The Accuracy of Death Certificates in Identifying Work-related Fatal Injuries

Abstract

Three national US agencies report on work-related fatal injuries, and one uses the "injury at work" designation on the death certificate to identify and characterize these fatalities. The accuracy of the "injury at work" notation has not been validated. The authors used selected external causes of death (from the International Classification of Diseases, Ninth Revision, Clinical Modification) that are highly likely to be work-related or not work-related as a standard to compare with the California death certificate "at work" designation for the years 1979-1989. Data from the National Center for Health Statistics for the years 1979-1984 were used to measure prevalence for purposes of determining the predictive value of a positive or negative work-related notation on the death certificate. The sensitivity of the "at work" designation was 77.6%, with a specificity of over 99%. Sensitivity but not specificity varied by age, sex, and specific external cause of death. The predictive value positive of the "at work" designation was about 60%, which suggests caution in using it for some epidemiologic purposes.

Using Death Certificates and Medical Examiner Records for Adolescent Occupational Fatality Surveillance and Research: A Case Study

“…(5,20) With regard to death certificate identification, our finding that 71% of cases were identified by death certificates was higher than the death certificate identification rate of 61% among 16-to 19-yearolds reported by Smith et al (20) and fell between the estimates of 57-89% among workers of all ages reported by Stout and Bell. (5,20) As in prior studies of adult work-related fatalities, (5,19,30) we found that both death certificates and ME records tend to miss certain types of deaths. Using data on means of death from our earlier published analysis, (27) we determined that the three fatalities that were not identified as work-related in the ME system, and four of the nine cases not identified as being work-related on the death certificates, were due either to homicides or motor vehicle crashes.…”

“…Both of these are common causes of work-related fatalities (2,31) but may not be systematically recognized as being work-related by coders. (5,19,30) This suggests the need for clear and consistent guidelines for those coding death records.…”

Toxicology Testing in Fatally Injured Workers: A Review of Five Years of Iowa FACE Cases

“…This disparity may be due to undercounting of work-related deaths that are then investigated and tested for drugs and alcohol, particularly in studies where only one source of data exists. Most cases identified by coroners and medical examiners underestimated work-related fatalities as defined by federal agencies [15,16]. In rural states like Iowa, misclassification of work-related injuries is particularly problematic for cases of work-related deaths to farmers—a group prone to high misclassification due to the nature of the agricultural work (rural and isolated) and the demographics of farmers (older, often retired or farming as a secondary or part-time job) [14,17].…”

“…This designation is imperfect with both low sensitivity (77%) and positive predictive value (60%) [15,16]. Due to the different definitions used by coroners and medical examiners, young workers and farmers, in particular, are among those frequently misclassified as not work-related [14,16,17].…”

Traumatic occupational fatalities in the retail industry, United States 1992-1996

“…Previous research has indicated that measurement of work-related deaths using the death certificate has low sensitivity but high specificity [Kraus et al, 1995], leading to underestimates of the actual number of work-related deaths. Furthermore, homicides were especially prone to misclassification as non-work related [Kraus et al, 1995;Peek-Asa et al, 1997;Stout and Bell, 1991]. Since retail deaths were more likely to be related to violence, misclassification of deaths as non-work related may be higher in the retail than in other industries.…”