A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century (2018) / Chapter Skim
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4 Current Status of Federal and State Programs and Cross-cutting Issues
4 Current Status of Federal and State Programs and Cross-cutting Issues
Pages 73-142
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From page 73... ...
Figure 4-1 shows a Venn diagram representing major data sources for occupational injuries and illnesses ( nder the major categories of employers, medical records, and individuals) u and the overlap among the systems that collect these data for occupational injury and illness surveillance.
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) , and proposed Household Survey of Nonfatal Occupational Injuries and Illnesses (HSOII)
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report -- established the Census of Fatal Occupational Injuries (CFOI) , a nationwide surveillance system designed to produce a timely census of all fatal work injuries in the United States.1 A federal-state cooperative program implemented in all 50 states, CFOI uses multiple data sources, such as death certificates, police reports, federal agency administrative data, workers' compensation claim records, and news media, to identify, verify, and describe fatal work injuries.
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O: Fatal Gas Extraction occupational injuries and illnesses NOTES: BLS, Bureau of Labor Statistics; NIOSH, National Institute for Occupational Safety and Health; OSHA, Occupational Safety and Health Administration; asterisk denotes funding agency. aGeographic levels at which findings are publicly available.
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Distinguishing fatal work-related motor vehicle incidents from non-work-related incidents is particularly difficult, and BLS is currently working with NIOSH, the National Highway Traffic Safety Administration (NHTSA) and state agency partners to pilot new approaches to provide more comprehensive information about fatal occupational crashes.
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CFOI is well respected as an authoritative count of fatal work injuries at the national and state levels and a model for multisource surveillance of a health outcome. It provides robust information about the burden and distribution of fatal occupational injuries over time and serves as an important example of how surveillance findings can be used to monitor progress in meeting prevention goals, target intervention activities, and set research priorities.
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program, to conduct in-depth investigations of targeted fatal occupational incidents with the objective of identifying factors contributing to these deaths. Currently seven states are funded by NIOSH to conduct approximately 100 investigations each year.3 NIOSH identifies national targets for investigation, which currently include falls from elevations and machine-related deaths, and the participating states have the option of identifying their own targets.
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. SURVEILLANCE OF NONFATAL OCCUPATIONAL INJURIES Nonfatal occupational injuries as discussed in this chapter encompass traumatic injuries due to sudden events such as falls, motor vehicle crashes, violence, and being struck by machinery.
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Major activities include the following: • BLS enhancements to the SOII to collect additional data on more severe injuries, add data on public employees, and expand data analysis; • OSHA's severe injury reporting system; • NIOSH's leveraging of other national public health surveillance systems and surveys; and • State-based projects, funded largely by NIOSH, using state data sources to conduct surveillance of nonfatal occupational injuries at the state level. Survey of Occupational Injuries and Illnesses The SOII is the only source of uniform nationwide statistics on nonfatal work-related injuries in the United States, providing annual estimates of the number and rates of work-related injuries and illnesses for the nation and for the states that collaborate with BLS.
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SOURCE: BLS, 2016d. from the railroad and mining industries included in the SOII published findings are obtained by BLS from the Federal Railroad Administration and the Mine Safety and Health Administration, which require reporting of all fatal and nonfatal work-related injuries and illnesses by railroad and mine employers.
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to generate and publish experimental rates by occupation, age, and gender -- as the employment data provided by participating employers are not broken down by these data elements. 7 eporting by states and local agencies is voluntary for the 22 states without federally R approved OSHA state plans covering state and local government workers.
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. While it has long been recognized that the SOII does not adequately capture chronic occupational illnesses for reasons discussed under disease surveillance below, there is increasing evidence that undercounting of injuries and acute illnesses is also a significant limitation, and there may be differential rates of reporting by establishment, injury, and incident characteristics, as well as by state.
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• Failure of health care provider to recognize work-relatedness (especially true for musculoskeletal disorders and chronic illnesses)
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The SOII data are available to researchers for BLS-approved projects. In the past, this research had to be carried out at BLS headquarters but the Census Bureau and the Bureau of Labor Statistics are in the process of making certain BLS restricted data sets, including SOII and CFOI data, available to qualified researchers for statistical research exclusively through the Federal Statistical Research Data Centers managed by the U.S.
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While there are robust data on the differential risk of fatal occupational injury across racial and ethnic groups available through CFOI, there is a paucity of such information on nonfatal injuries and illnesses. Collection of race and ethnicity data as an optional variable in the SOII for approximately 40 percent of cases suggests it is feasible for employers to report this information.
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From page 88... ...
Conclusion: Although limited, the SOII remains the most extensive system for standardized information on nonfatal occupational injuries and acute illnesses across the nation and the SOII continues to be an important source of information today. Better and more efficient use of the SOII to meet surveillance objectives, including characterization of disparities in risk among vulnerable groups of workers, is possible.
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From page 89... ...
OSHA Severe Injury Reporting OSHA has undertaken many initiatives over the years to address the lack of access to establishment-specific injury and illness data in the SOII. Since OSHA was established in 1971, employers under OSHA jurisdiction have been required to promptly report workplace fatalities and incidents resulting in hospitalizations of three or more employees to the agency for evaluation and investigation.
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During the severe injury report intake process, the agency collects data on the employer, the employee (including employee's age and employment arrangement [e.g., contract or temporary worker]
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Since the early 1990s, NIOSH has had an interagency agreement with the Consumer Product Safety Commission to collect data on nonfatal occupational injuries through an occupational supplement to the National Electronic Injury Surveillance System (NEISS)
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NIOSH in collaboration with BLS has developed this website and the accompanying downloadable software application as a resource for occupational safety and health researchers, policy makers, employers, and others who may need to use the OIICS for uniformly characterizing occupational injuries and ill nesses or better understanding the national occupational injury and illness data prevention measures. Other disadvantages of NEISS-Work include a small sample size, lack of information about lost work time (other than limited information if the individual is hospitalized)
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and the Enhanced Coal Workers' Health Surveillance Program. The CWXSP also includes x rays from the National Coal Study (also known as the National Study of Coal Workers' Pneumoconiosis)
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Each injury is only counted once, regardless of the number of ED visits. Rates were calculated by CDC based on the number of injuries and the number of primary employed FTE workers from the BLS Current Population Survey, 2011.
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Future evaluations will need to be conducted to determine if recommended changes are sufficient to address the current limitations in OSH surveillance in agriculture. BOX 4-3 Data to Action Preventing Injuries in Michigan: The Michigan OSH surveillance program uses hospital data and workers' compensation data to track amputations, burns, crushing injuries, acute hospitalized injuries, farm-related injuries, and skull frac tures among workers.
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Past research by Washington's state-based OSH surveillance program indicated that the most common and costly injuries were musculoskeletal disorders and falls. In response to this prob lem, Washington developed the Trucking Injury Reduction Emphasis through Surveillance (TIRES)
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Half of the fundamental state surveillance programs, supported by NIOSH, use available state data sources to generate a standard set of over 20 occupational health indicators (Thomsen et al., 2007; CSTE, 2017a)
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BLS, Bureau of Labor Statistics; CDC, Centers for Disease Control and Prevention; CPSC, Consumer Product Safety Commission; NIOSH, National Institute for Occupational Safety and Health; OSHA, Occupational Safety and Health Administration. aGeographic levels at which findings are publicly available.
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dThe population covered may include active and former workers, retirees, and others depending on the system. eInformation for Guam, Puerto Rico, and the U.S.
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, state-based surveillance programs usually using workers' compensation data -- 43 percent of compensable claims in Washington State (Marcum and Adams, 2017) , and the National Health Interview Survey Occupational Health Supplement (CDC, 2017e)
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workforce demanding a continued emphasis on surveillance of these disorders. OCCUPATIONAL DISEASE SURVEILLANCE Surveillance of diseases in which an occupational hazard or hazards were the cause or contributing factor is especially challenging because the illnesses of interest (e.g., coronary artery disease, chronic obstructive pulmonary disease [COPD]
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that are almost invariably work related, and the diagnosis itself as an indicator for work-relatedness (pathognomonic occupational diseases) and multifactorial diseases for which occupational causes are only one of a number of contributing factors.
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Rather, over the past several decades, NIOSH has taken more limited steps to advance surveillance of occupational disease. The major strategies used by NIOSH have been to leverage use of existing health data sources and surveys and to support state health agencies in building case- and population-based surveillance systems for select occupational health conditions.
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Periodic (5-year) Multiple Occupational Health outcomes Supplement and hazards that vary with NIOSH supplement Adult Blood Lead 26 states (and P, C NIOSH*
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Multiple data sources: All workers Census Varies by state provider case reports, hospital workers' compensation records, death certificates Mandated sharps injury All workers in Census Annual logs maintained by hospitals including acute and chronic care students in hospitals training Death certificates All workers Census Intermittent continued
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O: Hearing loss surveillance NOTES: Asterisk indicates funding agency. NCHS, National Center for Health Statistics; NIOSH, National Institute for Occupational Safety and Health; OSHA, Occupational Safety and Health Administration.
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The National Occupational Respiratory Mortality System (NORMS) is an interactive data system that is based on mortality data from death certificates provided to NIOSH annually by the NCHS (see Box 4-2)
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were listed on death certificates were identified using CDC multiple cause-of-death data for 1999-2015. SOURCE: Mazurek et al., 2017.
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Periodically NIOSH funds occupational health supplements (NHISOSH) to collect national-level data on various occupational health outcomes and exposures, focusing on information not available in the SOII (NIOSH, 2016d)
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workers, 2010) , Occupational Health Supplement to the National Health Interview Survey All U.S.
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These are described in Chapter 6. Medical Monitoring Program Data Several ongoing programs that routinely monitor worker health in specific industries provide data useful for occupational health and safety surveillance.
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Conclusion: NIOSH has effectively used the results from a mandatory medical monitoring program for coal miners and a voluntary program for noise exposed workers for occupational illness surveillance. Use of the results of mandatory medical monitoring required by OSHA and the recommended medical monitoring conducted by employers has the potential to improve surveillance data for selected occupational illnesses.
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Timely information about work-related transmission of infectious diseases can be strategically important to facilitate rapid assessment and intervention to control the spread of disease to other workers and the public, particularly workers in critical and public-related services such as health care, medical waste treatment, emergency response, postal and package delivery, utilities, and transportation. In the United States, state, local, and territorial public health agencies take the lead on receiving cases of specified infectious conditions.
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OSH surveillance programs in state health agencies may also collaborate with their infectious disease programs to investigate and address clusters of infectious disease in the workplace. For example, occupational safety and health staff worked with infectious disease colleagues in California to identify, investigate, and prevent coccidioidomycosis among construction workers in the solar industry (Wilken et al., 2015)
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. Initially based primarily on case reporting by health care providers, the model has evolved over time to include use of multiple sources such as death certificates, administrative data sources such as statewide hospital data sets and worker's compensation records, laboratory reports, and other sources such as calls to poison control centers and agricultural extension programs for case ascertainment, e.g., silicosis (Schleiff et al., 2016)
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. The occupational health indicators generated by NIOSH-funded OSH programs in about half the states include measures of several diseases almost always caused by work such as mesothelioma and asbestosis as well as elevated blood lead levels in adults and occupationally related calls to poison control centers (Appendix D)
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Recommendation B: NIOSH, working with the state occupational safety and health surveillance programs and across divisions within the agency, should develop a methodology and coordinated system for surveillance of both fatal and nonfatal occupational disease using multiple data sources. The data should be analyzed, interpreted, and presented regularly in a comprehensive public report.
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• Increased collaboration between NIOSH and CDC infectious disease surveillance programs, with improved collection of occupational information, will be important to improve documentation of endemic and epidemic infectious disease related to work. In the longer term: • Gaps identified in the occupational illness surveillance system will need to be addressed through future developments that may involve o or modified state regulations, requiring close coordina New tion with the states, many of which have already promulgated reporting regulations.
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OCCUPATIONAL HAZARD AND EXPOSURE SURVEILLANCE Occupational hazard surveillance is the systematic assessment of the occurrence of workplace risks with potential to contribute to health, disease, and injury among working populations. Exposure surveillance measures actual risk by including distribution of, and the secular trends in exposure to workplace risks.
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include quantitative industrial hygiene measurements from a variety of sources.11 Assessment of IMIS data from the 1980s found that, despite the limitations in using exposure data from a compliance database, some surveillance objectives are met when examining exposures to airborne lead and airborne silica. An analysis of the airborne concentrations of lead collected during OSHA compliance in 11 he CEHD, available since 2010 as part of the OSHA Information System, also contains T quantitative industrial hygiene measurements but these are limited to those that are processed by the OSHA Salt Lake Technical Center.
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State-Based OSH Surveillance Programs The 1987 NRC panel recognized the importance of the state-federal partnership and recommended that NIOSH continue and expand its efforts to develop the occupational health surveillance capability of state health departments through technical assistance and financial support. NIOSH responded positively to these recommendations and, even in the absence of
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Consequently, whereas in some public health domains, such as infectious disease and cancer prevention, surveillance programs are in most if not all states, close to half of the states report having little or no OSH surveillance capacity. In a nationwide assessment of state health agencies regarding epidemiologic and surveillance capacity in eight public health domains, only 20 percent of states reported having substantial epidemiologic and surveillance capacity in occupational health, the lowest percentage of all domains assessed (CSTE, 2013b)
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. State programs come and go over funding cycles leaving gaps in the nation's OSH surveillance capacity.
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o Encourage NIOSH-funded Education Research and Training Centers and Agricultural Health and Safety Centers to provide technical and research support to state surveillance programs in their regions as part of their required outreach and education core activity. Surveillance Research Research is the process of systematic investigation to generate new facts, and it is important for all types of surveillance, including OSH surveillance.
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Applied surveillance research will play an important role in developing new approaches and adapting new technologies to build a smart OSH surveillance system for the 21st century. Research Using Surveillance Data to Generate New Knowledge About Occupational Health Within a surveillance system, the data collected are usually limited to the minimum data necessary to accomplish the objectives.
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These include, for example, development of coding software for assigning standard codes for occupation and event based on free text, and web-sweeping approaches for ascertaining fatal occupational injuries in publicly available data sets. As described above, the agency has processes in place for researchers to apply to use CFOI and SOII data for research purposes and is in the process of making these data available at their Federal Statistical Research Data
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As will be described in Chapter 6, they are also supporting research to explore the feasibility of a worker survey. NIOSH likewise conducts and supports surveillance research using surveillance data as well as applied research to develop new surveillance methods.
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. One of the most widely used sources of employment information in generating injury or illness rates at the national and state levels is the Current Population Survey (CPS)
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Practical guidance tools for selecting appropriate denominators for state OSH surveillance programs and other researchers are also needed. With changes in the health care delivery system there is increasing emphasis on documenting health needs at the community level.
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• Limited data on nonfatal injuries in populations under surveillance due to underreporting, insufficient collection of detailed information for majority of cases reported, limited indictors of injury severity • Insufficient data on chronic occupational disease and limited synthesis of available information • No approach for systematic collection of information about hazards and exposures • Lack of data on economic and social impact of occupational injuries and illnesses Objective: Detect new or emerging hazards Gaps: • Limited capacity in federal agencies to analyze available injury, illness, fatality, and exposure data to identify workplaces or populations at high risk, emerging trends, and actively promote use of data for prevention SUMMARY While substantially improved since 1987, the current state of OSH surveillance continues to have gaps and lacks maturity across the end points under surveillance. A robust system for fatal injuries is in place.
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CURRENT STATUS OF FEDERAL AND STATE PROGRAMS 131 Objective: Identify high-risk industries, occupations, worksites and populations Gaps: • Ready access to establishment level data by government agencies for targeting preventive outreach and enforcement • Lack of data on nonfatal injuries and acute illnesses at the firm level and on multiemployer worksites • Limited data on socio-demographic characteristics and work arrange ments needed to identify potential vulnerable populations • Lack of occupational information in data sources originating in the health care delivery system that are a crucial complement to employer-based reporting • Insufficient employment data on the contingent workforce needed to generate estimates of risk Objective: Guide planning, implementation, and evaluation of prevention programs at establishment and state levels Gaps: • No systematic means to foster use of data by employers and workers at the establishment level or to provide feedback on injury and illness experience to assist with hazard identification and prevention efforts • Limited or no OSH surveillance capacity in many states and missed op portunities for collaboration across public health domains Objective: Generate hypothesis and make data available for research Gap: • No surveillance research agenda lacking. Although there is some coordination across the multiple entities engaged in surveillance, the current "system" operates more as a collection of separate and sometimes fragmented data systems, rather than a coordinated national OSH surveillance system that effectively promotes use of the data for prevention.
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American Journal of Industrial Medicine 57(2)
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2013. Hispanic/Latino fatal occupational injury rates.
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migrant and seasonal farmworkers in twenty-four states. American Journal of Industrial Medicine 40:604-611.
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2013. The proportion of work-related emergency department visits not expected to be paid by workers' compensation: Implications for occupational health surveillance, research, policy, and health equity.
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American Journal of Industrial Medicine 60(5)
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Available online at https://www.health.ny.gov/environmental/workplace/ heavy_metals_registry (accessed June 14, 2017)
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2016d. National Health Interview Survey: Occupational health supplement.
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Monthly Labor Review November. Available online at https://www.bls.gov/ opub/mlr/2013/article/an-analysis-of-fatal-occupational-injuries-at-road-construction sites-2003-2010.htm (accessed April 4, 2017)
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: A basis for physician recognition and public health surveillance. American Journal of Public Health 73(9)
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Presentation to the National Academies Committee on Developing a Smarter National Surveillance System for Occupational Safety and Health in the 21st Century, September 21. Sears, J
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American Journal of Industrial Medicine 57(10)
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