Accuracy of fatal occupational injury registration in a high-income country: A comparison of two-source capture-recapture estimates with the number of cases identified in four register systems in Norway, 2000-2003.

Background: Globally, work-related deaths (injuries and diseases) are a major social and public health problem. Register data on fatal occupational injuries in high-income countries may be considered to have high quality, especially when reporting is mandatory and regulated by law. We aimed to assess the accuracy of work-related injury death statistics in Norway, with reference to the Labour Inspection Authority and three other on-going registration systems (the cause-specific mortality register, the register for governmental compensations, and the register for insurance companies). Methods: In this register-based study, we used the capture-recapture technique to adjust for undercounting. We investigated whether the capture-recapture method using two or three sources gave a valid estimate of fatal occupational injuries as compared with the number of cases identified in four registers administrated by the Norwegian Labour Inspection Authority, Statistics Norway, the Labour and Welfare Administration, and Finance Norway. The inclusion criteria were fatal unintentional injuries among residents of Norway between 2000 and 2003 that occurred while working for income in private and public land-based industries. We obtained ethical and legal approvals. Results: In a period of four years (2000-2003), the Labour Inspection Authority registered 171 occupational injury deaths among residents employed in land-based industries. Two combinations of data sources gave capture-recapture estimates of 246 [95% CI 216; 279] and 265 [95% CI 234; 299] deaths. In total, 246 cases were identified in the four registration systems, which was 44% higher than the number of deaths registered by the Labour Inspection Authority. The Labour Inspection Authority had the most complete register out of the four registration systems. Conclusions: The capture-recapture method used on two overlapping data sources gave highly valid estimates of the total deaths. We demonstrated the existence of significant weaknesses in the registration systems in a country considered to have high-quality register data.

Cause-specific mortality and cancer morbidity in 390 male workers exposed to high purity talc, a six-decade follow-up.

BACKGROUND: This study updates information on mortality and cancer morbidity in a cohort of Norwegian talc workers. METHODS: Follow-up was extended with 24 years, covering 1953-2011. Comparisons were made with the general population and between subgroups within the cohort. RESULTS: Standardized mortality ratio for non-malignant respiratory disease (NMRD) was 0.38 (95%CI: 0.18, 0.69) and for diseases of the circulatory system (CVD) 0.98 (95%CI: 0.82, 1.16). A non-significantly increased NMRD risk was observed at high dust exposures. There were no deaths from pneumoconiosis. CONCLUSIONS: With the clear limitations of a small cohort, our results do hint at an effect of talc dust on mortality from NMRD other than pneumoconiosis, covered by a strong and persisting healthy worker effect. Also, an effect on CVD mortality, masked by a healthy worker selection into the cohort cannot be ruled out. Excess mortality from pneumoconiosis seen in other studies, may reflect exposure to quartz and, possibly, bias due to comparability problems.

Doctors' reports of work-related hearing loss.

BACKGROUND: Noise-induced hearing loss is the diagnosis that is most frequently reported to the Norwegian Labour Inspection Authority. The objective of this study was to describe the doctors' reports on noise-induced hearing loss and assess the quality of the information. MATERIAL AND METHOD: The study is based on reports to the Labour Inspection Authority for the years 2005-09. We grouped the reporting incidence according to industry, gender and age on the basis of Statistics Norway's employment statistics. The reports were compared to data from Statistics Norway's living conditions survey from 2009. RESULTS: A total of 7,888 reports had been submitted in the study period (2005-2009), 96% of which concerned men. The annual reporting incidence amounted to 66 per 100,000 employees; six and 120 for women and men respectively. The reporting incidence was highest in the age group 55-74 years and for the construction and manufacturing industries. Altogether 52% of the reports pertained to employees who were no longer working in the enterprise where they had been exposed to noise. The proportion of reports pertaining to employees aged under 40 years was lower than the corresponding proportion of those who reported work-related hearing loss in Statistics Norway's living conditions survey from 2009. Occupational health physicians submitted 85% of the reports. INTERPRETATION: Of those exposed to noise, only a small proportion of women, younger employees and employees in enterprises with no access to occupational health services are captured by the reporting system. The same may apply to employees in industries such as transport and retail trade, but this will require further investigation.

Estimating work-related amputations in the Norwegian manufacturing sector: a 10-year retrospective study based on two-source capture-recapture method.

BACKGROUND: Work-related amputations are serious yet preventable injuries. Workers in the manufacturing sector in particular are vulnerable to amputation injuries compared to workers in other sectors. METHODS: In this study, we used a two-source capture recapture method to estimate the true number of annual work-related amputations in the Norwegian manufacturing sector for a 10-year study period (1998-2007). The two-sources utilized in this study were the Norwegian Labor Inspection Authorities Registry of Work-Related Injuries (RWI) and the Association of Norwegian Private Insurance Companies registry for occupational injuries (ANPIC). RESULTS: We estimated an annual incidence rate that ranged from 21/100 000 to 62/100 000 workers during the study period. Our findings indicate an undercount of amputations reported to the Norwegian Labour Inspection Authority's registry ranging from 16% to 58% during the study period. CONCLUSIONS: Work-related amputations remain a challenge in the Norwegian manufacturing sector. This study underscores the need of robust epidemiological surveillance infrastructure and effective interventions to prevent amputations at work.

Self-reported versus expert-assessed work-relatedness of pain in the neck, shoulder, and arm.

OBJECTIVES: The aim of this study was to compare self-reported work-relatedness of neck-shoulder and arm pain with experts' assessments based on specific criteria. METHODS: A sample of 217 employed participants in the Oslo Health Study 2000-2001, aged 30, 40, and 45 years, who reported neck-shoulder or arm pain in the past month, underwent a health examination. A criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders was used to -establish clinical diagnoses and assess the work-relatedness of pain with respect to the subject's present job. We measured agreement between the participants and experts on whether pain was related to work as observed agreement, positive and negative specific agreement, and kappa. RESULTS: A major proportion of the cases were assessed as work-related, somewhat more frequently by self-report than when assessed by experts (80% versus 65% for neck-shoulder pain, and 78% versus 72% for arm pain, respectively). However, there was considerable disagreement as to which cases were work-related. The experts disagreed more frequently in cases that were reported as non-work-related (particularly for neck-shoulder pain and cases reported by men). Positive specific agreement was fairly high (76-85% in the total population), while negative specific agreement was lower (37-51%). Kappa values were also low (0.16-0.34). CONCLUSIONS: Compared with expert assessment, self-reporting did not seem to particularly exaggerate work-relatedness. Nevertheless, there was considerable disagreement, especially on cases assessed as non-work--related. However, agreement will depend on the case definitions and the criteria for work-relatedness used both by the participants and the experts.

[Mortality due to occupational injury is underreported]. / Arbeidsskadedødsfall blir underrapportert.

BACKGROUND: The Norwegian Labour Inspection Authority records fatal occupational injuries in mainland bases activities, i.e. all sectors except offshore, aviation, shipping, hunting and fishing; the Registry's information on these injuries has been considered complete. The present study aimed at testing this assumption. MATERIAL AND METHODS: In 2000 - 03, the Labour Inspection Authority recorded 183 fatal occupational injuries; 171 of the deceased were residents in Norway. Each of these deaths were compared with fatal occupational injuries in the Norwegian Cause of Death Registry. A capture-recapture model was used to estimate the real number of fatal occupational injuries. RESULTS: In 2000 - 03, 214 fatal occupational injuries were recorded among residents in Norway employed in all sectors (except offshore, aviation, shipping, hunting and fishing) in at least one of the two registries (98 cases were reported in both registries). The Norwegian Labour Inspection Authority mainly lacked information about (in comparison with the Death Registry) deaths in the military (1 of 9), in the health and social services (3 of 7), road traffic accidents (36 of 52) and deaths in Northern Norway/Spitsbergen (17 of 28). One third of all recorded cases (77 of 214) were caused by transport accidents. Risk by industry (deaths per 100 million work hours) was highest for primary industries (7.0) and for <> (4.1). The real number of fatal injuries was estimated to 246, or 44 % more than the 171 deaths registered by the Labour Inspection Authority. INTERPRETATION: Fatal occupational injuries are much more frequent than reported in the official registries. Underreporting, particularly of road traffic accidents/transport accidents, may lead to misinterpretation of risks and time trends and of need for preventive action.

The Norwegian Labour Inspectorate's Registry for Work-Related Diseases: data from 2006.

The Norwegian Labour Inspectorates (NLI's) Registry for Work-Related Diseases was established in 1920. Based on the principle of sentinel health events (SHE), its central purpose is to provide information to the NLI to enable workplace interventions and the prevention of hazardous exposures. Although physicians are required to report work-related diseases to the NLI, only 3% did so in 2006. There were 3392 cases of work-related diseases reported to the NLI by 561 physicians in 2006. Diseases of the ear (noise-induced hearing loss) comprised 59% (n=1987) of the cases, while 12% (n=398) of the cases were attributed to the diseases of the respiratory system and 7% (n =239) were diseases of the skin and subcutaneous tissue. Despite limitations, the registry continues to inform NLI's prevention strategies, supplements data concerning work-environment surveillance, and provides impetus for epidemiological studies.

Are occupational factors important determinants of socioeconomic inequalities in musculoskeletal pain?

OBJECTIVES: The aim of this study was to quantify socioeconomic inequalities in low-back pain, neck-shoulder pain, and arm pain in the general working population in Oslo and to examine the impact of job characteristics on these inequalities. METHODS: All economically active 30-, 40-, and 45-year-old persons who attended the Oslo health study in 2000-2001 and answered questions on physical job demands, job autonomy, and musculoskeletal pain were included (N=7293). Occupational class was used as an indicator of socioeconomic status. The lower occupational classes were compared with higher grade professionals, and prevalences, prevalence ratios, prevalence differences, and population attributable fractions were calculated. RESULTS: There were marked, stepwise socioeconomic gradients for musculoskeletal pain, steeper for the men than for the women. The relative differences (prevalence ratios) were larger for low-back pain and arm pain than for neck-shoulder pain. The absolute differences (prevalence differences) were the largest for low-back pain. Physical job demands explained a substantial proportion of the absolute occupational class inequalities in low-back pain, while job autonomy was more important in explaining the inequalities in neck-shoulder pain and arm pain. The estimated population attributable fractions supported the impact of job characteristics at the working population level, especially for low-back pain. CONCLUSIONS: In this cross-sectional study, physical job demands and job autonomy explained a substantial proportion of occupational class inequalities in self-reported musculoskeletal pain in the working population in Oslo. This finding indicates that the workplace may be an important arena for preventive efforts to reduce socioeconomic inequalities in musculoskeletal pain.

Self-reported work-related health problems from the Oslo Health Study.

BACKGROUND: Lack of knowledge about the occurrence of work-related health problems in the general population makes it difficult to estimate the potential for their prevention in the workplace. AIMS: To examine the prevalence of self-reported work-related health problems among adult citizens of Oslo, Norway. METHODS: The study was part of the Oslo Health Study 2000-2001, in which all individuals in certain age cohorts were invited to a comprehensive health screening. All 30-, 40- and 45-year old subjects who attended the screening were asked if they had experienced any of 11 common health problems in the past month, and whether they considered these to be work-related. Of the 26,074 invitees in these age cohorts, 8,594 (33%) answered the questionnaire. RESULTS: Nearly 60% of subjects reported one or more work-related health problems, most commonly reported were pain in the neck/shoulders (38%) and low back pain (23%). Neck/shoulder pain was most frequently attributed to working conditions, by 74% of subjects with this problem; followed by arm pain (72%), fatigue (51%) and low back pain (50%). Work-related fractions for eczema and asthma symptoms were 23 and 18%, respectively. There were marked gender differences, but small age differences. CONCLUSIONS: A substantial proportion of common health problems in the Oslo population were attributed to working conditions. This implies a large preventive potential and call for increased preventive efforts targeted at known risk factors in the workplace.

[Risk factors for accidental injuries in the construction industry]. / Risikofaktorer for ulykkesskader i bygge- og anleggsbransjen.

BACKGROUND: The construction industry is prone to accidents. In Norway there is little research-based knowledge on accident pattern and risk factors. The main objective of the study was to examine whether in-depth studies of accidents in this industry, leading to injuries registered by the health services, could identify preventable risk factors and preventive measures. MATERIAL AND METHODS: 50 accidents in the construction industry were thoroughly investigated. All had led to serious personal injury. Patients were interviewed after treatment in emergency wards and hospitals in Oslo, and inspections of the accident sites were performed. An interdisciplinary expert group discussed the accidents in order to identify risk factors and suggest preventive measures. The accident reports in the study were compared to reports from the Labour Inspectorate on the same accidents. RESULTS: The investigation identified several risk factors, and a number of detailed preventive measures were proposed. We submitted these proposals to the authorities and organisations involved. Accidents because of time pressure and electricity were two main groups. More than one third of the respondents said that time pressure had contributed to the accident. Accident risk caused by time pressure can be reduced by avoiding piecework contracts, unrealistic time limits, and the use of day penalties for breach of contract. Possible preventive measures for electric injuries imply modification of the reporting system and of the work organisation so that workers can comply with the regulations more easily. The study reports generally contained more information of relevance for prevention than the routine reports from the Labour Inspectorate did. For accidents reported by the Inspectorate to the police, their reports were more informative than the study reports. INTERPRETATION: By the method presented, we obtained detailed information about accidents and preventable risk factors, so that preventive measures could be proposed. The method can also be used for other types of accidents.