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Substate Measures
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Occupational health surveillance plays an essential role in maintaining the health of the working population. The standardized Occupational Health Indicators (OHIs) currently recommended by the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC) measure statewide work-related indices. While state-level occupational health and safety data increase our understanding of the occupational health status of a statewide population, sub-state level data such as at the county or regional levels are needed to inform local decision making and action.
This document is intended to provide guidance for generating occupational health measures at the sub-state geographic level as well as provide examples of reporting and using such measures. These measures can be used to assess regional differences in health and safety risks within states. Such data may be useful to state, regional, and local health departments; federal, state, and local government officials; non-profit/advocacy organizations; health care providers; and academic research institutions.
The Council of State and Territorial Epidemiologists (CSTE) Occupational Health Subcommittee reviewed the existing list of standardized state-level OHIs and selected several measures for which sub-state level data are easily available in many states. The subcommittee adapted state OHI methodology for select OHI measures and created guidance for additional non-OHI measures to enable calculation of sub-state level indicators.
This document details the method of generating these measures and includes the discussion of identifying and accessing numerator and denominator data sources, event inclusion/exclusion criteria, steps for calculating frequencies, calculating rates and other indices, recommendations for use, and some limitations of sub-state analyses. In some cases, sample statistical code is included. Additionally, this document provides examples of ways sub-state measures are being used and reported by state health departments.
Readers are encouraged to adapt these methods to suit their specific needs. The measures presented in this document are examples and not intended to be exhaustive. Rather, the guidance provides a starting point from which states can examine and calculate OHIs and other data at the sub-state levels.
For more information about the occupational health substate measures, please contact Amy Patel. Click here to view other occupational health activities.

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