NCIS - data quality and its ability to provide timely and accurate information on work-related traumatic fatalities in Australia - NATIONAL ...

 
NCIS - data quality and its ability to provide timely and
accurate information on work-related traumatic fatalities
                      in Australia

     NATIONAL OCCUPATIONAL HEALTH AND SAFETY COMMISSION

                       Canberra, Australia
December 2002
FURTHER INFORMATION AND USE OF THIS PUBLICATION

 Commonwealth of Australia 2001

ISBN 0 642 70594 1

This work is copyright. It may be reproduced in whole or part subject to the inclusion of an
acknowledgment of the source and no commercial usage or sale. Reproduction for purposes
other than those indicated above require the written permission of the Commonwealth
available through AusInfo. Requests and inquiries should be addressed to the Manager,
Legislative Services, AusInfo, GPO Box 1920, Canberra ACT 2601.

The suggested citation is: NCIS - data quality and its ability to provide timely and accurate
information on work-related traumatic fatalities in Australia. National Occupational
Health and Safety Commission: December 2002.

                                               ii
TABLE OF CONTENTS
TABLE OF CONTENTS                                                   iii
LIST OF TABLES                                                       v
LIST OF FIGURES                                                     vi
EXECUTIVE SUMMARY                                                  vii
 Introduction                                                      vii
 Main findings                                                     vii
 Conclusions                                                       viii
INTRODUCTION                                                        10
AIMS                                                                11
METHODS                                                             11
 Approval for Access                                                11
 Access Via the Web                                                 11
 Speed of Access                                                    12
 Identification of Work-Related Cases                               14
 Data Used in the Review                                            14
 Final Selection Criteria                                           16
 Merging Files                                                      16
 Identifying Work-Related Fatalities                                16
 Analysis                                                           17
RESULTS                                                             18
 General Description of Overall File                                18
 Overall Reporting                                                  18
 Identifying Work-Related Cases                                     19
 Inspection of the Police Description of Circumstances              19
 NCIS Activity at the Time of the Incident                         22
   Basic Description                                                22
   Validity                                                         22
 NCIS Work-Related Data Element                                     23
   Basic Description                                                23
   Validity                                                         24
   Final Decision on Work-Related Fatalities                        26
 Assessment of the Coverage of Work-Related Fatalities              27
   Cases with an Appropriate Police Description of Circumstances   27
   Comparison Between the NCIS, NDS and WRF2                        28
   Using the NCIS Activity at the Time of the Incident              32

                                             iii
Using the NCIS Work-Relatedness Data Element   32
   Basic Review of Main Data Elements             32
 Problems with Case Type and Intent               34
DISCUSSION AND RECOMMENDATIONS                    35
 Overall                                          35
 Identification of Work-related Fatalities        35
 Areas for Improvements                           36
CONCLUSIONS                                       36
REFERENCES                                        38
ABBREVIATIONS                                     39
APPENDIX ONE                                      40

                                             iv
LIST OF TABLES
Table 1: Data elements useful for identifying work-related cases ....................................................... 13
Table 2: External cause deaths by jurisdiction of Coroner's investigation. 1 July 2000 - 30 June
          2001. Actual and expected1. Number and percent. ............................................................ 18
Table 3: Presence and adequacy of police description of circumstances of external cause deaths.
          By jurisdiction. Only external cause deaths with a known mechanism. 1 July 2000 -
          30 June 2001. Number and percent..................................................................................... 19
Table 4: Presence and adequacy of police description of circumstances of external cause deaths.
          By jurisdiction and mechanism. Only external cause deaths with a known
          mechanism. 1 July 2000 - 30 June 2001. Number and percent.......................................... 20
Table 5: Classification on the basis of the police description of circumstance. External cause
          deaths. 1 July 2000 - 30 June 2001. Number and per cent. ................................................ 21
Table 6: NCIS activity at the time of incident. External cause deaths. 1 July 2000 - 30 June
          2001. Number and per cent................................................................................................. 22
Table 7: Comparison of NCIS activity at the time of incident with the work-related
          classification on the basis of the police description of circumstance. Only files with
          an adequate police description. External cause deaths. 1 July 2000 - 30 June 2001.
          Number. ............................................................................................................................... 23
Table 8: NCIS work-related data element. External cause deaths. 1 July 2000 - 30 June 2001.
          Number and per cent............................................................................................................ 24
Table 9: Comparison of NCIS activity at the time of incident with NCIS work-related data
          element. External cause deaths. 1 July 2000 - 30 June 2001. Number. ............................. 24
Table 10: Comparison of NCIS work-related data element with work-related classification on
          the basis of the police description of circumstance. Only files with an adequate
          police description. External cause deaths. 1 July 2000 - 30 June 2001. Number. ............. 25
Table 11: Final classification of work-related status of cases. External cause deaths. 1 July 2000
          - 30 June 2001. Number and per cent. ................................................................................ 26
Table 12: Comparison of proportion of classifiable NCIS files that were work-related to
          classified proportions of work-related deaths from WRF2. External cause deaths. 1
          July 2000 - 30 June 2001. Per cent. .................................................................................... 28
Table 13: Number of fatalities in Australian jurisdictions, excluding QLD. Data was recorded
          in 1999-2000 in the NCIS and NDS. WRF2 data is the average for 1989-1992. ................ 29
Table 14: Percentage of fatalities in Australian jurisdictions, excluding QLD, estimated from
          thee databases. NCIS and NDS data was recorded in 1999-2000. WRF2 data is the
          average for 1989-1992. ........................................................................................................ 29
Table 15: Distribution of fatalities by industry in Australian jurisdictions, excluding QLD. Data
          was recorded in 1999-2000 in the NCIS and NDS. WRF2 data is the average for
          1989-1992. ........................................................................................................................... 31
Table 16: Percentage of known status for selected data elements. For all deaths and work-
          related deaths. External cause deaths. 1 July 2000 - 30 June 2001. Per cent..................... 33

                                                                         v
LIST OF FIGURES

Figure 1: Distribution of fatalities by occupation in Australian jurisdictions, excluding QLD.
          Data was recorded in 1999-2000 in the NCIS and NDS. WRF2 data is the average
          for 1989-1992. ..................................................................................................................... 30

                                                                       vi
EXECUTIVE SUMMARY

Introduction
The National Occupational Health and Safety Commission (NOHSC) has reviewed the
content and quality of the National Coroners Information System (NCIS) database with a
view to assessing the suitability of the NCIS to provide timely and accurate information on
work-related fatalities in Australia. There is currently no on-going and comprehensive source
of such information.

Australian work-related fatalities recorded between July 2000 and June 2001 in the NCIS
were reviewed in this study. Only cases available at end September 2001 were reviewed to
determine which were work-related fatalities.

Main findings
The review found that the NCIS dataset was very large comprising of 3,546 cases. This
presented a significant challenge to NOHSC in accessing the cases. Access is normally
attained through downloading data from the NCIS website via the Internet. This proved
impractical since the process was painstakingly slow and data integrity could not be
maintained. NOHSC is grateful to Monash University National Centre for Coronial
Information (MUNCCI) for copying the NCIS data to a CD ROM which proved the only
practical medium through which NOHSC could access the data to carry out the review and
statistical analysis of the full NCIS dataset.

Inspection of the NCIS dataset indicated that it was not possible to rely on a single coded data
field to adequately identify work-related fatalities. The methodology for identifying all work-
related fatalities in Australia required a multi-faceted approach that relied on the police text
description of the circumstances surrounding the incident resulting in fatality, the work-
relatedness data element and the activity at the time of incident. Some other data fields were
also used (e.g. cause of fatality, object causing fatality) where these suggested a work-related
fatality.

A review of work-related cases identified by police text descriptions of the incident revealed
that jurisdiction coverage was very poor especially in NSW (9%) and VIC (30%). The review
found that police text descriptions provided adequate information enabling work-relatedness
to be determined in only 1 in 4 cases. The adequacy of the text descriptions was poorest in
NSW (6%) and VIC (17%) and best in WA (71%) and the ACT (74%). Further analysis of
work-related cases identified using police text descriptions where an external cause of injury
was present suggested that the adequacy of text descriptions was highly dependent on the
circumstances of the incident. Nationally, only 1 in 4 cases with information on external
causes had enough information to allow a definitive work-related classification.

NOHSC found that overall, reporting of coronial cases by jurisdictions to the NCIS was
incomplete. For example, coverage of WA cases was 7% lower than what was expected based
on the second work-related study (WRF2, 1998). It was estimated the NCIS was
underreporting work-related fatalities in WA and VIC when the National Data Set for
Compensation-based Statistics (NDS) is used as the yardstick. The NCIS tended to report
more cases in the small jurisdictions such as TAS and NT compared to the NDS. There were
significant differences in the distribution of workers by industry and occupation between the
NCIS and either the NDS or WRF2. For example, the NCIS had proportionately fewer
fatalities than the NDS and WRF2 in the Transport and Storage, Wholesale Trades and
                                              vii
Electricity, Gas and Water and Mining industries. Further, fatalities among Labourers and
Related Workers in NCIS were proportionately four times those in the NDS or WRF2.

Ninety-two of the 3,546 NCIS cases (2.8%) were classified as work-related using the incident
activity data element alone. This data element was missing in 340 of the 3,546 cases (9.6%).

The work-related data element and the incident activity field identified comparable numbers
of work-related fatalities. However, evidence suggests that codes for the work-related data
may need refining to further enhance this alignment.

The case-status field in the NCIS provides information on whether a coronial inquest is still
ongoing (i.e. open case) or complete (i.e. closed case). This review found that main data
elements (e.g. incident activity, mechanism, object, occupation and industry) were incomplete
in most open cases and cases identified as work-related using the work-related data element.
In general, closed cases had better coverage of the main data elements. Among the main data
elements, incident activity and place had the highest coverage (80-100%) and occupation and
industry both had the lowest (0-0.3%).

There was generally a higher chance for a given data element to have text information rather
than coded information. For a given data element, there was a higher chance that the
information was missing if it related to the secondary or tertiary level of classification.

About 169 cases that were identified by NOHSC as working and commuting and 20
bystanders were coded by occupation and industry following the ASCO (ABS 1997) and
ANZSIC (ABS 1993) coding systems. The occupation and industry codes will be given to
MUNCCI for uploading to the NCIS.

Conclusions
The review has concluded that the NCIS is not yet able to reliably identify all work-related
fatalities in Australia. Notwithstanding, there is no other system in Australia, other than
compensation-based systems such as the NDS, capable of identifying such cases. It is
suspected that compensation based systems under-report work-related fatalities mainly
because most some self-employed (and military personnel) are excluded. Of course, also
missing from compensation-based data were cases where no compensation of any kind is paid
– e.g. where there were no relatives. The NCIS could potentially be a surveillance system for
occupational fatalities providing a wide workforce coverage because it is not restrained by
working arrangements or compensation status. The NCIS can potentially provide timely
surveillance information about age, gender, external cause of injury and bodily location of
injury all of which are important to the detection of emerging injury trends and formulation of
appropriate OHS preventive measures as well as the identification of priority areas for further
research. Further, the NCIS is potentially capable of providing time series information on a
given injury type and therefore information for monitoring the effectiveness of OHS
preventive measures.

At present, identification of work-related fatalities in the NCIS cannot be reliably achieved on
the basis of a single coded data field. Consequently, a time consuming strategy involving a
manual comparison of coded values and free text, with external criteria, is required. This
situation should improve as a result of changes already adopted by MUNCCI. It is unlikely,
however, that within the next twelve month period, the NCIS will achieve the ideal of being a
comprehensive source of data on work-related fatalities in Australia.

                                              viii
This review has identified a number of improvements necessary to the NCIS before it can be
confidently used as a national surveillance system for work-related fatalities in Australia. The
review found that of the 3,546 cases recorded in the NCIS, only 2 in 5 were closed cases,
meaning that a coronial inquest was complete. Further, only 1 in 3 work-related case was
closed. It is therefore strongly recommended that NOHSC continues to have access to all
NCIS cases (both open and closed) in order to obtain optimal coverage.

NOHSC has produced a separate report which provides a blueprint for statistically analysing
and reporting work-related fatalities estimated by the NCIS in the future (NOHSC, 2002). The
report is based on work-related fatalities identified using the police text descriptions of the
circumstance surrounding the fatal work-related incident.

                                              ix
INTRODUCTION
Until now, there has been no on-going source of information in Australia providing all
work-related fatalities (Moller, 1994; Harrison and Frommer, 1986). The only on-
going collected data capable of identifying work-related fatalities is the
compensation-based, NDS. It is suspected that the NDS underreport work-related
fatalities since it covers conforms to strict work-arrangements, covers only persons in
the workforce and does not cover military personnel or some self-employed persons.
National surveillance systems for traumatic occupational fatalities exist in OEDC
countries such as the USA (Herbert and Landrigan, 2000; NIOSH, 2000; Feyer et al.,
2001), the United Kingdom (HSE, 2002) and New Zealand (Langley et al., 1997;
Feyer et al., 2001). Since all work-related fatalities are (by definition) external cause
fatalities, and all external cause fatalities are supposed to be reported to, and
investigated by, a coroner, the coronial system, is potentially a source of information
on all work-related traumatic fatalities. This has been the basis for the two work-
related fatalities studies conducted by NOHSC, and which provided the only
comprehensive and reliable information on work-related fatalities in Australia over
the last twenty years. These two studies covered the periods 1982 to 1984 inclusive
(Harrison and Frommer, 1986; Harrison et al., 1989) and 1989 to 1992 inclusive
(WRF2, 1998). Unfortunately, until very recently, coronial records were paper based
and poorly indexed from an injury prevention viewpoint. This meant that identifying
fatalities of interest, and extracting the relevant information from the cases files, was
very time consuming and resource intensive (Harrison and Frommer, 1986). The
work-related fatalities studies, and other similar studies of other public health issues,
could therefore only be conducted on an irregular basis.

The National Coroners Information System (NCIS) was designed to overcome many
of these problems. The NCIS is an electronic database and supporting infrastructure
for all coronial cases in Australia (Stathakis and Scott, 1999; Owens and Lightfoot,
2000). The information is provided in the form of coded data elements, structured
text and free text, with coding done largely by clerical officers in each coronial office.
Data quality and IT integrity is monitored and supported by the managing
organisation at Monash University, the Monash University National Centre for
Coronial Information (MUNCCI), which is based at the Victorian Coroner’s Court.

Development work began on the NCIS in February 1998 (Owens and Lightfoot;
2000). Capital funding of $165,000 was provided by Monash University, and the
Victorian Department of Justice provided $165,000. In June 1998 the Commonwealth
Department of Health and Aged Care provided development funding of $355,000.
Funding for the NCIS for 1999/2000 was received from the Commonwealth, of which
NOHSC contributed $50,000 and a proportionate amount from the States and
Territories totalling $250,000. The State and Territory figure was calculated at
$10,000 base fee plus a fee per population. Commonwealth funding of the NCIS
development will continue into the financial year 2002/03 after which a fee-for-
service payment system will be considered.

NOHSC has been closely involved in the development and implementation of the
NCIS since its inception (Owens and Lightfoot; 2000). This is because the NCIS is
potentially a very valuable source of information for occupational health and safety
purposes. Some of its advantages over other datasets include coverage of all persons

                                           10
regardless of compensation status or work arrangement (i.e. covers self-employed
persons) and timeliness, as it is an on-going data collection. With the NCIS now in
operation, NOHSC wishes to assess how useful the NCIS, as implemented, is for
OHS purposes, and to describe the available information on work-related fatalities
recorded in the NCIS. The assessment process has been on going, with identified
problems reported to MUNCCI and addressed by them as and when they were able.
Therefore, some of the problems or issues documented in this report have already
been resolved. This is noted where appropriate.

AIMS
In May 2001, the Information Committee of NOHSC approved a project to assess the
quality and completeness of coverage of work-related fatalities by the NCIS, to code
work-related cases in the NCIS by occupation and industry and to prepare a final
report on the NCIS project by the end of June 2002.

The NCIS project has two main aims. The first aim is to review the adequacy of the
NCIS as a source of information on work-related fatalities and to suggest areas of
improvement, if relevant. The second aim is to summarise the information on work-
related fatalities to provide an up-to-date description of work-related fatalities in
Australia.

This report focuses on the first aim. The second aim will be covered in a separate
report.

METHODS
The NCIS began operation in 2000. Access was available to external users from
1 July 2001. Cases have been entered systematically from 1 July 2000.

Approval for Access
Access to the NCIS by external users is only provided after approval by an ethics
committee established by MUNCCI and based at Monash University. A second ethics
approval, provided by a Western Australian ethics committee, is required for access to
data from the Western Australian coronial system. NOHSC provided the first
application for external access and received approval from both the Monash
University and Western Australian ethics committees. The approval process was
thorough, straightforward, and appears appropriate.

Access Via the Web
The main intended method of obtaining information from the NCIS is via a secure
internet     connection,     entered     via      the     MUNCCI        web      site
(http://www.vifp.monash.edu.au/ncis/). This connection is password protected. The
speed and ease of access to the site has been considerably improved since it first
began operation, and it now functions well as a source of information on individual
cases or small groups of cases selected against specific criteria. However, a number
of issues have been identified, and while many of these remain, most are being
addressed at the moment. The structure and function of the web site are documented

                                         11
elsewhere by MUNCCI (Owens and Lightfoot; 2000; NCIS, 2002). They are briefly
summarised here where necessary to give context to the comments.

Speed of Access
Access is much easier out of normal business hours, or at least early in the morning
and late in the afternoon. It is not unusual for requests for information to be “timed
out”, and the connection broken, although this was much more common when a
specific request for data extraction from the database was being made than when
information from a particular case was being sought. It is not clear to what extent
access problems arise from the internet connection as opposed to the set up of the
NCIS itself.

There are five sections in the NCIS site.

The first of these is “Home”, from which the other four sections can be accessed.

The “NCIS Search” section allows a specific case to be requested, based on various
identifying criteria such as case number, name, age, sex and court. This section also
allows queries to be designed, accessed and downloaded.

The “Case” section provides access to the five main forms relevant to each case. It is
only relevant if a case has already been selected and opened. This is the section that
contains the information of interest in the NCIS. The five forms within this section
are “Case detail”, “Time location”, “Procedure”, “Mechanism”, and “Linking
numbers”. These forms are discussed in more detail later.

The key data elements of interest in terms of identifying work-related cases are shown
in Table 1.

                                            12
Table 1: Data elements useful for identifying work-related cases
Case detail           Description
Work-relatedness      This should be the main coded data element for identifying work-related cases.
                      However, its completion may initially be unreliable for the first 18 months of the
                      system, because the data element was only introduced in late 2001.
Case-type (on         This is used to distinguish between natural and external cause fatalities.
  notification and    An external cause fatality is defined as any fatality that resulted directly or
  on completion)      indirectly from environmental events or circumstances that caused injury,
                      poisoning and other adverse effects.

                      All other fatalities are natural cause fatalities, unless the cause cannot be
                      determined.

Intent (on            This data element is required to exclude suicides (coded as ‘intentional self-
  notification and    harm’).
  on completion)
Police file           This is used to validate coding and identify work-related cases.

                      Each file should have a police description of the circumstances of the event.
                      These descriptions are the best way of validating the coding, but the quality and
                      depth of the descriptions vary widely. Some descriptions are detailed but do not
                      address the question of work-relatedness. This is especially the case in motor
                      vehicle crashes. Other descriptions are too brief to provide much useful
                      information. At present, many cases do not have accessible police descriptions,
                      primarily because of problems at the coronial office end of the system, although
                      there have also been some difficulties in attaching some of the police description
                      files to the relevant case. This latter problem is being corrected by MUNCCI, and
                      the former problem is being addressed by MUNCCI in conjunction with the
                      coronial offices.
Usual occupation      This is sometimes helpful when trying to put the police description of
 text                 circumstances into context.

Time location
Incident location –   Fatalities in certain locations are likely to be work-related.
  levels 1 and 2
Incident activity –   This should identify all work-related fatalities of workers and commuters.
  levels 1 and 2
Fatality date         This identifies fatalities occurring in the time period of interest.

Procedure
Finding               If present and comprehensive, the coronial finding is the best source of
                      information on the circumstances of fatality and should serve as the definitive
                      document used to identify work-related fatalities. However, to date, there are
                      very few findings in the NCIS, and nearly all of them come from the Northern
                      Territory, though not all completed NT cases have the findings attached.

Cause of fatality
Ib                    This often has a brief description that identifies a fatality as work-related (e.g.
                      “industrial accident”). However, it is unlikely that text here will definitively
                      identify a fatality as work-related without other supporting information from,
                      more specific, data elements.

                                                    13
Table 1 (continued) Data elements useful for identifying work-related cases

Mechanism
Mechanism levels    These may be useful as broad screening data elements. For example, the majority
 1, 2 and 3         of (but by no means all) electrocutions will be work-related. Note that there are a
                    primary, and two secondary, mechanisms, each with three levels.
Object category 1   Fatalities involving certain objects are likely to be work-related. Note that there
 and description    are a primary, and two secondary, objects, each with three levels.
Vehicle details     These data elements actually describe the crash details for motor vehicle crashes.
                    The four related data elements may be useful in identifying work-related road
                    incidents by specifying working vehicles. For example, nearly all motor vehicle
                    crashes involving semi-trailers will be work-related.

Linking numbers
WorkCover           If there is a number present, it means that WorkCover has probably investigated
  number            the case, and that the case is probably work-related. However, nearly all cases
                    have no information in this data element.

Identification of Work-Related Cases
Cases of interest in the review of work-related fatalities were persons who died as a
result of external causes sometime in the 12-month period 1 July 2000 to June 30
2001, and whose fatality was related to work. The definition of work was the same as
that used for the second work-related fatalities study, except that only working
persons, commuters and bystanders were included. The second work-related fatalities
study also included a number of other groups whose fatality was related to work in a
more indirect way. These groups were volunteers, students, persons performing home
duties and persons fatally injured on farms but not due to obvious farm work. These
groups did not form part of the current review. The relevant definitions are available
in most publications arising from WRF2 (1998), and are documented in detail in the
main report on pages 143-152. These are summarised in APPENDIX ONE.

A several stage approach was used to identify fatalities as work-related. These were
initially conducted independently, to allow a comparison to be made between the
different approaches. The results from the various approaches were then combined to
produce a final dataset of work-related fatalities.

Data Used in the Review
Cases of interest were those that met, or might meet, the criteria of all non-suicide
external cause fatalities that occurred in the period 1 July 2000 to 30 June 2001
inclusive. This period was chosen as it was the earliest 12-month period for which
information from the NCIS is available. Since it can take many months for the
coronial investigation process to be completed, many cases from this period were
expected to still be open at the time the data was to be reviewed.

Data was first obtained from the MUNCCI in September 2001. This information was
always intended as draft information that could be used to develop the screening and
analysis protocol. It was then intended that data would again be extracted in early
2002, by which time it was hoped that most of the cases from the time period of

                                                 14
interest would have been closed. This second data extraction occurred in February
2002 and forms the basis of the review.

Although the criteria for selection were straightforward, extracting these cases was
not simple. The case-type on completion could not be relied upon to identify external
cause cases because this had not been completed for many cases. For the same
reason, the intent on completion could not be relied upon to identify non-suicide
cases. To a lesser extent, date of fatality could not be relied upon because it was
missing in some instances. Therefore, an inclusive approach was taken with the data
supplied by MUNCCI, and unwanted cases excluded later. The February 2002 data
set comprised all cases entered into the dataset except the following:
    - case type equal to natural cause at both notification and completion;
    - intent equal to intentional self harm at both notification and completion; and
    - Queensland cases.

The February 2002 information was extracted by MUNCCI staff according to
NOHSC requirements. Initially, an attempt had been made by NOHSC to extract the
data using the enquiry procedure via the NCIS web site. However, this system proved
too inflexible to obtain the large class of cases with varying selection criteria that
were required for this project.

The data was supplied in four data files – one containing the main case data, including
cause of fatality; one containing information from the time-location form; one
containing information from the mechanism form; and one containing the police
descriptions of circumstances.

All files uniquely identified a case with the combination of the year, state and
sequence data elements. Not every case appeared in all four MUNCCI files, because
certain case types (e.g. natural causes) would not be expected to have all forms
completed, and certain cases had no information entered into a form. A case with a
blank form in the NCIS did not appear in the MUNCCI data file corresponding to that
form.

The main case-fatality file contained the main data elements of interest, being most of
those from the "Case detail" form. All potential cases appeared in this file.

The time-location file contained information on the dates of incident and fatality, the
activity at the time of incident (and fatality), and the place of activity and fatality.
Virtually all potential cases appeared in this file. However, many cases had more than
one row in the file, as there was a separate row for each of the ‘incident’, ‘fatality’,
‘last seen alive’ and ‘found’ aspects of the form. Also, some cases had only one
entry, either for date of incident or date of fatality, because the other information had
not been entered.

The mechanism file contained information on mechanism and object from the
mechanism form. Multiple entries per case were possible in this form also, because of
the facility to enter multiple mechanisms and agencies in the mechanism form.

The police description file contained the police descriptions for each case. There was
an entry for each case, but many of the cases did not have an associated description.

                                           15
Final Selection Criteria
The final dataset consisted of cases that met one of the criteria for each of date of
fatality, case type and intent.

Date of fatality
Date of fatality between 1 July 2000 and 30 June 2001 inclusive; OR
No date of fatality, but date of incident between 1 July 2000 and 29 June 2001
inclusive; OR
No date of fatality or date of incident, but date of notification strongly implying the
fatality occurred between 1 July 2000 and 30 June 2001 inclusive.

Case type
Case type on completion equal to external cause; OR
Case type on completion coded as unknown or missing, and case type on notification
was external cause; OR
The cause of fatality (described in the four cause of Fatality text data elements)
clearly external cause, or clearly related to an External Cause, regardless of the final
case type (but note that cases coded as natural cause on notification and completion
would not have been in the initial dataset, so their description of cause of fatality was
not inspected).

Intent
Intent on completion was not equal to Deliberate Self-harm.

Merging Files
Data supplied in September 2001 were in the form of Excel files, and included most
of the data elements in the NCIS. Data supplied in February 2002 were flat data files.
The data was initially imported into Excel, partially matched by hand, and partially
cleaned and checked. The edited Excel files were then made into comma-delimited
(CSV) files and imported into SAS, where the files were merged.

Identifying Work-Related Fatalities
Prior to applying the above selection criteria and merging the files, the police
description of circumstances from the September files were read and classified as to
their work-relatedness, based on the study definitions. Fatalities were classified as
working, commuting, bystander (separately as workplace or road bystander), not
work-related, indeterminate because of inadequate information in the text description,
and indeterminate because there was no text description. No other information in the
NCIS was used in making this determination.

The police description of circumstances obtained in February 2002 contained all the
descriptions provided in the September 2001, plus several hundred more. (The
content of some of the text descriptions for Victorian cases corrupted the importation
of the file into Excel, requiring a labour-intensive manual correction of the file prior

                                           16
to its use.) The new descriptions were read and classified as had been done for the
September cases. Descriptions classified from the September file were not re-
classified.

A final classification into the work-related and other categories was made using the
merged files. The definitive classification based on the police description of
circumstances was used as the most valid measure of work-relatedness. Definitive
classification was possible for 744 fatalities. For the remaining 2,802 fatalities,
classification was made in a series of steps. Those with an incident activity code of
working or commuting were assigned the relevant classification. Fatalities coded as
working or commuting were assigned as working fatalities. Next, fatalities assigned
as indeterminate because of inadequate information in the text description were given
a final classification of indeterminate. Then, fatalities with a code of work-related
using the NCIS work-related data element were accepted as bystanders. Remaining
fatalities were either classified as not work-related, if they had a definitive incident
activity code, or as unknown if they had a missing or unknown activity code.

Working fatalities were further classified as workplace and work-road on the basis of
the location and mechanism of the incident. Fatalities that involved a motor vehicle
crash on a public road were classified as work-road. All other working fatalities were
classified as workplace.

Bystander cases were classified as workplace or road on the basis of the text
description classification or, if there was no description, on the basis of the location
and mechanism of the incident.

Analysis
The analysis of the work-related determination and cases is the focus of this review,
but some general data description is also presented here.

Estimates of the expected numbers and proportions of various parameters were made
using the information collected during WRF2. Relevant information available from
this study included the total and state-specific number and percentage of coronial
files. This provided an indication of the likely coverage of all external cause cases by
the NCIS. Similar information on working, commuting and bystander cases was also
available, both overall and stratified by various characteristics such as state, place of
occurrence and mechanism. The findings from the current review were compared to
the WRF2 findings to provide an insight into the completeness of coverage of work-
related cases by the NCIS. Since Queensland cases were not included in the data
upon which this review was based, Queensland cases were also excluded from the
WRF2 data used for comparison.

All analysis was performed using SAS and Excel.

                                           17
RESULTS
General Description of Overall File
The main file sent by MUNCCI in February 2002 had 7,586 cases. The selection
procedure described above resulted in a final dataset for analysis of 3,546 cases.

Overall Reporting
The overall percentages suggested that there was an under-reporting to the NCIS of
cases from Western Australia, with only 4.2% of cases compared to an expected
11.4%. All the other jurisdictions except New South Wales and the Australian Capital
Territory had a lower than expected percentage of cases, but the differences were too
small to be sure that there was significant under-reporting. Consideration of the
number and percentage of cases reported in three-month periods during the 12 months
covered by the review supported a suspicion of problems with reporting of cases in
some jurisdictions. For example, the percentage of reported fatalities in each three-
month period varied from 4% to 34% in South Australia, whereas it could be expected
that there would be approximately 25% reported each quarter. Under-reporting in the
July to December 2000 period might be expected, since this was the first six months
covered by the NCIS, and this appears to have occurred in Tasmania. However, only
4% of South Australia's reported cases died in the final quarter. Similar problems of
significant apparent under-reporting in the final quarter were seen in Victoria (only
12% of reported cases), Western Australia (15%) and the Australian Capital Territory
(12%) (Table 2).

Table 2: External cause fatalities by jurisdiction of coroner's investigation. 1 July
2000 - 30 June 2001. Actual and expected1. Number and percent.
                                                             Jurisdiction
                        NSW          VIC         SA         WA        TAS    NT     ACT     Australia
Number
- actual                1,765       1,014         304       150       125    113       75    3,546
- expected              1,657       1,215         425       472       168    155       63    4,153
Percent
- actual                 49.8        28.6         8.6        4.2      3.5     3.2     2.1    100.0
- expected               39.9        29.2        10.2       11.4      4.0     3.7     1.5    100.0

Number
Jul-Sep 2000              462         345          98        27        15     33       19      999
Oct-Dec 2000              470         313         103        64        23     26       23    1,022
Jan-Mar 2001              414         234          90        37        52     25       24      876
Apr-Jun 2001              419         122          13        22        35     29        9      649
Total                   1,765       1,014         304       150       125    113       75    3,546

Percentage2
Jul-Sep 2000            26.2         34.0        32.2       18.0     12.0    29.2    25.3     28.2
Oct-Dec 2000            26.6         30.9        33.9       42.7     18.4    23.0    30.7     28.8
Jan-Mar 2001            23.5         23.1        29.6       24.7     41.6    22.1    32.0     24.7
Apr-Jun 2001            23.7         12.0         4.3       14.7     28.0    25.7    12.0     18.3
Total                  100.0        100.0       100.0      100.0    100.0   100.0   100.0    100.0
1: Expected on the basis of WRF2 results.
2: Percentage of all files in the relevant jurisdiction.

                                                    18
Identifying Work-Related Cases
Cases were identified as being work-related using three main approaches:
- inspection of the police descriptions of circumstances;
- analysis of the activity at the time of the incident data element; and
- analysis of the general work-related data element.

Inspection of the Police Description of Circumstances
The definitive classifications of work-relatedness based on the police text descriptions
were used as a basis against which NCIS coded values could be compared. However,
only 1,213 cases (34%) had police text descriptions available at the time the data was
provided by MUNCCI, and only 744 cases (21%) had enough information in the
description to be assigned a definitive classification. (Information on about 1,500
further NSW cases was provided in late February, but this arrived too late to be
incorporated into the analysis). Descriptions were available for only 9% of fatalities
from New South Wales and 29% from Victoria, but virtually all fatalities from the
other jurisdictions had police descriptions. The adequacy of the descriptions for
allowing definitive classification of the work-relatedness of the fatality varied from
54% (in South Australia) to 76% (in the Australian Capital Territory), giving an
Australian value of 61%. This meant that only 21% of all fatalities in the NCIS had a
text description that allowed adequate classification of the work-relatedness of a
fatality (Table 3).

Table 3: Presence and adequacy of police description of circumstances of external
cause fatalities. By jurisdiction. Only external cause fatalities with a known
mechanism. 1 July 2000 - 30 June 2001. Number and percent.

                                                             Jurisdiction
                        NSW          VIC         SA         WA        TAS       NT     ACT    Australia
Description1
- number                 152         298         304        149           124    112    74     1,213
- %2                     8.6         29.4       100.0       99.3         99.2   99.1   98.7    34.2

Adequate
description3
- number                 108         167         164        106            79     64    56      744
- % description4         70.0        56.0        53.9       71.1         63.7   57.1   75.7     61.3
- % all fatalities5       6.1        16.5        54.0       70.7         63.2   56.6   74.7     21.0

1:   Fatalities with a police description.
2:   Percentage of all fatalities.
3:   Fatalities with an adequate police description.
4:   Percentage of all fatalities with an adequate police description.
5:   Percentage of all fatalities.

                                                    19
The adequacy of the text description was strongly dependent on the circumstances of
the incident. Most fatalities that involved a motor vehicle crash on a public road did
not have an adequate text description. This was usually because the purpose of the
journey was not documented. This problem existed in all jurisdictions (nationally,
25% of such descriptions were adequate), and particularly in South Australia and
Tasmania, where the descriptions that were present were adequate in less than 20% of
cases. In contrast, the adequacy of text descriptions for non-motor vehicle crash
fatalities was very good, with 90% of such descriptions at a national level being
adequate for definitive classification of the work-relatedness of fatalities. However, it
should be noted that only 55% of all fatalities had a valid mechanism code and only
25% of all fatalities had both an adequate text description and valid mechanism code
(Table 4).

Table 4: Presence and adequacy of police description of circumstances of external
cause fatalities. By jurisdiction and mechanism. Only external cause fatalities with a
known mechanism. 1 July 2000 - 30 June 2001. Number and percent.

                                                           Jurisdiction
                        NSW         VIC         SA        WA        TAS          NT         ACT      Australia

Known motor vehicle crash fatalities1
- number               16          53            13         16           7         14          3         122
                  2
- % description      32.7       30.3           11.3       30.8        19.4       27.5       27.3        25.0
- % all fatalities3   5.9       18.9           11.3       30.2        19.4       26.9       25.0        14.9

Known non-motor vehicle crash fatalities4
- number              90        110         22               1          61         34         29         347
- % description5    89.1       92.4       88.0           100.0        80.3       94.4      100.0        89.7
- % all fatalities6 15.4       29.9       88.0           100.0        80.3       94.4      100.0        31.0

1:   Fatalities with an adequate police description and a motor vehicle crash mechanism code.
2:   Percentage of all fatalities with a police description and a motor vehicle crash mechanism code.
3:   Percentage of all fatalities with a motor vehicle crash mechanism code.
4:   Fatalities with an adequate police description and a non-motor vehicle crash mechanism code.
5:   Percentage of all fatalities with a police description and a non-motor vehicle crash mechanism code.
6:   Percentage of all fatalities with a non-motor vehicle crash mechanism code.

Two of the main problems with the text descriptions that were present were
concentrated on the aspects of the circumstances important from a legal point of view
rather than an injury prevention point of view, and lack of inclusion of information on
the purpose of travel of persons involved in motor vehicle crashes.

                                                  20
Of the 1,213 cases with text descriptions, 5.4% were coded as working fatalities, 0.4%
as commuting, 0.7% as workplace bystander, 0.9% as road bystander, and 54% as not
work-related. The remaining 39% cases with a description had insufficient
information to allow the fatality to be definitively classified (Table 5).

Table 5: Classification on the basis of the police description of circumstance.
External cause fatalities. 1 July 2000 - 30 June 2001. Number and percent.

         Work-relatedness                   Number              % all files1       % all       % all classified3
                                                                               descriptions2
                                                                n = 3,564        n = 1,213         n = 744
Not working                                      655               18.5             54.0             88.0
Working                                           65                1.8              5.4              8.7
Commuting                                          5                0.1              0.4              0.7
Bystander - work                                   8                0.2              0.7              1.1
Bystander - road                                  11                0.3              0.9              1.5
Inadequate information                           469               13.2             38.6              -
No description                                 2,333               65.8              -                -
Total                                          3,546             100.0            100.0            100.0

1:   Percentage of all files.
2:   Percentage of all files with a police description.
3:   Percentage of files with an adequate police description.

                                                   21
NCIS Activity at the Time of the Incident
Basic Description
The work-related status of fatalities coded as indeterminate on the basis of the police
description, or which did not have a police description, was determined by using the
NCIS-assigned values of activity at the time of the incident and the work-related data
element. Fatalities where the activity at the time of the incident was coded 3.1 were
accepted as working cases, and those coded 3.2 were accepted as commuting cases.
Fatalities where the activity was coded 3.9 were accepted as working, on the basis of
the coding of activity for known work-related cases with a police description. One
hundred and twenty eight fatalities had an incident activity of working or “working or
commuting”. Another 16 were coded as commuting. Activity was unknown for 382
fatalities and missing for another 340, so no information on incident activity was
available for 20% of the fatalities (Table 6).

Table 6: NCIS activity at the time of incident. External cause fatalities. 1 July 2000 -
30 June 2001. Number and percent.

            Activity                 Number               %
Sport                                  100                 2.8
Leisure                                548                15.5
Working                                 92                 2.6
Commuting                               16                 0.5
Working or commuting                    36                 1.0
Home duties                            105                 3.0
Resting, etc                           534                15.1
Being nursed                           195                 5.5
Formal education                         2                 0.1
Other specified                       1196                33.7
Unspecified                            382                10.8
Missing                                340                 9.6
Total                                3,546               100.0

Validity
The activity codes of the 744 cases with a definitive classification based on the police
description are shown in Table 7. Seventy of these cases were definitively
categorised as working or commuting, of these, 44 (63%) had an incident activity of
working or commuting. Half of the remaining 26 were coded to another specified
activity, with general travel accounting for most of these. All five commuting cases
had an NCIS activity code of general travel. If the NCIS activity category of
“working or commuting” is accepted as meaning working, then 66% of the true
working cases had an NCIS activity code of working.

Again looking only at the 744 cases with a definitive work-related code, 46 of these
fatalities had an NCIS activity code of working, commuting or commuting and
working. There were two apparent errors in these - one of the working fatalities was
not work-related, and one of the commuting fatalities was actually a working fatality.
Another fatality classified as a road bystander fatality had an incident activity code of

                                           22
commuting, which may have been correct if other information was available
(Table 7).

These results suggest that the NCIS activity coding system underestimates the number
of work-related fatalities amongst reported cases, with an underestimate of
approximately 32% for working cases and 60% for commuting cases.

Table 7: Comparison of NCIS activity at the time of incident with the work-related
classification on the basis of the police description of circumstance. Only files with
an adequate police description. External cause fatalities. 1 July 2000 - 30 June 2001.
Number.

        Activity                                 True classification
                        Not working    Working     Commuting         Bystander      Total
Sport                         22            3                0             0           25
Leisure                       74            1                0             5           80
Working                        1           23                0             0           24
Commuting                      0            1                0             1            2
Working or commuting           0           20                0             0           20
Home duties                   13            1                0             0           14
Resting, etc                 223            0                0             0          223
Being nursed                  56            1                0             0           57
Formal education               1            0                0             0            1
Other specified              166            8                5            10          189
Unspecified                   91            5                0             2           98
Missing                        8            2                0             1           11
Total                        655           65                5            19          744

NCIS Work-Related Data Element
Basic Description
The work-related data element was designed to identify all work-related fatalities,
regardless of whether the person was working, commuting or a bystander. Working
and commuting fatalities should be identifiable using the incident activity data
element. However, bystanders would, by definition, not have an activity of working
or commuting. Therefore, the incident activity data element cannot be used to
identify them. Fatalities that have an incident activity code other than working or
commuting, and an NCIS work-related code of one, should therefore be bystander
fatalities.

One hundred and sixty four fatalities (4.6%) were identified as work-related using this
data element, and 2,025 (57%) as not work-related. However, this information was
unknown for 38% of fatalities (Table 8).

                                          23
Table 8: NCIS work-related data element. External cause fatalities. 1 July 2000 - 30
June 2001. Number and percent.

        Work-relatedness               Number             %
Not work-related                       2,025              57.1
Work-related                             164               4.6
Unspecified                            1,254              35.4
Missing                                  103               2.9
Total                                  3,546             100.0

The agreement between the work-related data element and the incident activity data
element for working cases was very good, with only two fatalities with an incident
activity coded as working or commuting not being identified as such by the work-
related data element (Table 9).

Table 9: Comparison of NCIS activity at the time of incident with NCIS work-related
data element. External cause fatalities. 1 July 2000 - 30 June 2001. Number.

           Activity                                 Work-relatedness
                           Not work-      Work-       Unspecified    Unknown       Total
                            related       related
Sport                            57             0           42           1            100
Leisure                         274             7          255          12            548
Working or commuting              1           142            1           0            144
Home duties                      40             0           64           1            105
Resting, etc                    444             1           72          17            534
Being nursed                     98             2           85          10            195
Formal education                  2             0            0           0              0
Other specified                 850             6          313          27          1,196
Unspecified                     246             4           97          35            382
Missing                          13             2          325           0            340
Total                         2,025           164        1,254         103          3,546

Twenty fatalities were identified as work-related by the work-related data element but
had an activity code other than working or commuting, and another two had a missing
activity code. These fatalities were initially accepted as bystander cases, subject to
the gold standard classification made on the 744 fatalities classified on the basis of
their police description.

Validity
The NCIS work-related data element codes were compared to the definitive
classifications that were possible for 744 fatalities on the basis of the police
descriptions. Of the 70 fatalities definitively classified as working or commuting, 45
(64%) had an NCIS work-related code of work-related. Most of the rest were coded
as not work-related rather than as unknown. All five commuting cases had an NCIS
work-related code of not work-related (Table 10).

                                           24
Again looking only at the 744 cases with a definitive work-related code, 53 of these
fatalities had an NCIS work-related code of work-related. Forty-nine of these
appeared to be correctly coded. The remaining four were actually not work-related
fatalities.

These results suggest that the NCIS work-related code under-estimates the number of
work-related fatalities amongst reported cases by about 40%.

Table 10: Comparison of NCIS work-related data element with work-related
classification on the basis of the police description of circumstance. Only files with
an adequate police description. External cause fatalities. 1 July 2000 - 30 June 2001.
Number.

   Work-relatedness                              True classification
                       Not working     Working     Commuting         Bystander     Total
Not work-related            547            15                5            15         582
Work-related                  4            45                0             4          53
Unspecified                  75             4                0             0          79
Missing                      29             1                0             0          30
Total                       655            65                5            19         744

                                         25
Final Decision on Work-Related Fatalities
On the basis of this approach, 149 cases were identified as working, 20 as commuting
and 30 as bystanders (16 as workplace bystander and 14 as road bystander). Working
cases were further classified as workplace and work-road on the basis of the location
and mechanism of the incident. Fatalities that involved a motor vehicle crash on a
public road were classified as work-road. All other working fatalities were classified
as workplace. There were 94 workplace fatalities and 55 work-road fatalities
identified. Unless fatalities had an NCIS activity code of indicating working or
commuting, fatalities that had an inadequate or missing text description were
classified on this basis, regardless of the NCIS activity code (Table 11). NOHSC has
coded the 169 cases identified as working and commuting by occupation and industry
following the ASCO (ABS 1997) and ANZSIC (ABS 1993) coding systems and will
give the codes to MUNCCI for uploading onto the NCIS.

Table 11: Final classification of work-related status of cases. External cause fatalities.
1 July 2000 - 30 June 2001. Number and percent.

       Work-relatedness                     Number         %
Not working                                    655        18.5

Working
- workplace                                     94         2.7
- workroad                                      55         1.6
- total                                        149         4.2

Commuting                                      20          0.6

Working and commuting                          169         4.8

Bystander
- bystander - work                             16          0.5
- bystander - road                             13          0.4
- total                                        29          0.8

Inadequate information                         466        13.1

No description                               2,227        62.8

Total                                        3,546       100.0

                                                26
Assessment of the Coverage of Work-Related Fatalities
One hundred and forty nine work-related fatalities of workers (working fatalities)
were identified in the NCIS for the 12-month period under review. There is no gold
standard against which to compare this number to directly gauge its validity.
However, information from WRF2 provides a good indication of what numbers might
be expected, with the proviso that a drop of 10% or 20% in the rate of fatality might
be expected as a result of possible improvements in OHS in the decade since the
period covered by WRF2. For this comparison, Queensland fatalities were excluded
from the WRF2 data because the available NCIS information did not include
Queensland fatalities.

Cases with an Appropriate Police Description of Circumstances
The classification of fatalities for which the police description allowed a definitive
classification to be made provides the best insight into the true level of work-related
fatality over the 12-month period under review.

Of the 744 fatalities that could be definitively classified, 8.7% were classified as
working cases. This compares to 8.2% of all coroner's files in WRF2 being classified
as working fatalities. Percentages of workplace and work-road fatalities were also
similar between the definitively classified files and WRF2. Assuming that the
classifiable fatalities are a representative sample of all the fatalities from the NCIS,
this result suggests that the number of working fatalities has not changed greatly
between the period covered by WRF2 and the 2000-2001 period covered by this
review (although the rate may have changed). It also suggests that those text
descriptions that do provide adequate information can be used to appropriately
identify working fatalities (Table 12). Note that it is likely that fatalities with
classifiable text descriptions are not a fully representative sample of all NCIS external
cause fatalities. This is because workplace fatalities are more likely to be able to be
identified or excluded on the basis of basic descriptive information than are work-road
fatalities, which often require an explicit statement regarding the purpose of the
journey to allow them to be identified or excluded (see Table 4 and the preceding
text). Assuming that the 744 fatalities are approximately representative of all the
3,546 external fatalities under review, the 65 working fatalities extrapolate to a figure
of about 310 working fatalities (3,546/744 * 65), compared to a predicted 340
fatalities based on WRF2 findings.

The finding regarding coverage of commuting and bystander fatalities is not as
encouraging as that for working fatalities. The percentage of fatalities identified as
commuting was much lower in the classifiable NCIS group than in WRF2 (0.7%
versus 2.9%). Similarly, the percentage was lower in the NCIS group for workplace
bystanders (1.1% versus 1.5%) and road bystanders (1.5% versus 2.4%). These
results suggest that the police descriptions are not a sensitive source of information for
identifying commuting fatalities. This is not surprising, because identifying a fatality
as involving commuting requires detailed information about the purpose of the
journey, since the vehicle involved will often not be an obvious work vehicle, such as
a truck. Similar problems seem to affect the identification of road bystander fatalities,
although not to the same extent, especially when it is considered that improvements in
road safety in the last decade may have decreased the proportion of road fatalities that
might be expected. (This may also have affected the expected number of commuting

                                               27
fatalities.) In addition, the four years covered by WRFS included two incidents that
resulted in a significant loss of life for road bystanders, so the number of road
bystander fatalities expected as a result of the WRF2 results may be a little
exaggerated.      Workplace bystander fatalities also seem to be somewhat
underestimated in the NCIS using the work-relatedness and incident activity data
elements (Table 12).
Table 12: Comparison of proportion of classifiable NCIS files that were work-related
to classified proportions of work-related fatalities from WRF2. External cause
fatalities. 1 July 2000 - 30 June 2001. Percent.

        Work-relatedness                 % all classified1   % of WRF2 files2
                                            n = 744             n = 16,612
Working
- workplace                                    5.6                5.6
- workroad                                     3.1                2.6
- total                                        8.7                8.2

Commuting                                      0.7                2.9

Working and commuting                          9.4               11.1

Bystander
- bystander - work                             1.1                1.5
- bystander - road                             1.5                2.4
- total                                        2.6                3.9

1:   Only files with an adequate police description
2:   Excludes Queensland files.

Comparison Between the NCIS, NDS and WRF2
A study was undertaken to further assess how well the NCIS compared with the NDS
and WRF2. The NDS data was obtained from the NOHSC Online Statistics
Interactive (NOSI). The comparison carried out with the knowledge that the WRF2
data predated the NCIS and NDS data by 10-12 years and that the NDS being a
compensation-based system has particular attributes which are not necessarily similar
to those of the NCIS (e.g. age group coverage and work arrangements). In this
comparison, the Queensland data was omitted, as it is not currently reported in the
NCIS. Since the NCIS did not adequately identify bystanders in work-related
situations (especially on roads and highways), it was decided to include all by-
standers in the NCIS data (see Table 11).

Overall, the total number of fatalities in the NCIS and NDS datasets were nearly
identical and about 60% of the number of fatalities recoded in the WRF2 dataset
(Tables 13). A closer scrutiny of the results reveals that the NCIS contained about the
same number and proportion of fatalities in NSW as the NDS (Tables 13-14).
However, the authors suspect a slight under-reporting in the NCIS because all NSW
files were not uploaded to this system when the study was carried out. Clearly, the
NCIS seriously under-reported the number of fatalities in the other large states namely

                                                     28
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