Appendix A
Surveillance System Descriptions
Overview
The data described in this document represent compilations from several
surveillance systems administered by various government agencies. In general, numerators
and denominators are determined differently from one system to the next. This appendix
provides a description of each of the surveillance systems used as data sources for much
of the information contained in this chartbook. The appendix also provides contact
information for acquiring additional details about the systems or using those systems for
surveillance or research. Table A–1 describes selected surveillance systems.
Bureau of Labor Statistics (BLS) of the U.S.
Department of Labor
BLS, under the U.S. Department of Labor, was established in 1884 and is
charged with collecting annual data on occupational safety and health. BLS publishes
either repeating annual bulletins or one-time bulletins addressing specific topics. Each
BLS office is responsible for a program that gathers information about the American
worker. The Office of Employment and Unemployment Statistics administers the Current
Population Survey (CPS), and the Office of Safety, Health, and Working Conditions
administers the Survey of Occupational Injuries and Illnesses (SOII) and the Census of
Fatal Occupational Injuries (CFOI).
Current Population Survey (CPS)
BLS compiles statistics on the employment status and related data using
CPS. This survey is published in a series of reports including, of most importance, the
annual
Employment and Earnings report. This survey provides denominators for many
of the injury and illness incidence rates presented in this chartbook.
To view, click on image.
Table A–1. Description of selected
systems
CPS is a monthly survey of households conducted for BLS by the Bureau of
the Census through a scientifically selected sample that represents the civilian
noninstitutional population. Respondents are interviewed to obtain information about the
employment status of each member of the household aged 15 years and older, although data
are routinely published on those aged 16 and older. The inquiry relates to activity or
status during the calendar week (Sunday through Saturday) that includes the 12th day of
the month. This is known as the "reference week." Actual field interviewing is
conducted in the following week, referred to as the "survey week." The concepts
and definitions underlying labor force data have been modified but not substantially
altered since the inception of the survey in 1940.
Each month, about 50,000 occupied units are eligible for interview. The sample provides
estimates for the Nation as a whole and provides data for model-based estimates for
individual States and other geographic areas. Some 3,200 of these households are contacted
but not interviewed because the occupants are not at home after repeated calls or are
unavailable for other reasons. This figure represents a noninterview rate for the survey
that ranges between 6% and 7%. In addition to the 50,000 occupied units, 9,000 sample
units in an average month are visited but found to be vacant or otherwise not eligible for
enumeration.
Part of the sample is changed each month. Three-fourths of the sample is
common from one month to the next, and one-half is common with the same month a year
earlier. Since 1953 (when the current 4–8–4 rotation system was adopted), households are
interviewed for 4 consecutive months, leave the sample for 8 months, and then return to
the sample for the same 4 months of the following year. Estimates obtained from CPS
include employment, unemployment, earnings, hours worked, and other indicators. They are
available for various demographic characteristics including age, sex, race, marital
status, and education. They are also available by occupation, industry, and class of
worker. Supplemental questions are also often added to the regular CPS questionnaire to
produce estimates on other topics including school enrollment, income, previous work
experience, health, employee benefits, and work schedules.
This
information for the employed applies to the job held in the reference week.
Persons with two or more jobs are classified in the job at which they worked the
greatest number of hours. The unemployed are classified according to their last
job. The occupational and industrial classification of CPS data is based on the
coding systems used in the 1990 census until recently. Over the next years, BLS
will begin using the newly developed North American Industry Classification
System (NAICS) (www.census.gov/epcd/www/naics.html).
For further information contact <
Office of Employment and Unemployment Statistics
Bureau of Labor Statistics
2 Massachusetts Avenue, NE
Washington, DC 20212
Telephone: 202—691—6400
(www.bls.gov)
Survey of Occupational Injuries and Illnesses
(SOII)
The annual SOII is a surveillance system in which employer reports are
collected by BLS from private industry establishments. About 165,000 establishments were
included in the 1997 survey. A two-part survey is conducted and provides estimates for the
United States and separately for participating States. Part 1, which has been collected
since 1972, provides estimates of the number and incidence of injuries and illnesses by
Standard Industrial Classification (SIC). Part 2, which was added to the survey in 1992,
provides estimates of demographic characteristics of workers with injuries and illnesses
involving time away from work. Part 2 also provides data on the circumstances of the
injuries and illnesses with time away from work.
The survey sample is selected using stratified random sampling from all
private industry employers of one or more workers. MSHA and the Department of
Transportation's Federal Railroad Administration provide comparable occupational injury
and illness data for coal, metal mining, nonmetal mining, and for railroad activities. The
survey also gathers information on the average number of workers employed and the total
hours worked at each establishment during the year. The survey collects the number of
work-related injuries and illnesses that the employer has recorded on the Annual Log and
Summary of Occupational Injuries and Illnesses (OSHA No. 200) kept by each establishment
[29 CFR* 1904; OSHA 2000a]. Injury is a single reporting category. Illnesses are divided
into seven broad categories: skin diseases or disorders, dust diseases of the lungs,
respiratory conditions due to toxic agents, poisoning, disorders due to physical agents,
disorders associated with repeated trauma, and all other occupational illnesses. These
data are called the industry summary data (Part 1 of the survey). Since 1972, this
information has been used to identify industries with high rates of injuries and
illnesses.
In 1992, a second part was added that collects descriptive information about
a sample of the cases that resulted in at least 1 day away from work. Establishments take
this information from workers' compensation reports, insurance forms, or other supplementary
records (for example, the OSHA Form 101—Supplementary Record of
Occupational Injury and Illness [29 CFR 1904; OSHA 2000b]). These data are called the case
and demographic data. The descriptive information includes the personal characteristics of
the injured or ill worker: industry, occupation, race/ethnicity, sex, age, and length of
service with the employer. The injury or illness is characterized with information on the
nature of the injury or illness; the part of body affected; the event or exposure leading
to the injury or illness; and the source (the object, substance, bodily motion) that
directly produced the injury or illness. The number of days away from work is collected as
a surrogate for the severity of the case.
Industry is coded using the 1987 SIC Manual [OMB 1987], and occupation is
coded using the 1990 Bureau of the Census classification system. For manufacturing
industries, information is available at the 4-digit SIC level. For all other industries,
the most detailed level is 3-digit. The nature of the injury or illness, the part of body
affected, the source of injury or illness, and the event are coded according to the
Occupational Injury and Illness Classification System developed by BLS [1992]. This system
provides coding at four levels, from 1-digit to 4-digit, although not all categories can
be expanded to the 4-digit level. NAICS will be used to code industry beginning with the
2003 survey (see Appendix B).
The complex statistical design of the annual survey required BLS to design
special computer software to calculate estimates and variances. Data are not released when
estimates do not meet publication guidelines as determined by BLS. The self-employed;
farms with fewer than 11 employees; private households; and Federal, State, and local
government agencies are excluded from the survey.
From 1972 through 1997, BLS disseminated this summary data either in a BLS publication
or on the Internet. Information is available about the number and rates of all injuries
and the seven illness categories by industry. The categories of all injuries and all
illnesses are divided into cases without lost workdays and lost-workday cases. Lost-workday
cases are further divided into cases with restricted work activity only and cases
with days away from work. Selected information is available by number of
employees. Information about workers with injuries and illnesses requiring recuperation
away from work and the characteristics of their injuries and illnesses is available for
1992 through 1997.
For further information contact
Office of Safety, Health, and Working Conditions
Bureau of Labor Statistics
2 Massachusetts Avenue, NE
Washington, DC 20212
Telephone: 202–691–6170
(www.bls.gov/iif/)
Census of Fatal Occupational Injuries (CFOI)
CFOI is a
Federal and State cooperative program that each year accesses multiple data
sources to compile a complete roster of occupational fatal injuries. Since 1992,
the fatality census has been conducted in all 50 States and the District of
Columbia. CFOI includes data for all fatal work injuries—those that are covered
by the Occupational Safety and Health Administration (OSHA) or other Federal or
State agencies and those that are outside the scope of regulatory coverage.
A fatality is included in the census if the decedent was working for pay,
compensation, or profit at the time of the event; engaged in a legal work activity; or
present at the site of the incident as a requirement of his or her job. These criteria are
generally broader than those used by Federal and State agencies. Thus any comparison
between BLS census counts and those released by other agencies should take into account
the different coverage requirements and definitions. Fatalities that occur during a
person's commute to or from work are excluded from the BLS census.
An injury is defined as any intentional or unintentional wound or damage to the body resulting
from (1) acute exposure to energy such as heat or electricity or kinetic
energy from a crash, or (2) the absence of such essentials as heat or oxygen caused by an
event, incident, or series of events within a single workday or shift. Included are open
wounds, intracranial and internal injuries, heatstroke, hypothermia, asphyxiation, acute
poisonings resulting from a short-term exposure limited to the worker's shift, suicides
and homicides, and work injuries listed as underlying or contributory causes of death.
Occupational fatal illnesses are not reported in the BLS census.
Data for CFOI are compiled from various Federal, State, and local administrative sources (including death certificates, workers' compensation reports and claims, reports to various
regulatory agencies, medical examiner reports, and police reports) as well as
news reports. Multiple sources are accessed because studies have shown that no single
source captures all occupational fatalities. Source documents are matched so that each
fatality is counted only once. To ensure that a fatality occurred while the decedent was
at work, information is verified from two or more independent source documents, or from a
source document and a followup questionnaire.
Approximately 30 data elements are collected, coded, and tabulated,
including information about the worker, the fatal incident, and the machinery or equipment
involved. Industry and occupation describe the job the worker held at the time of the
fatal incident. Industry is classified according to the 1987 SIC system. Occupation is
coded according to the Bureau of the Census occupational classification system. Industry
data are typically reported separately for the public and private sectors. The BLS
Occupational Injury and Illness Classification System is used to classify the nature of
the injury, part of body affected, primary and secondary sources of injury, and the
exposure leading to the fatality. Other data elements include the worker's age, sex, and
race; the time of day that the fatal event occurred; the activity the worker was
performing when injured; and the location where the event occurred.
States may identify additional fatal work
injuries after data collection closeout for a reference year. Other fatalities
excluded from the published count because of insufficient information to
determine work relationship may be subsequently verified as work related. States
have 1 year to update their initial published counts. This procedure ensures
that fatality data are disseminated as quickly as possible, and that no
legitimate case is excluded from the counts.
Approximately 8 months after the end of the reference year,
BLS publishes summary data in a national news release. Articles and detailed
tables containing national and State data are published regularly in the BLS
quarterly publication Compensation and Working
Conditions and occasionally in the Monthly Labor
Review. Other products of the CFOI program include profiles of occupations,
industries, or types of events; a yearly compendium (Fatal Workplace Injuries in [year]: A Collection of Data and Analysis);
and a data file for researchers that is available through a letter of agreement
to protect confidentiality of workers and companies. Most of the published
reports are available on the BLS Web site (www.bls.gov/iif/oshcfoi1.htm). States
also produce news releases and reports on State-specific hazards. A list of
participating agencies and their phone numbers is available in the 1998 news
release on the BLS CFOI Internet site.
For further information contact
Office of Safety, Health, and Working Conditions
Bureau of Labor Statistics
2 Massachusetts Avenue, NE
Washington, DC 20212
Telephone: 202–691–6175
(www.bls.gov/iif/oshcfoi1.htm)
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Centers For Disease Control and Prevention (CDC), U.S. Department
of Health and Human Services
CDC is one of eight public health agencies in
the U.S. Department of Health and Human Services with the mission of promoting
health and quality of life by preventing and controlling disease, injury, and
disability. CDC added prevention to its mission after an increasing percentage
of its resources were spent on preventing diseases rather than controlling
existing ones (www.cdc.gov/aboutcdc.htm#mission). CDC consists of
12 centers,
institutes, and offices in 10 locations and additional employees in State health
departments, quarantine offices, and other countries.
National Institute for Occupational Safety and Health
(NIOSH)
NIOSH, an institute within CDC, was
established by the Occupational Safety and Health Act of 1970. NIOSH maintains a
range of surveillance systems and produces a wide variety of reports. These
range from the approximately biennial work-related lung disease (WoRLD) reports
to one-time reports covering a group of diseases or conditions over several
years, such as Fatal Injuries to Workers in the United
States, 1980–1989: a Decade of Surveillance [NIOSH 1993], Mortality by Occupation, Industry, and Cause of Death: 1984–1988
[NIOSH 1997], and the Atlas of Respiratory Disease
Mortality, United States: 1982–1993 [Kim 1998]. Reports describing
point prevalence of a range of diseases or conditions in certain industries
(such as health hazard evaluation surveys) or project reports are generally
accessible through the NIOSH Web site (www.cdc.gov/niosh/pubs.html).
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National Electronic Injury Surveillance
System (NEISS)
The Consumer Product Safety Commission (CPSC)
developed NEISS to monitor injuries involving consumer products and to serve as
a source for followup investigation of selected product-related injuries
[McDonald 1994]. Data are collected at 101 hospitals selected from a stratified
probability sample of all hospitals in the United States and its territories.
The sampling frame was stratified by hospital size (determined by the annual
total of emergency department visits) and geographic region, and the final
sample of 101 hospitals was then selected. NIOSH entered into an interagency
agreement to collect work-related injury data in 67 of the 101 hospitals. Each
injury case in the sample was assigned a statistical weight based on the inverse
of the hospital's probability of selection, and this weight was used to
calculate national estimates. Confidence intervals (CIs) were calculated using
methods described in detail elsewhere [Layne and Landen 1997].
A work-related case was defined as any injury
sustained during (1) work for compensation, (2) volunteer work for an organized
group, or (3) a work task on a farm. The Operational
Guidelines for Determination of Injury at Work were provided to hospital
coders to identify work-related injuries [NIOSH 1993]. Unlike CPSC consumer
product data, the work-related data collected for NIOSH included all cases
regardless of whether a consumer product was involved in the injury event.
Estimates of numbers of workers, used to
calculate injury rates, were derived from the monthly Current Population Survey
(CPS) of BLS, a national, population-based household survey that includes
approximately 50,000 households each month [BLS 1997]. For this report, injury
and illness rates were estimated as the number of cases per 100 full-time
workers (2,000 working hr/full-time worker). Workers less than 16 years of age
were excluded from this analysis.
For further information contact
Surveillance and Field Investigations Branch
Division of Safety Research
National Institute for Occupational Safety and Health
1095 Willowdale Road, MS 1812
Morgantown, WV 26505
Telephone: 304–285–5980
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National Occupational
Mortality Surveillance System (NOMS)
NOMS was developed to provide information
about work-related deaths by industry and occupation using the United States
Standard Certificate of Death. Information about the occupation of the decedent
has been recorded since 1900, but this information has not been readily
accessible until recently.
Over the last decade, NIOSH, the National Center for Health
Statistics (NCHS), the National Cancer Institute (NCI), and Bureau of the Census
have collaborated to (1) improve the quality of the occupational data collected
on death certificates, (2) develop routine standardized coding of this
information by State health departments, and (3) partially reimburse selected
States for producing these data. The first report using these data was a Monthly
Vital Statistics Report Supplement, based on the 1984 data from 12 States
[Rosenberg et al. 1993]. The data included cause-specific estimates of relative
risk for broad occupation and industry categories for both male and female
workers.
The United States Standard Certificate of
Death requests information about the usual occupation and kind of business or
industry for each decedent. Beginning in 1983, an increasing number of State
health departments have coded this information using standardized coding
procedures. Twenty-four State health departments included the data in the coded
death certificate information provided to NCHS for 1 or more years from 1984
through 1988.
The information about occupation and industry was coded according to the 1980 Bureau of the
Census classification [Bureau of the Census 1982]. The underlying cause of death
was coded according to the International Classification of Diseases, Ninth
Revision (ICD–9) [WHO 1977]. Data included in this chartbook are based on an
analysis of 185 selected causes of death for male workers and 188 selected
causes for female workers. The analysis includes deaths that occurred in the 24-State reporting area among residents of one of the 24 States. The criteria for
inclusion in the analysis differed for male and female workers. For male
workers, all white and black decedents aged 20 and older were included. For
female workers, decedents reported in the occupation category of "Housewives,
homemakers" were not included in either the occupation or industry analysis.
Therefore, all white and black female decedents aged 20 and older with an
occupation code other than "Housewives, homemakers" were included.
Age-standardized proportionate mortality
ratios (PMRs) for the four racesex groups reported in this chartbook were
calculated using a computer program developed at NIOSH [Dubrow et al. 1993]. For
each racesex group, the program calculates PMRs by comparing the proportion of
deaths from a specific cause within an occupation or industry group with the
proportion of deaths from that cause for all occupations or industries. Age
stratification was done by 5year age groups. The program provides 95% confidence
limits for the PMRs. The limitations of PMR studies include potential inaccuracy
of cause of death and imprecise exposure classification based on usual
occupation [Breslow and Day 1987]. In addition, information is lacking about
length of employment and possible confounders such as smoking, alcohol, or
socioeconomic status. Although PMR studies are useful for hypothesis generation
[Checkoway et al. 1989], lack of population data precludes obtaining death rates
[Rothman 1986]. The PMR indicates only whether the age-standardized proportion
of deaths from a specific cause appears to be higher or lower than the expected
proportion for an occupation or industry. Also, the PMR for one cause of death
may be relatively high if proportions of other causes of death are relatively
low [DeCouflé et al. 1980]. Thus the PMR for each cause of death depends on the
PMRs computed for the other causes in an occupation or industry analysis. This
can be especially important if the occupation under study has relatively high or
low mortality due to some common cause of death. If the PMR is low, the PMR for
other causes may be artificially inflated. The PMR will be a poor estimate of
the risk of death if the population-based standardized mortality ratio (SMR) for
all causes for an occupation or industry group is greatly above or below 100.
Prior publications from this system include Mortality by Occupation, Industry, and
Cause of Death, 24 Reporting States (1984–1988) [NIOSH 1997], which includes
a data diskette for those years. More recent versions are being mounted on a
Web-accessible version at the NCI.
For further information contact
Surveillance Branch
Division of Surveillance, Hazard Evaluations, and Field Studies
National Institute for Occupational Safety and Health
4676 Columbia Parkway, MS R18
Cincinnati, OH 45226
Telephone: 513–841–4219
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National Surveillance System for Pneumoconiosis Mortality
(NSSPM)
NSSPM is a pneumoconiosis mortality
surveillance system developed and maintained by the Division of Respiratory
Disease Studies, NIOSH. The system provides statistics for the surveillance of
occupational respiratory diseases in an easily accessible, user-friendly format.
The data are a subset of national mortality data obtained annually from NCHS
since 1968. Currently, NSSPM contains death certificate information for
1968–1996 for all U.S. decedents aged 15 and older identified with any type of
pneumoconiosis listed as either an underlying or contributing cause of death.
Additional information includes age, race, sex, and State and county of
residence at the time of death. Usual occupation and industry of each decedent
have been available for several States since 1985.
Types of pneumoconioses included in the NSSPM
are based on International Classification of Diseases coding categories (ICD–8
[WHO 1967] from 1968–1979, and ICD–9 [WHO 1977] from 1979–1996): asbestosis,
coal workers' pneumoconiosis (CWP), silicosis, byssinosis, other/unspecified
pneumoconioses, and all pneumoconioses aggregated.
NSSPM is designed to generate a variety of
summary statistics, tables, charts, and maps. Examples of the types of
statistics this system generates are counts of deaths, crude and age-adjusted
rates, and years of potential life lost by year, age group, race, sex, and usual
occupation or industry at the national, State, and county levels. Data from
additional sources, such as population statistics, comparative standard
population, and life table values are incorporated into the system.
For further information contact
Public Health Surveillance Team
Surveillance Branch
Division of Respiratory Disease Studies
National Institute for Occupational Safety and Health
1095 Willowdale Road
Morgantown, WV 26505–2888
Telephone: 304–285–6115
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Coal Workers' X-Ray Surveillance
Program (CWXSP)
The United States Federal Coal Mine Health and
Safety Act of 1969 mandated several programs as part of a broad lung disease
prevention effort. One program, CWXSP, makes available radiographic chest-
examinations to working coal miners at all underground coal mines in the United
States. Examinations are available to miners on a voluntary basis at least once
every 5 years. If the results indicate radiographic evidence of coal workers'
pneumoconiosis (CWP), the miner is given the right [under 30 CFR Part 90] to
transfer to an area of the mine where exposures are continuously at or below l mg/m3 respirable coal dust. This program provides
secondary (medical monitoring) occupational disease prevention efforts for the
mining industry.
The operation of CWXSP is guided by
regulations published in Title 42 of the Code of Federal regulations [42 CFR
37]. In brief, the regulations specify the following:
- Every new miner must be examined within 6
months of employment and again 3 years later.
- If the 3-year X-ray shows signs of CWP, a
third X-ray must be taken 2 years later.
- After these initial examinations, miners are
eligible to have a voluntary chest X-ray once every 5 years.
- At NIOSH-certified facilities, miners can
receive radiographic examinations that consist of chest radiographs and
supporting demographic and work history information.
- Chest radiographs must be classified by at
least two NIOSH-certified readers according to a standardized system for
classifying radiographs of the pneumoconioses [ILO 1980].
- A final determination value is based on
these classifications.
- A final determination value of small opacity profusion
category 1/0 or higher is accepted as evidence of CWP.
- A miner with evidence of CWP may choose to
transfer to a low-dust work environment.
For further information contact
Coal Workers' X-Ray Surveillance Program Activity
Surveillance Branch
Division of Respiratory Disease Studies
National Institute for Occupational Safety and Health
1095 Willowdale Road
Morgantown, WV 26505–2888
Telephone: 304–285–5724
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National Traumatic Occupational
Fatalities Surveillance System (NTOF)
NTOF is composed of information obtained from
death certificates from the 52 U.S. vital statistics reporting units in the 50
States, New York City, and the District of Columbia for workers aged 16 and
older for whom an external cause of death [WHO 1977] was noted, and for whom the
certifier entered a positive response to the Injury at
Work? item.
The industry and occupation on death
certificates are defined as the "usual" industry and occupation of the victim.
Industry and occupation narratives were coded according to the 1980 and 1990
Bureau of the Census classification schemes [Bureau of the Census 1982, 1992].
These data are reported by the major industry and occupation divisions as
defined by the Bureau of the Census.
Limitations of death certificates used to ascertain
work-related fatality information have previously been described [Russell and
Conroy 1991; Stout and Bell 1991; NIOSH 1993]. Incomplete or unclear information
on the death certificate and the lack of a national standard for completing the
Injury at Work? item on the death certificate during
this period are particular problems.
For much of the period this system has been used, no
standardized guidelines were available for completing the Injury at Work? item on the death certificate. This item was subject to certifier interpretation. Although the lack of standardized reporting of this item may result in both false positives and false negatives,
the numbers reported here are apt to represent the minimum number of
occupational deaths that occurred in the United States during the period.
Death certificates ask for the "usual"
occupation and industry of the person who died, which may not necessarily
reflect the occupation or industry engaged in at the time of the fatal injury.
Studies comparing death certificate entries for usual occupation and industry
with information about occupation and industry at the time of death found
agreement for occupation in 64% to 74% of the cases, and for industry in 60% to
76% of the cases [Karlson and Baker 1978; Baker et al. 1982; Davis 1988; Schade
and Swanson 1988; Massachusetts Department of Public Health 1989]. Some studies
indicate that although death certificates ask for the "usual" occupation and
industry, the information recorded on the death certificates is more likely to
reflect occupation or industry at time of death rather than lifetime employment
[Davis 1988; Schade and Swanson 1988]. For these reasons, the possibility exists
that for any surveillance system based on death certificates, cases may be
misclassified with respect to industry and occupation.
Denominator data were obtained from BLS CPS, a
sample survey of the civilian noninstitutional population. These data were
extracted from the BLS Employment and Earnings and
the CPS monthly employment files [BLS 1981–1996; BLS 1992]. Fatality rates were
calculated as average annual deaths per 100,000 workers. Rates were not
calculated for cells with fewer than three cases because of the instability of
rates based on small numbers. Frequencies and rates are presented for the
civilian workforce only because denominator data are not easily obtainable for
military personnel.
For further information contact
Surveillance and Field Investigations Branch
Division of Safety Research
National Institute for Occupational Safety and Health
1095 Willowdale Road, MS 1812
Morgantown, WV 26505
Telephone: 304–285–6009
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Sentinel Event Notification System for
Occupational Risk (SENSOR)
The original concept of SENSOR was based on a
communicable disease surveillance model: providers (individual practitioners or
health care facilities) reported disease cases to a health department. It had
two organizational components—a network of sentinel providers (individual
practitioners, laboratories, or clinics) who identified and reported the
occupational cases, and a surveillance center in a State agency that analyzed
reports and took action (confirmed cases and collected additional information
through case followup, evaluated worksite factors, and recommended
interventions). SENSOR created a cooperative, State-Federal effort to develop
State capacity for recognizing, reporting, following up, and preventing selected
occupational conditions. Initially, 10 States participated by focusing on one or
more selected occupational conditions (acute pesticide-related illness and
injury, asthma, carpal tunnel syndrome (CTS), lead poisoning, noise-induced
hearing loss, and silicosis).
The SENSOR program of today is different from
the original concept. Case identification has been enhanced to include not only
physician reporting but information sources such as death certificates, hospital
discharge data, and workers' compensation records. Intervention- activities
have been broadened to include information dissemination, education, referral to
enforcement agencies, and consultation. Currently, 13 States (California,
Florida, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York,
Ohio, Oregon, Texas, Utah, and Washington) have SENSOR programs for one or more
of the following occupational conditions: acute pesticide poisoning, asthma,
CTS, lead poisoning, noise-induced hearing loss, amputations, silicosis, and
youth occupational injury.
For further information contact
Asthma and silicosis surveillance at NIOSH/CDC are coordinated through the:
Public Health Surveillance Team
Surveillance Branch
Division of Respiratory Disease Studies
National Institute for Occupational Safety and Health
1095 Willowdale Road, MS HG900
Morgantown, WV 26505–2888
Telephone: 304–285–6115
Pesticide-related illness and injury surveillance
activities at NIOSH/CDC
are coordinated through the:
Medical Section
Surveillance Branch
Division of Surveillance, Hazard Evaluations, and Field Studies.
4676 Columbia Parkway, MS R21
Cincinnati, OH 45226
Telephone: 513–841–4448
CTS and noise surveillance coordinated through the:
Surveillance Branch
Division of Surveillance, Hazard Evaluations, and Field Studies.
4676 Columbia Parkway, MS R17
Cincinnati, OH 45226
Telephone: 513–841–4303
SENSOR coordination occurs through the:
Surveillance Branch
Division of Surveillance, Hazard Evaluations, and Field Studies.
4676 Columbia Parkway, MS R17
Cincinnati, OH 45226
Telephone: 513–841–4303
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Adult Blood Lead Epidemiology
and Surveillance Program (ABLES)
The ABLES program is a national model for
developing State-based surveillance. The surveillance of elevated blood lead
levels (BLLs) provides the public health community (local, State, Federal) with
essential data for monitoring adult lead poisoning and setting priorities for
indepth research, intervention, and information dissemination. The public health
objective of the ABLES program is to eliminate exposures that result in workers
having BLLs greater than 25 µg/dL of whole blood [DHHS 1990].
In 1998, the nationwide ABLES
consisted of 27 State programs funded by NIOSH. These programs collect BLL data
from local health departments, private health care providers, and private and
State reporting laboratories. State ABLES use their data to (1) conduct
followups with physicians, workers, and employers, (2) target onsite inspections
of worksites, (3) provide referrals to cooperating agencies in the event
regulatory action is necessary, and (4) conduct hazard surveillance to identify
workplace exposures and control technology solutions. Findings from ABLES data
have been used to identify high-risk industries, occupations, and tasks,
including radiator repair shops, battery recycling operations, and
construction-related jobs such as bridge repair and home remodeling. State
educational materials for preventing adult and take-home lead poisoning are
listed on the NIOSH Web site (www.cdc.gov/niosh/ables.html).
An essential criterion for ABLES is
a State requirement that laboratories report BLL results to the State health
department or designee. The lowest BLL to be reported varies from State to
State. However, the reporting of all BLLs, elevated
or not, is extremely useful for analyzing trends in these data. State ABLES
programs are required to develop effective, well-defined working relationships
with childhood lead poisoning prevention programs within their State. Lead may
be taken home from the workplace on clothes or in cars, thus potentially
exposing spouses and children. Children who come in contact with lead-exposed
workers should be targeted for blood lead screening. Results are presented to
the public via ABLES reports in the CDC Morbidity and
Mortality Weekly Report.
For further information contact
Medical Section
Surveillance Branch
Division of Surveillance
Hazard Evaluations and Field Studies
National Institute for Occupational Safety and Health
4676 Columbia Parkway
Cincinnati, OH 45226
Telephone: 513–841–4424
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Mining Injury and Employment
Statistics
Data were obtained from the Mine Safety and
Health Administration (MSHA) databases of reported employment and reported cases
of accident/injury/illness for mine operators as well as independent contractors
working on mine property as required under 30 CFR Part 50 [MSHA 1999]. The
historical data (presented in Figure 6–1 for
the period 1911–1995) were derived from several different sources [MSHA 1999;
Adams and Wrenn 1941; Adams and Kolhos 1941; Reese et al. 1955; MSHA 1984].
According to 30 CFR Part 50, mine
operators and independent contractors whose employees perform certain types of
work on mine property are required to file a Mine
Accident, Injury, and Illness Report (Form 70001) [30 CFR 50.20; MSHA 2000a]
for reportable incidents within 10 working days after the accident or injury, or
10 working days following the illness diagnosis. The term "reportable injury" as
defined by MSHA includes all incidents that require medical treatment or result
in death, loss of consciousness, inability to perform all job duties, or
temporary assignment or transfer to another job. Injuries involving "first-aid
only" are not reportable. (First-aid only is defined as one-time treatment and
subsequent observation of minor scratches, cuts, burns, splinters, etc. that do
not ordinarily require medical care, even if it was provided by a physician or a
registered health care professional.) Information reported on MSHA Form 70001
includes demographics of the injured or ill worker such as age, sex, years of
total mining experience, years of experience at current mine, where the incident
occurred (i.e., underground, surface, plant/mill), days away from work, days of
restricted work activity, source of the injury, body part(s) injured, and a
narrative description of the incident.
Also, under 30 CFR Part 50, mine operators and independent
contractors whose employees perform certain types of work on mine property are
required to file a Quarterly Mine Employment and Coal
Production Report (MSHA Form 7000-2) [30 CFR 50.30; MSHA 2000b] within 15
days after the end of each calendar quarter. This information is reported in the
address and employment files and includes the address and other contact
information, production of clean coal tonnage, average number of- persons
employed during the reporting period, and the corresponding number of hours
worked for each type of operation (designated by MSHA as operational subunits
that include underground operations, strip operations, plants or mills, etc.).
Commodity
differences for type of employer (mining operators versus independent
contractors).
The five commodity groups of coal (anthracite and
bituminous), metal, nonmetallic minerals (nonmetal†),
stone, and sand and gravel are based on a modification of the six ‘canvass classes’ designated by MSHA for mine operators. The only modification combines
anthracite coal and bituminous coal into coal. Because independent contractors
may work at multiple mining operations associated with a diversity of
commodities, a ‘canvass class’ is not designated for independent contractors.
Rather, independent contractors report employment under two aggregates: (1) all
coal locations, and (2) all metal, nonmetal, stone, and sand and gravel
locations. As a result of these reporting differences, fatality and injury rates
for independent contractors can only be computed for coal and metal/nonmetal
locations. However, within these two aggregates, independent contractors report
employment separately for each type of operation (designated by MSHA as
operational subunits that include underground operations, strip operations,
plants or mills, etc.). Consequently, fatality and injury rates can be computed
for both mine operators and independent contractors by type of operation.
Injury data inclusion
criteria
For the period 1988 to 1997, only cases that were coded as a
degree injury 1–6 were included. This excludes reportable incidents not
associated with an injury (degree injury 0), illnesses (degree injury 7), and
nonoccupational injuries and illnesses that are maintained in the MSHA files
because they occurred on mine property. Of those cases coded degree injury 1–6,
office workers were excluded from analyses by excluding both employee hours and
injuries reported for office locations (MSHA subunit code = 99).
Selection criteria for fatalities
The number of fatalities used for the analyses varies from the number of fatalities reported
in the MSHA accident/injury/illness databases as follows:
- Seventeen fatalities attributed to and associated with
a contractor code of "ZZZ" were excluded from all analyses. Although these
fatalities occurred on mine property, the victims were not employees of either
an independent contractor or mine operator. Rather, these victims were on mine
property for other reasons (e.g., visitors, customers) when they were fatally
injured.
- Three fatalities attributed to mine operators were
excluded from all analyses. Although fatally injured on mine property, the
victims were nonemployees and minors (aged 5, 15, and 16).
- Four additional fatalities were included in all
analyses, two for independent contractors and two for mine operators per
subsequent MSHA errata file. Two of these fatalities were originally reported
in the database as nonfatal injuries.
- One independent contractor fatality was excluded as
not having occurred on mine property per subsequent MSHA errata file.
Selection criteria for
lost-workday cases
Lost-workday cases include only those cases that
resulted in total or partial permanent disabilities, days away from work, or
days of restricted work activity (MSHA degree of injury codes 2 through 5). The
number of lost workdays were computed by summing the days away from work and
days of restricted work activity, with one exception. For injuries resulting in
total or partial permanent disabilities, lost workdays were the statutory days
charged to the incident [MSHA 1998] whenever the statutory days exceeded the
lost workdays reported or when lost workdays were unreported.
Calculation of injury
rates.
Injury rates for the period 1988–1997 were computed using employment
estimates derived from total hours worked. Full-time workers were calculated by
dividing total hours by 2,000 hours/worker. Nonfatal injury rates were
constructed per 100 full-time workers, and fatal injury rates per 100,000
full-time workers. Of note, MSHA publishes both fatal and nonfatal injury rates
on the basis of 200,000 hours worked, which is equivalent to 100 full-time
workers. Fatality rates for the historical data (Figure 6–1) were computed using
average numbers of workers, because of the lack of exposure hours during the
first few decades of this century.
Determining the type of incident
associated with the injury.
MSHA's accident/injury/illness
classification scheme was used to establish the type of incident associated with
a fatality or nonfatal injury [MSHA 1998]. The type of incident is identical to
MSHA's accident/injury/illness with two exceptions:
-
Both fatal and nonfatal cases classified as
a fall of highwall or rib (accident/injury/illness
code = 06) or as a fall of roof or back
(accident/injury/illness code = 07) are reported under the type of incident fall of ground.
- Nonfatal injury cases occurring underground
and classified under machinery (accident/injury/illness = 17) were reclassified as a fall of ground if the source of the injury was caving rock, ore, etc. (MSHA source of injury code =
90). This reclassification is consistent with the way in which MSHA classifies
similar incidents that resulted in a fatal injury. Typically, the victim is
operating a roof bolter or continuous miner and is struck by caving rock from
the mine roof or rib.
MSHA data compared with
other surveillance systems.
The mining data presented in this report may
differ from mining industry data for the same period using NTOF and CFOI
surveillance systems. Both NTOF and CFOI use the 1987 SIC Manual [OMB 1987] to categorize
fatal injuries by industry. The SIC classification scheme includes oil and gas
extraction in the mining industry. MSHA excludes oil and gas extraction, as
regulatory authority is delegated to OSHA. In addition, MSHA data include only
incidents that occur on mine property. Therefore, an injury occurring during the
course of work, but off mine property, is excluded from the MSHA file. NTOF and
CFOI systems would capture this type of injury.
For more information please see
Injuries, Illnesses, and Hazardous Exposures in the Mining
Industry, 1986–1995: A Surveillance Report
[NIOSH 2000]. The report
summarizes available data on work-related fatal and nonfatal injuries in the
mining industry for the 10-year period 1986–1995.
For further information contact
Surveillance, Statistics, and Research Support Activity
National Institute for Occupational Safety and Health
Pittsburgh Research Laboratory
626 Cochrans Mill Road
Pittsburgh, PA 15236
Telephone: 412–386–6617
or
Mining Surveillance and Statistical Support Activity
National Institute for Occupational Safety and Health
Spokane Research Laboratory
315 E. Montgomery Avenue
Spokane, WA 99207
Telephone: 509–354–8065
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National Center for Health Statistics (NCHS)
NCHS is one of 12 centers, institutes, and
offices of CDC. As the Nation's principal health statistics agency, NCHS
provides statistical information to guide actions and policies to improve the
health of the American people. NCHS surveys and data systems provide fundamental
public health and health policy statistics that are used to track changes in
health and health care delivery. Statistics are obtained through a broad-based
program of ongoing and special studies in partnership with State government,
including household interview surveys, examination surveys, surveys of health
care providers, and collection of statistics on birth and death. NCHS
participates with other agencies, such as NIOSH, and maintains some data systems
collaboratively, such as NOMS. Further information is accessible through its Web
site (www.cdc.gov/nchs/about.htm).
National Hospital Ambulatory
Medical Care Survey (NHAMCS)
The National Ambulatory Medical Care Survey
(NAMCS) was begun in 1973 to collect data on the use of ambulatory medical care
services provided by office-based physicians. In 1992, NHAMCS was inaugurated to
expand the scope of data collection to the medical services provided by hospital
outpatient departments and emergency departments. Together, NAMCS and NHAMCS
data provide an important tool for tracking ambulatory care use in the United
States. These surveys along with a third survey, the National Survey of
Ambulatory Surgery, constitute the ambulatory care component of the National
Health Care Survey, which measures health care use across various types of
providers.
Approximately 2,500
physicians are in the NHAMCS sample each year. The four-stage probability sample
design used in the survey involves (1) primary sampling units, (2) hospitals
within primary sampling units, (3) emergency departments within hospitals and/or
clinics within outpatient departments, and (4) patient visits within emergency
departments and/or clinics. Approximately 500 hospitals are in the sample each
year. Hospitals are defined as facilities having an average patient stay of less
than 30 days or those whose specialty is general (medical or surgical) or
children's general. Clinic types are general medicine including internal
medicine and primary care, surgery, pediatrics, obstetrics and gynecology, and
other, such as neurology and psychiatry.
The Bureau of the Census is responsible for NHAMCS data
collection. Information is collected on patient characteristics such as age,
sex, race, expected source of payment, reason for visit, diagnoses, place of
injury- occurrence, whether the injury was work-related, whether the injury
was intentional, cause of injury, diagnostic and screening services,
medications, disposition, and providers seen. Data have been collected on
work-related injury visits since 1995. Beginning in 1997, verbatim text that
describes the cause of injury may be analyzed. As with all probability sample
surveys, the sample data may not have enough cases to produce reliable estimates
for some subgroups.
For further information contact
Ambulatory Care Statistics Branch
Division of Health Care Statistics
National Center for Health Statistics
6525 Belcrest Road, Room 952
Hyattsville, MD 20782
Telephone: 301–458–4600
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National Health and Nutrition
Examination Survey (NHANES)
NCHS makes available public-use data from
NHANES, a series of national surveys initiated in 1960. The fundamental purpose
of these surveys is to characterize the health and nutritional status of the
civilian noninstitutionalized population of the United States. The third
National Health and Nutrition Examination Survey (NHANES III), conducted from
1988 to 1994, was a cross-sectional household interview and physical examination
survey of the U.S. civilian noninstitutionalized population aged 2 months and
older. NHANES III data were collected in 81 counties across the Nation from
approximately 30,000 respondents among 39,696 persons selected for
participation. Adults aged 17 and older constituted 20,050 respondents.
On the basis of the NHANES III adult (aged 17
and older) household interview, chronic obstructive pulmonary disease (COPD) was
defined as a yes response to either of the following
questions: (1) Has a doctor ever told you that you had chronic bronchitis? or
(2) Has a doctor ever told you that you had emphysema? Asthma was defined as a
yes response to the question, "Has a doctor ever told
you that you had asthma?" Prevalence rates for COPD and for asthma were
estimated for nonsmokers (using sample weights and adjustment for nonresponses)
by usual industry (using the 44 industry categories as regrouped by NCHS in the
NHANES III data files). Survey Data Analysis (SUDAAN) software was used to
estimate variances, enabling calculation of 95% CIs for COPD and asthma
prevalence rates.
For further information contact
Surveillance Branch
Division of Respiratory Disease Studies
National Institute for Occupational Safety and Health
1095 Willowdale Road
Morgantown, WV 26505–2888
Telephone: 304–285–6115
Back to Top
Multiple-Cause-of-Death Data
Each year since 1968, NCHS has made public-use
data files available on multiple causes of death. These public-use files contain
records of all U.S. deaths that are reported to State vital statistics offices
(approximately 2 million annually). Each death record includes codes for up to
20 conditions listed on the death certificate, including both underlying and
contributory causes of death. Other data include age, race, sex, and State and
county of residence at the time of death. In addition, usual occupation and
industry codes have been available for decedents from some States since 1985,
and NCHS annually determines that certain quality criteria have been met by
usual industry and occupation data from selected States.
Potential limitations of
multiple-cause-of-death data include underreporting or overreporting of
conditions on the death certificate by certifying physicians, incomplete or
unclassified reporting of usual occupation and industry, and nonspecificity of
codes.
For further information contact
Public Health Surveillance Team
Surveillance Branch
Division of Respiratory Disease Studies
National Institute for Occupational Safety and Health
1095 Willowdale Road
Morgantown, WV 26505–2888
Telephone:304–285–6115
Back to
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National Center for Infectious Diseases (NCID)
NCID is one of 12 centers, institutes, and
offices of CDC. The mission of NCID is to prevent illness, disability, and death
caused by infectious diseases in the United States and around the world. To
accomplish this goal, NCID staff work in partnership with local and State public
health officials, other Federal agencies, medical and public health professional
associations, infectious disease experts from academic and clinical practice,
and international and public service organizations. NCID accomplishes its
mission by conducting surveillance, epidemic investigations, epidemiologic and
laboratory research, training, and public education programs to develop,
evaluate, and promote prevention and control strategies for infectious diseases.
Further information about NCID is available through its Web site (www.cdc.gov/ncidod/about.htm).
National Surveillance System for Hospital Health
Care Workers (NaSH)
NaSH is a surveillance system that began in
1995 through the NCID Hospital Infections Program. NaSH focuses on surveillance
of exposures and infections among hospital-based health care workers. The
purpose of NaSH is to monitor national trends; identify newly emerging hazards
for health care workers; assess the risk of occupational infection; and evaluate
preventive measures, including engineering controls, work practices, protective
equipment, and post exposure prophylaxis to prevent occupationally acquired
infections. Participating hospitals are not randomly selected; they are usually
hospitals that have previously participated in the National Nosocomial
Infections Surveillance (NNIS) system and have also volunteered to participate
in NaSH. Participating hospitals benefit by being able to conduct occupational
health surveillance, analyze their data in an integrated system, and compare
these data with a national database.
Initial entry of a health care worker into NaSH usually
occurs during the provision of health care at the hospital's Employee Health
Service for a relevant event (e.g., routine tuberculin skin test, initial
assessment or followup after an exposure to blood, or initial assessment or
followup after an exposure to a vaccine-preventable disease). Not all hospital
employees have NaSH records.
The system collects the following data on
health care workers: demographic information (identifying data is not sent to
CDC), occupation, vaccination history, serologic results, immune status for
vaccine-preventable diseases (including hepatitis B virus), TB exposure test and
therapy status, detailed information on the nature of the exposure to blood/body
fluids and blood borne pathogens, post exposure prophylaxis treatment, information
about exposures and infections from vaccine-preventable diseases such as
measles, and information about exposures to infectious TB. Hospitals provide CDC
with denominator data related to number of staff once a year. Every 2 years,
participating hospitals distribute a survey to employees to be filled out
anonymously that asks about history of needle sticks or sharps injuries; the
purpose of this survey is to assess underreporting of incidents in the NaSH
system.
For further information contact
Office of Surveillance
National Center for Infectious Diseases
1600 Clifton Road, NE, MS D59
Atlanta, GA 30333
Telephone: 800–893–0485
Back to
Top
Sentinel Counties Study of Acute
Viral Hepatitis
Although CDC conducts nationwide surveillance
for acute viral hepatitis, several factors make it difficult to assess
accurately changes in incidence of disease and risk factors associated with
transmission: underreporting, failure to apply appropriate case definitions, and
incomplete serologic testing and epidemiologic evaluation of all reported cases.
To define the incidence and epidemiology of all types of viral hepatitis more
accurately, a program of intensive surveillance for acute viral hepatitis was
begun in several "Sentinel Counties" in 1979. Six counties currently participate
in this system: Tacoma-Pierce County, WA; Pinellas County, FL; Jefferson County,
AL; Denver, CO; Multnomah, OR; and San Francisco, CA.
All patients reported to the health
departments participating in the Sentinel Counties Study of Acute Viral
Hepatitis who meet the following clinical criteria for acute viral hepatitis are
eligible for the study: (1) discrete date of onset of symptoms or jaundice and
(2) liver enzymes greater than 2.5 times the upper limit of normal. For patients
with non-A, non-B hepatitis (including those who test positive for hepatitis C
antibodies), other possible causes of liver injury are excluded by interviewing
the diagnosing physician and abstracting the medical record. All patients with
acute viral hepatitis have serum drawn within 6 weeks of onset of symptoms and
shipped to CDC for testing. Patients also complete a detailed epidemiologic
interview.
The Sentinel Counties Study of Acute Viral
Hepatitis has provided precise data on the significant sources of viral
hepatitis infection in the United States and the contribution of these sources
to disease incidence. In recent years, major changes have occurred in the
incidence and epidemiology of the different types of viral hepatitis in the
United States. Many of these changes were first recognized in the Sentinel
Counties. For example, the Sentinel Counties study has been the primary source
for data showing that hepatitis C is the etiologic agent of most non-A, non-B
hepatitis and for describing the epidemiology and natural history of those
diseases.
For further information contact
Hepatitis Branch
Division of Viral and Rickettsial Diseases
National Center for Infectious Diseases
1600 Clifton Road, NE, MS G37
Atlanta, GA 30333
Telephone: 404–371–5910
Back to Top
Viral Hepatitis Surveillance
Program (VHSP)
The Hepatitis Branch of NCID operates VHSP,
which obtains national surveillance data on clinical, serologic, and
epidemiologic data pertaining to risk factors for viral hepatitis. Cases are
submitted to the program by State governments. Limitations of the system include
underreporting of cases and frequent omission of occupation on case records.
[VHSP 1999]
For further information contact
Hepatitis Branch
Division of Viral and Rickettsial Diseases
National Center for Infectious Diseases
1600 Clifton Road, NE, MS G37
Atlanta, GA 30333
Telephone: 404–371–5910
National Center for HIV, STD, and TB Prevention (NCHSTP)
NCHSTP is one of 12 centers, institutes, and
offices of CDC. The Center is responsible for public health surveillance,
prevention research, and programs to prevent and control HIV infection and AIDS,
other sexually transmitted diseases (STDs), and TB. Center staff work in
collaboration with government and nongovernment partners at community, State,
national, and international levels, applying well-integrated multidisciplinary
programs of research, surveillance, technical assistance, and evaluation.
For further information contact
Communications Office
HIV, STD, and TB Prevention
1600 Clifton Road, NE, MS E07
Atlanta, GA 30333
Telephone: 404–639–8890
Back to Top
Surveillance of Health Care
Workers with HIV/AIDS
Since 1981, all 50 States, the District of
Columbia, and U.S. Trusts and Territories have reported AIDS cases, without
names or other identifying information, to CDC's HIV/AIDS Reporting System
(HARS). In addition to HIV risk information, the HARS case report form also
requests information about past employment and occupation in the health care
setting.
In 1991, CDC's HIV/AIDS
Surveillance Branch developed a standardized protocol for State and local health
departments to investigate in greater detail any cases of HIV infection or AIDS
in health care workers without a behavioral or transfusion risk for HIV. The
health departments are requested to investigate reports of health care workers
who may have occupationally acquired HIV infection even if they have not yet met
the criteria of the AIDS surveillance case definition and the State does not
have formal requirements for HIV infection reporting. The reporting sources for
potential cases of occupational transmission in health care workers include
health care providers, HARS, and two sources within the CDC Hospital Infections
Program: the Postexposure Prophylaxis Failure Study and the National
Surveillance System for Hospital Health Care Workers.
The standardized protocol for investigating
potential cases of occupational transmission in health care workers consists of
a medical records review, an incident report review, discussion with the health
care worker's health care provider, an interview by health department staff, and
a laboratory investigation. The data are used to determine which occupations are
at risk, where and how exposures to HIV commonly occur, the sources of
transmission, effective prevention strategies, and HIV post exposure prophylaxis
recommendations. The data also are used by manufacturers to create safer designs
for medical devices and personal protective equipment.
Following an investigation by the State or
local health department, cases of HIV infection in health care workers may be
determined to be associated with a nonoccupational risk, or may be classified as
cases of possible or documented occupational HIV transmission. Health care
workers with possible occupational transmission are
those with a history of occupational exposure to blood, other body fluids, or
HIV-infected laboratory material who report no other risk factors for HIV
infection but for whom no seroconversion associated with any of the occupational
exposures was documented. Health care workers with documented occupational transmission have had documented
evidence of HIV seroconversion in temporal association with an occupational
exposure and have no other known exposure to HIV during the same period of time;
also included in this category are those persons infected with HIV strains that
are closely related to the occupational exposure source by deoxyribonucleic acid
(DNA) sequencing.
For further information contact
Surveillance Branch
Surveillance and Epidemiology
HIV, STD, and TB Prevention
1600 Clifton Road, NE, MS E47
Atlanta, GA 30333
Telephone: 404–639–2050
Back to
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Surveillance for Tuberculosis
Infection in Health Care Workers (staffTRAK-TB)
CDC recommends periodic tuberculin skin
testing of health care workers with a potential for exposure to Mycobacterium tuberculosis. However, many health care
facilities (e.g., hospitals, correctional facilities, long-term care facilities,
and health departments) do not have a system for identifying and tracking
workers due for tuberculin skin testing or a means of analyzing aggregate data.
To facilitate the surveillance for TB infection in health care workers in health
departments, CDC developed a software package called staffTRAK–TB to track, analyze, and report information
pertaining to tuberculin skin testing surveillance in health care workers. The
software allows the collection of data for each health care worker including
demographic information, occupation, work location, multiple tuberculin skin
test results, and results of evaluations determining if clinically active TB is
present. Programmed reports include lists of workers due and overdue for skin
tests, and skin test conversion rates by occupation and worksite. Standardizing
types of occupations and work locations allows data from multiple facilities to
be aggregated and compared. Data transfers to CDC can be performed via floppy
diskettes.
In 1995, CDC
implemented tuberculin skin testing demonstration projects in selected health
departments and hospitals in the United States. The tuberculin skin testing
demonstration project is designed to help participating sites develop model
tuberculin skin test programs consistent with CDC Guidelines for Preventing the Transmission of Mycobacterium
tuberculosis in Health-Care Facilities and to facilitate local data analysis
and evaluation of tuberculin skin testing programs. Results of tuberculin skin
testings are entered into the staffTRAK–TB software
and tuberculin skin testing data without personal
identifiers (e.g., name, social security number, or address) and are transferred
to CDC at least quarterly from each of the participating sites. This project
will allow CDC to gain information about the incidence of occupationally related
tuberculin skin testing conversions among health care workers in the
participating sites and determine if research is needed.
For further information contact
Division of Tuberculosis Elimination
National Center for HIV, STD, and TB Prevention
1600 Clifton Road, NE, MS E10
Atlanta, GA 30333
Telephone: 404–639–8117
Back to
Top
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Appendix B
Description of Industry and Occupation Coding Systems
Overview
Appendix B presents a detailed description of
the following occupational classification systems: North American Industry
Classification System (NAICS), Standard Industrial Classification (SIC),
Standard Occupational Classification (SOC), and Bureau of the Census Industry
and Occupation Classification. Table B–1 gives
an overview of these systems.
North
American Industry Classification System/Standard Industrial Classification
(NAICS/SIC)
Over the course of history, the United States
has gone from a largely agrarian economy in its earliest period, to one based
more on manufacturing, to the current more service-oriented economy. The SIC
system was introduced in the 1930s to help classify the growing number of new
manufacturing industries that had developed since the early 1900s. The SIC
system provided a consistent framework for assigning descriptive industry codes
to each establishment and for the subsequent collection, tabulation, and
analysis of economic statistics by government agencies and private research
firms [Murphy 1998].
The 1987 SIC includes 11 divisions and 1,004
detailed industries. Each industry is designated by a hierarchical four-digit
code. For example, the industry video tape rental has
the code 7841. The first two digits represent the major group; the third digit
represents the industry group; and the fourth digit represents the detailed
industry [OMB 1987].
By 1992, however, a new classification system
was clearly needed to accommodate newly developed industries in such areas as
information services, health care services, and high-tech manufacturing.
Furthermore, the initiation of the North American Free Trade Agreement in 1994
increased the need for comparable statistics from the United States, Canada, and
Mexico [Levine et al. 1999].
Economic changes that have taken place in
the last several decades—such as the movement toward a more service-oriented
economy, the increased use of computers and other new technology, and
globalization—have precipitated the need for a new system of industrial
classification [Murphy 1998].
The resulting system, NAICS [OMB 1998], is a
complete restructuring of the SIC. This system was organized to conform to the
principle of grouping establishments by their production processes alone. Thus
NAICS is a supply-based or production-oriented classification system. By
contrast, the former system uses a combination of supply and demand
characteristics (production and marketing activities). Supply-based categories
group establishments using similar raw material inputs, capital equipment, and
labor in the same industry. Demand-based categories group activities that are
similar in the eyes of customers or users of the product or service. A
supply-based approach creates more homogeneous categories that are better suited
for economic analysis. Another advantage of NAICS is that each participating
country can individualize the new system to meet its own needs as long as data
can be aggregated to standard NAICS industries [Levine et al. 1999].
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To view,
click on image.
Table B–1.Overview of industry and occupation coding
systems
The following is a list of the 21 NAICS
sectors:
| 11 |
Agriculture, forestry, fishing, and hunting |
| 21 |
Mining |
| 22 |
Utilities |
| 23 |
Construction |
| 31–33 |
Manufacturing, electric, gas, and sanitary
services |
| 42 |
Wholesale trade |
| 44–45 |
Retail trade |
| 48–49 |
Transportation and warehousing |
| 51 |
Information |
| 52 |
Finance and insurance |
| 53 |
Real estate, rental, and leasing |
| 54 |
Professional, scientific, and technical services |
| 55 |
Management of companies and enterprises |
| 56 |
Administrative and support, waste management, and
remediation services |
| 61 |
Educational services |
| 62 |
Health care and social assistance |
| 71 |
Arts, entertainment, and recreation |
| 72 |
Accommodations and food services |
| 81 |
Other services (except public administration) |
| 92 |
Public administration |
| 99 |
Unclassified establishments |
Although NAICS uses a hierarchical structure much like
the existing SIC, important structural differences exist between the systems.
For example, NAICS uses a six-digit classification code that allows greater
flexibility in the coding structure. The SIC system is limited to only four
digits. Another important difference is that NAICS uses the first two digits of
the six-digit code to designate the highest level of aggregation, with 21 such
two-digit industry sectors under the new system. The SIC system, by contrast,
has only 11 divisions. For example, the industry software
publishers has the code 511210. The first two digits designate the highest
level of aggregation, the third digit represents the subsector; the fourth digit
represents the industry group, the fifth digit represents the
international industry level, the sixth digit designates national detail [Murphy
1998].
During the transition period from SIC to
NAICS, SIC codes will be assigned to create linkages between statistics
classified under the two systems [Murphy 1998].
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Standard Occupational Classification (SOC)
Since the early part of this century, several
agencies have developed their own occupational classifications. The U.S.
Employment Service needed occupational statistics for its work and developed a
Convertibility List of Occupations with Conversion Tables to serve as a bridge
between its statistics and information from the 1940 Census of Population.
Continued revisions to the census classification scheme and publication of the
third edition of the Department of Labor's Dictionary of
Occupational Titles in 1965 encouraged the government to devise such a
standard to link these different systems. This effort resulted in the 1977
Standard Occupational Classification (SOC) (revised and reissued in 1980) [U.S.
Department of Commerce 1980; Levine et al. 1999].
However, the original system was not revised
after 1980, and many agencies set up data collection systems with occupational
classification schemes that differed from the SOC:
- BLS—the Occupational Employment Statistics survey
classifies workers according to occupational definitions.
- Bureau of the Census—both the decennial Census of
Population and the monthly Current Population Survey (CPS) classify workers
according to the job titles given by the survey respondents.
- Employment and Training Administration—the Dictionary of Occupational Titles, which identifies and defines more than 12,000 jobs, has been replaced by the Occupational
Information Network (O*NET), which adheres to the SOC.
- Department of Education—collects data on teachers.
- Bureau of Health Professions—gathers information on
health occupations.
- National Science Foundation—surveys focus on
scientists and engineers.
Observing this problem, the Bureau of Labor
Statistics (BLS) hosted an International Occupational Classification Conference
to establish a context for a new SOC revision process. Similarly, the
Employment and Training Administration's Advisory Panel for the Dictionary of Occupational Titles had just completed a
review of the dictionary and had recommended substantial new occupations [Levine
et al. 1999].
Persuaded that a reconciliation was in order,
OMB subsequently invited all Federal agencies with an occupational
classification system to join together to revise the SOC. The SOC Committee
included representatives from BLS, the Bureau of the Census, the Employment and
Training Administration, the Defense Manpower Data Center, and the Office of
Personnel Management. In addition, ex-officio members included the National
Science Foundation, the National Occupational Information Coordinating Committee
(NOICC), and OMB. Representatives from other Federal agencies such as the U.S.
Department of Education, the U.S. Department of Health and Human Services, and
the Equal Employment Opportunity Commission participated in several meetings of
the SOC Committee as well, or in the Federal Consultation Group [Levine et al.
1999].
The SOC Committee chose a practical approach
to classification and continued the previous focus on work performed (with skills-based considerations) as the key classification
principle for the revised (1998) SOC [Levine et al. 1999].
BLS provides information about the 1998 SOC at
their Web site (www.bls.gov/soc/home.htm). This site contains
links to the 1998 SOC major groups; the complete 1998 SOC hierarchical structure
and detailed occupational definitions; a numerical index of detailed
occupations; an SOC user's guide; and an SOC search capability, as well as SOC
Federal Register notices and related documents.
The 1998 SOC is composed of four levels of
aggregation: (1) major group, (2) minor group, (3) broad occupation, and (4)
detailed occupation. BLS, through its establishment survey that classifies
workers according to occupational definitions, is generally better able to
collect data on more detailed occupations than is the Bureau of the Census,
whose household surveys rely almost exclusively on job titles given by
respondents to classify workers.
The following list shows the 23 major
occupational groups of the 1998 SOC [Levine et al. 1999]:
| 11 |
Management occupations |
| 13 |
Business and financial operations occupations |
| 15 |
Computer and mathematical occupations |
| 17 |
Architecture and engineering occupations |
| 19 |
Life, physical, and social science occupations |
| 21 |
Community and social services occupations |
| 23 |
Legal occupations |
| 25 |
Education, training, and library occupations |
| 27 |
Arts, design, entertainment, sports, and media
occupations |
| 29 |
Healthcare practitioners and technical occupations |
| 31 |
Healthcare support occupations |
| 33 |
Protective service occupations |
| 35 |
Food preparation and serving-related
occupations |
| 37 |
Building and grounds cleaning and maintenance
occupations |
| 39 |
Personal care and service occupations |
| 41 |
Sales and related occupations |
| 43 |
Office and administrative support occupations |
| 45 |
Farming, fishing, and forestry occupations |
| 47 |
Construction and extraction occupations |
| 49 |
Installation, maintenance, and repair
occupations |
| 51 |
Production occupations |
| 53 |
Transportation and material-moving occupations |
| 55 |
Military-specific occupations |
These major groups include 98 minor groups,
452 broad occupations, and 822 detailed occupations in the SOC [Levine et al.
1999].
The 1980 SOC included 22 divisions (comparable
to major groups in the 1998 SOC), 60 major groups (comparable to minor groups in
the 1998 SOC), 223 minor groups (comparable to broad occupations in the 1998
SOC), and 664 unit groups (comparable to detailed occupations in the 1998 SOC)
[Levine et al. 1999]. Each occupation is designated by a six-digit code. For
example, the occupation printing machine operator has
the code 51-5023. The hyphen between the second and third digit is used only for
presentation clarity. The first two digits represent the major group; the
third digit represents the minor group; the fourth and fifth digits represent
the broad occupation; and the sixth digit represents the detailed occupation.
To facilitate consistent classification by
data collection agencies across surveys, the 1998 SOC associates some 30,000 job
titles with detailed occupations. Because many of these job titles are
industry-specific, the industries are also listed for many titles. To further
facilitate consistent classification, each detailed occupation has a definition
that uniquely defines the workers included. Most historical comparisons with
older classification systems are still possible.
The SOC Committee proposed that a permanent
review committee be established to keep the SOC current, and OMB is considering
the proposal. In addition, it was proposed that the review committee provide
timely advice to the Bureau of the Census during its 2000 Census occupations
coding operation, particularly with respect to the proper classification of
unfamiliar job descriptions and job titles. The next major revision of the SOC
is expected to begin in 2005, in preparation for the 2010 Census of Population
[Levine et al. 1999].
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Bureau of the Census
The census occupational data result from the
decennial Census of Population and Housing, the monthly CPS, and other
demographic surveys conducted by the Bureau of the Census. The most currently
available decennial census occupational data are from the 1990 census, which
collected data from about 17% of households. The job titles given by the survey
respondents were classified into 501 occupations in 236 industries. The monthly
CPS collects occupational data from about 50,000 of the approximately 118
million households in the United States. The CPS data provide national
occupational trend information. The CPS uses the decennial census classification
structure of occupational coding [Thompson 1981; Bureau of the Census 1992a].
The alphabetical and classified indexes used
by the Bureau of the Census in its coding operation presents a listing of some
21,000 industry and 30,000 occupation titles that have appeared on schedule
returns, together with the census code for each, but includes no descriptive
material [Bureau of the Census 1992a, 1992b; Miller et al. 1980].
The 1990 census occupational classification
structure is arranged into 6 summary and 13 major occupational groups and
contains 501 occupational categories, each of which is assigned a 3-digit
numeric code. For example, the occupation dental
hygienist has the code 204. However, the major group can only be determined
by referring to the classification manual; in this case it is within the first
major group—technical, sales, and administrative support
occupations.
The 1990 census industry classification
structure is arranged into 13 major industry groups and contains 236 industry
categories, each of which is assigned a 3-digit numeric code. For example, the
industry drafting service has the code 741. The major
group is determined by referring to the classification manual; in this case it
is within the major industry category business and repair
services.
NAICS United States has been adopted for
statistical use by all Federal agencies, including the Bureau of the Census.
Government-wide implementation is underway and will continue at least through
the year 2004. Planning is underway for implementing NAICS in the current
programs of the Bureau of the Census, however, the Bureau's plans for
implementing NAICS United States in current survey programs, including the 2000
decennial census, are not yet final [U.S. Economic Classification Policy
Committee 1998].
The Bureau of the Census uses the SOC (last
revised in 1980) to classify responses to its household surveys. The SOC is
currently undergoing revision, and the proposed 1998 SOC was released in the
Federal Register in August 1998. The revised SOC will be used to classify
responses to the 2000 decennial census and will be adapted for use with
household surveys shortly thereafter [Bureau of the Census 1999].
NOICC is a committee with representation from
10 Federal agencies. It maintains the NOICC Master Crosswalk, a computerized
database that shows relationships among the major occupational and educational
classification systems used by the Federal government. A formal crosswalk is
available electronically at (http://www.state.ia.us/ncdc/xw_xwalk.html). Since the major
occupation coding systems are being revised, a new crosswalk will be developed
to reflect the changes.
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