Epidemiology of fatal occupational injuries in Jefferson County, Alabama.

ABSTRACT

Background. In Alabama, little is known about the overall characteristics of job-related injuries.

Methods. We examined fatal occupational injuries that occurred in Jefferson County, Alabama, from 1990 through 1999 using files maintained by the Jefferson County. Coroner/Medical Examiner Office. Mortality rates were calculated by sex, age, race, occupation, and industry.

Results. There were 186 fatal occupational injuries; 136 were unintentional. The overall fatality rate was 4.45 deaths per 100,000 worker-years. Mortality rates were higher among men than among women, and they increased with advancing age. The homicide rate was higher among black workers than among whites. Mining, manufacturing, and transportation were the industries with the highest fatal injury rates. Transportation-related jobs and manual labor were high-risk occupations.

Conclusion. High-risk industries should consider worker-targeted injury prevention programs, and particular attention should be paid to elderly workers.

**********

BETWEEN 1992 and 1999, more than 6,000 workers were fatally injured in the United States annually. (1) Transportation incidents were the leading cause of occupational fatalities, with highway crashes accounting for more than one fifth of the fatal work injuries overall. (1) Workplace homicides were the second leading cause of death from 1992 to 1998, but their occurrence progressively declined from 1994, and by 1999 on-the-job falls surpassed workplace homicide as the second leading cause of death. (1)

The Bureau of Labor Statistics (BLS) reported that men and older workers were at greater risk of fatal occupational injuries. (1) Women accounted for less than 10% of all job-related fatalities, and nearly two thirds of the work injury deaths among women were caused by homicides and highway incidents. (1) Americans of African and Asian descent accounted for less than 14% of all job-related fatalities, but they represented almost 30% of the victims of homicide at the workplace. (1)

Industry groups reported to have the highest fatality rates were mining, agriculture, forestry and fishing, construction, and transportation and public utilities. (1) Occupations with the highest fatality rates were timber cutter, fisherman, structural metal worker, and airplane pilot. (1) Within the United States, there is regional variation in fatal occupational injury numbers and rates, (1) particularly among specific industries, occupations, events, and exposures. (2)

In Alabama, little is known about the overall characteristics of job-related injuries, since the majority of recent research has focused on a small number of occupations and risk factors. (3-8) This paper presents the frequency and characteristics of fatal occupational injuries in Jefferson County, Alabama, from 1990 to 1999, and describes high-risk industries and occupations toward which preventive activities should be targeted.

METHODS

To identify fatal occupational injuries in Jefferson County, Alabama, from January 1990 to December 1999, we abstracted data from the files maintained by the Jefferson County Coroner/Medical Examiner Office (JCCMEO). The JCCMEO operates under a consistent medical examiner's statute, and all deaths are certified by 1 of 5 forensic pathologists. The JCCMEO investigates all sudden and unexpected deaths that occur in Jefferson County and in its database classifies as job-related any death for which the surviving family members could expect to receive governmental workers' compensation death benefits. We included in this study as cases all the fatal occupational injuries identified as such by the JCCMEO. However, the definition adopted by the JCCMEO does not include all the deaths that may occur in an employment context. For this reason, we also reviewed all the deaths investigated by the JCCMEO that were not recorded as job-related but were the result of an injury that occurred at a foundry, railroad track, insti tute, construction site, business, or mine. We determined that 20 deaths that were not previously identified as work-related by the JCCMEO occurred within the scope of the decedents' employment. Eight of them resulted from self-inflicted injuries, 2 from motor vehicle crashes, 2 from falls from scaffolds, 1 from a truck running over the decedent, and 7 from homicide in the workplace. Therefore, these 20 cases were added to the deaths identified by the JCCMEO. Natural causes were excluded from the study, and fatal occupational injuries were classified as "accidental" (referred to hereafter as "unintentional injury"), "homicide," or "suicide."

The information abstracted from the JCCMEO files included demographic characteristics of the victim (sex, age, and race), time and place of both injury and death, the cause, manner, and circumstances of death, the mechanism of the injury, the victim's occupation at the time of injury, and the type of industry. According to this information, codes developed by the BLS were assigned to classify the event or exposure that produced the injury (Occupational Injury and Illness Classification Structures [OIICS] codes (9)), the location where the injury occurred, and the victim's activity at the time of injury (Census of Fatal Occupational Injuries [CFOI] codes (10)). The industry of the decedent's employer was classified using the 23 Major Industry Recodes developed by the Bureau of the Census. (11) Each victim's occupation was coded according to the Census Occupation Classification System, 1990. (10)

In addition, information on the result of toxicologic analyses was abstracted from the JCCMEO files. The JCCMEO collects routine postmortem toxicology samples of blood, urine, vitreous, bile, gastric contents, and liver, when available, in all autopsy cases. From 1990 through 1999, routine toxicologic analysis was done independently of this study as directed by the individual pathologist. Testing for ethanol was done directly on whole blood via gas chromatography. Any ethanol concentration greater than or equal to 0.01 mg/dL was considered a positive result. Screening for medications and drugs of abuse was done on urine by either enzyme multiplied immunoassay technique or thin layer chromatography. When urine was unavailable, the cases were screened by enzyme multiplied immunoassay technique on a supernatant of whole blood from which the protein had been precipitated by acetone. Drugs detected on a screen were confirmed and then quantified by gas chromatography--mass spectrometry. The reports of these routin e toxicologic analyses were available for this study. Since vitreous and urine ethanol concentrations were determined only if ethanol was detected in blood or if no blood sample was available, the results of ethanol screening presented in this paper refer only to blood analyses.

A descriptive analysis was done of the characteristics of both unintentional and intentional fatal occupational injuries that occurred in the study area during the 10-year period and of the characteristics of the deceased subjects. In addition, death rates were calculated using denominators derived from the 1990 and 1998 Current Population Survey files specific to Jefferson County, Alabama. (12) Rates were expressed as deaths per 100,000 worker-years. In the analyses stratified by industry and occupation, mortality rates were computed only for subgroups in which more than 3 fatal injuries had occurred.

RESULTS

Demographic Characteristics of the Victims

Between January 1, 1990, and December 31, 1999, 186 fatal job-related injuries occurred in Jefferson County, Alabama. Overall, the mortality rate was 4.45 deaths per 100,000 worker-years. Unintentional injuries accounted for 73% of deaths. Among intentional injuries, 84% were caused by interpersonal violence, and only 8 cases (16%) were recorded as suicides.

Almost 95% of all victims were men, and the mortality rate among men (8.13 deaths per 100,000 worker-years) was much greater than among women (0.50 deaths per 100,000 worker-years) (Table 1). Differences by sex were striking in unintentional injuries. For this type of injury, the mortality rate among men was 40 times as great as among women. No deaths in the workplace were recorded as self-inflicted violence among women. Although the homicide rate among men was 4.6 times that among women, interpersonal violence was the leading cause of occupational death among women (70% of fatalities). Firearms were the most common cause of homicide (37 cases of 42), but whereas only 5% of men were killed by other means, 43% of the female homicide victims (3 of 7 cases) were killed by non-firearm assaults.

Overall, the mean age of the victims of fatal occupational injuries was 41.4 years. Mortality rates for all types of injury increased as age increased. The increase in mortality was particularly evident among elderly workers, whose rate was about 3 times as great as among younger subjects for unintentional injuries, about 6 times as great for homicides and about 17 times as great for suicides.

No substantial race differences in mortality rates were found among unintentional injury deaths. The homicide rate among African American workers was about 1.5 times as great as among white subjects, whereas the suicide rate was 3.6 times higher for the white race. Among Asian Americans, homicide was the leading cause of occupational death (5 injuries of 6).

Temporal Characteristics

In the 10-year period studied, there was no trend in fatal occupational injury occurrence, though both homicides and unintentional injuries have steadily declined since 1996 and 1997, respectively. The smallest number of unintentional injuries during the 1990 to 1999 period was recorded in 1995, whereas in the same year homicides reached their highest peak.

Occupational fatalities varied by season, day of the week, and time of day. Although in the winter fewer fatal occupational injuries occurred than in the summer, the single month in which the highest number of injuries took place was December. Overall, the highest number of fatal job-related injuries occurred on Mondays; however, the number of homicides committed on Saturdays was greater than on any other day. Most unintentional injuries occurred from 6 AM to 6 PM (80%), whereas homicides clustered between 8 PM and midnight (43%), with an additional peak at 5 PM (12%).

Characteristics of the Injuries

Table 2 presents the events and exposures that produced the fatal injuries. Assaults and interpersonal violent acts were the leading cause of occupational death (22.6%). Among unintentional injuries, three causes accounted for almost 50% of fatalities: workers struck by objects, workers caught in or compressed by equipment or objects, and falls to a lower level.

The locations where most injuries occurred are shown in Table 3. More than 40% of unintentional injuries took place at industrial places and premises. More than 80% of homicides were committed in commercial buildings, with stores ranking in the first position, followed by dining establishments.

The occupations with the greatest number of fatal unintentional injuries were manual labor, truck driving, and construction trades (Table 4). Four deaths occurred among tree trimmers (who were included in the groundskeepers and gardeners category, since no appropriate OIICS code was found for this occupation). Eleven of the 13 truck drivers who died on the job were actually driving the vehicle or riding on it when the injury occurred. One decedent was boarding or alighting from the truck, and another was loading and unloading materials. Among the 8 construction laborers, 4 were fatally injured while performing tasks directly related to construction, such as assembling building components. One decedent was injured while cleaning a machine, one was injured while loading and unloading materials, and one was hit by an automobile while he was moving barrels on a highway. The occupations in which most homicides took place were either sales-related or were protective service or managerial occupations, particularly in food serving and lodging establishments.

Table 5 shows mortality rates by occupation. Rates for unintentional injuries above the overall rate of 3.25 deaths per 100,000 worker-years were found among the following: (1) motor vehicle operators and other transportation and material moving occupations (in particular, truck drivers had a rate of 24.66 deaths per 100,000 worker-years); (2) construction laborers and other handlers (laborers other than construction laborers had a rate of 30.77 deaths per 100,000 worker-years, construction laborers of 12.77), equipment cleaners, and laborers; (3) construction trades (painters and construction and maintenance workers had a rate of 4.10 deaths per 100,000 worker-years), and other precision production occupations; (4) protective service occupations (the rate among sheriffs, bailiffs, and other law enforcement officers was 4.86 deaths per 100,000 worker-years, and among police and detectives during public service the rate was 4.25; all of the victims were struck by vehicles while on the side of the road); (5) fa rm workers and related occupations (tree trimmers); (6) mechanics and repairers (the rate among millwrights was 9.02 deaths per 100,000 worker-years).

The highest homicide rate was in the protective service occupations (six times as great as in the County as a whole). As compared with the overall homicide rate among workers in the study area, other occupations at increased risk of interpersonal violence were executives, administrators and managers, supervisors and proprietors in sales occupations, sales workers (2.98 homicides per 100,000 worker-years among cashiers), retail, and personal service occupations. In addition to a high homicide frequency, supervisors and proprietors in sales occupations also had the highest suicide rate (1.91 deaths per 100,000 worker-years).

Table 6 presents fatal occupational injury rates by industry. The mining industry had the highest mortality rate (n = 6), followed by the manufacturing industry (durable goods), in which almost one third of all unintentional injuries occurred. The construction industry accounted for 22% of unintentional deaths, and its mortality rate was three times as great as in Jefferson County as a whole. The transportation industry accounted for 10% of fatal occupational injuries. Unintentional injury mortality above the overall County rate was also observed in agriculture, manufacturing of nondurable goods, utility and sanitary service, and in business and repair services.

Almost half of the homicides took place in the retail trade industry, which also had a high homicide rate (2.35 deaths per 100,000 worker-years) as compared with Jefferson County workers as a whole and with the other industries. Business and repair services also had an increased homicide rate (2.01 homicides per 100,000 worker-years).

Toxicologic Analysis

Overall, alcohol was detected in the blood of 13 male victims and drugs in biologic samples from 27 persons (26 men and 1 woman). Drugs were detected in 20 of 100 tested workers aged 20 to 44, in 5 of 50 tested workers aged 45 to 64, and in 2 of 12 tested subjects 65 or older. Higher proportions of African American subjects tested positive for blood alcohol than whites (15.7% vs 4.5%). Among unintentional injury deaths, drugs were detected more frequently among white subjects (Table 7). Among homicide victims, a higher proportion of blacks tested positive (one third).

The construction trades accounted for 38.5% of all subjects who tested positive for alcohol. In this category, 5 subjects of the 21 tested had alcohol in their blood. Of 13 persons in protective service occupations, 4 tested positive for drugs. The same number of motor vehicle operators (4 of 16) tested positive for drugs. Some drugs were detected in the biologic samples from 2 of the 4 tree trimmers and in 3 of 15 handlers and equipment cleaners.

DISCUSSION

In Jefferson County, Alabama, 186 persons died as a consequence of occupational injuries in the years 1990 to 1999. Unintentional injuries represented approximately 73% of the cases, homicides 23%, and suicides 4%. Overall, the mortality rate due to occupational injuries was 4.45 deaths per 100,000 worker-years. Using the National Institute for Occupational Safety and Health/National Traumatic Occupational Fatalities surveillance system, Bailer et al (13) estimated that occupational injury mortality rates in the United States have been progressively declining from 1985 to 1992, passing from 5.30 fatal injuries per 100,000 person-years in 1985 to 3.87 fatal injuries per 100,000 person-years in 1992. Using the same source of data, the Centers for Disease Control and Prevention (14) estimated that in 1994 the national fatal occupational injury rate was 4.4 per 100,000. Using the CFOI as the source of information, the BLS reported a national fatal occupational injury rate of 4.8 per 100,000 for the year 1996. (1 ) The fatal injury rate in Jefferson County is similar to the rates estimated for the United States, though they do not embrace the whole period we studied and they are based on different sources of data.

In Jefferson County, the mortality rate due to occupational injury increased with age, elderly workers having a fourfold risk of being killed on the job as compared with workers less than 65 years of age. A similar pattern was reported for the United States as a whole. (13,15) Similar to findings reported by Loomis et al (16) for North Carolina, our study showed that elderly workers had an excess mortality due to both unintentional and intentional injuries. With respect to unintentional injuries, both increased incidence and decreased survival after the injury occurrence may account for the excess mortality. A higher prevalence of preexisting medical conditions, physical impairment, and medication use among the elderly likely contributed to both injury occurrence and postinjury survival. (17) On the other hand, a possible explanation for the high homicide rate among elderly workers could be related to their occupations. The elderly might be more likely to work in, own, or supervise commercial stores or resta urants as compared with young adults. For example, the Current Population Survey data for the years 1990 and 1998 showed that subjects 65 years of age and older represented less than 2% of the workforce in Jefferson County, but they represented more than 5% of the supervisors and proprietors in the sales occupations. (12) Additionally, a limited ability for escape and self-defense may make elderly workers a more desirable target of aggression and robbery, and result in a higher incidence of death. The high rate of suicides in the workplace among subjects [greater than or equal to]65 may simply reflect the high general suicide rate among the elderly in the United States. (18)

In our study, female workers had fatal injury rates much lower than men, consistent with rates reported nationally and in other states. (13,16,19,20) Differences in the proportions of men and women employed in particular industries and occupations, differences in the jobs held, and behavioral differences within the same industry, occupation, or job type may explain part of this gender gap.

Overall, blacks and whites had the same mortality rate due to occupational injuries. Stone (20) reported a higher mortality rate due to injury among blacks than among white workers in South Carolina in the years 1989 and 1990. Similarly, the mortality rate due to occupational injury was higher for black workers than for whites in North Carolina in the years 1977 to 1991. (16) Geographic and temporal differences may account for the inconsistency between their findings and ours. In the United States, between the years 1983 and 1992, the mortality rate as reported by Bailer et al (13) was only slightly higher among black workers (4.82 deaths per 100,000 person-years) than among whites (4.64 deaths per 100,000 person-years). According to the CFOI data, the mortality rate was the same for black and white workers in the more recent time interval 1994 to 1996. (1)

With respect to unintentional fatal injuries, the most common injury mechanisms were workers struck by objects, workers caught in equipment, falls to a lower level, and contact with electric current. Highway accidents, which account for more than 20% of all occupational fatal injuries at a national level, (1) caused less than 6% of fatal injuries among workers in our study area. Also, Stone (20) reported motor vehicle crashes as the leading cause (32%) of occupational injury death in South Carolina in 1989 to 1990. In North Carolina, from 1977 to 1991, motor vehicle crashes were identified as the leading cause of fatal occupational unintentional injury among men, and the second leading cause of death among female workers, after explosions. (1) The national estimates and the data for South Carolina and North Carolina include deaths that occurred in both rural and urban areas, whereas Jefferson County is largely an urban area. Although the frequency of motor vehicle crashes in urban areas may be higher than in rural areas, the severity tends to be lower, (21,22) and this could account for the relative rarity of deaths due to highway accidents in Jefferson County. Jefferson County might also have an excess of deaths from the other causes, rather than an infrequent occurrence of motor vehicle crashes. As an alternative, the relatively low frequency of highway accidents in our study could depend on a failure by the JCCMEO to identify all motor vehicle crashes occurring on the job as job related. Despite our review of the deaths investigated by the JCCMEO, highway accidents may have been underreported. In addition, subjects working in Jefferson County who had a motor vehicle crash and died while traveling outside the County limits were not included among the cases for this study.

The results of the analysis regarding industry groups are similar to findings from other studies in the United States. (1, 13) In particular, the mining industry had the highest rate of fatal unintentional injury. Other industrial groups consistently identified as having a high risk of occupational death were agriculture, construction, and transportation (1,13,20) There was an exception, in that the manufacturing of durable goods had the second highest mortality rate due to occupational injuries in Jefferson County, whereas it was not enumerated among the high-risk industry groups in other studies. (1,3,20) When we examined with more detail the manufacturing of durable goods, we found that 55% of the fatal injuries occurred in the primary metal industry and in the fabricated metal products industry. In these subgroups, 23% of the victims were laborers, 14% were machine operators, and 14% were in the precision production occupations. No patterns emerged when we analyzed the activities of the manufacturing wor kers at the time of the injury and the events and exposures that caused the injuries.

The high risk reported by Bailer et al (13) for occupational groups such as transportation and material moving, handlers, helpers and laborers, precision production, craft, and repair was confirmed by our data. We also found a high rate of unintentional fatal injuries among the protective service occupations. The most common cause of fatal unintentional injuries in this group was being hit by vehicles while working on the side of a road. The fatal injury rate among farm workers in Jefferson County was high as compared with the overall fatal occupational injury rate, though it was lower than the rate reported for farm workers in the United States. (13) It must be noted, however, that Jefferson County is not a rural area, and all of the 4 victims whose occupation we classified as "farm workers" were in reality tree trimmers. An appropriate code for this occupation does not exist in the Census Occupation Classification System, 1990. (10)

In Jefferson County, homicides were the leading cause of death due to injury in the workplace. Homicides represented almost one fourth of all deaths and largely outnumbered transportation incidents, the leading cause of fatal occupational injury at the national level. (1) Our results confirm previous findings that among female workers the homicide rate was higher than the mortality rate due to unintentional injuries. (20) Similarly, Loomis et al (16) reported that deaths were evenly divided between unintentional injuries and homicide among female workers, but not among men. We also observed that the homicide rate was higher among the blacks than among the whites, even though no racial differences were found in the overall occupational injury fatality rates. Demographic characteristics of the workers probably are not directly associated with homicide risk, but race and sex may influence such a risk if they are differentially distributed across those industries and occupations in which homicides are most likel y to occur. For example, according to the Current Population Survey data for Jefferson County in the years 1990 and 1998, women represented almost half of the workforce, but virtually the totality of cashiers. (12) African American workers represented approximately one third of the overall workforce but were two thirds of the subjects employed in eating and drinking places and accounted for half of the employees of grocery stores, drug stores, and car washes. (12) The hypothesis that occupation rather than personal behavior influences the risk of being assaulted on the job is supported by the findings of Sygnatur and Toscano. (23) They reported that in the United States in 1998 more than two thirds of occupational homicides involved robberies, and only few were committed by acquaintances. Workers engaged in cash transactions would then be at increased risk of being fatally assaulted. In accordance with that, almost 70% of homicides in Jefferson County occurred in commercial stores, convenience stores, restaur ants, and hotels. The industry with the highest homicide rate was the retail industry. This local finding is in accordance with national statistics. Retail workers in the United States have been reported to be at increased risk of violent death by Peek-Asa et al. (24) Employment in services and sales occupations and in the retail industry was also reported to confound the association between sex and job-related homicides in a study conducted in Colorado in the years 1982 to 1994.25 In our study area, the protective service occupations had the highest rate of homicides, which accounted for half of the job-related injury deaths. The same proportion of homicides among police was reported at the national level by Sygnatur and Toscano. (23) They also identified taxicab drivers and chauffeurs as the occupation with the highest homicide rate in the United States. In Jefferson County, there were no homicides among taxicab drivers during the study time interval. This difference between the local and national level is probably due to the rarity of this occupation in Jefferson County, as compared with other areas in the United States. (12) We observed that most homicide victims were shot. However, women were killed by non--firearm assaults much more commonly than men. A high frequency of non--firearm homicides among women was also noticed in South Carolina (20) and at a national level. (25)

The analysis of toxicology reports showed that the proportion of the victims with positive tests for blood ethanol was the same for unintentional injuries and for homicides. More subjects were positive for drugs than for ethanol. The proportion of victims who tested positive for drugs was higher among homicide victims. In cases of unintentional injury, toxicologic analyses were done more commonly when the victim was white than if the victim was black, whereas in homicides, toxicologic analyses were much more frequent among the blacks. The proportion of positive tests was always greater among blacks. The construction trades represented the greatest proportion of victims with positive tests for ethanol. The construction trade was also identified by Greenberg et al (27) as the most common occupation among victims with positive toxicology reports. The occupations that were associated with positive drug tests in our analyses (protective service occupations, motor vehicle operators, agricultural workers, helpers, and laborers) were also reported by Greenberg et al. (27) As they pointed out, however, toxicology data have some limitations. (27) First, toxicologic analyses were done on deceased workers. No assessment of alcohol or drug consumption was done for coworkers or other subjects possibly having a role in the fatal injury. Further, some of the victims who survived the initial event and died later in the hospital might have received certain analyzed drugs (such as narcotics, benzodiazepines) as part of their therapy. In these cases, a positive toxicologic test could be misleading. Information on whether a patient had received pain medications in the hospital was not available at the time the study was conducted.

The present study has a number of other major limitations. The cases were workers who sustained fatal occupational injuries in and fell within the jurisdiction of Jefferson County. The population experience that we used in the denominator for the mortality rates was constituted of workers whose residence was in Jefferson County, and not of persons actually working in the County. There might be inconsistency between the cases and the population used in the denominator. In fact, the JCCMEO investigated all the deaths resulting from an injury that occurred in Jefferson County during the study period, but if a person who was resident in Jefferson County was fatally injured outside the County while working, that worker was included in the denominator of the rates but not in the numerator. The opposite situation could also have occurred. In fact, workers not resident in Jefferson County could have been fatally injured in Jefferson County and been included in the study as cases. Given that the Birmingham area is an important industrial and financial center that attracts workers from neighboring counties, the situation hypothesized was possible. According to the US Census Bureau, in 1990 6.8% of the workers who were residents in Jefferson County had a job in another county, (28) and 19.8% of the persons working in Jefferson County were residents in another county. (29)

Another limitation of the present study depends upon the source of data for the cases. In fact, a study by Runyan et al (30) showed how determining on-the-job status may be challenging for medical examiners, despite the use of consistent criteria for assigning work-relatedness, especially when transportation and nonpaid workers were involved. Underreporting or, less likely, overreporting, of fatal occupational injuries may have occurred. Despite this possible limitation, the use of data from one medical examiner's jurisdiction guarantees consistency in the assignment of work-relatedness, which is not a characteristic of death certificates. (31)

This study has the merit of using local data, which allow for the identification of industries, occupations, and situations in which the risk of injury may be unrecognized at the national level. Regulations for occupational safety developed without the knowledge of local epidemiology may fail to address relevant issues.

CONCLUSION

In Jefferson County, Alabama, occupational injuries cause approximately 20 deaths every year. In addition to encouraging the enhancement of and adherence to Occupational Safety and Health Administration guidelines, high-risk industries should consider worker targeted prevention programs as part of the overall initiative to reduce occupational death and injury. This is particularly important when considering the aging workforce and the high risk of fatal injury observed among elderly workers.

TABLE 1

Demographic Characteristics of the Victims of Fatal Occupational
Injuries in Jefferson County, Alabama, 1990 to 1999

                                           All Injuries

                                 Number of  Percent of
                                  Deaths    All Deaths  Rate *

Total                               186       100.0      4.45
Sex

   Male                             176        94.6      8.13
   Female                            10         5.4      0.50
Age group (years)
   <20                                3         1.6      2.59
   20-44                            111        59.7      4.10
   45-64                             58        31.2      4.55
   [greater than or equal to]65      14         7.5     18.24
Race/Ethnicity
   Asian +                            6         3.2      -
   Black                             58        31.2      4.34
   Hispanic                           3         1.6      -
   White                            119        64.0      4.31 **

                                         Unintentional Injuries

                                 Number of    Percent of
                                   Deaths     All Deaths     Rate *

Total                               136          100.0        3.25
Sex

   Male                             133           97.8        6.14
   Female                             3            2.2        0.15
Age group (years)
   <20                                2            1.5        1.73
   20-44                             84           61.8        3.10
   45-64                             43           31.6        3.37
   [greater than or equal to]65       7            5.1        9.12
Race/Ethnicity
   Asian +                            1            0.7        -
   Black                             41           30.1        3.07
   Hispanic                           3            2.2        -
   White                             91           66.9        3.32 **

                                              Homicides

                                 Number of    Percent of
                                   Deaths     All Deaths  Rate *

Total                                42         100.0      1.00
Sex

   Male                              35          83.3      1.62
   Female                             7          16.7      0.35
Age group (years)
   <20                                1           2.4      0.86
   20-44                             23          54.8      0.85
   45-64                             13          30.9      1.02
   [greater than or equal to]65       5          11.9      6.51
Race/Ethnicity
   Asian +                            5          11.9      -
   Black                             16          38.1      1.20
   Hispanic                           0             0      -
   White                             21          50.0      0.74 **

                                              Suicides

                                 Number of   Percent of
                                  Deaths     All Deaths  Rate *

Total                                8         100.0      0.19
Sex

   Male                              8         100.0      0.37
   Female                            0           0        0
Age group (years)
   <20                               0           0        0
   20-44                             4          50.0      0.15
   45-64                             2          25.0      0.16
   [greater than or equal to]65      2          25.0      2.61
Race/Ethnicity
   Asian +                           0           0        -
   Black                             1          12.5      0.07
   Hispanic                          0           0        -
   White                             7          87.5      0.25 **

* Deaths/100,000 worker-years.

+ Rate not computed because of the lack of comparable denominators from
the Current Population Survey.

** Death rate includes whites and Hispanics.

TABLE 2

Most Common Events or Exposures Causing Occupational Deaths in Jefferson
County, Alabama, 1990 to 1999

OIICS *                                          Number of  Percent of
 Code    Description                              Deaths    All Deaths

  02     Struck by object                           23         12.4
  03     Caught in or compressed                    23         12.4
           by equipment or objects
  04     Caught in or crushed in                     4          2.1
           collapsing materials
  11     Fall to lower level                        21         11.3
  13     Fall on same level                          2          1.1
  21     Bodily reaction                             1          0.5
  31     Contact with electric current              13          7.0
  32     Contact with temperature extremes           3          1.6
  34     Exposure to caustic, noxious,               2          1.1
           or allergenic substances
  41     Highway accident                           11          5.9
  42     Nonhighway accident, except                 1          0.5
           rail, air, water
  43     Pedestrian, nonpassenger struck             9          4.8
           by vehicle, mobile equipment
  44     Railway accident                            7          3.8
  46     Aircraft accident                           4          2.1
  51     Fire--unintended or uncontrolled            1          0.5
  52     Explosion                                   9          4.8
  61     Assaults and violent acts by person(s)     42         22.6
  62     Self-inflicted injury                      10          5.4

 Total                                             186        100.0

* Occupational Injury and Illness Classification Structures, 1992.

TABLE 3

Locations of Fatal Unintentional Injuries, Homicides and Suicides,
Jefferson County, Alabama, 1990 to 1999

                        Unintentional Fatal Injuries

CFOI * Code  Description                   Number of Deaths +

    48       Factory plant                         22
    47       Construction site                     20
    49       Industrial place, repair
             shop or premises **                   15
    19       Home **                               12
    62       Local road or street                   7
    75       Office building                        5
    11       Home, unspecified                      4
    34       Mine                                   3
    45       Railway yard, line or tracks           3
    46       Warehouse (except loading
             platform)                              3
    73       Hotel, motel                           3
    79       Public building **                     3
    92       Parking lot, garage
             (employer's premises)                  3

                Unintentional Fatal
                     Injuries
                  Percent of All
CFOI * Code   Unintentional Injuries

    48                 16.2
    47                 14.7
    49
                       11.0
    19                  8.8
    62                  5.1
    75                  3.7
    11                  2.9
    34                  2.2
    45                  2.2
    46
                        2.2
    73                  2.2
    79                  2.2
    92
                        2.2


* Census of Fatal Occupational Injuries, 1999.

+ Only categories with 3 deaths or more are represented.

** Not elsewhere classified

                                Homicides
CFOI * Code  Description                 Number of Deaths +

    77       Other commercial store
             (including grocery stores)          11
    74       Convenience store                    9
    76       Restaurant, cafe                     6
    73       Hotel, motel                         3
    75       Office building                      3

                     Homicides
CFOI * Code  Percent of All Homicides

    77
                       26.2
    74                 21.4
    76                 14.3
    73                  7.1
    75                  7.1

* Census of Fatal Occupational Injuries, 1999.

+ Only categories with 3 deaths or more are represented.

** Not elsewhere classified

                              Suicides
CFOI * Code  Description            Number of Deaths +

    75       Office building                 3
    92       Parking lot, garage
             (employer's premises)           3

                     Suicides
CFOI * Code  Percent of All Suicides

    75                 37.5
    92
                       37.5

* Census of Fatal Occupational Injuries, 1999.

+ Only categories with 3 deaths or more are represented.

** Not elsewhere classified

TABLE 4

Occupations of the Victims of Fatal Unintentional Injuries, Homicides
and Suicides, Jefferson County, Alabama, 1990 to 1999

                            Unintentional Fatal Injuries

COCS * Codes  Description                          Number of Deaths +

    889       Laborers, except construction               16
    804       Truck drivers                               13
    869       Construction laborers                        8
    599       Construction trades, NEC                     5
    486       Groundskeepers and gardeners,
              except farm **                               4
    595       Roofers                                      4
    637       Machinists                                   4
    226       Airplane pilots and navigators               3
    426       Guards and police, except
              public service                               3
    567       Carpenters                                   3
    575       Plumbers, pipefitters and
              steamfitters                                 3
    628       Supervisors, production occupations          3
    783       Welders and cutters                          3
    825       Railroad brake, signal, and
              switch operators                             3
    849       Crane and tower operators                    3
    853       Excavating and loading
              machine operators                            3

                Unintentional Fatal
                      Injuries
                  Percent of All
COCS * Codes  Unintentional Injuries

    889                11.8
    804                9.6
    869                5.9
    599                3.7
    486
                       2.9
    595                2.9
    637                2.9
    226                2.2
    426
                       2.2
    567                2.2
    575
                       2.2
    628                2.2
    783                2.2
    825
                       2.2
    849                2.2
    853
                       2.2

* Census Occupation Classification System, 1990

+ Only categories with 3 deaths or more are represented.

** The occupation of these subjects was "tree trimmer." They were
classified in this category since no COCS code exists for this
occupation.

NEC = Not elsewhere classified.

                                  Homicides
COCS * Codes  Description                   Number of Deaths +

    243       Supervisors and proprietors,
              sales occupations                      6
    426       Guards and police, except
              public service                         6
    017       Managers, food serving and
              lodging establishments                 5
    275       Sales counter clerks                   4
    276       Cashiers                               4

                      Homicides
COCS * Codes  Percent of All Homicides

    243
                        14.3
    426
                        14.3
    017
                        11.9
    275                  9.5
    276                  9.5

* Census Occupation Classification System, 1990

+ Only categories with 3 deaths or more are represented.

** The occupation of these subjects was "tree trimmer." They were
classified in this category since no COCS code exists for this
occupation.

NEC = Not elsewhere classified.

                                  Suicides
COCS * Code  Description                   Number of Deaths +

    243      Supervisors and proprietors,
             sales occupations                      4

                     Suicides
COCS * Code  Percent of All Suicides

    243
                       50.0

* Census Occupation Classification System, 1990

+ Only categories with 3 deaths or more are represented.

** The occupation of these subjects was "tree trimmer." They were
classified in this category since no COCS code exists for this
occupation.

NEC = Not elsewhere classified.

TABLE 5

Fatal Occupational Injuries in Jefferson County, Alabama, 1990 to 1999,
by Occupation

                                                 Injury
                                                 Deaths
Code                Occupation *          No.        Rate ++

02        Other executive,
          administrators, and managers     10        3.09
03        Management related occupations    1        -
04        Engineers                         3        -
10        Teachers, except college and
          university                        1        -
12        Other professional specialty
          occupations                       1        -
15        Technicians, except health
          engineering, and science          3        -
16        Supervisors and proprietors,
          sales occupations                11        5.24
19        Sales workers, retail and
          personal services                10        3.23
22        Computer equipment operators      1        -
26        Other administrative support
          occupations, including
          clerical                          2        -
28        Protective service occupations   14       12.64
29        Food service occupations          1        -
32        Personal service occupations      2        -
33        Mechanics and repairers          14        5.86
34        Construction trades              24       11.31
35        Other precision production
          occupations                      12       13.46
36        Machine operators and tenders,
          except precision                  4        2.34
37        Fabricators, assemblers,
          inspectors, and samplers          3        -
38        Motor vehicle operators          16       15.16
39        Other transportation
          Occupations and material
          moving                           13       28.37
40        Construction laborer              8       12.77
42        Other handlers, equipment
          cleaners, and laborers           20       20.67
44        Farm workers and related
          occupations                       4        6.86
Missing                                     8
 Total                                    186        4.45

                 Unintional
                  Injuries                Homicides         Suicides
Code      No.            Rate  ++  No.       Rate  ++  No.

02
            2            -           8       2.47        0
03          0            -           0       -           1
04          2            -           0       -           1
10
            1            -           0       -           0
12
            1            -           0       -           0
15
            3            -           0       -           0
16
            1            -           6       2.86        4
19
            1            -           9       2.91        0
22          1            -           0       -           0
26

            0            -           1       -           1
28          7            6.32        7       6.32        0
29          0            -           1       -           0
32          0            -           2       -           0
33         11            4.60        3       -           0
34         24           11.31        0       -           0
35
           12           13.46        0       -           0
36
            3            -           1       -           0
37
            3            -           0       -           0
38         15           14.21        1       -           0
39

           13           28.37        0       -           0
40          8           12.77        0       -           0
42
           18           18.60        1       -           1
44
            4            6.86        0       -           0
Missing     6                        2                   0
 Total    136            3.25       42       1.00        8


           Suicides
Code      Rate  ++

02
          -
03        -
04        -
10
          -
12
          -
15
          -
16
          1.91
19
          -
22        -
26

          -
28        -
29        -
32        -
33        -
34        -
35
          -
36
          -
37
          -
38        -
39

          -
40        -
42
          -
44
          -
Missing
 Total    0.19

* Detailed Occupation Records, as coded in the Current Population
Survey, 1998.

++ Deaths/100,000 worker-years; death rates are presented only for
categories with more than 3 deaths.

TABLE 6

Fatal Occupational Injuries in Jefferson County, Alabama, 1990 to 1999,
by industry

                                                      Injury
                                                      Death

Code      Industry *                           No.       Rate +

01        Agriculture                            6         8.79
02        Mining                                 6        14.81
03        Construction                          33        10.51
04        Manufacturing (durable goods)         44        13.33
05        Manufacturing (nondurable goods)       6         7.37
06        Transportation                        17        11.92
08        Utilities and sanitary service         6         6.73
09        Wholesale trade                        3         -
10        Retail trade                          23         2.85
11        Finance, insurance, and real estate    1         -
13        Business and repair services          16         6.43
14        Personal services, except              4         4.52
           private households
17        Medical services, except hospitals     1         -
18        Educational services                   1         -
20        Other professional services            2         -
22        Public administration                  8         3.33
Missing                                          9

  Total                                        186         4.45

                                                   Unintentional
                                                     Injuries

Code      Industry *                           No.       Rate +

01        Agriculture                            6         8.79
02        Mining                                 6        14.81
03        Construction                          31         9.87
04        Manufacturing (durable goods)         40        12.11
05        Manufacturing (nondurable goods)       5         6.14
06        Transportation                        14         9.82
08        Utilities and sanitary service         6         6.73
09        Wholesale trade                        1         -
10        Retail trade                           3         -
11        Finance, insurance, and real estate    1         -
13        Business and repair services          11         4.42
14        Personal services, except              1         -
           private households
17        Medical services, except hospitals     1         -
18        Educational services                   1         -
20        Other professional services            1         -
22        Public administration                  4         1.66
Missing                                          4

  Total                                        136         3.25


                                                    Homicides

Code      Industry *                           No.       Rate +

01        Agriculture                            0         -
02        Mining                                 0         -
03        Construction                           0         -
04        Manufacturing (durable goods)          3         -
05        Manufacturing (nondurable goods)       1         -
06        Transportation                         2         -
08        Utilities and sanitary service         0         -
09        Wholesale trade                        2         -
10        Retail trade                          19         2.35
11        Finance, insurance, and real estate    0         -
13        Business and repair services           5         2.01
14        Personal services, except              3         -
           private households
17        Medical services, except hospitals     0         -
18        Educational services                   0         -
20        Other professional services            0         -
22        Public administration                  2         -
Missing                                          5

  Total                                         42         1.00


                                                     Suicides

Code      Industry *                           No.       Rate +

01        Agriculture                            0         -
02        Mining                                 0         -
03        Construction                           2         -
04        Manufacturing (durable goods)          1         -
05        Manufacturing (nondurable goods)       0         -
06        Transportation                         1         -
08        Utilities and sanitary service         0         -
09        Wholesale trade                        0         -
10        Retail trade                           1         -
11        Finance, insurance, and real estate    0         -
13        Business and repair services           0         -
14        Personal services, except              0         -
           private households
17        Medical services, except hospitals     0         -
18        Educational services                   0         -
20        Other professional services            1         -
22        Public administration                  2         -
Missing                                          0

  Total                                          8         0.19

* Major Industry Recodes, as coded in the Current Population Survey,
1998.

+ Death/100,000 worker-years; death rates are presented only for
categories with more than 3 deaths.

TABLE 7

Results of Toxicologic Analysis on Victims of Fatal Occupational
Unintentional Injuries and Homicides, Jefferson County, Alabama, 1990 to
1999

                                            Unintentional
                                              Injuries

                                          Alcohol

All subjects                              136
  Number of subjects tested with known    120 (88.2)
   result (% of all subjects)
  Number of cases of substance detection    9 (7.5)
   (% of tested subjects)
White subjects                             91
  Number of subjects tested with known     82 (90.1)
   result (% of all white subjects)
  Number of cases of substance detection    3 (3.6)
   (% of tested white subjects)
Black subjects                             41
  Number of subjects tested with known     34 (82.9)
   result (% of all black subjects)
  Number of cases of substance detection    6 (17.6)
   (% of tested black subjects)

                                           Unintentional     Homicides
                                              Injuries

                                          Drugs of Abuse  Alcohol

All subjects                              136             42
  Number of subjects tested with known    117 (86.0)      40 (95.2)
   result (% of all subjects)
  Number of cases of substance detection   17 (14.5)       3 (7.5)
   (% of tested subjects)
White subjects                             91             21
  Number of subjects tested with known     80 (87.9)      19 (90.5)
   result (% of all white subjects)
  Number of cases of substance detection   13 (16.2)       1 (5.3)
   (% of tested white subjects)
Black subjects                             41             16
  Number of subjects tested with known     33 (80.5)      16 (100.0)
   result (% of all black subjects)
  Number of cases of substance detection    4 (12.1)       2 (12.5)
   (% of tested black subjects)

                                             Homicides

                                          Drugs of Abuse

All subjects                              42
  Number of subjects tested with known    38 (90.5)
   result (% of all subjects)
  Number of cases of substance detection   9 (23.7)
   (% of tested subjects)
White subjects                            21
  Number of subjects tested with known    18 (85.7)
   result (% of all white subjects)
  Number of cases of substance detection   3 (16.7)
   (% of tested white subjects)
Black subjects                            16
  Number of subjects tested with known    15 (93.7)
   result (% of all black subjects)
  Number of cases of substance detection   5 (33.3)
   (% of tested black subjects)

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RELATED ARTICLE: KEY POINTS

* The majority (95%) of occupational injury fatalities were among men; however, the rate of intentional injury death was much greater among women than men.

* Rates of occupational injury fatality increased with age.

* Industries with the highest mortality rates were mining, manufacturing, and transportation.

* Transportation-related jobs and manual labor were the occupations with the highest rates.

From the center for Injury Sciences; the Department of Surgery, Section of Trauma, Burns, and Surgical Critical Care; the Department of Epidemiology, School of Public Health; and the Department of Pathology, Forensic Division, University of Alabama at Birmingham; and from the Coroner/Medical Examiner Office, Jefferson County, Alabama.

Reprint requests to Gerald McGwin, Jr, PhD, University of Alabama at Birmingham, Center for Injury Sciences, 120 Kracke Bldg, 1922 7th Ave 5, Birmingham, AL 35294-0016.