Work-related injury burden, workers' compensation claim filing, and barriers: Results from a statewide survey of janitors.

BACKGROUND: Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness. METHODS: Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages. RESULTS: There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims. CONCLUSIONS: Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors.

Work-related injury factors and safety climate perception in truck drivers.

INTRODUCTION: The trucking industry has a high burden of work-related injuries. This study examined factors, such as safety climate perceptions, that may impact injury risk. METHOD: A random sample of 9800 commercial driver's license holders (CDL) were sent surveys, only 4360 were eligible truck drivers. Descriptive statistics and logistic regression models were developed to describe the population and identify variables associated with work-related injury. RESULTS: 2189 drivers completed the pertinent interview questions. Driving less-than-truckload, daytime sleepiness, pressure to work faster, and having a poor composite score for safety perceptions were all associated with increased likelihood of work-related injury. Positive safety perception score was protective for odds of work-related injury, and increased claim filing when injured. CONCLUSIONS: Positive psychological safety climate is associated with decreased likelihood of work-related injury and increased likelihood that a driver injured on the job files a workers' compensation claim.

Occupational Hydrofluoric Acid Injury from Car and Truck Washing--Washington State, 2001-2013.

Exposure to hydrofluoric acid (HF) causes corrosive chemical burns and potentially fatal systemic toxicity. Car and truck wash cleaning products, rust removers, and aluminum brighteners often contain HF because it is efficient in breaking down roadway matter. The death of a truck wash worker from ingestion of an HF-based wash product and 48 occupational HF burn cases associated with car and truck washing in Washington State during 2001-2013 are summarized in this report. Among seven hospitalized workers, two required surgery, and all but one worker returned to the job. Among 48 injured workers, job titles were primarily auto detailer, car wash worker, truck wash worker, and truck driver. Because HF exposure can result in potentially severe health outcomes, efforts to identify less hazardous alternatives to HF-based industrial wash products are warranted.

Distribution of asthma by occupation: Washington State behavioral risk factor surveillance system data, 2006-2009.

OBJECTIVE: To estimate the prevalence of asthma in workers by occupation in Washington State. METHODS: Data from the 2006-2009 Behavioral Risk Factor Surveillance System (BRFSS) and the BRFSS Asthma Call-Back Survey (ACBS) in Washington State (WA) were analyzed. Using state-added and coded Industry and Occupation questions, we calculated prevalence ratios (PRs) for 19 occupational groups. RESULTS: Of the 41,935 respondents who were currently employed during 2006-2009, the prevalence of current asthma was 8.1% [95% confidence interval (CI) 7.8-8.5%] When compared with the reference group of executive, administration and managerial occupations, three occupational groups had significantly (p < 0.05) higher PRs of current asthma: "Teachers, all levels, and Counselors' (PR 1.3, 95% CI 1.1-1. 6%); 'Administrative Support, including Clerical" (PR 1. 5, 95% CI 1.2-1.9%); and "Other Health Services" (PR 1.5, 95% CI 1.2-1.9). Half of the 2511 ACBS respondent workers (55.1%) indicated that they believed exposure at work had caused or worsened their asthma, but only 10.7% had ever spoken with a health care professional about their asthma being work related. CONCLUSIONS: Some occupations have a higher prevalence of current asthma than other occupations. The systematic collection of industry and occupation data can help identify worker populations with a high burden of asthma and can be used to target disease prevention efforts as well as to aid clinician recognition and treatment. Workers indicated that work-related asthma exposures are not discussed with their health care provider and this communication gap has implications for asthma management.

Prevention guidance for isocyanate-induced asthma using occupational surveillance data.

Data from Washington State's work-related asthma surveillance system were used to characterize isocyanate-induced asthma cases occurring from 1999 through 2010. Injured worker interviews and medical records were used to describe the industry, job title, work process, workers' compensation cost, and exposure trends associated with 27 cases of isocyanate-induced asthma. The majority (81%) of cases were classified within the surveillance system as new-onset asthma while 19% were classified as work-aggravated asthma. The workers' compensation cost for isocyanate-induced asthma cases was $1.7 million; this was 14% of the total claims cost for all claims in the asthma surveillance system. The majority of cases (48%) occurred from paint processes, followed by foam application or foam manufacturing (22%). Nine of the asthma cases associated with spray application occurred during application to large or awkward-shaped objects. Six workers who did not directly handle isocyanates (indirect exposure) developed new-onset asthma. Two cases suggest that skin contact and processes secondary to the isocyanate spray application, such as cleanup, contributed to immune sensitization. Surveillance data provide insight for the prevention of isocyanate-induced respiratory disease. Key observations are made regarding the development of work-related asthma in association with a) paint application on large objects difficult to ventilate, b) indirect exposure to isocyanates, c) exposure during secondary or cleanup processes, and d) reports of dermal exposure.

Occupation and the prevalence of current depression and frequent mental distress, WA BRFSS 2006 and 2008.

BACKGROUND: Workers with depression and frequent mental distress (FMD) have lost work productivity. Limited systematic comparisons exist for the prevalence of depression and FMD across occupational groups. METHODS: Using a state-added question for occupation coupled to measures of depression and FMD on the Washington State (WA) 2006 and 2008 Behavioral Risk Factor Surveillance System survey, we estimated the prevalence and odds ratios (ORs) among the 20,560 WA workers. RESULTS: The prevalences of current depression and FMD were 5.2% and 7.5%, respectively. The prevalence varied considerably across occupations. Compared with Management occupation, Truck drivers had significantly increased odds for both current depression [OR = 6.18, 95% confidence interval (CI): 2.52-15.16] and FMD (OR = 1.85, 95% CI: 1.01-3.41). Cleaning/Building services (OR = 1.95, 95% CI: 1.11-3.40) and Protective services (OR = 1.97, 95% CI: 1.19-3.27) were associated with increased FMD. CONCLUSIONS: These findings demonstrate the need for research on possible sources of the differences for current depression and FMD across occupations.

The job demand-control-support model and work-related musculoskeletal complaints in daytime and nighttime janitors: The mediating effect of burnout.

Janitors' jobs require repetitive work with low control (skill discretion, decision authority) and social support. Previous studies have found this constellation of work conditions leads to high stress levels. This study investigated the relationships among job demand-control-support, burnout, and musculoskeletal symptoms for commercial janitors in Washington State. Structural equation modeling was performed using data from 208 participants with analyses comparing models of daytime and nighttime janitors. Burnout fully mediated the relationship between job demands and musculoskeletal complaints among daytime janitors. Among nighttime janitors, burnout mediated between job demands, job control, and social support, and musculoskeletal complaints. The nighttime janitors' model was more fully supported compared to the daytime model. This study is one of a small number that examine and bring attention to the importance of janitors' burnout. Recommendations to improve the psychosocial work environment toward mitigating burnout and reducing musculoskeletal complaints are provided.

Work-related asthma in Washington State.

OBJECTIVE: Asthma is a common and costly public health problem. Occupational exposures contribute to the burden of asthma. Identifying workplace exposures and industries and occupations at risk can lead to more effective prevention measures. METHODS: Data from Washington State's work-related asthma (WRA) surveillance program from October 2001 to December 2008 were analyzed. Workers' compensation records, physician reports, and telephone interviews were used to describe the occurrence of WRA during this time, in order to identify contributing exposure sources and industries and occupations that are associated with WRA in Washington. RESULTS: There were 1343 identified WRA cases in Washington State during this time. Of these, 1285 were workers' compensation claims, with a total medical cost for State Fund claims of approximately $3 million dollars. The top three sources identified were miscellaneous chemicals and materials, mineral and inorganic dusts, and plant material. Plant material claims proved to be widespread throughout various industries, were largely classified as new-onset asthma cases, and had higher median medical cost and higher median time loss days than cases associated with other exposure sources. CONCLUSIONS: Washington State has an abundance of plant-material-related WRA cases among US states conducting WRA surveillance. Washington State's industry mix might explain the higher prevalence of cases, particularly its logging and wood processing industries and as a world leader in hops production. In Washington, further WRA prevention efforts should emphasize workplaces working with plant materials.

The persistent gap in health-care coverage between low- and high-income workers in Washington State: BRFSS, 2003-2007.

OBJECTIVES: We examined the disparities in health-care coverage between low- and high-income workers in Washington State (WA) to provide support for possible policy decisions for uninsured workers. METHODS: We examined data from the WA Behavioral Risk Factor Surveillance System 2003-2007 and compared workers aged 18-64 years of low income (annual household income <$35,000) and high income (annual household income ≥$35,000) on proportions and sources of health-care coverage. We conducted multivariable logistic regression analyses on factors that were associated with the uninsured. RESULTS: Of the 54,536 survey respondents who were working-age adults in WA, 13,922 (25.5%) were low-income workers. The proportions of uninsured were 38.2% for low-income workers and 6.3% for high-income workers. While employment-based health benefits remained a dominant source of health insurance coverage, they covered only 40.2% of low-income workers relative to 81.5% of high-income workers. Besides income, workers were more likely to be uninsured if they were younger; male; Hispanic; less educated; not married; current smokers; self-employed; or employed in agriculture/forestry/fisheries, construction, and retail. More low-income workers (28.7%) reported cost as an issue in paying for health services than did their high-income counterparts (6.7%). CONCLUSION: A persistent gap in health-care coverage exists between low- and high-income workers. The identified characteristics of these workers can be used to implement policies to expand health insurance coverage.

Work-related amputations in Washington state, 1997-2005.

BACKGROUND: Work-related amputations are infrequent but devastating injuries. Attempts to more accurately estimate the burden of amputations and industries at risk have led the Washington State occupational surveillance program to explore new methods for case identification in Washington State workers' compensation data. METHODS: Two methods were utilized for case identification of work-related amputations. The first method used the ANSI Z16 nature code for amputation. An alternative method utilized medical, hospital, and claim administration coding of medical bills and bill payment systems. After identifying suspected amputation claims, a sample of the medical records associated with different case identification methods were reviewed to verify that an amputation likely occurred. RESULTS: From 1997 to 2005, 2,528 amputations were identified using the ANSI Z16 code for amputation (Nature = 100) and an additional 3,912 amputations were identified using the alternative method. There was an increasing trend of amputation injuries over the time period using the ANSI amputation definition; however, the trend in amputation injuries captured by the alternative method was decreasing. This may indicate a bias in estimating a trend due to misclassification of amputation injuries. The sectors with the highest amputation claims rates were Manufacturing; Construction; Agriculture, Forestry, Fishing and Hunting; Accommodation and Food Services; and Wholesale and Retail Trade. CONCLUSIONS: Current methods to identify work-related amputations in the workers' compensation data system underestimate the burden of amputations in Washington State. By utilizing alternative case identification methods, we estimate that there were about 150% more amputations in Washington State over the time period.

Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile: Washington State Janitors, 2011 to 2017.

OBJECTIVE: Janitorial workers have a high burden of occupational injury and illness, but little information exists on their overall health. METHODS: Data from the Washington State Behavioral Risk Factor Surveillance System (BRFSS) were analyzed to characterize the working population of Janitors in Washington State from 2011 to 2017 (n = 490) as compared with all other workers (n = 38,885). RESULTS: Compared with other workers, Janitors were significantly more diverse, had lower socioeconomic status, and reported poorer general health and higher rates of arthritis and depression. Janitors were less likely to have adequate sleep, health insurance, and access to technology. Janitors reported higher rates of smoking and marijuana use. CONCLUSIONS: Multiple risk factors compound the vulnerability of Janitors. BRFSS data can be used to characterize the health of occupational groups. Identifying overall health needs can better inform policy and help formulate strategies to improve workers' health.

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.

Prioritizing industries for occupational injury prevention and research in the Services Sector in Washington State, 2002-2010.

BACKGROUND: The Services Sector, as defined by the National Occupational Research Agenda (NORA), is comprised of a diverse industry mix and its workers face a variety of occupational exposures and hazards. The objective of this study was to identify high-risk industry groups within the Services Sector for prevention targeting. METHODS: Compensable Washington State workers' compensation claims from the Services Sector from 2002 through 2010 were analyzed. A "prevention index" (PI), the average of the rank orders of claim count and claim incidence rate, was used to rank 87 Services Sector industry groups by seven injury types: Work- Related Musculoskeletal Disorders (WMSDs), Fall to Lower Level, Fall on Same Level, Struck By/Against, Caught In/Under/Between, Motor Vehicle, and Overexertion. In the PI rankings, industry groups with high injury burdens appear higher ranked than industry groups with low counts or low rates of injury, indicating a need for prioritizing injury prevention efforts in these groups. RESULTS: In the Services Sector, these 7 injury types account for 84% of compensable claims in WA. The industry groups highest ranked by PI across the injury types included: Services to Buildings and Dwellings; Executive, Legislative, and Other General Government Support; and Waste Collection. WMSDs had the highest compensable claims rates. CONCLUSIONS: Services is a large sector of the economy, and the substantial number, rate, and cost of occupational injuries within this sector should be addressed. Several Services Sector industry groups are at high risk for a variety of occupational injuries. Using a PI to rank industry groups based on their injury risk provides information with which to guide prevention efforts.

Distribution of influenza-like illness (ILI) by occupation in Washington State, September 2009-August 2010.

OBJECTIVES: We aim to estimate the prevalence of influenza-like illness (ILI) by occupation and to identify occupations associated with increased ILI prevalence. METHODS: Between September 2009 and August 2010, the Centers for Disease Control (CDC) included questions on ILI symptoms on the Behavioral Risk Factor Surveillance System (BRFSS). Washington State collects the occupation of all employed BRFSS respondents. ILI prevalence and prevalence ratios (PR) were calculated by occupational group. RESULTS: There were 8,758 adult, currently employed, non-military respondents to the Washington BRFSS during the study period. The ILI prevalence for all employed respondents was 6.8% (95% Confidence Interval (95% CI) = 6.1, 7.6). PRs indicated a lower prevalence of ILI in Technicians (PR = 0.4, 95% CI = 0.2, 0.9) and Truck Drivers (PR = 0.2, 95% CI = 0.1, 0.7) and higher prevalence in Janitors and Cleaners (PR = 2.5, 95% CI = 1.3, 4.7) and Secretaries (PR = 2.4, 95% CI = 1.1, 5.4). CONCLUSIONS: Some occupations appear to have higher prevalence of ILI than others. These occupational differences may be explained, in part, by differing levels of social contact with the public or contact with contaminated surfaces at work, or by other occupational factors such as stress or access to health care resources.

Psychiatric diagnoses after hospitalization with work-related burn injuries in Washington State.

This study aims to describe workers who were hospitalized with work-related burn injuries and their psychiatric sequelae in Washington State. Psychiatric sequelae of interest were depression, posttraumatic stress disorder, and other anxiety disorders. Workers' compensation claims meeting a definition for a hospitalized burn patient from Washington State from January 2001 through April 2008 were analyzed. The resulting claims were searched for the presence of certain psychiatric diagnoses or treatment codes, and descriptive analyses performed. In Washington State during the time period, the prevalence of claims with psychiatric diagnoses after hospitalization with burn injury was 19%. Claims with psychiatric diagnoses had higher medical costs and more days of time loss than those without these diagnoses. Workers with electrical burns in the construction industry and in construction and extraction occupations had a higher proportion of psychiatric sequelae. Burns are devastating yet preventable injuries. Workers who were hospitalized with work-related burn injuries, particularly those in certain industries and occupations and those with electrical burns, are at high risk for developing serious psychiatric sequelae with major costs to both the individual and the society.