Occupational fatality risks in the United States and the United Kingdom.

BACKGROUND: There are very few careful studies of differences in occupational fatality rates across countries, much less studies that try to account for those differences. METHODS: We compare the rate of work injury fatalities (excluding deaths due to highway motor vehicle crashes and those due to violence) identified by the US Census of Fatal Occupational Injuries in recent years with the number reported to the Health and Safety Executive in the United Kingdom (UK) and by other European Union (EU) members through Eurostat. RESULTS: In 2010, the fatality rate in the UK was about 1/3 the rate in the US. In construction the rate was about » the US rate, a difference that had grown substantially since the 1990s. Several other EU members had rates almost as low as the UK rate. Across EU countries, lower rates were associated with high-level management attention to safety issues and to in-house preparation of "risk assessments." CONCLUSIONS: Although work fatality rates have declined in the US, fatality rates are much lower and have declined faster in recent years in the UK. Efforts to find out the reasons for the much better UK outcomes could be productive.

States with low non-fatal injury rates have high fatality rates and vice-versa.

BACKGROUND: State-level injury rates or fatality rates are sometimes used in studies of the impact of various safety programs or other state policies. How much does the metric used affect the view of relative occupational risks among U.S. states? This paper uses a measure of severe injuries (fatalities) and of less severe injuries (non-fatal injuries with days away from work, restricted work, or job transfer-DART) to examine that issue. METHODS: We looked at the correlation between the average DART injury rate (from the BLS Survey of Occupational Injuries and Illnesses) and an adjusted average fatality rate (from the BLS Census of Fatal Occupational Injuries) in the construction sector for states for 2003-2005 and for 2006-2008. The RAND Human Subjects Protection Committee determined that this study was exempt from review. RESULTS: The correlations between the fatal and non-fatal injury rates were between -0.30 and -0.70 for all construction and for the subsector of special trade contractors. The negative correlation was much smaller between the rate of fatal falls from heights and the rate of non-fatal falls from heights. Adjusting for differences in the industry composition of the construction sector across states had minor effects on these results. CONCLUSION: Although some have suggested that fatal and non-fatal injury rates should not necessarily be positively correlated, no one has suggested that the correlation is negative, which is what we find. We know that reported non-fatal rates are influenced by workers' compensation benefits and other factors. Fatality rates appear to be a more valid measure of risk. Efforts to explain the variations that we find should be undertaken.

A new estimate of the impact of OSHA inspections on manufacturing injury rates, 1998-2005.

BACKGROUND: A prior study indicated that the effect of OSHA inspections on lost workday injuries had declined from 1979 through 1998. This study provides an updated estimate for 1998-2005. METHODS: Injury data from the Pennsylvania workers' compensation program were linked with employment data from unemployment compensation records to calculate lost-time rates for single-establishment manufacturing firms with more than 10 employees. These rates were linked to OSHA inspection findings. The RAND Human Subjects Protection Committee determined that this study was exempt from review. RESULTS: Inspections with penalties reduced injuries by an average of 19-24% annually in the 2 years following the inspection. These effects were not found for workplaces with fewer than 20 or more than 250 employees or for inspections without penalties. CONCLUSIONS: These findings should be generalizable to the 29 states where federal OSHA directly enforces standards. They suggest that the impact of inspections has increased from the 1990s.

The Pennsylvania certified safety committee program: an evaluation of participation and effects on work injury rates.

BACKGROUND: Since 1994, Pennsylvania, like several other states, has provided a 5% discount on workers' compensation insurance premiums for firms with a certified joint labor management safety committee. This study explored the factors affecting program participation and evaluated the effect of this program on work injuries. METHODS: Using Pennsylvania unemployment insurance data (1996-2006), workers' compensation data (1998-2005), and the safety committee audit data (1999-2007), we conducted propensity score matching and regression analysis on the program's impact on injury rates. RESULTS: Larger firms, firms with higher injury rates, firms in high risk industries, and firms without labor unions were more likely to join the safety committee program and less likely to drop out of the program. The injury rates of participants did not decline more than the rates for non-participants; however, rates at participant firms with good compliance dropped more than the rates at participant firms with poor compliance. CONCLUSIONS: Firm size and prior injury rates are key predictors of program participation. Firms that complied with the requirement to train their safety committee members did experience reductions in injuries, but non-compliance with that and other requirements was so widespread that no overall impact of the program could be detected.

A national view of workplace injuries in nursing homes.

OBJECTIVES: Data from a large sample of nursing homes were used to examine the cross-sectional association between workplace injuries and organizational factors, caregiver staffing levels, and quality. METHODS: Three sources of data were used, the Occupational Safety and Health Administration data initiative for 2004, the Online Survey Certification and Recording system representing 2004, and the 2004 Area Resource File. RESULTS: For the organizational characteristics of interest, the results show that for-profit facilities were less likely to report high injury rates and that facilities with a higher average occupancy and belonging to a chain were more likely to report high injury rates. For the staffing characteristics of interest, facilities with high staffing levels of registered nurses were more likely to report high injury rates, whereas those with high staffing levels of nurse aides were less likely to report high injury rates. For the quality characteristic of interest, facilities of low quality (as measured by quality-of-care deficiency citations) were more likely to report high injury rates. CONCLUSIONS: Workplace injuries are associated with organizational, caregiver, and quality characteristics of nursing homes. This may present an opportunity to reduce high injury rates.

Procuring organ donors as a health investment: how much should we be willing to spend?

BACKGROUND: This paper examines the benefits and costs that accrue when a cadaveric organ donor is procured. We estimate the cost per quality-adjusted life year (QALY) for donor procurement. Our objective was not only to see whether organ procurement is a "good" health investment, but also to clarify how much it is worth spending to obtain additional donors. METHODS: We calculated the average number of kidney, heart, and liver transplants that a typical cadaveric donor generates. Relying primarily on reviewing the published literature, we estimated for each organ type the average number of QALYs that transplants add and the average medical costs they generate. We multiplied per organ benefits and costs by the number of organs from the typical donor, and summed the results to calculate the cost per QALY from procuring an additional donor. We conducted extensive sensitivity analyses of the assumptions. RESULTS: Our central estimate indicates that the typical donor generates about 13 QALYs at an added medical cost of about $214,000, a cost of approximately $16,000 per QALY. Our high estimate is approximately $57,000. CONCLUSIONS: The implications of these findings depend upon how we choose to value QALYs. Most analysts agree that a figure of $100,000 is reasonable. At this value, the benefit obtained from one added donor would be $1.3 million (13 x $100,000) while the medical costs would be $214,000. The implication is that we should be willing to spend up to $1,086,000 ($1.3 million - $214,000) to obtain one more donor.

An Evaluation of the California Injury and Illness Prevention Program.

The Injury and Illness Prevention Program (IIPP) requirement has been the most frequently cited standard in California workplace health and safety inspections almost every year since it became effective in July 1991. Every workplace safety inspection must assess compliance with the IIPP. This article presents the results of an evaluation of the IIPP's effects on worker injuries in California and should inform policy both in California and in the federal Occupational Safety and Health Administration (OSHA) program, which has made the adoption of a similar national requirement a top priority. Using data from the Workers' Compensation Information System, OSHA Data Initiative statistics, and Workers' Compensation Insurance Rating Bureau of California reports on medical and indemnity claims from single-establishment firms, the evaluation team analyzed the impact of citations for violations of the IIPP on safety performance by (1) using the number of citations as a measure of effectiveness and (2) assessing the number of establishments that were cited for noncompliance and then came into compliance. They found that enforcement of the IIPP appears to prevent injuries only when inspectors cite firms for violations of specific subsections of that standard. Eighty percent of the citations of the IIPP by the California Division of Occupational Safety and Health program are for only a different section, the one that requires employers to have a written IIPP. The specific subsections refer to the provisions that mandate surveying and fixing hazards, investigating the causes of injuries, and training employees to work safely. Because about 25 percent of all inspections cite the IIPP, citations of the specific subsections occur in about 5 percent of all inspections. In those inspections, the total recordable injury rate falls by more than 20 percent in the two years following the inspection.

What kinds of injuries do OSHA inspections prevent?

OBJECTIVE: OSHA's enforcement program is one of the major public efforts to protect American workers. We examine both the scope of injury prevention that inspections can contribute and the types of standards that contribute the most. METHODS: We linked Pennsylvania Department of Labor and Industry files for lost-time injuries and employment to calculate injury rates for 1998-2005 for all single-establishment manufacturing firms. We linked these to OSHA inspection records. RESULTS: Inspections with penalties did affect injury types unrelated to standards as well as those related. We also found again that citations for violations of the standard requiring personal protective equipment had the largest impact on preventing injuries. IMPACT ON INDUSTRY: Programs requiring protective equipment use deserve added attention from consultants and inspectors. In addition, some inspections spur managers to undertake safety measures that go beyond compliance with standards.

Assessing the accuracy of OSHA's projections of the benefits of new safety standards.

BACKGROUND: In the preambles to the safety and health standards that it has issued since 1987, the Occupational Safety and Health Administration (OSHA) projected that new safety standards would prevent over 2,600 death each year. For six safety standards issued since 1990, we compare OSHA's projections of the impact of full compliance on fatalities with actual fatality changes and examine the reasons for the differences. METHODS: We reviewed the preambles to OSHA standards and the Regulatory Impact Analyses (RIAs) prepared for them to identify the baseline and the prevention factor that the agency used to project the number of deaths that would be prevented. We used three data sources to track the relevant categories of fatalities: the Census of Fatal Occupational Injuries (CFOI), the National Traumatic Occupational Fatality program, and OSHAs Fatality/Catastrophe investigations. RESULTS: For all six standards, OSHA appeared to overestimate the number of deaths prevented. The availability of CFOI led to better estimates of the fatality baseline, but the prevention factor was always overestimated, especially for standards which emphasized training. CONCLUSIONS: OSHA needs to develop better methods for projecting injury impacts. Research is needed to help OSHA predict the effects of behavioral requirements (e.g., training) on actual work practices and injury outcomes. For non-fatal injuries, new methods of data collection will be required.