Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances

Injuries That Happen at Work Lead to More Opioid Prescriptions and Higher Opioid Costs

OBJECTIVES

This study aimed to compare opioid prescription incidence, supply days, and cost associated with occupational injury and other injury-caused conditions.

METHODS

We used Medical Expenditure Panel Survey (MEPS) data for 2010-2019. The MEPS provides information on medical conditions and associated medical encounters, treatments, and treatment costs, as well as demographic, education, health, working status, income, and insurance coverage information. We used descriptive statistics and logistic and 2-part regressions.

RESULTS

Controlling for covariates and compared with other injury-caused conditions, occupational injury-caused conditions resulted in 33% higher odds of opioid prescribing, 32.8 more opioid prescription supply days, and $134 higher average cost.

CONCLUSIONS

Occupational injuries were associated with higher opioid incidence and costs, and more opioid supply days. These findings point to the need to focus on making work safer and the role employers may play in supporting worker recovery from injury and opioid use disorders.

Occupational injury and psychological distress among U.S. workers: The National Health Interview Survey, 2004-2016

INTRODUCTION

Injuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (b) the association between injury status and SPD.

METHODS

Self-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004-2016). Psychological distress during the past 30 days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0-4, total score range: 0-24). SPD was defined as K6 ≥ 13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates.

RESULTS

The prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI = 7.71%, NOI = 6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR = 2.19, 95%CI: 1.62-2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR = 0.98, 95%CI: 0.65-1.48).

CONCLUSION

The prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.

Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States

INTRODUCTION

Falls are the leading cause of injury in almost all age-strata in the U.S. However, fall-related injuries (FI) and their circumstances are under-studied at the population level, particularly among young and middle-aged adults. This study examined the circumstances of FI among community-dwelling U.S. adults, by age and gender.

METHODS

Narrative texts of FI from the National Health Interview Survey (1997-2010) were coded using a customized taxonomy to assess place, activity, initiating event, hazards, contributing factors, fall height, and work-relatedness of FI. Weighted proportions and incidence rates of FI were calculated across six age-gender groups (18-44, 45-64, 65+ years; women, men).

RESULTS

The proportion of FI occurring indoors increased with age in both genders (22%, 30%, and 48% among men, and 40%, 49% and 62% among women for 18-44, 45-64, 65+ age-groups, respectively). In each age group the proportion of indoor FI was higher among women as compared to men. Among women, using the stairs was the second leading activity (after walking) at the time of FI (19%, 14% and 10% for women in 18-44, 45-64, 65+ age groups, respectively). FI associated with tripping increased with age among both genders, and women were more likely to trip than men in every age group. Of all age-gender groups, the rate of FI while using ladders was the highest among middle-aged men (3.3 per 1000 person-year, 95% CI 2.0, 4.5). Large objects, stairs and steps, and surface contamination were the three most common hazards noted for 15%, 14% and 13% of fall-related injuries, respectively.

CONCLUSIONS

The rate and the circumstances of FI differ by age and gender. Understanding these differences and obtaining information about circumstances could be vital for developing effective interventions to prevent falls and FI.

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004-2012

INTRODUCTION

Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers.

METHODS

Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004-2012. Participants were categorized as normal weight (BMI: 18.5-24.9kg/m(2)), overweight (BMI: 25.0-29.9), obese I (BMI: 30.0-34.9), and obese II (BMI: 35+). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software.

RESULTS

During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000±1.2), fingers (11.5±1.3), and knees (7.1±0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR=1.25 (95% CI=1.04-1.52); obese I: 1.41 (1.14-1.74); obese II: 1.68 (1.32-2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR=1.48, (95% CI=1.03-2.13); obese I: 1.70 (1.13-2.55); obese II: 2.91 (1.91-4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR=1.73 (95% CI=1.29-2.31); obese I: PR=2.24 (1.64-3.06); obese II: PR=2.95 (2.04-4.26)].

CONCLUSIONS

Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers.

PRACTICAL APPLICATIONS

Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.

The direct cost burden of 13years of disabling workplace injuries in the U.S. (1998-2010): Findings from the Liberty Mutual Workplace Safety Index

INTRODUCTION

Although occupational injuries are among the leading causes of death and disability around the world, the burden due to occupational injuries has historically been under-recognized, obscuring the need to address a major public health problem.

METHODS

We established the Liberty Mutual Workplace Safety Index (LMWSI) to provide a reliable annual metric of the leading causes of the most serious workplace injuries in the United States based on direct workers compensation (WC) costs.

RESULTS

More than $600 billion in direct WC costs were spent on the most disabling compensable non-fatal injuries and illnesses in the United States from 1998 to 2010. The burden in 2010 remained similar to the burden in 1998 in real terms. The categories of overexertion ($13.6B, 2010) and fall on same level ($8.6B, 2010) were consistently ranked 1st and 2nd.

PRACTICAL APPLICATION

The LMWSI was created to establish the relative burdens of events leading to work-related injury so they could be better recognized and prioritized. Such a ranking might be used to develop research goals and interventions to reduce the burden of workplace injury in the United States.

Nail gun injuries treated in U.S emergency departments, 2006-2011: not just a worker safety issue

BACKGROUND

Nail guns increase productivity in residential building but with a corresponding increase in worker injuries. They are also easily accessible, at low cost, to consumers.

METHODS

Data from the occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were used to calculate national estimates of work-related injuries from nail guns between 2006 and 2011. These were compared to estimates of consumer injuries obtained through online access to the Consumer Product Safety Commission's (CPSC) NEISS data.

RESULTS

Approximately 25,000 ED-treated work-related and consumer nail gun injuries were estimated each year. During the construction economy collapse, injuries among workers declined markedly, closely following patterns of reduced residential employment. Reduction in consumer injuries was much more modest.

CONCLUSIONS

Current nail gun injury patterns suggest marked blurring of work and home exposures. A united effort of CPSC, NIOSH, and OSHA is warranted to address these preventable injuries.

Rationale, design and methods for the 22 year follow-up of the Western Australian Pregnancy Cohort (Raine) Study

BACKGROUND

Young adulthood is a critical life period for health and health behaviours. Related measurements collected before and after birth, and during childhood and adolescence can provide a life-course analysis of important factors that contribute to health and behaviour in young adulthood. The Western Australian Pregnancy Cohort (Raine) Study has collected a large number of such measurements during the fetal, perinatal, infancy, childhood and adolescence periods and plans to relate them to common health issues and behaviours in young adults, including spinal pain, asthma, sleep disorders, physical activity and sedentary behaviour and, work absenteeism and presenteeism. The aim of this paper is to describe the rationale, design and methods of the 22 year follow-up of the Raine Study cohort.

METHODS/DESIGN

The Raine Study is a prospective cohort study. Participants still active in the cohort (n = 2,086) were contacted around the time of their 22nd birthday and invited to participate in the 22 year follow-up. Each was asked to complete a questionnaire, attend a research facility for physical assessment and an overnight sleep study, wear activity monitors for a week, and to maintain a sleep and activity diary over this week. The questionnaire was broad and included questions related to sociodemographics, medical history, quality of life, psychological factors, lifestyle factors, spinal pain, respiratory, sleep, activity and work factors. Physical assessments included anthropometry, blood pressure, back muscle endurance, tissue sensitivity, lung function, airway reactivity, allergic status, 3D facial photographs, cognitive function, and overnight polysomnography.

DISCUSSION

Describing the prevalence of these health issues and behaviours in young adulthood will enable better recognition of the issues and planning of health care resources. Providing a detailed description of the phenotype of these issues will provide valuable information to help educate health professionals of the needs of young adults. Understanding the life-course risk factors of health issues and behaviours in young adulthood will have important health planning implications, supporting the development of targeted interventions to improve current health status and reduce the onset and development of further ill-health across adulthood.

Independent effects of sleep duration and body mass index on the risk of a work-related injury: evidence from the US National Health Interview Survey (2004-2010)

Fatigue has been linked to adverse safety outcomes, and poor quality or decreased sleep has been associated with obesity (higher body mass index, BMI). Additionally, higher BMI is related to an increased risk for injury; however, it is unclear whether BMI modifies the effect of short sleep or has an independent effect on work-related injury risk. To answer this question, the authors examined the risk of a work-related injury as a function of total daily sleep time and BMI using the US National Health Interview Survey (NHIS). The NHIS is an in-person household survey using a multistage, stratified, clustered sample design representing the US civilian population. Data were pooled for the 7-yr survey period from 2004 to 2010 for 101 891 "employed" adult subjects (51.7%; 41.1 ± yrs of age [mean ± SEM]) with data on both sleep and BMI. Weighted annualized work-related injury rates were estimated across a priori defined categories of BMI: healthy weight (BMI: <25), overweight (BMI: 25-29.99), and obese (BMI: ≥30) and also categories of usual daily sleep duration: <6, 6-6.99, 7-7.99, 8-8.99, and ≥9 h. To account for the complex sampling design, including stratification, clustering, and unequal weighting, weighted multiple logistic regression was used to estimate the risk of a work-related injury. The initial model examined the interaction among daily sleep duration and BMI, controlling for weekly working hours, age, sex, race/ethnicity, education, type of pay, industry, and occupation. No significant interaction was found between usual daily sleep duration and BMI (p = .72); thus, the interaction term of the final logistic model included these two variables as independent predictors of injury, along with the aforementioned covariates. Statistically significant covariates (p ≤ .05) included age, sex, weekly work hours, occupation, and if the worker was paid hourly. The lowest categories of usual sleep duration (<6 and 6-6.9 h) showed significantly (p ≤ .05) elevated injury risks than the referent category (7-8 h sleep), whereas sleeping >7-8 h did not significantly elevate risk. The adjusted injury risk odds ratio (OR) for a worker with a usual daily sleep of <6 h was 1.86 (95% confidence interval [CI]: 1.37-2.52), and for 6-6.9 h it was 1.46 (95% CI: 1.18-1.80). With regards to BMI, the adjusted injury risk OR comparing workers who were obese (BMI: ≥30) to healthy weight workers (BMI: <25) was 1.34 (95% CI: 1.09-1.66), whereas the risk in comparing overweight workers (BMI: 25-29.99) to healthy weight risk was elevated, but not statistically significant (OR = 1.08; 95% CI: .88-1.33). These results from a large representative sample of US workers suggest increase in work-related injury risk for reduced sleep regardless of worker's body mass. However, being an overweight worker also increases work-injury risk regardless of usual daily sleep duration. The independent additive risk of these factors on work-related injury suggests a substantial, but at least partially preventable, risk.

Daily sleep, weekly working hours, and risk of work-related injury: US National Health Interview Survey (2004-2008)

The impact on health and safety of the combination of chronic sleep deficits and extended working hours has received worldwide attention. Using the National Health Interview Survey (NHIS), an in-person household survey using a multistage, stratified, clustered sample design representing the US civilian, non-institutionalized population, the authors estimated the effect of total daily self-reported sleep time and weekly working hours on the risk of a work-related injury. During the survey period 2004-2008, 177,576 persons (ages 18-74) sampled within households reported that they worked at a paid job the previous week and reported their total weekly work hours. A randomly selected adult in each household (n = 75,718) was asked to report his/her usual (average) total daily sleep hours the prior week; complete responses were obtained for 74,415 (98.3%) workers. Weighted annualized work-related injury rates were then estimated across a priori defined categories of both average total daily sleep hours and weekly working hours. To account for the complex sampling design, weighted multiple logistic regression was used to independently estimate the risk of a work-related injury for categories of usual daily sleep duration and weekly working hours, controlling for important covariates and potential confounders of age, sex, race/ethnicity, education, type of pay, industry, occupation (proxy for job risk), body mass index, and the interaction between sleep duration and work hours. Based on the inclusion criteria, there were an estimated 129,950,376 workers annually at risk and 3,634,446 work-related medically treated injury episodes (overall injury rate 2.80/100 workers). Unadjusted annualized injury rates/100 workers across weekly work hours were 2.03 (< or =20 h), 3.01 (20-30 h), 2.45 (31-40 h), 3.45 (40-50 h), 3.71 (50-60 h), and 4.34 (>60 h). With regards to self-reported daily sleep time, the estimated annualized injury rates/100 workers were 7.89 (<5 h sleep), 5.21 (5-5.9 h), 3.62 (6-6.9 h), 2.27 (7-7.9 h), 2.50 (8-8.9 h), 2.22 (9-9.9 h), and 4.72 (>10 h). After controlling for weekly work hours, and aforementioned covariates, significant increases in risk/1 h decrease were observed for several sleep categories. Using 7-7.9 h sleep as reference, the adjusted injury risk (odds ratio [OR] for a worker sleeping a total of <5 h/day was 2.65 (95% confidence interval [CI]: 1.57-4.47), for 5-5.9 h 1.79 (95% CI: 1.22-2.62), and for 6-6.9 h 1.40 (95% CI: 1.10-1.79). No other usual sleep duration categories were significantly different than the reference; however, for >10 h of usual daily sleep, the OR was marginally significantly elevated, 1.82 (95% CI: 0.96-3.47). These results suggest significant increases in work-related injury risk with decreasing usual daily self-reported sleep hours and increasing weekly work hours, independent of industry, occupation, type of pay, sex, age, education, and body mass.

Work-related non-fatal injuries among foreign-born and US-born workers: Findings from the U.S. National Health Interview Survey, 1997-2005

BACKGROUND

Millions of foreign-born workers are employed in the US. Population-based surveys have value in describing the non-fatal work-related injuries that these workers suffer.

METHODS

Using data from the 1997-2005 National Health Interview Survey, we compared the rates of non-fatal work-related injuries among foreign-born and US-born adult workers. Logistic regression was used to produce work-related injury odds ratios (ORs) and 95% confidence intervals (95% CI) by nativity and years of residence while controlling for sex, age, race/ethnicity, education, poverty, family size, insurance status, delayed medical care, and alcohol use. Industry-specific rates were also compared.

RESULTS

Foreign-born workers reported a lower rate of work-related injuries than US-born workers, 50 per 10,000 foreign-born workers versus 89 per 10,000 US-born workers (P < 0.01). After controlling for confounding variables, the OR of work-related injuries for foreign-born workers as compared to US-born workers was 0.50 (95% CI = 0.38-0.66). The construction, agriculture/forestry and fisheries, and manufacturing industries had the highest work-related injury rates for both groups of workers.

CONCLUSIONS

Foreign-born workers had a lower overall rate of work-related injury when compared to US-born workers. Both US-born and foreign-born workers face significant injury risks, especially in certain industries. Interventions tailored with ethnic and cultural differences in mind are still warranted.

The contribution of alcohol to falls at home among working-aged adults

The role of alcohol in the occurrence and burden of fall related injury at home is unclear. We examined the contribution of alcohol to fatal and hospitalized injuries due to unintentional falls at home among working-aged adults. We conducted a population-based case-control study in Auckland, New Zealand between July 2005 and July 2006. Cases were 335 people aged 25-60 years who were admitted to hospital or died as a result of unintentional falls at home. Control subjects were 352 people randomly selected from the electoral roll from the same age band as the cases. The participants or next-of-kin completed a structured interview that ascertained data on sociodemographic, personal, and lifestyle factors including alcohol consumption. After controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding 6h relative to none was associated with a significantly increased risk of fall related injury (for two standard drinks: odds ratio: 3.7, 95% confidence interval: 1.2-10.9; for three or more drinks: odds ratio: 12.9, 95% confidence interval: 5.2-31.9). Approximately 20% of unintentional falls at home in this population may be attributable to the consumption of two or more alcoholic drinks in the preceding 6h. Drinking is strongly associated with unintentional falls at home that result in admission to hospital or death. Moreover, a substantial proportion of falls at home among working-age people can be attributed to alcohol consumption. This largely unrecognized problem should be addressed in falls prevention programs.

Chronic disease and severe disability among working-age populations

BACKGROUND

Recent work has shown that rates of severe disability, measured by the inability to perform basic activities of daily living, have been rising in working age populations. At the same time, the prevalence of important chronic diseases has been rising, while others falling, among working age populations. Chronically ill individuals are more likely than others to have activity of daily living limitations.

OBJECTIVE

We examine the extent to which chronic disease trends can explain these disability trends.

DATA

We use nationally representative survey data from the 1984-1996 National Interview Survey, which posed a consistent set of questions regarding limitations in activities of daily living over that period.

METHODS

We decompose trends in disability into 2 parts-1 part due to trends in the prevalence of chronic disease and the other due to trends in disability prevalence among those with chronic disease.

RESULTS

: Our primary findings are that for working age populations between 1984 and 1996: (1) disability prevalence fell dramatically among the nonchronically ill; (2) rising obesity prevalence explains about 40% of the rise in disability attributable to trends chronic illness; and (3) rising disability prevalence among the chronically ill explains about 60% of the rise in disability attributable to trends in chronic illness.

CONCLUSIONS

Disability prevention efforts in working age populations should focus on reductions in obesity prevalence and limiting disability among chronically ill populations. Given the rise in disability among these population subgroups, it is unclear whether further substantial declines in elderly disability can be expected.

Time allocation between work and recreation and the associated injury risks among young people

PROBLEM

The purpose of this study was to examine the relationship between overall risk of injury and time use patterns between work and active recreation among adolescents and young adults.

METHODS

Using a representative sample of 9,795 Canadians aged 15-24 years, a multivariate logistic regression on the likelihood of any medically attended injury was conducted, including sociodemographic, individual, and time factors.

RESULTS

Young people who engaged in a combination of high work and high activity hours were twice as likely to sustain a medically attended injury compared to those who worked low hours, but did not participate in any recreational activity. Those respondents who were not in school had a 43% increase in injury risk compared to full-time students.

SUMMARY

Our findings suggest that injury risk was not a simple function of fatigue and cumulative exposure time. Our findings suggest the importance of considering time use and the associated injury risk tradeoffs.

IMPACT ON INDUSTRY

Relevant to state and federal work safety policy makers, our findings suggest the importance of understanding where youth might otherwise spend their time if constraint were placed on their employment opportunities, and the associated injury risk tradeoffs must be taken into consideration.

Injuries at work in the US adult population: contributions to the total injury burden

OBJECTIVES

We estimated the contribution of nonfatal work-related injuries on the injury burden among working-age adults (aged 18-64 years) in the United States.

METHODS

We used the 1997-1999 National Health Interview Survey (NHIS) to estimate injury rates and proportions of work-related vs non-work-related injuries.

RESULTS

An estimated 19.4 million medically treated injuries occurred annually to working-age adults (11.7 episodes per 100 persons; 95% confidence interval [CI]=11.3, 12.1); 29%, or 5.5 million (4.5 per 100 persons; 95% CI=4.2, 4.7), occurred at work and varied by gender, age, and race/ethnicity. Among employed persons, 38% of injuries occurred at work, and among employed men aged 55-64 years, 49% of injuries occurred at work.

CONCLUSIONS

Injuries at work comprise a substantial part of the injury burden, accounting for nearly half of all injuries in some age groups. The NHIS provides an important source of population-based data with which to determine the work relatedness of injuries. Study estimates of days away from work after injury were 1.8 times higher than the Bureau of Labor Statistics (BLS) workplace-based estimates and 1.4 times as high as BLS estimates for private industry. The prominence of occupational injuries among injuries to working-age adults reinforces the need to examine workplace conditions in efforts to reduce the societal impact of injuries.