The law and incomplete database information as confounders in epidemiologic research on occupational injuries and illnesses

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.

Exploring the relationship between employer recordkeeping and underreporting in the BLS Survey of Occupational Injuries and Illnesses

BACKGROUND

Little empirical data exist to identify the reasons for underreporting in the US Bureau of Labor Statistics (BLS) non-fatal occupational injury and illness data.

METHODS

We interviewed occupational injury and illness record keepers from Washington State establishments that participated in the 2008 BLS Survey of Occupational Injuries and Illnesses (SOII). Qualitative and quantitative methods were used to explore recordkeeping and business practices that may explain SOII's incomplete case capture compared with WC claims data.

RESULTS

Most participants (90%) did not comply with OSHA recordkeeping regulations. Other factors including using workplace injury data to evaluate supervisors' or SOII respondent's job performance, recording injuries for a worksite that operates multiple shifts, and failing to follow SOII instructions were more common among establishments with unreported WC claims.

CONCLUSION

Business practices that incentivize low injury rates, disorganized recordkeeping, and limited communication between BLS and survey respondents are barriers to accurate employer reports of work-related injuries and illnesses.

Medical expenditures associated with nonfatal occupational injuries among immigrant and U.S.-born workers

Background

No national study has investigated whether immigrant workers are less likely than U.S.-workers to seek medical treatment after occupational injuries and whether the payment source differs between two groups.

Methods

Using the 2004–2009 Medical Expenditure Panel Survey (MEPS) data, we estimated the annual incidence rate of nonfatal occupational injuries per 100 workers. Logistic regression models were fitted to test whether injured immigrant workers were less likely than U.S.-born workers to seek professional medical treatment after occupational injuries. We also estimated the average mean medical expenditures per injured worker during the 2 year MEPS reference period using linear regression analysis, adjusting for gender, age, race, marital status, education, poverty level, and insurance. Types of service and sources of payment were compared between U.S.-born and immigrant workers.

Results

A total of 1,909 injured U.S.-born workers reported 2,176 occupational injury events and 508 injured immigrant workers reported 560 occupational injury events. The annual nonfatal incidence rate per 100 workers was 4.0% (95% CI: 3.8%-4.3%) for U.S.-born workers and 3.0% (95% CI: 2.6%-3.3%) for immigrant workers. Medical treatment was sought after 77.3% (95% CI: 75.1%-79.4%) of the occupational injuries suffered by U.S.-born workers and 75.6% (95% CI: 69.8%-80.7%) of the occupational injuries suffered by immigrant workers. The average medical expenditure per injured worker in the 2 year MEPS reference period was $2357 for the U.S.-born workers and $2,351 for immigrant workers (in 2009 U.S. dollars, P = 0.99). Workers’ compensation paid 57.0% (95% CI: 49.4%-63.6%) of the total expenditures for U.S.-born workers and 43.2% (95% CI: 33.0%-53.7%) for immigrant workers. U.S.-born workers paid 6.7% (95% CI: 5.5%-8.3%) and immigrant workers paid 7.1% (95% CI: 5.2%-9.6%) out-of-pocket.

Conclusions

Immigrant workers had a statistically significant lower incidence rate of nonfatal occupational injuries than U.S.-born workers. There was no significant difference in seeking medical treatment and in the mean expenditures per injured worker between the two groups. The proportion of total expenditures paid by workers’ compensation was smaller (marginally significant) for immigrant workers than for U.S.-born workers.

The Primary Care Practitioner and the diagnosis of occupational diseases

Background

Rather than a clinical diagnosis, in occupational medicine the critical point is the etiological diagnosis. The first is useful for the therapy, the latter for preventive, epidemiological, regulatory, and insurance measures.

Discussion

As with causality criteria which are employed in population studies, the answering of four easy questions allows a Primary Care Practitioner to establish a causal link between the work activities and a potential disease that a specific patient may present.

After determining the clinical diagnosis and the actual pathology of an occupational disease, the identity, duration, and intensity of the exposure have to be detected for establishing a close-causal effect. The judgment on the occupational origin of the disease requires an integrated approach using multiple sources of information, and goes beyond the clinical diagnosis. This may require consultation with a specialist in occupational medicine.

Summary

It is important that the Primary Care Practitioner takes an accurate medical history since this may be the only chance a patient has to have their occupational disease recognised and properly detected/identified. Proper identification of the causative nature of such diseases is important for establishing preventive measures in eliminating and controlling future cases against exposure, epidemiological reporting and studies (particularly in identifying the rates of disease), regulatory reporting requirements and insurance compensation.

Researcher judgment and study design: challenges of using administrative data

BACKGROUND

Questions have been raised about methods of studies finding substantial undercounting of workplace injuries and illnesses by the Bureau of Labor Statistics (BLS) and workers' compensation agencies. A more recent study of Minnesota concluded that the BLS survey captures 84-90% of workers' compensation cases.

METHODS

We examined the sensitivity of findings in two studies to alternate sample definitions and study assumptions.

RESULTS

Applying alternate sample construction rules to the earlier study increased estimated BLS reporting rates from 68% to 77%, assuming source independence. Applying alternate assumptions to the more recent Minnesota study reduced its high estimate of BLS reporting from 90% to 53-64%.

CONCLUSIONS

Studies linking administrative data from different sources require substantial judgment in constructing research datasets and choosing analytic methods. Moreover, different sample construction rules lead to different results. This suggests that sensitivity analysis should be carried out when alternatives cannot be ruled out. In this case, sensitivity analysis supports the hypothesis of substantial underreporting.