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Biswas A, Mustard CA, Landsman V. Trends in severity of work-related traumatic injury and musculoskeletal disorder, Ontario 2004-2017. Am J Ind Med 2024; 67:646-656. [PMID: 38751170 DOI: 10.1002/ajim.23614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Traumatic injury surveillance can be enhanced by describing injury severity trends. This study reports trends in work-related injury severity for males and females over the period 2004-2017 in Ontario, Canada. METHODS A weighted measure of workers' compensation benefit expenditures was used to define injury severity, obtained from the linkage of workers' compensation claims to emergency department (ED) records where the main injury or illness was attributed to work. Denominator counts were obtained from Statistics Canada's Labor Force Survey. Trends in the annual incidence of injury, classified as low, moderate, or high severity, were examined using regression modeling, stratified by age and sex. RESULTS Over a 14-year observation period, there were 1,636,866 ED records included in the analyses. Overall, 57.6% of occupational injury records were classified as low severity, 29.5% as moderate severity, and 12.8% as high severity conditions. There was an increase in the incidence of high severity injuries among females (annual percent change (APC): 1.52%; 95% CI: 0.77, 2.28), while the incidence of low and moderate severity injuries generally declined for males and females. Among females, injuries attributed to animate mechanical forces and assault increased as causes of low, moderate, and high severity injuries. The incidence of concussion increased for both males (APC: 10.51%; 95% CI: 8.18, 12.88) and females (APC: 16.37%; 95% CI: 13.37, 19.45). CONCLUSION The incidence of severe work-related injuries increased among females in Ontario between 2004 and 2017. The methods applied in this surveillance study of traumatic injury severity are plausibly generalizable to applications in other jurisdictions.
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Affiliation(s)
- Aviroop Biswas
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cameron A Mustard
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Landsman
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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2
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Sears JM, Victoroff TM, Bowman SM, Marsh SM, Borjan M, Reilly A, Fletcher A. Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition. Am J Ind Med 2024; 67:18-30. [PMID: 37850904 DOI: 10.1002/ajim.23545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations. METHODS Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition. RESULTS Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition. CONCLUSIONS Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, Seattle, Washington, USA
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Tristan M Victoroff
- Western States Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Spokane, Washington, USA
| | - Stephen M Bowman
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Suzanne M Marsh
- Division of Safety Research, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Marija Borjan
- New Jersey Department of Health, Occupational Health Surveillance Unit, Trenton, New Jersey, USA
| | - Anna Reilly
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Alicia Fletcher
- New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, New York, USA
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3
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Pratt S, Hagan-Haynes K. Applying a Health Equity Lens to Work-Related Motor Vehicle Safety in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6909. [PMID: 37887647 PMCID: PMC10606728 DOI: 10.3390/ijerph20206909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
Motor vehicle crashes (MVCs) are the leading cause of fatal work-related injuries in the United States. Research assessing sociodemographic risk disparities for work-related MVCs is limited, yet structural and systemic inequities at work and during commutes likely contribute to disproportionate MVC risk. This paper summarizes the literature on risk disparities for work-related MVCs by sociodemographic and employment characteristics and identifies worker populations that have been largely excluded from previous research. The social-ecological model is used as a framework to identify potential causes of disparities at five levels-individual, interpersonal, organizational, community, and public policy. Expanded data collection and analyses of work-related MVCs are needed to understand and reduce disparities for pedestrian workers, workers from historically marginalized communities, workers with overlapping vulnerabilities, and workers not adequately covered by employer policies and safety regulations. In addition, there is a need for more data on commuting-related MVCs in the United States. Inadequate access to transportation, which disproportionately affects marginalized populations, may make travel to and from work less safe and limit individuals' access to employment. Identifying and remedying inequities in work-related MVCs, whether during the day or while commuting, will require the efforts of industry and multiple public sectors, including public health, transportation, and labor.
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Affiliation(s)
- Stephanie Pratt
- National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV 26505, USA;
- Strategic Innovative Solutions, LLC, Clearwater, FL 33760, USA
| | - Kyla Hagan-Haynes
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- National Institute for Occupational Safety and Health, Western States Division, Denver, CO 80225, USA
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4
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McMullin B, Fraser J, Robinson B, French J, Adisesh A. Work-related injuries and attendance at a Canadian regional emergency department. Occup Med (Lond) 2023; 73:138-141. [PMID: 36719101 DOI: 10.1093/occmed/kqad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Monitoring trends in the burden of illness and injury attributable to work is key in assessing occupational health hazards; however, New Brunswick does not participate in the Canadian National Ambulatory Care Reporting System which itself does not collect details of occupation and industry. AIMS We set out to determine the proportion of emergency department attendances that were attributable to a work-related cause. We also wanted to evaluate the recording of occupation in the electronic health record system, and to describe the characteristics of patients with a work-related presentation. METHODS A retrospective observational study over a 1-year period was conducted using an administrative database obtained from Canadian Emergency Department Information System. Descriptive statistics are used to present the analysis of categorical and continuous data. RESULTS A total of 49 365 patients were included for analysis. Two per cent of patients presented with a self-reported work-related condition. Health care and social assistance, construction, retail trade and manufacturing were the most common industries reported by patients. CONCLUSIONS This study found the rate of work-related medical conditions to be substantially less than expected, and that occupation was not captured for any patients presenting to the emergency department with a work-related condition, despite a field being available in the electronic health record registration system. We were able to analyse the industry sectors for work-related presentations. The recording and coding of occupation and industry would significantly benefit occupational epidemiology in emergency medicine as well as potentially improving patient outcomes and health system efficiencies.
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Affiliation(s)
- B McMullin
- Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2K 5E2, Canada
| | - J Fraser
- Department of Emergency Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick E2L 4L2, Canada
| | - B Robinson
- Research Services, Horizon Health Network, Saint John, New Brunswick E2L 4L2, Canada
| | - J French
- Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2K 5E2, Canada
- Department of Emergency Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick E2L 4L2, Canada
- Trauma New Brunswick, Saint John Regional Hospital, Saint John, New Brunswick E2L 4L2, Canada
| | - A Adisesh
- Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2K 5E2, Canada
- Division of Occupational Medicine, Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
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5
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Lundstrom EW, Hendricks SA, Marsh SM, Groth CP, Smith GS, Bhandari R. Temporal trends in occupational injuries treated in US emergency departments, 2012-2019. Inj Epidemiol 2023; 10:13. [PMID: 36899403 PMCID: PMC9999541 DOI: 10.1186/s40621-023-00423-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Evidence suggests that rates of occupational injuries in the US are decreasing. As several different occupational injury surveillance systems are used in the US, more detailed investigation of this trend is merited. Furthermore, studies of this decrease remain descriptive and do not use inferential statistics. The aim of this study was to provide both descriptive and inferential statistics of temporal trends of occupational injuries treated in US emergency departments (EDs) for 2012 to 2019. METHODS Monthly non-fatal occupational injury rates from 2012 to 2019 were estimated using the national electronic injury surveillance system-occupational supplement (NEISS-Work) dataset, a nationally representative sample of ED-treated occupational injuries. Rates were generated for all injuries and by injury event type using monthly full-time worker equivalent (FTE) data from the US Current Population Survey as a denominator. Seasonality indices were used to detect seasonal variation in monthly injury rates. Trend analysis using linear regression adjusted for seasonality was conducted to quantify changes in injury rates from 2012 to 2019. RESULTS Occupational injuries occurred at an average rate of 176.2 (95% CI = ± 30.9) per 10,000 FTE during the study period. Rates were highest in 2012 and declined to their lowest level in 2019. All injury event types occurred at their highest rate in summer months (July or August) apart from falls, slips, and trips, which occurred at their highest rate in January. Trend analyses indicated that total injury rates decreased significantly throughout the study period (- 18.5%; 95% CI = ± 14.5%). Significant decreases were also detected for injuries associated with contact with foreign object and equipment (- 26.9%; 95% CI = ± 10.5%), transportation incidents (- 23.2%; 95% CI = ± 14.7%), and falls, slips, and trips (- 18.1%; 95% CI = ± 8.9%). CONCLUSIONS This study supports evidence that occupational injuries treated in US EDs have decreased since 2012. Potential contributors to this decrease include increased workplace mechanization and automation, as well as changing patterns in US employment and health insurance access.
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Affiliation(s)
- Eric W Lundstrom
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, Morgantown, WV, 26506, USA.
| | - Scott A Hendricks
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Suzanne M Marsh
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Caroline P Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Gordon S Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, Morgantown, WV, 26506, USA
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Torres IR, Shklanko S, Haq C, LeBrón AMW. Occupational health within the bounds of primary care: Factors shaping the health of Latina/o immigrant workers in federally qualified health centers. Am J Ind Med 2022; 65:468-482. [PMID: 35426145 DOI: 10.1002/ajim.23356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many workers seek care for work-related medical conditions in primary care settings. Additionally, occupational medicine training is not consistently addressed in primary care professional training. These patterns raise concerns about the health outcomes of low-wage Latina/o immigrant workers who make use of primary care settings to obtain care for work-related injuries and illnesses. The objective of this qualitative study was to investigate how primary care clinicians assessed and addressed the role of occupational exposures on the health and well-being of Latina/o immigrant workers. METHODS We conducted semistructured in-depth interviews with 17 primary care clinicians (physicians, resident physicians, and nurse practitioners) employed in an urban federally qualified health center (FQHC) with two sites located in Orange County, CA. RESULTS Using a constructivist grounded theory approach, we determined that primary care clinicians had a general understanding that employment influenced the health and well-being of their Latina/o immigrant patients. Clinicians delivered care to Latina/o immigrant workers who feared reporting their injury to their employer and to Latina/o immigrants whose workers' compensation claim was terminated before making a full recovery. Clinicians were responsive to patients' work-related concerns and leveraged the resources available within the FQHC. Although some clinicians offered suggestions to improve occupational health in the FQHC, a few clinicians raised concerns about the feasibility of additional health screenings and clinic-based interventions, and pointed to the importance of interventions outside of the healthcare system. CONCLUSION This study underscores the complexities of addressing occupational health concerns in urban FQHCs.
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Affiliation(s)
- Ivy R Torres
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Sarah Shklanko
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Cynthia Haq
- Department of Family Medicine, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Alana M W LeBrón
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Chicano/Latino Studies, School of Social Sciences, University of California, Irvine, Irvine, California, USA
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7
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Montoya‐Barthelemy AG, Leniek K, Bannister E, Rushing M, Abrar FA, Baumann TE, Manly M, Wilhelm J, Niece A, Riester S, Kim H, Sellman J, Desai J, Anderson PJ, Bovard RS, Pronk NP, McKinney ZJ. Using advanced racial and ethnic identity demographics to improve surveillance of work-related conditions in an occupational clinic setting. Am J Ind Med 2022; 65:357-370. [PMID: 35235683 PMCID: PMC9314926 DOI: 10.1002/ajim.23332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
Abstract
Background Although racial and ethnic identities are associated with a multitude of disparate medical outcomes, surveillance of these subpopulations in the occupational clinic setting could benefit enormously from a more detailed and nuanced recognition of racial and ethnic identity. Methods The research group designed a brief questionnaire to capture several dimensions of this identity and collected data from patients seen for work‐related conditions in four occupational medicine clinics from May 2019 through March 2020. Responses were used to calculate the sensitivity and specificity of extant racial/ethnic identity data within our electronic health records system, and were compared to participants' self‐reported industry and occupation, coded according to North American Industry Classification System and Standard Occupational Classification System listings. Results Our questionnaire permitted collection of data that defined our patients' specific racial/ethnic identity with far greater detail, identified patients with multiple ethnic identities, and elicited their preferred language. Response rate was excellent (94.2%, n = 773). Non‐White participants frequently selected a racial/ethnic subcategory (78.1%–92.2%). Using our race/ethnicity data as a referent, the electronic health record (EHR) had a high specificity (>87.1%), widely variable sensitivity (11.8%–82.2%), and poorer response rates (75.1% for race, 82.5% for ethnicity, as compared to 93.8% with our questionnaire). Additional analyses revealed some industries and occupations disproportionately populated by patients of particular racial/ethnic identities. Conclusions Our project demonstrates the usefulness of a questionnaire which more effectively identifies racial/ethnic subpopulations in an occupational medicine clinic, permitting far more detailed characterization of their occupations, industries, and diagnoses.
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Affiliation(s)
| | - Karyn Leniek
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Emily Bannister
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Marcus Rushing
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Fozia A. Abrar
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Tobias E. Baumann
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Madeleine Manly
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Jonathan Wilhelm
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Ashley Niece
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Scott Riester
- Department of Occupational Medicine Mayo Clinic Rochester Minnesota USA
| | - Hyun Kim
- School of Public Health, Division of Environmental Health Sciences University of Minnesota Minneapolis Minnesota USA
| | - Jonathan Sellman
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Jay Desai
- Minnesota Department of Health Health Promotion and Chronic Disease Division St. Paul Minnesota USA
| | - Paul J. Anderson
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
| | - Ralph S. Bovard
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
- School of Public Health, Division of Environmental Health Sciences University of Minnesota Minneapolis Minnesota USA
| | | | - Zeke J. McKinney
- HealthPartners Department of Occupational and Environmental Medicine St. Paul Minnesota USA
- School of Public Health, Division of Environmental Health Sciences University of Minnesota Minneapolis Minnesota USA
- HealthPartners Institute Bloomington Minnesota USA
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Bush AM, Bunn TL, Liford M. Identification of work-related injury emergency department visits using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Inj Prev 2021; 27:i3-i8. [PMID: 33674326 PMCID: PMC7948185 DOI: 10.1136/injuryprev-2019-043507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 11/19/2020] [Accepted: 11/27/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Emergency department (ED) visit discharge data are a less explored population-based data source used to identify work-related injuries. When using discharge data, work-relatedness is often determined by the expected payer of workers' compensation (WC). In October 2015, healthcare discharge data coding systems transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). ICD-10-CM's structure offers potential new work-related codes to enhance work-related injury surveillance. This study identified work-related ED visits using relevant ICD-10-CM work-related injury codes. Cases identified using this method were compared with those identified using the WC expected payer approach. METHODS State ED visit discharge data (2016-2019) were analysed using the CDC's discharge data surveillance definition. Injuries were identified using a diagnosis code or an external cause-of-injury code in any field. Injuries were assessed by mechanism and expected payer. Literature searches and manual review of ICD-10-CM codes were conducted to identify possible work-related injury codes. Descriptive statistics were performed and assessed by expected payer. RESULTS WC was billed for 87 361 injury ED visits from 2016 to 2019. Falls were the most frequent injury mechanism. The 246 ICD-10-CM work-related codes identified 36% more work-related ED injury visits than using WC as the expected payer alone. CONCLUSION This study identified potential ICD-10-CM codes to expand occupational injury surveillance using discharge data beyond the traditional WC expected payer approach. Further studies are needed to validate the work-related injury codes and support the development of a work-related injury surveillance case definition.
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Affiliation(s)
- Ashley M Bush
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Terry L Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Madison Liford
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
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9
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Shire J, Vaidyanathan A, Lackovic M, Bunn T. Association Between Work-Related Hyperthermia Emergency Department Visits and Ambient Heat in Five Southeastern States, 2010-2012-A Case-Crossover Study. GEOHEALTH 2020; 4:e2019GH000241. [PMID: 32821873 PMCID: PMC7429406 DOI: 10.1029/2019gh000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 06/10/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work-related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work-related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case-crossover design. For exposure metrics, day- and location-specific measures of ambient temperatures and county-specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work-related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having "lower" or "moderate" heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work-related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states. Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States.
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Affiliation(s)
- Jeffrey Shire
- National Institute for Occupational Safety and HealthCenters for Disease Control and PreventionCincinnatiOHUSA
| | - Ambarish Vaidyanathan
- National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaGAUSA
| | | | - Terry Bunn
- Kentucky Injury Prevention and Research Center, Department of Preventive Medicine and Environmental HealthUniversity of Kentucky College of Public HealthLexingtonKYUSA
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10
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Punnett L. On the Relationship of Musculoskeletal Disorder Compensation Claims to Ergonomic Factors in Manufacturing. Ann Work Expo Health 2020; 64:111-113. [DOI: 10.1093/annweh/wxaa004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura Punnett
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA
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11
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Harduar Morano L, Richardson D, Proescholdbell S. Descriptive evaluation of methods for identifying work-related emergency department injury visits. Am J Ind Med 2019; 62:568-579. [PMID: 31104330 DOI: 10.1002/ajim.22984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of worker's compensation (WC) as payer underestimates work-related (WR) injuries. We evaluated three methods to identify WR injuries: WC as payer, ICD-9-CM work-status codes E000.0/E000.1, and other ICD-9-CM external cause codes. METHODS We identified injury-related emergency department visits from North Carolina's syndromic surveillance system (2010-2013). Characteristics were compared by indicator. We manually reviewed 800 admission notes to confirm if the visit was WR or non-WR; WR keywords from the review were applied to all visits. RESULTS 133 156 injury-related visits (age, 16 years or older) were identified: WC = 69%, work-status codes = 18%, other ICD-9-CM codes = 13%. Among manually reviewed visits: few visits identified by WC (0.3%) or work-status codes (2%) were non-WR, while 12% of other ICD-9-CM code identified visits were non-WR; 53%, 46%, and 31% of visits identified by WC, work-status codes, and other ICD-9-CM codes were WR, respectively. CONCLUSIONS Findings support use of WC and work-status codes to capture WR injuries; other ICD-9-CM codes should be used with caution or in combination with other indicators.
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Affiliation(s)
- Laurel Harduar Morano
- Department of Emergency Medicine, Center for Health InformaticsUniversity of North Carolina at Chapel HillChapel Hill North Carolina
| | - David Richardson
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel Hill North Carolina
| | - Scott Proescholdbell
- Injury and Violence Prevention BranchNC Division of Public HealthRaleigh North Carolina
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12
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Sears JM, Edmonds AT, Coe NB. Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden? Med Care Res Rev 2019; 77:223-235. [PMID: 31018756 DOI: 10.1177/1077558719845726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.
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Affiliation(s)
- Jeanne M Sears
- University of Washington, Seattle, WA, USA.,Harborview Injury Prevention and Research Center, Seattle, WA, USA.,Institute for Work and Health, Toronto, Ontario, Canada
| | | | - Norma B Coe
- University of Washington, Seattle, WA, USA.,University of Pennsylvania, Philadelphia, PA, USA.,National Bureau of Economic Research, Cambridge, MA, USA
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Saxton DI, Stuesse A. Workers' Decompensation: Engaged Research with Injured Im/migrant Workers. ANTHROPOLOGY OF WORK REVIEW 2018. [DOI: 10.1111/awr.12147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tadros A, Sharon M, Chill N, Dragan S, Rowell J, Hoffman S. Emergency department visits for work-related injuries. Am J Emerg Med 2018; 36:1455-1458. [PMID: 29728284 DOI: 10.1016/j.ajem.2018.04.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Work-related injuries are commonly seen in the emergency department (ED). This study sought to analyze characteristics of ED patient visits that were billed under workers' compensation. METHODS This was a retrospective chart review of visits during 2015 that were billed under workers' compensation at an academic ED. The following variables were collected: age, gender, mechanism of injury/exposure, diagnoses, imaging performed, specialty consultation, operative requirement, follow-up specialty, and ED disposition. RESULTS In 2015, 377 patients presented to the ED for work-related injuries. The most common mechanism of injury was fall. Frequent diagnoses included lower extremity injuries and hand/finger injuries. The most common consulting service was orthopedics. Only five patients were referred to occupational medicine for follow up. CONCLUSION Knowledge of the types of occupational injuries and subsequent care required may help guide both workers and employers how to best triage patients within the healthcare system. Alternative settings such as occupational medicine or primary care services may be appropriate for some patients.
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Affiliation(s)
- Allison Tadros
- West Virginia University, School of Medicine, Department of Emergency Medicine, United States.
| | - Melinda Sharon
- West Virginia University, School of Medicine, Department of Emergency Medicine, United States
| | - Nicholas Chill
- West Virginia University, School of Medicine, Department of Emergency Medicine, United States
| | - Shane Dragan
- West Virginia University, School of Medicine, Department of Emergency Medicine, United States
| | - Jeremy Rowell
- West Virginia University, School of Medicine, Department of Emergency Medicine, United States
| | - Shelley Hoffman
- West Virginia University, School of Medicine, Department of Emergency Medicine, United States
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Boggess B, Scott B, Pompeii L. Uninsured Workers Have More Severe Hospitalizations: Examining the Texas Workers' Compensation System, 2012. New Solut 2017; 27:154-175. [PMID: 28530473 DOI: 10.1177/1048291117710781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Texas' unique elective system of workers' compensation (WC) coverage is being discussed widely in the United States as a possible model to be adopted by other states. Texas is the only state that does not mandate that employers provide state-certified WC insurance. Oklahoma passed legislation for a similar system in 2013, but it was declared unconstitutional by the Oklahoma Supreme Court in 2016. This study examined 9523 work-related hospitalizations that occurred in Texas in 2012 using Texas Department of State Health Services data. We sought to examine work-related injury characteristics by insurance source. An unexpected finding was that among those with WC, 44.6% of the hospitalizations were not recorded as work related by hospital staff. These unrecorded cases had 1.9 (1.6-2.2) times higher prevalence of a severe risk of mortality compared to WC cases that were recorded as work related. Uninsured and publicly insured workers also had a higher prevalence of severe mortality risk. The hospital charges for one year were $615.2 million, including at least $102.8 million paid by sources other than WC, and with $29.6 million that was paid for by injured workers or by taxpayers. There is an urgent need for more research to examine how the Texas WC system affects injured workers.
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Affiliation(s)
| | - Brittany Scott
- 2 National Economic and Social Rights Initiative, New York, NY, USA
| | - Lisa Pompeii
- 3 Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
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Sears JM, Bowman SM. State Trauma Registries as a Resource for Occupational Injury Surveillance and Research: Lessons From Washington State, 1998-2009. Public Health Rep 2017; 131:791-799. [PMID: 28123225 DOI: 10.1177/0033354916669358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Work-related traumatic injury is a leading cause of death and disability among US workers. Occupational injury surveillance is necessary for effective prevention planning and assessing progress toward Healthy People 2020 objectives. Our objectives were to (1) describe the Washington State Trauma Registry (WTR) as a resource for occupational injury surveillance and research, (2) compare the WTR with 2 population-based data sources more widely used for these purposes, and (3) compare the number of injuries ascertained by the WTR with other data sources. METHODS We linked WTR records to hospital discharge records in the Comprehensive Hospital Abstract Reporting System for 2009 and to workers' compensation claims from the Washington State Department of Labor and Industries for 1998 to 2008. We assessed the 3 data sources for overlap, concordance, and case ascertainment. RESULTS Of 9185 work-related injuries in the WTR, 3380 (37%) did not link to workers' compensation claims. Use of payer information in hospital discharge records along with the WTR work-relatedness field identified 20% more linked injuries as work related (n = 720) than did use of payer information alone (n = 602). The WTR identified substantial numbers of work-related injuries that were not identified through workers' compensation or hospital discharge records. CONCLUSIONS Workers' compensation and hospital discharge databases are important but incomplete data sources for work-related injuries; many work-related injuries are not billed to, reported to, or covered by workers' compensation. Trauma registries are well positioned to capture severe work-related injuries and should be included in comprehensive injury surveillance efforts.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA; Institute for Work and Health, Toronto, ON, Canada
| | - Stephen M Bowman
- Department of Healthcare Administration, Woods College of Advancing Studies, Boston College, Chestnut Hill, MA, USA
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Marsh SM, Reichard AA, Bhandari R, Tonozzi TR. Using emergency department surveillance data to assess occupational injury and illness reporting by workers. Am J Ind Med 2016; 59:600-9. [PMID: 27400439 DOI: 10.1002/ajim.22615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Researchers from the National Institute for Occupational Safety and Health (NIOSH) share detailed methodologies from conducting two follow-back studies initiated in 2010 that were designed to assess whether workers reported their injuries and illnesses to their employers and to identify worker incentives and disincentives for reporting work-related injuries to employers. METHODOLOGY Study respondents were sampled from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work), an emergency department-based surveillance system. Telephone interviews were used to collect information directly from workers. OUTCOMES Among persons treated in emergency departments who could be identified as working at the time of injury or illness, most reported their injury or illness to their employer. Our studies did not assess if these reported injuries and illnesses were recorded on the Occupational Safety and Health logs. DISCUSSION Our approach suggests that emergency department-based surveillance data are limited in their utility to investigate underreporting among workers. Am. J. Ind. Med. 59:600-609, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Suzanne M. Marsh
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; Division of Safety Research, Surveillance and Field Investigations Branch; Morgantown West Virginia
| | - Audrey A. Reichard
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; Division of Safety Research, Surveillance and Field Investigations Branch; Morgantown West Virginia
| | - Ruchi Bhandari
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; Division of Safety Research, Surveillance and Field Investigations Branch; Morgantown West Virginia
| | - Theresa R. Tonozzi
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; Division of Safety Research, Surveillance and Field Investigations Branch; Morgantown West Virginia
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A Comprehensive Evaluation of the Burden of Heat-Related Illness and Death within the Florida Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060551. [PMID: 27258296 PMCID: PMC4924008 DOI: 10.3390/ijerph13060551] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 05/22/2016] [Accepted: 05/25/2016] [Indexed: 11/24/2022]
Abstract
The failure of the human body to thermoregulate can lead to severe outcomes (e.g., death) and lasting physiological damage. However, heat-related illness (HRI) is highly preventable via individual- and community-level modification. A thorough understanding of the burden is necessary for effective intervention. This paper describes the burden of severe HRI morbidity and mortality among residents of a humid subtropical climate. Work-related and non-work-related HRI emergency department (ED) visits, hospitalizations, and deaths among Florida residents during May to October (2005–2012) were examined. Sub-groups susceptible to HRI were identified. The age-adjusted rates/100,000 person-years for non-work-related HRI were 33.1 ED visits, 5.9 hospitalizations, and 0.2 deaths, while for work-related HRI/100,000 worker-years there were 8.5 ED visits, 1.1 hospitalizations, and 0.1 deaths. The rates of HRI varied by county, data source, and work-related status, with the highest rates observed in the panhandle and south central Florida. The sub-groups with the highest relative rates regardless of data source or work-relatedness were males, minorities, and rural residents. Those aged 15–35 years had the highest ED visit rates, while for non-work-related hospitalizations and deaths the rates increased with age. The results of this study can be used for targeted interventions and evaluating changes in the HRI burden over time.
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Sears JM, Bowman SM, Blanar L, Hogg-Johnson S. Industrial Injury Hospitalizations Billed to Payers Other Than Workers' Compensation: Characteristics and Trends by State. Health Serv Res 2016; 52:763-785. [PMID: 27140591 DOI: 10.1111/1475-6773.12500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe characteristics of industrial injury hospitalizations, and to test the hypothesis that industrial injuries were increasingly billed to non-workers' compensation (WC) payers over time. DATA SOURCES Hospitalization data for 1998-2009 from State Inpatient Databases, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. STUDY DESIGN Retrospective secondary analyses described the distribution of payer, age, gender, race/ethnicity, and injury severity for injuries identified using industrial place of occurrence codes. Logistic regression models estimated trends in expected payer. PRINCIPAL FINDINGS There was a significant increase over time in the odds of an industrial injury not being billed to WC in California and Colorado, but a significant decrease in New York. These states had markedly different WC policy histories. Industrial injuries among older workers were more often billed to a non-WC payer, primarily Medicare. CONCLUSIONS Findings suggest potentially dramatic cost shifting from WC to Medicare. This study adds to limited, but mounting evidence that, in at least some states, the burden on non-WC payers to cover health care for industrial injuries is growing, even while WC-related employer costs are decreasing-an area that warrants further research.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, University of Washington, Seattle, WA.,Harborview Injury Prevention and Research Center, Seattle, WA.,Institute for Work and Health, Toronto, ON, Canada
| | - Stephen M Bowman
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Laura Blanar
- Department of Health Services, University of Washington, Seattle, WA.,Harborview Injury Prevention and Research Center, Seattle, WA
| | - Sheilah Hogg-Johnson
- Institute for Work and Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Care Transfers for Patients With Upper Extremity Trauma: Influence of Health Insurance Type. J Hand Surg Am 2016; 41:516-525.e3. [PMID: 26880497 DOI: 10.1016/j.jhsa.2016.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/31/2015] [Accepted: 01/01/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To understand the differences in transfer incidence for patients with upper extremity trauma by hospital trauma center designation. We hypothesized that patients with public or no insurance were more likely to be transferred to another facility compared with privately insured patients. METHODS Trauma centers are designated by local authorities and verified by the American College of Surgeons. Using the 2012 National Trauma Data Bank, we examined the probability of being transferred from one center to another for patients who sustained isolated upper extremity trauma. We used multivariable logistic regression with a clustered variance method to adjust for intrahospital correlation to compare risk-adjusted transfer incidence for patients with upper extremity injuries by trauma center designation. RESULTS In 2012, 6,214 patients ages 18-64 with isolated upper extremity trauma presented to 477 hospitals. Overall, transfer incidence was significantly higher among level III trauma centers (26%) compared with level II (11%) or level I (2%) trauma centers. Adjusting for patient and hospital characteristics patients with Medicaid were more likely to be transferred from level III trauma centers to another center compared with privately insured patients. CONCLUSIONS Current regulations may not prevent unnecessary patient transfers based on insurance status among level III trauma centers. Policy makers should compensate or provide incentives to hospitals that take care of poorly insured patients. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/decision III.
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Sears JM, Bowman SM, Rotert M, Blanar L, Hogg-Johnson S. Improving occupational injury surveillance by using a severity threshold: development of a new occupational health indicator. Inj Prev 2015; 22:195-201. [DOI: 10.1136/injuryprev-2015-041807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/10/2015] [Indexed: 11/03/2022]
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Harduar Morano L, Bunn T, Lackovic M, Lavender A, Dang G, Chalmers J, Li Y, Zhang L, Flammia D. Occupational heat-related illness emergency department visits and inpatient hospitalizations in the southeast region, 2007-2011. Am J Ind Med 2015; 58:1114-25. [PMID: 26305997 DOI: 10.1002/ajim.22504] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Heat-related illness (HRI) is an occupational health risk for many outdoor, and some indoor, workers. METHODS Emergency department (ED) and inpatient hospitalization (IH) data for 2007-2011 from nine southeast states were analyzed to identify occupational HRI numbers and rates, demographic characteristics, and co-morbid conditions. RESULTS There were 8,315 occupational HRI ED visits (6.5/100,000 workers) and 1,051 IHs (0.61/100,000) in the southeast over the study period. Out-of-state residents comprised 8% of ED visits and 12% of IHs. Rates for both, ED visits and IHs were significantly elevated in males and blacks. Younger workers had elevated rates for ED visits, while older workers had higher IH rates. CONCLUSIONS This is the first study to evaluate occupational HRI ED visits and IHs in the southeast region and indicates the need for enhanced heat-stress prevention policies in the southeast. Findings from this study can be used to direct state health department tracking and evaluation of occupational HRI.
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Affiliation(s)
- L. Harduar Morano
- University of North Carolina at Chapel Hill; Gillings School of Global Public Health; Department of Epidemiology; Chapel Hill North Carolina
| | - T.L. Bunn
- University of Kentucky; College of Public Health; Kentucky Injury Prevention and Research Center; Lexington Kentucky
| | - M. Lackovic
- Louisiana Department of Health and Hospitals; Office of Public Health; New Orleans Louisiana
| | - A. Lavender
- Georgia Department of Public Health; Atlanta Georgia
| | - G.T.T. Dang
- Florida Department of Health, Division of Disease Control and Health Protection; Occupational and Environmental Epidemiology Branch; Raleigh North Carolina
| | - J.J. Chalmers
- Division of Disease Control and Health Protection, Florida Department of Health; Bureau of Epidemiology; Tallahassee Florida
| | - Y. Li
- Tennessee Department of Health; Division of Family Health and Wellness; Nashville Tennessee
| | - L. Zhang
- Mississippi State Department of Health; Office of Health Data and Research; Jackson Mississippi
| | - D.D. Flammia
- Virginia Department of Health; Division of Environmental Epidemiology; Richmond Virginia
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Linkage and concordance of Trauma Registry and hospital discharge records: lessons for occupational injury surveillance and research. J Occup Environ Med 2015; 56:878-85. [PMID: 25099416 DOI: 10.1097/jom.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Occupational injury researchers typically use payer to identify work-related injuries in hospital discharge records. Many trauma registries contain a work-related field, independent of payer. Linked trauma registry and hospital discharge records were used to assess data field concordance and to assess the validity of using payer or external cause of injury (E-codes) to identify work-related injuries. METHODS Washington State Trauma Registry records were linked to hospital discharges (year 2009). RESULTS There was substantial agreement between Washington State Trauma Registry and hospital discharge records for workers' compensation as primary payer. E-code based methods of identifying occupational injuries had high specificity (more than 99%) but low sensitivity (less than 14%). Payer was 76% sensitive and 98% specific. CONCLUSIONS This study found substantial agreement for data fields key to occupational injury surveillance and research. Nevertheless, many work-related injuries could not be identified using hospital discharge records.
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Dong XS, Wang X, Largay JA, Sokas R. Long-term health outcomes of work-related injuries among construction workers--findings from the National Longitudinal Survey of Youth. Am J Ind Med 2015; 58:308-18. [PMID: 25678458 DOI: 10.1002/ajim.22415] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study examined the relationship between work-related injuries and health outcomes among a cohort of blue-collar construction workers. MATERIALS AND METHODS Data were from the National Longitudinal Survey of Youth, 1979 cohort (NLSY79; n = 12,686). A range of health outcomes among blue-collar construction workers (n = 1,435) were measured when they turned age 40 (1998-2006) and stratified by these workers' prior work-related injury status between 1988 and 2000. Univariate and multivariate analyses were conducted to measure differences among subgroups. RESULTS About 38% of the construction cohort reported injuries resulting in days away from work (DAFW); another 15% were injured but reported no DAFW (NDAFW). At age 40, an average of 10 years after injury, those with DAFW injury had worse self-reported general health and mental health, and more diagnosed conditions and functional limitations than those without injury. This difference was statistically significant after controlling for major demographics. DISCUSSION Adverse health effects from occupational injury among construction workers persist longer than previously documented.
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Affiliation(s)
- Xiuwen Sue Dong
- CPWR-The Center for Construction Research and Training; Data Center; Maryland
| | - Xuanwen Wang
- CPWR-The Center for Construction Research and Training; Data Center; Maryland
| | - Julie A. Largay
- CPWR-The Center for Construction Research and Training; Data Center; Maryland
| | - Rosemary Sokas
- Department of Human Science; Georgetown University School of Nursing and Health Studies; Washington District of Columbia
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Occupational injury trends derived from trauma registry and hospital discharge records: lessons for surveillance and research. J Occup Environ Med 2014; 56:1067-73. [PMID: 25285829 DOI: 10.1097/jom.0000000000000225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The suitability of the Washington State Trauma Registry (WTR) for occupational injury surveillance was assessed via comparing estimated rates and trends with those derived from state hospital discharge data. METHODS Descriptive methods and negative binomial regression were used to model occupational injury trends (1998 to 2009). RESULTS Nonlinear trends based on WTR data closely tracked those based on hospital discharge data, beginning about 2002. Rate estimates differed somewhat by data source and were most similar when a severity threshold was applied. Conclusions regarding temporal trends in work-related injury rates were the same using either data source. CONCLUSIONS This study found substantial similarity between occupational injury trends estimated using either WTR or hospital discharge data. We conclude that a mature state trauma registry with mandatory reporting requirements can be used for surveillance of severe work-related traumatic injuries.
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Sears JM, Bowman SM, Hogg-Johnson S. Using injury severity to improve occupational injury trend estimates. Am J Ind Med 2014; 57:928-39. [PMID: 24811970 DOI: 10.1002/ajim.22329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hospitalization-based estimates of trends in injury incidence are also affected by trends in health care practices and payer coverage that may differentially impact minor injuries. This study assessed whether implementing a severity threshold would improve occupational injury surveillance. METHODS Hospital discharge data from four states and a national survey were used to identify traumatic injuries (1998-2009). Negative binomial regression was used to model injury trends with/without severity restriction, and to test trend divergence by severity. RESULTS Trend estimates were generally biased downward in the absence of severity restriction, more so for occupational than non-occupational injuries. Restriction to severe injuries provided a markedly different overall picture of trends. CONCLUSIONS Severity restriction may improve occupational injury trend estimates by reducing temporal biases such as increasingly restrictive hospital admission practices, constricting workers' compensation coverage, and decreasing identification/reporting of minor work-related injuries. Injury severity measures should be developed for occupational injury surveillance systems.
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Affiliation(s)
- Jeanne M. Sears
- Department of Health Services, School of Public Health; University of Washington; Seattle Washington
| | - Stephen M. Bowman
- Department of Health Policy and Management, College of Public Health; University of Arkansas for Medical Sciences; Little Rock Arkansas
- Center for Injury Research and Policy, Department of Health Policy and Management, Bloomberg School of Public Health; Johns Hopkins University; Baltimore Maryland
| | - Sheilah Hogg-Johnson
- Institute for Work and Health; Toronto Ontario Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
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Ye M, Beach J, Martin JW, Senthilselvan A. Occupational pesticide exposures and respiratory health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6442-71. [PMID: 24287863 PMCID: PMC3881124 DOI: 10.3390/ijerph10126442] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 12/14/2022]
Abstract
Pesticides have been widely used to control pest and pest-related diseases in agriculture, fishery, forestry and the food industry. In this review, we identify a number of respiratory symptoms and diseases that have been associated with occupational pesticide exposures. Impaired lung function has also been observed among people occupationally exposed to pesticides. There was strong evidence for an association between occupational pesticide exposure and asthma, especially in agricultural occupations. In addition, we found suggestive evidence for a link between occupational pesticide exposure and chronic bronchitis or COPD. There was inconclusive evidence for the association between occupational pesticide exposure and lung cancer. Better control of pesticide uses and enforcement of safety behaviors, such as using personal protection equipment (PPE) in the workplace, are critical for reducing the risk of developing pesticide-related symptoms and diseases. Educational training programs focusing on basic safety precautions and proper uses of personal protection equipment (PPE) are possible interventions that could be used to control the respiratory diseases associated with pesticide exposure in occupational setting.
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Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, 3-276 Edmonton Heath Clinic Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada; E-Mail:
| | - Jeremy Beach
- School of Public Health, University of Alberta, 3-276 Edmonton Heath Clinic Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada; E-Mail:
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303-112 Street, Edmonton, AB T6G 2T4, Canada; E-Mail:
| | - Jonathan W. Martin
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, University of Alberta, 10-102C Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada; E-Mail:
| | - Ambikaipakan Senthilselvan
- School of Public Health, University of Alberta, 3-276 Edmonton Heath Clinic Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada; E-Mail:
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