A state trauma registry as a tool for occupational injury surveillance

Trends in severity of work-related traumatic injury and musculoskeletal disorder, Ontario 2004-2017

OBJECTIVES

Traumatic injury surveillance can be enhanced by describing injury severity trends. This study reports trends in work-related injury severity for males and females over the period 2004-2017 in Ontario, Canada.

METHODS

A weighted measure of workers' compensation benefit expenditures was used to define injury severity, obtained from the linkage of workers' compensation claims to emergency department (ED) records where the main injury or illness was attributed to work. Denominator counts were obtained from Statistics Canada's Labor Force Survey. Trends in the annual incidence of injury, classified as low, moderate, or high severity, were examined using regression modeling, stratified by age and sex.

RESULTS

Over a 14-year observation period, there were 1,636,866 ED records included in the analyses. Overall, 57.6% of occupational injury records were classified as low severity, 29.5% as moderate severity, and 12.8% as high severity conditions. There was an increase in the incidence of high severity injuries among females (annual percent change (APC): 1.52%; 95% CI: 0.77, 2.28), while the incidence of low and moderate severity injuries generally declined for males and females. Among females, injuries attributed to animate mechanical forces and assault increased as causes of low, moderate, and high severity injuries. The incidence of concussion increased for both males (APC: 10.51%; 95% CI: 8.18, 12.88) and females (APC: 16.37%; 95% CI: 13.37, 19.45).

CONCLUSION

The incidence of severe work-related injuries increased among females in Ontario between 2004 and 2017. The methods applied in this surveillance study of traumatic injury severity are plausibly generalizable to applications in other jurisdictions.

Developing Surveillance Methodology for Agricultural and Logging Injury in New Hampshire Using Electronic Administrative Data Sets

OBJECTIVE

Agriculture and logging rank among industries with the highest rates of occupational fatality and injury. Establishing a nonfatal injury surveillance system is a top priority in the National Occupational Research Agenda. Sources of data such as patient care reports (PCRs) and hospitalization data have recently transitioned to electronic databases.

METHODS

Using narrative and location codes from PCRs, along with International Classification of Diseases, 9th Revision, external cause of injury codes (E-codes) in hospital data, researchers are designing a surveillance system to track farm and logging injury.

RESULTS

A total of 357 true agricultural or logging cases were identified.

CONCLUSIONS

These data indicate that it is possible to identify agricultural and logging injury events in PCR and hospital data. Multiple data sources increase catchment; nevertheless, limitations in methods of identification of agricultural and logging injury contribute to the likely undercount of injury events.

Linkage and concordance of Trauma Registry and hospital discharge records: lessons for occupational injury surveillance and research

OBJECTIVE

Occupational injury researchers typically use payer to identify work-related injuries in hospital discharge records. Many trauma registries contain a work-related field, independent of payer. Linked trauma registry and hospital discharge records were used to assess data field concordance and to assess the validity of using payer or external cause of injury (E-codes) to identify work-related injuries.

METHODS

Washington State Trauma Registry records were linked to hospital discharges (year 2009).

RESULTS

There was substantial agreement between Washington State Trauma Registry and hospital discharge records for workers' compensation as primary payer. E-code based methods of identifying occupational injuries had high specificity (more than 99%) but low sensitivity (less than 14%). Payer was 76% sensitive and 98% specific.

CONCLUSIONS

This study found substantial agreement for data fields key to occupational injury surveillance and research. Nevertheless, many work-related injuries could not be identified using hospital discharge records.

Disparities in occupational injury hospitalization rates in five states (2003-2009)

BACKGROUND

Achievement of health equity and elimination of disparities are overarching goals of Healthy People 2020, yet there is a paucity of population-based data regarding race/ethnicity-based disparities in occupational injuries.

METHODS

Hospital discharge data for five states (Arizona, California, Florida, New Jersey, and New York) were obtained from the Healthcare Cost & Utilization Project (HCUP) for 2003-2009. Age-adjusted rates and trends for work-related injury hospitalizations were calculated using negative binomial regression (reference category: non-Latino white).

RESULTS

Latinos were significantly more likely to have a work-related traumatic injury hospitalization. The disparity for Latinos was greatest for machinery-related hospitalizations. Latinos were also more likely to have a fall-related hospitalization. African-Americans were more likely to have an occupational assault-related hospitalization, but less likely to have a fall-related hospitalization.

CONCLUSIONS

We found evidence of substantial multistate disparities in occupational injury-related hospitalizations. Enhanced surveillance and further research are needed to identify and address underlying causes.

Spatial clustering of occupational injuries in communities

OBJECTIVES

Using the social-ecological model, we hypothesized that the home residences of injured workers would be clustered predictably and geographically.

METHODS

We linked health care and publicly available datasets by home zip code for traumatically injured workers in Illinois from 2000 to 2009. We calculated numbers and rates of injuries, determined the spatial relationships, and developed 3 models.

RESULTS

Among the 23 200 occupational injuries, 80% of cases were located in 20% of zip codes and clustered in 10 locations. After component analysis, numbers and clusters of injuries correlated directly with immigrants; injury rates inversely correlated with urban poverty.

CONCLUSIONS

Traumatic occupational injuries were clustered spatially by home location of the affected workers and in a predictable way. This put an inequitable burden on communities and provided evidence for the possible value of community-based interventions for prevention of occupational injuries. Work should be included in health disparities research. Stakeholders should determine whether and how to intervene at the community level to prevent occupational injuries.

Occupational injury trends derived from trauma registry and hospital discharge records: lessons for surveillance and research

OBJECTIVE

The suitability of the Washington State Trauma Registry (WTR) for occupational injury surveillance was assessed via comparing estimated rates and trends with those derived from state hospital discharge data.

METHODS

Descriptive methods and negative binomial regression were used to model occupational injury trends (1998 to 2009).

RESULTS

Nonlinear trends based on WTR data closely tracked those based on hospital discharge data, beginning about 2002. Rate estimates differed somewhat by data source and were most similar when a severity threshold was applied. Conclusions regarding temporal trends in work-related injury rates were the same using either data source.

CONCLUSIONS

This study found substantial similarity between occupational injury trends estimated using either WTR or hospital discharge data. We conclude that a mature state trauma registry with mandatory reporting requirements can be used for surveillance of severe work-related traumatic injuries.

Case identification of work-related traumatic brain injury using the occupational injury and illness classification system

OBJECTIVES

Traumatic brain injury (TBI) is one of the most common, costly, and disabling occupational injuries. Objectives included determining whether work-related TBI could be reliably identified using the Occupational Injury and Illness Classification System (OIICS) and describing challenges in developing an OIICS-based TBI case definition.

METHODS

Washington State trauma registry reports and workers' compensation claims were linked (1998 to 2008). Trauma registry diagnoses were used as the gold standard for six OIICS-based TBI case definitions.

RESULTS

The OIICS-based case definitions were highly specific but had low sensitivity, capturing less than a third of fatal and nonfatal TBI.

CONCLUSION

The use of OIICS versus International Classification of Diseases-Ninth Revision-Clinical Modification codes underestimated TBI and changed the attributable cause distribution, with potential implications for prevention efforts. Surveillance methods that can more fully and accurately capture the impact of work-related TBI across the United States are needed.

Predicting work-related disability and medical cost outcomes: a comparison of injury severity scoring methods

INTRODUCTION

Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes.

METHODS

Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers' compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression.

RESULTS

The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa=0.73), and between WTR scores and those estimated by ICDPIC (kappa=0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability.

CONCLUSIONS

Injury severity was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity can be estimated using either ICDMAP-90 or ICDPIC when ICD-9-CM codes are available. We observed little practical difference between severity measures or scoring methods. This study demonstrated that using existing software to estimate injury severity may be useful to enhance occupational injury surveillance and research.

Occupational injury patterns of Turkey

Introduction and aim

Each year, a significant number of people die or become handicapped due to preventable occupational accidents or occupational diseases. The aim of this study was to investigate socio-demographic features, mechanism, causes, injury area, and sectoral features of occupational accidents in patients presented to our department.

Materials and methods

The study was carried out retrospectively after local ethics committee approval. Age and sex of the patients, mechanism of injury, type and exact location of injuries were all evaluated. The groups were compared using Chi-Square test, Student’s T test and Kruskall-Wallis test. p value <0.05 was accepted as statistically significant.

Results

Totally 654 patients were included in the study. 93.4% of patients were male, and mean age was 32.96 ± 5.97 (18–73) years. Sectoral distribution of accidents was statistically significant and mostly occurred in industrial and construction workers (p < 0.05, respectively). There is a statistically significant relationship between educational level and sector of the worker (p < 0.05). While the most frequent cause of admission to emergency department was penetrating injuries (36.4%), the least was due to multiple traumas (0.5%). Distribution of occupational accidents according to injury type was statistically significant (p < 0.05). The mean Injury Severity Score (ISS) was 9.79 ± 8.1. The mean cost of occupational injury was $1729.57 ± 8178.3. There was statistically significant difference between the sectors with respect to cost. Seventy-one patients (10.9%) recovered with permanent sequel and two (0.3%) died in hospital.

Conclusion

Occupational accidents are most commonly seen in young males, especially in primary school graduated workers, and during daytime period.

Who pays for work-related traumatic injuries? Payer distribution in washington state by ethnicity, injury severity, and year (1998-2008)

BACKGROUND

Acute work-related trauma is a leading cause of death and disability for U.S. workers but it is difficult to obtain information about injured workers not covered by workers' compensation (WC). This study aimed to: (1) describe trends in expected payer and linkage to WC claims, (2) compare characteristics of injured workers who did and did not have a linked WC claim, and (3) describe variation in expected payer and linkage to WC claims by ethnicity and injury severity.

METHODS

Data for injuries occurring from 1998 through 2008 were obtained from the Washington State Trauma Registry and linked to WC claims.

RESULTS

We found that 27% of work-related traumatic injuries did not have WC listed as a payer, while 37% did not link to a WC claim. Among those with WC listed as a payer, the odds of having a linked WC claim were 57% lower for workers with other non-WC insurance compared with the otherwise uninsured. Latinos were more likely to have a linked WC claim compared with non-Latinos, but there was no significant difference after partially controlling for WC-covered employment and other insurance.

CONCLUSIONS

This study demonstrated the importance of considering differential access to other insurance coverage and adaptation by health care settings to financial pressures when assessing trends in occupational injury incidence and reporting, especially when using WC as a proxy for work-relatedness. The addition of occupation, industry, and work status to trauma registries and hospital discharge databases would improve surveillance, research, policy and prevention efforts.

The burden of traumatic brain injury among adolescent and young adult workers in Washington State

OBJECTIVE

This study describes injury characteristics and costs of work-related traumatic brain injury (WRTBI) among 16-24 year olds in Washington State between 1998 and 2008.

METHODS

WRTBIs were identified in the Washington Trauma Registry (WTR) and linked to workers' compensation (WC) claims data. Medical and time-loss compensation costs were compared between workers with isolated TBI and TBI with other trauma.

RESULTS

Of 273 WRTBI cases identified, most (61.5%) were TBI with other trauma. One-third of WRTBI did not link to a WC claim. Medical costs averaged $88,307 (median $16,426) for isolated TBI cases, compared to $73,669 (median $41,167) for TBI with other trauma.

CONCLUSIONS

Results highlight the financial impact of WRTBI among young workers. Multiple data sources provided a more comprehensive picture than a single data source alone. This linked-data approach holds great potential for future traumatic occupational injury research.

IMPACT ON INDUSTRY

TBI among young workers not only involves long-term health and psychological impacts, but is costly as well.

Predicting work-related disability and medical cost outcomes: estimating injury severity scores from workers' compensation data

PURPOSE

Acute work-related trauma is a leading cause of death and disability among US workers. The research objectives were to assess: (1) the feasibility of estimating Abbreviated Injury Scale-based injury severity scores (ISS) from ICD-9-CM codes available in workers' compensation (WC) medical billing data, (2) whether ISS predicts work-related disability and medical cost outcomes, (3) whether ISS adds value over other injury severity proxies, and (4) whether the utility of ISS differs for an all-injury sample compared with three specific injury samples (amputations, extremity fractures, traumatic brain injury).

METHODS

ISS was estimated from ICD-9-CM codes using Stata's user-written -icdpic- program for 208,522 compensable nonfatal WC claims for workers injured in Washington State from 1998 to 2008. The Akaike Information Criterion and R(2) were used to compare severity measures. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modeled using linear regression.

RESULTS

Work disability and medical costs increased monotonically with injury severity. For a subset of 4,301 claims linked to the Washington State Trauma Registry (WTR), there was moderate agreement between WC-based ISS and WTR-based ISS. Including ISS together with an early hospitalization indicator resulted in the most informative models; however, early hospitalization is a more downstream measure.

CONCLUSIONS

ISS was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity should be considered as a potential confounder for occupational injury intervention, program evaluation, or outcome studies, and can be estimated using existing software when ICD-9-CM codes are available.

What is the potential of trauma registry data to be used for road traffic injury surveillance and informing road safety policy?

INTRODUCTION

Information from hospital trauma registries is increasingly being used to support injury surveillance efforts. This research examines the potential of using trauma registry data for road traffic injury surveillance for different types of road users in terms of both the information collected and how representative trauma data are compared to two population-based road traffic injury data collections.

METHODS

The three data collections were assessed against recommended variables to be collected for injury surveillance purposes and the representativeness of the distribution of road traffic-related injury data from the trauma registry was compared to hospital admission and road traffic authority data collections.

RESULTS

Data from the trauma registry was largely not representative of the distribution of age groups or activities compared to the two population-based collections, but was representative for gender for some road user groups to at least one population-based data collection.

CONCLUSIONS

Trauma data could be used to supplement information from population-based data collections to inform road safety efforts.

IMPACT ON INDUSTRY

Road safety policy makers should be aware of the potential and the limitations of using trauma registry data for road traffic injury surveillance.

Traumatic occupational injuries in Hispanic and foreign born workers

BACKGROUND

Hispanic and foreign-born workers suffer high rates of occupational fatality. Reasons for this are not well understood. Our aim was to gather information about the details related to severe, non-fatal occupational injuries in this vulnerable population.

METHODS

Eight years of data were obtained from an urban trauma center. In addition, medical consultations of individuals admitted for an occupational injury during an 8-month period are reported.

RESULTS

Hispanics were more highly represented than expected; their number of injuries steadily rose. Hispanics were more likely to be injured by machinery and hand tools. Workers reported hazardous working conditions, lack of workers compensation, short time in current employment, and not working in their usual job.

CONCLUSION

Trauma systems can provide a glimpse of risk factors for severe injuries in vulnerable workers. We recommend greater use of this data source, follow backs, long-term follow up of individuals, and improvement of surveillance of vulnerable working populations.

Gravidade dos acidentes de trabalho atendidos em serviços de emergência

OBJETIVO: Estimar o nível de gravidade de acidentes de trabalho e fatores associados. MÉTODOS: Estudo longitudinal realizado em Salvador, BA, conduzido com todos os 406 casos de acidentes de trabalho atendidos em duas unidades de emergência de hospitais públicos, entre junho e agosto de 2005. Os participantes foram identificados durante a admissão no serviço de emergência e entrevistados mensalmente em suas residências, até o retorno ao trabalho ou finalização do tratamento. A gravidade foi definida com a Abbreviated Injury Scale utilizada para calcular escores do Injury Severity Score. Foram estimadas a letalidade e a mortalidade hospitalar, permanência e internação na unidade de terapia intensiva (UTI). Variáveis descritoras foram sexo, idade, ramo de atividade econômica e ocupação. Empregaram-se proporções, razões de proporções e intervalos de confiança para a inferência estatística e média e teste t de Student para variáveis normais contínuas. RESULTADOS: A maior parte dos 406 casos foi de gravidade leve (39,4%) e moderada (38,7%), seguida pelos de nível sério (17,2%), severo (3,2%) e crítico (1,5%). A letalidade global foi 0,7% e 5,0% entre os que ficaram internados (14,8%), enquanto a média de hospitalização foi 3,2 dias (DP=2,8). Três casos (0,7%) necessitaram UTI (média= 8,4 dias, DP=1,2). A maior parte dos casos graves ocorreu entre os homens e os que tinham mais que 37 anos de idade. Acidentes com trabalhadores de transporte (RP=2,20; IC 90%: 1,06;4,58) e comércio (RP=1,85 IC 90%: 1,14;3,00) foram mais graves do que o do grupo referente. A proporção de acidentes graves foi 54% maior entre os de trajeto em comparação com os típicos. No total foram 325 dias de hospitalização e 34 dias de permanência em UTI. CONCLUSÕES: Foi elevada a gravidade de acidentes de trabalho, especialmente os ocorridos com trabalhadores do ramo de transporte e comércio, repercutindo nos serviços de emergência e ocupação de leitos hospitalares e UTI.

The value of trauma registries

Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

Use of employer administrative databases to identify systematic causes of injury in aluminum manufacturing

BACKGROUND

Employer administrative files are an underutilized source of data in epidemiologic studies of occupational injuries.

METHODS

Personnel files, occupational health surveillance data, industrial hygiene data, and a real-time incident and injury management system from a large multi-site aluminum manufacturer were linked deterministically. An ecological-level measure of physical job demand was also linked. This method successfully created a database containing over 100 variables for 9,101 hourly employees from eight geographically dispersed U.S. plants.

RESULTS

Between 2002 and 2004, there were 3,563 traumatic injuries to 2,495 employees. The most common injuries were sprain/strains (32%), contusions (24%), and lacerations (14%). A multivariable logistic regression model revealed that physical job demand was the strongest predictor of injury risk, in a dose dependent fashion. Other strong predictors of injury included female gender, young age, short company tenure and short time on current job.

CONCLUSIONS

Employer administrative files are a useful source of data, as they permit the exploration of risk factors and potential confounders that are not included in many population-based surveys. The ability to link employer administrative files with injury surveillance data is a valuable analysis strategy for comprehensively studying workplace injuries, identifying salient risk factors, and targeting workforce populations disproportionately affected.

Occupational Injury Surveillance of Traumatic Injuries in Illinois, Using the Illinois Trauma Registry: 1995–2003

BACKGROUND

Trauma registries continue to be underutilized for surveillance, despite providing data on the most severe injuries with a level of detail not available in national data sets or workers' compensation files.

METHODS

We evaluate trends and patterns of traumatic occupational injuries from the Illinois Trauma Registry (ITR).

RESULTS

Between 1995 and 2003, 44.4 of every 100,000 Illinois workers (age-adjusted) suffered work-related, nonfatal traumatic injuries. The majority of workers suffering traumatic injuries were white males younger than 55 years old. Falls were the most common cause of injury, and fracture of the extremities was the most common type of injury experienced by Illinois workers. Approximately 8% of all workers required either partial or total ambulatory assistance at time of discharge.

CONCLUSION

The ITR provides detailed and complete data regarding the most severe occupational injuries.

CLINICAL SIGNIFICANCE

In contrast to reports from national surveillance data sets, we do not observe a significant decline in occupational injuries between 1995 and 2003. Trauma registries should be used more frequently for surveillance programs, because they provide detailed and reliable data regarding the most severe occupational injuries not available in other data sets.

Industrial sectors with high risk of women's hospital-treated injuries

BACKGROUND

Women's occupational injury rates are converging with those of males. Associations between female workers' hospital treated injury rates, industrial sector and injured body area were analyzed to provide for better-focused injury prevention of women's hazardous jobs.

METHODS

Females' standardized hospital treatment ratios (SHR) and the excess fraction for five body regions (head/neck, thorax, back, upper and lower extremities) were calculated for 58 industrial sectors for 1999-2003.

RESULTS

Five industrial sectors, "Cleaning, laundries and dry cleaners," "Transport of passengers," "Hotels and restaurants," "Hospitals" and "Transport of goods" had significantly high SHRs for all five body regions. The excess fraction for upper extremity injuries revealed that 14%-27% of injuries could theoretically have been avoided.

CONCLUSIONS

There is strong evidence for an association between women's hospital treated injuries and industrial sector. The results justify the need for gender-sensitive analyses to orient injury prevention programs.

Occupational accidents and forensic medicine in Turkey

In Turkey, evaluation of the ratio of loss of working capacity is made according to various laws and regulations. These laws and regulations use different standards in computing the above-mentioned ratio depending on the professional status of the worker, whether he or she is a member of SSK (Social Security Institution) or ES (The Retirement Pension Institution) system. The aim of this study is to point out at the differences and deficiencies in computing the degree of disability and at the need to bring common standards to these computations. This prospective descriptive research is based on the cases of occupational accidents and occupational diseases brought to the 3rd specialized branch of the Institution of Forensic Medicine (which is the highest ruling instance concerning the decision on this field). Of the 164 accident cases included in this research, 95.1% are males, and 4.9% females. According to distribution by age of the cases, the modal group is respectively (30-39) years for men and (12-19) years for women. 43.8% of the injuries were localized at the hand or wrist. No meaningful statistical relationship could be found between the level of qualification of the workers (skilled-unskilled) and the proportion of those suffering from total disability. For the cases included in the categories 3, 4 and 5 is the ES system; the ratio of disability was similar to those computed according to the SSK system. In conclusion, we would like to insist on the need for our country to amend our laws and regulations according to changing and prevailing conditions and sex differentials and to bring homogeneous standards for all workers.

[Frequency of occupational injuries and the health status of workers]

INTRODUCTION

Occupational injuries are the leading cause of morbidity and mortality among workers. The aim of this study was to analyze the frequency of occupational injuries and health status of workers.

MATERIAL AND METHODS

The examined group consisted of 3,750 workers with health disorders. The control group included 1,800 healthy workers. Both groups were similar in terms of many factors that could contribute to the occurrence of occupational injuries. The injury rates were calculated in both groups.

RESULTS

Workers with psychomotor and sensorimotor disorders, neuroses, obstructive sleep apnea, arterial hypertension, diabetes mellitus, hearing, vascular and sight impairments have been frequently injured compared to workers with other diseases.

DISCUSSION

Due to the belief that accidents and occupational injuries are preventable, it is an imperative to study those factors which are likely to contribute to occurrence of accidents. The contributing factors could be the physical and mental state of workers.

CONCLUSION

Occupational injuries are significantly more common in the examined group than in controls.

Fatal falls in the US construction industry, 1990 to 1999

The Occupational Safety and Health Administration's (OSHA's) Integrated Management Information System (IMIS) database allows for the detailed analysis of risk factors surrounding fatal occupational events. This study used IMIS data to (1) perform a risk factor analysis of fatal construction falls, and (2) assess the impact of the February 1995 29 CFR Part 1926 Subpart M OSHA fall protection regulations for construction by calculating trends in fatal fall rates. In addition, IMIS data on fatal construction falls were compared with data from other occupational fatality surveillance systems. For falls in construction, the study identified several demographic factors that may indicate increased risk. A statistically significant downward trend in fatal falls was evident in all construction and within several construction categories during the decade. Although the study failed to show a statistically significant intervention effect from the new OSHA regulations, it may have lacked the power to do so.