Occupational vs. industry sector classification of the US workforce: which approach is more strongly associated with worker health outcomes?

Occupational status and health disparities among workers-An empirical study based on China health and nutrition survey data

This study uses data from the China Health and Nutrition Survey (CHNS) in 2004, 2006, and 2015 and employs a fixed-effects model based on Driscoll-Kraay standard errors to investigate the impact of occupation type, employment type, and work unit type on workers' health and the underlying mechanisms. The main findings suggest that higher levels of occupation type and employment type are associated with better self-rated health among workers, but simultaneously increase the probability of chronic diseases, demonstrating a "dual effect" of occupational characteristics on health. Additionally, workers in the public sector have a higher probability of chronic diseases and lower self-rated health compared to those in the non-public sector. Furthermore, the impact of occupation type, employment type, and work unit type on health is greater for male workers than for female workers. The negative impact of an increase in occupation type on chronic diseases is significantly higher in the absence of overtime work and for workers engaged in moderate and heavy physical labor. The mechanism analysis reveals that work intensity, labor income, and work hours play a crucial role in explaining the impact of occupation on health, jointly accounting for a significant portion of the impact of employment type on chronic diseases, occupation type on self-rated health, and work unit type on self-rated health.

Health conditions among male workers in mining and other industries reliant on manual labor occupations: National Health Interview Survey, 2007-2018

INTRODUCTION

Mining is an industry with diverse, demanding occupational exposures. Understanding the prevalence of chronic health conditions in working miners is an area of active research. Of particular interest is how the health of miners compares to that of workers in other industry sectors with a high proportion of manual labor occupations. By comparing similar industries, we can learn what health conditions may be associated with manual labor and with individual industries. This study analyzes the prevalence of health conditions in miners compared to workers employed in other manual-labor-reliant industries.

METHODS

National Health Interview Survey public data were analyzed for the years 2007-2018. Mining and five other industry groups with a high proportion of manual labor occupations were identified. Female workers were excluded because of small sample sizes. The prevalence of chronic health outcomes was calculated for each industry group and compared to that of nonmanual labor industries.

RESULTS

Currently-working male miners showed increased prevalence of hypertension (in those age <55 years), hearing loss, lower back pain, leg pain progressing from lower back pain, and joint pain, compared to nonmanual labor industries workers. Construction workers also demonstrated a high prevalence of pain.

CONCLUSION

Miners demonstrated increased prevalence of several health conditions, even when compared to other manual labor industries. Given previous research on chronic pain and opioid misuse, the high pain prevalence found among miners suggests mining employers should reduce work factors that cause injury while also providing an environment where workers can address pain management and substance use.

Rural-Urban disparities in self-reported physical/mental multimorbidity: A cross-sectional study of self-reported mental health and physical health among working age adults in the U.S

Purpose

Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts.

Methods

Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity.

Results

Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes.

Conclusion

Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM.

Effects of Serving as a State Functionary on Self-Rated Health: Empirical Evidence From China

Purpose

There is a strong link between occupation and self-rated health. Existing research has revealed the effects of occupation on self-rated health outcomes and the corresponding mechanisms. However, there is a lack of research on the effects of state services on self-rated health in China. Therefore, this study focuses on exploring the effects of serving as a state functionary in China on self-rated health to enrich research in related fields.

Method

Based on the data of 14,138 individuals collected from the 2016 China Labour-Force Dynamics Survey, the logit model was used to investigate the effects of serving as a state functionary on self-rated health and the difference in the effects across different populations.

Results

The results show that (1) serving as a state functionary has a significant positive effect on self-rated health; (2) self-rated health of elderly state functionaries is higher than that of younger state functionaries; (3) self-rated health of state functionaries in non-eastern regions is higher than that of state functionaries in eastern regions; and (4) state functionaries with lower education have higher self-rated health than highly-educated state functionaries; (5) Higher self-rated health of state functionaries is achieved primarily through better work time, better work environment and lower relative deprivation.

Conclusion

Serving as a state functionary in China has a significant positive correlation with self-rated health, with differences across populations of state functionaries. This study expands the current literature on the effects of occupation on self-rated health in the context of China.

Health conditions in retired manual labor miners and oil and gas extraction workers: National Health Interview Survey, 2007-2017

BACKGROUND

Within the mining industrial sector, workers in the mining and oil and gas extraction (OGE) industries have demonstrated disparities in chronic health status compared with the general working population. However, we know much less about miner and OGE worker health once retired. This study separately compares chronic illnesses in retired miners and OGE workers with all other retirees.

METHODS

National Health Interview Survey (NHIS) public data were analyzed for the years 2007-2017 to estimate weighted unadjusted and adjusted prevalence of selected health conditions (cancer, cardiovascular disease, high cholesterol, diabetes, hypertension, respiratory conditions, health status, and hearing loss) in retirees. Three retired worker groups (miners, OGE, and other retirees) were defined using the respondents' longest-held industry and occupation.

RESULTS

Higher prevalence of a number of adverse health conditions was noted in miners and OGE workers when compared with all other retirees. A significantly higher adjusted prevalence of hypertension, hearing loss, functionally limiting lung problems, and fair or poor health was seen in miners over other retirees. Retired OGE workers demonstrated a significantly higher adjusted prevalence of both hearing loss and poor health status.

CONCLUSIONS

Miners and OGE workers have higher morbidity during their working years, and this study demonstrates that poorer health appears to continue into retirement. These results suggest the need to expand occupational health and safety programs in the mining sector to improve the health of workers into retirement. Future studies that include more robust information on workplace exposures are needed to evaluate the long-term health of retired workers.

Employment Changes Following Breast Cancer Diagnosis: The Effects of Race and Place

The financial implications of breast cancer diagnosis may be greater among rural and black women. Women with incident breast cancer were recruited as part of the Carolina Breast Cancer Study. We compared unadjusted and adjusted prevalence of cancer-related job or income loss, and a composite measure of either outcome, by rural residence and stratified by race. We included 2435 women: 11.7% were rural; 48.5% were black; and 38.0% reported employment changes after diagnosis. Rural women more often reported employment effects, including reduced household income (43.6% vs 35.4%, two-sided χ2 test P = .04). Rural white, rural black, and urban black women each more often reported income reduction (statistically significant vs. urban white women), although these groups did not meaningfully differ from each other. In multivariable regression, rural differences were mediated by socioeconomic factors, but racial differences remained. Programs and policies to reduce financial toxicity in vulnerable patients should address indirect costs of cancer, including lost wages and employment.

Development of a Coding and Crosswalk Tool for Occupations and Industries

Introduction

Job coding into a standard occupation or industry classification is commonly performed in occupational epidemiology and occupational health. Sometimes, it is necessary to code jobs into multiple classifications or to convert job codes from one classification to another. We developed a generic tool, called CAPS-Canada (http://www.caps-canada.ca/), that combines a computer-assisted coding tool covering seven International, Canadian and US occupation and industry classifications and an assistant facilitating crosswalks from one classification to another. The objectives of this paper are to present the different functions of the CAPS-Canada tool and to assess their contribution through an inter-rater reliability study.

Method

The crosswalk assistant was built based on a database of >30,000 jobs coded during a previous project. We evaluated to what extent it would allow automatic translation between pairs of classifications. The influence of CAPS-Canada on agreement between coders was assessed through an inter-rater reliability study comparing three approaches: manual coding, coding with CAPS-Canada without the crosswalk assistant, and coding with the complete tool. The material for this trial consisted of a random sample of 1000 jobs extracted from a case-control study and divided into three subgroups of equivalent size.

Results

Across the classification systems, the crosswalk assistant would provide useful information for 83-99% of jobs (median 95%) in a population similar to ours. Eighteen to eighty-one percent of jobs (median 56%) could be entirely automatically recoded. Based on our sample of 1000 jobs, inter-rater reliability in occupation coding ranged from 35.7 to 66.5% (median 53.7%) depending on the combination of classification/resolution. Compared with manual coding, the use of CAPS-Canada substantially improved inter-rater reliability.

Conclusion

CAPS-Canada is an attractive alternative to manual coding and is particularly relevant for coding a job into multiple classifications or for recoding jobs into other classifications.

Occupational Groups and Environmental Justice: A Case Study in the Bronx, New York

We used spatial analyses to examine exposure of people in vulnerable occupational groups to neighborhood-level environmental pollutants in the Bronx borough of New York City. Five-year estimates of environmental ambient exposures (derived from land use regression models for PM2.5 [particulate matter with an aerodynamic diameter ≤2.5 µm] and black carbon) and demographic and occupational variables were harmonized at the census tract level. Correlations revealed that areas with high environmental exposures also had high proportions of people in service industries and manufacturing and high proportions of socioeconomically vulnerable populations. This combination of vulnerabilities may be cumulative, suggesting residents could have high occupational and residential exposures in addition to sociodemographic-related inequity.

High exposure mining occupations are associated with obstructive lung disease, National Health Interview Survey (NHIS), 2006-2015

BACKGROUND

The association between mining occupation categories and obstructive lung disease (OLD) has not been well explored in the United States.

METHODS

National Health Interview Survey (NHIS) data from 2006 to 2015 was used to determine the relationship between mining occupations and diagnosis of chronic bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), and asthma. We classified occupations into low, moderate, high, and very high dust exposure groups. Extraction workers were categorized as very high dust exposure.

RESULTS

We found 4.5% of miners had chronic bronchitis, 3.3% had emphysema, 6.2% had COPD, and 9.9% had asthma. In fully adjusted models, extraction workers had significantly increased odds of having chronic bronchitis (OR = 2.18 [95%CI: 1.02, 4.64]), emphysema (OR = 7.85 [95%CI: 1.70, 36.27]), and COPD (OR = 2.56 [95%CI: 1.29, 5.12]) compared to lower exposure occupations.

CONCLUSIONS

Occupation is an important predictor of OLD in the mining industry.

Job Characteristics Associated With Self-Rated Fair or Poor Health Among U.S. Workers

INTRODUCTION

Approximately 60% of the U.S. adult population is employed. Many aspects of a person's job may influence health, but it is unclear which job characteristics are most strongly associated with health at a population level. The purpose of this study was to identify important associations between job characteristics and workers' self-rated health in a nationally representative survey of U.S. workers.

METHODS

Data from the 2010 National Health Interview Survey were used to calculate weighted prevalence rates for self-reported fair/poor health for five categories of job characteristics: occupation; pay/benefits (economic); work organization; chemical/environmental hazards; and psychosocial factors. Backward elimination methods were used to build a regression model for self-reported health with the significant job characteristics, adjusting for sociodemographic variables and health behaviors. Data were collected in 2010 and analyzed in 2012-2016.

RESULTS

After adjusting for covariates, workers were more likely to have fair/poor health if they were employed in business operations occupations (e.g., buyers, human resources workers, event planners, marketing specialists; adjusted prevalence ratio [APR]=1.85, 95% CI=1.19, 2.88); had no paid sick leave (APR=1.35, 95% CI=1.11, 1.63); worried about becoming unemployed (APR=1.43, 95% CI=1.22, 1.69); had difficulty combining work and family (APR=1.23, 95% CI=1.01, 1.49); or had been bullied/threatened on the job (APR=1.82, 95% CI=1.44, 2.29).

CONCLUSIONS

Occupation, lack of paid sick leave, and multiple psychosocial factors were associated with fair/poor health among U.S. workers at the population level in 2010. Public health professionals and employers should consider these factors when developing interventions to improve worker health.

The impact of non-fatal workplace injuries and illnesses on mortality

BACKGROUND

Little research has examined the relationship between non-fatal workplace injuries and illnesses, and long-term mortality.

METHODS

We linked non-fatal injury cases reported to the New Mexico workers' compensation system for 1994-2000 with Social Security Administration data on individual earnings and mortality through 2014. We then derived sex-specific Kaplan-Meier curves to show time to death for workers with lost-time injuries (n = 36,377) and comparison workers (n = 70,951). We fit multivariable Cox survival models to estimate the hazard ratio separately for male and female workers with lost-time injuries.

RESULTS

The estimated hazard ratio for lost-time injuries is 1.24 for women and 1.21 for men. Ninety-five percent confidence intervals were 1.15, 1.35 and 1.15, 1.27, respectively.

CONCLUSION

Lost-time occupational injuries are associated with a substantially elevated mortality hazard. This implies an important formerly unmeasured cost of these injuries and a further reason to focus on preventing them. Am. J. Ind. Med. 59:1061-1069, 2016. © 2016 Wiley Periodicals, Inc.

The economic burden of disease by industry: Differences in quality-adjusted life years and associated costs

BACKGROUND

This study compares differences in quality-adjusted life expectancy across the eight original National Occupational Research Agenda (NORA) industry sectors.

METHODS

Data from the 1997 to 2012 National Health Interview Survey (NHIS) were used to estimate quality-adjusted life years (QALYs) for all workers and by NORA sector. Differences in QALYs were calculated and translated into economic values using estimates of the societal willingness-to-pay per QALY.

RESULTS

Mean QALYs across workers was 29.17 years. Among NORA sectors, wholesale, and retail trade workers had the highest average QALYs remaining (35.88), while mining workers had the lowest QALYs (31.4). The economic value of this difference ranges from $604,843 to $1,155,287 per worker depending on the societal willingness-to-pay per QALY.

CONCLUSION

The value of life lost within some industries is very high relative to others. Additional investments in occupational safety, benefits, and health promotion initiatives may reduce these losses, but experimental research is needed to assess the effectiveness of such programs.

Risk factors, health behaviors, and injury among adults employed in the transportation, warehousing, and utilities super sector

BACKGROUND

The TWU super sector is engaged in the movement of passengers and cargo, warehousing of goods, and the delivery of services. The purpose of this study is to describe employee self-reported personal risk factors, health behaviors and habits, disease and chronic conditions, and employer-reported nonfatal injury experiences of workers in the TWU super sector.

METHODS

National Health Interview Survey (NHIS) data for 1997-2007, grouped into six morbidity and disability categories and three age groups, were reviewed. Demographic characteristics and prevalence estimates are reported for workers in the TWU super sector and the entire U.S. workforce, and compared with national adult population data from the NHIS. Bureau of Labor Statistics employer-reported TWU injury data from 2003 to 2007 was also reviewed.

RESULTS

An average of 8.3 million workers were employed annually in the TWU super sector. TWU workers 65 or older reported the highest prevalence of hypertension (49%) across all industry sectors, but the 20% prevalence is notable among middle age workers (25-64). TWU workers had the highest prevalence of obesity (28%), compared to workers in all other industry sectors. Female TWU workers experienced the highest number of lost workdays (6.5) in the past year across all TWU demographic groups.

CONCLUSIONS

Self-reported high proportions of chronic conditions including hypertension and heart disease combined with elevated levels of being overweight and obese, and lack of physical activity-particularly among TWUs oldest workers-can meaningfully inform wellness strategies and interventions focused on this demographic group. Am. J. Ind. Med. 56:556-568, 2013. © 2012 Wiley Periodicals, Inc.