What percentage of workers with work-related illnesses receive workers' compensation benefits?

Are plumbing apprentice graduates safer than their non-apprentice peers? Workers' compensation claims among journey level plumbers by apprenticeship participation

INTRODUCTION

Apprenticeships combine mentored on-the-job training with related instruction to develop a workforce with the skills sought by employers. Workplace safety is an important component of apprenticeship training. Whether that training results in fewer work injuries, however, is largely unknown.

METHOD

We linked Washington's registered apprenticeship data, plumber certification (licensing) data, employment data, and workers' compensation claims to compare claim rates among journey level plumbers (JLP) by apprenticeship participation. We used negative binomial regression models to estimate rates of total claims, wage replacement/disability claims, acute injuries, and musculoskeletal disorders (MSD), adjusted for worker characteristics.

RESULTS

Among JLP certified between 2000 and 2018, rates among JLP with no apprenticeship training were 46% higher for total workers' compensation claims (adjusted Rate Ratio (aRR) = 1.46, 95% CI: 1.26-1.69) and 60% higher for wage replacement/disability claims (aRR = 1.60, 95% CI: 1.22-2.11), compared to rates among JLP who completed a plumbing apprenticeship. Apprentice graduates experienced a greater decline in the rate of total claims between the 5 years preceding JLP certification and the years after certification (55.3% vs. 41.4% among JLP with no apprenticeship training). Greater rate reductions among JLP apprentice graduates were also observed for acute injuries and MSD, although the decline in MSD was not significantly different from the decline among JLP with no apprenticeship training.

CONCLUSIONS

Successful completion of a plumbing apprenticeship program is associated with fewer work injuries throughout the career of a JLP. Apprenticeships appear to play a key role in reducing work injuries among JLP, especially acute injuries.

PRACTICAL APPLICATIONS

Apprenticeships are an effective model for reducing workplace injuries. The mechanisms by which apprenticeship training improves workplace safety should be identified to better inform injury prevention efforts among apprentices as well as among workers outside of a formal apprenticeship arrangement.

Burden of cardiovascular diseases and depression attributable to psychosocial work exposures in 28 European countries

BACKGROUND

This study aimed to estimate the annual burden of cardiovascular diseases and depression attributable to five psychosocial work exposures in 28 European Union countries (EU28) in 2015.

METHODS

Based on available attributable fraction estimates, the study covered five exposures, job strain, effort-reward imbalance, job insecurity, long working hours and workplace bullying; and five outcomes, coronary/ischemic heart diseases (CHD), stroke, atrial fibrillation, peripheral artery disease and depression. We estimated the burden attributable to each exposure separately and all exposures together. We calculated Disability-Adjusted Life Years (DALY) rate per 100 000 workers in each country for each outcome attributable to each exposure and tested the differences between countries and between genders using the Wald test.

RESULTS

The overall burden of CHD attributable to the five studied psychosocial work exposures together was estimated at 173 629 DALYs for men and 39 238 for women, 5092 deaths for men and 1098 for women in EU28 in 2015. The overall burden of depression was estimated at 528 549 DALYs for men and 344 151 for women (respectively 7862 and 1823 deaths). The three highest burdens in DALYs in EU28 in 2015 were found for depression attributable to job strain (546 502 DALYs), job insecurity (294 680 DALYs) and workplace bullying (276 337 DALYs). Significant differences between countries were observed for DALY rates per 100 000 workers.

CONCLUSIONS

Such results are necessary as decision tools for decision-makers (governments, employers and trade unions) when defining public health priorities and work stress preventive strategies in Europe.

Workers' compensation claim counts and rates by injury event/exposure among state-insured private employers in Ohio, 2007-2017

INTRODUCTION

This study analyzed workers' compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury.

METHODS

A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state's unemployment insurance (UI) data to identify the employer's industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE.

RESULTS

140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified.

CONCLUSIONS

Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research.

Do Injured Workers Receive Opioid Prescriptions Outside the Workers' Compensation System?: The Case of Private Group Health Insurances

OBJECTIVES

We explored the impact of workplace injury on receiving opioid prescriptions from employer-sponsored private group health insurances (GHI) and how long injured workers receive opioid prescriptions after injury.

METHODS

We used a difference-in-differences method and MarketScan databases for the years 2013 to 2015.

RESULTS

Estimated odds for injured workers relative to noninjured workers to receive opioid prescriptions from the GHI within 60 and 180 days from the index date of injury were 4.9 and 1.5, respectively. In addition, the number of opioid prescriptions received within 60 days of injury was 2.5 times higher.

CONCLUSION

Workplace injury could be a risk factor for both short and long-term prescription opioid use. Studies that use only workers' compensation medical claim data likely underestimate the magnitude of the impact of workplace injuries on opioid prescriptions.

Assessing disabling and non-disabling injuries and illnesses using accepted workers compensation claims data to prioritize industries of high risk for Oregon young workers

INTRODUCTION

Young workers are especially vulnerable to occupational injuries and illnesses. There is a continued need to investigate injury burden among young workers across demographics and industry to inform targeted interventions. Workers compensation (WC) claims are important for quantifying work-related injuries and illnesses, however published studies have focused on disabling claims. This study extended previous research on Oregon young workers by including the most recent WC claims data to identify patterns of injury and high risk industries.

METHODS

We obtained all accepted disabling claims (N = 13,360) and a significant portion of non-disabling claims (N = 24,660) on workers aged 24 years and under from 2013 to 2018. Claim count, rate and cost were calculated by year, age, gender, industry, and injury type. A prevention index (PI) method was used to rank industries in order to inform prevention efforts.

RESULTS

Average annual disabling and non-disabling claim rates were 111.6 and 401.3 per 10,000 young workers. Workers aged 19-21 (disabling: 119.0 per 10,000 and non-disabling: 429.3) and 22-24 years (115.7 and 396.4) and male workers (145.3 and 509.0) had higher claim rates than workers aged 14-18 (80.6 and 297.0) and female workers (79.8 and 282.9). The most frequent injury types were "struck by/against" (35.6%) and "work-related musculoskeletal disorders (WMSDs)" (19.5%). High risk industries included agriculture, construction, and manufacturing for both genders combined. For female young workers, the highest risk industry was healthcare.

CONCLUSIONS

This study demonstrated the added value of non-disabling WC claims data. Using both disabling and non-disabling data and PI method, agriculture, construction, manufacturing and healthcare industries were identified as priority workplaces to prevent common and costly injuries among Oregon young workers. Practical Applications: While the industries identified are considered hazardous for all workers, findings in this study can guide targeted research and prevention efforts specific to young workers.

Cost, Severity and Prevalence of Agricultural-Related Injury Workers' Compensation Claims in Farming Operations from 14 U.S. States

(1) Background: There is no national surveillance of agricultural injuries, despite agricultural occupations being among the most hazardous in the U.S. This effort uses workers' compensation (WC) data to estimate the burden of agricultural injuries and the likelihood of experiencing an injury by body part involved, cause, and nature in farming operations. (2) Methods: WC data from 2010 to 2016 provided by a large insurance company covering small to medium-sized farm operations from 14 U.S. states was used. We investigated the associations between injury characteristics and WC costs and the risk of having a more severe versus a less severe claim. The proportion of costs attributable to specific claim types was calculated. (3) Results: Of a total 1000 claims, 67% were medical only. The total cost incurred by WC payable claims (n = 866) was USD 21.5 million. Of this, 96% was attributable to more severe claims resulting in disabilities or death. The most common body part injured was the distal upper extremity. Falling or flying objects and collisions were the most expensive and common causes of injury. (4) Conclusions: Characterizing the cost and severity of agricultural injury by key injury characteristics may be useful when prioritizing prevention efforts in partnership with insurance companies and agricultural operations.

The effectiveness of ergonomic interventions in material handling operations

This study evaluated the effectiveness of ergonomic interventions in material handling operations involving 33 employers and 535 employees from 2012 to 2017. Outcomes included employee-reported low back/upper extremity pain and safety incidents at baseline, every three months, and annually for up to two years. A total of 32.5% of employees completed at least one survey, while 13.6% completed all nine surveys over two years. Among highly exposed employees (who reported handling >= 50 lbs. > 33% of the time), upper extremity pain frequency and severity were lower among those who reported using the intervention routinely versus those that reported using their body strength alone to handle objects >= 50 lbs. After excluding from analyses one employer that used anti-fatigue mats, low back pain frequency was also significantly lower among highly exposed intervention users. In conclusion, there was some evidence that the interventions were effective in reducing employee-reported pain for highly exposed employees.

Occupational traumatic injuries rarely affect genitourinary organs: a retrospective, comparative study

PURPOSE

To determine the mechanisms of injury associated with occupational injuries (OI) to genitourinary (GU) organs and compare GU OIs with GU non-OIs.

METHODS

A single institution, retrospective study was conducted at a level 1 trauma center between 2010 and 2016 of all patients with GU injuries. OI was defined as any traumatic event that occurred in the workplace requiring hospital admission. Types of occupations were recorded in addition to the location of injury, mechanisms of injury, concomitant injuries, operative interventions, total cost, and mortality. GU OI patients were then compared to GU non-OI patients.

RESULTS

623 patients suffered a GU injury, of which 39 (6.3%) had a GU OI. Fall (43%) was the most common mechanism of injury; followed by motor vehicle collision/motorcycle crash (31%), crush injury (18%), and pedestrian struck (8%). The adrenal gland (38%) and kidney (38%) were the most commonly injured organs. There was no difference in mortality (13% GU OI vs. 15% GU non-OI, p = 0.70) or total direct cost ($21,192 ± 28,543 GU OI vs. $28,215 ± 32,332 GU non-OI, p = 0.45). Total costs were decreased with mortality from a GU injury (odds ratio (OR) 0.3, CI 0.26-0.59; p = < 0.001) and increased with higher injury severity scores (OR 1.1, CI 1.09-1.2; p = < 0.0001). Total costs were not affected by OI status.

CONCLUSIONS

Occupational GU trauma presents with similar patterns of injury, hospital course, and direct cost as GU trauma that occurs in non-occupational settings.

Comparative analyses of workers' compensation claims of injury among temporary and permanent employed workers in Ohio

BACKGROUND

A small but increasing number of studies have examined the risk of injury among temporary workers compared to that among workers in permanent employer arrangements. The purpose of this study was to conduct a comparative analysis of injury risk among temporary and permanent employer workers using a large dataset of workers' compensation (WC) claims of injury.

METHODS

Over 1.3 million accepted WC claims in Ohio during the years 2001 to 2013 were analyzed, including 45 046 claims from workers employed by temporary services agencies. General descriptive statistics, injury rates and rate ratios (temporary to permanent workers) were calculated by injury type and event, industry group, and industry manual classes.

RESULTS

Injured temporary workers were younger and had less tenure compared to injured permanent workers. Temporary workers had higher injury rates, and lower lost-time and medical costs. Differences in injury rates between temporary and permanent workers varied by injury event, industry, and manual class.

CONCLUSION

Temporary workers had higher overall injury rates than permanent workers, controlling for industry manual class. These differences were pronounced for certain industries and injury events. We were not able to control for age and tenure of the worker, so it is not clear how these factors affected observed results. These findings were mostly similar to those from other studies using WC data from the states of Washington and Illinois. Together, these studies provide insights to improve injury prevention among temporary workers, however, additional research is still needed to improve safety and health programming for this group of workers.

Applying Machine Learning to Workers' Compensation Data to Identify Industry-Specific Ergonomic and Safety Prevention Priorities: Ohio, 2001 to 2011

OBJECTIVE

This study leveraged a state workers' compensation claims database and machine learning techniques to target prevention efforts by injury causation and industry.

METHODS

Injury causation auto-coding methods were developed to code more than 1.2 million Ohio Bureau of Workers' Compensation claims for this study. Industry groups were ranked for soft-tissue musculoskeletal claims that may have been preventable with biomechanical ergonomic (ERGO) or slip/trip/fall (STF) interventions.

RESULTS

On the basis of the average of claim count and rate ranks for more than 200 industry groups, Skilled Nursing Facilities (ERGO) and General Freight Trucking (STF) were the highest risk for lost-time claims (>7 days).

CONCLUSION

This study created a third, major causation-specific U.S. occupational injury surveillance system. These findings are being used to focus prevention resources on specific occupational injury types in specific industry groups, especially in Ohio. Other state bureaus or insurers may use similar methods.

Development of methods for using workers' compensation data for surveillance and prevention of occupational injuries among State-insured private employers in Ohio

BACKGROUND

Workers' compensation (WC) claims data may be useful for identifying high-risk industries and developing prevention strategies.

METHODS

WC claims data from private-industry employers insured by the Ohio state-based workers' compensation carrier from 2001 to 2011 were linked with the state's unemployment insurance (UI) data on the employer's industry and number of employees. National Labor Productivity and Costs survey data were used to adjust UI data and estimate full-time equivalents (FTE). Rates of WC claims per 100 FTE were computed and Poisson regression was used to evaluate differences in rates.

RESULTS

Most industries showed substantial claim count and rate reductions from 2001 to 2008, followed by a leveling or slight increase in claim count and rate from 2009 to 2011. Despite reductions, there were industry groups that had consistently higher rates.

CONCLUSION

WC claims data linked to employment data could be used to prioritize industries for injury research and prevention activities among State-insured private employers. Am. J. Ind. Med. 59:1087-1104, 2016. © 2016 Wiley Periodicals, Inc.

Injuries and Seasonal Risks among Young Workers in West Virginia—A 10-Year Retrospective Descriptive Analysis

This study used workers' compensation data to examine seasonal trends of compensable injuries among workers 14 to 24 years old during a 10-year period. These workers had higher rates of occupational injuries in major classes of industry (e.g., service, manufacturing, and agriculture) during summer and non-summer months. The overall rate of occupational injury was significantly higher for male workers than female workers in all age groups ( p & .001). Young workers experienced occupational injuries within less than 3 hours of starting a shift. Among males, injury rates were highest in the manufacturing industry for those 14 to 18 years old and in the service industry for those 22 to 24 years old for both seasons. These results indicate that preventing injuries among young workers should be a primary concern of education and health and safety professionals and parents.

Employer reasons for failing to report eligible workers' compensation claims in the BLS survey of occupational injuries and illnesses

Background

Little research has been done to identify reasons employers fail to report some injuries and illnesses in the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII).

Methods

We interviewed the 2012 Washington SOII respondents from establishments that had failed to report one or more eligible workers’ compensation claims in the SOII about their reasons for not reporting specific claims. Qualitative content analysis methods were used to identify themes and patterns in the responses.

Results

Non‐compliance with OSHA recordkeeping or SOII reporting instructions and data entry errors led to unreported claims. Some employers refused to include claims because they did not consider the injury to be work‐related, despite workers’ compensation eligibility. Participant responses brought the SOII eligibility of some claims into question.

Conclusion

Systematic and non‐systematic errors lead to SOII underreporting. Insufficient recordkeeping systems and limited knowledge of reporting requirements are barriers to accurate workplace injury records. Am. J. Ind. Med. 59:343–356, 2016. © 2016 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

Unreported workers' compensation claims to the BLS Survey of Occupational Injuries and Illnesses: Establishment factors

Background

Studies suggest employers underreport injuries to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII); less is known about reporting differences by establishment characteristics.

Methods

We linked SOII data to Washington State workers’ compensation claims data, using unemployment insurance data to improve linking accuracy. We used multivariable regression models to estimate incidence ratios (IR) of unreported workers’ compensation claims for establishment characteristics.

Results

An estimated 70% of workers’ compensation claims were reported in SOII. Claims among state and local government establishments were most likely to be reported. Compared to large manufacturing establishments, unreported claims were most common among small educational services establishments (IR = 2.47, 95%CI: 1.52–4.01) and large construction establishments (IR = 2.05, 95%CI: 1.77–2.37).

Conclusions

Underreporting of workers’ compensation claims to SOII varies by establishment characteristics, obscuring true differences in work injury incidence. Findings may differ from previous research due to differences in study methods. Am. J. Ind. Med. 59:274–289, 2016. © 2016 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

Isocyanates and work-related asthma: Findings from California, Massachusetts, Michigan, and New Jersey, 1993-2008

BACKGROUND

Isocyanates remain a leading cause of work-related asthma (WRA).

METHODS

Two independent data systems were analyzed for the period 1993-2008: (1) State-based WRA case surveillance data on persons with isocyanate-induced WRA from four states, and (2) Occupational Safety and Health Administration (OSHA) Integrated Management Information System (IMIS) isocyanate air sampling results.

RESULTS

We identified 368 cases of isocyanate-induced WRA from 32 industries and 678 OSHA isocyanate air samples with detectable levels from 31 industries. Seventeen industries were unique to one or the other dataset.

CONCLUSION

Isocyanate-induced WRA continues to occur in a wide variety of industries. Two data systems uncovered industries with isocyanate exposures and/or illness. Improved control measures and standards, including medical surveillance, are needed. More emphasis is needed on task-specific guidance, spill clean-up procedures, skin and respiratory protection, and targeted medical monitoring to mitigate the hazards of isocyanate use.

Musculoskeletal disorders and associated healthcare costs among family members of injured workers

BACKGROUND

Research has infrequently looked beyond the injured worker when gauging the burden of occupational injury.

OBJECTIVES

We explored the relationship between occupational injury and musculoskeletal disorders (MSDs) among family members of injured workers.

DATA AND METHODS

We used 2005 and 2006 Truven Health Analytics databases, which contain information on workers' compensation and family healthcare claims. We used descriptive analyses, and negative binomial and two-part models.

RESULTS

Family members of severely injured workers had a 15% increase in the total number of MSD outpatient claims and a 34% increase in the mean cost of MSD claims compared to family members of non-severely injured workers within 3 months after injury. Extrapolating cost results to the national level implies that severe occupational injury would be associated with between $29 and $33 million additional cost of family member outpatient MSD claims.

CONCLUSION

Occupational injury can impose a formerly unrecognized health burden on family members of injured workers.

Underreporting of musculoskeletal disorders in 10 regions in France in 2009

BACKGROUND

Underreporting of occupational diseases (OD) has been quantified, in particular in the United States, but little information is available in other countries. The aim of this study was to evaluate underreporting of musculoskeletal disorders (MSD) in France in 2009.

METHODS

We calculated an indicator that approximated the underreporting rate of MSD in 10 regions of France. Two databases were used: data on OD compensated by insurance funding and data from the surveillance program for uncompensated work-related diseases. Analyses were performed for carpal tunnel syndrome (CTS) and elbow, shoulder, and lumbar spine MSD.

RESULTS

The underreporting rate was estimated at 59% (range 52-64%) for CTS, 73% (range 67-79%) for elbow MSD, 69% (range 63-74%) for shoulder MSD, and 63% (range 50-76%) for lumbar spine MSD.

CONCLUSIONS

This study revealed that MSD are substantially underreported in France, as in the United States, despite the differences in workers' compensation systems.

Work-related injury underreporting among young workers: prevalence, gender differences, and explanations for underreporting

INTRODUCTION

Although notifying an employer of a lost-time work-related injury is a legal requirement in many jurisdictions, employees frequently do not report such injuries.

METHOD

Based on data from 21,345 young part-time Canadian workers (55% male), we found that 21% of respondents had experienced at least one lost-time injury, with about half reporting the injury to an employer and a doctor.

RESULTS

Respondents provided 10 reasons for avoiding reporting lost-time injuries, with perceived low severity of the injury, negative reactions of others, and ambiguity about whether work caused the injury as the most common ones. Additional analysis of these categories revealed that young males cited concern about their self-identity as a reason for not reporting an injury more often than young females did. We discuss the findings in terms of implications for management practice (i.e., educating young workers about accurate injury reporting) and public policy.

PRACTICAL APPLICATIONS

Targeted campaigns should be developed for young workers, especially young male workers, who are less likely to report injuries than young female workers, to understand the importance of and to encourage injury reporting.

Estimating the social cost of respiratory cancer cases attributable to occupational exposures in France

PURPOSE

The objective of this article was to estimate the social cost of respiratory cancer cases attributable to occupational risk factors in France in 2010.

METHODS

According to the attributable fraction method and based on available epidemiological data from the literature, we estimated the number of respiratory cancer cases due to each identified risk factor. We used the cost-of-illness method with a prevalence-based approach. We took into account the direct and indirect costs. We estimated the cost of production losses due to morbidity (absenteeism and presenteeism) and mortality costs (years of production losses) in the market and nonmarket spheres.

RESULTS

The social cost of lung, larynx, sinonasal and mesothelioma cancer caused by exposure to asbestos, chromium, diesel engine exhaust, paint, crystalline silica, wood and leather dust in France in 2010 were estimated at between 917 and 2,181 million euros. Between 795 and 2,011 million euros (87-92%) of total costs were due to lung cancer alone. Asbestos was by far the risk factor representing the greatest cost to French society in 2010 at between 531 and 1,538 million euros (58-71%), ahead of diesel engine exhaust, representing an estimated social cost of between 233 and 336 million euros, and crystalline silica (119-229 million euros). Indirect costs represented about 66% of total costs.

CONCLUSION

Our assessment shows the magnitude of the economic impact of occupational respiratory cancers. It allows comparisons between countries and provides valuable information for policy-makers responsible for defining public health priorities.

Effects of social, economic, and labor policies on occupational health disparities

BACKGROUND

This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States.

METHODS

We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.

RESULTS

Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker's compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.

CONCLUSIONS

There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.

Underreporting work absences for nontraumatic work-related musculoskeletal disorders to workers' compensation: results of a 2007-2008 survey of the Québec working population

OBJECTIVES

We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers' compensation (WC).

METHODS

In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression.

RESULTS

Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized.

CONCLUSIONS

The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation.

The impact of workplace factors on filing of workers' compensation claims among nursing home workers

Background

Injuries reported to workers’ compensation (WC) system are often used to estimate incidence of health outcomes and evaluate interventions in musculoskeletal epidemiology studies. However, WC claims represent a relatively small subset of all musculoskeletal disorders among employed individuals, and perhaps not a representative subset. This study determined the influence of workplace and individual factors on filing of workers’ compensation claims by nursing home employees with back pain.

Methods

Surveys were conducted in 18 skilled nursing facilities in four U.S. states. Self-administered questionnaires obtained information on demographic characteristics, working environment, and health behaviors/status. Employees who reported low back pain at least once in four questionnaire surveys were included. WC claims from the same facilities were obtained from the employer’s workers compensation insurer and matched by employee name. The dichotomous dependent variable was filing of back-related worker’s compensation claim. Association with predictors of interest, including pain severity, physical job demand, job strain, social support, schedule control, and safety climate, was assessed using multivariate regression modeling. Individual characteristics were tested as potential confounders.

Results

Pain severity level was significantly associated with filing low-back related claims (odds ratio (OR) = 1.49, 95% CI = 1.18 – 1.87). Higher physical demands at work (OR = 1.07, 95% CI = 1.01 – 1.14) also increased the likelihood of claim filing. Higher job strain (OR = 0.83, 95% CI = 0.73 – 0.94), social support at work (OR = 0.90, 95% CI = 0.82 – 0.99), and education (OR = 0.79, 95% CI = 0.71 – 0.89) decreased the likelihood of claim filing.

Conclusions

The results suggest that the WC system captured the most severe occupational injuries. Workplace factors had additional influence on workers’ decision to file claims, after adjusting for low back pain severity. Education was correlated with worker’s socioeconomic status; its influence on claim filing is difficult to interpret because of the possible mixed effects of working conditions, self-efficacy, and content knowledge.

Do zero-cost workers' compensation medical claims really have zero costs? The impact of workplace injury on group health insurance utilization and costs

OBJECTIVE

Previous research suggests that non-workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.

METHODS

Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.

RESULTS

Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.

CONCLUSION

Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.

The annual costs of cardiovascular diseases and mental disorders attributable to job strain in France

BACKGROUND

Work stress has become a major occupational risk factor in industrialized countries and an important economic issue. The objective was to estimate the annual costs of coronary heart diseases (CHD) and mental disorders (MD) attributable to job strain exposure according to Karasek's model in France for the year 2003 from a societal perspective.

METHODS

We produced attributable fraction estimates which were applied to the number of cases (morbidity and mortality) and the costs of CHD and MD. Relative risk estimates came from a systematic literature review of prospective studies. We conducted meta-analyses based on this selection of studies. Prevalence of exposure to job strain came from the national SUMER survey conducted in France in 2003. Costs included direct medical costs and indirect costs: production losses due to sick leaves and premature deaths.

RESULTS

Between 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD was attributable to job strain for men, and between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910-1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The total number of sick leave days amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from 1.8 to 3 billion euros for the year 2003 (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113-133 million euros and the cost of MD was between 1.7 - 2.8 billion euros in 2003.

CONCLUSION

This study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies.

The proportion of work-related emergency department visits not expected to be paid by workers' compensation: implications for occupational health surveillance, research, policy, and health equity

OBJECTIVE

To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits.

DATA SOURCE

A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys.

STUDY DESIGN

Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression.

PRINCIPAL FINDINGS

A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation.

CONCLUSIONS

Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications.

Safety, incentives, and the reporting of work-related injuries among union carpenters: "you're pretty much screwed if you get hurt at work"

BACKGROUND

In the high-risk construction industry little is known about the prevalence or effects of programs offering rewards for workers and/or their supervisors for improved safety records or those that punish workers in some way for injury.

METHODS

We conducted an anonymous survey of 1,020 carpenter apprentices in three union training programs to document prevalence of their exposure to such efforts. We explored associations between perceptions of the reporting of work-related injury and elements of these programs.

RESULTS

Fifty-eight percent (58%; n = 592) reported some safety incentive or negative consequence of work-related injuries on their current jobsite. Reporting of work-related injuries was 50% less prevalent when workers were disciplined for injury experiences. Otherwise, we saw minimal evidence of association between injury reporting practices and safety incentive programs. However, considerable evidence of fear of reprisal for reporting injuries was revealed. Less than half (46.4%) reported that work-related injuries were reported in their current workplace all or most of the time; over 30% said they were almost never or rarely reported.

CONCLUSIONS

There are multiple layers of disincentives to the reporting of work-related injuries that hamper understanding of risk and pose threats to workplace safety and productivity. These pressures do not arise in a vacuum and are likely influenced by a host of contextual factors. Efforts that help us understand variation across jobsites and time could be enlightening; such inquiries may require mixed methodologies and should be framed with consideration for the upper tiers of the public health hierarchy of hazard control.

Uncompensated consequences of workplace injuries and illness: long-term disability and early termination

PROBLEM

Costs related to early retirement, termination, or long-term disability could fall outside workers' compensation (WC).

METHOD

Statistical models examined early retirement, long-term disability status, or early termination related to WC claims.

RESULTS

The WC-associated early-termination rate ratio was 1.20 (95% CI=1.14-1.28) for hourly nonunion employees, 1.05 (95% CI=0.97-1.13) for hourly union employees, and 3.43 (95% CI=3.11-3.79) for salaried nonunion employees. In the manufacturing-durable sector the WC-associated rate ratio was 1.58 (95% CI=1.42-1.76) for hourly nonunion employees and 1.23 (95% CI=1.10-1.38) for union hourly employees. In contrast, in transportation-utilities-communications, the rate ratio was 0.52 (95% CI=0.46-0.59) for hourly nonunion and 1.22 (95% CI=1.08-1.38) for union hourly employees.

DISCUSSION

Uncompensated costs of workplace injuries and illnesses may result from adverse events previously compensated by WC. In some workplaces reduced termination rates with prior WC suggests added costs to employers.

SUMMARY

Conditions leading to WC claims have cost implications related to early - or delayed - removal from the workforce.

IMPACT ON INDUSTRY

Additional costs from work-related injury or illness that are not covered by workers compensation may result from the effect of continuing impairment on the subsequent early termination (or prolonging) of employment. These costs would accrue to both employers and employees and are not generally included in global estimates of the burden of workplace injuries and illnesses.

Incidence and cost of depression after occupational injury

OBJECTIVES

We examined if injured workers were more likely than noninjured workers to be treated for depression after an occupational injury and estimated the cost paid by group medical insurance.

METHOD

Nearly 367,900 injured and noninjured workers were drawn from the 2005 Thomson Reuters MarketScan data. Descriptive, logistic, and two-part model regression analyses were used.

RESULTS

The odds of injured workers being treated for depression within the study period were 45% higher than those of noninjured workers (95% confidence interval, 1.17-1.78). The unconditional average cost of outpatient depression treatment was 63% higher for injured workers than for noninjured workers.

CONCLUSIONS

Injured workers were more likely than noninjured workers to suffer from depression during the study period. Consequently, additional costs are incurred for treating injured workers' depression; these costs were not covered by the workers' compensation system.

Excess healthcare costs associated with prior workers' compensation activity

BACKGROUND

Workers compensation (WC) does not fully compensate workplace injuries and illnesses. This work examines whether cost shifting occurs to group health insurance for work-related injuries and illnesses.

METHODS

Thomson Reuters MarketScan databases of medical insurance claims were used. WC and other benefit system data, employee status and types of medical insurance coverage were also available. Medical cost was analyzed using two-part models: the first part modeled the monthly probability of a worker having any group health medical claims, and the second part modeled the total monthly cost of those medical claims. Models included an estimate of a worker's annual medical costs prior to a WC claim. The predicted monthly medical costs were derived by retransformation using Duan's smearing factor.

RESULTS

Individuals with prior WC claims were more likely to file a group health medical claim compared to those with no prior WC claims (OR = 1.25) and incurred a higher average monthly medical costs (among nonunion hourly men aged 18-34 years with prior WC claims: $203.72 vs. $160.29 with no prior claim, an increase of $43). These increases were observed in all industrial sectors with the service sector having the highest monthly increase ($66).

DISCUSSION

The results reveal that individuals with prior WC claims had higher probability of filing a group health medical claim and higher average monthly medical costs in all sectors. This suggests that a part of employer liability costs related to WC gets shifted to the group health medical insurance system.

Incidence and costs of family member hospitalization following injuries of workers' compensation claimants

BACKGROUND

The consequences of occupational injuries for the health of family members have rarely been studied. We hypothesized that non-fatal occupational injury would increase the incidence and costs of hospitalization among workers' families, and that family members of severely injured workers would be likely to experience greater increases in hospitalizations than family members of non-severely injured workers.

DATA AND METHODS

We used the MarketScan databases from Thomson Reuters for 2002-2005, which include workers' compensation and inpatient medical care claims data for injured workers' families. We used a before-after analysis to compare the odds and costs of family hospitalization 3 months before and after the index occupational injury among 18,411 families. Severe injuries were defined by receipt of indemnity payments and at least 7 days of lost work. Family hospitalizations were measured by the incidence of hospitalization of at least one family member.

RESULTS

Among families of all injured workers, the odds of at least one family member being hospitalized were 31% higher [95% confidence intervals (CI) = 1.11-1.55] in the 3 months following occupational injury than in the 3 months preceding injury. Among the families of severely injured workers, the odds of hospitalization were 56% higher [95% CI = 1.05-2.34] in the 3 months following injury. Hospitalization costs were found to rise by approximately the same percentage as hospitalization incidence.

CONCLUSION

The impact of occupational injury may extend beyond the workplace and adversely affect the health and inpatient medical care use of family members.

Work-related injuries and musculoskeletal disorders among factory workers in a major city of China

This study describes the frequency of occurrence of work-related injuries and musculoskeletal disorders (MSDs) among factory workers in Shenzhen, China, and examines the determinants of injuries and MSDs. A cross-sectional survey was conducted with 3479 frontline workers in 60 factories during 2008-2009. We calculated the annual incidence rates of work-related injuries and the prevalence rates of MSD (based on the Nordic Standard Form) for the factory workers. Logistic regression analysis was applied to explore the associations between potential risk factors and occupational injury and MSD. Among all participating workers, 8.3% reported acute traumatic injuries in the previous 12 months. The event-based incidence rate was 119.6 per 1000 person-years. About half of the frontline workers reported suffering from MSDs during the previous 12 months. The injury risk was reduced for female workers (Odds ratio, OR: 0.48; 95% confidence interval, CI: 0.36-0.66) and those with higher educational levels, but increased in workers with over 55 work hours/week (OR: 1.64; 95% CI: 1.21-2.22), high mental stress at work (OR: 3.50; 95% CI: 1.70-7.19) and previous injury history (OR: 3.94; 95% CI: 2.78-5.58). The MSD risk was increased among female workers (OR: 1.58; 95% CI: 1.34-1.87), and those with over 55 work hours/week (OR: 1.56; 95% CI: 1.28-1.90), high mental stress at work (OR: 3.16; 95% CI: 2.04-4.89) and a past injury history (OR: 3.04; 95% CI: 2.14-4.32). High proportions of frontline workers were affected by work injuries and MSDs in these factories in China. Long work hours, high mental stress at work and previous injury history were important risk factors for work-related injury and MSD.

The lack of correspondence between work-related disability and receipt of workers' compensation benefits

BACKGROUND

Previous studies suggest that many persons with disabilities caused by work do not receive workers' compensation benefits.

METHODS

Data from surveys of persons with disabilities were used to estimate the proportion of disability due to work-related injuries and diseases. Studies examining the proportion of workers with work-related disability who received workers' compensation benefits were reviewed. Legal and other factors explaining the lack of receipt of workers' compensation benefits were examined.

RESULTS

Many workers with disabilities caused by work do not receive workers' compensation benefits. The obstacles to compensation include increasingly restrictive rules for compensability in many state workers' compensation programs.

CONCLUSIONS

A substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits. The solutions to this problem, such as providing healthcare to workers regardless of the source of injuries or diseases, are complicated and controversial, and will be difficult to implement.

Use of statewide electronic emergency department data for occupational injury surveillance: a feasibility study in Massachusetts

BACKGROUND

Statewide datasets of emergency department (ED) visits may be useful for occupational injury surveillance. Using data from 12 hospitals, we evaluated two indicators of work-relatedness in reported ED data and the availability of employment information in medical charts.

METHODS

Workers' compensation as payer and/or "yes" in an injury-at-work field were used to define probable work-related (PWR) injury visits in the Massachusetts ED dataset. Charts were reviewed for a sample of 1,002 PWR and 250 probable nonwork-related (PNWR) cases.

RESULTS

Using chart information as the gold standard, indicators of work-relatedness had a sensitivity of 82%, specificity of 97%, and predictive value positive of 86%. Employer name was in charts for 89% of PWR and 42% of PNWR cases. Occupation was available for 34% of PWR cases.

CONCLUSION

Electronic ED data are useful for state surveillance of occupational injuries. Improvements in attribution of work-relatedness and collection of available employer identifiers and occupational information would enhance its usefulness. The performance of indicators of work-relatedness in ED datasets should be examined in different states.

Estimating the extent and distribution of new-onset adult asthma in British Columbia using frequentist and Bayesian approaches

INTRODUCTION

We previously described a method to identify the incidence of new-onset adult asthma (NOAA) in Alberta by industry and occupation, utilizing Workers' Compensation Board (WCB) and physician billing data. The aim of this study was to extend this method to data from British Columbia (BC) so as to compare the two provinces and to incorporate Bayesian methodology into estimates of risk.

METHODS

WCB claims for any reason 1995-2004 were linked to physician billing data. NOAA was defined as a billing for asthma (ICD-9 493) in the 12 months before a WCB claim without asthma in the previous 3 years. Incidence was calculated by occupation and industry. In a matched case-referent analysis, associations with exposures were examined using an asthma-specific job exposure matrix (JEM). Posterior distributions from the Alberta analysis and estimated misclassification parameters were used as priors in the Bayesian analysis of the BC data.

RESULTS

Among 1 118 239 eligible WCB claims the incidence of NOAA was 1.4%. Sixteen occupations and 44 industries had a significantly increased risk; six industries had a decreased risk. The JEM identified wood dust [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.08-2.24] and animal antigens (OR 1.66, 95% CI 1.17-2.36) as related to an increased risk of NOAA. Exposure to isocyanates was associated with decreased risk (OR 0.57, 95% CI 0.39-0.85). Bayesian analyses taking account of exposure misclassification and informative priors resulted in posterior distributions of ORs with lower boundary of 95% credible intervals >1.00 for almost all exposures.

CONCLUSIONS

The distribution of NOAA in BC appeared somewhat similar to that in Alberta, except for isocyanates. Bayesian analyses allowed incorporation of prior evidence into risk estimates, permitting reconsideration of the apparently protective effect of isocyanate exposure.

Economic burden of occupational injury and illness in the United States

CONTEXT

The allocation of scarce health care resources requires a knowledge of disease costs. Whereas many studies of a variety of diseases are available, few focus on job-related injuries and illnesses. This article provides estimates of the national costs of occupational injury and illness among civilians in the United States for 2007.

METHODS

This study provides estimates of both the incidence of fatal and nonfatal injuries and nonfatal illnesses and the prevalence of fatal diseases as well as both medical and indirect (productivity) costs. To generate the estimates, I combined primary and secondary data sources with parameters from the literature and model assumptions. My primary sources were injury, disease, employment, and inflation data from the U.S. Bureau of Labor Statistics (BLS) and the Centers for Disease Control and Prevention (CDC) as well as costs data from the National Council on Compensation Insurance and the Healthcare Cost and Utilization Project. My secondary sources were the National Academy of Social Insurance, literature estimates of Attributable Fractions (AF) of diseases with occupational components, and national estimates for all health care costs. Critical model assumptions were applied to the underreporting of injuries, wage-replacement rates, and AFs. Total costs were calculated by multiplying the number of cases by the average cost per case. A sensitivity analysis tested for the effects of the most consequential assumptions. Numerous improvements over earlier studies included reliance on BLS data for government workers and ten specific cancer sites rather than only one broad cancer category.

FINDINGS

The number of fatal and nonfatal injuries in 2007 was estimated to be more than 5,600 and almost 8,559,000, respectively, at a cost of $6 billion and $186 billion. The number of fatal and nonfatal illnesses was estimated at more than 53,000 and nearly 427,000, respectively, with cost estimates of $46 billion and $12 billion. For injuries and diseases combined, medical cost estimates were $67 billion (27% of the total), and indirect costs were almost $183 billion (73%). Injuries comprised 77 percent of the total, and diseases accounted for 23 percent. The total estimated costs were approximately $250 billion, compared with the inflation-adjusted cost of $217 billion for 1992.

CONCLUSIONS

The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers' compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job-related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed.

Work-relatedness of selected chronic medical conditions and workers' compensation utilization: National health interview survey occupational health supplement data

BACKGROUND

An occupational health supplement (OHS) to the 1988 National Health Interview Survey (NHIS) bypassed many limitations of traditional occupational health surveillance systems, but the data collected about chronic work-related conditions have not yet been reported.

METHODS

We calculated the prevalence and proportion of cases related to work for the aggregation of 13 chronic conditions included in the NHIS-OHS, and for 11 conditions individually. For each of nine conditions, and for the aggregation of all conditions, we also calculated the prevalence of workers' compensation claims filed.

RESULTS

The overall prevalence of work-related chronic conditions was 7.5% (SE = 0.16). The work-related conditions with the highest prevalence were repeated trouble with the back/neck/spine (4.91%; SE = 0.13) and trouble hearing (1.14%; SE = 0.06). Overall, workers' compensation claims were filed for 39.0% (SE = 1.00) of work-related cases.

CONCLUSIONS

The burden of work-related illnesses in the US is substantial, and the workers' compensation system is underutilized.

Second WCB claims: who is at risk?

OBJECTIVES

Many workers with one Workers' Compensation Board (WCB) claim make further claims. If the characteristics of the job, initial injury or worker were predictive of an early second claim, interventions at the time of return to work after the first claim might be effective in reducing the burden of work-related injury. This report explores the characteristic of those who make a second claim.

METHODS

Records of all Alberta WCB claims from January 1, 1995, to December 31, 2004, for individuals 18 to < 66 years old were reviewed. For each individual's first claim, sex and age of claimant, type of injury, type of accident, occupation, industry, an indicator of company size, and industry claim rate were extracted, as well as the date of any second claim. The likelihood of second claim and mean time to second claim were estimated. Multivariate analyses were performed using Cox regression.

RESULTS

1,047,828 claims were identified from 490,230 individuals. Of these, 49.2% had at least two claims. In the multivariate model a reduced time to second claim was associated with male sex, younger age and some types of injury and accident. Machining trades were at highest risk of early second claim (hazard ratio [HR] 2.54 compared with administration), and of the industry sectors manufacturing was at highest risk (HR 1.37 compared with business, personal and professional services).

CONCLUSION

Some caution is needed in interpreting these data as they may be affected by under-reporting and job changes between claims. Nonetheless, they suggest that there remains room for interventions to reduce the considerable differences in risk of a second claim among workers, jobs and industries.

Who is paying the bills? Health care costs for musculoskeletal back disorders, Washington State Union Carpenters, 1989-2003

OBJECTIVE

Factors associated with private health insurance payment rates for musculoskeletal back disorders were examined among a 15-year cohort of union carpenters. Payment patterns were contrasted with work-related back injury rates over time.

METHODS

Negative binomial regression was used to assess payment rates; generalized estimated equations accounted for multiple observations per person and cost correlation within subjects.

RESULTS

Payment rates increased after work-related injury and with the number of injuries. Increasing private payments and deductibles (inflation-adjusted and discounted) were observed in contrast with a marked decline in reported work-related injuries.

CONCLUSIONS

Private insurance payments do not appear to be independent of work-related back injury. Findings suggest cost-shifting from workers' compensation to the union-provided health insurance and to the worker; they also provide a warning regarding reliance on workers' compensation statistics for surveillance of work-related disorders or disease.

Injured Workers' Underreporting in the Health Care Industry: An Analysis Using Quantitative, Qualitative, and Observational Data

Underreporting of occupational injuries was examined in four health care facilities using quantitative, qualitative, and observational data. Occupational Safety and Health Administration logs accounted for only one-third of the workers' compensation records; 45 percent of injured workers followed by survey had workers' compensation claims. Workers reported 63 percent of serious occupational injuries. Underreporting is explained by time pressure and workers' doubts about eligibility, reputation, income loss, and career prospects. Though aware of underreporting, managers subtly believe in workers' moral hazard behaviors.

Community campaigns, supply chains, and protecting the health and well-being of workers

The growth of contingent work (also known as precarious employment), the informal sector, and business practices that diffuse employer responsibility for worker health and safety (such as outsourcing and the development of extended national and international contracting networks [supply chains]) pose a serious threat to occupational health and safety that disproportionately affects low-wage, ethnic minority, and immigrant workers. Drawing on cases from the United States and Australia, we examine the role that community-based campaigns can play in meeting these challenges, including several successful campaigns that incorporate supply chain regulation.

Data linkage to estimate the extent and distribution of occupational disease: new onset adult asthma in Alberta, Canada

BACKGROUND

Although occupational asthma is a well recognized and preventable disease, the numbers of cases presenting for compensation may be far lower than the true incidence.

METHODS

Workers' Compensation Board (WCB) claims for any reason 1995-2004 were linked to physician billing data. New onset adult asthma (NOAA) was defined as a billing for asthma (ICD-9 code of 493) in the 12 months prior to a WCB claim without asthma in the previous 3 years. Incidence was calculated by occupation, industry and, in a case-referent analysis, exposures estimated from an asthma specific job exposure matrix.

RESULTS

There were 782,908 WCB eligible claims, with an incidence rate for NOAA of 1.6%: 23 occupations and 21 industries had a significantly increased risk. Isocyanates (OR 1.54: 95% CI 1.01-2.36) and exposure to mixed agricultural allergens (OR = 1.59: 95% CI 1.17-2.18) were related to NOAA overall, as were exposures to cleaning chemicals in men (OR = 1.91:95% CI 1.34-2.73). Estimates of the number of cases of occupational asthma suggested a range of 4% to about half for the proportion compensated.

CONCLUSIONS

Data linkage of administrative records can demonstrate under-reporting of occupational asthma and indicate areas for prevention.

Information and feedback to improve occupational physicians' reporting of occupational diseases: a randomised controlled trial

Purpose

To assess the effectiveness of supplying occupational physicians (OPs) with targeted and stage-matched information or with feedback on reporting occupational diseases to the national registry in the Netherlands.

Methods

In a randomized controlled design, 1076 OPs were divided into three groups based on previous reporting behaviour: precontemplators not considering reporting, contemplators considering reporting and actioners reporting occupational diseases. Precontemplators and contemplators were randomly assigned to receive stage-matched, stage-mismatched or general information. Actioners were randomly assigned to receive personalized or standardized feedback upon notification. Outcome measures were the number of OPs reporting and the number of reported occupational diseases in a 180-day period before and after the intervention.

Results

Precontemplators were significantly more male and self-employed compared to contemplators and actioners. There was no significant effect of stage-matched information versus stage-mismatched or general information on the percentage of reporting OPs and on the mean number of notifications in each group. Receiving any information affected reporting more in contemplators than in precontemplators. The mean number of notifications in actioners increased more after personalized feedback than after standardized feedback, but the difference was not significant.

Conclusions

This study supports the concept that contemplators are more susceptible to receiving information but could not confirm an effect of stage-matching this information on reporting occupational diseases to the national registry.

A conceptual framework for integrating workplace health promotion and occupational ergonomics programs

Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health--especially ergonomics--with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.

Livestock-handling injuries in agriculture: an analysis of Colorado workers' compensation data

BACKGROUND

Previous studies have reported that livestock-handling injuries are among the most severe of agricultural injuries. This study identifies the costs, characteristics, and contributing factors associated with livestock-handling injuries among Colorado dairy farmers, cattle/livestock raisers, and cattle dealers.

METHODS

A 10-year (1997-2006) history of Colorado's workers' compensation claims data was used for analysis. Descriptive analyses of livestock-handling injury claims were performed. Claim cost analysis was also conducted. The agent-host-environment epidemiological model was used to analyze injury event descriptions.

RESULTS

A total of 1,114 livestock-handling claims were analyzed. Claims associated with milking parlor tasks represented nearly 50% of injuries among dairy workers. Claims associated with riding horseback, sorting/penning cattle, and livestock-handling equipment represented high proportions of livestock-handling injuries among cattle/livestock raisers and cattle dealers. Claims associated with livestock-handling represented the highest percentage of high-cost and high-severity injuries in all three sectors.

CONCLUSIONS

Livestock-handling injuries are a significant problem, more costly, and result in more time off work than other causes of agricultural injuries. There is a strong and compelling need to develop cost-effective interventions to reduce the number of livestock-handling injuries in agriculture.

Work-related hand fracture injuries in British Columbia, Canada: a population-based BC-linked health data-set study

Objective

To define population-based incidence, demographics and claim rates, as well as clinical presentation and claims duration and costs for work-related hand fractures in British Columbia (BC), Canada in 2001.

Methods

A BC-linked health data-set one-year retrospective review of all reported work-place hand fracture injuries in BC in 2001 with additional evaluation of individual health care and claims data from randomly selected individuals with a compensation claim in 2001.

Results

There were 14,654 hand fractures, of which 14% (2085) were work related; an annual incidence rate of 11/10,000 workers. Males accounted for 88% (1488/2085) of the fractures and the mean age was 39 (SD: ±12). Only 60% (290/482) of randomly selected people filed a compensation claim. Of these claims, 90% (260) had a validated hand fracture injury, 72% (218) were non-articular and 13% (38) had complex associated tissue injuries. About 69% (180) had no or simple closed reduction, 82% (213) had no additional fixation, 63% (163) were immobilized for at least 21 days and 9% (24) developed a secondary complication that required surgery. Average days off work was 46 (range 0–290) and average claims cost was $5500 CDN (range $145–$56,900).

Conclusions

Hand fractures are a common workplace injury in BC, with a significant proportion of workers not claiming compensation. These injuries generally presented clinically as simple fractures that were managed conservatively with few complications. Despite this, there was still a significant socioeconomic burden primarily due to lost work-place productivity due to time loss from work. These findings likely reflect similar trends for work-related hand fractures throughout Canada and other countries with similar health care and workers' compensation systems.

Doenças do trabalho e benefícios previdenciários relacionados à saúde, Bahia, 2000

OBJETIVO: Estimar a contribuição das doenças relacionadas ao trabalho nos afastamentos por problemas de saúde em geral e ocupacionais. MÉTODOS: Foram analisados dados sociodemográficos, ocupacionais e de saúde referentes a 29.658 registros dos benefícios por incapacidade temporária concedidos por agravos à saúde pelo Instituto Nacional do Seguro Social, no Estado da Bahia, em 2000. Foram considerados casos todos os diagnósticos clínicos constantes da CID-10, com exceção das causas externas e fatores que influenciam o contato com os serviços de saúde. A vinculação do diagnóstico com a ocupação baseou-se no código CID-10 e se a espécie do benefício era "acidentária". RESULTADOS: Dentre os benefícios, 3,1% foram concedidos para doenças do trabalho: 70% eram doenças do sistema osteomuscular e do tecido conjuntivo e 14,5% do sistema nervoso. No geral, benefícios concedidos numa freqüência maior que o dobro da esperada foram: para tenossinovites na indústria da transformação (Razão de Proporção-RP=2,70), síndrome do túnel do carpo na intermediação financeira (RP=2,43) e transtornos do disco lombar no ramo de transporte, correio e telecomunicações (RP=2,17). Entretanto, não foi estabelecido nexo causal para estas doenças, nesses ramos de atividade, em percentual significativo de benefícios. CONCLUSÕES: Os resultados sugerem a existência de possíveis fatores de risco ocupacionais para enfermidades nesses ramos de atividade, como também o sub-registro da vinculação das patologias com o trabalho, camuflando a responsabilidade das empresas e a perspectiva de prevenção pela reorganização do trabalho.