Analysis of ethnic disparities in workers' compensation claims using data linkage

Racial and Ethnic Inequities in the Return-to-Work of Workers Experiencing Injury or Illness: A Systematic Review

PURPOSE

Non-White workers face more frequent, severe, and disabling occupational and non-occupational injuries and illnesses when compared to White workers. It is unclear whether the return-to-work (RTW) process following injury or illness differs according to race or ethnicity.

OBJECTIVE

To determine racial and ethnic differences in the RTW process of workers with an occupational or non-occupational injury or illness.

METHODS

A systematic review was conducted. Eight academic databases - Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, ASSIA, ABI Inform, and Econ lit - were searched. Titles/abstracts and full texts of articles were reviewed for eligibility; relevant articles were appraised for methodological quality. A best evidence synthesis was applied to determine key findings and generate recommendations based on an assessment of the quality, quantity, and consistency of evidence.

RESULTS

15,289 articles were identified from which 19 studies met eligibility criteria and were appraised as medium-to-high methodological quality. Fifteen studies focused on workers with a non-occupational injury or illness and only four focused on workers with an occupational injury or illness. There was strong evidence indicating that non-White and racial/ethnic minority workers were less likely to RTW following a non-occupational injury or illness when compared to White or racial/ethnic majority workers.

CONCLUSIONS

Policy and programmatic attention should be directed towards addressing racism and discrimination faced by non-White and racial/ethnic minority workers in the RTW process. Our research also underscores the importance of enhancing the measurement and examination of race and ethnicity in the field of work disability management.

Challenges and solutions in immigrant occupational health in the United States: a literature review and comparative analysis

OBJECTIVES

Because of the declining birthrate in Japan, an increasing number of companies are hiring immigrants to fill the labor shortage. Although research on migrant occupational health has progressed in the United States, this topic has received little attention in Japan. The aim of this study was to elucidate the current situation, challenges, and solutions surrounding the occupational health of immigrant workers in the United States.

METHODS

Data and selected studies were reviewed and analyzed. The results are discussed, and a few anecdotal experiences in the United States are introduced and compared.

RESULTS

Possible causes of disparities in immigrant occupational health fell into the following seven categories. (Keywords for each category are shown in parentheses.) (1) Occupation (hazardous job, injury, missed workday, blue-collar worker, low birth weight); (2) Education (academic record, health literacy, training); (3) Culture (culture-specific, community-based); (4) Environment (poor hygiene, regional disparities, environmental change); (5) Access (language, statistics, workers' compensation, health insurance, voluntary restraint); (6) Infection (tuberculosis, human immunodeficiency virus/AIDS, follow-up); and (7) Discrimination (race, assault, harassment). Lack of data on immigrant workers was found to be a common problem. Some businesses and community groups achieved positive results by simultaneously dealing with multiple aforementioned categories.

DISCUSSION

In the United States, the occupational health of immigrant workers has been studied mainly in terms of health disparities. Possible causes of disparities in immigrant occupational health fell into seven categories. Solutions centered on the keywords in each category were inferred. Some businesses and community groups achieved positive results by simultaneously dealing with multiple aforementioned categories. Occupational health professionals have to take each of seven categories into account to improve immigrant occupational health. Even the United States-a developed country facing many migrant occupational health problems-needs further research and better data. To address this issue in Japan, we too need more data and further research on immigrants, along with efforts by businesses and community groups.

The proportion of work-related emergency department visits not expected to be paid by workers' compensation: implications for occupational health surveillance, research, policy, and health equity

OBJECTIVE

To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits.

DATA SOURCE

A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys.

STUDY DESIGN

Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression.

PRINCIPAL FINDINGS

A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation.

CONCLUSIONS

Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications.