Occupational impairment and disability among applicants for Social Security disability benefits in Pennsylvania

Association between longest-held occupation and Social Security Disability Insurance benefits receipt

INTRODUCTION

The cost of the Social Security Disability Insurance (DI) program has increased over time though recent reports showed that disability incidence and prevalence rates have started declining. We explored whether occupation was one of the risk factors for the rising number of disabled workers who received DI benefits during 1992-2016.

METHODS

We used a cohort of 16 196 Health and Retirement Survey respondents between the age of 51 and 64 years who were followed from their date of entry until they received DI benefits, died, reached full retirement age, or reached the end of the follow-up period (2016). We used the extended stratified Cox proportional hazard model. Because one-third of the respondents in our cohort did not report their longest-held occupation, we used a multiple-imputation method.

RESULTS

The hazard of receiving DI benefits was 51%, 78%, 81%, and 85% higher among workers with longest-held occupations in sales, mechanics and repair, protective services, and personal services, respectively than among workers with longest-held occupations in the reference managerial occupation. The hazard of receiving DI benefits was more than double among workers with longest-held occupations in the construction trade and extractors, transportation operation, machine operators, handlers, and food preparation than among workers with the longest-held occupation in the reference managerial occupation.

CONCLUSION

Improving the overall working conditions in these occupations would help reduce worker suffering and the number of applicants for DI benefits, thereby reducing the burden of workplace injury and illness on the DI program.

Disability and occupational assessment: objective diagnosis and quantitative impairment rating

Industrial insurance originated in Europe in the nineteenth century and replaced the old system of negligence liability in the United States between 1910 and 1940. Today psychiatric disability assessments are performed by psychiatrists in the context of Social Security Disability Insurance applications, workers' compensation claims, private disability insurance claims, and fitness for duty evaluations. Expertise in the performance of psychiatric disability evaluations is required, but general psychiatric residency programs provide experience only with treatment evaluations, which differ fundamentally from independent medical evaluations as to role boundaries and the focus of assessment. Psychiatrists offer opinions regarding psychiatric impairments, but administrative or judicial tribunals make the actual determinations of disability. Social Security Disability Insurance evaluations and workers' compensation evaluations are discussed, as is the distinction between diagnoses, which are categorical, and impairment ratings, which are dimensional. Inconsistency in impairment ratings has been problematic in the United States and elsewhere in the workers' compensation arena. A protocol for achieving more consistent impairment ratings is proposed, one that correlates three commonly used global rating scales in a 3 × 5 grid, supplemented by objective psychological test data.

Risk factors for occupational knee related disability among enlisted women in the US Army

AIMS

To identify sociodemographic and occupational determinants of knee related disability discharge from the US Army among enlisted women, and to investigate effect modification.

METHODS

A case-control study of 692 cases of knee related disability discharge and 2080 incidence density matched controls nested within the population of all 244 000 enlisted women on active duty in the US Army, 1980-97. We used logistic regression to identify determinants of disability, stratified to explore effect modification by demographic and work characteristics.

RESULTS

The risk of disability discharge was twice as high (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.71 to 3.47) for the oldest (33-60 years) versus the youngest (17-21 years) women. Non-whites had lower risk than whites (OR 0.5, 95% CI: 0.41 to 0.60), as did married (OR 0.7, 95% CI: 0.54 to 0.81) relative to non-married women. Those of lower rank (pay grades E1-E3) were at five times the risk of disability discharge compared to those of higher ranks (pay grades E4-E9, OR 5.0, 95% CI: 2.86 to 8.33), while ORs were highest for those with longer duration of service compared to women on active duty for a year or less (OR 1.4, 95% CI: 0.8 to 2.55 after 12 years). Race modified several effects, including that of rank. Age, duration of service, and pay grade were too highly correlated to draw firm conclusions about their independent modifying effects on risk of disability discharge from the Army.

CONCLUSIONS

Sociodemographic factors had larger effects than occupational characteristics on risk of knee related disability discharge from the US Army. Interactions suggest subgroups at differing risk levels that might be targeted for more detailed investigations.

Occupational orthopaedics in this millennium

Treatment of musculoskeletal pain in the workplace by early return to work and prevention is the future of occupational orthopaedics. Patients who receive workers' compensation comprise 20% of the general orthopaedist's practice, 65% of a hand surgeon's practice, and 90% of the independent medical examiner's practice. To improve the treatment outcomes for patients who receive workers' compensation, orthopaedists in this millennium will need knowledge about how individual and job risk factors can combine to result in musculoskeletal pain in the workplace. This knowledge will promote the safe return of their patients to the workplace after injury. With the prediction that more than 50% of the workforce in the United States will have experienced an occupational injury or illness, it is important for orthopaedists who are treating patients with work-related injuries to understand how management of these workplace risk prevention programs will impact their patients and practice of orthopaedics. In this millennium, orthopaedists will need to know how to talk the language, interpret the information, and understand the benefits of early return to work and prevention of injuries in the workplace. The future will be about legislated prevention and healthcare in the workplace.

Chronic symptoms in construction workers treated for musculoskeletal injuries

BACKGROUND

Soft tissue musculoskeletal injuries make up a high proportion of all work-related injuries in construction. Data from Workers' Compensation claims indicate that strains and sprains are the leading compensable injury for construction workers. This study describes the consequences of soft tissue musculoskeletal injuries for construction workers, and assesses the persistence of symptoms after an injury and the impact of that injury on return to work.

METHODS

Through an Emergency Department surveillance system [Hunting et al., 1994a], we recorded 176 construction worker visits, from 5/01/93 through 2/28/95, for strains, sprains, joint injury or pain, tendinitis, dislocations, hernias, or other musculoskeletal injuries excluding fractures. Telephone interviews were conducted several months after workers had visited the emergency room for a musculoskeletal injury.

RESULTS

Seventy individuals were interviewed about the long-term impacts of 72 incidents that had resulted in work-related musculoskeletal injuries. For 46 (62%) of the 74 diagnoses, problems continued beyond two months. The likelihood of problems continuing more than two months varied considerably by body location of injury. Hispanic workers and older workers were more likely to have continuing symptoms. Eleven of the 45 construction workers with symptoms persisting longer than two months were not employed at the time of the interview. Only 11 of the 45 workers with ongoing symptoms told us that modifications had been made to their jobs to accommodate their symptoms. About one-quarter of these 45 subjects reported substantial effects on home or work life.

CONCLUSIONS

Acute musculoskeletal injuries in construction workers frequently result in chronic symptoms, and those with chronic symptoms report substantial effects of the injury on their quality of life. Job accommodations were made in a minority of these injuries. These findings point to the need for heightened efforts for injury prevention in this industry.