Use of employer administrative databases to identify systematic causes of injury in aluminum manufacturing

Disparities in job characteristics by race and sex in a Southern aluminum smelting facility

BACKGROUND

Former workers at a Southern aluminum smelting facility raised concerns that the most hazardous jobs were assigned to Black workers, but the role of workplace segregation had not been quantified or examined in the company town. Prior studies discuss race and gender disparities in working conditions, but few have documented them in the aluminum industry.

METHODS

We obtained workers' company records for 1985-2007 and characterized four job metrics: prestige (sociologic rankings), worker-defined danger (worker assessments), annual wage (1985 dollars), and estimated total particulate matter (TPM) exposure (job exposure matrix). Characteristics of job at hire and trajectories were compared by race and sex using linear binomial models.

RESULTS

Non-White males had the highest percentage of workers in low prestige and high danger jobs at hire and up to 20 years after. After 20 years tenure, 100% of White workers were in higher prestige and lower danger jobs. Most female workers, regardless of race, entered and remained in low-wage jobs, while 50% of all male workers maintained their initial higher-wage jobs. Non-White females had the highest prevalence of workers in low-wage jobs at hire and after 20 years-increasing from 63% (95% CI: 59-67) to 100% (95% CI: 78-100). All female workers were less likely to be in high TPM exposure jobs. Non-White males were most likely to be hired into high TPM exposure jobs, and this exposure prevalence increased as time accrued, while staying constant for other race-sex groups.

CONCLUSIONS

There is evidence of job segregation by race and sex in this cohort of aluminum smelting workers. Documentation of disparities in occupational hazards is important for informing health interventions and research.

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Despite the implications of gender and sex differences for health risks associated with blue-collar work, adverse health outcomes among blue-collar workers has been most frequently studied among men. The present study provides a "state-of-the-field" systematic review of the empiric evidence published on blue-collar women's health. We systematically reviewed literature related to the health of blue-collar women published between January 1, 1990 and December 31, 2015. We limited our review to peer-reviewed studies published in the English language on the health or health behaviors of women who were presently working or had previously worked in a blue-collar job. Studies were eligible for inclusion regardless of the number, age, or geographic region of blue-collar women in the study sample. We retained 177 studies that considered a wide range of health outcomes in study populations from 40 different countries. Overall, these studies suggested inferior health among female blue-collar workers as compared with either blue-collar males or other women. However, we noted several methodological limitations in addition to heterogeneity in study context and design, which inhibited comparison of results across publications. Methodological limitations of the extant literature, alongside the rapidly changing nature of women in the workplace, motivate further study on the health of blue-collar women. Efforts to identify specific mechanisms by which blue-collar work predisposes women to adverse health may be particularly valuable in informing future workplace-based and policy-level interventions.

The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health

The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.

Risk of Injury by Unionization: Survival Analysis of a Large Industrial Cohort

OBJECTIVE

To investigate the effect of union status on injury risk among a large industrial cohort.

METHODS

The cohort included hourly employees at 19 US plants between 2000 and 2007. Plants were classified by union status, and injuries were classified by severity. Cox-proportional hazard shared frailty model was used to determine time to first reportable injury.

RESULTS

A total of 26,462 workers were included: 18,955 (72%) unionized and 7507 (28%) non-unionized. Union workers incurred 3194 injuries (16.9%) compared with 618 injuries for non-union workers (8.2%). After adjusting for multiple covariates, union workers had a 51% higher risk of reportable injury.

CONCLUSIONS

Our results provide evidence for higher risk of reportable injuries in union workers; explanations for this increased risk remain unclear.

Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence

Studies on the physical and social characteristics of the workplace have begun to provide evidence for the role of specific workplace factors on health. However, the overall contribution of the workplace to health has not been considered. Estimates of the influences on health across domains of the work environment are a critical first step toward understanding what level of priority the workplace should take as the target for public policies to improve health. The influences or contribution of these domains on health in the work environment are particularly useful to study since they are potentially modifiable through changes in policies and environment. Our analysis used detailed data from blue-collar industrial workers at two dozen Alcoa plants. It includes work environmental measures of psychological hazards, physical hazards, and the workplace social environment, to estimate the overall importance of the workplace environment for hypertension. Our findings suggest that social, psychological, and physical aspects of the work environment could contribute to a substantial proportion of hypertension prevalence. These attributes of the workplace could thus be a useful target for improving workforce health.

An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers

OBJECTIVES

Emergency medical services (EMS) clinicians are shift workers deployed in two-person teams. Extended shift duration, workplace fatigue, poor sleep and lack of familiarity with teammates are common in the EMS workforce and may contribute to workplace injury. We sought to examine the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors.

METHODS

We obtained 3 years of shift schedules and occupational injury and illness reports were from 14 large EMS agencies. We abstracted shift length and additional scheduling and team characteristics from shift schedules. We matched occupational injury and illness reports to shift records and used hierarchical logistic regression models to test the relationship between shift length and occupational injury and illness while controlling for teammate familiarity.

RESULTS

The cohort contained 966,082 shifts, 4382 employees and 950 outcome reports. Risk of occupational injury and illness was lower for shifts ≤8 h in duration (RR 0.70; 95% CI 0.51 to 0.96) compared with shifts >8 and ≤12 h. Relative to shifts >8 and ≤12 h, risk of injury was 60% greater (RR 1.60; 95% CI 1.22 to 2.10) for employees that worked shifts >16 and ≤24 h.

CONCLUSIONS

Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers.

Expert ratings of job demand and job control as predictors of injury and musculoskeletal disorder risk in a manufacturing cohort

Objective

To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expert ratings of job-level psychosocial demand and job control, adjusting for job-level physical demand.

Methods

Among a cohort of 9260 aluminium manufacturing workers in jobs for which expert ratings of job-level physical and psychological demand and control were obtained during the 2 years following rating obtainment, multivariate mixed effects models were used to estimate relative risk (RR) of minor injury and minor MSD, serious injury and MSD, minor MSD only and serious MSD only by tertile of demand and control, adjusting for physical demand as well as other recognised risk factors.

Results

Compared with workers in jobs rated as having low psychological demand, workers in jobs with high psychological demand had 49% greater risk of serious injury and serious MSD requiring medical treatment, work restrictions or lost work time (RR=1.49; 95% CI 1.10 to 2.01). Workers in jobs rated as having low control displayed increased risk for minor injury and minor MSD (RR=1.45; 95% CI 1.12 to 1.87) compared with those in jobs rated as having high control.

Conclusions

Using expert ratings of job-level exposures, this study provides evidence that psychological job demand and job control contribute independently to injury and MSD risk in a blue-collar manufacturing cohort, and emphasises the importance of monitoring psychosocial workplace exposures in addition to physical workplace exposures to promote worker health and safety.

Psychological well-being during the great recession: changes in mental health care utilization in an occupational cohort

OBJECTIVES

We examined the mental health effects of the Great Recession of 2008 to 2009 on workers who remained continuously employed and insured.

METHODS

We examined utilization trends for mental health services and medications during 2007 to 2012 among a panel of workers in the 25 largest plants, located in 15 states, of a US manufacturing firm. We used piecewise regression to compare trends from 2007 to 2010 in service and medication use before and after 2009, the year of mass layoffs at the firm and the peak of the recession. Our models accounted for changes in county-level unemployment rates and individual-level fixed effects.

RESULTS

Mental health inpatient and outpatient visits and the yearly supply of mental health-related medications increased among all workers after 2009. The magnitude of the increase in medication usage was higher for workers at plants with more layoffs.

CONCLUSIONS

The negative effects of the recession on mental health extend to employed individuals, a group considered at lower risk of psychological distress.

Association between ambient noise exposure, hearing acuity, and risk of acute occupational injury

OBJECTIVE

This study aimed to examine the associations between acute workplace injury risk, ambient noise exposure, and hearing acuity, adjusting for reported hearing protection use.

METHODS

In a cohort of 9220 aluminum manufacturing workers studied over six years (33 300 person-years, 13 323 person-jobs), multivariate mixed effects models were used to estimate relative risk (RR) of all injuries as well as serious injuries by noise exposure category and hearing threshold level (HTL) adjusting for recognized and potential confounders.

RESULTS

Compared to noise <82 dBA, higher exposure was associated with elevated risk in a monotonic and statistically significant exposure-response pattern for all injuries and serious injuries with higher risk estimates observed for serious injuries [82-84.99 dBA: RR 1.26, 95% confidence interval (95% CI) 0.96-1.64; 85-87.99 dBA: RR 1.39, 95% CI 1.05-1.85; ≥88 dBA: RR 2.29, 95% CI 1.52-3.47]. Hearing loss was associated with increased risk for all injuries, but was not a significant predictor of risk for the subset of more serious injuries. Compared to those without hearing loss, workers with HTL ≥25 dB had 21% increased all injury risk (RR 1.21, 95% CI 1.09-1.33) while those with HTL 10-24.99 dB had 6% increased risk (RR 1.06, 95% CI 1.00-1.13). Reported hearing protection type did not predict injury risk.

CONCLUSION

Noise exposure levels as low as 85 dBA may increase workplace injury risk. HTL was associated with increased risk for all, but not the subset of serious, injuries. Additional study is needed both to confirm the observed associations and explore causal pathways.

Does tinnitus, hearing asymmetry, or hearing loss predispose to occupational injury risk?

OBJECTIVE

To determine the relative contributions of tinnitus, asymmetrical hearing loss, low frequency hearing loss (pure tone average of 0.5, 1, 2, 3 kHz; PTA.5123), or high frequency hearing loss (pure tone average of 4, 6 kHz; PTA46), to acute injury risk among a cohort of production and maintenance workers at six aluminum manufacturing plants, adjusting for ambient noise exposure and other recognized predictors of injury risk.

DESIGN

Retrospective analysis.

STUDY SAMPLE

The study considered 9920 workers employed during 2003 to 2008. The cohort consisted of 8818 workers (89%) whose complete records were available.

RESULTS

Adjusting for noise exposure and other recognized injury predictors, a 25% increased acute injury risk was observed among workers with a history of tinnitus in conjunction with high-frequency hearing loss (PTA46). Low frequency hearing loss may be associated with minor, yet less serious, injury risk. We did not find evidence that asymmetry contributes to injury risk.

CONCLUSION

These results provide evidence that tinnitus, combined with high-frequency hearing loss, may pose an important safety threat to workers, especially those who work in high-noise exposed environments. These at risk workers may require careful examination of their communication and hearing protection needs.

Occupational injury risk by sex in a manufacturing cohort

OBJECTIVES

This study expands previous research comparing injury risk for women and men in a cohort of 24,000 US aluminium manufacturing workers in 15 facilities from 2001 to 2010.

METHODS

We compared injury rates (all injury, first aid, medical treatment, restricted work and lost work time) by sex and by job and sex. Using a mixed effect modelling approach, we calculated ORs and 95% CIs adjusting for age, job tenure, ethnicity and year as fixed effects and person, job and plant as random effects. Additionally, we modelled the data stratified by plant type to examine potential differences in injury risk between smelter (generally recognised as more hazardous) and fabrication production environments.

RESULTS

Risk of injury was higher for women in four out of the five injury outcomes: all injuries combined (OR: 1.58, CI 1.48 to 1.67), injuries requiring first aid (OR: 1.61, CI 1.54 to 1.70), injuries requiring medical treatment (OR: 1.18, CI 1.03 to 1.36) and injuries requiring restricted work (OR: 1.65, CI 1.46 to 1.87). No difference in the risk of lost time injury by sex was found in this cohort. Analyses stratified by plant type showed similarly elevated injury risk for women, although the risk estimates were higher in smelters than fabrication plants.

CONCLUSIONS

To our knowledge, this is the largest single-firm study examining injury risk by sex with sufficient data to appropriately adjust for job. We show a consistently higher injury risk for women compared with men in the smelting and fabrication environments.

Acoustic neuroma: potential risk factors and audiometric surveillance in the aluminium industry

OBJECTIVES

To look for an association between acoustic neuroma (AN) and participation in a hearing conservation programme (HCP) and also for an association between AN and possible occupational risk factors in the aluminium industry.

METHODS

We conducted a case-control analysis of a population of US aluminium production workers in 8 smelters and 43 other plants. Using insurance claims data, 97 cases of AN were identified between 1996 and 2009. Each was matched with four controls. Covariates included participation in a HCP, working in an aluminium smelter, working in an electrical job and hearing loss.

RESULTS

In the bivariate analyses, covariates associated with AN were participation in the HCP (OR=1.72; 95% CI 1.09 to 2.69) and smelter work (OR=1.88; 95% CI 1.06 to 3.36). Electrical work was not significant (OR=1.60; 95% CI 0.65 to 3.94). Owing to high participation in the HCP in smelters, multivariate subanalyses were required. In the multivariate analyses, participation in the HCP was the only statistically significant risk factor for AN. In the multivariate analysis restricted to employees not working in a smelter, the OR was 1.81 (95% CI 1.04 to 3.17). Hearing loss, an indirect measure of in-ear noise dose, was not predictive of AN.

CONCLUSIONS

Our results suggest the incidental detection of previously undiagnosed tumours in workers who participated in the company-sponsored HCP. The increased medical surveillance among this population of workers most likely introduced detection bias, leading to the identification of AN cases that would have otherwise remained undetected.

Individual-level and plant-level predictors of acute, traumatic occupational injuries in a manufacturing cohort

Objectives

Workplace and contextual factors that may affect risk for worker injury are not well described. This study used results from an employee job satisfaction survey to construct aggregate indicators of the work environment and estimate the relative contribution of those factors to injury rates in a manufacturing cohort.

Methods

Principal components analysis was used to construct four plant-level factors from responses to a 32 question survey of the entire workforce, administered in 2006. Multilevel Poisson regression was used to evaluate the relationship between injury rate, individual-level and plant-level risk factors, unionisation and plant type.

Results

Plant-level ‘work stress’ (incident rate ratio (IRR)=0.50, 95% CI 0.28 to 0.90) was significant in the multilevel model, indicating the rate of injury for an average individual in that plant was halved (conditional on plant) when job stress decreased by a tertile. ‘Overall satisfaction’, ‘work environment’ and ‘perception of supervisor’ showed the same trend but were not significant. Unionisation was protective (IRR=0.40, 95% CI 0.17 to 0.95) as was any plant type compared with smelter.

Conclusions

We demonstrated utility of data from a human resources survey to construct indicators of the work environment. Our research suggests that aspects of the work environment, particularly work stress and unionisation, may have a significant effect on risk for occupational injury, emphasising the need for further multilevel studies. Our work would suggest monitoring of employee perceptions of job stress and the possible inclusion of stress management as a component of risk reduction programmes.

Methods for evaluating temporal trends in noise exposure

OBJECTIVE

Hearing conservation programs have been mandatory in many US industries since 1983. Since then, three program elements (audiometric testing, hearing protection, and training) have been the focus of much research. By comparison, little has been done on noise exposure evaluation.

DESIGN

Temporal trends in time weighted average (TWA) exposures and the fraction of measurements exceeding 85 dBA were evaluated by facility, by exposure group within facility, and by individual worker within facility.

STUDY SAMPLE

A large dataset (> 10 000 measurements over 20 years) from eight facilities operated by a multinational aluminum manufacturing company was studied.

RESULTS

Overall, exposures declined across locations over the study period. Several facilities demonstrated substantial reductions in exposure, and the results of mean noise levels and exceedance fractions generally showed good agreement. The results of analyses at the individual level diverged with analyses by facility and exposure group within facility, suggesting that individual-level analyses, while challenging, may provide important information not available from coarser levels of analysis.

CONCLUSIONS

Validated metrics are needed to allow for assessment of temporal trends in noise exposure. Such metrics will improve our ability to characterize, in a standardized manner, efforts to reduce noise-induced hearing loss.

Age-related injury and compensation claim rates in heavy industry

BACKGROUND

Although ageing workers face specific health and safety concerns, conflicting evidence exists regarding the effects of age on workplace injury rates and workers' compensation claims.

AIMS

To examine injury and workers' compensation claim rates by age and injury type in an aluminium smelter over a 9-year period.

METHODS

Routinely collected data for workplace injuries and workers' compensation claims were retrieved for the period from 1997 to 2005.

RESULTS

The study included a total of 709 workers who experienced 2281 at-work injuries and submitted 446 claims. In 1997, 16% of employees were aged 50 or over; by 2005 that proportion had more than doubled to 35%. Injury and claim rates in all age groups did not change significantly during this period. Workers younger than 30 years of age had the highest injury rates, with differences most significant for injuries other than sprains and strains. Claim rates were not significantly different across age groups.

CONCLUSIONS

These findings do not provide evidence to support the notion that older workers sustain more injuries and are more likely to claim compensation for their injuries. Our findings demonstrate that in this workplace, older workers were able to maintain their ability to work safely. This contrasts with the finding that younger workers had the highest injury and claim rates. While adapting to the needs of an ageing workforce, employers should not lose sight of the need to nurture a strong culture of working safely among their youngest workers.

Epidemiology of occupational accidents in iran based on social security organization database

Background:

Background: Today, occupational accidents are one of the most important problems in industrial world. Due to lack of appropriate system for registration and reporting, there is no accurate statistics of occupational accidents all over the world especially in developing countries.

Objectives:

The aim of this study is epidemiological assessment of occupational accidents in Iran.

Materials and Methods:

Information of available occupational accidents in Social Security Organization was extracted from accident reporting and registration forms. In this cross-sectional study, gender, age, economic activity, type of accident and injured body part in 22158 registered accidents during 2008 were described.

Results:

The occupational accidents rate was 253 in 100,000 workers in 2008. 98.2% of injured workers were men. The mean age of injured workers was 32.07 ± 9.12 years. The highest percentage belonged to age group of 25-34 years old. In our study, most of the accidents occurred in basic metals industry, electrical and non-electrical machines and construction industry. Falling down from height and crush injury were the most prevalent accidents. Upper and lower extremities were the most common injured body parts.

Conclusion:

Due to the high rate of accidents in metal and construction industries, engineering controls, the use of appropriate protective equipment and safety worker training seems necessary.

Associations between employee and manager gender: impacts on gender-specific risk of acute occupational injury in metal manufacturing

Background

Prior research has shown increased risk of injury for female employees compared to male employees after controlling for job and tasks, but have not explored whether this increased risk might be moderated by manager gender. The gender of one’s manager could in theory affect injury rates among male and female employees through their managers’ response to an employee’s psychosocial stress or through how employees differentially report injuries. Other explanations for the gender disparity in injury experience, such as ergonomic factors or differential training, are unlikely to be impacted by supervisor gender. This study seeks to explore whether an employee’s manager’s gender modifies the effect of employee gender with regards to risk of acute injury.

Methods

A cohort of employees and managers were identified using human resources and injury management data between January 1, 2002 and December 31, 2007 for six facilities of a large US aluminum manufacturing company. Cox proportional hazards models were employed to examine the interaction between employee gender and whether the employee had female only manager(s), male only manager(s), or both male and female managers on injury risk. Manager gender category was included as a time varying covariate and reassessed for each employee at the midpoint of each year.

Results

The percentage of departments with both female and male managers increased dramatically during the study period due to corporate efforts to increase female representation in management. After adjustment for fixed effects at the facility level and shared frailty by department, manager gender category does not appear to moderate the effect of employee gender (p = 0.717). Manager category was not a significant predictor (p = 0.093) of time to first acute injury. Similarly, having at least one female manager did not modify the hazard of injury for female employees compared to males (p = 0.899) and was not a significant predictor of time to first acute injury (p = 0.601).

Conclusions

Prior findings suggest that female manufacturing employees are at higher risk for acute injury compared to males; this analysis suggests that this relationship is not affected by the gender of the employee’s manager(s).

Effect of systematic ergonomic hazard identification and control implementation on musculoskeletal disorder and injury risk

OBJECTIVES

This study aimed to examine the effect of an ergonomic hazard control (HC) initiative, undertaken as part of a company ergonomics standard, on worker injury risk.

METHODS

Using the company's ergonomic hazards database to identify jobs with and without ergonomic HC implementation and linking to individual job and injury histories, injury risk among person-jobs with HC implementation (the HC group) was compared to those without HC (NoHC group) using random coefficient models. Further analysis of the HC group was conducted to determine the effect of additional ergonomic hazards controlled on injury risk.

RESULTS

Among 123 jobs at 17 plant locations, 347 ergonomic hazards were quantitatively identified during the study period. HC were implemented for 204 quantified ergonomic hazards in 84 jobs, impacting 10 385 persons (12 967 person-jobs). No HC were implemented for quantified ergonomic hazards in the remaining 39 jobs affecting 4155 persons (5046 person-jobs). Adjusting for age, sex, plant origin, and year to control for any temporal trend in injury risk, the relative risk (RR) for musculoskeletal disorder (MSD) was 0.85 and the RR for any injury or MSD was 0.92 in the HC compared to NoHC group. Among the HC group, each ergonomic hazard controlled was associated with risk reduction for MSD and acute injury outcomes (RR 0.93).

CONCLUSION

Systematic ergonomic HC through participatory ergonomics, as part of a mandatory company ergonomics standard, is associated with MSD and injury risk reduction among workers in jobs with HC implemented.

Contribution of health status and prevalent chronic disease to individual risk for workplace injury in the manufacturing environment

Objectives

An ‘information gap’ has been identified regarding the effects of chronic disease on occupational injury risk. We investigated the association of ischaemic heart disease, hypertension, diabetes, depression and asthma with acute occupational injury in a cohort of manufacturing workers from 1 January 1997 through 31 December 2007.

Methods

We used administrative data on real-time injury, medical claims, workplace characteristics and demographics to examine this association. We employed a piecewise exponential model within an Andersen–Gill framework with a frailty term at the employee level to account for inclusion of multiple injuries for each employee, random effects at the employee level due to correlation among jobs held by an employee, and experience on the job as a covariate.

Results

One-third of employees had at least one of the diseases during the study period. After adjusting for potential confounders, presence of these diseases was associated with increased hazard of injury: heart disease (HR 1.23, 95% CI 1.11 to 1.36), diabetes (HR 1.17, 95% CI 1.08 to 1.27), depression (HR 1.25, 95% CI 1.12 to 1.38) and asthma (HR 1.14, 95% CI 1.02 to 1.287). Hypertension was not significantly associated with hazard of injury. Associations of chronic disease with injury risk were less evident for more serious reportable injuries; only depression and a summary health metric derived from claims remained significantly positive in this subset.

Conclusions

Our results suggest that chronic heart disease, diabetes and depression confer an increased risk for acute occupational injury.

Piecewise exponential models to assess the influence of job-specific experience on the hazard of acute injury for hourly factory workers

Background

An inverse relationship between experience and risk of injury has been observed in many occupations. Due to statistical challenges, however, it has been difficult to characterize the role of experience on the hazard of injury. In particular, because the time observed up to injury is equivalent to the amount of experience accumulated, the baseline hazard of injury becomes the main parameter of interest, excluding Cox proportional hazards models as applicable methods for consideration.

Methods

Using a data set of 81,301 hourly production workers of a global aluminum company at 207 US facilities, we compared competing parametric models for the baseline hazard to assess whether experience affected the hazard of injury at hire and after later job changes. Specific models considered included the exponential, Weibull, and two (a hypothesis-driven and a data-driven) two-piece exponential models to formally test the null hypothesis that experience does not impact the hazard of injury.

Results

We highlighted the advantages of our comparative approach and the interpretability of our selected model: a two-piece exponential model that allowed the baseline hazard of injury to change with experience. Our findings suggested a 30% increase in the hazard in the first year after job initiation and/or change.

Conclusions

Piecewise exponential models may be particularly useful in modeling risk of injury as a function of experience and have the additional benefit of interpretability over other similarly flexible models.

Fatal occupational injuries among U.S. law enforcement officers: a comparison of national surveillance systems

BACKGROUND

This study describes and compares the three surveillance systems used to record occupational injury fatalities among U.S. law enforcement officers (LEOs).

METHODS

The Census of Fatal Occupational Injuries (CFOI), National Law Enforcement Officer Memorial Fund database (NLEOMF), and Law Enforcement Officers Killed and Assaulted reports (LEOKA) were examined for LEO deaths between 2003 and 2009. Fatality rates per 100,000 workers were calculated and compared.

RESULTS

Between 2003 and 2009, the NLEOMF reported 1,050 fatalities (rate of 16.4 per 100,000 workers), the CFOI reported 968 fatalities (15.1 per 100,000), and the LEOKA recorded 853 fatalities (13.3 per 100,000). The LEOKA under-counted the number of fatalities compared to the NLEOMF and CFOI. Discrepancies were found between the LEOKA, NLEOMF, and CFOI regarding age, race, and Hispanic origin. Similar patterns for cause of fatality were found; however, the NLEOMF recorded a higher number of "other" fatalities compared to the other two systems.

CONCLUSIONS

This study fills a critical knowledge gap by providing an overview of the three surveillance systems used to enumerate LEO occupational deaths. Understanding the differences across the systems is critical when utilizing them for surveillance research.

Health consequences of the 'Great Recession' on the employed: evidence from an industrial cohort in aluminum manufacturing

While the negative effects of unemployment have been well studied, the consequences of layoffs and downsizing for those who remain employed are less well understood. This study uses human resources and health claims data from a large multi-site fully insured aluminum company to explore the health consequences of downsizing on the remaining workforce. We exploit the variation in the timing and intensity of layoff to categorize 30 plants as high or low layoff plants. Next, we select a stably employed cohort of workers with history of health insurance going back to 2006 to 1) describe the selection process into layoff and 2) explore the association between the severity of plant level layoffs and the incidence of four chronic conditions in the remaining workforce. We examine four health outcomes: incident hypertension, diabetes, asthma/COPD and depression for a cohort of approximately 13,000 employees. Results suggest that there was an increased risk of developing hypertension for all workers and an increased risk of developing diabetes for salaried workers that remain at the plants with the highest level of layoffs. The hypertension results were robust to a several specification tests. In addition, the study design selected only healthy workers, therefore our estimates are likely to be a lower bound and suggest that adverse health consequences of the 2007-2009 recession may have affected a broader proportion of the population than previously expected.

Further validation that claims data are a useful tool for epidemiologic research on hypertension

BACKGROUND

The practice of using medical service claims in epidemiologic research on hypertension is becoming increasingly common, and several published studies have attempted to validate the diagnostic data contained therein. However, very few of those studies have had the benefit of using actual measured blood pressure as the gold standard. The goal of this study is to assess the validity of claims data in identifying hypertension cases and thereby clarify the benefits and limitations of using those data in studies of chronic disease etiology.

METHODS

Disease status was assigned to 19,150 employees at a U.S. manufacturing company where regular physical examinations are performed. We compared the presence of hypertension in the occupational medical charts against diagnoses obtained from administrative claims data.

RESULTS

After adjusting for potential confounders, those with measured blood pressure indicating stage 1 hypertension were 3.69 times more likely to have a claim than normotensives (95% CI: 3.12, 4.38) and those indicating stage 2 hypertension were 7.70 times more likely to have a claim than normotensives (95% CI: 6.36, 9.35). Comparing measured blood pressure values identified in the medical charts to the algorithms for diagnosis of hypertension from the claims data yielded sensitivity values of 43-61% and specificity values of 86-94%.

CONCLUSIONS

The medical service claims data were found to be highly specific, while sensitivity values varied by claims algorithm suggesting the possibility of under-ascertainment. Our analysis further demonstrates that such under-ascertainment is strongly skewed toward those cases that would be considered clinically borderline or mild.

Near-miss reporting system as an occupational injury preventive intervention in manufacturing

BACKGROUND

a database of near-misses (NM), minor injuries, and OSHA recordable injuries was established at a mid-size electrical manufacturing plant as part of injury prevention efforts. The utility of a NM reporting system was evaluated by estimating its impact on the annual incidence of minor and OSHA recordable injuries.

METHODS

logistic regression was performed to examine the effects of predictor variables (year, age, duration of employment) on the type of event (NM, minor, OSHA recordable). Poisson regression was fit to model the annual rate of OSHA recordable injuries as a function of time.

RESULTS

1690 events were reported between 1999 and 2006 including 261 NM, 1205 minor, and 205 OSHA recordable injuries. The expected rate of OSHA recordable injuries decreased by 0.84 (95% CI: 0.73-0.97) annually.

CONCLUSIONS

the implementation of a NM reporting system was associated with decrease in the rate of OSHA recordable injuries. NM reporting systems may be valuable injury interventions in manufacturing.

Surveillance of occupational health disparities: challenges and opportunities

Increasingly, the occupational health community is turning its attention to the effects of work on previously underserved populations, and researchers have identified many examples of disparities in occupational health outcomes. However, the occupational health status of some underserved worker populations is not described due to limitations in existing surveillance systems. As such, the occupational health community has identified the need to enhance and improve occupational health surveillance to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This report summarizes the data sources and methods discussed at an April 2008 workshop organized by NIOSH on the topic of improving surveillance for occupational health disparities. We discuss the capability of existing occupational health surveillance systems to document occupational health disparities and to provide surveillance data on minority and other underserved communities. Use of administrative data, secondary data analysis, and the development of targeted surveillance systems for occupational health surveillance are also discussed. Identifying and reducing occupational health disparities is one of NIOSH's priority areas under the National Occupational Research Agenda (NORA).

Effects of externally rated job demand and control on depression diagnosis claims in an industrial cohort

This study examined whether externally rated job demand and control were associated with depression diagnosis claims in a heavy industrial cohort. The retrospective cohort sample consisted of 7,566 hourly workers aged 18-64 years who were actively employed at 11 US plants between January 1, 1996, and December 31, 2003, and free of depression diagnosis claims during an initial 2-year run-in period. Logistic regression analysis was used to model the effect of tertiles of demand and control exposure on depression diagnosis claims. Demand had a significant positive association with depression diagnosis claims in bivariate models and models adjusted for demographic (age, gender, race, education, job grade, tenure) and lifestyle (smoking status, body mass index, cholesterol level) variables (high demand odds ratio = 1.39, 95% confidence interval: 1.04, 1.86). Control was associated with greater risk of depression diagnosis at moderate levels in unadjusted models only (odds ratio = 1.47, 95% confidence interval: 1.12, 1.93), while low control, contrary to expectation, was not associated with depression. The effects of the externally rated demand exposure were lost with adjustment for location. This may reflect differences in measurement or classification of exposure, differences in depression diagnosis by location, or other location-specific factors.

Sex differences in injury patterns among workers in heavy manufacturing

The objective of the study was to determine if female workers in a heavy manufacturing environment have a higher risk of injury compared with males when performing the same job and to evaluate sex differences in type or severity of injury. By use of human resources and incident surveillance data for the hourly population at 6 US aluminum smelters, injuries that occurred from January 1, 1996, through December 21, 2005, were analyzed. Multivariate logistic regression, adjusted for job, tenure, and age category, was used to calculate odds ratios and 95% confidence intervals for female versus male injury risk for all injuries, recordable injuries, and lost work time injuries. The analysis was repeated for acute injuries and musculoskeletal disorder-related injuries separately. Female workers in this industry have a greater risk for sustaining all forms of injury after adjustment for age, tenure, and standardized job category (odds ratio = 1.365, 95% confidence interval: 1.290, 1.445). This excess risk for female workers persisted when injuries were dichotomized into acute injuries (odds ratio = 1.2) and musculoskeletal disorder-related injuries (odds ratio = 1.1). This study provides evidence of a sex disparity in occupational injury with female workers at higher risk compared with their male counterparts in a heavy manufacturing environment.