a critical gap in information on fatal occupational injuries, CDC's National Institute for Occupational Safety and Health (NIOSH) began gathering data in 1985 to establish the National Traumatic Occupational Fatality (NTOF) data base. The 50 states and the District of Columbia provided death certificates indicating deaths from traumatic occupational fatalities for 1980-1984*. Preliminary analyses of these data revealed a total of 32,342 traumatic occupational fatalities occurring at an average annual crude rate of 8.8/100,000 workers and resulting in an annual average of 165,172 years of potential life lost (YPLL) before age 65.
The NTOF data base includes only data from death certificates indicating that: 1) death was related to external causes*, 2) the deceased was greater than or equal to16 years of age at the time of death, and 3) the injury occurred at work. Data from 16 of the reporting jurisdictions were incomplete because they did not include any certificates reporting homicides or suicides or stating the cause of death as "pending". NIOSH is currently acquiring this missing information. For the initial analysis of NTOF data, occupational homicides and suicides were estimated for those states that did not provide them. These estimates were made using a regression equation based on data from states that did provide this information. Age-specific fatality rates were calculated using 1980 Bureau of the Census data (1). Denominator data for state- and industry-specific rates were derived from Bureau of the Census annual County Business Patterns bulletins for 1980-1984 and the 1982 Census of Agriculture (2,3). Denominator data did not include persons employed in public administration.
Analysis of the NTOF data indicates that approximately 7,000 traumatic occupational fatalities occurred per year in all 50 states and the District of Columbia during the period studied. Male workers were involved in 94.6 of the deaths, and females, in 5.4. For the 35 jurisdictions including homicides and suicides in their reports, 84.2 of fatalities resulted from unintentional injuries, 13.0 represented occupational homicides, and 2.8 represented occupational suicidesS (Table 1). Although the distribution for males was similar to the overall distribution, it was quite different for females. Forty-two percent of fatalities among females were homicides, and 4.6 were suicides. The number of reported fatalities for most age groups varied in direct proportion to the population of the work force in the age group. Fatality rates among the age groups generally ranged from 6.3 to 7.5/100,000 workers (Figure 1). Exceptions were the youngest age group (ages 16-19), which had a lower fatality rate (4.0), and the older age groups (55-59, 60-64, and greater than 64), which had progressively higher rates (8.5, 9.7, and 17.7, respectively).
The states with the highest average rates of occupational fatalities per 100,000 workers over the 5-year period were Wyoming (34.6), Alaska (33.5), and Montana (24.8). The lowest rates were in Massachusetts (2.1) and Rhode Island (2.4) (Figure 2). States with similar rates tended to cluster into regional groups. State-specific values for YPLL ranged from 174 years (Rhode Island) to 21,990 years (Texas) and generally reflected state-specific numbers of fatalities, which, in turn, depended largely on the size of each state's working population. Industry-specific rates of fatalities from all causes showed the highest annual average in mining (30.1/100,000 workers), construction (23.1), and agriculture (20.3); the lowest rate was in wholesale trade (1.1) (Table 2, see page 469). However, a significant proportion (20) of the total reported fatalities could not be included in the industry-specific analysis because data were not adequate to determine the industry involved. Reported by: Div of Safety Research, National Institute for Occupational Safety and Health, CDC.
Editorial Note: Although no complete and reliable nationwide census of traumatic occupational fatalities has been available previously, fatal occupational injuries-- whether measured by numbers of fatalities, rates, or YPLL--are recognized as an important source of preventable mortality in the United States (4). Estimates of the magnitude of the problem have varied considerably, as illustrated by the following 1984 estimates: the Bureau of Labor Statistics (BLS) reported 3,750 such deaths in 1984 (5); the National Safety Council (NSC) reported 11,500 (6); and the National Center for Health Statistics (NCHS) reported 4,960 (unpublished data). While the discrepancies can be attributed in part to the use of different methodologies, sampling strategies, and exclusions, they illustrate the need for more complete data. The NTOF data base represents an attempt to provide a complete census of work-related traumatic deaths rather than a sampling of such deaths.
There is adequate justification for basing NTOF surveillance on data from death certificates. This type of surveillance for occupational fatalities has found increasing use (7,8). The certificates are standardized and universally available, and they provide the required data (e.g., demographics, location, industry/occupation, etc.) with acceptable accuracy. The preliminary analyses reported here indicate that this surveillance system can provide current numbers of occupational fatalities, identify high-risk industries (or occupations) at the state level, and monitor trends over time. The average of 7,000 fatalities per year falls in the middle range of estimates reported by BLS, NSC, and NCHS, lending credence to the NTOF figures. The identification of mining, construction, and agriculture as highest risk industries is also consistent with other nationwide and state-based studies (4,9).
While this study demonstrates the potential value of this surveillance method, it also indicates some limitations currently in the system. Death certificates are selected and initially processed by different reporting units, and there may be inconsistencies in the way different jurisdictions determine whether or not an injury occurred at work (e.g., 16 reporting units failed to classify homicides and suicides as work-related). Another potential source of undercounting might be a failure to include work-related motor vehicle accidents.
This study also illustrates the difficulties encountered in obtaining denominator data to calculate rates. No single source of employment data provides complete information on geographic location, demographics, and industry/occupation for all workers. Therefore, NIOSH used 1980 census data to compute overall age-specific rates, but used separate census data bases to calculate state- and industry-specific rates. Even so, some analyses were incomplete because denominator data did not include certain worker populations (e.g., those employed in public administration). Fully satisfactory sources of denominator data must yet be identified for surveillance of occupational safety and health.
Nevertheless, the NTOF appears to provide the most accurate analysis of traumatic occupational fatalities to date and may well provide the data necessary to identify high-risk populations and, thus, reduce such deaths. Except for the homicides and suicides that occur "at work" and pose additional social parameters, the national toll of occupational traumatic deaths reported in the NTOF is largely preventable. The identification of particular states with higher fatality rates suggests possibilities for state-based or regional intervention efforts.
Bureau of the Census. 1980 census of population: U.S. summary. Washington, DC: US Department of Commerce, 1983; publication no. PC 80-1-B1.
Bureau of the Census. County business patterns (1980, 1981, 1982, 1983, 1984). Washington, DC: US Department of Commerce, 1982, 1983, 1984, 1985, 1986.
Bureau of the Census. 1982 census of agriculture. Washington, DC: US Department of Commerce, 1984.
CDC. Leading work-related diseases and injuries--United States. MMWR 1984;33:213-5.
Bureau of Labor Statistics. Occupational injuries and illnesses in the United States by industry, 1984. Washington, DC: US Department of Labor, 1986; bulletin 259.
National Safety Council. Accident facts, 1985 edition. Chicago, Illinois: National Safety Council, 1985.
Milham S. Occupational mortality in Washington state, 1950-1979. Cincinnati, Ohio: US Department of Health and Human Services, Public Health Service, CDC, 1983; DHHS publication no. (NIOSH)83-116.
Dubrow R, Wegman DH. Occupational characteristics of cancer victims in Massachusetts, 1971-1973. Cincinnati, Ohio: US Department of Health and Human Services, Public Health Service, CDC, 1984; DHHS publication no. (NIOSH)84-109.
CDC. Fatal occupational injuries--Texas, 1982. MMWR 1985;34:130-4, 139.
*Death certificates will be collected through 1990.
**Classified within the range of categories E800-E999 according to the International Classification of Diseases, 9th Edition.
***Suicides occurring in the workplace.
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