15 Major Causes of
Death
Work-Related Aviation
Fatalities
"How long do you want to live? How much are you
prepared to invest in your health and mental
well-being? This negotiation calls upon our inner
resources and usually prompts a new willingness to devise stratagems
for eluding death and illness." New Passages. What are you
going to do in the next year to insure that your mind, body and
spirit will be healthy so that you can join us and celebrate the year
2040? That's not that far away. Mortality
Chart
Ratio of Deaths (Men to
Women)
Age in Years Male:Female
1-4 130:100
5-14 158:100
15-24 315:100
25-44 229:100
45-64 162:100
65+ 85:100 (Only because there are few men left to die.)
Accidents 196:100
Suicide 422:100 (Boys/men don't ask for help.)
Homicide 336:100
Source: Statistical Abstract of the US, 1997
10 Leading Causes of Death before age 65
Cause/Ratio-Men to Women
Heart Disease 237:100
Cancer 112:100
Stroke 119:100
Chronic Obstruction Pulmonary Disease 115:100
Accidents 196:100
Pneumonia 157:100
Diabetes 116:100
HIV 551:100
Suicide 422:100
Homicide 336:100
Source: Statistical Abstract of the US, 1997,
for the Year 1994 - Deaths before age 65.
Leading Causes of Death - 2000
|
|
|
||||||
|
Rank-All |
Rank |
Number |
Percent |
Rank |
Number |
Percent |
|
|
All Causes |
2,403,351 |
1,117,578 |
100.0 |
1,225,773 |
100.0 |
||
|
Heart |
1 |
1 |
344,807 |
29.3 |
1 |
365,953 |
29.9 |
|
Malignant neoplasms |
2 |
2 |
286,082 |
24.3 |
2 |
267,009 |
21.8 |
|
Cerebrovascular diseases |
3 |
3 |
64,769 |
5.5 |
3 |
102,892 |
8.4 |
|
Accidents (unintentional injuries) |
4 |
5 |
60,004 |
5.1 |
4 |
62,005 |
5.1 |
|
Chronic lower respiratory diseases |
5 |
4 |
63,817 |
5.4 |
8 |
34,083 |
2.8 |
|
Diabetes mellitus |
6 |
6 |
31,602 |
2.7 |
5 |
37,699 |
3.1 |
|
Influenza and pneumonia |
7 |
7 |
28,658 |
2.4 |
6 |
36,655 |
3.0 |
|
Alzheimer's |
8 |
-- |
14,438 |
1.2 |
7 |
35,120 |
2.9 |
|
Nephritis, nephritic syndrome and nephrosis |
9 |
9 |
17,811 |
1.5 |
9 |
19,440 |
1.6 |
|
Septicemia |
10 |
-- |
13,537 |
1.1 |
10 |
17,687 |
1.4 |
|
Intentional self-harm (suicide) |
-- |
8 |
23,618 |
2.0 |
-- |
5,732 |
0.5 |
|
Chronic liver disease and cirrhosis |
-- |
10 |
17,214 |
1.5 |
-- |
9,338 |
0.8 |
Work-Related Aviation Fatalities
For all aircraft crashes during the study period, National Transportation Safety Board (NTSB) Accident Briefs were abstracted to obtain information about flight purpose, weather, aircraft, pilot, and probable cause. These reports were merged with records from the Alaska Occupational Injury Surveillance System, a database established and maintained by CDC's National Institute for Occupational Safety and Health, which includes information about cause of death, occupation of decedent, and circumstancesassociated with the crash. This study includes all occupational deaths related to commercial, military, and general aviation (i.e., all flying not involving military aircraft, scheduled airlines, and commuter or air-taxi service). For this analysis, an aircraft crash was defined as an incident in Alaska in which an aircraft in motion sustained substantial damage or an incident that resulted in injury or death to an aircraft occupant. An aircraft crash was categorized as occupational if at least one of the occupants in the aircraft was 1) working for pay or compensation; 2) working as a volunteer emergency medical technician, firefighter, or law enforcement officer; 3) traveling on business, including to and from customer/business contacts; or 4) engaging in a work activity in which the aircraft is the work environment. Denominator data for rates were based on 1990 U.S. Bureau of the Census and Alaska Department of Labor estimates. \
During 1990-1994, a total of 876 aircraft crashes occurred in Alaska; of these, 405 (46%) were occupational. Overall, 106 (12%) crashes resulted in at least one fatality, and 69 (65%) of these were classified as occupational. Of these, 62 (90%) involved fixed-wing aircraft, and seven (10%) involved helicopters. Nearly all (61 [98%]) of the fixed-wing crashes involved propeller-driven aircraft; 54 (89%) were single-engine aircraft. No occupational fatalities occurred on scheduled commercial airline operations.
A total of 192 occupants were on board the 69 aircraft involved in the fatal occupational crashes; 149 (78%) of these occupants were killed. Of the 149 fatalities, 99 (66%) were occupation-related. The annual occupational fatality rate for pilots in Alaska was 268 per 100,000, 2.1 times higher than the U.S. pilot-specific rate of 126 per 100,000 (1). For all workers in Alaska, regardless of occupation, the death rate for work-related aircraft crashes was 8.3 per 100,000, 27.1 times higher than the U.S. rate of 0.3 per 100,000 (1).
The mean number of persons on board the aircraft was 2.8 (range: one-11); in 23 (33%) of these crashes, only the pilot was on board at the time of the crash. The mean age of the occupational decedents was 39 years (range: 20-68 years), and most (58 [59%]) were aged 30-44 years. In addition, nearly all (96 [97%]) deaths occurred among men. The most common cause of death was multiple impact injuries (48 [48%]), followed by head injuries (27 [27%]) and injuries to the chest (11 [11%]).
The takeoff and landing phases of flight together accounted for 228 (56%) occupational crashes, but for only eight (12%) of the fatal occupational crashes. Most (137 [60%]) of these crashes were associated with unimproved, off-airport sites (e.g., sandbars, mountain ridges, and meadows). Controlled flight into terrain during the cruise phase of flight (i.e., straight and level flying) or the maneuvering phase of flight (i.e., changing altitude or direction) together accounted for 46 (67%) fatal occupational crashes. The most common (28 [41%]) impact sites of fatal crashes were mountain sides and passes.
The Federal Aviation Administration (FAA) defines two categories of flying conditions based on meteorologic considerations. Instrument Meteorological Conditions (IMC) exist when visibility is less than 1 mile or the aircraft cannot be operated clear of clouds or overcast; in IMC, pilots must rely on instrumentation for navigation. Visual Meteorological Conditions (VMC) exist when visibility is greater than or equal to 1 mile and pilots can use visual cues for navigation. In Alaska, crashes occurring under IMC were 5.3 times (95% confidence interval=3.5-7.9) more likely to be associated with a death than crashes in VMC.
NTSB determined that pilot error (defined as aircrew action or inaction that became a contributing cause or factor in the crash) was a cause in 53 (77%) of the fatal occupational aviation crashes in Alaska. In addition, 23 (33%) of the aircraft involved in fatal occupational incidents were not completely destroyed; however, only 22% of the occupants of these aircraft survived. Reported by: Alaska Field Station, Div of Safety Research, National Institute for Occupational Safety and Health, CDC.
Editorial Note: When compared with risks for all U.S. workers, occupational aviation fatalities among workers in Alaska accounted for a disproportionate number of occupational fatalities in that state: workers in Alaska were 27 times more likely to be killed in an aircraft than were all U.S. workers. This increased risk reflects, in part, the greater use of aircraft for routine transportation in Alaska. Controlled flight into terrain during the transition from VMC to IMC was the most frequently identified cause of occupational crashes. This transition is a difficult flight task for pilots, and FAA regulations prohibit pilots of single-engine aircraft from flying in IMC while carrying passengers for compensation.
In Alaska, many pilots risk flying into potentially hazardous conditions because of the demand for reliable air service. In 1994, 70% of pilots in Alaska involved in the commuter and air-taxi industry reported inherent pressures in their flight operations, including self-induced pressures, mail-delivery responsibilities, and pressures from passengers, management, and other pilots (2). Approximately half of pilots surveyed reported having flown from VMC into IMC on at least one occasion, and 84% reported having inadvertently entered IMC on a VMC flight. Weather conditions in Alaska can change rapidly, and the vast distances between some weather reporting points often conceal substantial local variation in the weather. However, VMC flight into IMC usually involved poor pilot decision making (3).
The frequency of pilot error in the incidents described in this report underscores the need for the development and introduction of Alaska-specific Aeronautical Decision Making (ADM) and judgement training (3). ADM is designed to assist pilots in making better decisions during potentially hazardous conditions, to avoid situations that require skill beyond their capabilities, and to reduce the number of judgement-related crashes. The FAA has proposed requiring ADM training for all levels of pilot certification in the United States (4).
NTSB has recommended that all pilots use protective equipment to reduce aviation fatalities (5). Helmets, energy-absorbing structures, padding the occupant's immediate environment, and use of shoulder restraints could reduce the number of aircraft-related occupational fatalities (5,6).
This analysis produced a descriptive characterization of the epidemiology of occupational aviation fatalities in Alaska. Additional efforts will be required to assess the association between other potential risk factors (e.g., carbon monoxide exposure, aging aircraft, pilot fatigue, and risk-taking) and occupational aviation fatalities. One important limitation of this analysis was the lack of accurate and reliable denominator data to control for exposure (i.e., flight hours). Fatal aircraft incident rates provided by the NTSB generally are presented as fatal incidents per 100,000 aircraft flight hours; however, these rates are based on national estimates, and these estimates cannot be applied to occupational aviation in Alaska.
In response to this study, the Alaska Interagency Working Group for the Prevention of Occupational Injuries has formed an aviation working group (including representatives from industry and state and federal agencies), to determine strategies for reducing such crashes. Ongoing activities include data collection and dissemination of information to local news media, industry, and educational and flight-safety organizations in Alaska.
References
1. Toscano G, Windau J. Compensation and working conditions.
Washington, DC: Bureau of Labor Statistics, National Census of Fatal
Occupational Injuries, 1995.
2. National Transportation Safety Board. Aviation safety in Alaska:
safety study. Washington, DC: National Transportation Safety Board,
1995; document no. NTSB/SS-95/03.
3. National Transportation Safety Board. Safety recommendation.
Washington, DC: National Transportation Safety Board, 1995; document
no. A-95-121-136.
4. Federal Aviation Administration. Notice of proposed rule-making:
95-11, human factors and aeronautical decision making. Part 61 B,
Human Factors (paragraph 28) and ADM (paragraph 29). Federal Register
1995;60:41160.
5. National Transportation Safety Board. General aviation
crashworthiness project: impact severity and potential injury
prevention in general aviation accidents. Springfield, Virginia:
National Technical Information Service, 1985; document no.
NTSB/SR-85/01.
6. Desjardins SF, Laananen DH, Singley GT. Aircraft crash survival
design guide: design criteria and checklist. Vols 1-4. Springfield,
Virginia: National Technical Information Service, 1980; document no.
AD-A093784.
Deaths/Mortality
(All figures are for U.S.)
Number of Deaths Annually: 2,314,245 (1997)
Death Rate (age-adjusted): 479.1 deaths per 100,000 population
(1997)
Ten Leading Causes of Death in the U.S.:
Source: National Vital Statistics Report, Vol. 47, No.19
Heart Disease: 726,974
Cancer: 539,577
Stroke: 159,791
Chronic Obstructive Pulmonary Disease: 109,029
Accidents: 95,644
Pneumonia/Influenza: 86,449
Diabetes: 62,636
HIV/AIDS: 16,516
Suicide: 30,535
Chronic Liver Disease and Cirrhosis: 25,175
Source: NAT
Prostate Disease
(All figures are for U.S.)
Annual Number of Deaths from Prostate Cancer: 34,123 (1996)
Source: National Vital Statistics Reports, Vol. 47, No. 9
Cases of Prostate Disease Reported Annually: 2.6 million (1995)
Source: Vital and Health Statistics Series 10, No. 199
Number of Ambulatory Care Visits for Prostate Cancer: 2.4 million (1996)
Source: Vital and Health Statistics Series 13, No. 134
Cancer
(All figures are for U.S.)
Deaths Annually: 539,577 (1997)
Age-Adjusted Death Rate: 125.6 deaths per 100,000 population
(1997
Cause of Death Rank: 2 (1997)
Source: National Vital Statistics Report, Vol. 47, No. 19
Hospital Discharges: 1,374,000 (1996)
Average Length of Hospital Stay: 7.0 days (1996)
Source: Advance Data 301
