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

Abstract

BackgroundDeath 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.MethodsThe 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.ResultsWe 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.ConclusionsThe 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.

The prevalence of work‐related suicides varies by reporting source from the National Violent Death Reporting System

“…For example, for this study period of 2013–2017, the death certificate identified 1.13% of suicides as work‐related, but when all three sources were considered, the proportion was 12.11%. Prior studies found that under‐reporting of occupational injury occurred by sex, age, and mechanism of injury 4–6 . These studies have found that work‐relatedness is undercounted in death certification overall and that this undercount is disproportional for suicides.…”

“…A study in Michigan estimated the sensitivity from 2001 through 2016 to be 73.1% overall, although for suicides was only 61.9%. Sensitivity decreased over time and reached 63.1% in 2016 6 . In a survey of California Medical Examiners, only 38.9% reported that they would consider a suicide as work‐related even if it occurred during paid work and in the decedent's workplace 5 .…”

“…On the basis of the wording of the item, the focus is strongly tied to the location of the suicide rather than circumstances of work underlying the suicidal behavior. Research has shown that the death certificate may significantly undercount work‐related suicides 4–6 . Though the death certificate has high specificity for work‐related suicides (few false positives), it lacks sensitivity (has high false negatives).…”

Robot‐related fatalities at work in the United States, 1992–2017

“…Therefore, all traumatic work‐related cases should theoretically be captured by the surveillance system without limitations such as industry, business size, or type of employment (i.e., public, private, or self‐employed). While the true sensitivity of the CFOI system may be unknown, a study comparing the death certificate's Injury‐At‐Work item to a multi‐source surveillance system showed that both the manufacturing industry and machinery‐related incidents had high levels of sensitivity, suggesting a greater likelihood of robot‐related incidents being captured by CFOI 35 …”

Characteristics and Circumstances Associated with Work-Related Suicides from the National Violent Death Reporting System, 2013–2017

“…The Census of Fatal Occupational Injuries, which relies on the death certificate, worker’s compensation records, and newspaper reports, estimates that 1% to 3% of suicides are work-related. Although the Census of Fatal Occupational Injuries has been the most comprehensive data to identify occupational fatalities, its sources have limited information on suicide circumstances and thus estimates for suicide are considerably low [ 9 , 10 , 11 ]. Data from the National Violent Death Reporting System, which includes more in-depth investigation of circumstances associated with suicide and homicide, identified work factors in 13.5% of suicides [ 12 ].…”