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. 2024 Jan;67(1):18-30.
doi: 10.1002/ajim.23545. Epub 2023 Oct 18.

Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition

Jeanne M Sears  1   2   3   4 , Tristan M Victoroff  5 , Stephen M Bowman  6 , Suzanne M Marsh  7 , Marija Borjan  8 , Anna Reilly  9 , Alicia Fletcher  10
Affiliations

Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition

Jeanne M Sears et al. Am J Ind Med. 2024 Jan.

Abstract

Background: Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations.

Methods: Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition.

Results: Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition.

Conclusions: Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.

Keywords: International Classification of Diseases; hospital discharge data; injury surveillance; occupational injuries; trauma severity indices; workers' compensation.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

DISCLOSURE BY AJIM EDITOR OF RECORD

John Meyer declares that he has no conflict of interest in the review and publication decision regarding this article.

Figures

FIGURE 1
FIGURE 1
Annual OHI #22 “Work-Related Severe Traumatic Injury Hospitalizations” (counts) as a proportion of annual OHI #2 “Work-Related Hospitalizations” (counts), averaged across 17 states (2012–2019). OHI #22 data not available for 2015, due to the International Classification of Diseases lexicon transition as of October 1, 2015. OHI, Occupational Health Indicator.
FIGURE 2
FIGURE 2
OHI #2 “Work-Related Hospitalizations” and OHI #22 “Work-Related Severe Traumatic Injury Hospitalizations”: Annual rates per 100,000 employed persons aged 16 years or older, by state (2012–2019). OHI #22 data not available for 2015, due to the International Classification of Diseases lexicon transition as of October 1, 2015. OHI, Occupational Health Indicator.
FIGURE 3
FIGURE 3
OHI #2 “Work-Related Hospitalizations” and OHI #22 “Work-Related Severe Traumatic Injury Hospitalizations”: Annual rates per 100,000 employed persons aged 16 years or older, averaged across 17 states (2012–2019). OHI #22 data not available for 2015, due to the International Classification of Diseases lexicon transition as of October 1, 2015. OHI, Occupational Health Indicator.
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