Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths--United States, 2007-2012.
The opioid epidemic affects multiple segments of the U.S. population (1). Occupational patterns might be critical to understanding the epidemic. Opioids are often prescribed for specific types of work-related injuries, which vary by occupation* (2). CDC used mortality data from the National Occupational Mortality Surveillance (NOMS) system to examine unintentional or undetermined drug overdose mortality within 26 occupation groups. This study included data from the 21 U.S. states participating in NOMS during 2007-2012. ([dagger]) Drug overdose mortality was compared with total mortality using proportional mortality ratios (PMRs) indirectly standardized for age, sex, race, year, and state. Mortality patterns specific to opioid-related overdose deaths were also assessed. Construction occupations had the highest PMRs for drug overdose deaths and for both heroin-related and prescription opioid-related overdose deaths. The occupation groups with the highest PMRs from methadone, natural and semisynthetic opioids, and synthetic opioids other than methadone were construction, extraction (e.g., mining, oil and gas extraction), and health care practitioners. The workplace is an integral part of life for the majority of the adult U.S. population; incorporating workplace research and interventions likely will benefit the opioid epidemic response.NOMS is a population-based surveillance system and a collaborative effort between state vital statistics offices and CDC's National Institute for Occupational Safety and Health (NIOSH) and National Center for Health Statistics (NCHS). Through data sharing agreements with NIOSH, all participating states, or NCHS under states' direction, share selected data from their death certificates, including the decedent's usual industry and occupation, coded to the U.S. Census industry and occupation codes. This analysis includes 4,024,086 deaths that occurred in persons aged [greater than or equal to] 18 years, from the 21 states that contributed [greater than or equal to] 1 year of data * to NOMS during 2007-2012. ([section]) International Classification of Disease, Tenth Revision (ICD-10) codes for underlying cause of death were used to identify unintentional (X40-X44) and undetermined (Y10-Y14) drug overdose deaths. Among drug overdose deaths, the specific type of opioid was indicated by the following ICD-10 multiple cause of deaths codes: T40.1 (heroin) and T40.2-T40.4 (prescription opioids [i.e., T40.2, natural and semisynthetic opioids; T40.3, methadone; and T40.4, synthetic opioids other than methadone]). ([paragraph]) Deaths that involved multiple opioid types were included in multiple categories.
Usual occupation, recorded as free-text on the death certificate, was coded to 1990 or 2000 U.S. Census occupation codes ** by NIOSH or by the state. A crosswalk based on U.S. Census data was used to convert the 1990 U.S. Census occupation codes to the 2000 U.S. Census occupation codes. ([dagger][dagger]) Occupation codes were binned into 26 groups based on job duties. ([section][section]) For each outcome, the proportion of deaths among each occupation group was compared with the proportion of deaths among all occupations combined using PMRs indirectly standardized by age, sex, race, calendar year, and state of occurrence. A PMR >1.00 indicated that the proportion of deaths within that occupation group is higher than the proportion of deaths among all occupation groups combined. Corresponding 95% confidence intervals were calculated.
The analysis identified 57,810 drug overdose deaths within the study population (1.4% of the 4,024,086 deaths). The majority of drug overdose deaths were among persons who were male (61.8%), white (89.8%), and aged 45-54 years (30.1%) or 35-44 years (24.1%). ([paragraph][paragraph]) PMRs from drug overdose were significantly above 1.00 for the following six occupation groups: 1) construction (1.25); 2) extraction (1.16); 3) food preparation and serving (1.11); 4) health care practitioners and technical (1.16); 5) health care support (1.18); and 6) personal care and service (1.10) (Table 1). PMRs from drug overdose were also significantly elevated among deaths where the usual occupation was unpaid/unemployed (1.10) *** or unknown (1.31). ([dagger][dagger][dagger]) For each specific opioid type, significantly elevated PMRs were generally observed only for those occupation groups that also had a significantly elevated PMR for drug overdose overall (Table 1) (Table 2). The only two exceptions were the arts, design, entertainment, sports, and media occupation group and the building and grounds cleaning and maintenance occupation group. For these groups, the proportion of drug overdose deaths among the two occupation groups was similar to the proportion of drug overdose deaths overall (i.e., PMR approximately = 1.00), whereas the proportional distribution of specific drugs involved in an overdose was different,[section][section][section] with heroin-involved overdose deaths higher than expected (Table 1). The highest PMRs for methadone, natural and semisynthetic opioids, and synthetic opioids were in the construction (1.34), extraction (1.39), and healthcare practitioner (1.81) occupation groups, respectively.
Because the PMRs for all opioid types within the construction occupation group were elevated, a subanalysis further examined opioid-related deaths in this group. The analysis identified 7,402 drug overdose deaths among persons aged [greater than or equal to] 18 years within the construction occupation group. The majority of decedents were male (96.7%), white (92.6%), and aged 45-54 years (30.4%) or 35-44 years (26.9%). ([paragraph][paragraph][paragraph])
These deaths were examined by the following occupation subgroups ****: first-line supervisors and managers, ([dagger][dagger][dagger][dagger]) construction trade workers (e.g., carpenters, electricians, painters, iron and steel workers, operating engineers, and construction equipment operators), construction trade helpers, and other construction and related workers (e.g., building inspectors, hazardous waste workers, and highway maintenance workers). PMRs were significantly elevated for all types of opioids within the occupation subgroup construction trade workers (Table 3).
Discussion
In this study, unintentional and undetermined overdose deaths varied by occupation group, with the construction group having elevated PMRs for all drug types. Although few related studies have been conducted, similar results have been observed. In Kentucky (2011) (3) and Ohio (2016) (4), for example, overdose deaths varied by industry and occupation and were highest among construction workers. Multiyear studies conducted in two Massachusetts jurisdictions (Barnstable County and Mystic Valley Public Health Coalition communities) found trade workers (e.g., construction, building/grounds maintenance, and mechanics) had the largest proportion of opioid overdose deaths (37% and 42%, respectively) (5,6). Variation was expected because work-related injuries and illnesses vary by occupation and industry. In addition, other factors that might affect opioid use, such as psychosocial work-related stress (e.g., job insecurity or high demand/low control jobs), socioeconomic standing, and education level, also vary by occupation and industry (7-9).
The specific drugs influencing higher than expected proportions of overdose deaths also varied by occupation group. In this study, heroin PMRs were highest for the construction; food preparation and serving; and arts, design, entertainment, sports, and media occupation groups. Among the drug types evaluated, heroin is illicit, whereas among the other types, usage is both licit (i.e., prescribed and used as directed) and illicit. Data from the National Survey on Drug Use and Health illustrate that self-reported illicit drug use varies by industry. ([section][section][section][section]) The top three industries among persons aged 18-64 years who reported using illicit drugs in the past month were accommodations and food services; arts, entertainment, and recreation; and construction (10).
The variation by occupation group in this study leads to speculation about opioid initiation or use and the work environment. A single on-the-job injury (e.g., fracture or dislocation) or chronic work-related pain (e.g., caused by repetitive motion or lifting) might result in a prescription for pain medication (2,&). Workers' compensation data from 26 states (2013-2015) indicated that opioids were prescribed for 52%-80% of injured workers who received pain medications (2). Persons might also self-medicate or work in an environment with normative support for illicit drug use (9). An estimated 64.2% of self-reported illicit opioid ([paragraph][paragraph][paragraph][paragraph]) users were employed full-time or part-time in 2016. ***** As licit and illicit opioid users participate in the workforce, occupation might be an important factor in understanding and responding to the opioid epidemic.
The findings in this report are subject to at least six limitations. First, data were analyzed in aggregate, but occupational patterns for each drug type might have differed by year. Second, NOMS has limited information on the specific circumstances of death. It is not known, for example, whether the death occurred at work. Death certificates do not state whether decedents were employed at their usual job (listed on the death certificate), another job, or unemployed at the time of death; if the drug use was legal or illegal; or if drug use was initiated while decedents were employed at their usual job, another job, or before employment. Third, the specific drug involved in the drug overdose death might have been misclassified (e.g., heroin deaths misclassified as morphine deaths because of similar metabolites) or given nonspecific codes (1). Within this study, the only drug code listed for one fourth of overdose deaths was "other and unspecified drugs" (T50.9 excluding T36-T50.8). Outcome misclassification might vary by state and year. Fourth, intentional overdose deaths were excluded; however, an unknown proportion of undetermined deaths might have included homicides or suicides and might therefore have resulted in overestimates. In this study, 9.6% of drug overdose deaths were of undetermined intent. The distribution of overdose deaths by intent and occupation group need to be explored. Fifth, PMRs are mutually dependent and cannot distinguish whether occupation was associated with increasing a specific cause of death, preventing the occurrence of other causes of death, or some combination of these effects. Finally, only 21 states participated in NOMS during the study period, which limits generalizability of the findings.
This study identified occupation groups with a higher proportion of drug and opioid-specific overdose mortality but was unable to identify specific factors that might have led to the observed results. The surveillance data presented in this study generated many questions; future studies are needed to identify potential work-related factors along the causal pathway from drug initiation to overdose mortality and to investigate ways of tailoring prevention measures to specific occupations. Workplace-specific programs and policies to reduce the impact of the opioid epidemic can be implemented. Since 2009, a decline in opioid use among nonsurgical workers' compensation claims in 26 states has occurred, which is associated with changes to workers' compensation laws and regulations regarding pain management and the prescribing and distribution of opioids, in addition to corresponding national and state-level legislative and regulatory changes (2). Examples of programs ([dagger][dagger][dagger][dagger][dagger]) that might address both licit and illicit opioids include comprehensive drug-free workplace programs, employee assistance programs, peer-support networks, and education targeted to employees and employers (3,5,6). Continued evaluation of the effectiveness and impact of these programs and interventions are needed to prevent opioid misuse and abuse and to reduce opioid-related morbidity and mortality.
Summary
What is already known about this topic? A majority of the U.S. population participates in the workforce. A person's job affects both physical and psychological well-being. The opioid epidemic negatively affects workers, workplaces, and employers.
What is added by this report?
During 2007-2012 proportional mortality ratios (PMR) for heroin-related overdose deaths (1.46) and methadone-related overdose deaths (1.34) were highest for the construction occupation group. PMRs for natural and semisynthetic opioids were highest for the extraction (1.39) and health care practitioner (1.81) occupation groups.
What are the implications for public health practice?
Identification of occupations associated with drug overdose deaths further characterizes the opioid epidemic. Incorporating workplace research and targeted interventions might benefit the opioid epidemic response.
Acknowledgments
Florida Department of Health; Georgia Department of Public Health; Hawaii State Department of Health; Idaho Department of Health and Welfare; Indiana State Department of Health; Kansas Department of Health and Environment; Kentucky Department for Public Health; Louisiana Department of Health; Missouri Department of Health and Senior Services; Nebraska Department of Health and Human Services; Nevada Department of Health and Human Services; New Hampshire Department of Health and Human Services; New Jersey Department of Health; New Mexico Department of Health; North Dakota Department of Health; Ohio Department of Health; Texas Department of State Health Services; Utah Department of Health; Vermont Department of Health; Washington State Department of Health; West Virginia Department of Health and Human Resources; National Occupational Mortality Surveillance staff members, National Institute for Occupational Safety and Health, CDC; National Center for Health Statistics, CDC; U.S. Census Bureau.
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
References
(1.) Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths--United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016; 65:1445-52. https://doi.org/10.15585/mmwr. mm655051e1
(2.) Thumula V, Wang D, Liu T. Interstate variations in use of opioids. Report no. WC-17-28, 4th ed. Cambridge, MA: Workers Compensation Research Institute; 2017.
(3.) Bunn T, Bush A, Slavova S. Drug overdose deaths by specific employment industry, occupation, and drug type. J Ky Med Assoc 2014; 112:201-11.
(4.) Dissell R. Ohio construction workers seven times more likely to die of an opioid overdose in 2016. The Plain Dealer. November 6, 2017. http:// www.cleveland.com/metro/index.ssf/2017/11/ohio_construction_ workers_seven_times_more_likely_to_die_of_an_opioid_overdose_ in_2016.html
(5.) Harik V, Janiszewski M, Allen N. Analysis of opioid-related overdose deaths on Cape Cod, 2004-2014: implications for trades/service workers and the straight-to-work population. Barnstable, MA: Barnstable County Department of Human Services; 2017. https://www.bchumanservices. net/library/2017/10/BCDHS-Death-Certificate-Analysis-Final-Report10-5-17a.pdf
(6.) Funaiole P, Dustin L, Spencer P. Harnessing the tradition of brotherhood to reduce opioid overdose deaths among trade workers in Massachusetts. Presented at the National Prevention Network Annual Conference in Anaheim, CA; September 14, 2017. http://www.npnconference.org/ wp-content/uploads/2017/09/Funaiole-Dustin-Spencer.pdf
(7.) Alterman T, Luckhaupt SE, Dahlhamer JM, Ward BW, Calvert GM. Job insecurity, work-family imbalance, and hostile work environment: prevalence data from the 2010 National Health Interview Survey. Am J Ind Med 2013; 56:660-9. https://doi.org/10.1002/ajim.22123
(8.) Kowalski-McGraw M, Green-McKenzie J, Pandalai SP, Schulte PA. Characterizing the interrelationships of prescription opioid and benzodiazepine drugs with worker health and workplace hazards. J Occup Environ Med 2017; 59:1114-26. https://doi.org/10.1097/ JOM.0000000000001154
(9.) Frone MR. Prevalence and distribution of illicit drug use in the workforce and in the workplace: findings and implications from a U.S. national survey. J Appl Psychol 2006; 91:856-69. https://doi. org/10.1037/0021-9010.91.4.856
(10.) Bush DM, Lipari RN. Substance use and substance use disorder, by industry. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2015. https://www.samhsa.gov/data/sites/default/files/report_1959/ ShortReport-1959.pdf
Laurel Harduar Morano, PhD [1,2]; Andrea L. Steege, PhD [2]; Sara E. Luckhaupt, MD [2]
Corresponding author: Laurel Harduar Morano, LHarduarMorano@cdc.gov, 513-841-4487.
[1] Epidemic Intelligence Service, CDC; [2] Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, CDC.
* The Bureau of Labor Statistics provides work-related injury, illness, and fatality data by industry and occupation. https://www.bls.gov/iif/.
([dagger]) Participating states (participation years): Florida (2012), Georgia (2011, 2012), Hawaii (2007-2012), Idaho (2007-2012), Indiana (2007-2010), Kansas (2007-2012), Kentucky (2010-2012), Louisiana (2008-2010), Michigan (2007-2012), Nebraska (2007-2011), Nevada (2007-2012), New Hampshire (2007-2012), New Jersey (2007-2012), New Mexico (2007-2012), North Dakota (2008-2012), Ohio (2007-2012), Texas (2007-2010), Utah (2007-2012), Vermont (2012), Washington (2007-2012), and West Virginia (2007-2012)
([section]) 2012 is the most recent year for which NOMS data are available. NOMS is the largest source of U.S. population-level mortality data that contains occupation and industry information. Only 21 states contributed data to NOMS during the study period.
([paragraph]) From 2013 to 2014, a large increase in illicitly manufactured fentanyl occurred. Within the study period, this category is mostly recording information about pharmaceutical synthetic opioids.
** https://www2.census.gov/programs-surveys/demo/guidance/industryoccupation/occ2000t.pdf. The 1990 census occupation codes are available upon request from the NOMS program (https://www.cdc.gov/niosh/ topics/noms/).
([dagger][dagger]) The crosswalk is based on data in Table 2 of U.S. Census Bureau Technical Paper #65. https://www.census.gov/content/dam/Census/library/workingpapers/2003/demo/techpaper2000.pdf.
([section][section]) https://usa.ipums.org/usa/volii/occ2000.shtml.
([paragraph][paragraph]) Opioid overdose decedent median age = 43 years.
*** Homemaker (not working on a farm), volunteer, or student.
([dagger][dagger][dagger]) This category includes deaths with insufficient information available on the death certificate to apply a U.S. Census occupation code or for which the usual occupation field was left blank.
([section][section][section]) The proportional distribution of drugs (i.e., the proportion of total drug overdoses deaths for each drug type) involved in drug overdose deaths include opioids and nonopioids (e.g., cocaine). PMRs are mutually dependent and a higher proportion for one cause (e.g., a specific drug) results in a lower proportion for another cause. In this analysis, cause-specific outcomes (e.g., heroin-related overdose or prescription opioid-related overdose) are not independent and are partially overlapping. Decedents might have multiple drug types within their system at time of death and therefore counted in more than one cause-specific outcome category.
([paragraph][paragraph][paragraph]) Construction occupation group.
**** Construction first-line supervisors and managers = census 2000 occupation code 620; construction trade workers = census 2000 occupation codes 621-653; construction trade helpers = census 2000 occupation code 660; other construction and related workers = census 2000 occupation codes 666-676. https://www.cdc.gov/niosh/topics/coding/pdfs/2000_Census_ Occupation.pdf.
([dagger][dagger][dagger][dagger]) This occupation group includes supervisors/managers for both construction and extraction. A subcode to separate construction supervisors/managers from extraction supervisors/managers is not available.
([section][section][section][section]) Within "Industry," jobs are organized into categories by type of establishment/business whereas within "Occupation," jobs are organized into categories with similar job duties. For instance, within the 2016 construction industry, 62.4% were construction and extraction occupations, 9.7% were office and administrative support occupations, 6.2% were management occupations, and 3.2% were transportation and material moving occupations. (https://www.bls.gov/emp/ep_table_109.htm).
([paragraph][paragraph][paragraph][paragraph]) Illicit opioid means heroin or the use of prescription pain relievers in any way not directed by a doctor (does not include over-the-counter medications).
***** https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/ NSDUH-DetTabs-2016.pdf.
([dagger][dagger][dagger][dagger][dagger]) The Substance Abuse and Mental Health Services Administration (SAMHSA) provides detailed information on drug-free workplace programs, related laws and regulations, and a toolkit for employers (https:// www.samhsa.gov/workplace).
TABLE 1. Usual occupation group and mortality from unintentional or
undetermined drug overdoses * and drug overdoses involving heroin' or
opioid analgesics ([section])--National Occupational Mortality
Surveillance, United States, 2007-2012
U.S. Census 2000 Drug overdose *
occupation group
([paragraph]) Total no. Deaths
of deaths
observed No. observed
Total 4,024,086 57,810
Management 325,123 2,458
Business operations 38,740 349
Financial 51,795 390
Computer and 21,425 422
mathematical
Architecture and 88,825 580
engineering
Life, physical, and social 24,332 257
science
Community and social 39,046 381
services
Legal 17,677 208
Education, training, and 146,334 701
library
Arts, design, 48,331 929
entertainment, sports,
and media
Health care practitioners 126,901 1,839
and technical ([dagger][dagger])
Health care support ([section][section]) 57,196 1,363
Protective service 57,986 653
Food preparation and 109,961 2,885
serving ([section][section])
Building and grounds 121,966 2,025
cleaning and
maintenance
Personal care 67,288 1,333
and service ([section][section])
Sales 287,191 3,413
Office and administrative 345,607 2,861
support
Farming, fishing, and 27,421 354
forestry
Construction ([section][section]) 244,534 7,402
Extraction ([section][section]) 19,536 431
Installation, maintenance, 124,578 2,179
and repair
Production 370,855 3,662
Transportation and 276,558 4,370
material moving
Military specific 37,616 352
Nonpaid workers ([section][section]) 856,256 13,001
Unknown ([section][section]) 91,008 3,012
U.S. Census 2000 Drug overdose *
occupation group
([paragraph]) Deaths
No. expected
Total -- ([dagger][dagger])
Management 3,324.2
Business operations 496.2
Financial 575.2
Computer and 585.2
mathematical
Architecture and 839.3
engineering
Life, physical, and social 301.8
science
Community and social 449.3
services
Legal 254.3
Education, training, and 1,187.8
library
Arts, design, 898.7
entertainment, sports,
and media
Health care practitioners 1,592.0
and technical ([dagger][dagger])
Health care support ([section][section]) 1,153.1
Protective service 909.7
Food preparation and 2,595.3
serving ([section][section])
Building and grounds 2,090.4
cleaning and
maintenance
Personal care 1,207.3
and service ([section][section])
Sales 3,795.9
Office and administrative 3,523.8
support
Farming, fishing, and 482.4
forestry
Construction ([section][section]) 5,902.5
Extraction ([section][section]) 370.8
Installation, maintenance, 2,201.1
and repair
Production 3,871.5
Transportation and 4,656.7
material moving
Military specific 425.3
Nonpaid workers ([section][section]) 11,819.2
Unknown ([section][section]) 2,301.4
U.S. Census 2000 Drug overdose *
occupation group
([paragraph]) Standardized
PMR (95% CI) **
Total -- ([dagger][dagger])
Management 0.74 (0.71-0.77)
Business operations 0.70 (0.63-0.78)
Financial 0.68 (0.61-0.75)
Computer and 0.72 (0.65-0.79)
mathematical
Architecture and 0.69 (0.64-0.75)
engineering
Life, physical, and social 0.85 (0.75-0.96)
science
Community and social 0.85 (0.77-0.94)
services
Legal 0.82 (0.71-0.94)
Education, training, and 0.59 (0.55-0.64)
library
Arts, design, 1.03 (0.97-1.10)
entertainment, sports,
and media
Health care practitioners 1.16 (1.10-1.21)
and technical ([dagger][dagger])
Health care support ([section][section]) 1.18 (1.12-1.25)
Protective service 0.72 (0.66-0.78)
Food preparation and 1.11 (1.07-1.15)
serving ([section][section])
Building and grounds 0.97 (0.93-1.01)
cleaning and
maintenance
Personal care 1.10 (1.05-1.17)
and service ([section][section])
Sales 0.90 (0.87-0.93)
Office and administrative 0.81 (0.78-0.84)
support
Farming, fishing, and 0.73 (0.66-0.81)
forestry
Construction ([section][section]) 1.25 (1.23-1.28)
Extraction ([section][section]) 1.16 (1.06-1.28)
Installation, maintenance, 0.99 (0.95-1.03)
and repair
Production 0.95 (0.92-0.98)
Transportation and 0.94 (0.91-0.97)
material moving
Military specific 0.83 (0.74-0.92)
Nonpaid workers ([section][section]) 1.10 (1.08-1.12)
Unknown ([section][section]) 1.31 (1.26-1.36)
U.S. Census 2000 Heroin ([dagger])
occupation group
([paragraph]) Deaths
No. observed
Total 7,463
Management 232
Business operations 31
Financial 31
Computer and 57
mathematical
Architecture and 62
engineering
Life, physical, and social 20
science
Community and social 35
services
Legal 15
Education, training, and 46
library
Arts, design, 144
entertainment, sports,
and media
Health care practitioners 109
and technical ([dagger][dagger])
Health care support ([section][section]) 116
Protective service 64
Food preparation and 486
serving ([section][section])
Building and grounds 344
cleaning and
maintenance
Personal care 144
and service ([section][section])
Sales 405
Office and administrative 261
support
Farming, fishing, and 49
forestry
Construction ([section][section]) 1,345
Extraction ([section][section]) 35
Installation, maintenance, 319
and repair
Production 514
Transportation and 710
material moving
Military specific 41
Nonpaid workers ([section][section]) 1,324
Unknown ([section][section]) 524
U.S. Census 2000 Heroin ([dagger])
occupation group
([paragraph]) Deaths
No. expected
Total -- ([dagger][dagger])
Management 383.2
Business operations 51.2
Financial 57.5
Computer and 85.5
mathematical
Architecture and 116.5
engineering
Life, physical, and social 37.9
science
Community and social 48.6
services
Legal 24.1
Education, training, and 109.1
library
Arts, design, 119.4
entertainment, sports,
and media
Health care practitioners 139.3
and technical ([dagger][dagger])
Health care support ([section][section]) 106.7
Protective service 125.6
Food preparation and 345.6
serving ([section][section])
Building and grounds 294.7
cleaning and
maintenance
Personal care 125.4
and service ([section][section])
Sales 460.4
Office and administrative 346.8
support
Farming, fishing, and 66.1
forestry
Construction ([section][section]) 922.9
Extraction ([section][section]) 43.9
Installation, maintenance, 339.5
and repair
Production 571.6
Transportation and 721.1
material moving
Military specific 60.9
Nonpaid workers ([section][section]) 1,380.0
Unknown ([section][section]) 379.7
U.S. Census 2000 Heroin ([dagger])
occupation group
([paragraph]) Standardized
PMR (95% CI) **
Total -- ([dagger][dagger])
Management 0.61 (0.53-0.69)
Business operations 0.61 (0.41-0.86)
Financial 0.54 (0.37-0.77)
Computer and 0.67 (0.5-0.86)
mathematical
Architecture and 0.53 (0.41-0.68)
engineering
Life, physical, and social 0.53 (0.32-0.81)
science
Community and social 0.72 (0.50-1.00)
services
Legal 0.62 (0.35-1.03)
Education, training, and 0.42 (0.31-0.56)
library
Arts, design, 1.21 (1.02-1.42)
entertainment, sports,
and media
Health care practitioners 0.78 (0.64-0.94)
and technical ([dagger][dagger])
Health care support ([section][section]) 1.09 (0.90-1.30)
Protective service 0.51 (0.39-0.65)
Food preparation and 1.41 (1.28-1.54)
serving ([section][section])
Building and grounds 1.17 (1.05-1.30)
cleaning and
maintenance
Personal care 1.15 (0.97-1.35)
and service ([section][section])
Sales 0.88 (0.80-0.97)
Office and administrative 0.75 (0.66-0.85)
support
Farming, fishing, and 0.74 (0.55-0.98)
forestry
Construction ([section][section]) 1.46 (1.38-1.54)
Extraction ([section][section]) 0.80 (0.55-1.11)
Installation, maintenance, 0.94 (0.84-1.05)
and repair
Production 0.90 (0.82-0.98)
Transportation and 0.98 (0.91-1.06)
material moving
Military specific 0.67 (0.48-0.91)
Nonpaid workers ([section][section]) 0.96 (0.91-1.01)
Unknown ([section][section]) 1.38 (1.26-1.50)
U.S. Census 2000 Prescription
occupation group opioid ([section])
([paragraph]) Deaths
No. observed
Total 25,058
Management 1,106
Business operations 155
Financial 181
Computer and 187
mathematical
Architecture and 265
engineering
Life, physical, and social 124
science
Community and social 160
services
Legal 98
Education, training, and 289
library
Arts, design, 412
entertainment, sports,
and media
Health care practitioners 876
and technical ([dagger][dagger])
Health care support ([section][section]) 626
Protective service 299
Food preparation and 1,207
serving ([section][section])
Building and grounds 811
cleaning and
maintenance
Personal care 612
and service ([section][section])
Sales 1,515
Office and administrative 1,341
support
Farming, fishing, and 158
forestry
Construction ([section][section]) 3,122
Extraction ([section][section]) 263
Installation, maintenance, 950
and repair
Production 1,544
Transportation and 1,680
material moving
Military specific 142
Nonpaid workers ([section][section]) 5,783
Unknown ([section][section]) 1,152
U.S. Census 2000 Prescription
occupation group opioid ([section])
([paragraph]) Deaths
No. expected
Total -- ([dagger][dagger])
Management 1,446.7
Business operations 213.2
Financial 254.6
Computer and 255.6
mathematical
Architecture and 354.1
engineering
Life, physical, and social 133.8
science
Community and social 190.4
services
Legal 116.1
Education, training, and 514.8
library
Arts, design, 401.0
entertainment, sports,
and media
Health care practitioners 709.2
and technical ([dagger][dagger])
Health care support ([section][section]) 518.9
Protective service 382.7
Food preparation and 1,142.6
serving ([section][section])
Building and grounds 888.9
cleaning and
maintenance
Personal care 540.3
and service ([section][section])
Sales 1,684.7
Office and administrative 1,564.7
support
Farming, fishing, and 222.1
forestry
Construction ([section][section]) 2,573.0
Extraction ([section][section]) 201.7
Installation, maintenance, 945.6
and repair
Production 1,580.7
Transportation and 1,869.1
material moving
Military specific 188.5
Nonpaid workers ([section][section]) 5,250.3
Unknown ([section][section]) 914.8
U.S. Census 2000 Prescription
occupation group opioid ([section])
([paragraph])
Standardized
PMR (95% CI) **
Total -- ([dagger][dagger])
Management 0.76 (0.72-0.81)
Business operations 0.73 (0.62-0.85)
Financial 0.71 (0.61-0.82)
Computer and 0.73 (0.63-0.84)
mathematical
Architecture and 0.75 (0.66-0.84)
engineering
Life, physical, and social 0.93 (0.77-1.11)
science
Community and social 0.84 (0.72-0.98)
services
Legal 0.84 (0.69-1.03)
Education, training, and 0.56 (0.50-0.63)
library
Arts, design, 1.03 (0.93-1.13)
entertainment, sports,
and media
Health care practitioners 1.24 (1.15-1.32)
and technical ([dagger][dagger])
Health care support ([section][section]) 1.21 (1.11-1.30)
Protective service 0.78 (0.7-0.88)
Food preparation and 1.06 (1.00-1.12)
serving ([section][section])
Building and grounds 0.91 (0.85-0.98)
cleaning and
maintenance
Personal care 1.13 (1.04-1.23)
and service ([section][section])
Sales 0.90 (0.85-0.95)
Office and administrative 0.86 (0.81-0.90)
support
Farming, fishing, and 0.71 (0.60-0.83)
forestry
Construction ([section][section]) 1.21 (1.17-1.26)
Extraction ([section][section]) 1.30 (1.15-1.47)
Installation, maintenance, 1.00 (0.94-1.07)
and repair
Production 0.98 (0.93-1.03)
Transportation and 0.90 (0.86-0.94)
material moving
Military specific 0.75 (0.63-0.89)
Nonpaid workers ([section][section]) 1.10 (1.07-1.13)
Unknown ([section][section]) 1.26 (1.19-1.33)
Abbreviations: CI = confidence interval; NOMS = National Occupational
Mortality Surveillance; PMR = proportionate mortality ratio.
* Deaths were classified using the International Classification of
Diseases, Tenth Revision (ICD-10). Drug overdose deaths were
identified using underlying cause-of death codes X40-X44
(unintentional) and Y10-Y14 (unknown intent).
([dagger]) Drug overdose deaths, as defined, that have heroin (T40.1)
as a contributing cause.
([section]) Drug overdose deaths, as defined, that have prescription
opioids (T40.2-T40.4) as a contributing cause.
([paragraph]) Occupation groups presented in ascending 2000 census
code order (e.g., Management = 001-043);
https://usa.ipums.org/usa/volii/occ2000.shtml.
** Indirectly standardized to the standard population of all NOMS
deaths with occupation information by age, sex, race (white, black,
other), calendar year (2007-2012), and state.
([dagger][dagger]) Not applicable.
([section][section]) PMR significantly above 1.00 for drug overdose
deaths in these categories.
TABLE 2. Usual occupation group and mortality from unintentional and
undetermined drug overdoses * involving natural and semisynthetic
opioids ([dagger]), methadone ([section]), or synthetic opioids other
than methadone ([paragraph])--National Occupational Mortality
Surveillance, United States, 2007-2012
U.S. Census 2000 Total no. Natural and
occupation group ** of deaths semisynthetic
observed opioids *
Deaths
No. observed
Total 4,024,086 16,603
Management 325,123 747
Business operations 38,740 111
Financial 51,795 132
Computer and 21,425 120
mathematical
Architecture and 88,825 178
engineering
Life, physical, and social 24,332 85
science
Community and social 39,046 100
services
Legal 17,677 73
Education, training, and 146,334 215
library
Arts, design, 48,331 268
entertainment, sports,
and media
Health care practitioners 126,901 565
and technical
Health care support 57,196 396
Protective service 57,986 216
Food preparation and 109,961 765
serving
Building and grounds 121,966 544
cleaning and
maintenance
Personal care and service 67,288 411
Sales 287,191 1,039
Office and administrative 345,607 908
support
Farming, fishing, and 27,421 103
forestry
Construction 244,534 2,013
Extraction 19,536 208
Installation, maintenance, 124,578 631
and repair
Production 370,855 1,018
Transportation and 276,558 1,084
material moving
Military specific 37,616 87
Nonpaid workers 856,256 3,841
Unknown 91,008 745
U.S. Census 2000 Natural and
occupation group ** semisynthetic
opioids *
Deaths
No. expected
Total -- ([section][section])
Management 965.5
Business operations 139.8
Financial 170.6
Computer and 167.1
mathematical
Architecture and 230.3
engineering
Life, physical, and social 88.0
science
Community and social 126.8
services
Legal 78.2
Education, training, and 346.4
library
Arts, design, 264.8
entertainment, sports,
and media
Health care practitioners 474.5
and technical
Health care support 339.5
Protective service 257.0
Food preparation and 744.9
serving
Building and grounds 591.7
cleaning and
maintenance
Personal care and service 361.1
Sales 1,118.5
Office and administrative 1,042.3
support
Farming, fishing, and 140.0
forestry
Construction 1,696.2
Extraction 149.7
Installation, maintenance, 625.8
and repair
Production 1,034.0
Transportation and 1,227.8
material moving
Military specific 122.3
Nonpaid workers 3,485.7
Unknown 614.6
U.S. Census 2000 Natural and
occupation group ** semisynthetic
opioids *
Standardized PMR
(95% CI)
([dagger][dagger])
Total -- ([section][section])
Management 0.77 (0.72-0.83)
Business operations 0.79 (0.65-0.96)
Financial 0.77 (0.65-0.92)
Computer and 0.72 (0.60-0.86)
mathematical
Architecture and 0.77 (0.66-0.90)
engineering
Life, physical, and social 0.97 (0.77-1.19)
science
Community and social 0.79 (0.64-0.96)
services
Legal 0.93 (0.73-1.17)
Education, training, and 0.62 (0.54-0.71)
library
Arts, design, 1.01 (0.89-1.14)
entertainment, sports,
and media
Health care practitioners 1.19 (1.09-1.29)
and technical
Health care support 1.17 (1.05-1.29)
Protective service 0.84 (0.73-0.96)
Food preparation and 1.03 (0.96-1.10)
serving
Building and grounds 0.92 (0.84-1.00)
cleaning and
maintenance
Personal care and service 1.14 (1.03-1.25)
Sales 0.93 (0.87-0.99)
Office and administrative 0.87 (0.82-0.93)
support
Farming, fishing, and 0.74 (0.60-0.89)
forestry
Construction 1.19 (1.14-1.24)
Extraction 1.39 (1.21-1.59)
Installation, maintenance, 1.01 (0.93-1.09)
and repair
Production 0.98 (0.93-1.05)
Transportation and 0.88 (0.83-0.94)
material moving
Military specific 0.71 (0.57-0.88)
Nonpaid workers 1.10 (1.07-1.14)
Unknown 1.21 (1.13-1.30)
U.S. Census 2000 Methadone (dagger])
occupation group **
Deaths
No. observed
Total 7,504
Management 326
Business operations 34
Financial 40
Computer and 51
mathematical
Architecture and 75
engineering
Life, physical, and social 31
science
Community and social 46
services
Legal 18
Education, training, and 50
library
Arts, design, 125
entertainment, sports,
and media
Health care practitioners 199
and technical
Health care support 197
Protective service 76
Food preparation and 400
serving
Building and grounds 249
cleaning and
maintenance
Personal care and service 205
Sales 422
Office and administrative 366
support
Farming, fishing, and 54
forestry
Construction 1,075
Extraction 42
Installation, maintenance, 304
and repair
Production 470
Transportation and 548
material moving
Military specific 41
Nonpaid workers 1,705
Unknown 355
U.S. Census 2000 Methadone (dagger])
occupation group **
Deaths
No. expected
Total -- ([section][section])
Management 433.0
Business operations 63.8
Financial 74.3
Computer and 81.2
mathematical
Architecture and 114.0
engineering
Life, physical, and social 43.1
science
Community and social 55.7
services
Legal 34.2
Education, training, and 143.6
library
Arts, design, 124.5
entertainment, sports,
and media
Health care practitioners 198.1
and technical
Health care support 152.4
Protective service 115.9
Food preparation and 357.3
serving
Building and grounds 265.4
cleaning and
maintenance
Personal care and service 159.0
Sales 507.2
Office and administrative 450.2
support
Farming, fishing, and 80.5
forestry
Construction 805.2
Extraction 45.8
Installation, maintenance, 293.2
and repair
Production 477.7
Transportation and 572.6
material moving
Military specific 62.8
Nonpaid workers 1,527.7
Unknown 265.7
U.S. Census 2000 Methadone (dagger])
occupation group **
Standardized PMR
(95% CI)
([dagger][dagger])
Total -- ([section][section])
Management 0.75 (0.67-0.84)
Business operations 0.53 (0.37-0.74)
Financial 0.54 (0.38-0.73)
Computer and 0.63 (0.47-0.83)
mathematical
Architecture and 0.66 (0.52-0.82)
engineering
Life, physical, and social 0.72 (0.49-1.02)
science
Community and social 0.83 (0.60-1.10)
services
Legal 0.53 (0.31-0.83)
Education, training, and 0.35 (0.26-0.46)
library
Arts, design, 1.00 (0.84-1.20)
entertainment, sports,
and media
Health care practitioners 1.00 (0.87-1.15)
and technical
Health care support 1.29 (1.12-1.49)
Protective service 0.66 (0.52-0.82)
Food preparation and 1.12 (1.01-1.23)
serving
Building and grounds 0.94 (0.83-1.06)
cleaning and
maintenance
Personal care and service 1.29 (1.12-1.48)
Sales 0.83 (0.75-0.92)
Office and administrative 0.81 (0.73-0.90)
support
Farming, fishing, and 0.67 (0.50-0.87)
forestry
Construction 1.34 (1.26-1.42)
Extraction 0.92 (0.66-1.24)
Installation, maintenance, 1.04 (0.92-1.16)
and repair
Production 0.98 (0.90-1.08)
Transportation and 0.96 (0.88-1.04)
material moving
Military specific 0.65 (0.47-0.89)
Nonpaid workers 1.12 (1.06-1.17)
Unknown 1.34 (1.20-1.48)
U.S. Census 2000 Synthetic opioids
occupation group ** other than
methadone ([section])
Deaths
No. observed
Total 3,966
Management 177
Business operations 29
Financial 28
Computer and 35
mathematical
Architecture and 32
engineering
Life, physical, and social 22
science
Community and social 34
services
Legal 18
Education, training, and 65
library
Arts, design, 60
entertainment, sports,
and media
Health care practitioners 229
and technical
Health care support 106
Protective service 49
Food preparation and 180
serving
Building and grounds 119
cleaning and
maintenance
Personal care and service 89
Sales 229
Office and administrative 233
support
Farming, fishing, and 23
forestry
Construction 416
Extraction 41
Installation, maintenance, 132
and repair
Production 237
Transportation and 235
material moving
Military specific 28
Nonpaid workers 946
Unknown 174
U.S. Census 2000 Synthetic opioids
occupation group ** other than
methadone ([section])
Deaths
No. expected
Total -- ([section][section])
Management 223.7
Business operations 36.2
Financial 41.9
Computer and 37.4
mathematical
Architecture and 51.6
engineering
Life, physical, and social 18.7
science
Community and social 31.3
services
Legal 18.4
Education, training, and 89.0
library
Arts, design, 57.9
entertainment, sports,
and media
Health care practitioners 126.3
and technical
Health care support 93.4
Protective service 55.0
Food preparation and 176.3
serving
Building and grounds 137.3
cleaning and
maintenance
Personal care and service 87.5
Sales 261.5
Office and administrative 269.0
support
Farming, fishing, and 28.4
forestry
Construction 366.3
Extraction 33.2
Installation, maintenance, 135.0
and repair
Production 256.6
Transportation and 283.2
material moving
Military specific 23.5
Nonpaid workers 887.7
Unknown 139.7
U.S. Census 2000 Synthetic opioids
occupation group ** other than
methadone ([section])
Standardized PMR
(95% CI)
([dagger][dagger])
Total -- ([section][section])
Management 0.79 (0.68-0.92)
Business operations 0.80 (0.54-1.15)
Financial 0.67 (0.44-0.97)
Computer and 0.94 (0.65-1.30)
mathematical
Architecture and 0.62 (0.42-0.88)
engineering
Life, physical, and social 1.18 (0.74-1.78)
science
Community and social 1.09 (0.75-1.52)
services
Legal 0.98 (0.58-1.54)
Education, training, and 0.73 (0.56-0.93)
library
Arts, design, 1.04 (0.79-1.33)
entertainment, sports,
and media
Health care practitioners 1.81 (1.59-2.06)
and technical
Health care support 1.13 (0.93-1.37)
Protective service 0.89 (0.66-1.18)
Food preparation and 1.02 (0.88-1.18)
serving
Building and grounds 0.87 (0.72-1.04)
cleaning and
maintenance
Personal care and service 1.02 (0.82-1.25)
Sales 0.88 (0.77-1.00)
Office and administrative 0.87 (0.76-0.98)
support
Farming, fishing, and 0.81 (0.51-1.22)
forestry
Construction 1.14 (1.03-1.25)
Extraction 1.23 (0.89-1.67)
Installation, maintenance, 0.98 (0.82-1.16)
and repair
Production 0.92 (0.81-1.05)
Transportation and 0.83 (0.73-0.94)
material moving
Military specific 1.19 (0.79-1.72)
Nonpaid workers 1.07 (1.00-1.14)
Unknown 1.25 (1.07-1.44)
Abbreviations: CI = confidence interval; NOMS = National Occupational
Mortality Surveillance; PMR = proportionate mortality ratio.
* Deaths were classified using the International Classification of
Diseases, Tenth Revision (ICD-10). Drug overdose deaths were
identified using underlying cause-of death codes X40-X44
(unintentional) and Y10-Y14 (unknown intent).
([dagger]) Drug overdose deaths, as defined, with natural and
semisynthetic opioids (T40.2) as a contributing cause.
([section] Drug overdose deaths, as defined, with methadone (T40.3)
as a contributing cause.
([paragraph]) Drug overdose deaths, as defined, with synthetic
opioids other than methadone (T40.4) as a contributing cause. This
category includes legal and illegal fentanyl along with other
synthetic opioids.
** Occupation groups presented in ascending 2000 census code order
(e.g., Management = 001-043);
https://usa.ipums.org/usa/volii/occ2000.shtml.
([dagger][dagger]) Indirectly standardized to the standard population
of all NOMS deaths with occupation information by age, sex, race
(white, black, other), calendar year (2007-2012), and state.
([section][section]) Not applicable.
TABLE 3. Construction occupation subgroup * and mortality from
unintentional and undetermined drug overdoses ([dagger]) by drug type
--National Occupational Mortality Surveillance, United States,
2007-2012
First-line supervisors/managers
No.
Opioid type observed PMR (95% CI) ([section])
Total 24,306 -- ([paragraph])
Overdose 338 0.94 (0.84-1.05)
Heroin ** 44 0.88 (0.64-1.18)
Prescription opioids 148 0.96 (0.81-1.12)
([section][section])
Natural semisynthetic 92 0.9 (0.72-1.10)
([paragraph][paragraph])
Methadone *** 49 1.01 (0.75-1.33)
Synthetic 27 1.26 (0.83-1.83)
([dagger][dagger][dagger])
Construction trades workers
No.
Opioid type observed PMR (95% CI) ([section])
Total 213,029 -- ([paragraph])
Overdose 6,901 1.28 (1.25-1.31)
Heroin ** 1,282 1.51 (1.42-1.59)
Prescription opioids 2,911 1.23 (1.19-1.28)
([section][section])
Natural semisynthetic 1,876 1.21 (1.15-1.26)
([paragraph][paragraph])
Methadone *** 1,007 1.36 (1.28-1.45)
Synthetic 383 1.14 (1.03-1.26)
([dagger][dagger][dagger])
Helpers, construction
No.
Opioid type observed
Total 419
Overdose 26
Heroin ** -- ([dagger][dagger])
Prescription opioids 12
([section][section])
Natural semisynthetic 6
([paragraph][paragraph])
Methadone *** -- ([dagger][dagger])
Synthetic -- ([dagger][dagger])
([dagger][dagger][dagger])
Helpers, construction
Opioid type PMR (95% CI) ([section])
Total -- ([paragraph])
Overdose 1.31 (0.85-1.91)
Heroin ** -- ([dagger][dagger])
Prescription opioids 1.42 (0.73-2.48)
([section][section])
Natural semisynthetic 1.07 (0.39-2.32)
([paragraph][paragraph])
Methadone *** -- ([dagger][dagger])
Synthetic -- ([dagger][dagger])
([dagger][dagger][dagger])
Other construction and
related workers
No.
Opioid type observed
Total 6,780
Overdose 137
Heroin ** 15
Prescription opioids 51
([section][section])
Natural semisynthetic 39
([paragraph][paragraph])
Methadone *** 15
Synthetic -- ([dagger][dagger])
([dagger][dagger][dagger])
Other construction and
related workers
Opioid type PMR (95% CI) ([section])
Total -- ([paragraph])
Overdose 1.15 (0.97-1.36)
Heroin ** 0.84 (0.47-1.38)
Prescription opioids 1.00 (0.74-1.31)
([section][section])
Natural semisynthetic 1.16 (0.82-1.58)
([paragraph][paragraph])
Methadone *** 0.93 (0.52-1.53)
Synthetic -- ([dagger][dagger])
([dagger][dagger][dagger])
Abbreviations: CI = confidence interval; NOMS = National Occupational
Mortality Surveillance; PMR = proportionate mortality ratio.
* Construction first-line supervisors and managers = census 2000
occupation code 620; construction trade workers = census 2000
occupation codes 621-653; construction trade helpers = census 2000
occupation code 660; other construction and related workers = census
2000 occupation codes 666-676.
([dagger]) Deaths were classified using Internationa! Classification
of Diseases, Tenth Revision (ICD-10J. Drug overdose deaths were
identified using underlying cause-of death codes X40-X44
(unintentional) and Y10-Y14 (unknown intent).
([section]) Indirectly standardized to the standard population of all
NOMS deaths with occupation information by age, sex, race (white,
black, other), calendar year (2007-2012), and state.
([paragraph]) Not applicable.
** Drug overdose deaths, as defined, that have heroin (T40.1) as a
contributing cause.
([dagger][dagger]) Observations <5 are not shown. PMRs were not
calculated.
([section][section]) Drug overdose deaths, as defined, that have
prescription opioids (T40.2-T40.4) as a contributing cause.
([paragraph][paragraph]) Drug overdose deaths, as defined, that have
natural and semisynthetic opioids (T40.2) as a contributing cause.
*** Drug overdose deaths, as defined, that have methadone (T40.3) as
a contributing cause.
([dagger][dagger][dagger][dagger]) Drug overdose death, as defined,
that have synthetic opioids other than methadone (T40.4) as a
contributing cause. This category includes legal and illegal fentanyl
along with other synthetic opioids.
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| Author: | Morano, Laurel Harduar; Steege, Andrea L.; Luckhaupt, Sara E. |
|---|---|
| Publication: | Morbidity and Mortality Weekly Report |
| Date: | Aug 24, 2018 |
| Words: | 7360 |
| Previous Article: | Trends in Human Papillomavirus-Associated Cancers--United States, 1999-2015. |
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