Death certificate-based occupational mortality surveillance in the United States.

Surveillance of cause-specific mortality patterns by occupation and industry through the use of death certificate records is a simple and relatively inexpensive approach to the generation of leads as to potential occupational disease problems. Researchers from the National Institute for Occupational Safety and Health (NIOSH) have been working with the National Center for Health Statistics, other federal agencies, and state health departments on a number of programs to foster the development of standardized, routine coding of occupation and industry entries on death certificates by state health departments. Thirty-one states and the District of Columbia are now doing such coding. These data are being analyzed currently by investigators at NIOSH and at individual state health departments for the purpose of hypothesis generation on occupation-disease relationships. The proportionate mortality ratio method is the predominant method being used, as appropriate denominator data are not generally available. This type of surveillance is particularly useful for the study of occupation and industry groups for which it is difficult to assemble cohorts, such as groups that are predominantly non-union and in small workplaces. Limitations of this surveillance include its inappropriateness for monitoring those occupational diseases which are not often fatal, and the limited scope and accuracy of death certificate information.