Rosenman Kenneth D, Reilly Mary Jo, Henneberger Paul K
Michigan State University, 117 West Fee, East Lansing, Michigan 48824-1315, USA.
Am J Ind Med. 2003 Aug;44(2):141-7. doi: 10.1002/ajim.10243.
The US employer-based surveillance system for documenting occupational injuries and illnesses undercounts chronic diseases. We suggest a method to estimate the number of individuals who are newly-recognized with silicosis each year in the United States.
Data from US death certificates, the Michigan state-based surveillance system, and capture-recapture analysis were used to calculate national estimates of silicosis.
From 1987 to 1996, 2,787 deaths occurred in the United States where silicosis was mentioned on the death certificates. During the same period, in Michigan 77% of death certificates with a mention of silicosis were confirmed as silicosis-related deaths and the ratio of the number of living to deceased confirmed silicosis cases was 6.44. The proportion of confirmed silicosis deaths, the ratio of the living to deceased silicosis cases and capture-recapture analysis from the Michigan surveillance system, were used to estimate that there were 3,600-7,300 cases per year of silicosis in the United States from 1987 to 1996.
Our estimate of the annual number of newly-recognized silicosis cases is significantly larger than the estimate from the employer-based reporting system used for counting occupational disease in the United States. This employer-based surveillance system is inadequate for determining the frequency of occupational disease. Our analysis which combines a readily-available and relatively inexpensive national administrative database (i.e., death certificates) with a more costly state-based active surveillance system is a cost-effective model that could be used to provide better estimates of a number of different occupational diseases. Accurate estimates of occupational illnesses are essential to both determine temporal trends and evaluate efforts to prevent silicosis.
美国基于雇主的职业伤害和疾病监测系统对慢性病的统计存在漏报情况。我们提出一种方法来估算美国每年新确诊矽肺病的人数。
利用美国死亡证明数据、密歇根州的监测系统数据以及捕获-再捕获分析来计算全国矽肺病的估算值。
1987年至1996年期间，美国有2787例死亡病例的死亡证明上提及了矽肺病。同一时期，在密歇根州，77%提及矽肺病的死亡证明被确认为与矽肺病相关的死亡，确诊矽肺病的存活病例与死亡病例之比为6.44。根据密歇根州监测系统中确诊矽肺病死亡的比例、存活与死亡矽肺病病例的比例以及捕获-再捕获分析，估计1987年至1996年期间美国每年有3600 - 7300例矽肺病病例。
我们对每年新确诊矽肺病病例数的估计显著高于美国用于统计职业病的基于雇主报告系统的估计值。这种基于雇主的监测系统不足以确定职业病的发病频率。我们将一个易于获取且相对廉价的全国行政数据库（即死亡证明）与一个成本更高的基于州的主动监测系统相结合的分析方法，是一种具有成本效益的模型，可用于更准确地估计多种不同职业病的数量。准确估计职业病对于确定时间趋势和评估预防矽肺病的努力至关重要。
