使用严重程度阈值提高职业伤害监测：在国际疾病分类词汇过渡中评估基于严重创伤性损伤的职业健康指标。
Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition.
机构信息
Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.
出版信息
Am J Ind Med. 2024 Jan;67(1):18-30. doi: 10.1002/ajim.23545. Epub 2023 Oct 18.
BACKGROUND
Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations.
METHODS
Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition.
RESULTS
Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition.
CONCLUSIONS
Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.
背景
在美国，创伤是导致工人死亡和残疾的主要原因。严重伤害受到与报告障碍、住院标准和工人赔偿范围等因素相关的系统确定偏差的影响较小。2012 年，为了跟踪与工作相关的严重创伤性伤害住院情况，启动了一项基于州的职业健康指标（OHI #22）。2015 年后，OHI #22 进行了修订，以考虑从国际疾病分类第 9 版临床修订版（ICD-9-CM）向 ICD-10-CM 的转变。本研究描述了 OHI #22 的发生率和趋势，以及所有与工作相关的住院治疗的相应指标。
方法
17 个州使用医院出院数据计算了 2012-2019 年的历年估计数。采用州面板固定效应回归模型对每年与工作相关的住院率、OHI #22 率以及因严重伤害导致的与工作相关的住院率比例的线性趋势进行建模。模型包括日历年度和 ICD-10-CM 转换前后的时间。
结果
与工作相关的住院率呈下降的单调趋势，与 ICD-10-CM 转换无显著关联。相比之下，OHI #22 率从 2012 年到 2014 年呈单调上升趋势，然后在 2015 年急剧下降 50%，从 2016 年到 2019 年又恢复到近乎单调上升的趋势。平均而言，在 ICD-10-CM 转换之前，OHI #22 占与工作相关的住院治疗的 12.9%，而转换后占 9.1%。
结论
尽管医院出院数据表明随着时间的推移，与工作相关的住院治疗有所减少，但与工作相关的严重创伤性伤害住院治疗显然在增加。OHI #22 通过减少对轻微伤害有不同影响的因素的影响，为州职业健康监测工作做出了重要贡献；然而，OHI #22 的趋势估计必须考虑到 2015 年 ICD-10-CM 转换带来的结构性断裂。
Zotero 插件