Trends and Rates of Reporting of Race, Ethnicity, and Social Determinants of Health in Spine Surgery Randomized Clinical Trials: A Systematic Review.

STUDY DESIGN: A systematic review. OBJECTIVE: We characterized the rates of sociodemographic data and social determinants of health (SDOH) reported in spinal surgery randomized control trials (RCTs) and the association between these RCTs' characteristics and their rates of reporting on race, ethnicity, and SDOH variables. SUMMARY OF BACKGROUND DATA: Although numerous institutions maintain guidelines and recommendations regarding the inclusion and reporting of sociodemographic and SDOH variables in RCTs, the proportion of studies that ultimately report such information is unclear, particularly in spine surgery. MATERIALS AND METHODS: We searched the MEDLINE, PubMed, and Embase databases for published results from spinal surgery RCTs from January 2002 through December 2022, and screened studies according to prespecified inclusion criteria regarding analysis and reporting of sociodemographic and SDOH variables. RESULTS: We analyzed 421 studies. Ninety-six studies (22.8%) reported race, ethnicity, or SDOH covariates. On multivariate analysis, study size [rate ratio (RR)=1.18; 95% CI, 1.06-1.32], public/institutional funding (RR=2.28; 95% CI, 1.29-4.04), and private funding (RR=3.27; 95% CI, 1.87-5.74) were significantly associated with reporting race, ethnicity, or SDOH variables. Study size (RR=1.26; 95% CI, 1.07-1.48) and North American region (RR=21.84; CI, 5.04-94.64) were associated with a higher probability of reporting race and/or ethnicity. Finally, study size (RR=1.27; 95% CI, 1.10-1.46), public/institutional funding (RR=2.68; 95% CI, 1.33-5.39), focus on rehabilitation/therapy intervention (RR=2.70; 95% CI, 1.40-5.21), and nonblinded study groups (RR=2.70; 95% CI, 1.40-5.21) were associated with significantly higher probability of reporting employment status. CONCLUSION: Rates of reporting race, ethnicity, and SDOH variables were lower in the spinal surgery RCTs in our study than in RCTs in other medical disciplines. These reporting rates did not increase over a 20-year period. Trial characteristics significantly associated with higher rates of reporting were larger study size, North American region, private or public funding, and a focus on behavioral/rehabilitation interventions. LEVEL OF EVIDENCE: Level III.

Occupational inequalities in mortality from cardiovascular disease, 2020-2021.

BACKGROUND: In recent years previous declines in cardiovascular disease (CVD) have stalled. There are occupational risk factors for CVD mortality. This study seeks to examine inequalities in CVD mortality for working-age adults in the United States by occupation. METHODS: Death certificate data for CVD deaths were obtained from the National Center for Health Statistics. Occupation data from these death certificates were coded to major occupation groups. Using information about the number of workers employed in these occupations obtained from the American Community Survey, we calculated mortality rates and rate ratios (RRs), adjusted for covariates associated with CVD mortality. RESULTS: After adjusting for age, sex, race/ethnicity, and educational attainment, workers in 11 occupations had significantly elevated RRs: food preparation and serving; construction and extraction; arts, design, entertainment, sports, and media; life, physical, and social science; farming, fishing, and forestry; legal; protective services; building and grounds cleaning and maintenance; healthcare practitioners and technical; personal care and service; and community and social services. CONCLUSIONS: Occupation appears to be a significant predictor of CVD mortality. Further research is needed to assess how occupational risk factors contribute to changing trends for CVD mortality. Interventions are needed to address workplace risk factors for CVD.

Burden and social distribution of occupational psychosocial exposures in the United States workforce, 2022.

OBJECTIVE: To characterize the burden and social distribution of occupational psychosocial exposures in the United States (US). METHODS: We merged 2022 US employment and demographic data from the Current Population Survey (CPS) with occupational characteristic data from the Occupational Information Network (O*NET), wage data from the Occupational Employment and Wage Statistics Survey, and hours worked from the CPS, to estimate the number and proportion of US workers at risk of exposure to 19 psychosocial hazards. We additionally estimated the number and proportion of US workers over- or underrepresented in exposure burden. RESULTS: Of the exposures examined, US workers were most commonly employed in occupations with high time pressure (67.5 million US workers exposed; 43.2% US workers exposed), high emotional labor (57.1 million; 36.6%), and low wages (47.8 million; 30.6%). The burden of exposures was uneven across sociodemographic strata, attributable to occupational segregation. The full data set is available online at https://deohs.washington.edu/us-exposure-burden. CONCLUSIONS: Work-related psychosocial exposures are ubiquitous and should be considered in occupational and public health research, policy, and interventions to reduce the burden of disease and health inequities in the United States.

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.

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.

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.

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.

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.

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.

Differences in psychosocial factors of mental health in an ethnically diverse Black adult population.

We conducted a cross-sectional analysis in a convenient sample of Black adults in the United States (n = 269, ages 18-65) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). We examined mean differences in self-reported medical mistrust, use of mental health services, depression symptom severity, mental health knowledge and stigma behavior (or a desire for separation away from people living with a mental illness) according to ethnicity, citizenship status, age group, and gender. African Americans with moderate to severe depression symptoms had greater stigma behavior (mean = 12.2, SD = 3.2) than African Americans who screened in the minimal to mild depression range (mean = 13.1, SD = 3.5). Across the spectrum of depression, immigrants showed greater stigma than African Americans (p = 0.037). This is a pilot study that explores heterogeneity in the Black population in depression symptom severity and psychosocial factors related to mental health. Understanding these differences may contribute to how we approach needs and health system practices and policies at the individual, systemic, and structural level of mental health care.

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.

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.

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.

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.

Results of three or more Gamma Knife radiosurgery procedures for recurrent trigeminal neuralgia.

OBJECTIVE: Gamma Knife radiosurgery (GKRS) is an established surgical option for the treatment of trigeminal neuralgia (TN), particularly for high-risk surgical candidates and those with recurrent pain. However, outcomes after three or more GKRS treatments have rarely been reported. Herein, the authors reviewed outcomes among patients who had undergone three or more GKRS procedures for recurrent TN. METHODS: The authors conducted a multicenter retrospective analysis of patients who had undergone at least three GKRS treatments for TN between July 1997 and April 2019 at two different institutions. Clinical characteristics, radiosurgical dosimetry and technique, pain outcomes, and complications were reviewed. Pain outcomes were scored on the Barrow Neurological Institute (BNI) scale, including time to pain relief (BNI score ≤ III) and recurrence (BNI score > III). RESULTS: A total of 30 patients were identified, including 16 women and 14 men. Median pain duration prior to the first GKRS treatment was 10 years. Three patients (10%) had multiple sclerosis. Time to pain relief was longer after the third treatment (p = 0.0003), whereas time to pain recurrence was similar across each of the successive treatments (p = 0.842). Complete or partial pain relief was achieved in 93.1% of patients after the third treatment. The maximum pain relief achieved after the third treatment was significantly better among patients with no prior percutaneous procedures (p = 0.0111) and patients with shorter durations of pain before initiation of GKRS therapy (p = 0.0449). New or progressive facial sensory dysfunction occurred in 29% of patients after the third GKRS treatment and was reported as bothersome in 14%. One patient developed facial twitching, while another experienced persistent lacrimation. No statistically significant predictors of adverse effects following the third treatment were found. Over a median of 39 months of follow-up, 77% of patients maintained complete or partial pain relief. Three patients underwent a fourth GKRS treatment, including one who ultimately received five treatments; all of them reported sustained pain relief at the extended follow-up. CONCLUSIONS: The authors describe the largest series to date of patients undergoing three or more GKRS treatments for refractory TN. A third treatment may produce outcomes similar to those of the first two treatments in terms of long-term pain relief, recurrence, and adverse effects.