Costs of occupational injuries and illnesses in California

Direct Healthcare Costs of Moderate and Severe Work-Related Injuries: Estimates from the National Trauma Center of Qatar

Work-related injuries (WRIs) are recognized as a leading cause of admission to the national trauma center of Qatar. A retrospective analysis of trauma registry data and electronic medical records was conducted on a cohort of all WRI patients who were admitted to the Hamad Trauma Center (HTC), in Doha, Qatar, between 2011 and 2017. A total of 3757 WRI patients were treated at the HTC over the 7-year study period. The overall cost for treatment was 124,671,431 USD (18 million USD per year), with a median cost of 19,071 USD. There was a strong positive correlation between the overall cost and hospital-stay cost (r² = 0.949, p = 0.00001) and between the overall cost and procedure cost (r² = 0.852, p = 0.00001). Motor vehicle crash (MVC) victims who wore seatbelts had significantly lower injury severity, hospital stay and median total costs. A comparison of patients by quartiles of the costs incurred showed that the proportions of MVC victims, pedestrian injuries and mortality were significantly higher in the fourth quartile when compared to other quartiles (p < 0.05). These findings suggest that investments in the primary prevention of work-related injuries from falls and MVCs, through proven interventions, should be priorities for occupational safety and health in Qatar.

Occupational injuries in California's health care and social assistance industry, 2009 to 2018

BACKGROUND AND AIM

The health care and social assistance industry has one of the highest rates of non-fatal occupational injuries and illnesses, both in California and nationally. In the coming years, the health care industry will face added pressure as both the population and workforce age. The aim of this study is to identify targeted populations that may benefit from interventions to prevent future injuries, keep the workforce healthy, and decrease injury-related costs.

METHODS

This retrospective study analyzed California workers' compensation claims from 2009 to 2018 in the health care and social assistance industry.

RESULTS

Across the four industry sub-groups, the highest number of claims came from hospitals (n = 243 605; 38.9%), followed by ambulatory care (n = 187 010; 29.9%), nursing/residential care (n = 133 206; 21.3%), and social assistance (n = 62 211; 9.9%). Nursing/residential care settings reported the highest proportion of both lifting injuries (15.8%) and low back injuries (16.9%) as compared to the other settings. Across all settings within California, nurses had the highest proportion of injuries (22.1%), followed by aides/assistants (20.4%), services staff (13.2%), administrative staff (11.0%), and technicians (10.3%). Thirty-five of California's counties had an increasing rate of population-adjusted claims during the study period.

CONCLUSION

This study found that while hospitals have the highest number of injuries, ambulatory care employee injuries are increasing. Employees involved in non-patient care tasks, such as those working in facility service roles, would likely benefit from additional injury prevention interventions.

Loss of Working Life Years Due to Mortality, Sickness Absence, or Ill-health Retirement: A Comprehensive Approach to Estimating Disease Burden in the Workplace

Background

While much effort has focused on quantifying disease burden in occupational health, no study has simultaneously assessed disease burden in terms of mortality and morbidity. We aimed to propose a new comprehensive method of quantifying the disease burden in the workplace.

Methods

The data were obtained from the Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study, a large-scale prospective study of approximately 80,000 workers. We defined disease burden in the workplace as the number of working years lost among the working population during a 6-year period (April 2012 to March 2018). We calculated the disease burden according to consequences of health problems (ie, mortality, sickness absence [SA], and ill-health retirement) and disease category. We also calculated the age-group- (20–39 and 40–59 years old) and sex-specific disease burden.

Results

The largest contributors to disease burden in the workplace were mental and behavioural disorders (47.0 person-years lost per 10,000 person-years of working years; ie, per myriad [proportion]), followed by neoplasms (10.8 per myriad) and diseases of the circulatory system (7.1 per myriad). While mental and behavioural disorders made a greater contribution to SA and ill-health retirement compared to mortality, the latter two disorders were the largest contributors to the disease burden in the workplace due to mortality. The number of working years lost was greater among younger versus older female participants, whereas the opposite trend was observed in males.

Conclusions

Our approach is in contrast to those in previous studies that focused exclusively on mortality or morbidity.

Smart Work Injury Management (SWIM) System: Artificial Intelligence in Work Disability Management

PURPOSE

This paper aims to illustrate an example of how to set up a work injury database: the Smart Work Injury Management (SWIM) system. It is a secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. It employs artificial intelligence to perform in-depth analysis via text-mining techniques in order to extract both dynamic and static data from work injury case files. When it is fully developed, this system can provide a more accurate prediction model for cost of work injuries. It can also predict return-to-work (RTW) trajectory and provide advice on medical care and RTW interventions to all RTW stakeholders. The project will comprise three stages. Stage one: to identify human factors in terms of both facilitators and barriers RTW through face-to-face interviews and focus group discussions with different RTW stakeholders in order to collect opinions related to facilitators, barriers, and essential interventions for RTW of injured workers; Stage two: to develop a machine learning model which employs artificial intelligence to perform in-depth analysis. The technologies used will include: 1. Text-mining techniques including English and Chinese work segmentation as well as N-Gram to extract both dynamic and static data from free-style text as well as sociodemographic information from work injury case files; 2. Principle component/independent component analysis to identify features of significant relationships with RTW outcomes or combine raw features into new features; 3. A machine learning model that combines Variational Autoencoder, Long and Short Term Memory, and Neural Turning Machines. Stage two will also include the development of an interactive dashboard and website to query the trained machine learning model. Stage three: to field test the SWIM system.

CONCLUSION

SWIM ia secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. When it is fully developed, SWIM can provide a more accurate prediction model for the cost of work injuries and advice on medical care and RTW interventions to all RTW stakeholders.

ETHICS

The project has been approved by the Ethics Committee for Human Subjects at the Hong Kong Polytechnic University and is funded by the Innovation and Technology Commission (Grant # ITS/249/18FX).

Costs of injuries and ill health in the workplace in South Korea

Industrial accidents affect the sustainable development of any country, enterprise or individual. This study estimated the costs of loss due to industrial accidents in South Korea in 2013, based on the 4th Korean Working Conditions Survey. The total costs of loss were estimated at USD 27,224 million, with individuals losing the most at 79.5%, followed by employers at 20.4% and the government at 0.1%. These costs were equivalent to 2.1% of South Korea's gross domestic product in 2013. The costs to society/death due to industrial accidents were USD 640,000; USD 7000/individual out of work for ≤3 days and USD 242,000/individual out of work for ≥4 days. These costs make it easy to calculate losses incurred due to industrial accidents. Costs of loss can also be used by the government as basic data to establish industrial safety and health policies.

The attributable annual health costs of U.S. occupational lead poisoning

BACKGROUND

U.S. occupational lead standards have not changed for decades, while knowledge about lead's health effects has grown substantially.

OBJECTIVE

The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages.

METHODS

I combined data voluntarily reported to NIOSH on the number of highly exposed workers with published literature on the health effects of lead in adults to estimate the potential health benefits of lowering the U.S. occupational limit. I developed simple algorithms for monetizing more fully both the direct medical and indirect (productivity) damages associated with those high lead exposures.

RESULTS

I estimated direct medical costs of $141 million (2014US$) per year for 16 categories of health endpoints, and combined direct and indirect costs of over $392 million (2014US$) per year for the 10,000 or so U.S. workers with high occupational lead exposures.

CONCLUSIONS

Reducing allowable occupational lead limits produces annual societal benefits of almost $40,000 per highly exposed worker. Given underreporting of actual exposures and the omission of important health effects, this is likely a severe underestimate.

Industry-Related Injuries in the United States From 1998 to 2011: Characteristics, Trends, and Associated Health Care Costs

OBJECTIVE

To describe the trends, correlates, and healthcare costs associated with industry-related injuries across the United States between 1998 and 2011.

METHODS

A retrospective, cross-sectional analysis of hospital discharges was conducted using the National Inpatient Sample. We used the International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify accidents occurring in industrial settings. Joinpoint regression modeling was used to analyze trends.

RESULTS

Most of the 357,716 inpatient hospitalizations were admissions from the emergency department (55%). Fractures were the most prevalent injuries (48.1%), whereas the lower and upper extremities were the most common injury sites (51.7%). The mean per admission cost of direct medical care was $12,849, with an overall downward trend in injuries during the study period.

CONCLUSIONS

A comprehensive trend analysis of industry-related injuries is valuable to policymakers in formulating targeted strategies and allocating resources to address disparities at various levels.

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.

Occupational injuries and illnesses and associated costs in Thailand

Background

The purpose of this study was to enumerate the annual morbidity and mortality incidence and estimate the direct and indirect costs associated with occupational injuries and illnesses in Bangkok in 2008. In this study, data on workmen compensation claims and costs from the Thai Workmen Compensation Fund, Social Security Office of Ministry of Labor, were aggregated and analyzed.

Methods

To assess costs, this study focuses on direct costs associated with the payment of workmen compensation claims for medical care and health services.

Results

A total of 52,074 nonfatal cases of occupational injury were reported, with an overall incidence rate of 16.9 per 1,000. The incidence rate for male workers was four times higher than that for female workers. Out of a total direct cost of $13.87 million, $9.88 million were for medical services and related expenses and $3.98 million for compensable reimbursement. The estimated amount of noncompensated lost earnings was an additional $2.66 million.

Conclusion

Occupational injuries and illnesses contributed to the total cost; it has been estimated that workers' compensation covers less than one-half to one-tenth of this cost.

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.

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.

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.

A program for thai rubber tappers to improve the cost of occupational health and safety

The purposes of this research were to determine the cost of occupational health and safety and work-related health problems, accidents, injuries and illnesses in rubber tappers by implementing a program in which rubber tappers were provided training on self-care in order to reduce and prevent work-related accidents, injuries and illnesses. Data on costs for healthcare, the prevention and the treatment of work-related accidents, injuries and illnesses were collected by interview using a questionnaire. The findings revealed that there was no relationship between what was spent on healthcare and the prevention of work-related accidents, injuries and illnesses and that spent on the treatment of work-related accidents, injuries and illnesses. The proportion of the injured subjects after the program implementation was significantly less than that before the program implementation (p<0.001). The level of pain after the program implementation was significantly less than that before the program implementation (p<0.05). The treatment costs incurred after the program implementation were significantly less than those incurred before the program implementation (p<0.001). It was demonstrated that this program raised the health awareness of rubber tappers. It strongly empowered the leadership in health promotion for the community.

Occupational accidents and injuries in Thailand

The Workers' Compensation Fund (WCF) represents only a limited fraction of work-related injuries in the Thai workforce. This cross-sectional study examined 258,986 records from the Thai National Injury Surveillance (NIS) system collected during 2001-2004, focusing on 17,538 injuries coded as work-related. NIS records provided information generally not represented in WCF statistics, such as construction and agriculture. The reported mechanisms in 129 work-related fatalities were particularly informative, including electrical current (27%), transport accidents (20%), and falls (15%). Mortality in transport accidents was dramatically higher when seat belts or motorcycle helmets were not used, whether work-related or not. The findings emphasize the need to use multiple sources of information for a complete picture of work-related injuries in Thailand, and possibly in other countries. The mechanisms of fatal injury indicate areas where focused efforts are warranted.

The Readiness for Return-To-Work (RRTW) scale: development and validation of a self-report staging scale in lost-time claimants with musculoskeletal disorders

INTRODUCTION

We report on the development and validation of a 22-item scale assessing stage of readiness for return-to-work, the Readiness for Return-to-Work (RRTW) scale.

METHODS

Lost-time claimants (n = 632) completed a telephone survey one month after a work-related musculoskeletal injury. Exploratory and confirmatory factor analyses of readiness items were conducted with two separate samples, and concurrent validity was examined.

RESULTS

For workers not working, 60% of the variance was explained by four factors--(1) Precontemplation, (2) Contemplation (3) Prepared for Action-Self-evaluative and (4) Prepared for Action-Behavioral. For those working, 58% of the variance was explained by two factors--(1) Uncertain Maintenance and (2) Proactive Maintenance. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. Concurrent validity of the scale was supported: relationships of readiness with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction.

CONCLUSIONS

Psychometric properties of the newly developed instrument suggest that the application of the Readiness for Change model to return-to-work is relevant to work disability research. The instrument may facilitate the offer of stage-specific services tailored to injured workers' needs, and be used for evaluation of return-to-work interventions.

Occupational Injury Surveillance of Traumatic Injuries in Illinois, Using the Illinois Trauma Registry: 1995–2003

BACKGROUND

Trauma registries continue to be underutilized for surveillance, despite providing data on the most severe injuries with a level of detail not available in national data sets or workers' compensation files.

METHODS

We evaluate trends and patterns of traumatic occupational injuries from the Illinois Trauma Registry (ITR).

RESULTS

Between 1995 and 2003, 44.4 of every 100,000 Illinois workers (age-adjusted) suffered work-related, nonfatal traumatic injuries. The majority of workers suffering traumatic injuries were white males younger than 55 years old. Falls were the most common cause of injury, and fracture of the extremities was the most common type of injury experienced by Illinois workers. Approximately 8% of all workers required either partial or total ambulatory assistance at time of discharge.

CONCLUSION

The ITR provides detailed and complete data regarding the most severe occupational injuries.

CLINICAL SIGNIFICANCE

In contrast to reports from national surveillance data sets, we do not observe a significant decline in occupational injuries between 1995 and 2003. Trauma registries should be used more frequently for surveillance programs, because they provide detailed and reliable data regarding the most severe occupational injuries not available in other data sets.

Costs and compensation of work-related injuries in British Columbia sawmills

OBJECTIVE

To estimate the costs of work-related injury in a cohort of sawmill workers in British Columbia from the perspective of the workers' compensation system.

METHODS

Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5786 actively employed sawmill workers. A total of 173 work-related injury cases were identified from these records using the International classification of diseases-ninth revision (ICD-9) external cause of injury codes and the responsibility of payment schedule. Workers' compensation records were extracted and matched with hospital records by dates and ICD-9 diagnosis codes. All costs were converted into 1995 constant Canadian dollars using the Provincial General Consumer Price Index for the non-healthcare costs and Medical Consumer Price Index for the healthcare costs. A 5% discounting rate was applied to adjust for the time value of money. For the uncompensated cases, costs were imputed from the compensated cases using the median cost for a similar nature of injury.

RESULTS

370 hospitalisation events due to injury were captured, and by either of the two indicators (E Codes or payment schedules), 173 (47%) hospitalisation events due to injury, were identified as work related. The median healthcare cost was 4377 dollars and the median non-healthcare cost was 16,559 dollars for a work-related injury. The median non-healthcare and healthcare costs by injury were falls, 19,978 dollars and 5185 dollars; struck by falling object, 32,398 dollars and 8625 dollars; struck against, 12,667 dollars and 5741 dollars; machinery related, 26,480 dollars and 6643 dollars; caught in or between, 24,130 dollars and 4389 dollars; and overexertion, 7801 dollars and 2710 dollars. The total cost was 10,374,115 dollars for non-healthcare and 1,764,137 dollars for healthcare. The compensation agency did not compensate 874,871 dollars (8.4%) of the non-healthcare costs and 200,588 dollars (11.4%) of the healthcare costs.

CONCLUSION

Eliminating avoidable work-related injury events can save valuable resources.

Characterizing the Burden of Occupational Injury and Disease

OBJECTIVES

To review the literature on the burden of occupational disease and injury and to provide a comprehensive characterization of the burden.

METHODS

The scientific and governmental literature from 1990 to the present was searched and evaluated. Thirty-eight studies illustrative of the burden of occupational disease were reviewed for findings, methodology, strengths, and limitations.

RESULTS

Recent U.S. estimates of occupational mortality and morbidity include approximately 55,000 deaths (eighth leading cause) and 3.8 million disabling injuries per year, respectively. Comprehensive estimates of U.S. costs related to these burdens range between dollar 128 billion and dollar 155 billion per year. Despite these significant indicators, occupational morbidity, mortality, and risks are not well characterized in comparative burden assessments.

CONCLUSIONS

The magnitude of occupational disease and injury burden is significant but underestimated. There is a need for an integrated approach to address these underestimates.

Costs of occupational asthma and of occupational chronic obstructive pulmonary disease

PURPOSE OF REVIEW

The purpose of this review is to summarize the most recent findings on the costs of occupational asthma and chronic obstructive pulmonary disease, illustrating the different approaches for estimates, the results and the social and financial implications.

RECENT FINDINGS

Many published data in the literature show that occupational asthma and chronic obstructive pulmonary disease represent a relevant proportion of the total prevalence of these diseases. Previous findings demonstrated that occupational asthma has adverse economic and employment consequences for the worker, and a significant cost related to the claims. Recent studies using a standard method have specifically estimated the cost of the proportion of cases of asthma and chronic obstructive pulmonary disease attributable to occupational exposure out of the total costs of these diseases, and demonstrated that it is significant. Some recent data indicate a beneficial outcome of occupational asthma and a reduction in the number of the claims from primary and secondary preventive intervention at the workplace.

SUMMARY

In conclusion, occupational asthma and chronic obstructive pulmonary disease are likely to pay a substantial contribution to the total costs of the two disorders. These costs are expected to rise with the increasing prevalence of the diseases. Intervention strategies for effective control and prevention at the workplace should lessen the burden of long-term illness and impact on public health costs.