Occupation recorded on certificates of death compared with self-report: the Atherosclerosis Risk in Communities (ARIC) Study

Drug poisoning deaths by occupation and drug type, Massachusetts 2010-2019

OBJECTIVE

To investigate variation in drug poisoning mortality rates by drug type and occupation in Massachusetts.

METHODS

Death certificates for deaths by drug poisonings occurring between 2010 and 2019 in Massachusetts were coded based on the decedent's occupation. Mortality rates and rate ratios (with all other occupations as the reference group) were calculated based on the occupation of the workers according to drug type. Poisson regression was used to determine significantly elevated mortality rates and trends in drug poisoning deaths by occupation and drug type.

RESULTS

The rate of drug poisoning deaths increased from 2010 to 2016 after which they plateaued. With respect to specific substances, fentanyl- and cocaine-related deaths increased throughout the surveillance period. For drug poisoning deaths overall, workers in construction trades (3,017); food preparation and serving (1,116); transportation and material moving (1,062) occupations had the highest number of drug poisoning deaths. When adjusting for age, sex, race/ethnicity, and educational attainment, workers in 7 occupations had significantly elevated mortality rate ratios for drug poisonings overall: farming, fishing, and forestry (3.42, P < 0.001); construction trades (2.58, P < 0.001); health care support (1.61, P < 0.001); community and social service (1.60, P < 0.001); food preparation and serving related (1.54, P < 0.001); personal care and service (1.37, P < 0.001); and arts, design, entertainment, sports, and media (1.21, P = 0.010). In many cases, workers in these same occupations had elevated mortality rate ratios for poisonings from specific substances. Health care practitioners and technical occupation workers only had elevated rates for methadone-related poisonings (1.73, P = 0.010).

CONCLUSIONS

These findings highlight that workers in certain occupations have an elevated risk for drug poisonings and that the patterns differ with respect to the drug type. These findings can be useful for providing services to workers in high-risk occupations and in identifying occupational factors that may be related to the risk of drug poisoning death. While previous research has begun to uncover work-related factors that may contribute to opioid use, further work is needed to identify occupational factors that may contribute to psychostimulant and benzodiazepine use.

Drug overdose mortality is associated with employment status and occupation in the National Longitudinal Mortality Study

BACKGROUND

Since 1999, over 702,000 people in the US have died of a drug overdose, and the drug overdose death rate has increased from 6.2 to 21.8 per 100,000. Employment status and occupation may be important social determinants of overdose deaths.

OBJECTIVES

Estimate the risk of drug overdose death by employment status and occupation, controlling for other social and demographic factors known to be associated with overdose deaths.

METHODS

Proportional hazard models were used to study US adults in the National Longitudinal Mortality Study with baseline measurements taken in the early 2000s and up to 6 years of follow-up (n = 438,739, 53% female, 47% male). Comparisons were made between adults with different employment statuses (employed, unemployed, disabled, etc.) and occupations (sales, construction, service occupations, etc.). Models were adjusted for age, sex, race/ethnicity, education, income and marital status.

RESULTS

Adults who were disabled (hazard ratio (HR) = 6.96 (95% CI = 6.81-7.12)), unemployed (HR = 4.20, 95% CI = 4.09-4.32) and retired (HR = 2.94, 95% CI = 2.87-3.00) were at higher risk of overdose death relative to those who were employed. By occupation, those working in service (HR = 2.05, 95% CI = 1.97-2.13); construction and extraction (HR = 1.69, 95% CI = 1.64-1.76); management, business and financial (HR = 1.39, 95% CI = 1.33-1.44); and installation, maintenance and repair (HR = 1.32, 95% CI = 1.25-1.40) occupations displayed higher risk relative to professional occupations.

CONCLUSIONS

In a large national cohort followed prospectively for up to 6 years, several employment statuses and occupations are associated with overdose deaths, independent of a range of other factors. Efforts to prevent overdose deaths may benefit from focusing on these high-risk groups.

Demographic considerations in analyzing decedents by usual occupation

BACKGROUND

Public health research uses decedents' usual industry and occupation (I&O) from US death certificates to assess mortality incidence and risk factors. Of necessity, such research may exclude decedents with insufficient I&O information, and assume death certificates reflect current (at time of death) I&O. This study explored the demographic implications of such research conditions by describing usual occupation and current employment status among decedents by demographic characteristics in a large multistate data set.

METHODS

Death certificate occupations classified by Standard Occupational Classification (SOC) (ie, compensated occupation) and other categories (eg, student) for 36 507 decedents (suicide, homicide, other, undetermined intent) age 22+ years from the 2016 National Violent Death Reporting System's (NVDRS) 32 US states were analyzed. Decedents not employed at the time of death (eg, laid off) were identified through nondeath certificate NVDRS data sources (eg, law enforcement reports).

RESULTS

Female decedents, younger (age < 30 years) male decedents, some non-White racial group decedents, less educated decedents, and undetermined intent death decedents were statistically less likely to be classified by SOC based on death certificates-primarily due to insufficient information. Decedents classified by SOC from death certificates but whose non-death certificate data indicated no employment at the time of death were more often 30+ years old, White, less educated, died by suicide, or had nonmanagement occupations.

CONCLUSIONS

Whether decedents have classifiable occupations from death certificates may vary by demographic characteristics. Research studies that assess decedents by usual I&O can identify and describe how any such demographic trends may affect research results on particular public health topics.

Assessing the accuracy of the death certificate injury at work box for identifying fatal occupational injuries in Michigan

BACKGROUND

Death certificates contain a box labeled "Injury at Work" which is to be marked "Yes" for all fatal occupational injuries. The accuracy of this box in Michigan is not fully characterized.

METHODS

The accuracy of the Injury at Work box on the Michigan death certificate was compared to deaths identified from 2001 through 2016 by the Michigan Fatality Assessment and Control Evaluation multi-source surveillance system. The sensitivity was calculated across this time period, while specificity and positive and negative predictive values were derived for 2011-2016. Univariate and multivariate regression were used to examine differences in the sensitivity over time and across demographic variables, industry, and the type of death.

RESULTS

We found a sensitivity for the Injury at Work box of 73.1% among 2156 deaths. The sensitivity showed a significant declining trend over the 17 years, from 79.8% to 63.1%. Sensitivity varied significantly across incident type (aircraft, animal-related, drug overdose, motor vehicle, and suicides having particularly lower sensitivities, and electrocutions, falls, and machine-related incidents having higher sensitivities), and industry sector (construction, manufacturing, public safety, transportation, and trade sectors having higher sensitivities, and agriculture and services sectors showing lower sensitivities). Across nearly all categories the sensitivity was significantly below 1.

CONCLUSIONS

The Injury at Work box on the Michigan death certificate was often incorrectly completed and has become less accurate with time, though the degree of this inaccuracy varies by the industry of the victim and the type of incident.

Codability of industry and occupation information from cancer registry records: Differences by patient demographics, casefinding source, payor, and cancer type

INTRODUCTION

Industry and occupation (I&O) information collected by cancer registries is useful for assessing associations among jobs and malignancies. However, systematic differences in I&O availability can bias findings.

METHODS

Codability by patient demographics, payor, identifying (casefinding) source, and cancer site was assessed using I&O text from first primaries diagnosed 2011-2012 and reported to California Cancer Registry. I&O were coded to a U.S. Census code or classified as blank/inadequate/unknown, retired, or not working for pay.

RESULTS

Industry was codable for 37% of cases; 50% had "unknown" and 9% "retired" instead of usual industry. Cases initially reported by hospitals, covered by preferred providers, or with known occupational etiology had highest codable industry; cases from private pathology laboratories, with Medicaid, or diagnosed in outpatient settings had least. Occupation results were similar.

CONCLUSIONS

Recording usual I&O for retirees and improving linkages for reporting entities without patient access would improve I&O codability and research validity.

Occupational exposure to respirable crystalline silica and chronic non-malignant renal disease: systematic review and meta-analysis

Background

While occupational exposure to respirable silica is known to lead to lung disease, most notably silicosis, its association with chronic kidney disease is unclear.

Objectives

This review explores the association between occupational exposure to respirable silica and chronic non-malignant renal disease such as glomerulonephritis. The evidence has been collected and compiled. Possible sources of bias are thoroughly discussed.

Methods

Cohort studies with silica exposure and case–control studies of renal disease were searched in PubMed until January 2015. Two authors independently abstracted data; any disagreement was resolved by consulting a third reviewer. A meta-analysis was performed to evaluate the association to silica exposure.

Results

A total of 23 cohort and four case–control studies were included in the analysis. The meta-analysis of cohort studies yielded elevated overall SMRs for renal disease. Some studies, however, included dose–response analyses, most of which did not show a positive trend. The approaches and results of the case–control studies were very heterogeneous.

Conclusions

While the studies of cohorts exposed to silica found elevated SMRs for renal disease, no clear evidence of a dose–response relationship emerged. The elevated risk may be attributed to diagnostic and methodological issues. In order to permit a reliable estimation of a possible causal link, exposed cohorts should be monitored for renal disease, as the information from mortality studies is hardly reliable in this field.

Electronic supplementary material

The online version of this article (doi:10.1007/s00420-017-1219-x) contains supplementary material, which is available to authorized users.

The epidemiology of cancer among police officers

BACKGROUND

This review summarizes peer-reviewed studies examining cancer risks among police officers. It provides an overview of existing research limitations and uncertainties and the plausible etiologic risk factors associated with cancer in this understudied occupation.

METHODS

Previous cancer studies among police officers were obtained via a systematic review of the MEDLINE, CABDirect, and Web of Science bibliographic databases.

RESULTS

Quality observational studies of cancer among police officers are sparse and subject to limitations in exposure assessment and other methods. Results from three studies suggested possible increased mortality risks for all cancers, and cancers of the colon, kidney, digestive system, esophagus, male breast, and testis, as well as Hodgkin's disease. Few incidence studies have been performed, and results have been mixed, although some associations with police work have been observed for thyroid, skin, and male breast cancer.

CONCLUSIONS

Police are exposed to a mix of known or suspected agents or activities that increase cancer risk. Epidemiologic evidence to date is sparse and inconsistent. There is a critical need for more research to understand the biological and social processes underlying exposures and the suggested disproportionate risks and to identify effective prevention strategies.