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1.  Traumatic occupational fatalities in South Carolina, 1989-90. 
Public Health Reports  1993;108(4):483-488.
Death certificates for South Carolina for 1989 and 1990 were examined to identify deaths resulting from injury incurred in the workplace. There were 277 deaths in that category in the 2-year period, an average yearly rate for traumatic occupational fatalities of 8.84 per 100,000 workers. The groups of industries with the highest fatality rates were transportation-communication-utilities, construction, and agriculture-fishing-forestry. The leading causes of death were injuries from motor vehicle crash, homicide, and falls. The traumatic occupational fatality rate for men was about 13 times greater than that for women; however, a much higher proportion of women died from homicide on the job. The findings in general reflect trends reported in other studies. The death rates for workers in South Carolina for 1989-90, however, were higher than national averages for 1980-88. National data for 1989-90 were not available for comparison. The data suggest that more effective injury prevention efforts need to be applied to such causes of on-the-job injury as motor vehicle crash, homicide, and falls. Those three categories accounted for more than 56 percent of all traumatic occupational fatalities in South Carolina in 1989 and 1990. Motor vehicle crash prevention efforts particularly are needed in the transportation-communication-utilities industries. The findings show that particular efforts need to be directed to the retail trade category for prevention of homicide and to the construction industry for prevention of falls.
PMCID: PMC1403413  PMID: 8341784
2.  Alaska's model program for surveillance and prevention of occupational injury deaths. 
Public Health Reports  1999;114(6):550-558.
The National Institute for Occupational Safety and Health (NIOSH) established its Alaska Field Station in Anchorage in 1991 after identifying Alaska as the highest-risk state for traumatic worker fatalities. Since then, the Field Station, working in collaboration with other agencies, organizations, and individuals, has established a program for occupational injury surveillance in Alaska and formed interagency working groups to address the risk factors leading to occupational death and injury in the state. Collaborative efforts have contributed to reducing crash rates and mortality in Alaska's rapidly expanding helicopter logging industry and have played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry (historically Alaska's and America's most dangerous industry). Alaska experienced a 46% overall decline in work-related acute traumatic injury deaths from 1991 to 1998, a 64% decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. Extending this regional approach to other parts of the country and applying these strategies to the entire spectrum of occupational injury and disease hazards could have a broad effect on reducing occupational injuries.
PMCID: PMC1308539  PMID: 10670623
3.  Occupational injury deaths of 16 and 17 year olds in the US: trends and comparisons with older workers. 
Injury Prevention  1997;3(4):277-281.
OBJECTIVE: To examine patterns of occupational injury deaths of 16 and 17 year olds in the United States for the three year period 1990-2, examine trends since the 1980s, and compare fatality rates with those of older workers. METHODS: Occupational injury deaths were analyzed using the death certificate based National Traumatic Occupational Fatalities (NTOF) surveillance system. Fatality rates were calculated using estimates of full time equivalent (FTE) workers based on data from the Current Population Survey, a monthly household survey. RESULTS: There were 111 deaths of 16 and 17 year olds for the years 1990-2. The average yearly rate was 3.5 deaths/100,000 FTE. The leading causes of death were motor vehicle related, homicide, and machinery related. All causes occupational injury fatality rates for 16 and 17 year olds were lower than for adults for 1990-2. Rates for the leading causes of death (motor vehicle related, homicide, and machinery related) were comparable or slightly higher than the rates for young and middle aged adult workers. Although rates decreased dramatically from 1980 to 1983, the decreasing trend attenuated in later years. CONCLUSIONS: Comparisons of youth fatality rates to those of adult workers should address differences in patterns of employment, most importantly hours of work. Comparisons to narrow age groupings of adults is preferable to a single category of all workers 18 years and older. Increasing compliance with federal child labor regulations could help reduce work related deaths of youth. Other measures are needed, however, as there are many work hazards, including those associated with homicides, that are not addressed by United States federal child labor law regulations.
PMCID: PMC1067854  PMID: 9493624
4.  Drowning in Alaskan waters. 
Public Health Reports  1996;111(6):531-535.
OBJECTIVE: To enumerate drowning fatalities in Alaska in order to identify risk factors and areas for intervention. METHODS: Information from death certificates, state troopers' reports, and medical examiner reports were abstracted and analyzed. Rates were calculated using 1990 census figures as denominator data. RESULTS: There were 542 drowning fatalities in Alaska for the years 1988 to 1992. The 20-29 age group had the highest frequency and rate of drownings. The incidence rate for the state was 20 drownings per 100,000 population per year, almost 10 times higher than the overall U.S. rate of 2.11 per 100,000 per year. Incidence rates were highest among adolescent males (10-19), young adult males (20-29). Alaska Natives, and rural residents. Alaska Native males, ages 30-39 averaged 159 drownings per 100,000 per year, the highest drowning rates in the state. CONCLUSIONS: Drowning is a major public health concern in Alaska. People who fish commercially and young Native males are groups at high risk for drowning. Intervention efforts should be concentrated on these two populations.
PMCID: PMC1381902  PMID: 8955701
5.  Preventing commercial fishing deaths in Alaska 
OBJECTIVES: To evaluate the effectiveness of the United States Commercial Fishing Industry Vessel Safety Act of 1988 in reducing the high occupational death rate (200/100,000/year in 1991-2) among Alaska's commercial fishermen. METHODS: Comprehensive surveillance of deaths in commercial fishing was established by our office during 1991 and 1992 for Alaska. Demographic data and data on risk factors and incidents were compiled and analysed for trend. RESULTS: During 1991-8, there was a significant (p < 0.001) decrease in deaths in Alaska related to commercial fishing. Although drownings from fishermen falling overboard and events related to crab fishing vessels (often conducted far offshore and in winter) have continued to occur, marked progress (significant downward trend, p < 0.001) has been made in saving the lives of people involved in vessels capsizing and sinking. CONCLUSIONS: Specific measures tailored to prevent drowning associated with vessels capsizing and sinking in Alaska's commercial fishing industry have been successful. However, these events continue to occur, and place fishermen and rescue personnel at substantial risk. Additional strategies must be identified to reduce the frequency of vessels capsizing and sinking, to enable parallel improvements in the mortality among crab fishermen, and to prevent fishermen falling overboard and drownings associated with them.
 
PMCID: PMC1757672  PMID: 10658549
6.  Fatal occupational electrocutions in the United States 
Injury Prevention  2002;8(4):306-312.
Introduction: The highest proportions of fatal occupational electrocutions have occurred among those employed in the electrical trades and in the construction and manufacturing industries.
Methods: Data from 1992 through 1999 were obtained from the Bureau of Labor Statistics Census of Fatal Occupational Injuries.
Results: Occupational electrocution deaths occurred almost entirely among males, with the highest rates among those aged 20–34 and among whites and American Indians. They were highest during the summer months, in the South, and in establishments employing 10 or fewer workers. The highest rates occurred in the construction, mining, and agriculture, forestry, and fishing industries and among trades associated with these industries.
Conclusions: Electrocution continues to be a significant cause of occupational death. Workers need to be provided with safety training and employers, particularly smaller employers, persuaded of the need for safety training.
doi:10.1136/ip.8.4.306
PMCID: PMC1756586  PMID: 12460968
7.  Trends in rates of occupational fatal injuries in the United States (1983-92) 
OBJECTIVES: An updated version of a national surveillance system of traumatic occupational fatalities was used to explore adjusted and unadjusted trends in rates of fatal injury. METHODS: Data from the national traumatic occupational fatalities surveillance system were combined with data on employment from the United States Bureau of Labor Statistics. Poisson regression was then used to examine trends in rates of occupational fatality injuries while controlling for demographic and workplace characteristics. RESULTS: Adjusted annual changes in rates of fatal injuries ranged from a decline of 6.2% for workers in technical and administrative support occupations--for example, health, science, and engineering technicians, pilots, computer programmers--to an increase of 1.6% in machine operators, assemblers, and inspectors. For industries, annual changes ranged from a decline of 5.3% for workers in public administration--for example, justice, public order, and safety workers--to an increase of 2.6% for workers in the wholesale trade. By comparison, the annual decline over all industries and occupations was 3.1%. In many industries and occupations, an effect modification of annual trends by the age of the worker was also found with the oldest workers experiencing either no decline or a significant increase in rates of fatal injuries. CONCLUSIONS: This general pattern of decline, adjusted for the effects of demographic characteristics of the worker population, is encouraging; however, increases in rates of fatal injuries found in particular industries and occupations, suggest appropriate targets for increased injury prevention efforts.
 
PMCID: PMC1757606  PMID: 9816383
8.  Descriptive epidemiology of unintentional residential fire injuries in King County, WA, 1984 and 1985. 
Public Health Reports  1992;107(4):402-408.
Although most studies have concentrated on fatal residential fire injuries, which are a leading cause of fatal injuries in the United States, few investigators have examined in detail nonfatal injuries as a consequence of residential fires. This population-based study used the Washington State Fire Incident Reporting System to assess the incidence and descriptive epidemiology of fatal and nonfatal burns or respiratory tract damage resulting from unintentional residential fires. For the 2-year period 1984-85 in King County, WA, the mortality rate due to injury in a residential fire was 0.7 per 100,000 per year, and the incidence of nonfatal injuries was 5.6 per 100,000 per year. Of 17 fatalities, 59 percent of the deaths occurred at the scene of the fire. Of 128 persons with nonfatal injuries, 19 percent were hospitalized; although the 55 percent seen as outpatients and the 26 percent treated by the fire department or paramedics at the fire scene usually had minor injuries, they would not have been captured if only traditional data sources had been employed. Those injured averaged 2.8 days of restricted activity, but the range was from less than 1 day to 1 year. Injuries were more common in the households with a low socioeconomic status and among nonwhites, especially American Indians. Variation in incidence by age, sex, and source of ignition for deaths and nonfatal injuries suggests appropriate targets for future fire injury prevention programs.
PMCID: PMC1403670  PMID: 1641436
9.  Fatal traumatic brain injury, West Virginia, 1989-1998. 
Public Health Reports  2004;119(5):486-492.
OBJECTIVE: The objective of this study was to describe fatal cases of traumatic brain injury (TBI) among West Virginia residents. METHODS: The authors analyzed data from the National Center for Health Statistics Multiple Cause of Death tapes for the period 1989-1998. They compared West Virginia's annualized average TBI death rate with the rates of other states and with the rate among U.S. residents for the same period. U.S. Bureau of Census population estimates were used as denominators. RESULTS: A total of 4,416 TBI deaths occurred in West Virginia in 1989-1998, for an annual average death rate of 23.6 per 100,000 population. From 1989 to 1998, TBI death rates declined 5% (p=0.4042). Seventy-five percent (n=3,315) of fatalities occurred among men. Adults > or =65 years of age accounted for the highest percentage of fatal injuries (n=1,135). The leading external causes of fatal TBI were: firearm-related (39% of reported fatalities), motor vehicles-related (34%), and fall-related (10%). Firearm-related TBI became the leading cause of TBI fatalities in 1991, surpassing motor vehicle-related TBI. Seventy-five percent of firearm-related TBI deaths were suicides (n=1,302). West Virginia's TBI death rate (23.6 per 100,000) was higher than the national rate (20.6 per 100,000). In 23 states, the average TBI death rates over the 10-year period were higher than West Virginia's. Whereas modest declines in TBI death rates occurred for motor vehicle-related and firearm-related causes in West Virginia, a concomitant 38% increase occurred in the fall-related TBI death rate during the decade. CONCLUSION: Data presented in this report can be used to develop targeted prevention programs in West Virginia.
doi:10.1016/j.phr.2004.07.006
PMCID: PMC1497660  PMID: 15313112
10.  Foodborne Botulism in the United States, 1990–2000 
Emerging Infectious Diseases  2004;10(9):1606-1611.
Home-canned foods and Alaska Native foods are leading causes of U.S. foodborne botulism; botulism’s epidemic potential renders each case a public health emergency.
Foodborne botulism, a potentially lethal neuroparalytic disease, is caused by ingesting preformed Clostridium botulinum neurotoxin. We reviewed surveillance data and reports from 1990 to 2000. Of 263 cases from 160 foodborne botulism events (episode of one or more related cases) in the United States, 103 (39%) cases and 58 events occurred in Alaska. Patients' median age was 48 years; 154 (59%) were female; the case-fatality rate was 4%. The median number of cases per event was 1 (range 1–17). Toxin type A caused 51% of all cases; toxin type E caused 90% of Alaska cases. A particular food was implicated in 126 (79%) events. In the lower 49 states, a noncommercial food item was implicated in 70 (91%) events, most commonly home-canned vegetables (44%). Two restaurant-associated outbreaks affected 25 persons. All Alaska cases were attributable to traditional Alaska Native foods. Botulism prevention efforts should be focused on those who preserve food at home, Alaska Natives, and restaurant workers.
doi:10.3201/eid1009.030745
PMCID: PMC3320287  PMID: 15498163
botulism; surveillance; epidemiology; foodborne disease; Clostridium botulinum; research
11.  Fatalities associated with farm tractor injuries: an epidemiologic study. 
Public Health Reports  1985;100(3):329-333.
Death certificates were used as a source of information to characterize fatalities associated with farm tractor injuries in Georgia for the period 1971-81. In this period, 202 tractor-associated fatalities occurred among residents of Georgia; 198 of these persons were males. The annual tractor-associated fatality rate for males based on the population of male farm residents was 23.6 per 100,000; rates of fatal injury increased with age for this population. Persons whose primary occupation was other than farming accounted for more than half of all tractor-associated deaths. Fatal injuries occurred throughout the year but predominantly during the planting and harvesting months. Injuries occurred throughout the day (7 a.m. to midnight), with a peak at 4 p.m. to 5 p.m. Most fatal injuries, 76 percent, resulted when tractors overturned. Fatalities were attributed to crushed chest, exsanguination, strangulation or asphyxia, drowning, and other injuries. Current safety standards for the operation of farm tractors are limited; rollover protective canopies are not required for farm owners or their family members. Descriptive epidemiologic information obtained from death certificates can be used to define injury determinants and to suggest approaches for the further study and prevention of specific types of injuries.
PMCID: PMC1424762  PMID: 3923543
12.  Comparison of unintentional fatal occupational injuries in the Republic of Korea and the United States 
Injury Prevention  2004;10(4):199-205.
Objectives: To compare the profile of unintentional fatal occupational injuries in the Republic of Korea and the United States to help establish prevention strategies for Korea and to understand country specific differences in fatality risks in different industries.
Methods: Occupational fatal injury data from 1998–2001 were collected from Korea's Occupational Safety and Health Agency's Survey of Causes of Occupational Injuries (identified by the Korea Labor Welfare Corporation) and from the United States Census of Fatal Occupational Injuries. Employment estimates were obtained in both countries. Industry coding and external cause of death coding were standardized. Descriptive analyses of injury rates and Poisson regression models to examine time trends were conducted.
Results: Korea exhibited a significantly higher fatal injury rate, at least two times higher than the United States, after accounting for different employment patterns. The ordering of industries with respect to risk is the same in the two countries, with mining, agriculture/forestry/fishing, and construction being the most dangerous. Fatal injury rates are decreasing in these two countries, although at a faster rate in Korea.
Conclusions: Understanding industrial practices within different countries is critical for fully understanding country specific occupational injury statistics. However, differences in surveillance systems and employment estimation methods serve as caveats to any transnational comparison, and need to be harmonized to the fullest extent possible.
doi:10.1136/ip.2003.004895
PMCID: PMC1730127  PMID: 15314045
13.  Sexual Health and Sexually Transmitted Infections in the North American Arctic 
STI rates reported for the Arctic are much higher than those reported for their southern counterparts.
Our objective was to describe the basic epidemiology of sexually transmitted infections for Arctic and sub-Arctic regions of North America. We summarized published and unpublished rates of chlamydial infection and gonorrhea reported from 2003 through 2006 for Alaska, Canada, and Greenland. In 2006, Alaska reported high rates of chlamydial infection (715 cases/100,000 population) compared with the United States as a whole; northern Canada reported high rates of chlamydial infection (1,693 cases/100,000) and gonorrhea (247 cases/100,000) compared with southern Canada; and Greenland consistently reported the highest rates of chlamydial infection (5,543 cases/100,000) and gonorrhea (1,738 cases/100,000) in the Arctic. Rates were high for both men and women, although the highest incidence of infection was predominantly reported for young women in their early twenties. We propose that community-based participatory research is an appropriate approach to improve sexual health in Arctic communities.
doi:10.3201/eid1401.071112
PMCID: PMC2600166  PMID: 18258070
Arctic; aboriginal health; sexual health; sexually transmitted diseases; community-based participatory research; perspective
14.  Sexually transmitted diseases and native Americans: trends in reported gonorrhea and syphilis morbidity, 1984-88. 
Public Health Reports  1989;104(6):566-572.
Native Americans experienced higher reported gonorrhea and syphilis morbidity than did non-Native Americans from 1984 through 1988 in 13 States with large Native American populations. Gonorrhea rates among American Indians and Alaska Natives were approximately twice the rates for non-Indians. The highest gonorrhea rate was reported among Alaska Natives, with a 5-year average of 1,470 cases per 100,000, more than five times the average non-Native rate in Alaska. The average primary and secondary (P&S) syphilis rate from 1984 through 1988 was more than two times higher among Native Americans, largely due to high syphilis morbidity in Arizona and New Mexico. In Arizona the average American Indian P&S syphilis case rate was seven times higher than the non-Indian rate. True rates for sexually transmitted diseases (STD) among Native Americans may be higher than those reported due to racial misclassification of Native American cases, particularly in nonreservation areas. Improved recognition and reporting of STD cases among Native Americans are needed to target STD prevention and education more effectively.
PMCID: PMC1580156  PMID: 2511589
15.  Fatal Occupational Injuries among Non-governmental Employees in Malaysia 
Background
In Malaysia, surveillance of fatal occupational injuries is fragmented. We therefore analyzed an alternative data source from Malaysia’s Social Security organization, the PERKESO.
Methods
We conducted a secondary data analysis of the PERKESO database comprised of 7 million employees from 2002 to 2006.
Results
Overall, the average annual incidence was 9.2 fatal occupational injuries per 100,000 workers. During the five-year period, there was a decrease in the absolute number of fatal injuries by 16% and the incidence by 34%. The transportation sector reported the highest incidence of fatal injuries (35.1/100,000), followed by agriculture (30.5/100,000) and construction (19.3/100,000) sectors. Persons of Indian ethnicity were more likely to sustain fatal injuries compared to other ethnic groups.
Conclusions
Government and industry should develop rigorous strategies to detect hazards in the workplace, especially in sectors that continuously record high injury rates. Targeted interventions emphasizing worker empowerment coupled with systematic monitoring and evaluation is critical to ensure success in prevention and control measures.
doi:10.1002/ajim.22056
PMCID: PMC3505558  PMID: 22544443
occupational injuries; fatal; transportation; agriculture; Malaysia
16.  Diversity of trends in occupational injury mortality in the United States, 1980–96 
Injury Prevention  2003;9(1):9-14.
Objectives: Although the United States has generally enjoyed declining rates of fatal occupational injury, the rate of decline has not been uniform. To examine the heterogeneity of trends, changes in fatal occupational injury rates from 1980 to 1996 were estimated by occupation, industry, geographic region, and demographic group.
Methods: Deaths due to injury at work during 1980–96 were identified from the US National Traumatic Occupational Fatality database and populations at risk were estimated from the census of population. Mortality rates were computed for unintentional injuries, homicides, and all injuries combined. The annual rate of change was estimated using Poisson regression to model the death rate as a function of time.
Results: The estimated average rates for all fatal occupational injuries and for unintentional injuries declined by 3% per year, while the estimated rate of homicide declined <1% per year. The improvement was faster for men (3% per year) than for women (<1% per year) and for younger relative to older workers (7% per year v 2%–3% per year). Trends were also geographically heterogeneous, with the most rapid declines (7%–8% per year) in the South and West. Injury rates for most occupations and industries declined at near the average rate, but some experienced no change or an increase. The rate of homicide also increased in a number of occupations and industries.
Conclusions: Broad downward trends in occupational fatality rates may be explained by several factors, including organized safety efforts, product and process changes, and the ongoing shift of employment toward safer sectors. Disparities in fatal injury trends draw attention to potential opportunities to reduce risk: work settings with increasing injury rates are of particular concern.
doi:10.1136/ip.9.1.9
PMCID: PMC1730941  PMID: 12642551
17.  Costs of Occupational Injuries in Construction in the United States 
Accident; analysis and prevention  2007;39(6):1258-1266.
This paper presents costs of fatal and non-fatal injuries for the construction industry using 2002 national incidence data from the Bureau of Labor Statistics and a comprehensive cost model that includes direct medical costs, indirect losses in wage and household productivity, as well as an estimate of the quality of life costs due to injury. Costs are presented at the three-digit industry level, by worker characteristics, and by detailed source and event of injury. The total costs of fatal and non-fatal injuries in the construction industry were estimated at $11.5 billion in 2002, 15% of the costs for all private industry. The average cost per case of fatal or nonfatal injury is $27,000 in construction, almost double the per-case cost of $15,000 for all industry in 2002. Five industries accounted for over half the industry’s total fatal and non-fatal injury costs. They were miscellaneous special trade contractors (SIC 179), followed by plumbing, heating and air-conditioning (SIC 171), electrical work (SIC 173), heavy construction except highway (SIC 162), and residential building construction (SIC 152), each with over $1 billion in costs.
doi:10.1016/j.aap.2007.03.012
PMCID: PMC2491397  PMID: 17920850
cost; injury; construction; national; fatal; nonfatal
18.  Colorectal Cancer in Alaska Native People, 2005–2009 
ABSTRACT
BACKGROUND:
Colorectal cancer (CRC) is the most frequently diagnosed cancer among Alaska Native (AN) people, and the second leading cause of cancer death. The incidence rate for the combined years 1999 through 2003 was 30% higher than the rate among U.S. whites (USWs) for the same period. Current incidence rates may serve to monitor the impact of screening programs in reducing CRC in the AN population.
METHODS:
Incidence data are from the Alaska Native Tumor Registry and the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. We compared AN CRC incidence, survival rates, and stage at diagnosis with rates in USWs for cases diagnosed from 2005 through 2009. Relative survival calculations were produced in SEER*Stat by the actuarial method.
RESULTS:
The CRC age-adjusted incidence rate among AN men and women combined was higher than those in USW men and women (84 vs. 43/100,000; P < .05; AN:USW rate ratio [RR] = 2.0). The greatest differences between rates in AN people and USWs were for tumors in the hepatic flexure (RR = 3.1) and in the transverse (RR = 2.9) and sigmoid (RR = 2.5) regions of the colon. Rectal cancer rates among AN people were significantly higher than rates in USWs (21 vs.12/100,000). Five-year relative survival proportions by stage at diagnosis indicate that the CRC 5-year relative survival was similar in AN people and USWs for the period 2004 through 2009.
CONCLUSIONS:
The high rate of CRC in AN people emphasizes the need for screening programs and interventions to reduce known modifiable risks. Research in methods to promote healthy behaviors among AN people is greatly needed.
PMCID: PMC3481146  PMID: 23112882
19.  Risks to Health Among American Indian/Alaska Native High School Students in the United States 
Preventing Chronic Disease  2011;8(4):A76.
Introduction
According to the World Health Organization, the 10 leading risk factor causes of death in high-income countries are tobacco use, high blood pressure, overweight and obesity, physical inactivity, high blood glucose, high cholesterol, low fruit and vegetable intake, urban air pollution, alcohol use, and occupational risks. We examined the prevalence of some of the leading risks to health among nationally representative samples of American Indian/Alaska Native (AI/AN) high school students and compared rates across racial/ethnic groups.
Methods
We combined data from the 2001, 2003, 2005, 2007, and 2009 national Youth Risk Behavior Survey. The survey is a biennial, self-administered, school-based survey of 9th- through 12th-grade students in the United States. Overall response rates for the surveys ranged from 63% to 72%. Of 73,183 participants, 952 were AI/AN students.
Results
For 7 of the 16 variables examined in this study, the prevalence among AI/AN high school students was higher than the prevalence among white high school students. For 1 variable (ate fruit and vegetables <5 times per day), the prevalence among AI/AN students was significantly lower than that among white students. The prevalence for the remaining 8 variables was similar among AI/AN students and white students. These findings also show differences in the prevalence of some behaviors among AI/AN, black, and Hispanic students.
Conclusion
These findings show the prevalence of some health risk behaviors was significantly higher among AI/AN high school students than among high school students in other racial/ethnic groups.
PMCID: PMC3136977  PMID: 21672400
20.  Mortality trends among Alaska Native people: successes and challenges 
International Journal of Circumpolar Health  2013;72:10.3402/ijch.v72i0.21185.
Background
Current mortality rates are essential for monitoring, understanding and developing policy for a population's health. Disease-specific Alaska Native mortality rates have been undergoing change.
Objective
This article reports recent mortality data (2004–2008) for Alaska Native/American Indian (AN/AI) people, comparing mortality rates to US white rates and examines changes in mortality patterns since 1980.
Design
We used death record data from the state of Alaska, Department of Vital Statistics and SEER*Stat software from the National Cancer Institute to calculate age-adjusted mortality rates.
Results
Annual age-adjusted mortality from all-causes for AN/AI persons during the period 2004–2008 was 33% higher than the rate for US whites (RR=1.33, 95% CI 1.29–1.38). Mortality rates were higher among AN/AI males than AN/AI females (1212/100,000 vs. 886/100,000). Cancer remained the leading cause of death among AN/AI people, as it has in recent previous periods, with an age-adjusted rate of 226/100,000, yielding a rate ratio (RR) of 1.24 compared to US whites (95% CI 1.14–1.33). Statistically significant higher mortality compared to US white mortality rates was observed for nine of the ten leading causes of AN/AI mortality (cancer, unintentional injury, suicide, alcohol abuse, chronic obstructive pulmonary disease [COPD], cerebrovascular disease, chronic liver disease, pneumonia/influenza, homicide). Mortality rates were significantly lower among AN/AI people compared to US whites for heart disease (RR=0.82), the second leading cause of death. Among leading causes of death for AN/AI people, the greatest disparities in mortality rates with US whites were observed in unintentional injuries (RR=2.45) and suicide (RR=3.53). All-cause AN/AI mortality has declined 16% since 1980–1983, compared to a 21% decline over a similar period among US whites.
Conclusion
Mortality rates and trends are essential to understanding the health of a population and guiding policy decisions. The overall AN/AI mortality rate is higher than that of US whites, although encouraging declines in mortality have occurred for many cause specific deaths, as well as for the overall rate. The second leading cause of AN/AI mortality, heart disease, remains lower than that of US whites.
doi:10.3402/ijch.v72i0.21185
PMCID: PMC3751233  PMID: 23977643
Native American; unintentional injury; suicide; death; vital statistics
21.  Surveillance of Traumatic Firefighter Fatalities: An Assessment of Four Systems 
Public Health Reports  2011;126(4):540-551.
Objectives
Firefighters regularly respond to hazardous situations that put them at risk for fatal occupational injuries. Traumatic occupational fatality surveillance is a foundation for understanding the problem and developing prevention strategies. We assessed four surveillance systems for their utility in characterizing firefighter fatalities and informing prevention measures.
Methods
We examined three population-based systems (the Bureau of Labor Statistics' Census of Fatal Occupational Injuries and systems maintained by the United States Fire Administration and the National Fire Protection Association) and one case-based system (data collected through the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program). From each system, we selected traumatic fatalities among firefighters for 2003–2006. Then we compared case definitions, methods for case ascertainment, variables collected, and rate calculation methods.
Results
Overall magnitude of fatalities differed among systems. The population-based systems were effective in characterizing the circumstances of traumatic firefighter fatalities. The case-based surveillance system was effective in formulating detailed prevention recommendations, which could not be made based on the population-based data alone. Methods for estimating risk were disparate and limited fatality rate comparisons between firefighters and other workers.
Conclusions
The systems included in this study contribute toward a greater understanding of firefighter fatalities. Areas of improvement for these systems should continue to be identified as they are used to direct research and prevention efforts.
PMCID: PMC3115213  PMID: 21800748
22.  Disparities in Infectious Disease Hospitalizations for American Indian/Alaska Native People 
Public Health Reports  2011;126(4):508-521.
Objectives
We described disparities in infectious disease (ID) hospitalizations for American Indian/Alaska Native (AI/AN) people.
Methods
We analyzed hospitalizations with an ID listed as the first discharge diagnosis in 1998–2006 for AI/AN people from the Indian Health Service National Patient Information Reporting System and compared them with records for the general U.S. population from the Nationwide Inpatient Survey.
Results
The ID hospitalization rate for AI/AN people declined during the study period. The 2004–2006 mean annual age-adjusted ID hospitalization rate for AI/AN people (1,708 per 100,000 populiation) was slightly higher than that for the U.S. population (1,610 per 100,000 population). The rate for AI/AN people was highest in the Southwest (2,314 per 100,000 population), Alaska (2,063 per 100,000 population), and Northern Plains West (1,957 per 100,000 population) regions, and among infants (9,315 per 100,000 population). ID hospitalizations accounted for approximately 22% of all AI/AN hospitalizations. Lower-respiratory--tract infections accounted for the largest proportion of ID hospitalizations among AI/AN people (35%) followed by skin and soft tissue infections (19%), and infections of the kidney, urinary tract, and bladder (11%).
Conclusions
Although the ID hospitalization rate for AI/AN people has declined, it remains higher than that for the U.S. general population, and is highest in the Southwest, Northern Plains West, and Alaska regions. Lower-respiratory-tract infections; skin and soft tissue infections; and kidney, urinary tract, and bladder infections contributed most to these health disparities. Future prevention strategies should focus on high-risk regions and age groups, along with illnesses contributing to health disparities.
PMCID: PMC3115210  PMID: 21800745
23.  Changing Trends in Viral Hepatitis-Associated Hospitalizations in the American Indian/Alaska Native Population, 1995–2007 
Public Health Reports  2011;126(6):816-825.
SYNOPSIS
Objective
We described the changing epidemiology of viral hepatitis among the American Indian/Alaska Native (AI/AN) population that uses Indian Health Service (IHS) health care.
Methods
We used hospital discharge data from the IHS National Patient Information Reporting System to determine rates of hepatitis A-, B-, and C-associated hospitalization among AI/ANs using IHS health care from 1995–2007 and summary periods 1995–1997 and 2005–2007.
Results
Hepatitis A-associated hospitalization rates among AI/AN people decreased from 4.9 per 100,000 population during 1995–1997 to 0.8 per 100,000 population during 2005–2007 (risk ratio [RR] = 0.2, 95% confidence interval [CI] 0.1, 0.2). While there was no significant change in the overall hepatitis B-associated hospitalization rate between time periods, the average annual rate in people aged 45–64 years increased by 109% (RR=2.1, 95% CI 1.4, 3.2). Between the two time periods, the hepatitis C-associated hospitalization rate rose from 13.0 to 55.0 per 100,000 population (RR=4.2, 95% CI 3.8, 4.7), an increase of 323%. The hepatitis C-associated hospitalization rate was highest among people aged 45–64 years, males, and those in the Alaska region.
Conclusions
Hepatitis A has decreased to near-eradication levels among the AI/AN population using IHS health care. Hepatitis C-associated hospitalizations increased significantly; however, there was no significant change in hepatitis B-associated hospitalizations. Emphasis should be placed on continued universal childhood and adolescent hepatitis B vaccination and improved vaccination of high-risk adults. Prevention and education efforts should focus on decreasing hepatitis C risk behaviors and identifying people with hepatitis C infection so they may be referred for treatment.
PMCID: PMC3185317  PMID: 22043097
24.  Stroke Epidemiology and Stroke Care Services in India 
Journal of Stroke  2013;15(3):128-134.
Developing countries like India are facing a double burden of communicable and non-communicable diseases. Stroke is one of the leading causes of death and disability in India. The estimated adjusted prevalence rate of stroke range, 84-262/100,000 in rural and 334-424/100,000 in urban areas. The incidence rate is 119-145/100,000 based on the recent population based studies. There is also a wide variation in case fatality rates with the highest being 42% in Kolkata. Stroke units are predominantly available in urban areas that too in private hospitals. Intravenous (IV) and intra-arterial thrombolysis (IA) are commonly used in India. In the on-going Indo USA National stroke registry the rate of IV thrombolysis is 11%. Stroke rehabilitation is not well developed in India due to lack of personnel. Organised rehabilitation services are available in the country but they are mainly in private hospitals of the cities. Even though India is a leading generic drugs producer still many people can't afford the commonly used secondary prevention drugs. As a first step the Government of India has started the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS). The government is focusing on early diagnosis, management, infrastructure, public awareness and capacity building at different levels of health care for all the non-communicable diseases including stroke. An organised effort from both the government and the private sector is needed to tackle the stroke epidemic in India.
doi:10.5853/jos.2013.15.3.128
PMCID: PMC3859004  PMID: 24396806
Stroke; India; Epidemiology; Incidence; Stroke unit; Rehabilitation
25.  Swimming pool drownings and near-drownings among California preschoolers. 
Public Health Reports  1997;112(1):73-77.
OBJECTIVE: To describe a significant but poorly understood public health problem, the authors compiled data on swimming pool drownings and near-drownings requiring hospitalization for California children ages 1 to 4. METHODS: Data from death certificates were used to analyze swimming pool drownings, and hospital discharge data were used to analyze near-drownings. RESULTS: Among California preschoolers in 1993, pool immersion incidents were the leading cause of injury death and the eighth leading cause of injuries leading to hospitalization. Rates per 100,000 population were 3.2 for fatalities and 11.2 for nonfatal incidents, with a fatality-to-case ratio of 1:3.5. Total charges for initial hospital stays (excluding physicians' fees) were $5.2 million for 1227 hospital days. CONCLUSIONS: Swimming pools remain a serious hazard for young children. Primary prevention continues to be an important public health goal. Public health officials should support the adoption of laws designed to protect children from drowning and near-drownings.
PMCID: PMC1381843  PMID: 9018293

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