Healthcare use before and after a workplace injury in British Columbia, Canada

Examining associations between work-related injuries and all-cause healthcare use among middle-aged and older workers in Canada using CLSA data

INTRODUCTION

Prior studies examining the relationship between work- related injuries and healthcare use among middle-aged and older workers were mainly cross-sectional and reported inconsistent results.

OBJECTIVE

The objective of this study was to examine the associations between work-related injuries and 10 types of healthcare service use for any cause among middle-aged and older Canadian workers using longitudinal data.

METHODS

Our study involved longitudinal analysis of baseline and 18-month follow-up Maintaining Contact Questionnaire data from the Canadian Longitudinal Survey on Aging (CLSA) for a national sample of Canadian males and females aged 45-85 years who worked or were recently retired (N = 24,748).

RESULTS

Among CLSA participants who worked or were recently retired, 361 per 10,000 reported a work-related injury within the year prior to the survey. Work-related injuries decreased with increasing age. Work-related injury was associated with emergency department visits, overnight hospitalization, visits to dentists, and visits to physiotherapists, occupational therapists, or chiropractors at follow-up in bivariate analyses. Compared to those with no work-related injuries, Canadians with work-related injuries had used, on average, a significantly higher number of health services within the last 12 months prior their survey. When controlling for the contribution of various socio-demographic, work-related, and health-related characteristics, work-related injuries remained a significant predictor of emergency department visits and visits to physiotherapists, occupational therapists, or chiropractors.

CONCLUSIONS

The relationship between work-related injuries, emergency department visits, and visits to physiotherapists, occupational therapists, or chiropractors in middle-aged and older workers in Canada suggests that workplace injuries can be associated with ongoing health problems.

PRACTICAL APPLICATIONS

Healthcare services used by injured employees must be considered priorities for employment insurance coverage, if not already covered. Future research should more fully examine whether pre-existing health conditions predict both work-related injury and subsequent health problems. Injury-specific healthcare use following work-related injuries in middle-aged and older workers, as well as economic costs, should also be examined.

Associations Between Firearm and Suicide Rates: A Replication of Kleck (2021)

OBJECTIVE

Using data from n = 194 nation-states, Kleck found that firearm availability was only associated with firearm suicide rates, but not total or non-firearm suicides. He thus concluded that while firearm availability influences how people commit suicide, it does not affect total numbers. However, the study contains numerous logical and methodological issues and is at odds with the evidence base. Therefore, I attempt to reproduce the original results.

METHOD

I reproduce the original study's methods: ordinary least squares regression, weighted by the square root of the population, with log-transformed suicide rates and three separate firearm availability measures: global estimates from the Small Arms Survey, proportion of suicides committed with firearms, and a European Union survey of firearm ownership. I also test several methodological variations and include U.S. suicide data.

RESULTS

In contrast to Kleck, global analyses with Small Arms Survey data found a significant and positive association between firearm availability and total suicides, as did U.S. analyses. Analyses with other firearm availability measures comported with the original study, finding no association.

CONCLUSION

The main result in Kleck failed to reproduce, finding instead a significant association between firearm availability and suicide rates, as did U.S. analyses. While reproductions of Kleck's other analyses continued to show no association, they were based on unreliable methods. I therefore reject Kleck's conclusion that that firearm availability does not influence suicide rates. HighlightsUsing data global data, I find firearm availability is positively associated with suicide rates.I identify serious flaws in the logic and methods of Kleck and an earlier review.For transparency, data and code have been archived on a public repository.

The impact of long-term workers' compensation benefit cessation on welfare and health service use: protocol for a longitudinal controlled data linkage study

Background

In 2012, the Australian state of New South Wales passed legislation that reformed its workers’ compensation system. Section 39 introduced a five-year limit on income replacement, with the first affected group having their benefits cease in December 2017. There is limited evidence on how this will affect their healthcare service use and where they will go for financial support.

Methods

Multiple data sources will be linked: administrate workers’ compensation claims data from the State Insurance Regulatory Authority (SIRA), universal health insurance data from the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), state hospital and emergency department data, and social welfare data from the Department of Social Services’ Data Over Multiple Individual Occurrences (DOMINO). An estimated 4,125 injured workers had their benefits cease due to Section 39. These will form the exposure group who will be compared to 1) a similar group of workers’ compensation claimants who have had at least two years of compensated time off work but whose benefits did not cease due to Section 39; and 2) a community comparison group drawn from state hospital and emergency department records.

An accredited third party will link the data, which will be accessible only via secure virtual machine. Initial analyses will compare the prevalence and incidence of service use across groups in both the year before and year after benefit cessation; the community control will be assigned the median benefit cessation date in lieu of an actual date. To estimate the impact of benefit cessation due to Section 39, we will conduct time series analysis of the prevalence and incidence of service use.

Discussion

This study will provide much-needed evidence on the consequences of long-term benefit cessation, particularly on subsequent healthcare and welfare service use.

Examining Canada's return visits to the emergency department after a concussion

OBJECTIVES

The purpose of this study was to identify 1) the proportion of patients discharged from the emergency department (ED) with a diagnosis of concussion and return within 14 days, and 2) the characteristics that prompt a return.

METHODS

A health records review was conducted on adult patients with a discharge diagnosis of a concussion who accessed care through Hamilton Health Sciences EDs and Urgent Care Centre in 2016. Subsequent data were collected from those who returned to the ED within 14 days. Clinical characteristics of returners were compared to those of non-returners.

RESULTS

Of the 389 patients included in the study, 38 (10%) returned within 14 days. Patients who sustained a concussion in a sport-related context or were referred to a specialized clinic were less likely to return (p = 0.03). Those who suffered an assault-related concussion were more likely to return (p = 0.01). Of those who did return, 42% received a CT scan with normal results, and 42% were given new discharge instructions.

CONCLUSIONS

Approximately 10% of patients diagnosed with a concussion in a Canadian hospital setting returned to the ED within 14 days of their index visit. Our study suggests the opportunity to reduce this burden to both the healthcare system and the patient through careful discharge instructions outlining anticipated symptoms following a concussion (specifically, headache) or referral to a concussion clinic.

Occupational Health in Community Health Centers: Practitioner Challenges and Recommendations

Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.

Diagnosed Chronic Health Conditions Among Injured Workers With Permanent Impairments and the General Population

OBJECTIVE

To profile chronic health conditions of an injured worker sample before and after workplace injury and compare injured workers to a matched community sample.

METHODS

Logistic regression analyses compared risk of certain chronic health conditions for permanently disabled injured workers in the pre- and post-injury periods to comparator subsamples from the Canadian Community Health Surveys 2003 and 2009/2010.

RESULTS

There were notable health differences between the injured worker and comparator samples for the post-injury period. Injured men and women were more likely to report arthritis, hypertension, ulcers, depression, and back problems than the comparator sample. Injured women were also more likely to report migraine headaches and asthma.

CONCLUSIONS

The observed differences suggest that permanently impaired injured workers experience more rapidly accelerated health declines than other aging workers, and this outcome is gendered.

Economic evaluation of occupational health and safety programmes in health care

BACKGROUND

Evidence-based resource allocation in the public health care sector requires reliable economic evaluations that are different from those needed in the commercial sector.

AIMS

To describe a framework for conducting economic evaluations of occupational health and safety (OHS) programmes in health care developed with sector stakeholders. To define key resources and outcomes to be considered in economic evaluations of OHS programmes and to integrate these into a comprehensive framework.

METHODS

Participatory action research supported by mixed qualitative and quantitative methods, including a multi-stakeholder working group, 25 key informant interviews, a 41-member Delphi panel and structured nominal group discussions.

RESULTS

We found three resources had top priority: OHS staff time, training the workers and programme planning, promotion and evaluation. Similarly, five outcomes had top priority: number of injuries, safety climate, job satisfaction, quality of care and work days lost. The resulting framework was built around seven principles of good practice that stakeholders can use to assist them in conducting economic evaluations of OHS programmes.

CONCLUSIONS

Use of a framework resulting from this participatory action research approach may increase the quality of economic evaluations of OHS programmes and facilitate programme comparisons for evidence-based resource allocation decisions. The principles may be applicable to other service sectors funded from general taxes and more broadly to economic evaluations of OHS programmes in general.

Long-term health outcomes of work-related injuries among construction workers--findings from the National Longitudinal Survey of Youth

BACKGROUND

This study examined the relationship between work-related injuries and health outcomes among a cohort of blue-collar construction workers.

MATERIALS AND METHODS

Data were from the National Longitudinal Survey of Youth, 1979 cohort (NLSY79; n = 12,686). A range of health outcomes among blue-collar construction workers (n = 1,435) were measured when they turned age 40 (1998-2006) and stratified by these workers' prior work-related injury status between 1988 and 2000. Univariate and multivariate analyses were conducted to measure differences among subgroups.

RESULTS

About 38% of the construction cohort reported injuries resulting in days away from work (DAFW); another 15% were injured but reported no DAFW (NDAFW). At age 40, an average of 10 years after injury, those with DAFW injury had worse self-reported general health and mental health, and more diagnosed conditions and functional limitations than those without injury. This difference was statistically significant after controlling for major demographics.

DISCUSSION

Adverse health effects from occupational injury among construction workers persist longer than previously documented.

Declining rates of work-related overexertion back injuries among union drywall installers in Washington State, 1989-2008: Improved work safety or shifting of care?

INTRODUCTION

Construction workers are at high risk of work-related musculoskeletal back disorders, and research suggests medical care and costs associated with these conditions may be covered by sources other than workers' compensation (WC). Little is known about the back injury experience and care seeking behavior among drywall installers, a high-risk workgroup regularly exposed to repetitive activities, awkward postures, and handling heavy building materials.

METHODS

Among a cohort of 24,830 Washington State union carpenters (1989-2008), including 5,073 drywall installers, we identified WC claims, visits for health care covered through union-provided health insurance and time at risk. Rates of work-related overexertion back injuries (defined using WC claims data) and health care utilization for musculoskeletal back disorders covered by private health insurance were examined and contrasted over time and by worker characteristics, stratified by type of work (drywall installation, other carpentry).

RESULTS

Drywall installers' work-related overexertion back injury rates exceeded those of other carpenters (adjusted IRR 1.63, 95% CI 1.48-1.78). For both carpentry groups, rates declined significantly over time. In contrast, rates of private healthcare utilization for musculoskeletal back disorders were similar for drywall installers compared to other carpenters; they increased over time (after the mid-1990s), with increasing years in the union, and with increasing numbers of work-related overexertion back injuries.

CONCLUSIONS

Observed declines over time in the rate of work-related overexertion back injury, as based on WC claims data, is encouraging. However, results add to the growing literature suggesting care for work-related conditions may be being sought outside of the WC system.

Legal sequelae of occupational back injuries: a longitudinal analysis of Missouri judicial records

STUDY DESIGN

Telephone survey and longitudinal analysis of judicial database for cohort of worker's compensation (WC) claimants in Missouri.

OBJECTIVE

To compare legal difficulties experienced by African American and white WC claimants presettlement versus postsettlement.

SUMMARY OF BACKGROUND DATA

Retrospective studies suggest that workers with occupational back injuries experience financial and personal duress after claim settlement. This study examined these issues by comparing financial and domestic court actions for the 5-year presettlement against 5-year postsettlement. Sociodemographic differences also were examined.

METHODS

Missouri judicial records were reviewed for African American (n = 580) and non-Hispanic white (n = 892) WC claimants to determine the frequency with which four types of cases occurred: general financial, domestic financial, residence financial, and domestic behavior. Average annual level of judicial activity during the 5 years before claim settlement was compared to activity for each of five postsettlement years; significance of change was evaluated with univariate and multivariate repeated measures analyses.

RESULTS

Statistically significant (P < 0.001) postsettlement increases in legal cases were noted for each of the four categories of cases. There were significant interactions between race and time for general financial and domestic financial cases. A significant interaction between age and time occurred for general financial cases. Significant three-way interactions (race × income change × time) emerged for general and domestic financial cases.

CONCLUSION

The results confirm that workers with occupational back injuries, especially African American and younger adults, encounter long-term financial and domestic duress that appears to escalate with each passing year after claim settlement. This pattern suggests that short-term studies underestimate postsettlement difficulties, particularly among selected demographic cohorts.

Access to workers' compensation benefits and other legal protections for work-related mental health problems: a Canadian overview

This article reports on a study of the legal and policy framework governing access, in Canada, to workers' compensation benefits for workers who are work disabled because of mental health problems attributed to stressful working conditions and events. It also provides a brief description of legislation regulating psychological harassment in Quebec and Saskatchewan. Applying classic legal methodology, the article examines the legal situation in Canada, relying on federal and provincial legislation and case law. While many of the jurisdictions studied explicitly restrict compensability to the consequences of traumatic incidents, application of this legislation is very different from one province to the next. In some provinces, legal exclusions are applied emphatically, whereas in others the workers' compensation appeal tribunals interpret the legislative exclusions much more narrowly, allowing for some access to compensation despite the legislative exclusions. Other provinces have no such exclusions and accept claims for both acute and chronic stress, although access to compensation remains more difficult for claimants with mental health problems than for those who are physically injured, regardless of where they live. The article concludes by offering an analysis of the consequences of the current situation from a public policy and public health perspective, notably underlining the negative consequences, particularly for women, of current workers' compensation policy in most Canadian provinces.

Increased expenditures for other health conditions after an incident of low back pain

STUDY DESIGN

We reviewed healthcare expenditures in a random sample of 655 patients from a managed health plan with new onset low back pain (LBP) in 1999.

OBJECTIVE

To understand the affect of LBP on health care utilization for other health conditions.

SUMMARY OF BACKGROUND DATA

Researchers often consider individual diseases in isolation rather than seeking a more comprehensive picture of comorbid conditions and their collective influence. Although underlying health conditions may exacerbate LBP, as has been discussed extensively, minimal attention has been given to the potential affect of LBP on other conditions.

METHODS

We compared the healthcare expenses using 30-, 60-, and 90-day back care time windows before and after the initial LBP visit. Diagnostic (International Classification of Diseases, Ninth Revision) and treatment codes (Current Procedural Terminology [CPT]) were used to identify the expenditures for LBP and other conditions.

RESULTS

Average monthly expenses per patient for other health conditions increased after LBP initiation when compared with the prior 1 to 3 months. This increase persisted even after the following conservative adjustments: (a) excluding all radiology expenses that occurred coincident with LBP; (b) excluding billings for non-LBP conditions that occurred on days of any LBP visit because these charges may have reflected mere convenience "shopping or servicing" behavior; (c) excluding patients with a baseline of low healthcare utilization before LBP initiation because convenience may have been especially important for this cohort. Patients with greater non-LBP expenses were likelier to have been prescribed psychiatric medications.

CONCLUSION

LBP episodes were associated with increased expenditures for other health conditions. This suggests that the traditional estimates of LBP based primarily on LBP services underestimate the true cost of the condition. Further research may help to delineate the role of LBP, along with physical or mental comorbidities in boosting non-LBP costs.

Healthcare use of families of injured workers before and after a workplace injury in british columbia, Canada

OBJECTIVES

To examine the overall healthcare and mental healthcare services use of families of injured workers before and after a workplace injury.

METHODS

We use an administrative database that links individual publicly funded healthcare data and Workers' Compensation Board (WCB) data for the entire population of British Columbia (BC), Canada. The spouses and children of all injured workers who filed a WCB claim in 1994 and missed one or more days of work due to the injury (lost time) were included. We compare their change in use of healthcare services relative to a year before the injury to families of workers who did not require time off for their injuries (no lost time) and families of individuals who were not injured (non-injured comparisons).

RESULTS

Differences in healthcare services use among the three groups of spouses were marginal, and differences for increases in mental healthcare services use were non-significant. As well, all three groups of children decreased their use of physician and hospital services and increased their use of mental healthcare services, with very little difference among groups.

CONCLUSION

This was a descriptive study looking at a broad group of injured workers and their families. Even modest increases in healthcare use following a workplace injury have some basis for further study.