摘要：Objectives. We describe trends in occupational and nonoccupational injury among working-age adults in Ontario. Methods. We conducted an observational study of adults aged 15 to 64 over the period 2004 through 2011, estimating the incidence of occupational and nonoccupational injury from emergency department (ED) records and, separately, from survey responses to 5 waves of a national health interview survey. Results. Over the observation period, the annual percentage change (APC) in the incidence of work-related injury was −5.9% (95% confidence interval [CI] = −7.3, −4.6) in ED records and −7.4% (95% CI = −11.1, −3.5) among survey participants. In contrast, the APC in the incidence of nonoccupational injury was −0.3% (95% CI = −0.4, 0.0) in ED records and 1.0% (95% CI = 0.4, 1.6) among survey participants. Among working-age adults, the percentage of all injuries attributed to work exposures declined from 20.0% in 2004 to 15.2% in 2011 in ED records and from 27.7% in 2001 to 16.9% in 2010 among survey participants. Conclusions. Among working-age adults in Ontario, nearly all of the observed decline in injury incidence over the period 2004 through 2011 is attributed to reductions in occupational injury. Although most developed countries have made progress in improving population health over the past 2 decades, reductions in the burden of mortality, morbidity, and disability attributed to injury have been uneven. 1 In the United States, the age-standardized death rate from motor vehicle collisions declined by 30% between 1990 and 2010. By contrast, the age-standardized death rate from falls and poisonings increased by 71% and 128%, respectively, over the period 2000 through 2009. 2 A recent surveillance report on injury mortality in Canada found that the share of all-cause mortality attributed to injury increased over the period 2001 through 2007. 3 Injury remains the leading cause of death among persons aged younger than 45. 4 The burden of injury among working-age adults arises from occupational and nonoccupational exposures. Although the reduction in hazardous exposures arising from work has been listed as among the 10 most important public health contributions to the improvement in population health over the past 100 years, 5 work exposures continue to cause a large fraction of injury morbidity, responsible for as much as 25% of the burden of injury in working-age adults. 6 The objective of surveillance in public health and occupational health is the systematic and ongoing assessment of population health status, based on the timely collection, analysis, and dissemination of information on health status and health risks. 7 Over the past 2 decades, the population surveillance of injury morbidity has made strengthened use of health interview surveys 6,8,9 and administrative records of health care utilization, particularly emergency department (ED) records. 10–17 These data sources can be used effectively to identify important trends in injury incidence and, if well-designed, can document occupational and nonoccupational injury causation. We estimated trends in the incidence of occupational and nonoccupational injury in Ontario over the period 2004 through 2011 for adults aged 15 to 64, drawing on a census of ED records and participants in national health interview surveys.
