Increased overall and cause-specific mortality associated with disability among workers' compensation claimants with low back injuries

Opioid-related mortality after occupational injury in Washington State: accounting for preinjury opioid use

OBJECTIVES

To estimate the impact of occupational injury and illness on opioid-related mortality while accounting for confounding by preinjury opioid use.

METHODS

We employed a retrospective cohort study design using Washington State workers' compensation data for 1994-2000 injuries linked to US Social Security Administration earnings and mortality data and National Death Index (NDI) cause of death data from 1994 to 2018. We categorised injuries as lost-time versus medical-only, where the former involved more than 3 days off work or permanent disability. We determined death status and cause of death from NDI records. We modelled separate Fine and Gray subdistribution hazard ratios (sHRs) and 95% CIs for injured men and women for opioid-related and all drug-related mortality through 2018. We used quantitative bias analysis to account for unmeasured confounding by preinjury opioid use.

RESULTS

The hazard of opioid-related mortality was elevated for workers with lost-time relative to medical-only injuries: sHR for men: 1.53, 95% CI 1.41 to 1.66; for women: 1.31, 95% CI 1.16 to 1.48. Accounting for preinjury opioid use, effect sizes were reduced but remained elevated: sHR for men was 1.43, 95% simulation interval (SI) 1.20 to 1.69; for women: 1.27, 95% SI 1.10 to 1.45.

CONCLUSIONS

Occupational injuries and illnesses severe enough to require more than 3 days off work are associated with an increase in the hazard of opioid-related mortality. The estimated increase is reduced when we account for preinjury opioid use, but it remains substantial. Reducing work-related injuries and postinjury opioid prescribing and improving employment and income security may decrease opioid-related mortality.

Suicide mortality according to occupation and method of suicide, Massachusetts, 2010-2019

BACKGROUND

Suicide rates in the United States have been increasing. Work-related factors may contribute to risk for suicide. These work-related factors may be reflected in a varied risk for different suicide methods between occupations. This study sought to assess occupational differences in suicide rates according to the method used.

METHODS

Death certificate data about suicide deaths in Massachusetts between 2010 and 2019 were used to calculate mortality rates and rate ratios with univariable and multivariable models controlling for age, sex, race ethnicity, and educational attainment for suicides overall, and for three specific methods of suicide (hanging/strangulation/suffocation, firearms, and poisoning) by occupation.

RESULTS

In multivariate models, the risk for suicide was significantly elevated for workers in arts, design, entertainment, sports, and media (relative risk [RR] = 1.84, 95% confidence interval [CI] = 1.53, 2.22); construction trades (RR = 1.68, 95% CI = 1.53, 1.84); protective services (RR = 1.49, 95% CI = 1.26, 1.77); and healthcare support occupations (RR = 1.55, 95% CI = 1.25, 1.93). Occupational risk for suicide differed across different methods. For hanging/strangulation/suffocation, workers in arts, design, entertainment, sports, and media occupations had the highest RR (2.09, 95% CI = 1.61, 2.71). For firearms, workers in protective service occupations had the highest RR (4.20, 95% CI = 3.30, 5.34). For poisoning, workers in life, physical, and social science occupations had the highest RR (2.32, 95% CI = 1.49, 3.60).

CONCLUSIONS

These findings are useful for identifying vulnerable working populations for suicide. Additionally, some of the occupational differences in the risk for suicide and for specific methods of suicide may be due to workplace factors. Further research is needed to understand these workplace factors so that interventions can be designed for prevention.

Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients

BACKGROUND

Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain.

METHODS

Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016-2019).

RESULTS

We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk.

CONCLUSIONS

These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.

Occupational patterns of opioid-related harms comparing a cohort of formerly injured workers to the general population in Ontario, Canada

OBJECTIVES

The role of work-related injuries as a risk factor for opioid-related harms has been hypothesized, but little data exist to support this relationship. The objective was to compare the incidence of opioid-related harms among a cohort of formerly injured workers to the general population in Ontario, Canada.

METHODS

Workers' compensation claimants (1983-2019) were linked to emergency department (ED) and hospitalization records (2006-2020). Incident rates of opioid-related poisonings and mental and behavioural disorders were estimated among 1.7 million workers and in the general population. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) were calculated, adjusting for age, sex, year, and region.

RESULTS

Compared to the general population, opioid-related poisonings among this group of formerly injured workers were elevated in both ED (SIR = 2.41, 95% CI = 2.37-2.45) and hospitalization records (SIR = 1.54, 95% CI = 1.50-1.59). Opioid-related mental and behavioural disorders were also elevated compared to the general population (ED visits: SIR = 1.86, 95% CI = 1.83-1.89; hospitalizations: SIR = 1.42, 95% CI = 1.38-1.47). Most occupations and industries had higher risks of harm compared to the general population, particularly construction, materials handling, processing (mineral, metal, chemical), and machining and related occupations. Teaching occupations displayed decreased risks of harm.

CONCLUSION

Findings support the hypothesis that work-related injuries have a role as a preventable risk factor for opioid-related harms. Strategies aimed at primary prevention of occupational injuries and secondary prevention of work disability and long-term opioid use are warranted.

Wellbeing After Finalization of a Workers' Compensation Claim: A Systematic Scoping Review

OBJECTIVE

A workers' compensation claim may have significant negative impacts on an injured worker's wellbeing. Wellbeing provides a good global measure of potential effects of a claim on an individual, and is important for contemporary economic modelling. The purpose of this study was to synthesize knowledge about the wellbeing of injured workers after the finalization of a workers' compensation claim and identify gaps in the current literature.

METHODS

A systematic scoping review was conducted.

RESULTS

71 full-text articles were screened for inclusion, with 32 articles eligible for this review. None of the included articles evaluated overall wellbeing. Included articles did evaluate a variety of constructs inherent in wellbeing. Injured workers were generally disadvantaged in some manner following claim finalization. The literature recommends a focus on reducing negative impacts on injured workers after finalization of a compensation claim, with a need for regulatory bodies to review policy in this area.

CONCLUSION

There appears to be potential for ongoing burden for individuals, employers, and society after finalization of a workers' compensation claim. A gap in knowledge exists regarding the specific evaluation of wellbeing of injured workers following finalization of a workers' compensation claim.

Increased Mortality Associated With Disability Among Workers' Compensation Claimants With Upper Extremity Neuropathy

OBJECTIVE

The aim of the study was to evaluate and compare mortality after disabling and nondisabling occupational injuries.

METHODS

Vital status was ascertained through 2020 for 2077 individuals with a workers' compensation claim for upper extremity neuropathy in West Virginia in 1998 or 1999. Standardized mortality ratios compared mortality to the West Virginia general population. Hazard ratios (HRs) obtained from Cox regression models compared mortality among those with and without lost work time or permanent disability.

RESULTS

Overall, the standardized mortality ratio for accidental poisoning deaths was elevated (1.75, 95% confidence interval [CI]: 1.08-2.68). All-cause mortality HRs and cancer HRs were elevated for lost work time (HR = 1.09, 95% CI: 0.93-1.28; HR = 1.50, 95% CI: 1.09-2.08, respectively) and permanent disability (HR = 1.22, 95% CI: 1.04-1.44; HR = 1.78, 95% CI: 1.27-2.48, respectively).

CONCLUSIONS

Work-related disability was associated with broad elevations in mortality.

Increased all-cause mortality following occupational injury: a comparison of two states

OBJECTIVES

To measure the impact of lost-time occupational injuries on all-cause mortality in Washington State and, using the same data elements and study design, to determine whether the estimated impact was similar to previous estimates for New Mexico.

METHODS

We linked injuries in the Washington workers' compensation system with Social Security Administration data on earnings and mortality. We estimated Cox survival models of mortality for women and men with lost-time compared with medical-only injuries, adjusting for age, pre-injury earnings and industry. We used quantitative bias analysis to account for confounding by pre-injury smoking and obesity.

RESULTS

The estimated mortality HR was 1.24 for women (95% CI 1.21 to 1.28) and 1.22 for men (95% CI 1.20 to 1.24). After adjusting for unmeasured pre-injury smoking and obesity, the estimated HR for women was 1.10, 95% simulation interval (SI) 1.00 to 1.21; for men, it was 1.15, 95% SI 1.04 to 1.27.

CONCLUSIONS

All-cause mortality for Washington workers with lost-time injuries was higher than for those with medical-only injuries. Estimated HRs for Washington were consistent with those previously estimated for New Mexico, a less populous state with lower median wages and a different workers' compensation insurance mechanism. This suggests that the relationship between workplace injury and long-term mortality may be generalisable to other US states. These findings support greater efforts to enhance safety and to investigate factors that improve postinjury employment opportunities and long-term health. This association should be examined in additional locations, with different study conditions, or using additional data on pre-injury risk factors.

Changes in drug poisoning mortality before and after the COVID-19 pandemic by occupation in Massachusetts

BACKGROUND

Incidence of drug poisoning deaths has increased during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has established that risks differ for drug poisoning death according to occupation, and that workers also have a different risk for exposure to and death from COVID-19. This study sought to determine whether workers in certain occupations had drug poisoning mortality rates that increased in 2020 (the first year of the COVID-19 pandemic) compared to the average mortality rate for workers in those occupations during the previous 3 years.

METHODS

Death certificates of Massachusetts residents who died from drug poisonings in 2017-2020 were obtained. Average mortality rates of drug poisoning according to occupation during the 2017-2019 period were compared to mortality rates in 2020.

RESULTS

Between the 2017-2019 period and 2020, mortality rates of drug poisoning increased significantly for workers in three occupational groups: food preparation and serving; healthcare support; and transportation and material moving. In these occupations, most of the increases in 2020 compared to 2017-2019 occurred in months after COVID-19 pandemic cases and deaths increased in Massachusetts.

CONCLUSION

Mortality rates from drug poisonings increased substantially in several occupations in 2020 compared to previous years. Further research should examine the role of occupational factors in this increase in drug poisoning mortality rates during the COVID-19 pandemic. Particular attention should be given to determine the role that exposure to severe acute respiratory syndrome coronavirus 2, work stress, and financial stress due to job insecurity played in these increases.

Impact of Body Mass Index on Postsurgical Outcomes for Workers' Compensation Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion

BACKGROUND

Increased morbidity associated with obesity imposes a greater financial burden on companies that provide insurance to their employees. Few studies have investigated the relationship between body mass index (BMI) and patient-reported outcome measures (PROMs) for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the workers' compensation (WC) population.

METHODS

WC patients who underwent a primary, single-level MIS TLIF were included/grouped according to BMI: nonobese (<30 kg/m2); obese I (≥30, <35 kg/m2); severe + morbid (≥35). PROMs were collected pre- and postoperatively: visual analog scale (VAS), Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) physical composite score (PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF). BMI predictive power grouping on PROMs was evaluated using simple linear regression. Established minimum clinically important difference values were used to compute achievement rates across PROMs using logistic regression.

RESULTS

A total of 116 nonobese, 70 obese I, and 61 severe + morbid patients were included. Demographics among BMI grouping significantly differed in gender, hypertensive status, and American Society of Anesthesiologists score (P ≤ 0.037, all). Operative time was significantly different in perioperative values among BMI grouping (P ≤ 0.001). Increased BMI was significantly associated with greater VAS back at 12 weeks and 2 years (P ≤ 0.026, all), greater ODI preoperatively at 12 weeks and 6 months (P ≤ 0.015, all), and decreased PROMIS-PF at 12 weeks (P ≤ 0.011, all). Mean PROMs between obese I and severe + morbid cohorts differed in SF-12 PCS at 12 weeks, only (P = 0.050). ODI overall was the only parameter for which minimum clinically important difference was achieved among BMI cohorts (P ≤ 0.023).

CONCLUSION

WC patients with increased BMI were more likely to develop significant back pain and disability at numerous postoperative timepoints compared with nonobese individuals. Our findings highlight the weight management importance within WC population to minimize back pain and disability following MIS TLIF, but provide a sense of reassurance with comparable clinical improvement regardless of BMI.

CLINICAL RELEVANCE

When considering the effect of weight, surgeons may incorporate these findings in managing patient expectations in the WC population undergoing lumbar spine surgery.

LEVEL OF EVIDENCE: 3

Occupational Differences in Deaths of Despair in the United States, Using Data From the Using the National Occupational Mortality Surveillance System

OBJECTIVE

To assess occupational differences in proportional mortality ratios (PMRs) and trends in these PMRs due to the deaths of despair in the United States.

METHODS

PMRs for deaths due to drug overdoses, suicide, and alcoholic liver disease were obtained from the National Occupational Mortality Surveillance system. Data came from various states for the years 1985 to 1998, 1999, 2003 to 2004, and 2007 to 2014.

RESULTS

Occupations with the highest risk for deaths of despair included construction; architects; and food preparation and service. Occupations with the highest increases in deaths due to deaths of despair included personal care and service and home aides.

CONCLUSIONS

Identifying occupations with elevated risk factors for deaths of despair makes it possible to focus interventions on these occupations. Occupational hazards and exposures may increase risk to deaths of despair for specific workers.

The relationship between work disability and subsequent suicide or self-harm: A scoping review

Work disability occurs when an injury or illness limits the ability of a worker to participate in employment. While evidence suggests that people with work disability are at increased risk of suicide and intentional self-harm, this relationship has not been the subject of systematic review. This scoping review aims to assess and summarise the research literature regarding the relationship between work disability and subsequent suicide or intentional self-harm. Review protocol was published on the Open Science Foundation and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Peer-reviewed studies published in English from 1st January 2000 were included if they reported suicide or self-harm outcomes in people aged 15 years or older with work disability. Studies were identified via systematic search of Medline, Scopus and Pubmed databases, via recommendation from topic experts, and citation searching of included articles. A narrative synthesis was undertaken. Literature search yielded 859 records of which 47 eligible studies were included, nine set in workers' compensation, 20 in sickness absence, 13 in disability pension systems, and five from mixed cohorts. Of 44 quantitative studies, 41 reported a positive relationship between work disability and suicidal behaviour. The relationship is observed consistently across nations, work disability income support systems and health conditions. Several factors elevate risk of suicidal behaviour, including presence of mental health conditions and longer work disability duration. There were few studies in some nations and no suicide prevention interventions. The risk of suicide and self-harm is elevated in people experiencing work disability. Further observational research is required to fill evidence gaps. This review suggests the need for governments, employers and those involved in the care of people with work disability to focus on identification and monitoring of those at greatest risk of suicidal behaviour, and suicide prevention.

Mortality following workplace injury: Quantitative bias analysis

PURPOSE

Recent studies have shown increased all-cause mortality among workers following disabling workplace injury. These studies did not account for 2 potentially important confounders, smoking and obesity. We estimated injury-related mortality accounting for these factors.

METHODS

We followed workers receiving New Mexico workers' compensation benefits (1994-2000) through 2013. Using data from the Panel Study of Income Dynamics, we derived the joint distribution of smoking status and obesity for workers with and without lost-time injuries. We conducted a quantitative bias analysis (QBA) to determine the adjusted relationship of injury and mortality.

RESULTS

We observed hazard ratios after adjusting for smoking and obesity of 1.13 for women (95% simulation interval (SI) 0.97 to 1.31) and 1.12 for men (95% SI 1.00 to 1.27). The estimated fully adjusted excess hazard was about half the estimates not adjusted for these factors.

CONCLUSIONS

Using QBA to adjust for smoking and obesity reduced the estimated mortality hazard from lost-time injuries and widened the simulation interval. The adjusted estimate still showed more than a 10 percent increase for both women and men. The change in estimates reveals the importance of accounting for these confounders. Of course, the results depend on the methods and assumptions used.

The Contribution of Occupation-Specific Factors to the Deaths of Despair, Massachusetts, 2005-2015

OBJECTIVES

In the USA, deaths from poisonings (especially opioids), suicides, and alcoholic liver disease, collectively referred to as 'deaths of despair', have been increasing rapidly over the past two decades. The risk of deaths from these causes is known to be higher among certain occupations. It may be that specific exposures and experiences of workers in these occupations explain these differences in risk. This study sought to determine whether differences in the risk of deaths of despair were associated with rate of occupational injuries and illnesses, job insecurity, and temporal changes in employment in non-standard work arrangements.

METHODS

Usual occupation information was collected from death certificates of Massachusetts residents aged 16-64 with relevant causes of death between 2005 and 2015. These data were combined with occupation-level data about occupational injuries and illnesses, job insecurity, and non-standard work arrangements. We calculated occupation-specific mortality rates for deaths of despair, categorized by occupational injury and illnesses rates and job insecurity. We calculated trends in mortality according to changes in non-standard work arrangements.

RESULTS

Workers in occupations with higher injury and illnesses rates and more job insecurity had higher rates of deaths of despair, especially opioid-related deaths. Rates of deaths of despair increased most rapidly for occupations with increasing prevalence of workers employed in non-standard work arrangements.

CONCLUSIONS

The findings suggest occupational factors that may contribute to the risk of deaths of despair. Future studies should examine these factors with individual-level data. In the meantime, efforts should be made to address these factors, which also represent known or suspected hazards for other adverse health outcomes.

Deaths of Despair Among Healthcare Workers, Massachusetts, 2011 to 2015

OBJECTIVE

To explore mortality rates and trends according to the occupation of healthcare workers who died from the deaths of despair (DoD).

METHODS

Death certificates for deaths from 2011 to 2015 due to poisonings, suicides, alcholic liver disease and cirrhosis were collected and coded based on the decedent's occupation. Mortality rates and rate ratios were calculated according to occupations for healthcare workers.

RESULTS

There were 540 DoDs among Massachusetts healthcare workers, accounting for an average annual rate of 32.4 deaths per 100,000 workers. The highest mortality rate for DoDs were among medical assistants; nursing, psychiatric, and home health aides; miscellaneous; health technologists and technicians; emergency medical technicians, and paramedics.

CONCLUSIONS

Further research should examine factors contributing to elevated rates for DoDs among healthcare workers. Interventions targeted for these workers should be developed.

The burden of non-specific chronic low back pain among adults in KwaZulu-Natal, South Africa: a protocol for a mixed-methods study

INTRODUCTION

Low back pain (LBP) is a major public health concern, affecting individuals of all age groups across the world. In about 90% of LBP cases, there is no specific cause identified and is, therefore, referred to as non-specific LBP. Due to the non-specific nature of LBP, investigations such as radiological and laboratory investigations are unnecessary and results to delayed diagnosis and improper treatment culminating in LBP progressing into chronic LBP (CLBP). LBP is now the leading cause of disability with a significant socioeconomic burden. Despite all these challenges, CLBP is regarded as a trivial condition in low-and-middle-income countries and remains poorly investigated. The distribution of CLBP in Africa is unclear.

METHODS AND ANALYSIS

The research will be conducted in two phases. The initial phase will be an observational, cross-sectional hospital-based study that will be recruiting 650 participants, to determine the prevalence and risk factors of CLBP. A standardised questionnaire will be used to collect baseline data on the socio-demographic characteristics of participants and other variables of interest (exercise history, occupational posture, level of education and the income status). Disability will be assessed using the Oswestry Disability Questionnaire and the psychological risk factors will be assessed using the Illness-Behaviour Questionnaire (IBQ) and the Fear-Avoidance Belief Questionnaire (FABQ). The second phase will be a retrospective, top-down, prevalence-based cost-of-illness study of the 2018-2019 health records, to estimate the burden of CLBP from the healthcare system's perspective. The SPSS V.25.0 statistical package will be used for data entry and analysis. Statistical analysis will include descriptive statistics by means of graphs and cross tabulations, inferential statistics by means of logistic regression and χ² test. A p value of 0.05 will be deemed statistically significant.

ETHICS AND DISSEMINATION

This protocol was approved by the University of KwaZulu-Natal's Biomedical Research Ethics Committee (Ref. No.: BREC/00000205/2019) and the KwaZulu-Natal Department of Health Research Ethics (Ref. No.: KZ_201909_002). This will be the first LBP cost-of-illness study in the sub-Saharan Africa, and, therefore, it will close these knowledge gaps and present important evidence on the estimated burden of CLBP in this context. The results of this study will be presented to the Department of Health and to the respective stakeholders and decision-makers to discuss the findings and draw their attention to the prioritisation of LBP research, its management, prevention programmes and implementation of educational programme and for the planning of cost-containment policies.

Increased risk of suicide after occupational injury in Korea

Objectives

This study sought to investigate the association between occupational injury and subsequent risk of suicide in Korea.

Methods

We linked compensation data for 775 537 workers injured at work during 2003–2014 with National Death Registry through 2015. Suicide among injured workers was compared with the economically active population in Korea separately for men and women by calculating SMRs, with 95% CIs.

Results

Injured workers showed higher mortality from suicide for both men (SMR=2.22, 95% CI 2.14 to 2.31) and women (SMR=2.11, 95% CI 1.81 to 2.45) compared with the economically active population in Korea.

Conclusions

Occupational injuries are associated with substantially elevated suicide risk in Korea. The results suggest the importance of social policies to protect and support injured workers as well as intensifying efforts to prevent workplace injuries.

Impact of workplace injury on opioid dependence, abuse, illicit use and overdose: a 36-month retrospective study of insurance claims

OBJECTIVES

To examine the impact of workplace injury on opioid dependence, abuse and overdose (opioid-related morbidity) and if severity of injury increases the hazard of these health effects.

METHODS

We used MarketScan databases to follow injured and propensity score matched non-injured workers, both without prior opioid-related diagnoses. Using a Cox proportional hazard model, we examined the impact of workplace injury on opioid-related morbidity.

RESULTS

The hazard of opioid-related morbidity for injured workers was 1.79 times than that of matched non-injured workers (95% CI 1.89 to 3.60). For medical-only and lost-time injured workers, it was respectively 1.54 (95% CI 1.02 to 2.32) and 2.91 (95% CI 1.75 to 4.84) times that of non-injured workers.

CONCLUSIONS

Reducing workplace injury or severity of workplace injury, as well as efforts to ensure appropriate opioid prescribing for injured workers, may help to reduce the societal costs of opioid use.

Prescription opioid overdose and adverse effect hospitalisations among injured workers in eight states (2010-2014)

OBJECTIVE

High-risk opioid prescribing practices in workers' compensation (WC) settings are associated with excess opioid-related morbidity, longer work disability and higher costs. This study characterises the burden of prescription opioid-related hospitalisations among injured workers.

METHODS

Hospital discharge data for eight states (Arizona, Colorado, Michigan, New Jersey, New York, South Carolina, Utah and Washington) were obtained from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We calculated 5-year (2010-2014) average annual rates of prescription opioid overdose/adverse effect (AE) hospitalisations. Injured workers were identified using payer (WC) and external cause codes.

RESULTS

State-level average annual prescription opioid overdose/AE hospitalisation rates ranged from 0.3 to 1.2 per 100 000 employed workers. Rates for workers aged ≥65 years old were two to six times the overall rates. Among those hospitalised with prescription opioid overdose/AEs, injured workers were more likely than other inpatients to have a low back disorder diagnosis, and less likely to have an opioid dependence/abuse or cancer diagnosis, or a fatal outcome. Averaged across states, WC was the primary expected payer for <1% of prescription opioid overdose/AE hospitalisations vs 6% of injury hospitalisations.

CONCLUSIONS

Population-based estimates of prescription opioid morbidity are almost nonexistent for injured workers; this study begins to fill that gap. Rates for injured workers increased markedly with age but were low relative to inpatients overall. Research is needed to assess whether WC as payer adequately identifies work-related opioid morbidity for surveillance purposes, and to further quantify the burden of prescription opioid-related morbidity.