Emergency department visits for heat-related illness among workers: Occupational health surveillance using Washington syndromic surveillance data.

BACKGROUND: Information on worker occupation and industry is critical to understanding the occupational risks of heat-related illness (HRI), yet few syndromic surveillance systems capture these key data elements. This study evaluates the work data reported through Washington syndromic surveillance for its utility in characterizing HRI ED visits by industry and occupation. METHODS: Standard industry and occupation codes were assigned to employer name and occupation descriptions reported in Washington ED visit records maintained within the state's syndromic surveillance system, for visits involving HRI in 2020-2022. HRI ED visits involving workplace heat exposure were identified based on discharge diagnoses or on keywords in the triage note or chief complaint fields. HRI ED visits were summarized by patient characteristics, and visit rates were calculated by industry and occupation. RESULTS: Employer name or occupation descriptions were reported in 21.5% of HRI ED records among patients age 16 and older, and in 41.2% of records with mention of heat exposure at work. Twice as many records were classified for industry as for occupation. Agriculture, forestry, fishing, and hunting and transportation and warehousing had the highest rates of HRI ED visits. Specific industries with the highest rates included support activities for agriculture and forestry, the postal service, and fruit and vegetable preserving and specialty food manufacturing. CONCLUSION: Syndromic surveillance data are a valuable source of occupational health surveillance information when work characteristics are reported, enhancing our understanding of the occupational risks of injuries and illnesses.

Occupation and Industry Data Quality Among Select Notifiable Conditions in Washington State.

CONTEXT: Occupation and industry are basic data elements that, when collected during public health investigations, can be key to understanding patterns of disease transmission and developing effective prevention measures. OBJECTIVE: To assess the completeness and quality of occupation and industry data among select notifiable conditions in Washington and discuss potential improvements to current data collection efforts. DESIGN: We evaluated occupation and industry data, collected by local health departments during routine case investigations, for 11 notifiable conditions, selected for inclusion based on an established or plausible link to occupational exposure. SETTING AND PARTICIPANTS: Confirmed cases of select notifiable conditions among Washington residents aged 16 to 64 years, for years 2019-2021. MAIN OUTCOME MEASURES: We calculated the percentage of cases among working-age adults reported as employed, the percentage with occupation and industry data collected, and the percentage assigned standard occupation and industry codes. We identified the most common responses for occupation and industry and challenges of assigning codes to those responses. RESULTS: Among the 11 conditions evaluated, one-third of cases aged 16 to 64 years were reported as employed. Among the cases reported as employed, 91.5% reported occupation data and 30.5% reported industry data. "Self-employed" was among the top responses for occupation, a response that does not describe a specific job and could not be assigned an occupation code. In the absence of additional information, 4 of the most common responses for industry could not be coded: "health care," "technology," "tech," and "food." CONCLUSION: Routine collection of informative occupation and industry data among working-age adults is largely absent from case investigations in Washington. Methods of data collection that improve quality while minimizing the burden of collection should be pursued. Suggestions for improving data quality are discussed.

Descriptive summary of fatal work-related injuries, Western States, 2011-2017.

Work-related deaths are a persistent occupational health issue that can be prevented. However, prevention opportunities can be hampered by a lack of adequate public health resources. The Western States Occupational Network (WestON) is a network of federal, state, and local occupational health professionals that includes a 19-state region of the United States. To encourage public health collaboration, WestON partners examined work-related fatalities within the region. Fatality counts (numerators) were obtained from the U.S. Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries restricted-access research files for all workers ages ≥15 years and fatally injured in WestON states from 2011 through 2017. Estimates of full-time equivalent hours worked (FTE) (denominators) were retrieved from the BLS Current Population Survey. Annual average fatality rates were calculated as number of fatalities per 100,000 FTE over the study period. Rates were stratified by state, select demographics, industry sector, and event/exposure types. Pearson chi-squared tests and rate ratios with 95% confidence probability limits were used to assess rate differences. All analyses were conducted using SAS v.9.4. From 2011 through 2017, the annual average overall occupational fatality rate for the WestON region was 3.5 fatalities per 100,000 FTE, comparable to the overall U.S. fatality rate. Male workers had a fatality rate almost 10 times higher than female workers in the region. Fatality rates increased with successive age groups. Alaska and New Mexico had significantly higher fatality rates for all racial/ethnic groups compared to respective regional rates. Wyoming, North Dakota, and Montana had the three highest occupational fatality rates among foreign-born workers. Agriculture/forestry/fishing, mining/oil/gas extraction, and transportation/warehousing/utilities were industry sector groups with the three highest fatality rates regionally. Transportation-related incidents were the most frequent event type associated with occupational fatalities for all 19 states. Work-related fatalities are a crosscutting occupational public health priority. This analysis can be an impetus for collaborative multistate initiatives among a dynamic and varied occupational public health network to better meet the needs of a rapidly changing workforce.

Heat related illness among workers in Washington State: A descriptive study using workers' compensation claims, 2006-2017.

BACKGROUND: Heat related illness (HRI) places a significant burden on the health and safety of working populations and its impacts will likely increase with climate change. The aim of this study was to characterize the demographic and occupational characteristics of Washington workers who suffered from HRI from 2006 to 2017 using workers' compensation claims data. METHODS: We used Washington workers' compensation data linked to weather station data to identify cases of work-related HRI. We utilized Occupational Injury and Illness Classification System codes, International Classification of Diseases 9/10 codes, and medical review to identify accepted and rejected Washington State (WA) workers' compensation claims for HRI from 2006 to 2017. We estimated rates of HRI by industry and evaluated patterns by ambient temperature. RESULTS: We detected 918 confirmed Washington workers' compensation HRI claims from 2006 to 2017, 654 were accepted and 264 were rejected. Public Administration had the highest third quarter rate (131.3 per 100 000 full time employees [FTE]), followed by Agriculture, Forestry, Fishing, and Hunting (102.6 per 100 000 FTE). The median maximum daytime temperature was below the Washington heat rule threshold for 45% of the accepted HRI claims. Latinos were estimated to be overrepresented in HRI cases. CONCLUSION: The WA heat rule threshold may not be adequately protecting workers and racial disparities are present in occupational HRI. Employers should take additional precautions to prevent HRI depending on the intensity of heat exposure. States without heat rules and with large industry sectors disproportionately affected by HRI should consider regulations to protect outdoor workers in the face of more frequent and extreme heat waves.

Employer knowledge of federal requirements for recording work-related injuries and illnesses: Implications for occupational injury surveillance data.

BACKGROUND: Accuracy of the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII) data is dependent on employer compliance with workplace injury and illness recordkeeping requirements. Characterization of employer recordkeeping can inform efforts to improve the data. METHODS: We interviewed representative samples of SOII respondents from four states to identify common recordkeeping errors and to assess employer characteristics associated with limited knowledge of the recordkeeping requirements and non compliant practices. RESULTS: Less than half of the establishments required to maintain OSHA injury and illness records reported doing so. Few establishments knew to omit cases limited to diagnostic services (22%) and to count unscheduled weekend days as missed work (27%). No single state or establishment characteristic was consistently associated with better or worse record-keeping. CONCLUSION: Many employers possess a limited understanding of workplace injury recordkeeping requirements, potentially leading them to over-report minor incidents, and under-report missed work cases.

Workers' compensation claims not reported in the Survey of Occupational Injuries and Illnesses: Injury and claim characteristics.

BACKGROUND: Underreporting in the nation's primary source of non-fatal occupational injury and illness data are well documented, but worker-level characteristics of unreported cases have not been fully explored. METHODS: Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses (SOII) data were linked to Washington workers' compensation claims to identify injury and claim characteristics associated with unreported cases. Workers' compensation administrative date data were used to characterize timing of disability and SOII case eligibility. RESULTS: Based on claim date data, one in five lost time claims with an injury date in the survey year were likely ineligible for SOII case reporting during the survey year. Among SOII-eligible claims, those involving sprains or strains, employer protests, and those not eligible for work disability payments until months after the initial injury were least likely to be reported in SOII. CONCLUSIONS: SOII case capture is limited both by its cross sectional survey design and employer underreporting. Am. J. Ind. Med. 60:264-275, 2017. © 2017 Wiley Periodicals, Inc.

Unreported workers' compensation claims to the BLS Survey of Occupational Injuries and Illnesses: Establishment factors.

BACKGROUND: Studies suggest employers underreport injuries to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII); less is known about reporting differences by establishment characteristics. METHODS: We linked SOII data to Washington State workers' compensation claims data, using unemployment insurance data to improve linking accuracy. We used multivariable regression models to estimate incidence ratios (IR) of unreported workers' compensation claims for establishment characteristics. RESULTS: An estimated 70% of workers' compensation claims were reported in SOII. Claims among state and local government establishments were most likely to be reported. Compared to large manufacturing establishments, unreported claims were most common among small educational services establishments (IR = 2.47, 95%CI: 1.52-4.01) and large construction establishments (IR = 2.05, 95%CI: 1.77-2.37). CONCLUSIONS: Underreporting of workers' compensation claims to SOII varies by establishment characteristics, obscuring true differences in work injury incidence. Findings may differ from previous research due to differences in study methods.

Employer reasons for failing to report eligible workers' compensation claims in the BLS survey of occupational injuries and illnesses.

BACKGROUND: Little research has been done to identify reasons employers fail to report some injuries and illnesses in the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII). METHODS: We interviewed the 2012 Washington SOII respondents from establishments that had failed to report one or more eligible workers' compensation claims in the SOII about their reasons for not reporting specific claims. Qualitative content analysis methods were used to identify themes and patterns in the responses. RESULTS: Non-compliance with OSHA recordkeeping or SOII reporting instructions and data entry errors led to unreported claims. Some employers refused to include claims because they did not consider the injury to be work-related, despite workers' compensation eligibility. Participant responses brought the SOII eligibility of some claims into question. CONCLUSION: Systematic and non-systematic errors lead to SOII underreporting. Insufficient recordkeeping systems and limited knowledge of reporting requirements are barriers to accurate workplace injury records.

Injury classification agreement in linked Bureau of Labor Statistics and Workers' Compensation data.

BACKGROUND: Estimates of select occupational injuries and illnesses often differ across data sources. We explored agreement in injury classifications and the impact of differences on case estimates among records reported to multiple data sources. METHODS: We linked cases reported in the Bureau of Labor Statistics (BLS) annual Survey of Occupational Injuries and Illnesses (SOII) to Washington State workers' compensation (WC) claims and evaluated agreement in injury characteristics coded in each data source according to the same occupational injury and illness classification system. RESULTS: Agreement between data sources was greatest for body part and lowest for event or exposure. Agreement on nature of injury varied by condition. WC-assigned injury codes estimated 94% more amputations than SOII-assigned codes while SOII-assigned codes estimated 34% more work-related MSD cases. CONCLUSIONS: Accounting for classification differences may improve case ascertainment within individual data sources and help align injury and illness estimates derived from different data sources.

Exploring the relationship between employer recordkeeping and underreporting in the BLS Survey of Occupational Injuries and Illnesses.

BACKGROUND: Little empirical data exist to identify the reasons for underreporting in the US Bureau of Labor Statistics (BLS) non-fatal occupational injury and illness data. METHODS: We interviewed occupational injury and illness record keepers from Washington State establishments that participated in the 2008 BLS Survey of Occupational Injuries and Illnesses (SOII). Qualitative and quantitative methods were used to explore recordkeeping and business practices that may explain SOII's incomplete case capture compared with WC claims data. RESULTS: Most participants (90%) did not comply with OSHA recordkeeping regulations. Other factors including using workplace injury data to evaluate supervisors' or SOII respondent's job performance, recording injuries for a worksite that operates multiple shifts, and failing to follow SOII instructions were more common among establishments with unreported WC claims. CONCLUSION: Business practices that incentivize low injury rates, disorganized recordkeeping, and limited communication between BLS and survey respondents are barriers to accurate employer reports of work-related injuries and illnesses.