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Silver SR, Sweeney MH, Sanderson WT, Pana-Cryan R, Steege AL, Quay B, Carreón T, Flynn MA. Assessing the role of social determinants of health in health disparities: The need for data on work. Am J Ind Med 2024; 67:129-142. [PMID: 38103002 PMCID: PMC10842318 DOI: 10.1002/ajim.23557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed. METHODS The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions. RESULTS While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse. CONCLUSION Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements.
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Affiliation(s)
- Sharon R Silver
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Marie H Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Wayne T Sanderson
- Department of Biosystems and Agricultural Engineering, Southeast Center for Agricultural Health and Injury Prevention, Central Appalachian Regional Education Research Center, College of Agriculture Food and Environment, University of Kentucky, Lexington, Kentucky, USA
| | - Regina Pana-Cryan
- National Institute for Occupational Safety and Health, Economic Research and Support Office, Washington, District of Columbia, USA
| | - Andrea L Steege
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Brian Quay
- National Institutes of Health (work performed at NIOSH), Bethesda, MD, USA
| | - Tania Carreón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Michael A Flynn
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Asfaw A, Quay B, Bushnell T, Pana-Cryan R. Injuries That Happen at Work Lead to More Opioid Prescriptions and Higher Opioid Costs. J Occup Environ Med 2022; 64:e823-e832. [PMID: 36136663 PMCID: PMC10066591 DOI: 10.1097/jom.0000000000002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Abay Asfaw
- From the Centers for Disease Control and Prevention (CDC)-National Institute for Occupational Safety and Health (NIOSH)-Economic Research and Support Office, Washington, DC (Drs Asfaw and Pana-Cryan); Centers for Disease Control and Prevention (CDC)-National Institute for Occupational Safety and Health (NIOSH)-Economic Research and Support Office, Cincinnati, Ohio (Mr Quay, Dr Bushnell)
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Wong IS, Quay B, Irvin E, Belzer MH. Describing economic benefits and costs of nonstandard work hours: A scoping review. Am J Ind Med 2022; 65:926-939. [PMID: 34687049 PMCID: PMC9023590 DOI: 10.1002/ajim.23302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/18/2021] [Accepted: 09/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The benefits of nonstandard work hours include increased production time and the number of jobs. While for some sectors, such as emergency services, around-the-clock work is a necessary and critical societal obligation, work outside of traditional daytime schedules has been associated with many occupational safety and health hazards and their associated costs. Thus, organizational- and policy-level decisions on nonstandard work hours can be difficult and are based on several factors including economic evaluation. However, there is a lack of systematic knowledge of economic benefits and costs associated with these schedules. METHODS We conducted a scoping review of the methodology and data used to examine the economic benefits and costs of nonstandard work hours and related interventions to mitigate risks. RESULTS Ten studies met all our inclusion criteria. Most studies used aggregation and analysis of national and other large datasets. Costs estimated include health-related expenses, productivity losses, and projections of future loss of earnings. Cost analyses of interventions were provided for an obstructive sleep apnea screening program, implementation of an employer-based educational program, and increased staffing to cover overtime hours. CONCLUSIONS A paucity of studies assess nonstandard work hours using economic terms. Future studies are needed to expand economic evaluations beyond the employer level to include those at the societal level because impacts of nonstandard work go beyond the workplace and are important for policy analysis and formulation. We pose the opportunity for researchers and employers to share data and resources in the development of more analyses that fill these research gaps.
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Affiliation(s)
- Imelda S. Wong
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Brian Quay
- Economic Research and Support Office, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Emma Irvin
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Michael H. Belzer
- Department of Economics, Wayne State University, Detroit, Michigan, USA
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Silver SR, Li J, Quay B. Visual representation of work as a social determinant of health: Augmenting Silver et al., Employment status, unemployment duration, and health-related metrics among US adults of prime working age. Am J Ind Med 2022; 65:697-698. [PMID: 35612358 PMCID: PMC9283259 DOI: 10.1002/ajim.23398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sharon R. Silver
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health Cincinnati Ohio USA
| | - Jia Li
- Division of Field Studies and Engineering National Institute for Occupational Safety and Health Cincinnati Ohio USA
| | - Brian Quay
- Economic Research and Support Office National Institute for Occupational Safety and Health Cincinnati Ohio USA
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Bushnell PT, Pana‐Cryan R, Howard J, Quay B, Ray TK. Measuring the benefits of occupational safety and health research with economic metrics: Insights from the National Institute for Occupational Safety and Health. Am J Ind Med 2022; 65:323-342. [PMID: 35293636 PMCID: PMC10111360 DOI: 10.1002/ajim.23347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/29/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Abstract
Measuring the ultimate impact of research on health and economic well-being has presented challenges that have rarely been surmounted, and research on preventing occupational injuries and illnesses is no exception. Nevertheless, there is an increasing need to demonstrate the value of publicly funded research. The National Institute for Occupational Safety and Health (NIOSH) recently contracted with the RAND Corporation to conduct six in-depth case studies that aimed to quantify the benefits of key NIOSH research efforts using economic metrics. These case studies focused on silica exposure in asphalt pavement milling, firefighter cancer risks, a multi-industry matching-grant program for purchase of safety equipment, personal coal dust monitors for coal miners, re-design of ambulance patient compartments for safety, and workplace amputation surveillance. In this article, we summarize what we learned about how measurement of research benefits may be pursued. We summarize the benefit measurement methods that were used and the results of these research efforts in terms of costs saved, injuries and illnesses prevented, and the statistical value of reductions in risk of death or illness. We then distill some observations about the characteristics of research efforts that make measurement of research benefits feasible and suggest steps that could make it feasible to apply the same methods more widely. We also outline key NIOSH activities that appear not to be amenable to benefit measurement but suggest potentials for progress toward at least partial or qualitative benefit assessment. Finally, we discuss implications of the benefit measurement case studies for strategic research planning.
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Affiliation(s)
- P. Timothy Bushnell
- Office of the Director, National Institute for Occupational Safety and Health Cincinnati Ohio USA
| | - Regina Pana‐Cryan
- Office of the Director, National Institute for Occupational Safety and Health Washington DC USA
| | - John Howard
- Economic Research and Support Office, National Institute for Occupational Safety and Health Washington DC USA
| | - Brian Quay
- Office of the Director, National Institute for Occupational Safety and Health Cincinnati Ohio USA
| | - Tapas K. Ray
- Office of the Director, National Institute for Occupational Safety and Health Cincinnati Ohio USA
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Silver SR, Li J, Quay B. Employment status, unemployment duration, and health-related metrics among US adults of prime working age: Behavioral Risk Factor Surveillance System, 2018-2019. Am J Ind Med 2022; 65:59-71. [PMID: 34748231 PMCID: PMC8678322 DOI: 10.1002/ajim.23308] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND While unemployment has been associated with poor health, few recent studies in the United States have comprehensively assessed associations between employment status (including duration unemployed) and healthcare access, health-related behaviors, and specific health outcomes. METHODS We assessed health-related metrics by employment status in 2018-2019 Behavioral Risk Factor Surveillance System respondents ages 25-54. We calculated the unadjusted prevalence and adjusted prevalence ratios to compare employed workers to respondents who were self-employed, short-term (<12 months) unemployed, long-term unemployed, and unable to work. RESULTS Adverse health outcomes increased with unemployment duration and were highest for those unable to work. Non-Hispanic Blacks were most likely to be unemployed or unable to work. Short-term unemployment and self-employment were associated with poor healthcare access. Health behaviors and outcomes declined with increasing duration of unemployment and were worst for those unable to work. CONCLUSIONS In the United States, access to affordable healthcare is problematic for both the self-employed and the short-term unemployed. Short-term unemployment is a particularly important locus for intervention and provision of resources to prevent health declines that may hinder re-employment.
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Affiliation(s)
- Sharon R. Silver
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Health Informatics Branch
| | - Jia Li
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Health Informatics Branch
| | - Brian Quay
- National Institute for Occupational Safety and Health, Office of the Director, Economic Research and Support Office
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Asfaw A, Pana‐Cryan R, Quay B. Association between longest-held occupation and Social Security Disability Insurance benefits receipt. Am J Ind Med 2020; 63:676-684. [PMID: 32445501 DOI: 10.1002/ajim.23121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The cost of the Social Security Disability Insurance (DI) program has increased over time though recent reports showed that disability incidence and prevalence rates have started declining. We explored whether occupation was one of the risk factors for the rising number of disabled workers who received DI benefits during 1992-2016. METHODS We used a cohort of 16 196 Health and Retirement Survey respondents between the age of 51 and 64 years who were followed from their date of entry until they received DI benefits, died, reached full retirement age, or reached the end of the follow-up period (2016). We used the extended stratified Cox proportional hazard model. Because one-third of the respondents in our cohort did not report their longest-held occupation, we used a multiple-imputation method. RESULTS The hazard of receiving DI benefits was 51%, 78%, 81%, and 85% higher among workers with longest-held occupations in sales, mechanics and repair, protective services, and personal services, respectively than among workers with longest-held occupations in the reference managerial occupation. The hazard of receiving DI benefits was more than double among workers with longest-held occupations in the construction trade and extractors, transportation operation, machine operators, handlers, and food preparation than among workers with the longest-held occupation in the reference managerial occupation. CONCLUSION Improving the overall working conditions in these occupations would help reduce worker suffering and the number of applicants for DI benefits, thereby reducing the burden of workplace injury and illness on the DI program.
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Affiliation(s)
- Abay Asfaw
- National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC) Washington, DC
| | - Regina Pana‐Cryan
- National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC) Washington, DC
| | - Brian Quay
- National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC)Cincinnati Ohio
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Asfaw A, Alterman T, Quay B. Prevalence and Expenses of Outpatient Opioid Prescriptions, With Associated Sociodemographic, Economic, and Work Characteristics. Int J Health Serv 2019; 50:82-94. [PMID: 31603364 DOI: 10.1177/0020731419881336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Information on opioids obtained by workers is important for both health and safety. We examined the prevalence and total expenses of obtaining outpatient opioid prescriptions, along with associated sociodemographic, economic, and work characteristics, in national samples of U.S. workers. We used Medical Expenditure Panel Survey data (2007–2016) along with descriptive and multiple logistic regression. During the study period, an estimated 21 million workers (12.6%) aged 16 years or older obtained one or more outpatient opioid prescriptions, at an expense of $2.81 billion per year. Private health insurance covered half of the total opioid expenses for workers. The prevalence of obtaining opioid prescriptions was higher for women than for men, but men had higher opioid expenses. In addition, the prevalence of obtaining opioid prescriptions was higher for workers who were older; non-Hispanic white; divorced, separated, or widowed; and non-college-educated. There is an inverse relationship between family income and the likelihood of obtaining opioids. Compared to workers with private insurance, workers with public health insurance had higher expenses for opioid prescriptions. Finally, workers in occupations at higher risk for injury and illness – including construction and extraction; farming; service; and production, transportation, and material moving occupations – were more likely to obtain opioid prescriptions.
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Affiliation(s)
- Abay Asfaw
- Office of the Director, Economic Research and Support Office, Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health, Washington, District of Columbia, USA
| | - Toni Alterman
- Division of Surveillance, Hazard Evaluations, and Field Studies, Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Brian Quay
- Office of the Director, Economic Research and Support Office, Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health, Washington, District of Columbia, USA
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