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NIOSH Respiratory Diseases Research Program

Evidence Package for the National Academies' Review 2006-2007

NIOSH Programs > Respiratory Diseases > Evidence Package > 8. Surveillance Activities

8.2 National Occupational Respiratory Mortality System

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 RDRP efforts generating early editions of the “WoRLD Surveillance Report” led to the realization that it would be possible to develop a standardized approach to editing, storing, and processing national mortality data relating to occupational lung disease. It was recognized that such a system would vastly improve efficiency of RDRP surveillance staff, would help assure consistency of output from year-to-year as new data became available on an annual basis. Perhaps most importantly, it was recognized that many inquiries to RDRP were amenable to being answered very rapidly if a user-friendly interface were to be developed to allow customized inquiries and outputs. NORMS, a data storage and data retrieval system developed and maintained by RDRP addresses these needs.


 In the late 1980s, RDRP initially established the National Surveillance System of Pneumoconiosis Mortality (NSSPM) to facilitate analysis and presentation of data on all U.S. pneumoconiosis deaths. The NSSPM, which was refined based on comments from external reviewers and which has been annually updated, formed the basis for an expanded system, NORMS, of which the NSSPM is now a component. Initially, the interface for customized queries was available only to a few intramural staff, but proved so useful to them that it was made more widely available to RDRP staff throughout NIOSH. In 2004, a Web-based interface was established so any individual with access to the Web can obtain customized outputs to address specific questions they may have.

NORMS offers a range of query options for generating tables, charts, and maps of the number of deaths, crude mortality rates, age-adjusted mortality rates, and years of potential life lost at national, state, and county levels for U.S. residents by age, race, and sex. In addition, users of NORMS can tabulate proportionate mortality ratios by industry and/or occupation at national and state levels. NORMS contains national mortality data updated annually from NCHS for pneumoconiosis and hypersensitivity pneumonitis (since 1968), and for mesothelioma (since 1999, when a new revision of the International Classification of Diseases that established a discrete code for mesothelioma began to be employed by NCHS). NORMS also includes data (for 1985–1999) for asthma, COPD, lung cancer, malignant mesothelioma, pneumoconiosis, TB, and other respiratory diseases and conditions, but only for states that electronically coded decedents’ usual industry and usual occupation.

Outputs and Transfer

 Electronic, Web-based surveillance resource: NORMS ( was posted on the internet for public access in July 2004. Of note is that the utility and quality of computer code used to run NORMS has been recognized by SAS Institute Inc. in a Web-based article entitled “Breathing Life into Government Reporting” ( [External link]).

Intermediate Outcomes

A variety of measures suggest that NORMS has influenced others outside of RDRP.

After CDC’s MMWR notified readers of the posting (, many different sites re-displayed the MMWR notice of the NORMS release (e.g. Medscape at [External link]).

There have been nearly 10,000 queries to NORMS during the 2003­ to mid-2006 period:

  • 5,710 from NIOSH and other parts of CDC (since 2003)
  • 3,361 from outside CDC (since July 2004)

A Google search in mid-2006 identified 39 distinct documents, including 17 from outside of CDC, that cite NORMS. NORMS is also directly linked from several state, federal, and private sites (see below).

Sites that refer to NORMS data:

Web sites that include links to NORMS:

Data presented in NORMS were used by California Department of Health Services to target an overall reduction in work-related pneumoconiosis deaths among Californians. ( [External link])

Importantly, NORMS output is used to track progress towards achievement of the U.S. Public Health Service’s “Healthy People 2010” objective to reduce pneumoconiosis deaths (

What’s Ahead

In response to users’ comments and requests new features will be added (e.g. to facilitate search for specific information, tabulation, or creation of maps). In addition, query options will be developed to facilitate outputs by NORA industry sector.