Assessing the role of social determinants of health in health disparities: The need for data on work.

BACKGROUND: Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed. METHODS: The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions. RESULTS: While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse. CONCLUSION: Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements.

Injuries That Happen at Work Lead to More Opioid Prescriptions and Higher Opioid Costs.

OBJECTIVES: This study aimed to compare opioid prescription incidence, supply days, and cost associated with occupational injury and other injury-caused conditions. METHODS: We used Medical Expenditure Panel Survey (MEPS) data for 2010-2019. The MEPS provides information on medical conditions and associated medical encounters, treatments, and treatment costs, as well as demographic, education, health, working status, income, and insurance coverage information. We used descriptive statistics and logistic and 2-part regressions. RESULTS: Controlling for covariates and compared with other injury-caused conditions, occupational injury-caused conditions resulted in 33% higher odds of opioid prescribing, 32.8 more opioid prescription supply days, and $134 higher average cost. CONCLUSIONS: Occupational injuries were associated with higher opioid incidence and costs, and more opioid supply days. These findings point to the need to focus on making work safer and the role employers may play in supporting worker recovery from injury and opioid use disorders.

Measuring the benefits of occupational safety and health research with economic metrics: Insights from the National Institute for Occupational Safety and Health.

Measuring the ultimate impact of research on health and economic well-being has presented challenges that have rarely been surmounted, and research on preventing occupational injuries and illnesses is no exception. Nevertheless, there is an increasing need to demonstrate the value of publicly funded research. The National Institute for Occupational Safety and Health (NIOSH) recently contracted with the RAND Corporation to conduct six in-depth case studies that aimed to quantify the benefits of key NIOSH research efforts using economic metrics. These case studies focused on silica exposure in asphalt pavement milling, firefighter cancer risks, a multi-industry matching-grant program for purchase of safety equipment, personal coal dust monitors for coal miners, re-design of ambulance patient compartments for safety, and workplace amputation surveillance. In this article, we summarize what we learned about how measurement of research benefits may be pursued. We summarize the benefit measurement methods that were used and the results of these research efforts in terms of costs saved, injuries and illnesses prevented, and the statistical value of reductions in risk of death or illness. We then distill some observations about the characteristics of research efforts that make measurement of research benefits feasible and suggest steps that could make it feasible to apply the same methods more widely. We also outline key NIOSH activities that appear not to be amenable to benefit measurement but suggest potentials for progress toward at least partial or qualitative benefit assessment. Finally, we discuss implications of the benefit measurement case studies for strategic research planning.

Work Flexibility and Work-Related Well-Being.

Work organization practices, including work flexibility, are changing and can affect worker well-being. Common work flexibility types include working at home, taking time off when needed, and changing one's work schedule. Given the changes in and the importance of work flexibility, the study assesses its prevalence and association with worker well-being in the United States. We used 2002-2018 General Social Survey-Quality of Worklife (GSS-QWL) data, descriptive statistics, and regression analyses to assess the reported likelihood of job stress, job satisfaction, healthy days, and days with activity limitations among workers reporting work flexibility. The prevalence of work flexibility remained relatively stable during the period examined. Working at home increased the likelihood of job stress by 22% and job satisfaction by 65%. Taking time off decreased the likelihood of job stress by 56% and days with activity limitations by 24%, and more than doubled the likelihood of job satisfaction. Changing one's schedule decreased the likelihood of job stress by 20% and increased the likelihood of job satisfaction by 62%. This study used all the available data from GSS-QWL and demonstrated the ongoing importance of work flexibility for well-being.

Association between longest-held occupation and Social Security Disability Insurance benefits receipt.

INTRODUCTION: The cost of the Social Security Disability Insurance (DI) program has increased over time though recent reports showed that disability incidence and prevalence rates have started declining. We explored whether occupation was one of the risk factors for the rising number of disabled workers who received DI benefits during 1992-2016. METHODS: We used a cohort of 16 196 Health and Retirement Survey respondents between the age of 51 and 64 years who were followed from their date of entry until they received DI benefits, died, reached full retirement age, or reached the end of the follow-up period (2016). We used the extended stratified Cox proportional hazard model. Because one-third of the respondents in our cohort did not report their longest-held occupation, we used a multiple-imputation method. RESULTS: The hazard of receiving DI benefits was 51%, 78%, 81%, and 85% higher among workers with longest-held occupations in sales, mechanics and repair, protective services, and personal services, respectively than among workers with longest-held occupations in the reference managerial occupation. The hazard of receiving DI benefits was more than double among workers with longest-held occupations in the construction trade and extractors, transportation operation, machine operators, handlers, and food preparation than among workers with the longest-held occupation in the reference managerial occupation. CONCLUSION: Improving the overall working conditions in these occupations would help reduce worker suffering and the number of applicants for DI benefits, thereby reducing the burden of workplace injury and illness on the DI program.

Burden, Need and Impact: An Evidence-Based Method to Identify Worker Safety and Health Research Priorities.

The importance of research and recommendations to address workforce safety and health derives from the continuing toll from worker fatalities, injuries, and illnesses. Estimates of the societal cost of work-related fatalities, injuries, and illnesses range up to $2.2 trillion in the USA from 2007 to 2015, which may be an underestimate of total societal costs. The ongoing changes in the nature of work, the workforce, and the workplace in the USA challenge old paradigms of worker safety and health research and require new decision criteria that are more solution oriented than observational and that result in interventions that can be readily applied to new occupational hazards and exposures. As public funding for science research programs becomes more constrained, and the demand for increased accountability of government spending grows, the need to demonstrate the impact or return on taxpayers' investment becomes a necessity for research agencies. The National Institute for Occupational Safety and Health has developed an evidence-based method that uses the criteria of 'burden', 'need', and 'impact' to identify research priorities and aid in the evaluation of the taxpayers' investment in research. This approach, named the BNI method, may be useful to other public and private sector research agencies or entities that need a systematic way to set research priorities and allocate increasingly scarce resources for research while ensuring the maximal return on investment.

Employment arrangement, job stress, and health-related quality of life.

OBJECTIVE: We aimed to understand the characteristics of U.S. workers in non-standard employment arrangements, and to assess associations between job stress and Health-related Quality of Life (HRQL) by employment arrangement. BACKGROUND: As employers struggle to stay in business under increasing economic pressures, they may rely more on non-standard employment arrangements, thereby increasing the pool of contingent workers. Worker exposure to job stress may vary by employment arrangement. Excessive exposure to stressors at work is considered to be a potential health hazard, and may adversely affect health and HRQL. METHODS: We used the Quality of Worklife (QWL) module which supplemented the General Social Survey (GSS) in 2002, 2006, 2010, and 2014. GSS is a biannual, nationally representative cross-sectional survey of U.S. households that yields a representative sample of the civilian, non-institutionalized, English-speaking, U.S. adult population. The QWL module assesses an array of psychosocial working conditions and quality of work life topics among GSS respondents. We used pooled QWL responses from 2002 to 2014 by only those who reported being employed at the time of the survey. After adjusting for sampling probabilities, including subsampling for non-respondents and correcting for the number of adults in the household, 6005 respondents were included in our analyses. We grouped respondents according to their employment arrangement, including: (i) independent contractors (contractor), (ii) on call workers (on call), (iii) workers paid by a temporary agency (temporary), (iv) workers who work for a contractor (under contract), or (v) workers in standard employment arrangements (standard). Respondents were further grouped into those who were stressed and those who were not stressed at work. Descriptive population prevalence rates were calculated by employment arrangement for select demographic and organizational characteristics, psychosocial working conditions, work-family balance, and health and well-being outcomes. We also assessed the effect of employment arrangement on job stress, and whether job stress was associated with the number of reported unhealthy days and days with activity limitations. These two health and well-being outcomes capture aspects of worker HRQL. RESULTS: Our results underscored the importance of employment arrangement in understanding job stress and associated worker health and well-being outcomes. Between 2002 and 2014, the prevalence of workers in non-standard employment arrangements increased from 19% to 21%; however, the observed trend did not monotonically increase during that period. Compared with workers in standard arrangements, independent contractors and on call workers were significantly less likely to report experiencing job stress. For workers in standard arrangements and for contractors, we observed significant association between perceived job stress and reported unhealthy days. We observed a similar association for reported days with activity limitations, for workers in standard and temporary arrangements. CONCLUSION: The major contribution of our study was to highlight the differences in job stress and HRQL by employment arrangement. Our results demonstrated the importance of studying each of these employment arrangements separately and in depth. Furthermore, employment arrangement was an important predictor of job stress, and compared with non-stressed workers, stressed workers across all employment arrangements reported more unhealthy days and more days with activity limitations.

Potential Economic Benefits of Paid Sick Leave in Reducing Absenteeism Related to the Spread of Influenza-Like Illness.

OBJECTIVE: Most U.S. employers are not required to provide paid sick leave (PSL), and there is limited information on the economic return of providing PSL. We estimated potential benefits to employers of PSL in reducing absenteeism related to the spread of influenza-like illness (ILI). METHODS: We used nationally representative data and a negative binomial random effects model to estimate the impact of PSL in reducing overall absence due to illness or injury. We used published data to compute the share of ILI from the total days of absence, ILI transmission rates at workplaces, wages, and other parameters. RESULTS: Providing PSL could have saved employers $0.63 to $1.88 billion in reduced ILI-related absenteeism costs per year during 2007 to 2014 in 2016 dollars. CONCLUSION: These findings might help employers consider PSL as an investment rather than as a cost without any return.

Musculoskeletal disorders and associated healthcare costs among family members of injured workers.

BACKGROUND: Research has infrequently looked beyond the injured worker when gauging the burden of occupational injury. OBJECTIVES: We explored the relationship between occupational injury and musculoskeletal disorders (MSDs) among family members of injured workers. DATA AND METHODS: We used 2005 and 2006 Truven Health Analytics databases, which contain information on workers' compensation and family healthcare claims. We used descriptive analyses, and negative binomial and two-part models. RESULTS: Family members of severely injured workers had a 15% increase in the total number of MSD outpatient claims and a 34% increase in the mean cost of MSD claims compared to family members of non-severely injured workers within 3 months after injury. Extrapolating cost results to the national level implies that severe occupational injury would be associated with between $29 and $33 million additional cost of family member outpatient MSD claims. CONCLUSION: Occupational injury can impose a formerly unrecognized health burden on family members of injured workers.

Profitability and occupational injuries in U.S. underground coal mines.

BACKGROUND: Coal plays a crucial role in the U.S. economy yet underground coal mining continues to be one of the most dangerous occupations in the country. In addition, there are large variations in both profitability and the incidence of occupational injuries across mines. OBJECTIVE: The objective of this study was to examine the association between profitability and the incidence rate of occupational injuries in U.S. underground coal mines between 1992 and 2008. DATA AND METHOD: We used mine-specific data on annual hours worked, geographic location, and the number of occupational injuries suffered annually from the employment and accident/injury databases of the Mine Safety and Health Administration, and mine-specific data on annual revenue from coal sales, mine age, workforce union status, and mining method from the U.S. Energy Information Administration. A total of 5669 mine-year observations (number of mines×number of years) were included in our analysis. We used a negative binomial random effects model that was appropriate for analyzing panel (combined time-series and cross-sectional) injury data that were non-negative and discrete. The dependent variable, occupational injury, was measured in three different and non-mutually exclusive ways: all reported fatal and nonfatal injuries, reported nonfatal injuries with lost workdays, and the 'most serious' (i.e. sum of fatal and serious nonfatal) injuries reported. The total number of hours worked in each mine and year examined was used as an exposure variable. Profitability, the main explanatory variable, was approximated by revenue per hour worked. Our model included mine age, workforce union status, mining method, and geographic location as additional control variables. RESULTS: After controlling for other variables, a 10% increase in real total revenue per hour worked was associated with 0.9%, 1.1%, and 1.6% decrease, respectively, in the incidence rates of all reported injuries, reported injuries with lost workdays, and the most serious injuries reported. CONCLUSION: We found an inverse relationship between profitability and each of the three indicators of occupational injuries we used. These results might be partially due to factors that affect both profitability and safety, such as management or engineering practices, and partially due to lower investments in safety by less profitable mines, which could imply that some financially stressed mines might be so focused on survival that they forgo investing in safety.

Incidence and costs of family member hospitalization following injuries of workers' compensation claimants.

BACKGROUND: The consequences of occupational injuries for the health of family members have rarely been studied. We hypothesized that non-fatal occupational injury would increase the incidence and costs of hospitalization among workers' families, and that family members of severely injured workers would be likely to experience greater increases in hospitalizations than family members of non-severely injured workers. DATA AND METHODS: We used the MarketScan databases from Thomson Reuters for 2002-2005, which include workers' compensation and inpatient medical care claims data for injured workers' families. We used a before-after analysis to compare the odds and costs of family hospitalization 3 months before and after the index occupational injury among 18,411 families. Severe injuries were defined by receipt of indemnity payments and at least 7 days of lost work. Family hospitalizations were measured by the incidence of hospitalization of at least one family member. RESULTS: Among families of all injured workers, the odds of at least one family member being hospitalized were 31% higher [95% confidence intervals (CI) = 1.11-1.55] in the 3 months following occupational injury than in the 3 months preceding injury. Among the families of severely injured workers, the odds of hospitalization were 56% higher [95% CI = 1.05-2.34] in the 3 months following injury. Hospitalization costs were found to rise by approximately the same percentage as hospitalization incidence. CONCLUSION: The impact of occupational injury may extend beyond the workplace and adversely affect the health and inpatient medical care use of family members.

Paid sick leave and nonfatal occupational injuries.

OBJECTIVES: We examined the association between US workers' access to paid sick leave and the incidence of nonfatal occupational injuries from the employer's perspective. We also examined this association in different industries and occupations. METHODS: We developed a theoretical framework to examine the business value of offering paid sick leave. Data from the National Health Interview Survey were used to test the hypothesis that offering paid sick leave is associated with a reduced incidence of occupational injuries. We used data on approximately 38 000 working adults to estimate a multivariate model. RESULTS: With all other variables held constant, workers with access to paid sick leave were 28% (95% confidence interval = 0.52, 0.99) less likely than workers without access to paid sick leave to be injured. The association between the availability of paid sick leave and the incidence of occupational injuries varied across sectors and occupations, with the greatest differences occurring in high-risk sectors and occupations. CONCLUSIONS: Our findings suggest that, similar to other investments in worker safety and health, introducing or expanding paid sick leave programs might help businesses reduce the incidence of nonfatal occupational injuries, particularly in high-risk sectors and occupations.

The business cycle and the incidence of workplace injuries: evidence from the U.S.A.

INTRODUCTION: The current study explored the association between the business cycle and the incidence of workplace injuries to identify cyclically sensitive industries and the relative contribution of physical capital and labor utilization within industries. METHOD: Bureau of Labor Statistics nonfatal injury rates from 1976 through 2007 were examined across five industry sectors with respect to several macroeconomic indicators. Within industries, injury associations with utilization of labor and physical capital over time were tested using time series regression methods. RESULTS: Pro-cyclical associations between business cycle indicators and injury incidence were observed in mining, construction, and manufacturing but not in agriculture or trade. Physical capital utilization was the highest potential contributor to injuries in mining while labor utilization was the highest potential contributor in construction. In manufacturing each effect had a similar association with injuries. CONCLUSION: The incidence of workplace injury is associated with the business cycle. However, the degree of association and the mechanisms through with the business cycle affects the incidence of workplace injuries was not the same across industries. IMPACT ON INDUSTRY: The results suggest that firms in the construction, manufacturing, and mining industries should take additional precautionary safety measures during cyclical upturns. Potential differences among industries in the mechanisms through which the business cycle affects injury incidence suggest different protective strategies for those industries. For example, in construction, additional efforts might be undertaken to ensure workers are adequately trained and not excessively fatigued, while safety procedures continue to be followed even during boom times.

The impact of self-insuring for workers' compensation on the incidence rates of worker injury and illness.

OBJECTIVE: There is moderate evidence that workers in experience-rated firms sustain less injuries when compared with workers in firms that are not experience rated. This study aims to provide more insight on this issue. METHODS: Panel data from the Bureau of Labor Statistics and National Academy of Social Insurance between 1999 and 2006 were used. A theoretical framework was developed, and a fixed effects vector decomposition model was estimated. RESULTS: Self-insuring was positively associated with relatively low worker injury and illness incidence rates when compared with insuring (including experience rating and manually rating). After controlling for workforce characteristics, industrial composition, firm size, and state-specific laws, states with an above the median percentage of self-insured firms had incidence rates that were lower than rates in states with a below the median percentage of self-insured firms. CONCLUSION: A higher degree of experience rating seems to better align the economic incentive to invest in prevention and the intended outcome of reducing worker injury and illness.

Cost-effectiveness of roll-over protective structures.

BACKGROUND: Roll-over protective structures (ROPS) are proven to prevent fatalities from agricultural tractor overturns, accounting for more than one-third of all production agriculture-related fatalities in the United States. In 1997, there were approximately 1.2 million ROPS-retrofittable tractors in the United States. METHODS: A decision analysis is used to compare the health outcomes of installing ROPS on retrofittable tractors, relative to doing nothing. A cost-effectiveness analysis builds on these results to assess the costs and benefits of installing ROPS on retrofittable tractors. RESULTS: Doing nothing would result in 1,450 fatalities and 1,806 nonfatal injuries, while installing ROPS would prevent 1,176 fatalities and 957 nonfatal injuries. Installing ROPS would cost $489,373 per injury prevented. CONCLUSIONS: Installing ROPS on retrofittable tractors would reduce fatalities from tractor overturns by more than 80% and nonfatal injuries by about 53%. The cost per injury prevented would be similar to that of other injury-preventing interventions. ROPS would help prevent additional injuries from falling off tractors and tractor collisions with motor vehicles.