Suicide mortality according to occupation and method of suicide, Massachusetts, 2010-2019.

BACKGROUND: Suicide rates in the United States have been increasing. Work-related factors may contribute to risk for suicide. These work-related factors may be reflected in a varied risk for different suicide methods between occupations. This study sought to assess occupational differences in suicide rates according to the method used. METHODS: Death certificate data about suicide deaths in Massachusetts between 2010 and 2019 were used to calculate mortality rates and rate ratios with univariable and multivariable models controlling for age, sex, race ethnicity, and educational attainment for suicides overall, and for three specific methods of suicide (hanging/strangulation/suffocation, firearms, and poisoning) by occupation. RESULTS: In multivariate models, the risk for suicide was significantly elevated for workers in arts, design, entertainment, sports, and media (relative risk [RR] = 1.84, 95% confidence interval [CI] = 1.53, 2.22); construction trades (RR = 1.68, 95% CI = 1.53, 1.84); protective services (RR = 1.49, 95% CI = 1.26, 1.77); and healthcare support occupations (RR = 1.55, 95% CI = 1.25, 1.93). Occupational risk for suicide differed across different methods. For hanging/strangulation/suffocation, workers in arts, design, entertainment, sports, and media occupations had the highest RR (2.09, 95% CI = 1.61, 2.71). For firearms, workers in protective service occupations had the highest RR (4.20, 95% CI = 3.30, 5.34). For poisoning, workers in life, physical, and social science occupations had the highest RR (2.32, 95% CI = 1.49, 3.60). CONCLUSIONS: These findings are useful for identifying vulnerable working populations for suicide. Additionally, some of the occupational differences in the risk for suicide and for specific methods of suicide may be due to workplace factors. Further research is needed to understand these workplace factors so that interventions can be designed for prevention.

Religiosity and Stigmatization Related to Mental Illness Among African Americans and Black Immigrants: Cross-Sectional Observational Study and Moderation Analysis.

ABSTRACT: Stigma about mental illness is a known barrier to engagement in mental health services. We conducted an online cross-sectional study, aiming to estimate the associations between religiosity and mental illness stigma among Black adults ( n = 269, ages 18-65 years) in the United States. After adjusting for demographic factors (age, education, and ethnicity), respondents with higher attendance at religious services or greater engagement in religious activities ( e.g. , prayer, meditation, or Bible study) reported greater proximity to people living with mental health problems (rate ratio [RR], 1.72; 95% confidence interval [CI], 1.14-2.59 and RR, 1.82; 95% CI, 1.18-2.79, respectively). Despite reporting greater past or current social proximity, respondents with higher religiosity indices also reported greater future intended stigmatizing behavior (or lower future intended social proximity) (RR, 0.92-0.98). Focusing specifically on future intended stigmatizing behavior and the respondent's level of religiosity, age, and ethnicity may be critical for designing effective stigma-reducing interventions for Black adults.

Understanding the Association Between Mental Health Knowledge and Mental Health Service Utilization Among Black Adults.

Mental health knowledge limitations may contribute to the treatment gap among Black adults. We conducted an online cross-sectional study of Black adults in the United States (n = 262, aged 18-65 years) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). Gamma regression using generalized linear models was used to estimate the associations between mental health knowledge and willingness to seek help from mental health professionals. After adjusting for age, education and ethnicity, participants with higher specific knowledge about mental health (such as recognition of schizophrenia as a mental illness) were 26% more likely to report willingness to seek help from a mental health professional for personal and emotional problems (RR = 1.26, CI 1.12-1.41, p < 0.001). Knowledge building interventions (such as psychoeducation) that seek to increase specific knowledge (rather than general knowledge) may correlate more strongly with utilization of mental health services among Black adults.

Changes in drug poisoning mortality before and after the COVID-19 pandemic by occupation in Massachusetts.

BACKGROUND: Incidence of drug poisoning deaths has increased during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has established that risks differ for drug poisoning death according to occupation, and that workers also have a different risk for exposure to and death from COVID-19. This study sought to determine whether workers in certain occupations had drug poisoning mortality rates that increased in 2020 (the first year of the COVID-19 pandemic) compared to the average mortality rate for workers in those occupations during the previous 3 years. METHODS: Death certificates of Massachusetts residents who died from drug poisonings in 2017-2020 were obtained. Average mortality rates of drug poisoning according to occupation during the 2017-2019 period were compared to mortality rates in 2020. RESULTS: Between the 2017-2019 period and 2020, mortality rates of drug poisoning increased significantly for workers in three occupational groups: food preparation and serving; healthcare support; and transportation and material moving. In these occupations, most of the increases in 2020 compared to 2017-2019 occurred in months after COVID-19 pandemic cases and deaths increased in Massachusetts. CONCLUSION: Mortality rates from drug poisonings increased substantially in several occupations in 2020 compared to previous years. Further research should examine the role of occupational factors in this increase in drug poisoning mortality rates during the COVID-19 pandemic. Particular attention should be given to determine the role that exposure to severe acute respiratory syndrome coronavirus 2, work stress, and financial stress due to job insecurity played in these increases.

Racial and ethnic differences in the prevalence of work organization and occupational psychosocial exposures.

BACKGROUNDS: This study sought to assess if there were differences in exposure to job insecurity, shift work, work-life imbalance, workplace harassment, and nonstandard work arrangements according to race and ethnicity in the United States. METHODS: Using data from the nationally representative National Health Interview Survey conducted in 2015, we calculated the prevalence of job insecurity, shift work, work-life imbalance, workplace harassment, and nonstandard work arrangements according to race and ethnicity. Using this data, we then modeled the prevalence of these exposures while adjusting for covariates including occupation. RESULTS: Compared to non-Hispanic White workers, Hispanic (prevalence ratio [PR] = 1.47, 95% confidence interval [CI] = 1.30, 1.66) and non-Hispanic Asian (PR = 1.57, 95% CI = 1.28, 1.92) workers reported more job insecurity. Non-Hispanic Black workers were more likely to report working in shifts (PR = 1.34, 95% CI = 1.22, 1.46) and Hispanic workers reported being employed in alternative work arrangements (PR = 1.40, 95% CI = 1.23, 1.58) more often than non-Hispanic White workers. Non-Hispanic White workers were slightly more likely to report work-life imbalance and workplace harassment than other races/ethnicities. Occupational segregation accounted for some of the racial/ethnic differences in shift work and alternative work arrangements. CONCLUSIONS: These findings are consistent with some previous research on differences in the prevalence of these work organization and psychosocial exposures by race/ethnicity, especially with respect to shift work and alternative work arrangements. However, other studies have found contradictory findings, especially with respect to workplace harassment. There is a need for future research that tackles the association between these exposures and racial/ethnic health disparities.

COVID-19 deaths by occupation, Massachusetts, March 1-July 31, 2020.

BACKGROUND: Exposure to COVID-19 is more likely among certain occupations compared with others. This descriptive study seeks to explore occupational differences in mortality due to COVID-19 among workers in Massachusetts. METHODS: Death certificates of those who died from COVID-19 in Massachusetts between March 1 and July 31, 2020 were collected. Occupational information was coded and age-adjusted mortality rates were calculated according to occupation. RESULTS: There were 555 deaths among MA residents of age 16-64, with usable occupation information, resulting in an age-adjusted mortality rate of 16.4 per 100,000 workers. Workers in 11 occupational groups including healthcare support and transportation and material moving had mortality rates higher than that for workers overall. Hispanic and Black workers had age-adjusted mortality rates more than four times higher than that for White workers overall and also had higher rates than Whites within high-risk occupation groups. CONCLUSION: Efforts should be made to protect workers in high-risk occupations identified in this report from COVID-19 exposure.

Disparities in the usage of maternity leave according to occupation, race/ethnicity, and education.

BACKGROUND: Unlike almost all other countries, the United States does not mandate paid maternity leave for mothers. Lack of access to maternity leave may be a risk factor for adverse maternal and child health outcomes. This study sought to assess disparities in the usage of maternity leave according to maternal occupation, race/ethnicity, and education, and to explore the relationships between these factors. METHODS: We used data from the Pregnancy Risk Assessment Monitoring System from the years 2016 and 2017. We calculated the prevalence of usage of maternity leave and paid maternity leave according to the mother's age, race/ethnicity, education, state, and occupation. We constructed regression models to explore the bivariate and mutually adjusted associations between these factors and usage of maternal leave. RESULTS: Usage of maternity leave and paid maternity leave were estimated at 89.3% and 49.0%, respectively. Usage of paid maternity leave was lower in younger mothers, in Black and Hispanic mothers, and in mothers with fewer years of education. Workers in several occupations, including building and grounds cleaning and maintenance, personal care, and food preparation and serving, used maternity leave at rates significantly lower than the average of all workers. Adjustment for education and occupation reduced, but did not obviate, racial/ethnic differentials in usage of paid maternity leave. CONCLUSIONS: There are substantial differentials in usage of maternity leave. Further research could examine whether these differences contribute to disparities in maternal and child health outcomes.

Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity.

BACKGROUND: There are racial and ethnic disparities in the risk of contracting COVID-19. This study sought to assess how occupational segregation according to race and ethnicity may contribute to the risk of COVID-19. METHODS: Data about employment in 2019 by industry and occupation and race and ethnicity were obtained from the Bureau of Labor Statistics Current Population Survey. This data was combined with information about industries according to whether they were likely or possibly essential during the COVID-19 pandemic and the frequency of exposure to infections and close proximity to others by occupation. The percentage of workers employed in essential industries and occupations with a high risk of infection and close proximity to others by race and ethnicity was calculated. RESULTS: People of color were more likely to be employed in essential industries and in occupations with more exposure to infections and close proximity to others. Black workers in particular faced an elevated risk for all of these factors. CONCLUSION: Occupational segregation into high-risk industries and occupations likely contributes to differential risk with respect to COVID-19. Providing adequate protections to workers may help to reduce these disparities.

Decline in the rate of occupational injuries and illnesses following the implementation of a paid sick leave law in Connecticut.

BACKGROUND: Workers with paid sick leave may have a lower rate of occupational injuries compared with other workers. This study sought to determine whether there was a decline in the rate of occupational injuries and illnesses following the implementation of a paid sick leave law in Connecticut (CT). METHODS: Data from the Bureau of Labor Statistics was used to calculate the rate of occupational injuries and illnesses in CT in the 3 years before (2009-11) and after (2012-14) the law was implemented. These numbers were compared with New York (NY) and the United States, and between the occupations specified by the CT law and other occupations. RESULTS: Among service occupations addressed by the CT paid-sick-leave law, the rate of occupational injuries declined more in CT compared to rates for those same occupations in NY and the United States. Within CT, injury and illness rates showed a greater decline in occupations specified by the law (-17.8%; 95% confidence interval [CI] = -15.6--19.9) compared with other occupations (-6.8%; 95% CI = -6.6%--7.0%) between the two periods. CONCLUSIONS: A paid sick leave law was associated with an increased decline in occupational injuries and illnesses in affected service workers in the period after implementation. Further research should examine the possible reasons for the associations seen here.

Opioid-related overdose deaths by industry and occupation-Massachusetts, 2011-2015.

BACKGROUND: Thousands of people in the United States continue to die from opioid overdoses every year. Work-related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid-related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work-related factors that might contribute to these differences. METHODS: We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work-related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD. RESULTS: Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD. CONCLUSIONS: These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.

Drug poisoning deaths by occupation and drug type, Massachusetts 2010-2019.

OBJECTIVE: To investigate variation in drug poisoning mortality rates by drug type and occupation in Massachusetts. METHODS: Death certificates for deaths by drug poisonings occurring between 2010 and 2019 in Massachusetts were coded based on the decedent's occupation. Mortality rates and rate ratios (with all other occupations as the reference group) were calculated based on the occupation of the workers according to drug type. Poisson regression was used to determine significantly elevated mortality rates and trends in drug poisoning deaths by occupation and drug type. RESULTS: The rate of drug poisoning deaths increased from 2010 to 2016 after which they plateaued. With respect to specific substances, fentanyl- and cocaine-related deaths increased throughout the surveillance period. For drug poisoning deaths overall, workers in construction trades (3,017); food preparation and serving (1,116); transportation and material moving (1,062) occupations had the highest number of drug poisoning deaths. When adjusting for age, sex, race/ethnicity, and educational attainment, workers in 7 occupations had significantly elevated mortality rate ratios for drug poisonings overall: farming, fishing, and forestry (3.42, P < 0.001); construction trades (2.58, P < 0.001); health care support (1.61, P < 0.001); community and social service (1.60, P < 0.001); food preparation and serving related (1.54, P < 0.001); personal care and service (1.37, P < 0.001); and arts, design, entertainment, sports, and media (1.21, P = 0.010). In many cases, workers in these same occupations had elevated mortality rate ratios for poisonings from specific substances. Health care practitioners and technical occupation workers only had elevated rates for methadone-related poisonings (1.73, P = 0.010). CONCLUSIONS: These findings highlight that workers in certain occupations have an elevated risk for drug poisonings and that the patterns differ with respect to the drug type. These findings can be useful for providing services to workers in high-risk occupations and in identifying occupational factors that may be related to the risk of drug poisoning death. While previous research has begun to uncover work-related factors that may contribute to opioid use, further work is needed to identify occupational factors that may contribute to psychostimulant and benzodiazepine use.

Disparities in Access to Paid Sick Leave During the First Year of the COVID-19 Pandemic.

OBJECTIVE: This study sought to assess disparities in access to paid sick leave in the first year of the COVID-19 pandemic based on demographic and socioeconomic factors. METHODS: The percentage of workers with access to paid sick leave was calculated according to age group, sex, race/ethnicity, educational attainment, region, health insurance coverage, receiving public assistance, income, occupation, and industry. RESULTS: A total of 65.6% of workers had access to paid sick leave. Access was lowest among Hispanic workers, workers with less than a high school education, and workers without health insurance coverage. CONCLUSIONS: There were wide disparities in access to paid sick leave during the first year of the COVID-19 pandemic, which may be associated with disparities in the risk for COVID-19. The introduction of mandatory paid sick leave may serve to protect workers from the spread of infectious diseases.

Characteristics of Occupational Environmental Heat Injuries/Illnesses: Survey of Occupational Injuries and Illnesses, 2011 to 2019.

OBJECTIVE: This study describes the characteristics of workers experiencing occupational heat-related injuries/illnesses in the United States and explores the associations between states' average annual temperatures and heat-related injury/illness rates. METHODS: The number and rate of occupational environmental heat injuries/illnesses were calculated according to age group, gender, race/ethnicity, occupation group, and state from 2011 to 2019. RESULTS: Injury/illness rates were higher among Black and Hispanic workers. Workers in farming, fishing, and forestry; installation, maintenance, and repair; and construction/extraction occupations had the highest rates. There was a positive correlation between states' average annual temperatures and heat-related injury/illness rates. DISCUSSION: There are demographic and occupational disparities in occupational environmental heat-related injuries/illnesses in the United States and a correlation between these injuries/illnesses and state average annual temperatures. There is a need for policies and other interventions to protect workers from occupational environmental heat injuries/illnesses.

Fatal Injuries in the Health Care and Social Assistance Industry, Census of Fatal Occupational Injuries, 2011 to 2019.

OBJECTIVE: This study aimed to describe the characteristics of workers in the health care and social assistance industry who experience fatal occupation injuries and the nature of these injuries. METHODS: Fatal occupational injury rates were calculated for workers in the health and social assistance industry according to age, sex, race ethnicity, industry, and year. RESULTS: There were 1224 fatalities among workers in the health care and social assistance industry, resulting in a rate of 6.7 fatalities per 1,000,000 worker-years. The rate of fatal injuries was highest among older workers, men, and Black and White workers. The highest number of fatal injuries was transportation and violent incidents. The highest mortality rates were in the vocational rehabilitation services industry. CONCLUSIONS: These findings can be useful for identifying methods for intervening and preventing fatal injuries among workers in the health care and social assistance industry.

Occupational Differences in Deaths of Despair in the United States, Using Data From the Using the National Occupational Mortality Surveillance System.

OBJECTIVE: To assess occupational differences in proportional mortality ratios (PMRs) and trends in these PMRs due to the deaths of despair in the United States. METHODS: PMRs for deaths due to drug overdoses, suicide, and alcoholic liver disease were obtained from the National Occupational Mortality Surveillance system. Data came from various states for the years 1985 to 1998, 1999, 2003 to 2004, and 2007 to 2014. RESULTS: Occupations with the highest risk for deaths of despair included construction; architects; and food preparation and service. Occupations with the highest increases in deaths due to deaths of despair included personal care and service and home aides. CONCLUSIONS: Identifying occupations with elevated risk factors for deaths of despair makes it possible to focus interventions on these occupations. Occupational hazards and exposures may increase risk to deaths of despair for specific workers.

Increase in Massachusetts deaths with ICD-10 codes associated with COVID-19 during the first four months of 2020.

Background: Previous research has suggested that some COVID-19 infections and deaths have gone unrecorded, especially in the early days of the pandemic. Therefore, it is likely that people in Massachusetts were exposed to, infected with, and died from COVID-19 before the first death was recorded and that other deaths in early 2020 may have been due to COVID-19, but were not coded that way. This study sought to determine the number of deaths in the first 4 months of 2020 that may have been due to COVID-19, by comparing deaths with selected ICD-10 codes to the same time frame in 2019 and 2018. Methods: Death certificate information was obtained for the first 21 weeks of 2018, 2019, and 2020. We calculated and compared the number of deaths for specific ICD-10 codes that may be related to COVID-19 during this time period for each year. Results: There was a notable increase in deaths potentially related to COVID-19 between the 11th and 17th weeks of 2020 in comparison with the same time period in 2018 and 2019. Conclusions: Even after Massachusetts began recording deaths as being due to COVID-19, the number of deaths that may have been due to the disease was higher than would have been expected based on data from the two preceding years. These findings may indicate that some COVID-19 deaths were not being recorded or that the pandemic was exacerbating other health issues.

Violence in Health Care: Trends and Disparities, Bureau of Labor Statistics Survey Data of Occupational Injuries and Illnesses, 2011-2017.

Background: The health care sector is one of the most rapidly growing industry sectors in the United States. This study examined differences in the rates and trends of violent occupational injuries among health care workers in the United States. Methods: This study used data about violent occupational injuries among health care workers in the United States collected by the Bureau of Labor Statistics (BLS) Survey of Occupational Injuries and Illnesses (SOII). The BLS SOII collects data about injuries that result in at least one lost workday. Violent injuries are defined as intentional injury by another person. Data were obtained for years 2011 to 2017. We examined injury rates and trends according to industry and occupation, as well as age, sex, and race/ethnicity. Results: Intentional injuries increased among health care workers between 2011 and 2017. Rates, expressed as injuries per 10,000 workers, were particularly elevated in residential care facilities (44.07) and among health practitioner support technologists and technicians (22.54); nursing, psychiatric, and home health aides (28.13); and occupational therapy and physical therapist assistants and aides (39.72). Black health care support and practitioners workers had injury rates three times higher than White workers. Conclusions/Application to practice: Efforts should be made to address the increasing rates of intentional occupational injuries among health care workers. These efforts should focus on comprehensive programs enforcing policies for prevention and management (including reporting and training) and employee engagement in such efforts. High-rate industries and occupations should receive particular attention.