In 1985, CDC's National Institute for Occupational Safety and Health (NIOSH) initiated the National Traumatic Occupational Fatality (NTOF) project, which provides surveillance of work-related traumatic deaths using data from death certificates (1). During 1980-1985, NTOF indicated that an estimated 7000 fatal work-related injuries occurred each year; greater than 13% of these deaths resulted from homicide (defined as death resulting from injury purposefully inflicted by another person). Among U.S. working women, who represent 47% of the U.S. workforce, homicide was a leading manner of death from occupational trauma, accounting for 42% of fatal injuries at work. Among men, 12% of occupational fatalities were homicides. This report presents information on the number and rate of homicides among women at work during 1980-1985.

During 1980-1985, NTOF records* from 46 states** and the District of Columbia identified 950 female homicide victims (mean: 158 per year). The 6-year average annual workplace homicide rate was 4.0 deaths per million working women, with a high of 4.8 per million in 1980 and a low of 3.6 per million in 1985. Rates for other years were: 1981, 4.4 per million; 1982, 4.4 per million; 1983, 3.7 per million; and 1984, 3.6 per million.

Victims were 16-93 years of age (mean: 38 years), accounting for 25,787 years of potential life lost before age 65 (YPLL) (an average of 27 YPLL per woman). Women aged 20-34 years accounted for the largest proportion (46%) of victims, with homicide rates of 4.5 deaths per million working women aged 20-24 years and 4.3 deaths per million working women aged 25-34 years. Women greater than or equal to 65 years of age had the highest age-specific homicide rate (an average annual rate of 11.3 deaths per million working women). The average annual workplace homicide rate for white women was 3.7 deaths per million working women; the rates for black women and women of other races were 6.3 and 7.4 deaths per million working women, respectively. The rate for women of other races was based on small numbers (48 fatalities). Forty-four (92%) of these women were Asian; 22 owned, managed, or worked in retail food establishments such as markets, groceries, and bakeries.

The most common cause of death was assault by firearms: 609 (64%) women died from gunshot wounds. In addition, 181 (19%) women died from stabbings and slashings; 69 (7%) from asphyxiation; 57 (6%) from blunt force injuries; and 34 (4%) from fires, explosions, motor vehicle crashes, poisonings, sexual assaults, or other causes. Gunshot wounds were the most frequent cause of death for women in all age groups from 25 to 54 years of age; in contrast, stabbings and other injuries involving physical contact (e.g., asphyxiation or blunt force trauma) were more common among women greater than or equal to 65 years of age.

Three hundred eighty-nine (41%) of the women were employed in retail trade; the annual homicide rate in this industry was 8.3 per million working women. In comparison, although 186 (20%) of the victims were employed in service industries, the service sector homicide rate was 1.9 deaths per million working women per year. Six hundred seventy-five (71%) of the victims were employed in one of four occupational categories: sales personnel (179 (19%)); clerical workers (172 (18%)); service employees, which includes public safety employees, (172 (18%)); and executives/managers/administrators, which includes many self-employed women, (152 (16%)).

The mean number of homicides per month (based on the mean number of cases per day each month), peaked from December through March and, to a lesser extent, (Continued on page 551)during July and August. Of the 680 cases for which hour of injury was reported, 69% occurred from 3 p.m. to 7 a.m.; fatal injuries most frequently occurred from 4 p.m. to 5 p.m. Reported by: Div of Safety Research, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: The U.S. Department of Justice (2) and CDC's National Center for Health Statistics maintain overall information on homicides. However, this analysis of NTOF data represents a comprehensive attempt to identify work-related homicides. NTOF data is affected by the quality of death certificate information, which is obtained from next-of-kin, mortuary personnel, and certifying authorities (e.g., physicians, medical examiners, and/or coroners) and may vary in accuracy (3). Case ascertainment through NTOF is also affected by state reporting practices and data automation and retrieval procedures. Between 67% and 88% of all traumatic occupational fatalities can be identified through death certificates (4). Despite these limitations, NTOF data are useful for this preliminary characterization of homicide victims at the workplace.

The workplace homicide rate for women identified through NTOF is approximately 5% of the general homicide rate for U.S. women (79 per million women) (5). Data from the Federal Bureau of Investigation indicate that 42% of female homicide victims in the United States are aged 20-34 years (5), and NTOF data are comparable for workplace homicide. The NTOF findings extend the results of studies of fatal occupational trauma in Texas (6,7) and California (8), where homicide was a leading manner of death among working women and the highest workplace homicide rates for women occurred in those greater than or equal to 65 years of age. The higher homicide rate for older women in Texas was interpreted as indicating that older women were more vulnerable targets and were less likely to survive traumatic assault, not as an artifact of underenumeration of working women in the oldest age group (7).

Race-specific workplace homicide rates differ from overall U.S. patterns. Nationally, black women have a substantially higher homicide rate than white women, with a rate ratio of 3.8 (9). In the workplace, black women remain at greater risk for homicide than white women, but the difference is less marked, with a rate ratio of 1.8.

Finally, the frequency of firearm involvement in the deaths of these women mirrors the national homicide pattern. Overall, the proportion of U.S. homicides caused by gunshot wounds ranges from 39% to 75%, depending on the region of the country (5); the NTOF data indicate similar proportions for workplace homicides, with parallel regional variation.

Other studies of violent occupational crime have found a greater risk for homicide in jobs with frequent contact with the public and/or the exchange of money (7,8,10,11). Effective training programs in conflict resolution and nonviolent response exist (9,12,13) and have been implemented in some retail settings (13). Additional risk-reduction strategies such as using locked drop-safes, posting signs indicating that only small amounts of cash are kept in the cash register, increasing the visibility of the work area to the general public, providing well-lit parking lots (13), controlling access to the premises, and, in certain settings, isolating workers behind bulletproof materials may be more widely applicable and should be carefully evaluated in these and other hazardous settings (14).

References

1. CDC. Traumatic occupational fatalities--United States,

1980-1984. MMWR 1987;36:461-4, 469-70.

2. Bureau of Justice Statistics. Report to the nation on crime and justice: the data. NCJ-87068. Washington, DC: US Department of Justice, Bureau of Justice Statistics, 1983.

3. Kirchner T, Nelson T, Burdo H. The autopsy as a measure of accuracy of the death certificates. N Engl J Med 1985;313:1263-9.

4. Bell CA. Stout NA, Bender TR, Conroy CS, Crouse WE, Myers JR. Fatal occupational injuries in the United States, 1980 through 1985. JAMA 1990;263:3047-50.

5. Federal Bureau of Investigation. Uniform crime reports: crime in the United States, 1985. Washington, DC: US Department of Justice, July 1986.

6. CDC. Fatal occupational injuries--Texas, 1982. MMWR 1985;34:130-4,139.

7. Davis H, Honchar PA, Suarez L. Fatal occupational injuries of women, Texas 1975-1984. Am J Public Health 1987;77:1524-7.

8. Kraus JF. Homicide while at work: persons, industries, and occupations at high risk. Am J Public Health 1987;77:1285-9.

9. CDC. Homicide surveillance: high risk racial and ethnic groups--blacks and Hispanics, 1970 to 1983. Atlanta: US Department of Health and Human Services, Public Health Service, 1986. 10. Davis H. Workplace homicides of Texas males. Am J Public Health 1987;77:1290-3. 11. Hales T, Seligman PD, Newman SC, Timbrook CL. Occupational injuries due to violence. J Occup Med 1988;30:483-7. 12. Erickson R, Crow W. Violence in business settings. Am Behav Scientist 1980;23:717-43. 13. Crow W, Bull JL. Robbery deterrence: an applied behavioral science demonstration. La Jolla, California: Western Behavioral Sciences Institute, 1975. 14. Cook PJ. Robbery in the United States: an analysis of recent trends and practices. Washington, DC: US Department of Justice, September 1983. *The NTOF database contains information from death certificates provided by the 50 states and the District of Columbia that meet the following criteria: 1) death was related to external causes (International Classification of Diseases, Ninth Revision, rubrics E800-E999), 2) the decedent was greater than or equal to 16 years of age, and 3) the injury occurred at work. **No information on workplace homicides was included in the NTOF data base from Louisiana, Nebraska, New York, and Oklahoma because, when these data were collected, each had death certification procedures that precluded obtaining this information.

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