Squeezing blood from a stone: how income inequality affects the health of the American workforce

Patient demographics as determinants of where they go for hospitalization, what inpatient care they get, and what they are charged: A national study

This study focuses on the impact of race, income, age, and gender on hospital charges in the US. The data include 28,133 discharge records for appendectomies from a stratified sample of 4,584 hospitals in the HCUP's (Hospital Cost and Utilization Project) NIS (National Inpatient Sample) database. Results show that race, income, and age were significant determinants of hospital charges. Gender was not significantly related to the variance in hospital charges. Additionally, hospital variables (ownership/control region, teaching status, size, and primary expected payer) had statistically significant effects on hospital charges. We conclude with implications for clinicians, hospital administrators, and policy makers.

Work-related injuries among commercial janitors in Washington State, comparisons by gender

INTRODUCTION

We analyzed workers' compensation (WC) data to identify characteristics related to workers' compensation claim outcomes among janitorial service workers in Washington State.

METHOD

We analyzed WC data from the Washington State Department of Labor & Industries (L&I) State Fund (SF) from January 1, 2003 through December 31, 2013, for janitorial service workers employed in the National Occupational Research Agenda (NORA) Services Sector. We constructed multivariable models to identify factors associated with higher medical costs and increased time lost from work.

RESULTS

There were 2,390 janitorial service compensable claims available for analysis. There were significant differences in injury type and other factors by gender, age, and language preference. Linguistic minority status was associated with longer time loss and higher median medical costs. Women were estimated to account for 35% of janitorial service workers but made up 55% of the compensable claims in this study.

CONCLUSIONS

Janitorial service workers comprise a large vulnerable occupational group in the U.S. workforce. Identifying differences by injury type and potential inequitable outcomes by gender and language is important to ensuring equal treatment in the workers' compensation process.

PRACTICAL APPLICATIONS

There were significant differences in injury and individual characteristics between men and women in this study. Women had twice the estimated rate of injury to men, and were more likely to require Spanish language materials. Improving communication for training and knowledge about the workers' compensation system appear to be high priorities in this population of injured janitorial service workers.

Economic Opportunity, Health Behaviors, and Mortality in the United States

OBJECTIVES

We assessed whether economic opportunity was independently associated with health behaviors and outcomes in the United States.

METHODS

Using newly available, cross-sectional, county-level data from the Equality of Opportunity Project Database and vital statistics, we estimated associations between all-cause mortality rates (averaged over 2000-2012) and economic opportunity, adjusting for socioeconomic, demographic, and health system covariates. Our measure of economic opportunity was the county-average rank in the national income distribution attained by individuals born to families in the bottom income quartile. Secondary outcomes included rates of age- and race-specific mortality, smoking, obesity, hypertension, and diabetes.

RESULTS

An increase in economic opportunity from the lowest to the highest quintile was associated with a 16.7% decrease in mortality. The magnitudes of association were largest for working-age adults and African Americans. Greater economic opportunity was also associated with health behaviors and risk factors.

CONCLUSIONS

Economic opportunity is a robust, independent predictor of health. Future work should investigate underlying causal links and mechanisms.

Code Red: Explaining Average Age of Death in the City of Hamilton

The aim of this study is to identify the underlying factors that explain the average age of death in the City of Hamilton, Ontario, Canada, as identified in the Code Red Series of articles that were published in the city's local newspaper in 2010. Using a combination of data from the Canadian Census, the Government of Ontario and the Canadian Institute for Health Information, factor analysis was performed yielding three factors relating to poverty, working class, and health and aging. In a regression analysis these factors account for 42% of the total variability in the average ages of death observed at the census tract level of geography within the city.

Black Jobs Matter: Racial Inequalities in Conditions of Employment and Subsequent Health Outcomes

African-Americans shoulder an excessive burden of unemployment, precarious employment, and low paying jobs in the United States, which may help explain why they experience some of the worst health outcomes among U.S. citizens. This paper presents a conceptual framework describing this phenomenon. The social determinants of health as described by this framework include racism, social and public policy formation, socioeconomic status, and conditions of employment. The intermediate determinants of health, which include the ability to afford health behavior, depression and addiction, environmental exposures, and access to primary care, are informed by conditions of employment, which leads to poor health outcomes for African-Americans. This paper will explore in detail these relationships.