Increased Mortality Associated With Disability Among Workers' Compensation Claimants With Upper Extremity Neuropathy.

OBJECTIVE: The aim of the study was to evaluate and compare mortality after disabling and nondisabling occupational injuries. METHODS: Vital status was ascertained through 2020 for 2077 individuals with a workers' compensation claim for upper extremity neuropathy in West Virginia in 1998 or 1999. Standardized mortality ratios compared mortality to the West Virginia general population. Hazard ratios (HRs) obtained from Cox regression models compared mortality among those with and without lost work time or permanent disability. RESULTS: Overall, the standardized mortality ratio for accidental poisoning deaths was elevated (1.75, 95% confidence interval [CI]: 1.08-2.68). All-cause mortality HRs and cancer HRs were elevated for lost work time (HR = 1.09, 95% CI: 0.93-1.28; HR = 1.50, 95% CI: 1.09-2.08, respectively) and permanent disability (HR = 1.22, 95% CI: 1.04-1.44; HR = 1.78, 95% CI: 1.27-2.48, respectively). CONCLUSIONS: Work-related disability was associated with broad elevations in mortality.

Increased overall and cause-specific mortality associated with disability among workers' compensation claimants with low back injuries.

BACKGROUND: Mortality tends to be higher among people who do not work than among workers, but the impact of work-related disability on mortality has not been well studied. METHODS: The vital status through 2015 was ascertained for 14 219 workers with an accepted workers' compensation claim in West Virginia for a low back injury in 1998 or 1999. Mortality among the cohort compared with the West Virginia general population was assessed using standard life table techniques. Associations of mortality and disability-related factors within the cohort were evaluated using Cox proportional hazards regression. RESULTS: Compared to the general population, mortality from accidental poisoning was significantly elevated among the overall cohort and lost-time claimants. Most deaths from accidental poisoning in the cohort were due to drug overdoses involving opioids. Mortality from intentional self-harm was also significantly elevated among lost-time claimants. In internal analyses, overall mortality and mortality from cancer, heart disease, intentional self-harm, and drug overdoses involving opioids was significantly associated with lost time. Overall mortality and mortality from drug overdoses involving opioids were also significantly associated with amount of lost time, permanent partial disability, and percent permanent disability. Heart disease mortality was also significantly associated with the amount of lost time. CONCLUSIONS: The results suggest that disability itself may impact mortality risks. If confirmed, these results reinforce the importance of return to work and other efforts to reduce disability.

Perfluoroalkyl acids including perfluorooctane sulfonate and perfluorohexane sulfonate in firefighters.

OBJECTIVE: Firefighters were likely exposed to perfluorooctane sulfonate since it was a component of extinguishing foams and perfluorohexane sulfonate (PFHxS), a surfactant coating carpet and other building materials, during firefighting. The objective of the study is to evaluate serum concentrations of perfluoroalkyl acids (PFAAs) in firefighters. METHODS: A total of 8826 male adults, including 37 firefighters, were analyzed. Multivariate analysis was conducted by using a general linear model. The least square mean of serum PFAAs was obtained after adjustment for demographic and socioeconomic variables. RESULTS: Serum concentration of PFHxS was statistically higher in firefighters both before and after adjustment. Perfluorooctane sulfonate and perfluorononanoic acid were also found higher in firefighters, though not statistically significant. CONCLUSIONS: The study suggests that fighting fire can be a risk of exposure to PFAAs, specifically PFHxS.

The C8 health project: design, methods, and participants.

BACKGROUND: The C8 Health Project was created, authorized, and funded as part of the settlement agreement reached in the case of Jack W. Leach, et al. v. E.I. du Pont de Nemours & Company (no. 01-C-608 W.Va., Wood County Circuit Court, filed 10 April 2002). The settlement stemmed from the perfluorooctanoic acid (PFOA, or C8) contamination of drinking water in six water districts in two states near the DuPont Washington Works facility near Parkersburg, West Virginia. OBJECTIVES: This study reports on the methods and results from the C8 Health Project, a population study created to gather data that would allow class members to know their own PFOA levels and permit subsequent epidemiologic investigations. METHODS: Final study participation was 69,030, enrolled over a 13-month period in 2005-2006. Extensive data were collected, including demographic data, medical diagnoses (both self-report and medical records review), clinical laboratory testing, and determination of serum concentrations of 10 perfluorocarbons (PFCs). Here we describe the processes used to collect, validate, and store these health data. We also describe survey participants and their serum PFC levels. RESULTS: The population geometric mean for serum PFOA was 32.91 ng/mL, 500% higher than previously reported for a representative American population. Serum concentrations for perfluorohexane sulfonate and perfluorononanoic acid were elevated 39% and 73% respectively, whereas perfluorooctanesulfonate was present at levels similar to those in the U.S. population. CONCLUSIONS: This largest known population study of community PFC exposure permits new evaluations of associations between PFOA, in particular, and a range of health parameters. These will contribute to understanding of the biology of PFC exposure. The C8 Health Project also represents an unprecedented effort to gather basic data on an exposed population; its achievements and limitations can inform future legal settlements for populations exposed to environmental contaminants.

Cost and outcome analyses on the timing of first independent medical evaluation in patients with work-related lumbosacral sprain.

OBJECTIVE: To assess outcomes for different times to the first independent medical evaluation (IME) for work-related lumbosacral sprain. METHODS: The 2005 West Virginia workers' compensation claims for "lumbosacral sprain" were used for our analyses. Outcomes included costs, maximal medical improvement status, number of IMEs performed, and the length of temporary total disability. Multiple logistic regression modeling was applied to determine the significance between the timing of first IME and these outcomes. RESULTS: Patients with a first IME within 101 to 150 days after the injury had the best outcomes, measured by no repeat IMEs, appropriately reaching maximal medical improvement, and decreasing the temporary total disability length and related costs. CONCLUSIONS: Scheduling the first IME between 101 and 150 days after the injury contained indemnity costs, and shortened the length of disability.