Occupational information on death certificates: a survey of state practices

Case-control study of occupational exposure to electric shocks and magnetic fields and mortality from amyotrophic lateral sclerosis in the US, 1991-1999

We investigated the relationship between occupational exposure to electric shocks (ES) and magnetic fields (MF) and amyotrophic lateral sclerosis (ALS) using 1991-1999 US mortality data. For each of the 5886 included ALS deaths, 10 controls-matched on sex-, age-, year- and region-were selected from among other deaths. Usual occupation as reported on death certificates was linked to job-exposure matrices for ES and MF. Education and electric occupations were associated with moderately increased ALS risks (odds ratio (OR)=1.85, 95% confidence interval (CI)=1.67, 2.04; OR=1.23, 95% CI=1.04, 1.47, respectively). For ES, ALS mortality OR were 0.73 (95% CI=0.67, 0.79) for high and 0.90 (95% CI=0.84, 0.97) for medium exposure compared with low exposure. For MF, ALS ORs were 1.09 (95% CI=1.00, 1.19) for high and 1.09 (95% CI=0.96, 1.23) for medium exposure as compared with low exposure. For electric occupations, ALS ORs were insensitive to adjustments for ES, MF or both. Consistent with previous publications, an association between electric occupations and ALS was observed. Findings do not support occupational exposure to ES or MF as an explanation.

[Mortality registries as a source for detecting health disorders probably of occupational etiology]

Study aim was to assess Andalucian death certificate records to find potential occupational disease problems. Methodology proposed by Rutstein (1983) has been adapted. We had checked Seville City Council Mortality Registry (1987-89) and Andalucian Mortality Registry (1975-85). In the former 8.1% of diagnoses and in the latter 8.6% of diagnoses have one included in the Sentinel Health Event (occupational) List. Accurate occupation data in the Seville City Council Mortality provides appropRiate information about occupational diseases. Limitations of the occupational data in the Andalucian Mortality Registries make it impossible to find the majority of potential occupational diseases, and occupation data were even worse during the second period of study (1980-85).

Death certificates in epidemiological studies, including occupational hazards: inaccuracies in occupational categories

We compared death certificates for asbestos-associated diseases (mesothelioma, lung cancer, asbestosis) in two asbestos workers' cohorts. One (insulation workers) had current or recent employment and a strong, continuing union support system which gave them much information about the effects of asbestos exposure. The second cohort, asbestos factory workers, had no such advantage. The factory had closed almost 30 years before, and its workers had dispersed into many areas of the state and nation. Accuracy of medical diagnosis was comparable in the two groups, but occupational listings were not. Three-quarters of the insulators' death certificates told of asbestos work, while virtually none of the factory workers' certificates provided such information, even for deaths of mesothelioma and asbestosis. The data indicate that disease categories, based on medical and pathological diagnoses, at least for asbestos-associated disease, tend to be accurate. Attempts to identify groups at risk by sorting occupational categories can give variable results, good for those with current exposures, much less satisfactory for those with long-past occupational exposures.

A methodology for the collection of supplemental information on agricultural fatalities

Due to the lack of a standardized methodology to identify agriculturally related fatalities and the inaccuracy of data from death certificates, NSC's and NIOSH's estimates of the level of agriculturally related fatalities conflict, and the validity of both is subject to criticism. A follow-up survey with the next of kin of 107 potential agricultural fatalities, from a pool of 150 Pennsylvania cases, has been conducted. This paper details the methods and success in gaining supplemental information. Next of kin were generally willing to provide the information (67%), with both telephone (66%) and mail (68%) methods generating comparable levels of cooperation. The optimal time frame for finding current addresses and telephone numbers as well as for gaining cooperation appeared to be about 1 year after the fatality. However, a retrospective investigation of up to 3 years past the anniversary of the fatality produced an acceptable rate of cooperation. How the collected data compares with fatality data for agriculture published by NSC and N1OSH has been addressed in another paper.

Problems with surveillance methods for alcoholism: differences in coding systems among federal, state, and private agencies

Social indicator systems can serve as a social accounting method to guide public policy on alcoholism, utilizing data which are routinely collected at public expense. An attempt to develop an alcoholism social indicator system for Minnesota demonstrated many differences in the coding schemes used by various state agencies and institutions. These findings have relevance to other social indicator systems being developed to assess public policies regarding the people's health.

Comparison of death certificate occupation and industry data with lifetime occupational histories obtained by interview: variations in the accuracy of death certificate entries

This study compares usual and recent occupation and industry data from lifetime work histories obtained by interview with death certificate entries for occupation and industry for 2,435 persons diagnosed with cancer. Match rates are calculated as the percent of death certificate occupation and industry entries that were confirmed by interview data and are compared for exact 3-digit 1980 U.S. Census Bureau occupation and industry codes and for groups of these codes. The overall match rate for individual usual occupation codes was 47.9% and for exact usual industry codes it was 61.8%. Significant differences between the interview data for usual occupation or industry and the death certificate entry were observed by race and gender, marital status, number of years worked, and occupation and industry groups and by age for industry. Misclassification or overreporting of occupation and industry data on the death certificate ranged from 30 to 50% in this study. Our results suggest that the utility of death certificate data for investigations into the occupational risk factors for cancer may be quite limited.

Summary measures of occupational history: a comparison of latest occupation and industry with usual occupation and industry

The utility of using latest occupational information as a summary of work history is assessed by comparing it to usual occupation and industry. We analyzed 5,734 complete occupational histories obtained by telephone interview as part of an ongoing occupational cancer surveillance study. Of these, 73.6 per cent reported the same usual occupation as latest occupation and 76.6 per cent the same usual industry as latest industry. Differences in match rates by race and sex, occupation and industry titles and categories suggest that bias may result in studies using latest occupation or industry as a summary measure of occupational exposures.

Occupational disease surveillance data sources, 1985

Health department epidemiologists in 50 states, New York City, and the District of Columbia were surveyed in 1985 about seven potential data sources for occupational disease surveillance. Reported sources of occupational disease data were: automated workers' compensation claims (63 per cent of the 52 respondents); provider reports (62 per cent); death certificates with occupation or industry (60 per cent); cancer registries with occupational histories (35 per cent); birth certificates with parent's occupation (27 per cent); non-cancer disease registries (13 per cent); and hospital or insurance records (8 per cent).

Death certificate-based occupational mortality surveillance in the United States

Surveillance of cause-specific mortality patterns by occupation and industry through the use of death certificate records is a simple and relatively inexpensive approach to the generation of leads as to potential occupational disease problems. Researchers from the National Institute for Occupational Safety and Health (NIOSH) have been working with the National Center for Health Statistics, other federal agencies, and state health departments on a number of programs to foster the development of standardized, routine coding of occupation and industry entries on death certificates by state health departments. Thirty-one states and the District of Columbia are now doing such coding. These data are being analyzed currently by investigators at NIOSH and at individual state health departments for the purpose of hypothesis generation on occupation-disease relationships. The proportionate mortality ratio method is the predominant method being used, as appropriate denominator data are not generally available. This type of surveillance is particularly useful for the study of occupation and industry groups for which it is difficult to assemble cohorts, such as groups that are predominantly non-union and in small workplaces. Limitations of this surveillance include its inappropriateness for monitoring those occupational diseases which are not often fatal, and the limited scope and accuracy of death certificate information.

Comparison of occupation and industry information from death certificates and interviews

Information on occupation and industry obtained via an interview prior to death was compared to occupation and industry on the death certificate of 184 colon cancer patients in Utah. The data were coded blindly using a five-digit code. Overall, agreement in the five-digit codes was found for 63 per cent. The industry codes agreed for 67 per cent of the individuals, and the occupation was identical for 68 per cent. Agreement by subjective evaluation of the two data sources, disregarding the five-digit codes, was 73 per cent. There were no differences in agreement of the five-digit codes by age, sex, and county of residence. The number of years worked at the job given by interview was related to agreement. Misclassification occurred in a random manner. It is concluded that the use of death certificates to study the association of occupation and disease is most appropriate for pilot studies.

Female labor force participation and female mortality in Wisconsin 1974-1978

The following research question is addressed in the study: what effect will the entrance of women into the labor force have on female mortality rates for all causes of death combined as well as specific causes relating to occupational stress, behavioral factors and physical hazards associated with occupation? This question is examined through comparisons of age, marital status and occupation-specific death rates for all causes of death combined and for selected causes of death. Death certificates provided by the Wisconsin Bureau of Health Statistics for the years 1974-1978 and population data provided by the 1976 Survey of Income and Education were used to construct death rates. The death rates of the white civilian female population of Wisconsin 16-64 years of age were examined using exploratory data analysis techniques (schematic plots and median polish) and standard errors. In general, the death rates of women in the labor force are substantially lower than those of housewives. These results may indicate that the role of housewife exposes women to health hazards. In addition, the results of this study may suggest some selectivity of healthy women into the labor force or a protective effect of labor force participation. In a limited number of instances, labor force participants' mortality rates exceed those of housewives. In the 60-64 year old population, white-collar workers, specifically, sales workers, managers and professionals, experience significantly higher death rates than housewives. In addition, specific groups of labor force participants experience significantly higher death rates than housewives for accidental deaths (i.e. laborers 16-44 and 45-54), deaths due to heart disease (i.e. laborers 45-54 and sales workers 60-64) and deaths due to malignant neoplasms (i.e. white-collar workers 60-64 years of age). The possibility that these instances indicate the direction of future mortality trends should be considered.

Agreement of occupation and industry data on Rhode Island death certificates with two alternative sources of information

There is increasing interest in documenting the putative health effects of occupational hazards, prompting Federal and State efforts that rely primarily on occupational information obtained from the death certificate. Previous studies have assessed the agreement of occupational data on death certificates with actual lifetime employment by using current employment data from census records for comparisons. Such analyses have largely been confined to males. We compared lifetime occupational information obtained from a panel survey for both sexes with death certificate data for 446 deceased panel members. After adjusting for inadequate information, the occupation recorded on the death certificates of the men agreed with the occupation recorded in the survey 66 percent of the time. The comparable percentage for the industry where the deceased had been employed was 78 percent. Among the women's records, agreement on occupation was 65 percent, and on industry, 69 percent. Using another sample of death certificates, comparisons of the information for 322 decedents with city directory data produced similar results. The higher level of agreement for women was due in part to the large number who were reported as "housewives." In a separate analysis, the agreement rate for nonhousewives declined. Suggestions for improvements in the recording of occupational data and the constraints imposed by the use of death certificate data in occupational epidemiology are presented.

An assessment of occupation and industry data from death certificates and hospital medical records for population-based cancer surveillance

This study analyzed 30,194 incident cases and 4,301 death certificates for completeness of occupational reporting. Analysis of data accuracy was based upon a comparison of more than 2,000 death certificates with incident abstracts and 352 death certificates with interview data. Death certificates had a higher proportion with occupation (94.3%) and industry (93.4%) reported than did incident abstracts of hospital medical records (39.0% and 63.5%, respectively). Compared with occupational history data obtained by interview, 76.1% of the death certificates were exact matches for usual occupation and industry.

Sentinel Health Events (occupational): a basis for physician recognition and public health surveillance

A Sentinel Health Event (SHE) is a preventable disease, disability, or untimely death whose occurrence serves as a warning signal that the quality of preventive and/or therapeutic medical care may need to be improved. A SHE (Occupational) is a disease, disability, or untimely death which is occupationally related and whose occurrence may: 1) provide the impetus for epidemiologic or industrial hygiene studies; or 2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required. The present SHE(O) list encompasses 50 disease conditions that are linked to the workplace. Only those conditions are included for which objective documentation of an associated agent, industry, and occupation exists in the scientific literature. The list will serve as a framework for developing a national system for occupational health surveillance that may be applied at the state and local level, and as a guide for practicing physicians caring for patients with occupational illnesses. We expect to update the list periodically to accommodate new occupational disease events which meet the criteria for inclusion.

Standard information on environmental exposure linked to data on cancer patients, with a brief review of the literature

A review of national resources presently available for linking cancer morbidity and mortality data with information on environmental factors is presented. Additional sources of data on exposure, obtained directly from the patient or from his/her hospital record, are discussed. At the patient level, an interview questionnaire records standardized data on residential and occupational experiences and on a variety of life-style factors such as smoking, alcohol, nutrition, medication, and exercise. At the hospital level, a simple model "exposure registry" is presented which, at minimal cost, would facilitate the collection of limited data on smoking and employment (occupation/business) from the in-patient hospital admission form and from the medical and nursing notes in the patient's record. Both of these instruments represent efforts toward the development of standardized data sets on environmental and personal exposures which would constitute valuable additions to data already collected by the worldwide network of cancer registries.