Concordance between ANSI occupational back injury codes and claim form diagnoses and a lower bound estimate of the fraction associated with disc displacement/herniation

The current BLS Annual Survey of Occupational Illnesses and Injuries and several recent analyses of factors affecting missed worktime in occupational back injuries rely on ANSI-based injury codes derived from injury narratives to classify occupational injuries and estimate incidence and outcome. No population-based studies of the concordance between back injury codes and clinical diagnoses have been reported. Back injury cases were identified in two large work-injured populations totaling almost 80,000 cases in the states of Michigan and Minnesota. In both populations, cases had been coded by the single nature-of-injury and part-of-body-injured codes assigned by an ANSI-based injury-coding system and by as many as four (Michigan) or three (Minnesota) clinical diagnoses according to the International Classification of Diseases-Clinical Modification, 9th Revision. Concordance was measured by the sensitivity and predictive value positive (PVP, aka PV+ or PPA) of the injury coding scheme for related diagnostic groups. We also used an algorithm based on the limited clinical information available to corroborate the diagnosis of displaced/herniated disc for cases that underwent spinal surgery. Cases identified by the algorithm were then used to obtain a lower bound estimate of the fraction with disc injury. The injury coding scheme had PVPs of 82.9-90.1% and overall sensitivities of 69.7-75.9%. Sensitivities for individual diagnostic groups show that their distribution in ANSI-coded injury groups is skewed slightly toward cases with sprain and disc displacement/herniation, but these shifts are modest. The lower bound estimate of the fraction of cases with disc displacement/herniation in a population of cases with back injuries producing at least 1 day of missed worktime is 5.8%. The demographic comparisons indicate that, as the time between injury and cohort ascertainment increases during the first 8 days of missed worktime following injury, the proportion of younger workers in an injury cohort decreases. The relationship between increasing age and increasing missed worktime disability, reported in various outcome studies, is also present during the first few days following injury. The use of ANSI injury codes underestimates the contribution of back injuries to missed worktime because 24-30% of cases are missed by the ANSI coding system. However, the distribution of diagnostic groups in the injury-coded groups approximates that observed with all diagnosed cases and supports the use of such data to study outcome. Our estimate, and one from Quebec, suggest that disc displacement/herniation occurs more frequently in the subset of occupational back injuries compared to the set of back injuries from all sources.     

Occupational injury and illness in the United States. Estimates of costs, morbidity, and mortality

OBJECTIVE: To estimate the annual incidence, the mortality and the direct and indirect costs associated with occupational injuries and illnesses in the United States in 1992. DESIGN: Aggregation and analysis of national and large regional data sets collected by the Bureau of Labor Statistics, the National Council on Compensation Insurance, the National Center for Health Statistics, the Health Care Financing Administration, and other governmental bureaus and private firms. METHODS: To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from national surveys and applied an attributable risk proportion method. To assess costs, we used the human capital method that decomposes costs into direct categories such as medical and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from the literature while others were generated within this study. Total costs were calculated by multiplying average costs by the number of injuries and illnesses in each diagnostic category. RESULTS: Approximately 6500 job-related deaths from injury, 13.2 million nonfatal injuries, 60,300 deaths from disease, and 862,200 illnesses are estimated to occur annually in the civilian American workforce. The total direct ($65 billion) plus indirect ($106 billion) costs were estimated to be $171 billion. Injuries cost $145 billion and illnesses $26 billion. These estimates are likely to be low, because they ignore costs associated with pain and suffering as well as those of within-home care provided by family members, and because the numbers of occupational injuries and illnesses are likely to be undercounted. CONCLUSIONS: The costs of occupational injuries and illnesses are high, in sharp contrast to the limited public attention and societal resources devoted to their prevention and amelioration. Occupational injuries and illnesses are an insufficiently appreciated contributor to the total burden of health care costs in the United States.     

Occupational injuries among working adolescents in New York State

OBJECTIVE: To determine the number, distribution, determinants, and health consequences of occupational injuries among working adolescents in New York State. DESIGN: A retrospective, population-based analysis of New York State workers' compensation award data and the Annual Demographic File, a supplement to the US Bureau of the Census Current Population Survey. PARTICIPANTS: Adolescents, aged 14 through 17 years, who received workers' compensation awards for occupational injury from 1980 through 1987. MAIN OUTCOME MEASURES: (1) Numbers, types, and rates of occupational injuries in working adolescents by age, sex, industry, and occupation; (2) health consequences of injury, especially disability and death; and (3) secular trends in injury award rates. RESULTS: A total of 9656 adolescents were compensated for occupational injuries; 4201 compensated adolescents (43.5%) suffered permanent disability; 31 working adolescents died. The annual mean rate of compensated occupational injury was 28.2 per 10,000 adolescent workers. Rates were higher in males than in females and ranged from 8.2 per 10,000 in 14-year-old male workers to 46.8 per 10,000 in 17-year-old male workers. Highest rates by industry were seen in manufacturing (49.0/10,000 adolescent workers) and agriculture (46.2/10,000). Unskilled labor was the most dangerous occupation (52.3/10,000). CONCLUSION: Occupational injuries are a substantial and underrecognized contributor to the continuing epidemic of injury among adolescents.     

The role of exhaustion and workarounds in predicting occupational injuries: A cross-lagged panel study of health care professionals.

Occupational injuries remain an important concern for employers, particularly in the health care industry where injury rates have increased despite decreases in other industries. Testing the notion of resource investment from conservation of resources theory, I predicted that exhaustion would be associated with a greater likelihood of safety workarounds (alternative work processes undertaken to “work around” a perceived block in work flow, such as a safety procedure). Furthermore, I hypothesized that safety workarounds would lead to a greater frequency and severity of occupational injuries. I found support for this mediation model with a 2-sample, 3-wave survey study of a variety of health care professionals (nurses, sonographers, and others). I discuss the implications of this research for future research in occupational safety and provide ideas for the reduction of injuries through action research strategies that reduce burnout and workarounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Falls through Roof and Floor Openings and Surfaces, Including Skylights: 1992–2000

Fall-related occupational injuries and fatalities are still serious problems in the U.S. construction industry. Two Bureau of Labor Statistics databases—Census of Fatal Occupational Injuries and Survey of Occupational Injuries and Illnesses—were examined for 1992–2000. An important subset of falls-to-lower-level incidents is when workers fall through openings or surfaces, including skylights. A total of 605 fall-through fatalities occurred during 1992–2000. Also, 21,985 workers were injured seriously enough from fall-through incidents to miss a day away from work (DAFW). Fall-through injuries are among the most severe cases for median number of DAFW. Median DAFW were 35, 11, 25, 12, and 36 for fall-through roof and floor openings, roof and floor surfaces, and skylights, respectively, compared to 10 DAFW for all fall-to-lower-level incidents in all U.S. private industry. A conservative approach, which assumes that direct and indirect costs are equal, estimates a range of $55,000–$76,000 for the total cost of a 1998 DAFW fall-through injury. Current work practices should use commercial fall-prevention products to reduce the frequency and costs of fall-through incidents. These analyses have identified a subset of fall-related incidents that contribute to excessive costs to the U.S. construction industry. Researchers can use a systems approach on these incidents to identify contributing risk factors. Employers and practitioners can alert managers and work crews about these dangerous locations to eliminate these hazards that are often obvious and easy to rectify.     

Changing to daylight saving time cuts into sleep and increases workplace injuries.

The authors examine the differential influence of time changes associated with Daylight Saving Time on sleep quantity and associated workplace injuries. In Study 1, the authors used a National Institute for Occupational Safety and Health database of mining injuries for the years 1983–2006, and they found that in comparison with other days, on Mondays directly following the switch to Daylight Saving Time—in which 1 hr is lost—workers sustain more workplace injuries and injuries of greater severity. In Study 2, the authors used a Bureau of Labor Statistics database of time use for the years 2003–2006, and they found indirect evidence for the mediating role of sleep in the Daylight Saving Time–injuries relationship, showing that on Mondays directly following the switch to Daylight Saving Time, workers sleep on average 40 min less than on other days. On Mondays directly following the switch to Standard Time—in which 1 hr is gained—there are no significant differences in sleep, injury quantity, or injury severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nature and incidence of self-reported adolescent work injury in Minnesota

Most studies of adolescent work-related injury that have been published to date have been confined to administratively collected data available through state or national departments of labor and industry and/or occupational safety and health administrations. These data do not contain information on the severity or the sequelae of injuries. In addition, estimates of incidence may be biased due to inadequate data on the nature, amount, and seasonal variability of work done by adolescent workers. The present study is a cross-sectional survey of work and work injuries of 3,051 10th through 12th grade students from 39 high schools throughout Minnesota. Injury was defined as an event which caused any of the following: loss of consciousness, seeking medical care, and/or restricting normal activities for at least 1 day. The average hours of work per week during the summer and during the school year were 30 (95% Confidence Interval [CI] = 27, 33) and 16 (95% CI = 15, 17), respectively. There was no difference in hours worked between ethnic minorities and white students. The rate of reportable injuries was 12 per 100,000 hr worked (95% CI = 7, 18) for rural and 13 per 100,000 hr worked (95% CI = 7, 28) for urban females, 16 (95% CI = 9, 22) per 100,000 hr for urban males, and 20 (95% CI = 12, 28) per 100,000 hr for rural males. Ongoing medical problems were reported by 26% of the injured workers. Previous estimates of work-related injury to adolescents may have been low. More study is required to clearly define the incidence of injury and risk factors for these injuries.     

A strategic approach to occupational injuries

The development of an integrated risk management approach to occupational injuries at Conrail had an enormously positive impact on injury incidence, lost work days, and company costs. Dr. Comstock describes managed care techniques that facilitate interface between quality assurance and risk management.     

Estimating the costs of occupational injury in the United States

This article estimates workplace injury costs in the U.S. These costs have been studied in less detail than most injury costs. Our methods, which mostly use regularly published data, produce order-of-magnitude estimates. Overall, workplace injuries cost the U.S. an estimated $140 billion annually. This estimate includes $17 billion in medical and emergency services, $60 billion in lost productivity, $5 billion in insurance costs, and $62 billion in lost quality of life. One sixth of the societal costs result from the 3% of workplace injuries in motor vehicle crashes. Motor vehicle costs per injury are almost 6 times the workplace injury average.     

Occupational burns in Washington State, 1989-1993

Occupational burns cause significant morbidity in the United States each year; however, there are few studies that report industries or workplaces where workers are at an increased risk of burn injuries. Washington State's Department of Labor and Industries (L and I) computerized workers' compensation database was used to describe work-related burns over 5 years. From 1989 to 1993, L and I accepted 27,323 claims for occupational burns, 71.4% of them thermal burns and 26.8% chemical burns. The most common sources of injury were cooking oils (14%) and hot water/steam (13%). Workers involved in food preparation or food handling accounted for the highest proportion of injured workers (30%). Industries involved in the smelting, sintering, or refining of ore had the highest rate for thermal burns, with a rate of 15.0 burn injuries per 100 full-time equivalent workers per year, followed by paper, pulp, or wood fiber manufacturing, with a rate of 5.8, then roof work, with a rate of 4.3. Industries involved in hazardous waste landfill clean-up had the highest rate for chemical burns, with a rate of 4.9, followed by portable cleaning and washing, with a rate of 3.5, and paper, pulp, and wood fiber manufacturing, with a rate of 2.6. Further study is needed to identify work practices that result in burn injuries in order to decrease the incidence of this preventable occupational injury.     

Complete remission of extensive metastatic renal cancer following immunotherapy

In order to assess the extent of the sports injury problem, it is necessary to identify both the incidence and severity of sports injuries. In the literature, the severity of sports injuries is usually described on the basis of 6 criteria: (i) nature of sports injury; (ii) duration and nature of treatment; (iii) sporting time lost; (iv) working time lost; (v) permanent damage; and (vi) monetary cost. It is important to include information on the severity of injuries in a sports injury registration system. This kind of information will help to set targets for preventive strategies. The more severe the injuries sustained, the higher the priority will be to prevent these injuries regardless of the injury incidence. When assessing injury severity one should take into account that, in order to enhance the comparability of research data, uniform definitions are also important in this area of sports injury surveillance. This paper briefly discusses the 6 criteria used to describe the severity of sports injuries.     

Occupational injuries among workers with disabilities: the National Health Interview Survey, 1985-1994

CONTEXT: As the baby boom generation ages, more people will be working with disabilities, but we have little information regarding how disabilities affect risk for occupational injury. OBJECTIVE: To test the hypothesis that work-limiting disabilities in general and hearing and visual impairments in particular are risk factors for occupational injuries. DESIGN: Retrospective cohort study. SETTING: The National Health Interview Survey (NHIS), 1985 to 1994. PARTICIPANTS: The 459827 participants in the NHIS from 1985 to 1994 who listed "working" as their primary activity, who were not farmers, and who were between 18 and 65 years of age. MAIN OUTCOME MEASURE: Occupational injuries in the year preceding the interview causing a residual impairment at the time of interview. RESULTS: After adjusting for occupation, self-employment, and age, occupational injury was associated with preceding work disability (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.19-1.56); blindness (OR, 3.21; 95% CI, 1.32-7.85); deafness (OR, 2.19; 95% CI, 1.17-4.12); hearing impairment (OR,1.55; 95% CI, 1.29-1.87); upper extremity impairment (OR, 1.46; 95% CI, 1.05-2.05); and arthritis (OR, 1.34; 95% CI, 1.07-1.68). Visual impairment was not associated with a significantly increased risk (OR, 1.37; 95% CI, 0.87-2.17). CONCLUSIONS: Workers with disabilities, especially sensory impairments, appear to have an elevated risk for occupational injury. Further research in the design and evaluation of improved workplace accommodations for workers with these disabilities is needed.     

Evaluating sources of traumatic spinal cord injury surveillance data in Colorado

The purpose of this study is to evaluate the sources reporting hospitalized spinal cord injury cases to the statewide, population-based surveillance system in Colorado for the year 1994. Three reporting sources were evaluated: clinical contact persons, medical records departments, and a centralized statewide hospital discharge database. Two evaluation strategies were utilized; these include both measures of accuracy and estimates of missed cases. For the latter, capture-recapture techniques were used to estimate the number of hospitalized spinal cord injury cases missed by all three reporting sources. The clinical contact persons reported 84 confirmed cases, missed 80 confirmed cases, and reported 10 cases that were later determined not to have spinal cord injuries, resulting in a sensitivity of 0.51. Medical records departments and the discharge database reported 143 and 147 cases, respectively, missed 21 and 17 confirmed cases, and reported 118 and 69 cases that were later determined not to be cases of hospitalized injuries of the spinal cord, resulting in sensitivities of 0.87 and 0.90. Capture-recapture results indicate all three sources combined missed an estimated 1-5 cases, yielding a total annual incidence rate for hospitalized spinal cord injury ranging from 45.1 to 46.3 per million population.     

Comparison of disability behavior after different sites and types of injury in a workers' compensation population

In this study, an extensive data set from a regional workers' compensation system was analyzed to determine whether particular sites or types of injury were associated with prolonged disability. This data shows a similar pattern of vocational disability for almost all sites and types of injury. A workers' compensation carrier collects data for financial purposes related to insurance, and such data therefore has several serious potential deficiencies when used for clinical research. However, published data on disablement after nonoccupational trauma shows similar patterns of vocational and nonvocational disability, and also shows dependence on severity of injury. In both settings, head injury is associated with greater occupational disability. Because treatment, policy, and medicolegal decisions are based on the impression of "typical disability" for particular sites and types of injury, there is a need for better documentation of post-traumatic disablement in compensation settings and in noncompensation settings. This should include better classification of the cause, type, and severity of the injury, and of the functional outcome in terms of both the resumption of occupational and nonoccupational roles, and of persistence in these roles.     

Organizational injury rate underreporting: The moderating effect of organizational safety climate.

The goals of this study were (a) to assess the extent to which construction industry workplace injuries and illness are underreported, and (b) to determine whether safety climate predicts the extent of such underreporting. Data from 1,390 employees of 38 companies contracted to work at a large construction site in the northwestern United States were collected to assess the safety climate of the companies. Data from the Occupational Safety and Health Administration (OSHA) logs kept by the contractors allowed for calculation of each company's OSHA recordable injury rate (i.e., the reported injury rate), whereas medical claims data from an Owner-Controlled Insurance Program provided the actual experienced rate of injuries for those same companies. While the annual injury rate reported to OSHA was 3.11 injuries per 100 workers, the rate of eligible injuries that were not reported to OSHA was 10.90 injuries per 100 employees. Further, organizations with a poor safety climate had significantly higher rates of underreporting (81% of eligible injuries unreported) compared with organizations with a positive safety climate (47% of eligible injuries unreported). Implications for organizations and the accuracy of the Bureau of Labor Statistics's national occupational injury and illness surveillance system are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heparin, but not other proteoglycans potentiates the mitogenic effects of FGF-2 on mesencephalic precursor cells

Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12-32%) of cases giving an incidence of 71/100,000 (95% CI 43-111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported, and accounts for a sizable proportion of adult-onset asthma.     

The Job Stress Survey: Assessing perceived severity and frequency of occurrence of generic sources of stress in the workplace.

In this article, the authors respond to comments in the October 1998 issue of the Journal of Occupational Health Psychology (Vol. 3, No. 4) in regard to measuring occupational stress with the Job Stress Survey (JSS). The authors are pleased that (a) the need to assess the perceived severity and frequency of occurrence of specific sources of occupational stress was acknowledged and (b) job pressure and lack of organizational support were recognized as key dimensions of stress in the workplace. In addressing concerns about the independence of JSS severity and frequency ratings and the utility of the JSS for assessing jobs with extensive person-machine interactions, the authors noted that correlations among JSS severity and frequency scores were relatively low, and that person-focused stressor items were relevant for employees with person-machine jobs because most workers are required to deal with supervisors and fellow employees. It was concluded that the JSS provides important information about sources of occupational stress that can adversely affect the health and productivity of men and women employed in a wide variety of work settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Corrective role of chickpea intake on a dietary-induced model of hypercholesterolemia

Occupational exposures are related to work processes carried out by the individual worker. A classification of the work processes was developed on the basis of analyses of several databases. Work-process data were collected in a sample of Danish employees. An unambiguous, exhaustive work-process classification was developed where the work process was defined as the transformation of a work object into a product. A test showed that at least 85% of free-text data on occupational injuries contained work-process data. To illustrate applications of the classification, work-process data were used to define highly exposed and unexposed job groups. This classification may be useful for (for example) major general surveys to supplement the exposure information that job and industry classifications yield.     

Outpatient laparoscopic cholecystectomy: safe and cost effective?

OBJECTIVE: Reports on the aetiology and risk of occupational rhinitis in different occupations are scarce. METHOD: The purpose of this study was to find the occupations with an increased risk of occupational rhinitis. Age and gender differences in occupational rhinitis and occupational asthma were also compared, and the most common causes of occupational rhinitis were analysed. DESIGN: This study covered the cases of occupational rhinitis and asthma reported to the Finnish Register of Occupational Diseases during the years 1986-1991. The cases on the Register were linked to the longitudinal census data file from the Finnish censuses. RESULTS: During 1986-1991, 1244 new cases of occupational rhinitis (474 women and 497 men) and 1867 new cases of occupational asthma (916 women and 951 men) were reported to the Register. Animal dander, flours, wood dusts, textiles, phthalic acid anhydrides and storage mites were important causes of occupational rhinitis. The highest relative risk of occupational rhinitis was among furriers, the age-standardized rate ratio (SRR) was 30.0. Bakers and livestock breeders had also a markedly elevated relative risk (SRR = 22.0). Men had the highest incidence of occupational rhinitis at the age of 25-29 years and among women the incidence gradually increased and reached the peak in the group 40-44 years of age. CONCLUSION: Furriers, bakers, and livestock breeders had the most elevated relative risk of occupational rhinitis. Occupational rhinitis cases reported at a younger age than asthma, suggesting that rhinitis often precedes asthma.     

Incentive effects of workers' compensation

Economic theory and evidence indicate that workers, employers, and healthcare personnel respond to the incentives built into state workers' compensation systems. Although empirical studies cannot provide precise estimates of the quantitative effects resulting from specific policy changes, research is useful in evaluating the qualitative effects of alternative policies. Studies show that workers' compensation claims are higher the more generous the level of benefits, the shorter the waiting period, and the more readily available is information on benefits to workers. States that decrease real benefit levels and lengthen the period required before workers are compensated for lost earnings can constrain future growth in workers' compensation costs, while continuing to provide partial compensation for workers with the most serious injuries. The most difficult problem facing policymakers is to design and implement reforms that take into account what are often the incompatible incentives of workers, employers, and medical care providers.