South carolina death certificate

Severe injury in the workplace has been identified as 1 of 10 leading problem areas in occupational safety and health by the Public Health Service's National Institute for Occupational Safety and Health (NIOSH)[1].

NIOSH has reported that injury in the workplace may be the primary threat to the health and well-being of America's workers. NIOSH estimates that at least 10 million persons suffer traumatic injury on the job each year. About 30 percent of those injuries are severe or fatal, including such types of injury as amputation, fracture, severe laceration, eye loss, acute poisoning, and burns. From 7,000 to 10,000 fatalities occur each year as a result of injuries at work. In the period 1980-85, more than 150,000 years of potential life were lost each year from fatal injuries in the workplace[2, 3]. Those years of potential life lost to traumatic occupational fatalities may be more than all years lost to occupational disease, because young workers tend to have a greater prevalence of occupational injury than older workers, who tend to have longer occupational disease latency, morbidity, and resulting death.

The Public Health Service (PHS) has set a national health objective for the year 2000 to lower the death rate for occupational injury to no more than 4 per 100,000 full-time workers. PHS specifically identified the mining, construction, transportation, and agricultural industries for special attention[4].

Severe occupational injuries have an important economic impact. In 1983, 80 million workdays were lost because of injury at work, resulting in about $33.4 billion in direct and indirect costs from lost wages, medical expenses, and administrative costs. The separate costs of such injuries in terms of physical and emotional suffering are incalculable[2].

Despite the magnitude of that economic loss, the statistics may be underestimations of the problems. More accurate statistics on many problems in occupational safety and health are unavailable, largely owing to a lack of uniformity in data sources, methods of data collection and reporting, and case definitions.

In an effort to obtain more complete and accurate information on work related diseases and death, NIOSH worked with the States during the 1980s to offer training for State death certificate coders, who use the 1980 census classification system to code both the usual occupation of those dying from an occupational injury and the industry in which they were working at the time of injury[5].

A recent synthesis of studies performed by NIOSH's Division of Safety Research shows death certificates to be the single most useful source of data for identifying traumatic occupational fatalities[6]. The average rates of capture for sources of data on occupational fatalities were reported as 81 percent for death certificates, 61 percent for medical examiner's records, 57 percent for Workers' Compensation reports, and 32 percent for Occupational Safety and Health Administration (OSHA) reports.

NIOSH began the National Traumatic Occupational Fatality Project in 1985 to examine the problem[3]. Source documents for the project were death certificates from 50 States, the City of New York, and the District of Columbia. Death certificates were included for those 16 years and older if the certificate showed a code for an injury as either an immediate, an underlying, or a contributory cause of death and if the injury was incurred at work. External causes of injury are coded on death certificates using the International Classification of Diseases codes E800 through E999[7].

The NIOSH report provided national level data on occupational fatalities, including age, race or ethnicity, sex, occupation, and death rates for specific industries or groups of industries. The death rate for occupational injury during the period 1980-85 was 7.8 per 100,000 workers. Four groups of industries, mining, transportation-communications-utilities, construction, and agriculture-fishing-forestry, had much higher death rates than other groups or industries. Summarizing additional data (including unpublished data) from the National Traumatic Occupational Fatality Project data base gives an average national rate for occupational fatalities of about 7 per 100,000 workers for the period 1980-88[3, 4].

The results of a study that used similar techniques to examine traumatic occupational fatalities in California have been reported by Cone and coworkers[8]. They examined data for 1983 from California death certificates as well as from California's Division of Labor Statistics and its Occupational Safety and Health Administration. In general, California rates for occupational fatalities were similar to the national rates reported by NIOSH. The overall rate for occupational fatalities in California in 1983 was 5.48 per 100,000 workers. Agriculture, construction, and transportation-utilities were among the industry groups with the highest mortality rates.

Schnitzer and Bender studied traumatic occupational fatalities in Alaska for the period 1980-85 and found higher overall death rates than for the nation or California[9]. The average annual traumatic occupational fatality rate for the 6-year period in Alaska was 36.3 per 100,000 workers. The leading causes of death in the Alaska study were related to drowning as well as to aircraft crash, presumably reflecting the significant travel requirements characteristic of major industries in the State.

Detailed statistics are not available on the magnitude of the problem of traumatic occupational fatalities in South Carolina. The State of South Carolina's Department of Health and Environmental Control (DHEC) makes nonconfidential death certificate information available to researchers. We used that data base in examining on-the-job fatal injuries occurring in the State and in calculating death rates by industry, sex, and race or ethnicity. We chose death certificates as a data source because of their sensitivity in capturing occupational fatalities and because of the availability of the DHEC data base.

Methods

The public access data file of DHEC's Office of Vital Records and Public Health Statistics contains demographic data, information on the cause of death, industry and occupation codes, and the injury-at-work item from all death certificates completed in South Carolina for the years 1989 and 1990. Although death certificate data for previous years are available from the public access file, 1989 is the first year with complete industry and occupation coding and the injury-at-work variable.

Funeral directors in South Carolina list on death certificates the decedents' occupation and industry. This information is translated into the appropriate industry-occupation code, using the 1980 census system. Previous surveys have shown that only 0.3 percent of industry-occupation entries on South Carolina death certificates were incomplete[5]. Death certificates were analyzed using the SAS Statistical Package, version 5.18[10]. Certificates were included that met the previously mentioned NIOSH project criteria.

Denominator data for nonfarm employment were obtained from the State of South Carolina's Employment Security Commission, Labor Market Information Division, in cooperation with the U.S. Department of Labor's Bureau of Labor Statistics[11]. Statistics on employment in agriculture-fishing-forestry for 1989 were obtained from the State of South Carolina's Statistical Abstract[12]. No employment statistics for agriculture-fishing-forestry for 1990 were available at the time the study was performed, and 1989 denominator data were used to estimate 1990 rates for that industry. For all other industries, specific yearly employment statistics were available.

Results

There were 277 fatal occupational injuries in South Carolina during the period 1989-90 that met the study criteria. Some demographic characteristics of that group are shown in table 1. Tables 2 and 3 list the numbers of deaths by industry and cause. Table 2 shows industry-specific death rates. Age-specific data were not available for employed persons in South Carolina during that period and age-specific death rates were not calculated. Fatality rates for subgroups with fewer than 10 subjects in the numerator were not calculated owing to their instability.