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Evaluation of the New Jersey Silicosis Surveillance System, 1993-2008

Evaluation of the New Jersey Silicosis Surveillance System, 1993-2008. Jessie Gleason, MSPH CDC/CSTE Applied Epidemiology Fellow New Jersey Department of Health and Senior Services Environmental and Occupational Health Surveillance Program jessie.gleason@doh.nj.state.us June 6, 2012.

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Evaluation of the New Jersey Silicosis Surveillance System, 1993-2008

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  1. Evaluation of the New Jersey Silicosis Surveillance System, 1993-2008 Jessie Gleason, MSPH CDC/CSTE Applied Epidemiology Fellow New Jersey Department of Health and Senior Services Environmental and Occupational Health Surveillance Program jessie.gleason@doh.nj.state.us June 6, 2012

  2. Disease BackgroundSilicosis • Occupational lung disease • Respirable crystalline silica • Fatal – Irreversible • Preventable • Long latency period

  3. Surveillance SystemBackground • Silicosis surveillance: New Jersey and Michigan • NIOSH has funded New Jersey since 1987 • Silicosis surveillance is part of the Sentinel Events Notifications Systems for Occupational Risk (SENSOR)

  4. Silicosis Surveillance System Two steps: • Report Sources: A. Hospital Discharge Data B. Death Certificates C. Emergency Department Data D. Worker’s Compensation E. Physician Reports

  5. Silicosis Surveillance System 2. Case Confirmation Requirements: • History of occupational exposure to airborne silica dust And Either or Both of the Following: B1. Chest radiograph or other imaging technique B2. Pathologic findings

  6. Evaluation of the Silicosis System • 2001 Updated Guidelines for Evaluating Public Health Surveillance Systems, CDC • Attributes: Positive Predictive Value (PPV), Representativeness, Data Quality, Simplicity, Timeliness, Flexibility, Stability • Methods: Staff interviews, Review of system documentation, database, publications and relevant literature

  7. Positive Predictive Value (PPV) • Proportion of reported potential cases which actually have the event • Number of Confirmed Cases/Total Number of Potential Cases Reported • PPV was calculated: • Overall • Report source by each status outcome

  8. Positive Predictive Value by Primary Reporting Source, 1993-2008

  9. Positive Predictive Value - Key Findings • Overall PPV is low (36%) • Hospital Discharge Data has the highest PPV (39%) • Insufficient: • 52% of Death Certificates • 36% Emergency Department Data • 24% Hospital Discharge Data • Missing: 100% Worker’s Compensation

  10. Representativeness • “A representative system accurately describes the occurrence of health-related events over time and its distribution in the population by place and person” 1 • Compared confirmed silicosis cases to potentially silica-exposed New Jersey workforce2 • Chi-square goodness of fit (2001) Updated Guidelines for Evaluating Public Health Surveillance Systems, Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Estimates of workforce by gender, race, ethnicity and industry obtained from the Bureau of Labor and Statistics, New Jersey, 2010

  11. Comparison of Demographic and Workforce Characteristics for Confirmed Silicosis Cases, (1993-2008) and Bureau of Labor Statistics, New Jersey Workforce, (2010)

  12. Comparison of Demographic and Workforce Characteristics for Confirmed Silicosis Cases, (1993-2008) and Bureau of Labor Statistics, New Jersey Workforce, (2010) - continued

  13. Representativeness – Key Findings • Gender (p-value >.05) • 86% Male silicosis cases vs. 84% Male workforce • Race (p-value >.05) • Occupation (p-value <.05) • Ethnicity • 7% Hispanic silicosis cases vs. 35% Hispanic workforce (p-value <.05)

  14. Report Source, Gender, and Occupation by Ethnicity for Confirmed Silicosis Cases, (1993-2008) *Fisher’s Exact Test evaluated at a 0.05 significance level

  15. Report Source and Gender by Ethnicity for Reported Potential Silicosis Cases, (1993-2008) *Fisher’s Exact Test evaluated at a 0.05 significance level

  16. Data Quality: Percent Completeness of Work History and Clinical Indicator by Case Status for all Reported Potential Cases, 1993-2008

  17. Data Quality: Percent Completeness of Work History and Clinical Indicator By First Reporting Source for all Reported Potential Cases, 1993-2008

  18. Attribute Rating

  19. Recommendations • Explore collaboration with Worker’s Compensation • Focus on obtaining and coding ethnicity as a priority data collection point • Target the Hispanic workforce for silicosis awareness and education interventions

  20. Recommendations - continued • More complete occupational information in hospital discharge data would improve timeliness, simplicity and PPV • Update database forms and tables to improve the completeness of data entry • Increase physician reporting through outreach efforts

  21. Acknowledgments New Jersey Department of Health and Senior Services Environmental and Occupational Health Surveillance Program Karen Worthington MS, RN, COHN-S Daniel Lefkowitz MS, PhD Margaret Lumia, MPH, PhD Jerald Fagliano MPH, PhD This report was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 5U38HM000414

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