Occupational medicine clinical practice data reveal increased injury rates among Hispanic workers.

BACKGROUND: Minnesota has an ethnically diverse labor force, with the largest number of refugees per capita in the United States. In recent years, Minnesota has been and continues to be a major site for immigrant and refugee resettlement in the United States, with a large population of both immigrant and native born Hmong, Hispanic, and East Africans. This study seeks to evaluate the injury risk among the evolving minority workforce in the Minnesota Twin Cities region. METHODS: A retrospective cohort study identifying work-related injuries following pre-employment examinations was performed using electronic health records from a large multi-clinic occupational medicine practice. Preplacement examinations and subsequent work-related injuries were pulled from the electronic health record using representative ICD-10 codes for surveillance examinations and injuries. This study included patient records collected over a 2-year period from January 1, 2015, through December, 2016. The patients in this cohort worked in a wide-array of occupations including production, assembly, construction, law enforcement, among others. RESULTS: Hispanic minority workers were twice as likely to be injured at work compared with White workers. Hispanics were 2.89 times more likely to develop back injuries compared with non-Hispanic workers, and 1.86 times more likely to develop upper extremity injuries involving the hand, wrist, or elbow. CONCLUSION: Clinical practice data shows that Hispanic workers are at increased risk for work-related injuries in Minnesota. They were especially susceptible to back and upper extremity injuries. Lower injury rates in non-Hispanic minority workers, may be the result of injury underreporting and require further investigation.

Trends in occupational injuries and diseases among Saudi and non-Saudi insured workers.

BACKGROUND: The ongoing industrial and infrastructural development in Saudi Arabia carries a high risk of occupational injuries/diseases. AIMS: To compare trends in occupational injuries and diseases among Saudi and non-Saudi insured workers. METHODS: We used the index values method and slope (S) calculation to analyse the occupational injuries/diseases trends from data in the annual statistical reports published by the General Organization for Social Insurance between 2004 and 2014. Data for 10 565 993 (18.5%) Saudi insured workers (SIWs) and 46 402 079 (81.5%) non-Saudi insured workers (NSIWs) and 896 627 occupational injuries/diseases were analysed. RESULTS: The distribution of incidences of occupational injuries/diseases among NSIWs (93.5%) was 14 times higher than that of SIWs (6.5%). Occupational injuries/diseases were more likely to increase among NSIWs than SIWs, particularly in the construction, trade, financing and real estate economic activities, and engineering, technicians and service workers occupations. There was a general decreasing trend in occupational injuries/diseases until 2013. CONCLUSIONS: Non-Saudi insured workers were at high risk of occupational injuries/diseases, therefore, implementation of an effective injury prevention programme is required.

Characteristics and circumstances of injuries vary with ethnicity of different population groups living in the same country.

OBJECTIVE: To examine whether characteristics and circumstances of injuries are related to ethnicity. DESIGN: The study was based on the Israeli National Trauma Registry data for patients hospitalized between 2008 and 2011. Data included demographics, injury, hospital resource utilization characteristics and outcome at discharge. Univariate analysis followed by logistic regression models were undertaken to examine the relationship between injury and ethnicity. RESULTS: The study included 116,946 subjects; 1% were Ethiopian Born Israelis (EBI), 11% Israelis born in the Former Soviet Union (FSUBI) and 88% the remaining Israelis (RI). EBI were injured more on street or at work place and had higher rates of penetrating and severe injuries. However, FSUBI were mostly injured at home, and had higher rates of fall injuries and hip fracture. Adjusted analysis showed that EBI and FSUBI were more likely to be hospitalized because of violence-related injuries compared with RI but less likely because of road traffic injuries. Undergoing surgery and referral for rehabilitation were greater among FSUBI, while admission to intensive care unit was greater among EBI. CONCLUSION: Targeted intervention programmes need to be developed for immigrants of different countries of origin in accordance with the identified characteristics.

Gambling with life: Masculinity, risk, and danger in the lives of unauthorized migrant roofers.

BACKGROUND: This paper examines the occupational experiences of unauthorized immigrants employed in one of the most dangerous occupations in the United States: roofing. METHODS: We draw on 40 in-depth interviews with return migrants in Guanajuato, Mexico, to examine how the adoption of masculinity, dangerous working conditions, the labor market structure, and absence of legal status exacerbates injuries for unauthorized roofers. FINDINGS: Undocumented men return to Mexico injured with chronic pain, health complications, and trauma. We find that men "do gender" that is adopt masculine beliefs, when they skirt safety practices, police each other's behaviors, withhold their emotions, experience heightened stress, and engage in poor health behaviors. It is a combination of dangerous working conditions, economic insecurity, and men seeking to fulfill their masculine roles that all combine to create unsafe working conditions and lead to injuries.

Occupational fatalities among young workers in the United States: 2001-2012.

BACKGROUND: While adolescent workers in the United States (US) are protected by child labor laws, they continue to suffer fatal occupational injuries. This study was designed to provide a comprehensive profile of occupational fatalities among this sub-population of US workers. METHODS: Using Census of Fatal Occupational Injuries data between 2001 and 2012, we calculated descriptive statistics and rates to examine the magnitude and nature of fatalities among workers under age 18. RESULTS: During the study period, there were 406 fatalities among young workers which translated into 24,790 years of potential life lost; 12,241 of which were in agriculture alone. Rates declined since 2001 yet Hispanics, foreign-born workers, males, and those working in agriculture continued to suffer a disproportionate fatality burden. CONCLUSIONS: Efforts to reduce young worker fatalities should focus on male Hispanics, particularly those who are foreign-born, as well as agricultural workers as these groups have the greatest fatality risks. Am. J. Ind. Med. 59:445-452, 2016. © 2016 Wiley Periodicals, Inc.

Reported work-related injuries and illnesses among Hispanic workers: Results from an emergency department surveillance system follow-back survey.

BACKGROUND: Research suggests Hispanic workers underreport injuries/illnesses to their employer. METHODS: The National Electronic Injury Surveillance System-occupational supplement was used to conduct a follow-back study of workers treated in emergency departments (EDs) from June 2012 through December 2013. RESULTS: An estimated 448,000 (95%CI 230,000-665,000) Hispanic workers treated in EDs for a work-related injury or illness were represented by 362 completed interviews. Of these, an estimated 443,000 (95%CI 228,000-657,000) workers reported the injury or illness to their employer or were self-employed. The majority had not heard of workers' compensation. Only 10% expected workers' compensation to cover their medical payment while 62% expected payment to be covered by their employer. CONCLUSION: We characterized our respondent workforce who reported their injury or illness. We determined that NEISS-Work data are not the most appropriate source to capture underreporting of work-related injuries and illnesses to employers among Hispanic workers. Am. J. Ind. Med. 59:621-629, 2016. © 2016 Wiley Periodicals, Inc.

Are immigrants in Canada over-represented in riskier jobs relative to Canadian-born labor market participants?

BACKGROUND: This paper uses new data to examine the gap in injury and fatality rates between immigrant men and women and their Canadian-born counterparts. METHODS: Data from the 2011 National Household Survey and the Association of Workers' Compensation Boards of Canada were used to determine the difference in occupational and industry injury and fatality rates between various arrival cohorts of immigrants and those Canadian born. RESULTS: For both men and women, there is no significant difference in occupational injury and fatality rates between various arrival cohorts of immigrants and Canadian-born workers. However, industry injury and fatality rates are lower for the most recent arrival cohorts of immigrants relative to Canadian-born workers. CONCLUSIONS: Although immigrants face many hurdles and challenges in their resettlement process in Canada, given the evidence from the paper, they are not likely to be at higher risk for work-related injuries relative to those Canadian-born.

Worker compensation injuries among the Aboriginal population of British Columbia, Canada: incidence, annual trends, and ecological analysis of risk markers, 1987-2010.

BACKGROUND: Aboriginal people in British Columbia (BC) have higher injury incidence than the general population, but information is scarce regarding variability among injury categories, time periods, and geographic, demographic and socio-economic groups. Our project helps fill these gaps. This report focuses on workplace injuries. METHODS: We used BC's universal health care insurance plan as a population registry, linked to worker compensation and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. We identified residents of specific Aboriginal communities by postal code. We calculated crude incidence rate and Standardized Relative Risk (SRR) of worker compensation injury, adjusted for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We assessed annual trend by regressing SRR as a linear function of year. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics of Aboriginal communities with community SRR of injury by multivariable linear regression. RESULTS: During the period 1987-2010, the crude rate of worker compensation injury in BC was 146.6 per 10,000 person-years (95% confidence interval: 146.4 to 146.9 per 10,000). The Aboriginal rate was 115.6 per 10,000 (95% CI: 114.4 to 116.8 per 10,000) and SRR was 0.88 (95% CI: 0.87 to 0.89). Among those living on reserves SRR was 0.79 (95% CI: 0.78 to 0.80). HSDA SRRs were highly variable, within both total and Aboriginal populations. Aboriginal males under 35 and females under 40 years of age had lower SRRs, but older Aboriginal females had higher SRRs. SRRs are declining, but more slowly for the Aboriginal population. The Aboriginal population was initially at lower risk than the total population, but parity was reached in 2006. These community characteristics independently predicted injury risk: crowded housing, proportion of population who identified as Aboriginal, and interactions between employment rate and income, occupational risk, proportion of university-educated persons, and year. CONCLUSIONS: As employment rates rise, so has risk of workplace injury among the Aboriginal population. We need culturally sensitive prevention programs, targeting regions and industries where Aboriginal workers are concentrated and demographic groups that are at higher risk.

Examining occupational health and safety disparities using national data: a cause for continuing concern.

BACKGROUND: Occupational status, a core component of socioeconomic status, plays a critical role in the well-being of U.S. workers. Identifying work-related disparities can help target prevention efforts. METHODS: Bureau of Labor Statistics workplace data were used to characterize high-risk occupations and examine relationships between demographic and work-related variables and fatality. RESULTS: Employment in high-injury/illness occupations was independently associated with being male, Black, ≤high school degree, foreign-birth, and low-wages. Adjusted fatal occupational injury rate ratios for 2005-2009 were elevated for males, older workers, and several industries and occupations. Agriculture/forestry/fishing and mining industries and transportation and materials moving occupations had the highest rate ratios. Homicide rate ratios were elevated for Black, American Indian/Alaska Native/Asian/Pacific Islanders, and foreign-born workers. CONCLUSIONS: These findings highlight the importance of understanding patterns of disparities of workplace injuries, illnesses and fatalities. Results can improve intervention efforts by developing programs that better meet the needs of the increasingly diverse U.S. workforce.

Occupational health disparities: a state public health-based approach.

BACKGROUND: This report used employment and public health surveillance data in Michigan to characterize work-related race/ethnic health disparities. METHODS: U.S. Census data were used to calculate the percent by race/Hispanic ethnicity in occupational groups ranked by three measures for potential work-related health risks. Disparities by race/ethnicity were generated from occupational health surveillance data. RESULTS: Blacks and Hispanics were over-represented in lower wage-higher manual-labor occupations and in highest risk occupations. Blacks were at greater risk of silicosis, work-related asthma, and work-related burns than whites, and Hispanics had higher rates of work-related acute fatal injuries and pesticide injury than non-Hispanics. CONCLUSIONS: Michigan employment data indicated that blacks and Hispanics were overly represented in lower paid and more hazardous jobs. Occupational health surveillance data confirmed disparate risks for some illnesses and injuries. This approach can be used in other states to bring awareness to policy makers and direct interventions.

Occupational health outcomes for workers in the agriculture, forestry and fishing sector: implications for immigrant workers in the southeastern US.

BACKGROUND: Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic. METHODS: We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US. RESULTS: Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries. CONCLUSION: As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.

More than training: Community-based participatory research to reduce injuries among hispanic construction workers.

BACKGROUND: Workplace mortality and severe injury are disproportionately distributed among foreign born and Hispanic construction workers. Worker Centers (WCs) provide services and advocacy for low-wage workers and a way for investigators to reach them. The goal of this project is to prevent occupational injuries by increasing awareness of hazards and self-efficacy among foreign born, Hispanic construction workers and by expanding the agenda of WCs to include occupational health and safety (H&S). METHODS: Investigators partnered with eight WCs in seven cities to train worker leaders to deliver a modified OSHA 10-hr curriculum to their peers. RESULTS: Thirty-two worker leaders trained 446 workers over 3 years. There was a demonstrated improvement in knowledge, hazard identification, self-efficacy, and sustainable H&S activities. CONCLUSIONS: This study provides evidence for successful implementation of a training intervention for low wage, low literacy Hispanic construction workers using a community-based participatory research approach.

Fatal occupational injuries among non-governmental employees in Malaysia.

BACKGROUND: In Malaysia, surveillance of fatal occupational injuries is fragmented. We therefore analyzed an alternative data source from Malaysia's Social Security organization, the Pertubuhan Keselamatan Sosial (PERKESO). METHODS: We conducted a secondary data analysis of the PERKESO database comprised of 7 million employees from 2002 to 2006. RESULTS: Overall, the average annual incidence was 9.2 fatal occupational injuries per 100,000 workers. During the 5-year period, there was a decrease in the absolute number of fatal injuries by 16% and the incidence by 34%. The transportation sector reported the highest incidence of fatal injuries (35.1/100,000), followed by agriculture (30.5/100,000) and construction (19.3/100,000) sectors. Persons of Indian ethnicity were more likely to sustain fatal injuries compared to other ethnic groups. CONCLUSIONS: Government and industry should develop rigorous strategies to detect hazards in the workplace, especially in sectors that continuously record high injury rates. Targeted interventions emphasizing worker empowerment coupled with systematic monitoring and evaluation is critical to ensure success in prevention and control measures.

Organization of work in the agricultural, forestry, and fishing sector in the US southeast: implications for immigrant workers' occupational safety and health.

BACKGROUND: There is widespread agreement that work organization is an important element of occupational safety and health, but the health effects of many aspects of work organization are likely to vary considerably across different sectors of work and geographies. METHODS: We examined existing employment policies and work organization-related research relevant specifically to immigrant workers in the Agriculture, Forestry, and Fishing (AgFF) Sector of the US workforce focusing, when possible, on the southeastern US. RESULTS: A number of specific aspects of work organization within AgFF subsectors have been described, but most of this literature exists outside the purview of occupational health. There are few studies that directly examine how attributes of work organization relevant to the AgFF Sector affect workers', much less immigrant workers', occupational health exposures and outcomes. CONCLUSIONS: In contrast to the broader literature, research linking occupational health outcomes to work organization in the AgFF Sector is limited and weak. A systematic program of research and intervention is needed to develop strategies that eliminate or substantially mitigate the deleterious health effects of occupational exposures whose origins likely lie in the organization of AgFF work.

Overview of immigrant worker occupational health and safety for the agriculture, forestry, and fishing (AgFF) sector in the southeastern United States.

BACKGROUND: Manual labor in the Agriculture, Forestry, and Fishing (AgFF) Sector is provided primarily by immigrant workers. Limited information is available that documents the demographic characteristics of these manual workers, the occupational illnesses, injuries and fatalities they experience; or the risk factors to which they are exposed. METHODS: A working conference of experts on occupational health in the AgFF Sector was held to address information limitations. This paper provides an overview of the conference. Other reports address organization of work, health outcomes, healthcare access, and safety policy. CONTENTS: This report addresses how best to define the population and the AgFF Sector, occupational exposures for the sector, data limitations, characteristics of immigrant workers, reasons for concern for immigrant workers in the AgFF Sector, regulations, a conceptual model for occupational health, and directions for research and intervention.

Health care access and health care workforce for immigrant workers in the agriculture, forestry, and fisheries sector in the southeastern US.

BACKGROUND: The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the US is comprised primarily of Latino immigrants. Health care access for these workers is limited and increases health disparities. METHODS: This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers. CONTENTS: Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US.

Upper body musculoskeletal symptoms of Latino poultry processing workers and a comparison group of Latino manual workers.

BACKGROUND: Upper body musculoskeletal injuries are often attributed to rapid work pace and repetitive motions. These job features are common in poultry processing, an industry that relies on Latino immigrants. Few studies document the symptom burden of immigrant Latinos employed in poultry processing or other manual jobs. METHODS: Latino poultry processing workers (n = 403) and a comparison population of 339 Latino manual workers reported symptoms for six upper body sites during interviews. We tabulated symptoms and explored factors associated with symptom counts. RESULTS: Back symptoms and wrist/hand symptoms lasting more than 1-day were reported by over 35% of workers. Poultry processing workers reported more symptoms than comparison workers, especially wrist and elbow symptoms. The number of sites at which workers reported symptoms was elevated for overtime workers and workers who spoke an indigenous language during childhood. CONCLUSION: Workplace conditions facing poultry processing and indigenous language speaking workers deserve further exploration.

Occupational health policy and immigrant workers in the agriculture, forestry, and fishing sector.

BACKGROUND: Immigrant workers make up an important portion of the hired workforce in the Agricultural, Forestry and Fishing (AgFF) sector, one of the most hazardous industry sectors in the US. Despite the inherent dangers associated with this sector, worker protection is limited. METHODS: This article describes the current occupational health and safety policies and regulatory standards in the AgFF sector and underscores the regulatory exceptions and limitations in worker protections. Immigration policies and their effects on worker health and safety are also discussed. Emphasis is placed on policies and practices in the Southeastern US. RESULTS: Worker protection in the AgFF sector is limited. Regulatory protections are generally weaker than other industrial sectors and enforcement of existing regulations is woefully inadequate. The vulnerability of the AgFF workforce is magnified by worker immigration status. Agricultural workers in particular are affected by a long history of "exceptionalism" under the law as many regulatory protections specifically exclude this workforce. CONCLUSIONS: A vulnerable workforce and high-hazard industries require regulatory protections that, at a minimum, are provided to workers in other industries. A systematic policy approach to strengthen occupational safety and health in the AgFF sector must address both immigration policy and worker protection regulations.

Occupational injury and work organization among immigrant Latino residential construction workers.

BACKGROUND: Rates of occupational injury among immigrant workers are widely believed to be underestimated. The goal of this study was to enhance understanding of the burden of occupational injury and the work organization factors underlying injury among immigrant Latino residential construction workers. METHODS: Prospective data were obtained from a community-based sample of Latino residential construction workers (N = 107) over a 3-month period. RESULTS: Twenty-eight participants were injured, resulting in an injury incidence rate of 55.0/100 FTE (95% CI = 41.4-71.6) during the 3-month observation period. The injury rate involving days away from work during the observation period was 3.9/100 FTE (CI = 0.2-7.2). Injuries were elevated among roofers relative to framers and general construction workers. Roofers had elevated exposure to a variety of deleterious work organization factors. CONCLUSIONS: Although imprecise given the small sample, our results suggest a threefold to fourfold underestimate of the injury burden to immigrant Latino construction workers. Work organization may contribute to elevated rates of non-fatal occupational injury, particularly among roofers.

Work organization and occupational health: perspectives from Latinos employed on crop and horse breeding farms.

BACKGROUND: Agriculture is hazardous and increasingly dependent on Latino workers, a vulnerable population. However, little research has studied how work organization influences Latino farmworker health. METHODS: Using a work organization framework, this cross-sectional study describes and compares the work organization and occupational health characteristics of a sample of Latino crop (n = 49) and horse production (n = 54) workers in Kentucky. RESULTS: Crop workers experienced more physical demands, work-related and environmental stressors, and musculoskeletal and ill-health symptoms. Significantly more crop workers indicated work-related illness or missed work due to work-related illness/injury, though one-fourth of both groups reported work-related injury in the past year. A majority of both groups cited exposure to toxic chemicals, a minority of whom received training on their use. CONCLUSION: Further surveillance is needed to understand the rate and precursors of illness/injury in these populations, as is research on the relationship between supervisory practices, psychosocial stressors, and occupational health.