Death certificate‐based occupational mortality surveillance in the united states

Abstract

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.

Proportionate Cancer Mortality in Methyl Methacrylate-Exposed Orthopedic Surgeons Compared to General Surgeons

“…In addition to its well-established design for studying proportionate deaths from cancer, other strengths of this investigation included its (1) lack of financial sponsorship by major MMA manufacturers, many of whom supported earlier no-excess cancer cohort studies; (2) exact confirmation of death for all study decedents using both professional association and NDI registries; (3) use of four-digit, not three-digit, ICD-9 CPT codes with the highest confirmation (>80%), detection (>80%), and nosological (≥97%) match rates for determination of cancer as underlying causes of death based on histopathological diagnoses; and (5) control-to-case ratio of 4:1 using socioeconomically matched general surgeons as controls in similar occupations without MMA exposures and with assumed similar lifestyle cancer risks from alcohol use, diet, and smoking [25][26][27].…”

Utility of Death Certificate Data in Predicting Cancer Incidence

“…Dubrow, Sestito, Lalich, Burnett, and Salg (1987) indicated that the use of DCs is a cost-effective and simple approach to the preliminary investigation of occupational disease surveillance. Burnett and Dosemeci (1994) pointed out that the strengths of DCs stem from their wide spread use, while the limitations include lack of accuracy and incomplete data.…”

Occupational disease surveillance with existing data sources.

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