Hospital records as a data source for occupational disease surveillance: a feasibility study

Our plain-English summary of Hospital records as a data source for occupational disease surveillance: a feasibility study, by J. Balmes, D. Rempel, M. Alexander, et al (American Journal of Industrial Medicine, 1992).

The study

• Authors: J. Balmes, D. Rempel, M. Alexander, R. Reiter, R. Harrison, B. Bernard, D. Benner, J. Cone
• Journal: American Journal of Industrial Medicine
• Published: 1992;21(3):341-51
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

To assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses--lung cancer, bladder cancer, and toxic hepatitis--were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for "usual" than for "last" categories with both cancer diagnoses, but were similar for "usual" and "last" categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work-relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work-relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely administered on admission.

In plain English

This feasibility study tested whether hospital records could be used to track possibly work-related diseases. The authors reviewed 1985 discharge diagnoses from 13 Kaiser-Permanente hospitals in northern California and selected lung cancer, bladder cancer and toxic hepatitis for closer review. Job information in patients' charts was compared with lifetime work histories from telephone interviews with surviving patients: 51 with lung cancer, 59 with bladder cancer and 12 with toxic hepatitis. Some occupation information appeared in about 80% of charts, but the authors put the accuracy of 'usual' job information in charts at 40-50% when checked against the interviews. A single occupational medicine physician, blinded to diagnosis, rated each job's likelihood of contributing to disease. High ratings were most frequent for lung cancer (24 of 51 lung cancer patients, or 47%, counting any job held), mainly because of jobs associated with asbestos exposure. The authors said the small numbers meant these ratings were not definitive. They concluded that hospital records could identify possible occupational diseases, but accurate job information would need a simple form routinely completed on admission.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Feasibility study: review of computerized hospital discharge diagnoses, abstraction of patient charts for industry/occupation information, and comparison with telephone-interview lifetime occupational histories
• Who was studied: Patients discharged in 1985 from 13 northern California Kaiser-Permanente Health Plan inpatient facilities (164,000 hospitalizations among about 2 million subscribers). The study focused on patients with a primary diagnosis of lung cancer (645), bladder cancer (349) or toxic hepatitis (57). Patients who had died were excluded. Interviews were completed with 59 bladder cancer, 51 lung cancer and 12 toxic hepatitis patients.
• Exposure: Occupation and industry (jobs) taken from hospital charts and from lifetime occupational histories obtained by interview. Each job was rated as high, moderate or low probability of contributing to the diagnosis. Asbestos exposure is mentioned as the main factor behind high lung cancer ratings. No fiber type is named.
• Main results:
  • For both lung cancer and bladder cancer, agreement between chart and interview was higher for 'usual' than for 'last' occupation and industry. For toxic hepatitis, agreement was similar for the two.
  • Some occupation information was present in about 80% of charts reviewed. The authors put the accuracy of 'usual' industry/occupation information in charts at 40-50%, using patient interviews as the reference.
  • No single chart form held industry/occupation information for more than 50% of cases for any of the three diagnoses.
  • Among lung cancer patients, the physician rated 24 (47%) as having a high probability of job contribution for any job held. The authors attributed the higher frequency of high ratings for lung cancer primarily to jobs associated with asbestos exposure.
  • Among bladder cancer patients, high probability of work-relatedness was rated for 7% of cases.
  • Diagnostic coding was often inappropriate for toxic hepatitis: 16 of 34 charts reviewed were judged miscoded.
• The authors' conclusion: The authors concluded that hospital records could be used to identify possible Sentinel Health Events (Occupational), and that work-relatedness can be assessed if adequate industry/occupation information is available. However, the accuracy of chart-based 'usual' industry/occupation information may be relatively low compared with patient interviews. They said a simple, easily coded instrument administered routinely on admission would be required.
• Limitations the authors state:
  • The small number of cases interviewed limits any analysis of the proportion of each diagnosis attributable to occupation.
  • Work-relatedness ratings came from a single physician, so the ratings should not be viewed as definitive.
  • Many lung cancer charts were unavailable for abstracting, a possible source of bias.
  • Diagnostic coding by staff was not always appropriate, especially for hepatitis.
  • Recall of industry/occupation information may have differed across the three diseases.
  • Only primary discharge diagnoses were used; secondary diagnoses were not pursued.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Disease, Lung Cancer, Occupational History, Asbestos Exposure.

Related studies

• Hospital records: an underutilized source of information regarding occupational diseases and exposures — G.M. Liss, R.A. Kusiak, et al. (1997)
• Recovering missing mesothelioma deaths in death certificates using hospital records — V.S. Santana, E. Algranti, et al. (2018)
• Use of court records for supplementing occupational disease surveillance — E. Schwartz, P. Landrigan (1987)
• Missing records in occupational disease epidemiology — P.E. Enterline, G.M. Marsh (1982)
• Results of the Meso-ORIGINS feasibility study regarding collection of matched benign-mesothelioma tissue pairs by longitudinal surveillance — K. Ferguson, M. Neilson, et al. (2023)
• Mesothelioma surveillance to locate sources of exposure to asbestos — K. Teschke, M.S. Morgan, et al. (1997)

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