Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China.

It remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and middle-income countries. Two cohort studies in China (in Anhui cohort 1402 older adults aged ≥ 60 followed up for 10 years; in Zhejiang cohort 6115 older adults followed up for 5 years) were conducted to examine particulate matter - PM2.5 associated with all dementia and air quality index (AQI) with Alzheimer's disease, respectively. A systematic literature review and meta-analysis was performed following worldwide literature searched until May 20, 2020 to identify 15 population-based cohort studies examining the association of AP with dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI. The cohort studies in China showed a significantly increased relative risk (RR) of dementia in relation to AP exposure; in Anhui cohort the adjusted RR was 2.14 (95% CI 1.00-4.56) in people with PM2.5 exposure at ≥ 64.5 µg/m3 versus <63.5 µg/m3 and in Zhejiang cohort the adjusted RR was 2.28 (1.07-4.87) in AQI>90 versus ≤ 80. The systematic review revealed that all 15 studies were undertaken in high income countries/regions, with inconsistent findings. While they had reasonably good overall quality of studies, seven studies did not adjust smoking in analysis and 13 did not account for depression. Pooling all eligible data demonstrated that dementia risk increased with the total AP exposure (1.13, 1.08-1.19). Data analysis of air pollutants showed that the RR significantly increased with PM2.5 (1.06, 1.03-1.10 in 2nd tertile exposure; 1.13, 1.07-1.19 in 3rd tertile versus 1st tertile), PM10 (1.05, 0.86-1.29; 1.62, 0.60-4.36), carbon monoxide (1.69, 0.72-3.93; 1.52, 1.35-1.71), nitrogen dioxide (1.06, 1.03-1.09; 1.18, 1.10-1.28) and nitrogen oxides (1.09, 1.04-1.15; 1.26, 1.13-1.41), but not ozone. Controlling air pollution and targeting on specific pollutants would reduce dementia globally.

Impact of fish consumption on all-cause mortality in older people with and without dementia: a community-based cohort study.

BACKGROUND: Increased fish consumption reduces the risk of dementia. However, it is unknown whether fish consumption reduced all-cause mortality in people with dementia. The purpose of the study is to investigate the association of fish consumption with all-cause mortality in older people with dementia versus those without dementia. METHODS: Using a standard method of the Geriatric Mental State, we interviewed 4165 participants aged ≥ 60 years who were randomly recruited from five provinces in China during 2007-2009 to collect the baseline data of socio-demography, disease risk factors, histories of disease, and details of dietary intakes, and diagnosed dementia (n = 406). They were followed up for vital status until 2012. RESULTS: The cohort follow-up documented 329 deaths; 61 were in participants with dementia (55.3 per 1000 person-years) and 224 were those without dementia (22.3). In all participants, the risk of all-cause mortality was reduced with fish intake at " ≥ twice a week" (multivariate-adjusted hazard ratio 0.58, 95% CI 0.34-0.96) and at "once a week or less" (0.79, 0.53-1.18) compared to "never eat" over the past two years. In participants without baseline dementia, the corresponding HRs for all-cause mortality were 0.57 (0.33-0.98) and 0.85 (0.55-1.31), while in participants with dementia were 1.36 (0.28-6.60) and 1.05 (0.30-3.66), respectively. CONCLUSION: This study reveals that consumption of fish in older age reduced all-cause mortality in older people without dementia, but not in people with dementia. Fish intake should be increased in older people in general, prior to the development of dementia in the hope of preventing dementia and prolonging life.

[Exploration on origin of Simiao Yong'an Decoction].

Simiao Yong'an Decoction is composed of Lonicerae Japonicae Flos, Scrophulariae Radix, Angelicae Sinensis Radix, Glycyrrhizae Radix et Rhizome, which was chosen as one of the 100 classic prescriptions in Catalogue of Ancient Classics Prescription(the first batch). Through tracing to the source, It was found that the Simiao Yong'an Decoction(but not named) originated from the Shi Shi Mi Lu, and was later cited by books such as Ancient and Modern Book Integration-Full Record of Medical Department and New Edition of Useful Prescriptions. Literature shows that this prescription was not named until first reported in the Effect of Traditional Chinese Medicine on Arterial Embolism Gangrene in 1956 by a journalist LYU Min. This article recorded that SHIJIA Baoshan, a monk from Hebei Province, used self-named "Simiao Yong'an Decoction" to treat local arterial embolic gangrene. After comparison, there was two difference between ancient books and SHIJIA Baoshan's records. Firstly, according to ancient books, the composition and dosage of Simiao Yong'an Decoction is Lonicerae Japonicae Flos 90 g, Scrophulariae Radix 90 g, Angelicae Sinensis Radix 60 g, Glycyrrhizae Radix et Rhizome 30 g", and the ratio is 3∶3∶2∶1. By SHIJIA Baoshan's record, the composition and dosage are: Lonicerae Japonicae Flos 66 g, Scrophulariae Radix 132 g, Angelicae Sinensis Radix 99 g, Glycyrrhizae Radix et Rhizome 33 g, and the ratio changed to 2∶4∶3∶1. Secondly, ancient books show that patients can be healed after taking seven or ten days of the previous prescription, however, it would take 3 or 4 months, even 7 months in SHIJIA Baoshan's records. It can be considered that the previous prescription should be used at the beginning of gangrene, while the modified Simiao Yong'an Decoction by SHIJIA Baoshan is widely used in the middle and late stages of gangrene, even the critical condition, that is the reason for longer treatment and larger dosage. Nowadays, Simiao Yong'an Decoction is not limited to the treatment of gangrene and bulla in clinic. Relevant studies have confirmed that Simiao Yong'an Decoction has the effects such as anti-inflammatory, plaque stabilization, lipid-lowering, vascular protection, improvement of hemorheology, anticoagulation, inhibition of thrombosis and fibrinolysis, etc. In the follow-up, we should carry out the analysis of the compatibility of this four medicines, and redefine the scope of its clinical application under the theory of traditional Chinese medicine.

Prenatal phthalate exposure in relation to gestational age and preterm birth in a prospective cohort study.

This study enrolled 3266 pregnant women, to explore the relationship of prenatal phthalate exposure with the risk of preterm birth and gestational age. All participants filled questionnaires and provided with up to three urine samples during three trimesters. Seven phthalate metabolites in urines were measured. The incidences of very preterm, late preterm, early-term, late-term and postterm births were 0.58%, 3.52%, 24.22%, 10.53%, and 0.34%, respectively. Non-linear relationships were shown between phthalate metabolites and gestational age. Except for monomethyl phthalate (OR = 1.65, 95%CI = 1.17-2.34), the average concentrations of phthalate metabolites were associated with a slightly and insignificantly increased risk of overall preterm birth (<37+0 gestational weeks). Through a restricted cubic spline regression, phthalate metabolites were found to be related to the risk of overall preterm birth in a linear manner (p-value >0.05) or a non-linear manner (p-value <0.05). All curves indicated the overall preterm birth risk rose with the increase of phthalate metabolite concentrations. Finally, compared with full-term birth (39+0 to 40+6 gestational weeks), phthalate metabolites were associated with the elevated risks of very preterm, late preterm and postterm births, although some relationships were not statistically significant. In conclusion, these findings suggested non-linear associations between phthalate metabolites and gestational age. Exposure to some phthalate metabolites was associated with increased risks of overall preterm birth and postterm birth.

Temporal Variability of Cumulative Risk Assessment on Phthalates in Chinese Pregnant Women: Repeated Measurement Analysis.

The assessment of the combined effects of multiple phthalate exposures at low levels is a newly developed concept to avoid underestimating their actual cumulative health risk. A previous study included 3455 Chinese pregnant women. Each woman provided up to three urine samples (in total 9529). This previous study characterized the concentrations of phthalate metabolites. In the present study, the data from 9529 samples was reanalyzed to examine the cumulative risk assessment (CRA) with two models: (1) the creatinine-based and (2) the volume-based. Hazard index (HI) values for three phthalates, dibutyl phthalate, butyl benzyl phthalate, and di(2-ethylhexyl) phthalate, in the first, second, and third trimesters of pregnancy, were calculated, respectively. In creatinine-based model, 3.43%, 14.63%, and 17.28% of women showed HI based on the European Food Safety Authority tolerable daily intake exceeding 1 in the first, second, and third trimester of pregnancy, respectively. The intraclass correlation coefficient of HI was 0.49 (95% confidence interval: 0.46-0.53). Spearman correlations between HI of the creatinine model and ∑androgen disruptor (a developed potency weighted approach) ranged from 0.824 to 0.984. In summary, this study suggested a considerable risk of cumulative exposure to phthalates during the whole gestation in Chinese pregnant women. In addition, moderate temporal reproducibility indicated that single HI, estimated by the phthalate concentration in single spot of urine, seemed representative to describe the throughout pregnancy CRA. Finally, strong correlation between HI of the creatinine model and ∑androgen disruptor revealed that the creatinine-based model was more appropriate to evaluate the CRA.

Epigenetic regulation of lncRNA connects ubiquitin-proteasome system with infection-inflammation in preterm births and preterm premature rupture of membranes.

BACKGROUND: Preterm premature rupture of membranes (PPROM) is responsible for one third of all preterm births (PTBs). We have recently demonstrated that long noncoding RNAs (lncRNAs) are differentially expressed in human placentas derived from PPROM, PTB, premature rupture of the membranes (PROM), and full-term birth (FTB), and determined the major biological pathways involved in PPROM. METHODS: Here, we further investigated the relationship of lncRNAs, which are differentially expressed in spontaneous PTB (sPTB) and PPROM placentas and are found to overlap a coding locus, with the differential expression of transcribed mRNAs at the same locus. Ten lncRNAs (five up-regulated and five down-regulated) and the lncRNA-associated 10 mRNAs (six up- and four down-regulated), which were identified by microarray in comparing PPROM vs. sPTB, were then validated by real-time quantitative PCR. RESULTS: A total of 62 (38 up- and 24 down-regulated) and 1,923 (790 up- and 1,133 down-regulated) lncRNAs were identified from placentas of premature labor (sPTB + PPROM), as compared to those from full-term labor (FTB + PROM) and from premature rupture of membranes (PPROM + PROM), as compared to those from non-rupture of membranes (sPTB + FTB), respectively. We found that a correlation existed between differentially expressed lncRNAs and their associated mRNAs, which could be grouped into four categories based on the gene strand (sense or antisense) of lncRNA and its paired transcript. These findings suggest that lncRNA regulates mRNA transcription through differential mechanisms. Differential expression of the transcripts PPP2R5C, STAM, TACC2, EML4, PAM, PDE4B, STAM, PPP2R5C, PDE4B, and EGFR indicated a co-expression among these mRNAs, which are involved in the ubiquitine-proteasome system (UPS), in addition to signaling transduction and beta adrenergic signaling, suggesting that imbalanced regulation of UPS may present an additional mechanism underlying the premature rupture of membrane in PPROM. CONCLUSION: Differentially expressed lncRNAs that were identified from the human placentas of sPTB and PPROM may regulate their associated mRNAs through differential mechanisms and connect the ubiquitin-proteasome system with infection-inflammation pathways. Although the detailed mechanisms by which lncRNAs regulate their associated mRNAs in sPTB and PPROM are yet to be clarified, our findings open a new approach to explore the pathogenesis of sPTB and PPROM.

Low Dose Radiation and Solid Tumors Mortality Risk.

BACKGROUND: US nuclear capable shipyard workers have increased potential for occupational radiation exposure. OBJECTIVE: The aim of the study is to examine solid tumor mortality risks at low doses. METHOD: 437,937 workers working from 1957 to 2004 at eight US shipyards were studied. RESULTS: Radiation workers with a median life-time dose at 0.82 mSv had a significantly lower solid tumor mortality risk (relative risk [RR]: 0.96, 95% confidence interval [CI]: 0.94-0.98) than nonradiation workers. Among 153,930 radiation workers, the RRs of solid tumors increased with increasing dose categories without statistical significance. The dose category >0-<25 mSv had significantly lower RR (0.95, 95% CI: 0.91-0.99) versus 0 dose and the excess relative risk was 0.05/100 mSv (95% CI: 0.01-0.08). CONCLUSIONS: Solid tumor risk might increase with radiation dose, but not linearly at low doses. Actual mortality risk may be dependent on dose received.

Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier.

BACKGROUND: Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. OBJECTIVE: To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). METHOD: A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. RESULTS: The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. CONCLUSIONS: Undergoing an AM is associated with an increased risk of TKA in WC claimants.

Dose Escalations Among Workers' Compensation Claimants Using Opioid Medications-An 8 Year Postinjury Follow up Study.

OBJECTIVE: The aim of the study is to determine the morphine equivalent dose in milligrams (MED)/day escalation trend after initial utilization. METHODS: A total of 25,108 lost time claims filed between 1998 and 2007 were followed for 8 years from injury date. Claims were stratified by initial MED/day at 3 months after injury into four groups (0, 1 to < 15, 15 to < 30, and ≥30 MED/day). The slopes in MED/year of opioid dose escalation were determined for each initial MED/day group. RESULTS: The slopes of MED/day escalation by initial MED categories were similar ( P ≥ 0.05) ranging from 5.38 to 7.76 MED annually. On average, MED/day increased in a liner pattern with a slope at 6.28 MED/year ( P < 0.01). CONCLUSIONS: Opioid MED/day increased in a linear pattern, regardless of initial MED/day dose.

Marked Decreases in Time Lost From Work Among COVID-19 Claimants During the SARS-CoV-2 Pandemic: An Observational Study of Claims Filed at a Nationwide US Workers Compensation Insurance Carrier.

OBJECTIVE: To explore the long-term persistence of COVID-19-related impairment and the ability to work after the acute phase of the illness. METHOD: The 19,101 COVID-19 workers' compensation claims filed between January 1, 2020, and December 31, 2021, with follow-up to May 31, 2022, were analyzed. RESULTS: The average time lost from work decreased from 77 days in the first quarter of 2020 to 9.2 days in the fourth quarter of 2021, and the proportion of claims with 30 days or more of lost time decreased from 40.4% to 2.8 days in the same time frame. CONCLUSION: COVID-19 indemnity claims filed in later quarters of the SARS-CoV-2 pandemic have much lower average time lost from work and lower proportions of workers' compensation claims with more than 30, 60, and 150 days of lost time compared with earlier quarters.

Low-Dose Radiation Risks of Lymphohematopoietic Cancer Mortality in U.S. Shipyard Workers.

The linear, non-threshold (LNT) hypothesis of cancer induction derived from studies of populations exposed to moderate-to-high acute radiation doses may not be indicative of cancer risks associated with lifetime radiation exposures less than 100 mSv. The objective of this study was to examine risks and dose-response patterns of lymphohematopoietic cancer (LHC) and its types associated with low radiation exposure while adjusting for possible confounding factors. A retrospective cohort of 437,937 U.S. nuclear shipyard workers (153,930 radiation and 284,007 non-radiation workers) was followed from 1957 to 2011, with 3,699 LHC deaths observed. The risk of LHC in radiation workers was initially compared to the risk in non-radiation workers. Time dependent accumulated radiation dose, lagged 2 years, was used in categorical and continuous dose analysis among radiation workers to examine the LHC risks and possible dose-response relationships based on Poisson regression models. These analyses controlled for sex, race, time dependent age, calendar time, socioeconomic status, solvent-related last job, and age at first hire. The median lifetime radiation dose for the radiation worker population was 0.82 mSv and the 95th percentile dose was 83.63 mSv. The study shows: 1. LHC mortality for radiation workers was significantly lower than non-radiation workers relative risk: 0.927; 95% confidence intervals (95% CI): 0.865, 0.992; P = 0.030]. Among LHC types, the risks for lymphoid leukemia and lymphomas in radiation workers were lower than the risk in non-radiation workers with statistical significance, while the risk for the rest of LHC types did not show any statistically significant difference. 2. In categorical dose analysis among radiation workers, sample size weighted linear trend of relative risk (RRs) for LHC and its types in five dose categories (>0-<25, 25-<50, 50-<100, 100-<200, and > = 200 mSv) vs. 0 mSv were not statistically significant, although there was an elevation of RR for chronic myeloid leukemia only in the 50-<100 mSv category (RR: 2.746; 95% CI: 1.002, 7.521; P = 0.049) vs. 0 mSv. 3. The Poisson regression analyses among radiation workers using the time dependent radiation dose as a continuous variable showed an excess relative risk (ERR) for LHC at 100 mSv of 0.094 (95% CI: -0.037, 0.225; P = 0.158) and leukemia less chronic lymphoid leukemia, of 0.178 (95% CI: -0.085, 0.440; P = 0.440) vs. 0 mSv. The ERRs and their linear trend for all other types were not statistically significant.

Updated Standardized Mortality Ratio Evaluation of Disease Risks of Shipyard Workers Exposed to Low Dose Ionizing Radiation.

OBJECTIVE: To examine the risk of diseases among industrial workers with low and fractionated radiation exposures. METHOD: The 372,047 US male shipyard radiation and non-radiation workers were followed for 54 years and compared with US men using standardized mortality ratio (SMR) method. RESULTS: SMRs for both radiation and non-radiation workers had lower risks of death from all causes (0.74; 95% confidence interval [CI] 0.74 to 0.75 and 0.77; 95% Cl 0.77 to 0.78, respectively) and from all cancers (0.92; 95% CI 0.91 to 0.93 and 0.90; 95% CI 0.89 to 0.91, respectively) compared with US men. Asbestos-related diseases including pleural cancers, mesothelioma, and asbestosis, but not lung cancers, were statistically higher in both radiation and non-radiation workers compared with the US men. CONCLUSION: US shipyard male radiation and non-radiation workers did not show any elevated mortality risks that might be associated with radiation exposure.

Attributes of Long Duration COVID-19 Workers' Compensation Claims.

OBJECTIVE: To examine the attributes associated with long duration COVID- 19 workers' compensation (WC) claims. METHODS: A study was conducted on 13,153 COVID-19 WC claims accepted by a workers' compensation insurance carrier between January 1, 2020 and November 30, 2021. RESULTS: 1) Ninety-five percent of accepted WC claims were closed within the study period; 2) five percent of claims had 30 days or longer of lost time accounting for 65% of total paid WC costs; 3) medical costs increased 8-fold once paid days lost crossed the threshold of 60 days or greater; 4) age was the strongest risk factor associated with increased WC costs and prolonged impairment. CONCLUSION: Age at the time of infection was the major factor associated with prolonged impairment and high costs of COVID-19 related WC claims.

Early Drug Prescription Patterns as Predictors of Final Workers Compensation Claim Costs and Closure: An Updated Analysis on an Expanded Cohort.

OBJECTIVE: The aim of the study is to determine the associations of workers' compensation claim costs and return to work with drugs prescribed for early symptom management. METHODS: Claims filed from 1998 to 2007 were followed for 10 years from the injury date. Drugs analyzed included gabapentin, pregabalin, antipsychotics, antidepressants, sedatives, benzodiazepines, carisoprodol, and opioids, controlling for initial reserve, sex, age, physical therapy, attorney involvement, and surgery. RESULTS: Gabapentin, antipsychotics, antidepressants, and sedatives used in the first 3 months after injury were significantly associated with higher claim cost (≥$100,000). All opioid morphine equivalent doses greater than or equal to 5 mg/d for the first 6 months was significantly associated with higher cost (≥$100,000) and not being released to work at end of third year after injury with dose-response relationships. CONCLUSIONS: Prescription patterns in the first 3 months or first 6 months of workers' compensation claim development may be used as predictors of claim outcomes.

Global trends and diversity in pentachlorophenol levels in the environment and in humans: a meta-analysis.

Pentachlorophenol (PCP) was banned or restricted in many countries worldwide because of its adverse effects on the ecological environment and humans. However, the endocrine disrupting effects caused by low environmental PCP exposure levels has warranted more analysis. We reviewed 80 studies conducted in 21 countries and published between 1967 and 2010, using meta-regression analysis to examine the time trends and regional differences in PCP levels. The results suggested that in indoor air, bodies of water, freshwater sediments in western countries, invertebrates and freshwater vertebrates, PCP levels had declined over time, with half-lives ranging from 2.0 years to 11.1 years. However, in marine sediments/vertebrates and Chinese surface water/sediments, PCP levels increased over time. PCP levels in human blood and urine had decreased since the 1970s, with population half-lives of 3.6 years and 5.7 years, respectively. The intervals for global population blood and urine reference values decreased to 1.1-6.3 µg/L (2002-2008) and 2.5-7 µg/L (1995-2003), respectively. The possible thyroid disrupting effects and other health risks correlated with low environmental PCP exposure should be concerning. This study can help to ascertain the effects of the banning/restriction policy, providing data for cost-benefit analysis in policy-making and further control of health risks caused by low environmental exposure to PCP.

Use of Vinegar and Water to Identify COVID-19 Cases During a Workplace Entrance Screening Protocol.

OBJECTIVE: To evaluate an empirical olfactory test to identify COVID-19 cases during a workplace entrance screening. METHOD: An active screening for olfactory dysfunction using water and vinegar was conducted in April to June 2020 among 4120 meat packing workers in Latin America. RESULTS: The sensitivity and specificity of the active olfactory screening examination were 41.2% and 85.3%, respectively, using reverse transcription polymerase chain reaction (RT-PCR) tests as a gold standard. 10.6% of employees who tested positive for COVID-19 had an olfactory dysfunction as their only symptom. These individuals would not have been identified with standard workplace screening measures including temperature screening. CONCLUSION: Active screening for olfactory dysfunction may serve as a valuable tool to both identify potential COVID-19 infections and exclude those who do not have infection and should be a part of parallel algorithm combined with standard workplace entrance screening procedures.

Standardizing the Accommodations Process for Health Care Workers During COVID-19.

ABSTRACT: The COVID-19 pandemic has resulted in a significant increase in accommodation requests from employees seeking temporary alterations to or relief from their job demands. To maintain consistency and ensure a standard approach, Johns Hopkins Medicine established a COVID-19 Accommodation Review committee that includes experts from the occupational health, legal, and human resources departments, as well as an Americans with Disabilities Act coordinator. In this article, the authors describe the workflow and various components of their institution's accommodations review process, which has resulted in a more consistent and equitable approach to granting requests.

Prevention, Medical Management, and Adjudication of Workplace Injuries: A Thirty-Two Year Follow-up of an Integrated Workers' Compensation Program.

OBJECTIVE: To describe the cost outcomes of an integrated workers' compensation program. METHODS: We studied a population that increased from 20K to 59K, incurring 8807 lost-time claims between 1988 and 2020. RESULTS: Lost-time claims decreased from 22.15 to 4.32 per 1000 employees (1988 to 2020), and total closed lost-time claim costs per $100 payroll, decreased from $0.62 to $0.17 (1988 to 2017). The percent of claims resolved within 3 years of the accident increased from 10% to 89% (1988 to 2017). Adjusting for medical inflation and wage increases, total workers' compensation benefits paid per claim decreased $124 per year, medical benefits decreased $45 per year and indemnity benefits decreased $79 per year. CONCLUSION: On both a population (per employee) and on a per claim basis, workers' compensation costs decreased substantially, which is attributable to improvements in accident prevention and decreases in claim duration.

Gabapentinoid and Opioid Utilization and Cost Trends Among Injured Workers.

OBJECTIVE: To characterize changes in opioid, gabapentin, and pregabalin utilization patterns and cost trends between 2008 and 2018 in a Louisiana workers' compensation claims population and explore the role of gabapentinoids as alternative analgesics during the opioid epidemic. METHOD: Filled prescriptions for gabapentinoids and opioids were studied for 11 years in a cohort of 18,737 claimants. RESULTS: The proportion of claimants prescribed gabapentin increased 2-fold (8.9% to 18.9%) and average drug cost per claimant decreased 22% ($612 to $480). The proportion of claimants prescribed pregabalin decreased approximately 80% (11.7% to 2.5%) and average drug cost per claim increased 224% ($911 to $2952). Proportion of claimants prescribed opioids decreased 20% (80% to 64.2%) and average drug cost per claim decreased 46% ($691 to $371). CONCLUSIONS: Utilization increased substantially for gabapentin and decreased for pregabalin and opioids.

What Industrial Categories Are Workers at Excess Risk of Filing a COVID-19 Workers' Compensation Claim? A Study Conducted in 11 Midwestern US States.

OBJECTIVE: Determine the industries with the highest proportion of accepted COVID-19 related workers' compensation (WC) claims. METHODS: Study included 21,336 WC claims (1898 COVID-19 and 19,438 other claims) that were filed between January 1, 2020 and August 31, 2020 from 11 states in the Midwest United States. RESULT: The overwhelming proportion of all COVID-19 related WC claims submitted and accepted were from healthcare workers (83.77%). Healthcare was the only industrial classification that was at significantly higher COVID-19 WC claim submission risk (odds ratio [OR]: 4.00; 95% confidence intervals [CI]: 2.77 to 5.79) controlling for type of employment, sex, age, and presumption of COVID-19 work-relatedness. Within healthcare employment, WC claims submitted by workers in medical laboratories had the highest risk (crude rate ratio of 8.78). CONCLUSION: Healthcare employment is associated with an increased risk of developing COVID-19 infections and submitting a workers' compensation claim.