Injury Epidemiology and the Aging Workforce ASSE Lunch & Learn - March 12, 2012 Ken Scott, MPH (kenneth.scott@ucdenver.edu) Mountain & Plains ERC Outreach Director
Who Does Injury Epidemiology? Injury Epidemiologists Safety Professionals Risk Managers HR Professionals Physicians Economists Actuaries
Take Home Points Epidemiology used to be about infectious diseases, but now it s about much, much more Epidemiologists compare groups of people to figure out: Who is getting sick and injured The numbers and rates of people experiencing illness and injury The causes of illness and injury Strategies to prevent illness and injury Epidemiology surveys and epidemiology studies can be of practical use to safety professionals
A SHORT HISTORY
The Bills of Mortality In 1592, during the Plague, England began collecting records of Burials and Christenings through a system of parishes The results were published as the Bills of Mortality every week and every year John Graunt, a haberdasherturned-politician arranged the data into tables in order to: have a view of the whole together, in order to the more ready comparing of one Year, Season, Parish or other Division of the City with another...
Table of Casualties The Years of our Lord 1647 1648 1649 1650 1651 1652 Aged 916 835 889 696 780 834 Cancer, Gangrene and Fistula 26 29 31 19 31 53 Wolf 8 Executed 8 17 29 43 24 12 Killed by Several Accidents 27 57 39 94 47 45 Plague 3597 611 67 15 23 16 Consumption and Cough 2423 2200 2388 1988 2350 2410 Murdered 3 2 7 5 4 3
Cholera Epidemic of 1854
The Epidemiology Triangle Host Agent Environment
The Epidemiology Triangle Host Risk Factors: Age Socioeconomic Status Prevention Strategies: Vaccination Education
The Epidemiology Triangle Risk Factors: Subtypes O1 & O139 Virulence Persistence in water Agent
The Epidemiology Triangle Risk Factors: Food contamination Untreated water Lack of plumbing Natural disasters Prevention Strategies: Waste management Pest control Clean water Environment
Risk Factor Cause Risk factor: some characteristic of the host, agent or environment that is associated with an increased risk of disease Cause: one link in a chain of events without which some outcome would not have occurred
Leading Causes of Death in 1900 1. Pneumonia 2. Tuberculosis 3. Diarrhea, enteritis and ulceration of the intestines 4. Diseases of the heart 5. Intracranial lesions of vascular origin 6. Nephritis 7. All accidents 8. Cancer and other malignant tumors 9. Senility 10. Diphtheria National Office of Vital Statistics, December 1947
Leading Causes of Death in 1950 1. Heart disease 2. Cancer 3. Stroke 4. Accidents 5. Certain diseases of early infancy 6. Influenza and pneumonia 7. Tuberculosis 8. General arteriosclerosis 9. Chronic and unspecified nephritis 10. Diabetes mellitus National Office of Vital Statistics, December 1957
Dr. William Haddon, Jr. Born May 24, 1926 Died March 4, 1985 First federal highway safety chief Used methods from infectious disease epidemiology to study injuries
The Epidemiology Triangle Host? Agent Environment
The Epidemiology Triangle Mechanical Thermal Chemical Electrical Radiant Energy Host Environment
The Epidemiology Triangle Host Energy Environment
The Haddon Matrix Host Vehicle Environment Pre-Crash Crash Post-Crash
The Haddon Matrix Host Vehicle Environment Pre-Crash Vision testing Brake check Well lit roads Crash Wearing seat belt Air bags Guard rails Post-Crash Poor fitness Automatic fuel shut off Emergency response systems
Tools for Assessing the Burden SURVEYS
The Point of Surveys To take a sample of individuals and make generalizable statements about bigger groups Example: The number of people living on Earth? 7.071 Billion People
Common Surveys in OSH Survey of Occupational Illnesses and Injuries (SOII) National Occupational Mortality Study (NOMS) Workers Compensation Data?... Census of Fatal Occupational Injuries (CFOI)?...
Case Study 1 Question: How many work-related fatalities occurred in Colorado during 2011? Answer: 87 Survey: The Census of Fatal Occupational Injuries Organization: BLS and CDPHE Data Sources: Death certificates, workers compensation claims, NIOSH FACE Investigations, OSHA Reports, Traffic Accident Reports, Newspaper Clippings Where to Find It: http://www.bls.gov/iif/oshcfoi1.htm
Case Study 2 Question: How many people go to the emergency room with a nail gun injury in a given year? Answer: ~37,000 ED Visits Survey: National Electronic Injury Surveillance System Data Sources: Hospital Emergency Departments Where to Find It: http://www.cpsc.gov/en/ Research--Statistics/NEISS-Injury- Data/
Tools for Determining Cause and Effect STUDIES
Exposure? Outcome Hazards Benzene Repetitive motion Silica Asbestos Interventions Slip-resistant-shoes N-95 Respirator Outcomes Leukemia Carpal tunnel syndrome Silicosis Mesothelioma Slip, trip and fall injury Influenza
Studies Studies compare two groups of people People with injury and people without injury People who were exposed to a hazard and people who were unexposed People who were given a drug and people who were given a placebo Various study designs are used to make the comparisons valid Case-control studies Cohort studies Randomized control trials (RCTs) We use (a lot of ) statistics to understand the similarities and differences between the two groups
Case Study 3 Question: Do back belts prevent back injuries? Answer: Probably not Study Title: A Prospective Study of Back Belts for Prevention of Back Pain and Injury Type of Study: Cohort study Data Sources: Data collected from 160 new retail merchandise stores in 30 states over two years Where to Find It: The Journal of the American Medical Association (JAMA 12/6/2000)
Case Study 4 Question: Is body armor a costeffective way to keep police officers safe? Answer: Probably so ($100/officer, 2x cost) Study Title: The Life-Saving Effectiveness of Body Armor for Police Officers Type of Study: Data Sources: FBI database Law Enforcement Officers Killed and Assaulted (LEOKA) Where to Find It: The Journal of Occupational and Environmental Hygiene (7/14/2010)
Case Study 5 Question: Do OSHA inspections actually prevent work-related injuries and illnesses? Answer: Probably so Study Title: Randomized Government Safety Inspections Reduce Worker Injuries with No Detectable Job Loss Type of Study: Randomized control trial Data Sources: Workers compensation data, employment data, company survival and compensation data Where to Find It: Science (5/18/2012)
THE AGING WORKFORCE
Aging & Host Factors What host factors change with age? Vision Balance Reaction time Job Income Family demands Health Experience
All Occ Injuries and Illnesses Rates and Median Days Absent from Work Rate per 10,000 fulltime equivalents 125 100 75 50 25 0 20 15 10 5 0 Median days absent from work Source: MMWR, April 29 th, 2011 Nonfatal Occupational Injuries and Illnesses Among Older Workers United States, 2009
Aging Workforce Haddon Matrix Pre-Event Host Agent Environment Event Post-Event
Perspective Not everything that counts can be measured. Not everything that can be measured counts.
Take Home Points Epidemiology used to be about infectious diseases, but now it s about much, much more Epidemiologists compare groups of people to figure out: Who is getting sick and injured The numbers and rates of people experiencing illness and injury The causes of illness and injury Strategies to prevent illness and injury Epidemiology surveys and epidemiology studies can be of practical use to safety professionals
Suggested Reading The Ghost Map Steven Johnson While You Were Sleeping David Hemenway
Lee Newman, MD, MA ERC Director Steve Reynolds, PhD Ag Center Director ERC Deputy Director
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What Is a Center, Anyway? $ 4 Graduate Degree Programs Industrial Hygiene Health Physics Occupational Health Psychology Residency Program Occupational and Environmental Medicine Core Values Interdisciplinary Collaboration Diversity Research to Practice Outreach Program Ergonomics Continuing Education Program Pilot Grants Program
ASSE, AIHA & the Mountain & Plains ERC: Present Collaborations ASSE & AIHA Have Representatives on our two advisory boards Annual Fall Technical Conference Sponsorship Development and promotion of the CIH Online Review Course Introducing students from CSU and CU to the EH&S Profession Panel at 1:30 pm Internship opportunities? Future ASSE members?
ASSE, AIHA & the Mountain & Plains ERC: Future Collaborations Development & promotion of a CSP Online Review course? Informal Poll Mentorship program? Student chapter of ASSE? Partnering on an epidemiological study?