Increased all-cause mortality following occupational injury: a comparison of two states.

OBJECTIVES: To measure the impact of lost-time occupational injuries on all-cause mortality in Washington State and, using the same data elements and study design, to determine whether the estimated impact was similar to previous estimates for New Mexico. METHODS: We linked injuries in the Washington workers' compensation system with Social Security Administration data on earnings and mortality. We estimated Cox survival models of mortality for women and men with lost-time compared with medical-only injuries, adjusting for age, pre-injury earnings and industry. We used quantitative bias analysis to account for confounding by pre-injury smoking and obesity. RESULTS: The estimated mortality HR was 1.24 for women (95% CI 1.21 to 1.28) and 1.22 for men (95% CI 1.20 to 1.24). After adjusting for unmeasured pre-injury smoking and obesity, the estimated HR for women was 1.10, 95% simulation interval (SI) 1.00 to 1.21; for men, it was 1.15, 95% SI 1.04 to 1.27. CONCLUSIONS: All-cause mortality for Washington workers with lost-time injuries was higher than for those with medical-only injuries. Estimated HRs for Washington were consistent with those previously estimated for New Mexico, a less populous state with lower median wages and a different workers' compensation insurance mechanism. This suggests that the relationship between workplace injury and long-term mortality may be generalisable to other US states. These findings support greater efforts to enhance safety and to investigate factors that improve postinjury employment opportunities and long-term health. This association should be examined in additional locations, with different study conditions, or using additional data on pre-injury risk factors.

Cost of lost work hours associated with the COVID-19 pandemic-United States, March 2020 through February 2021.

INTRODUCTION: Of the 22.8 million coronavirus disease 2019 (COVID-19) cases recorded in the United States as of March 21, 2021 with age information, three-fourths were in the workingage group, indicating the potentially high economic impact of the pandemic. This study estimates the cost of lost work hours associated with the COVID-19 pandemic between March 2020 through February 2021. METHOD: I used a before-and-after analysis of data from the 2017-2021 Current Population Survey to estimate the costs of lost work hours due to economic, workers' own health, and other reasons, from the COVID-19 pandemic. RESULTS: Across March 2020 through February 2021 (a year since the start of the pandemic in the United States), the estimated cost of lost work hours associated with the COVID-19 pandemic among US full-time workers was $138 billion (95% confidence interval [CI]: $73.4 billion-$202.46 billion). Shares of the costs attributed to economic, workers' own health, and other reasons were 33.7%, 13.7%, and 52.6%, respectively. CONCLUSION: The $138 billion cost of lost work hours associated with the COVID-19 pandemic during March 2020 through February 2021 highlights the economic consequences of the pandemic, as well as indicating the potential benefit of public health and safety interventions used to mitigate COVID-19 spread.

Impact of workplace injury on opioid dependence, abuse, illicit use and overdose: a 36-month retrospective study of insurance claims.

OBJECTIVES: To examine the impact of workplace injury on opioid dependence, abuse and overdose (opioid-related morbidity) and if severity of injury increases the hazard of these health effects. METHODS: We used MarketScan databases to follow injured and propensity score matched non-injured workers, both without prior opioid-related diagnoses. Using a Cox proportional hazard model, we examined the impact of workplace injury on opioid-related morbidity. RESULTS: The hazard of opioid-related morbidity for injured workers was 1.79 times than that of matched non-injured workers (95% CI 1.89 to 3.60). For medical-only and lost-time injured workers, it was respectively 1.54 (95% CI 1.02 to 2.32) and 2.91 (95% CI 1.75 to 4.84) times that of non-injured workers. CONCLUSIONS: Reducing workplace injury or severity of workplace injury, as well as efforts to ensure appropriate opioid prescribing for injured workers, may help to reduce the societal costs of opioid use.

Association between longest-held occupation and Social Security Disability Insurance benefits receipt.

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.

Suicide and drug-related mortality following occupational injury.

BACKGROUND: Drug overdoses and suicides have been rising since 2000 and are major contributors to a 3-year decline in US life expectancy. Studies suggest that injured workers have elevated rates of depression and opioid use, but no studies have measured excess mortality related to these risks. MATERIALS AND METHODS: We linked New Mexico workers' compensation data for 100 806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data. We then estimated the association between receiving lost-time workers' compensation benefits and mortality hazard ratios (HRs) and 95% confidence intervals (CIs) based on Fine and Gray cause-specific subdistribution hazards for common causes of death and for drug-related, suicide, and alcohol-related mortality. RESULTS: There was almost a 3-fold increase in combined drug-related and suicide mortality hazard among women (HR = 2.63, 95% CI = 1.91-3.64) and a substantial increase among men (HR = 1.42, 95% CI = 1.13-1.79). Circulatory disease mortality hazard was elevated for men (HR = 1.25, 95% CI = 1.05-1.50). CONCLUSION: Workplace injuries severe enough to require more than a week off work may impair workers' long-term health and well-being. Drug-related deaths and suicides may be important contributors to the long-term excess mortality of injured workers. Improved workplace conditions, improved pain treatment, better treatment of substance use disorders, and treatment of postinjury depression may substantially reduce mortality consequent to workplace injuries.

Association between parental access to paid sick leave and children's access to and use of healthcare services.

BACKGROUND: We examined the association between parental access to paid sick leave (PPSL) and children's use of preventive care and reduced likelihood of delayed medical care and emergency room (ER) visits. METHODS: We used the child sample of the National Health Interview Survey data (linked to the adult and family samples) from 2011 through 2015 and logistic and negative binomial regression models. RESULTS: Controlling for covariates, the odds of children with PPSL receiving flu vaccination were 12.5% [95%CI: 1.06-1.19] higher and receiving annual medical checkups were 13.2% [95%CI: 1.04-1.23] higher than those of children without PPSL. With PPSL, the odds of children receiving delayed medical care because of time mismatch were 13.3% [95%CI: 0.76-0.98] lower, and being taken to ER were 53.6% [95%CI: 0.27-0.81] lower than those of children without PPSL. PPSL was associated with 11% [95%CI: 0.82-0.97] fewer ER visits per year. CONCLUSION: PPSL may improve children's access and use of healthcare services and reduce the number of ER visits. Am. J. Ind. Med. 60:276-284, 2017. © 2017 Wiley Periodicals, Inc.

Musculoskeletal disorders and associated healthcare costs among family members of injured workers.

BACKGROUND: Research has infrequently looked beyond the injured worker when gauging the burden of occupational injury. OBJECTIVES: We explored the relationship between occupational injury and musculoskeletal disorders (MSDs) among family members of injured workers. DATA AND METHODS: We used 2005 and 2006 Truven Health Analytics databases, which contain information on workers' compensation and family healthcare claims. We used descriptive analyses, and negative binomial and two-part models. RESULTS: Family members of severely injured workers had a 15% increase in the total number of MSD outpatient claims and a 34% increase in the mean cost of MSD claims compared to family members of non-severely injured workers within 3 months after injury. Extrapolating cost results to the national level implies that severe occupational injury would be associated with between $29 and $33 million additional cost of family member outpatient MSD claims. CONCLUSION: Occupational injury can impose a formerly unrecognized health burden on family members of injured workers.

Workplace mistreatment and sickness absenteeism from work: results from the 2010 National Health Interview survey.

OBJECTIVE: This study examined the association between workplace mistreatment and occurrence, duration, and costs of sickness absenteeism. METHODS: We used the 2010 National Health Interview Survey and considered 13,807 employed adult respondents. We used a zero-inflated negative binomial (zinb) model to examine the association between exposure to workplace mistreatment and the occurrence and number of workdays missed due to illness/injury in the preceding 12 months. RESULTS: In 2010, 7.6% of US workers employed at the time of the survey reported having been mistreated at their workplace. Both occurrence and duration of sickness absence were higher for mistreated than for non-mistreated workers. The zinb results showed that being mistreated was associated with a 42% increase in the number of missed workdays, controlling for covariates. The marginal effect analysis showed that lost workdays differed by 2.45 days between mistreated and non-mistreated workers. This implies that workplace mistreatment was associated with $4.1 billion, or 5.5%, of sickness absenteeism costs in 2010. CONCLUSIONS: Workplace mistreatment is associated with sickness absence in the United States. While a causal relationship could not be established due to the cross-sectional design of the study, this study reveals the economic importance of developing workplace mistreatment prevention strategies.

Paid Sick Leave and Self-Reported Depression and Anxiety: Evidence From a Nationally Representative Longitudinal Survey.

INTRODUCTION: The objective of this study was to explore the association between access to paid sick leave (AtPSL) and self-reported feelings of depression and anxiety in a nationally representative U.S. working population. METHODS: In 2023, this study examined data from the 2019-2020 Longitudinal National Health Interview Survey. A Generalized Linear Latent and Mixed Model (GLLAMM) was used to analyze the longitudinal data. RESULTS: The descriptive analysis of population averages showed that fewer workers with AtPSL reported daily feelings of depression (45%), anxiety (24%), and both depression and anxiety (52%) than workers without AtPSL. According to the GLLAMM analysis, the odds of workers with AtPSL self-reporting feelings of daily depression, anxiety, and both were 48%, 27%, and 51% lower, respectively, than workers without AtPSL. This analysis controlled for different demographic and socioeconomic variables. Robustness analysis demonstrated that these associations persisted when the outcome variables were measured in terms of self-reported feelings of weekly depression and anxiety. CONCLUSIONS: The role of mental health in improving overall well-being and the recognition of AtPSL as a social justice issue have reinforced the importance of providing paid sick leave to help protect the mental health status of workers. This study, using a unique longitudinal data set, found that AtPSL was associated with a lower prevalence of self-reported daily or weekly feelings of depression and anxiety.

Association between reasons for not working and reporting of major depression and anxiety symptoms among U.S. adult population during the COVID-19 pandemic.

COVID-19 continues to take a large toll on the mental health of the not working population, particularly of those who were unable to work. This study, using the Household Pulse Survey, estimated the association between reasons for not working and major depression and anxiety symptoms (MDAS). The lowest MDAS was reported by retirees. Individuals who were unable to work because of transportation problems, layoffs, COVID-19 concerns, and sickness or disability reported the highest MDAS. Mediation analysis showed that the direct and indirect effects of reasons for not working were much higher for those individuals who were unable to work than for individuals who were working or decided not to work.

Paid sick leave and nonfatal occupational injuries.

OBJECTIVES: We examined the association between US workers' access to paid sick leave and the incidence of nonfatal occupational injuries from the employer's perspective. We also examined this association in different industries and occupations. METHODS: We developed a theoretical framework to examine the business value of offering paid sick leave. Data from the National Health Interview Survey were used to test the hypothesis that offering paid sick leave is associated with a reduced incidence of occupational injuries. We used data on approximately 38 000 working adults to estimate a multivariate model. RESULTS: With all other variables held constant, workers with access to paid sick leave were 28% (95% confidence interval = 0.52, 0.99) less likely than workers without access to paid sick leave to be injured. The association between the availability of paid sick leave and the incidence of occupational injuries varied across sectors and occupations, with the greatest differences occurring in high-risk sectors and occupations. CONCLUSIONS: Our findings suggest that, similar to other investments in worker safety and health, introducing or expanding paid sick leave programs might help businesses reduce the incidence of nonfatal occupational injuries, particularly in high-risk sectors and occupations.

Incidence and costs of family member hospitalization following injuries of workers' compensation claimants.

BACKGROUND: The consequences of occupational injuries for the health of family members have rarely been studied. We hypothesized that non-fatal occupational injury would increase the incidence and costs of hospitalization among workers' families, and that family members of severely injured workers would be likely to experience greater increases in hospitalizations than family members of non-severely injured workers. DATA AND METHODS: We used the MarketScan databases from Thomson Reuters for 2002-2005, which include workers' compensation and inpatient medical care claims data for injured workers' families. We used a before-after analysis to compare the odds and costs of family hospitalization 3 months before and after the index occupational injury among 18,411 families. Severe injuries were defined by receipt of indemnity payments and at least 7 days of lost work. Family hospitalizations were measured by the incidence of hospitalization of at least one family member. RESULTS: Among families of all injured workers, the odds of at least one family member being hospitalized were 31% higher [95% confidence intervals (CI) = 1.11-1.55] in the 3 months following occupational injury than in the 3 months preceding injury. Among the families of severely injured workers, the odds of hospitalization were 56% higher [95% CI = 1.05-2.34] in the 3 months following injury. Hospitalization costs were found to rise by approximately the same percentage as hospitalization incidence. CONCLUSION: The impact of occupational injury may extend beyond the workplace and adversely affect the health and inpatient medical care use of family members.

Racial and Ethnic Disparities in Teleworking Due to the COVID-19 Pandemic in the United States: A Mediation Analysis.

A growing literature has pointed out disparities in teleworking among different racial and ethnic (hereafter racial) workers. This study estimated racial disparities in teleworking due to the COVID-19 pandemic and the extent to which these disparities were mediated by four-year college education and occupation in the United States. The data source for this study was the Current Population Survey, May 2020 through July 2021. The results showed that in the reduced model, the odds for Black and Hispanic workers to telework were 35% and 55% lower, respectively, and for Asian workers 44% higher than for White workers, controlling for covariates. When four-year college education and occupation were included as mediator variables in the model, the odds for Black and Hispanic workers to telework were reduced to 7% and 16%, respectively. Overall, disparities in four-year college education and occupation explained 83% and 78% of the variation in the odds of teleworking for Black and Hispanic workers, respectively. Between the mediators, occupation explained more than 60% of the total effect. The results of this study could not rule out the possibility of racial discrimination in teleworking. Ultimately, reducing racial disparities in four-year college education and in different occupations might be a long-term solution for reducing racial disparities in teleworking.

Racial Disparity in Potential Occupational Exposure to COVID-19.

BACKGROUND: Nationwide, as of 20 June 2021, COVID-19 has claimed more than 599,000 lives and infected nearly 33 million people. Studies have shown that COVID-19 disproportionately affects some racial and ethnic minority groups. This study examined whether certain racial and ethnic groups were overrepresented in occupations with potentially high COVID-19 exposure risks, relative to their share in the total workforce. The study incorporates white collar workers, who to date have not gotten as much attention in terms of workers safety. METHODS: Using the March and April 2020 Current Population Survey and O*Net data, this study examined whether certain racial and ethnic groups were overrepresented in occupations with potentially high risk of exposure to COVID-19 (exposure to disease and infection at work, inability to maintain physical distancing at work, and inability to work from home) relative to their share in the total workforce. RESULTS: The results showed that Black workers were overrepresented in occupations with high potential risk of exposure to disease and infection at work and inability to maintain physical distancing at work. Hispanic workers were overrepresented in occupations where potential risk of inability to work from home was the highest. CONCLUSION: Occupation can be one of the risk factors for the current disproportionately high COVID-19 infection rates among Black and Hispanic workers. COVID-19-related prevention measures at high risk occupations, including providing adequate personal protective equipment, training, working space, and vaccinations, could help to reduce not only the spread of COVID-19 and infectious diseases but also their disproportionately high impact in certain minority racial and ethnic groups.

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.

Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala.

Overweight/obesity, caused by the 'nutrition transition', is identified as one of the leading risk factors for non-communicable mortality. The nutrition transition in developing countries is associated with a major shift from the consumption of staple crops and whole grains to highly and partially processed foods. This study examines the contribution of processed foods consumption to the prevalence of overweight/obesity in Guatemala using generalized methods of moments (GMM) regression. The results show that all other things remaining constant, a 10% point increase in the share of partially processed foods from the total household food expenditure increases the BMI of family members (aged 10 years and above) by 3.95%. The impact of highly processed foods is much stronger. A 10% point increase in the share of highly processed food items increases the BMI of individuals by 4.25%, ceteris paribus. The results are robust when body weight is measured by overweight/obesity indicators. These findings suggest that increasing shares of partially and highly processed foods from the total consumption expenditure could be one of the major risk factors for the high prevalence of overweight/obesity in the country.

Association of Parent Workplace Injury With Emotional and Behavioral Problems in Children.

OBJECTIVE: Investigate associations between occupational injury to parents and the psychological well-being of their children. METHODS: We used multiple logistic regression to examine effects of occupational injury to parents on measures of psychological well-being among their children using National Health Interview Survey data from 2012 through 2016. RESULTS: Children of injured workers exhibited greater impairment than children of workers who had not sustained injuries for four of five measures of emotional and behavioral functioning that were hypothesized to differentiate these two child groups. A significant group difference was not observed for a sixth behavioral measure that was expected to be insensitive to parent occupational injury. CONCLUSION: Study findings heighten concern over downstream effects of occupational injury and signal need for more expansive investigation of these effects and mitigation strategies among children of injured workers.

Mortality following workplace injury: Quantitative bias analysis.

PURPOSE: Recent studies have shown increased all-cause mortality among workers following disabling workplace injury. These studies did not account for 2 potentially important confounders, smoking and obesity. We estimated injury-related mortality accounting for these factors. METHODS: We followed workers receiving New Mexico workers' compensation benefits (1994-2000) through 2013. Using data from the Panel Study of Income Dynamics, we derived the joint distribution of smoking status and obesity for workers with and without lost-time injuries. We conducted a quantitative bias analysis (QBA) to determine the adjusted relationship of injury and mortality. RESULTS: We observed hazard ratios after adjusting for smoking and obesity of 1.13 for women (95% simulation interval (SI) 0.97 to 1.31) and 1.12 for men (95% SI 1.00 to 1.27). The estimated fully adjusted excess hazard was about half the estimates not adjusted for these factors. CONCLUSIONS: Using QBA to adjust for smoking and obesity reduced the estimated mortality hazard from lost-time injuries and widened the simulation interval. The adjusted estimate still showed more than a 10 percent increase for both women and men. The change in estimates reveals the importance of accounting for these confounders. Of course, the results depend on the methods and assumptions used.

Gender gap in parents' financing strategy for hospitalization of their children: evidence from India.

The 'missing women' dilemma in India has sparked great interest in investigating gender discrimination in the provision of health care in the country. No studies, however, have directly examined discrimination in health-care financing strategies in the case of severe illness of sons versus daughters. In this paper, we hypothesize that households who face tight budget constraints are more likely to spend their meager resources on hospitalization of boys rather than girls. We use the 60th round of the Indian National Sample Survey (2004) and a multinomial logit model to test this hypothesis and to throw some light on this important but overlooked issue. The results reveal that boys are much more likely to be hospitalized than girls. When it comes to financing, the gap in the usage of household income and savings is relatively small, while the gender gap in the probability of hospitalization and usage of more onerous financing strategies is very high. Ceteris paribus, the probability of boys to be hospitalized by financing from borrowing, sale of assets, help from friends, etc. is much higher than that of girls. Moreover, in line with our theoretical framework, the results indicate that the gender gap intensifies as we move from the richest to poorest households.

Relationship of work injury severity to family member hospitalization.

BACKGROUND: Working while under stress due to a family health event may result in injuries of greater severity. Work leave might mitigate such consequences. DATA AND METHODS: Workers' compensation data for 33,817 injured workers and inpatient medical data for 76,077 members of their families were extracted from the 2002-2005 Thomson Reuters Medstat MarketScan Health and Productivity Management (HPM) and Commercial Claims and Encounter (CCE) datasets. Using a probit model, the impact of family hospitalization on the probability that a subsequent injury would be severe (above average indemnity costs) was estimated, adjusting for age, sex, hourly versus salaried status, industry sector, state, and family size. RESULTS: Family hospitalization within 15 days before injury increased the likelihood that the injury would be severe (from 12.5% to 21.5%) and was associated with 40% higher indemnity costs and 50% higher medical costs. Hospitalizations over 30 days before injury had no impact. CONCLUSION: The observed higher severity of work injuries following family hospitalizations suggests additional analyses may find higher injury rates as well, and that timely family leaves might help prevent severe workplace injuries.