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Background: Little empirical data are available examining the injury experience of hired crop workers in the United States (US). This study analyzed work-related injury data collected on these workers from a national survey., Methods: Data were collected through the National Agricultural Workers Survey (NAWS) for the federal fiscal years 1999, 2002, 2003, and 2004. These data provided descriptive injury characteristics and rate estimates from a sample of 13,604 crop farm workers., Results: The injury rate was 4.3 injuries per 100 week-based full-time equivalents (FTE(WB) ). The majority of the injuries occurred to male (84%) and Mexican born (72%) workers. Shuttle migrants had the highest injury rate at 7.2 injuries/100 FTE(WB) . Workers reporting one or more health conditions and workers reporting one or more musculoskeletal complaints had higher injury. The most common injury events were overexertion from lifting (20%), being struck by hand held objects (13%), and falls to a lower level (10%). Injuries due to falls to a lower level accounted for the highest average number of restricted workdays (45 days)., Conclusions: The use of hand tools, falls, and lifting overexertion injuries were identified as significant causes of injury among hired crop workers. Increased injury risk was also seen for crop workers with existing health or musculoskeletal complaints. These results are useful for targeting injury prevention efforts and future research needs for this unique worker population. Am. J. Ind. Med. 54:734-747, 2011. © 2011 Wiley-Liss, Inc., (Copyright © 2011 Wiley-Liss, Inc.)

Background: Suicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non-Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites., Methods: This cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide., Results: Blacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84-0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active.", Conclusions: Data disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.

Background: Clinician training deficits and a low and declining autopsy rate adversely impact the quality of death certificates in the United States. Self-report and records data for the general population indicate that proximate mental and physical health of minority suicides was at least as poor as that of white suicides., Methods: This cross-sectional mortality study uses data from Multiple Cause-of-Death (MCOD) public use files for 1999-2003 to describe and evaluate comorbidity among black, Hispanic, and white suicides. Unintentional injury decedents are the referent for multivariate analyses., Results: One or more mentions of comorbid psychopathology are documented on the death certificates of 8% of white male suicides compared to 4% and 3% of black and Hispanic counterparts, respectively. Corresponding female figures are 10%, 8%, and 6%. Racial-ethnic discrepancies in the prevalence of comorbid physical disease are more attenuated. Cross-validation with National Violent Death Reporting System data reveals high relative under-enumeration of comorbid depression/mood disorders and high relative over-enumeration of schizophrenia on the death certificates of both minorities. In all three racial-ethnic groups, suicide is positively associated with depression/mood disorders [whites: adjusted odds ratio (AOR) = 31.9, 95% CI = 29.80-34.13; blacks: AOR = 60.9, 95% CI = 42.80-86.63; Hispanics: AOR = 34.7, 95% CI = 23.36-51.62] and schizophrenia [whites: AOR = 2.4, 95% CI = 2.07-2.86; blacks: AOR = 4.2, 95% CI = 2.73-6.37; Hispanics: AOR = 4.1, 95% CI = 2.01-8.22]. Suicide is positively associated with cancer in whites [AOR = 1.8, 95% CI = 1.69-1.93] and blacks [AOR = 1.8, 95% CI = 1.36-2.48], but not with HIV or alcohol and other substance use disorders in any group under review., Conclusion: The multivariate analyses indicate high consistency in predicting suicide-associated comorbidities across racial-ethnic groups using MCOD data. However, low prevalence of documented comorbid psychopathology in suicides, and concomitant racial-ethnic discrepancies underscore the need for training in death certification, and routinization and standardization of timely psychological autopsies in all cases of suicide, suspected suicide, and other traumatic deaths of equivocal cause.

Objective: To describe physical and mental comorbidity among male and female suicides in the US. This research replicates a seminal Australian study, which permits inference on comparative cause-of-death data quality., Design and Setting: National cross-sectional study of suicides and unintentional injury decedents (comparison group) using Multiple Cause of Death (MCOD) public use files for 1999-2003., Main Outcome Measures: Prevalence of medical conditions; relative odds of suicide-associated comorbidity., Results: For 14% of male suicides and 19% of female suicides, comorbidity was shown on their death certificates. Respective prevalences for mental and physical comorbidity were 7.2% and 7.1% for males and 10.0% and 9.3% for females. Mean numbers of psychopathologies mentioned were virtually identical for male and female suicides (1.22 and 1.21) for whom comorbidity was registered. Mean mentions of physical disease were lower for male suicides: 1.64 vs 1.77. Multiple medical conditions were registered for 4% of male suicides and 6% of female suicides. Suicides manifested excess comorbidity for depression and mood disorders (adjusted odds ratio (AOR) = 34.6, 95% CI = 32.41 to 36.92), schizophrenia (AOR = 2.5, 95% CI = 2.16 to 2.88), and cancer (AOR = 2.1, 95% CI = 1.93 to 2.19), but unexpectedly no excess comorbidity for HIV., Conclusions: The US system of death certification appears to be less fastidious than the Australian system. Although comorbidity patterns were very similar, only half as much psychopathology was reported for US suicides as for Australian suicides. A questionable deficit of comorbid physical disease was also documented for US suicides. Findings have important implications for medical training, as well as for suicide surveillance, policy, and prevention.