Health risk factors as predictors of workers' compensation claim occurrence and cost

Using the Functional Comorbidity Index with administrative workers' compensation data: Utility, validity, and caveats

BACKGROUND

Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes.

METHODS

WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes.

RESULTS

The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change).

CONCLUSIONS

The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.

Behavioral Health and Stress in Agriculture

Behavioral health and stress are often antecedents to chronic health problems and injury; however, until recently addressing health and safety issues from a behavioral perspective has received little treatment. In this article, we review the current state of behavioral health and stress in agriculture, examine current trends to address this stress, identify gaps still to be filled and make recommendations for future efforts.

Latin American Agricultural Workers' Job Demands and Resources and the Association With Health Behaviors at Work and Overall Health

In the present study, we describe the job demands and job resources (JD-R) experienced by agricultural workers in three Latin American countries and their relationship to proactive health behaviors at work and overall health. Following previous research on the JD-R model, we hypothesized that job demands (H1) would be negatively related to agricultural workers' self-reported overall health. On the other hand, we hypothesized that job resources (H2) would be positively related to agricultural workers' overall health. Furthermore, we hypothesized (H3) that workers' engagement in jobsite health promotion practices via their proactive health behaviors at work would partially mediate the relationship between workers' job resources and job demands and overall health. We also had a research question (R1) about whether there were differences by type of job held. The sample of workers who participated in this study (N = 1,861) worked in Mexico, Guatemala, and Nicaragua for one large agribusiness that produces sugar cane. They worked in two distinct areas: company administration and agricultural operations. We administered employee health and safety culture surveys using survey methods tailored to meet the needs of both types of workers. Stratified path analysis models were used to test study hypotheses. In general, we found support for hypotheses 1 and 2. For example, operations workers reported more physically demanding jobs and administrative workers reported more work-related stress. Regardless, the existence of high job demands was associated with poorer overall health amongst both types of workers. We found that workers in more health-supportive work environments perform more proactive health behaviors at work, regardless of their role within the organization. However, hypothesis 3 was not supported as proactive health behaviors at work was not associated with overall health. We discuss future research needs in terms of evaluating these hypotheses amongst workers employed by small- and medium-sized agribusinesses as well as those in the informal economy in Latin America. We also discuss important implications for agribusinesses seeking to develop health promotion programs that meet the needs of all workers.

Evaluation of a Total Worker Health® leadership program for small business leaders

Leaders play a critical role in the development and execution of Total Worker Health (TWH). Small businesses, in particular, can benefit from strong leadership support for TWH as the burden of work-related injury, illness and fatality, as well as poor health and well-being is high in this population. In the present study, we conducted a program evaluation of a TWH leadership development program for small business leaders using the RE-AIM framework. The goal of the program was to help change leaders' behaviors around health, safety and well-being practices following the theory of transformational leadership. Two leaders from each business participated in pre-training activities on their own, a 6-hour in-person training, and three months of access to virtual training transfer activities, including coaching and goal tracking. Our results suggest that the TWH leadership development program is effective at improving leaders' self-reported TWH leadership practices and that the in-person training was implemented successfully. However, leaders did not report improvements in their personal health and in fact reported increased levels of work stress after the program. We also observed some challenges when implementing our training transfer strategies. Our study suggests that leaders may benefit from attending TWH leadership trainings alongside other colleagues in their organization to facilitate a shared vision and goals for TWH in their organization. As a next step, it will be important to determine the program's effectiveness in changing business TWH policies and practices, employee perceptions of TWH and leadership, and employee health and safety outcomes.

Development and validation of a diabetes risk score among two populations

The purpose of this study was to assess the validity of a practical diabetes risk score amongst two heterogenous populations, a working population and a non-working population. Study population 1 (n = 2,089) participated in a large-scale screening program offered to retired workers to discover previously undetected/incipient chronic illness. Study population 2 (n = 3,293) was part of a Colorado worksite wellness program health risk assessment. We assessed the relationship between a continuous diabetes risk score at baseline and development of diabetes in the future using logistic regression. Receiver operating curves and sensitivity/specificity of the models were calculated. Across both study populations, we observed that participants with diabetes at follow-up had higher diabetes risk scores at baseline than participants who did not have diabetes at follow-up. On average, the odds ratio of developing diabetes in the future was 1.38 (95% CI: 1.26-1.50, p < 0.0001) for study population 1 and 1.68 (95% CI: 1.45-1.95, p-value < 0.0001) for study population 2. These findings indicate that the diabetes risk score may be generalizable to diverse individuals, and thus potentially a population level diabetes screening tool. Minimally-invasive diabetes risk scores can aid in the identification of sub-populations of individuals at risk for diabetes.

Fatigue and the Need for Recovery among Latino/a Immigrant Cattle Feedyard Workers

Cattle feedyards are animal feeding operations where beef cattle are finished to market weight on grain. Cattle feeding can be dirty, demanding, and dangerous work. This study sought to assess the predictors of fatigue and the need for recovery among Latino/a immigrant cattle feedyard workers in the United States. A path model was examined to explore direct and indirect relations among physical fatigue, mental fatigue, need for recovery, job characteristics, and health and sociodemographic covariates. Lower self-reported health, experiencing physical pain, not handling animals, and decreased decision latitude were directly related to increased physical fatigue. Shorter tenure working on cattle feedyards, lower educational level, experiencing physical pain, and increased job demands were directly related to heightened mental fatigue. Being female, experiencing physical pain, an elevated average of hours worked per day, increased job demands, and less decision latitude were directly related to an increased need for recovery and indirectly related to both physical and mental fatigue. Physical and mental fatigue have specific correlates, but job characteristics, including job demands and decision latitude, can directly and indirectly impact workers' levels of physical and mental fatigue and their need for recovery. Both preventive measures and restructuring work operations may reduce the risk for fatigue and the need for recovery. Implications for cattle feedyard workers, supervisors, and employers are discussed. Finding ways to balance productivity and the well-being of workers should be a high priority for cattle feedyards across the country.

Health Links™ Assessment of Total Worker Health® Practices as Indicators of Organizational Behavior in Small Business

OBJECTIVE

The aim of this study was to conduct a cross-sectional assessment of the adoption of Total Worker Health (TWH) policies and practices by business size and evaluate extent and alignment of their safety and health.

METHODS

We conducted an analysis of 382 businesses that completed the Health Links Assessment. We measured organizational adoption of TWH across six benchmarks: organizational supports, workplace assessments, health policies and programs, safety, engagement, and evaluation.

RESULTS

Benchmark scores were significantly associated with business size. Larger businesses were more likely to score higher across each benchmark.

CONCLUSION

Small businesses are implementing TWH in a variety of ways and the level of implementation differs by business size. Practical interventions as well as dissemination and implementation research should take business size into account to ensure that TWH is both effective and sustainable in meeting the needs of employees.

Health Risk Calculator: An Online, Interactive Tool to Estimate how Health Impacts Workers' Compensation Claim Incidence and Cost

OBJECTIVE

The purpose of this paper is to describe and evaluate a web-based, educational Health Risk Calculator that communicates the value of investing in employee health and well-being for the prevention of work-related injuries, illnesses, and fatalities.

METHODS

We developed and evaluated the calculator following the RE-AIM framework. We assessed effectiveness via focus groups (n = 15) and a post-use survey (n = 33) and reach via website analytics.

RESULTS

We observed evidence for the calculator's usability, educational benefit, and encouragement of action to improve worker health and safety. Website analytics data demonstrated that we reached over 300 users equally in urban and rural areas within 3 months after launch.

CONCLUSION

We urge researchers to consider the ways in which they can communicate their empirical research findings to their key stakeholders and to evaluate their communication efforts.

Medical marijuana and workers' compensation claiming

We study the effect of state medical marijuana laws (MMLs) on workers' compensation (WC) claiming among adults. Medical marijuana is plausibly related to WC claiming by allowing improved symptom management, and thus reduced need for the benefit, among injured or ill workers. We use data on claiming drawn from the Annual Social and Economic supplement to the Current Population Survey over the period 1989 to 2012, coupled with a differences-in-differences design to provide the first evidence on this relationship. Our estimates show that, post MML, WC claiming declines, both the propensity to claim and the level of income from WC. These findings suggest that medical marijuana can allow workers to better manage symptoms associated with workplace injuries and illnesses and, in turn, reduce need for WC. However, the reductions in WC claiming post MML are very modest in size.

Total Worker Health Leadership and Business Strategies Are Related to Safety and Health Climates in Small Business

The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part of the Small + Safe + Well (SSWell) Study, we confirm the primacy of the relationship between leadership commitment to safety and workplace safety climate. After accounting for leadership commitment to safety, business-reported policies and practices that promote the health, safety, and well-being of workers (i.e., TWH strategies) were no longer related to safety climate. In contrast, the relationship between TWH strategies and health climate were significantly associated with the level of small business leadership commitment to worksite wellness. Relatedly, our results demonstrate that leadership is a common correlate to both safety climate and health climate. Future research should investigate integrated TWH leadership development strategies as a means of simultaneously improving safety and health climates.

Reoccurring Injury, Chronic Health Conditions, and Behavioral Health: Gender Differences in the Causes of Workers' Compensation Claims

OBJECTIVE

The aim of this study was o examine how work and nonwork health-related factors contribute to workers' compensation (WC) claims by gender.

METHODS

Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models.

RESULTS

For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men.

CONCLUSION

This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.

Estimation of work-related injury and economic burden attributable to heat stress in Guangzhou, China

BACKGROUND

Climate change has exacerbated the health effects of high ambient temperatures on occupational health and safety; however, to what extent heat stress can induce workplace injuries and economic costs is poorly studied. This study aimed to quantify the attributable fractions of injury claims and subsequent insurance payouts using data from work-related injury insurance system in Guangzhou, China.

METHODS

Individual workers' injury claims data were collected for the period of 2011-2012, including demographic characteristics and work-related information. Daily maximum wet bulb globe temperature (WBGT, °C) was calculated from meteorological data. To examine the association between WBGT index and work-related injury, we fit a quasi-Poisson regression with distributed lag non-linear model. Then we calculated the numbers of injury claims and costs of insurance compensations attributable to days with WBGT above the heat stress limit according to the national occupational health standards.

RESULTS

There were 9550 work-related injury claims, resulting in an insurance payout of 282.3 million Chinese Yuan. The risks of injury claims increased with rising WBGT. 4.8% (95% eCI: 2.9%-6.9%) of work-related injuries and 4.1% (95% eCI: 0.2%-7.7%) of work-related injury insurance payouts were attributed to heat exposure for WBGT threshold above the heat stress limit. Male workers, those in small enterprises and with low educational attainment were especially sensitive to the effects of heat exposure.

CONCLUSIONS

Heat stress can contribute to higher risk of work-related injury and substantial economic costs. Quantified the impacts of injuries and related economic costs should be considered to develop targeted preventive measures in the context of climate change.

Building an allostatic load index from data of occupational medical checkup examinations: a feasibility study

The allostatic load index (ALI) assesses the physiological adaption to chronic stress by cumulative changes in the circulation, respiration, inflammation, metabolic and anthropometric systems. The ALI thus can function as a risk marker for secondary prevention in occupational medicine. The aim of this study was to investigate the feasibility of creating a predictive marker by using data from an executive checkup program of an international company and to examine its relationship to work-related surrogate health parameters. Datasets from 307 examinations of 151 executives (19 males and 132 females) were available. Each participant attended at least one checkup examination between 2003 and 2015. The mean age was 43.6 (SD ±6.6, 31-64y). We developed four different ALIs with different biomarkers of the cardio-vascular, immune, metabolic and anthropometric systems. As a primary mediator, the thyroid-stimulating hormone was used as a proxy. For each ALI, the associations with the work ability index (WAI) and categories of sick leave days (SLD) were examined. Zero inflation was considered for SLD. One ALI showed a significant negative association with the WAI (B = -0.680, SE =0.266, p = .049). The results of a second ALI had a similar trend (B= -0.355, SE =0.201, p = .081). After adjustment for zero inflation two other ALIs showed a positive association with SLD. This study provides the first hints that biomarkers form a secondary prevention program are useful in calculating a meaningful ALI. Thus, the concept of allostatic load could be used in workplace health-promotion.

Analyzing Large Workers’ Compensation Claims Using Generalized Linear Models and Monte Carlo Simulation

Insurance practitioners rely on statistical models to predict future claims in order to provide financial protection. Proper predictive statistical modeling is more challenging when analyzing claims with lower frequency, but high costs. The paper investigated the use of predictive generalized linear models (GLMs) to address this challenge. Workers’ compensation claims with costs equal to or more than US$100,000 were analyzed in agribusiness industries in the Midwest of the USA from 2008 to 2016. Predictive GLMs were built with gamma, Weibull, and lognormal distributions using the lasso penalization method. Monte Carlo simulation models were developed to check the performance of predictive models in cost estimation. The results show that the GLM with gamma distribution has the highest predictivity power (R2 = 0.79). Injury characteristics and worker’s occupation were predictive of large claims’ occurrence and costs. The conclusions of this study are useful in modifying and estimating insurance pricing within high-risk agribusiness industries. The approach of this study can be used as a framework to forecast workers’ compensation claims amounts with rare, high-cost events in other industries. This work is useful for insurance practitioners concerned with statistical and predictive modeling in financial risk analysis.

Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance

An aging workforce, increased prevalence of chronic health conditions, and the potential for longer working lives have both societal and economic implications. We analyzed the combined impact of workplace safety, employee health, and job demands (work task difficulty) on worker absence and job performance. The study sample consisted of 16,926 employees who participated in a worksite wellness program offered by a workers' compensation insurer to their employers-314 large, midsize, and small businesses in Colorado across multiple industries. We found that both workplace safety and employees' chronic health conditions contributed to absenteeism and job performance, but their impact was influenced by the physical and cognitive difficulty of the job. If employers want to reduce health-related productivity losses, they should take an integrated approach to mitigate job-related injuries, promote employee health, and improve the fit between a worker's duties and abilities.