Estimating the total number of newly-recognized silicosis cases in the United States

Background The US employer-based surveillance system for documenting occupational injuries and illnesses undercounts chronic diseases. We suggest a method to estimate the number of individuals who are newly-recognized with silicosis each year in the United States. Methods Data from US death certificates, the Michigan state-based surveillance system, and capture-recapture analysis were used to calculate national estimates of silicosis. Results From 1987 to 1996, 2,787 deaths occurred in the United States where silicosis was mentioned on the death certificates. During the same period, in Michigan 77% of death certificates with a mention of silicosis were confirmed as silicosis-related deaths and the ratio of the number of living to deceased confirmed silicosis cases was 6.44. The proportion of confirmed silicosis deaths, the ratio of the living to deceased silicosis cases and capture-recapture analysis from the Michigan surveillance system, were used to estimate that there were 3,600-7,300 cases per year of silicosis in the United States from 1987 to 1996. Conclusions Our estimate of the annual number of newly-recognized silicosis cases is significantly larger than the estimate from the employer-based reporting system used for counting occupational disease in the United States. This employer-based surveillance system is inadequate for determining the frequency of occupational disease. Our analysis which combines a readily-available and relatively inexpensive national administrative database (i.e., death certificates) with a more costly state-based active surveillance system is a cost-effective model that could be used to provide better estimates of a number of different occupational diseases. Accurate estimates of occupational illnesses are essential to both determine temporal trends and evaluate efforts to prevent silicosis. (C) 2003 Wiley-Liss, Inc.