It may cost an arm and a leg: workers value and occupational fatality rates in the U.S.
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ABSTRACT: Background
The present study aims to observe how societal indicators of workers' values at the state-level are related to health and safety outcomes, particularly major injuries and fatalities in the U.S. Underscoring workforce flexibility and workability over workforce stability and safety might be indicative of the worth of workers which can be associated with occupational safety and health concerns.Methods
Linear regression analysis with a log-transformed dependent variable was adopted to examine how the state-level indicators of worker value in terms of 1) minimum wage, using data from 2015; 2) average of workers' compensations for the loss of an arm, hand, leg, or foot in 2015 were concurrently and prospectively associated with occupational fatality rates averaged across 2015, 2016 and 2017. Socioeconomic contextual variables such as education level, GDP per capita, and population at the state-level were controlled for.Results
The present study showed that state-level quantitative indicators of how workers are valued at work, namely minimum wage and workers' compensation benefits, were significantly and negatively associated with fatality rates in the following year.Conclusions
The present study illustrates the gap in how workers are valued across the U.S. The study speaks to the importance of contextual factors regarding worker value, as they can affect outcomes of health and safety culminating at a state-level.
SUBMITTER: Klos LS
PROVIDER: S-EPMC8201718 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background:Workplace injuries are a public health concern, including among adolescents and young adults. Secondary school career-technical-vocational education related injuries are mandated by code under jurisdiction of New Jersey Department of Education to be reported online to New Jersey Safe Schools Program. These are the only U.S. law-based surveillance data for young workers in secondary school career-technical-vocational education. New Jersey Department of Health's hospitalization and fatality records provide additional information about other secondary school career-technical-vocational education and non- secondary school career-technical-vocational education related injuries not necessarily reported to New Jersey Safe Schools Program. This report compared data available to the New Jersey Department of Health and New Jersey Safe Schools Program on injuries among young workers ages 14-21?years. Methods:Annual work-related hospitalizations, 2007-2016, were abstracted from hospital discharge data. Denominator data from the U.S. Bureau of Labor Statistics was used to estimate annual crude rate of hospitalizations per 100,000 employed persons. Hospitalization rates were stratified by demographic data from the U.S. Bureau of Labor Statistics. Hospitalization rates for primary diagnoses and job title/status with ?2 documented cases were reported. Annual crude fatality rates per 100,000 full time equivalent workers, age???16?years, were estimated for 1990-2016 using annual average full time equivalent workers and the U.S. National Institute Occupational Safety and Health's Employed Labor Force Query System as denominator. Results:Annual crude hospitalization rates decreased over time. Hospitalization and fatality rates were higher among young adult workers ages 19-21?years; non-Hispanic Whites; and, males. Percent fatality for ages 19-21?years was greater than ages 14-17?years and 18?years. Declines in hospitalization rates corresponded to decreases in reported injuries among career-technical-vocational education students. Age distribution varied slightly between hospital discharge data and New Jersey Safe Schools Program data. Conclusion:Hospitalization and fatality rates were higher among males than among females, possibly reflecting a tendency for males to engage in riskier jobs than females. Understanding injury disparities can inform public health prevention efforts. Trainings/interventions should aim at addressing the most frequently diagnosed conditions or nature of reported injuries, within those most impacted career clusters like sales/restaurant workers.
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Project description:BackgroundMinnesota has an ethnically diverse labor force, with the largest number of refugees per capita in the United States. In recent years, Minnesota has been and continues to be a major site for immigrant and refugee resettlement in the United States, with a large population of both immigrant and native born Hmong, Hispanic, and East Africans. This study seeks to evaluate the injury risk among the evolving minority workforce in the Minnesota Twin Cities region.MethodsA retrospective cohort study identifying work-related injuries following pre-employment examinations was performed using electronic health records from a large multi-clinic occupational medicine practice. Preplacement examinations and subsequent work-related injuries were pulled from the electronic health record using representative ICD-10 codes for surveillance examinations and injuries. This study included patient records collected over a 2-year period from January 1, 2015, through December, 2016. The patients in this cohort worked in a wide-array of occupations including production, assembly, construction, law enforcement, among others.ResultsHispanic minority workers were twice as likely to be injured at work compared with White workers. Hispanics were 2.89 times more likely to develop back injuries compared with non-Hispanic workers, and 1.86 times more likely to develop upper extremity injuries involving the hand, wrist, or elbow.ConclusionClinical practice data shows that Hispanic workers are at increased risk for work-related injuries in Minnesota. They were especially susceptible to back and upper extremity injuries. Lower injury rates in non-Hispanic minority workers, may be the result of injury underreporting and require further investigation.
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Project description:IntroductionInjuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (b) the association between injury status and SPD.MethodsSelf-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004-2016). Psychological distress during the past 30?days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0-4, total score range: 0-24). SPD was defined as K6???13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates.ResultsThe prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI?=?7.71%, NOI?=?6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR?=?2.19, 95%CI: 1.62-2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR?=?0.98, 95%CI: 0.65-1.48).ConclusionThe prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.
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Project description:Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of nonadherence in the screening process compared with recommended guidelines are uncertain.To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements.Model-based cost-effectiveness analysis.New Mexico HPV Pap Registry; medical literature.Cohort of women eligible for routine screening.Lifetime.Societal.Current cervical cancer screening practice; improved adherence to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals.Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios, and incremental net monetary benefits (INMBs).Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect adherence to screening every 3 years with cytologic testing and adherence to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1645.Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds.The effect of human papillomavirus vaccination was not considered.The added health benefit of improving adherence to guidelines, especially the 3-year interval for cytologic screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice.U.S. National Cancer Institute.
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Project description:ObjectivesThe case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) varies significantly between countries. We aimed to describe the associations between health indicators and the national CFRs of COVID-19.MethodsWe identified for each country health indicators potentially associated with the national CFRs of COVID-19. We extracted data for 18 variables from international administrative data sources for 34 member countries of the Organization for Economic Cooperation and Development (OECD). We excluded the collinear variables and examined the 16 variables in multivariable analysis. A dynamic web-based model was developed to analyse and display the associations for the CFRs of COVID-19. We followed the Guideline for Accurate and Transparent Health Estimates Reporting (GATHER).ResultsIn multivariable analysis, the variables significantly associated with the increased CFRs were percentage of obesity in ages >18 years (? = 3.26; 95%CI = 1.20, 5.33; p 0.003), tuberculosis incidence (? = 3.15; 95%CI = 1.09, 5.22; p 0.004), duration (days) since first death due to COVID-19 (? = 2.89; 95%CI = 0.83, 4.96; p 0.008), and median age (? = 2.83; 95%CI = 0.76, 4.89; p 0.009). The COVID-19 test rate (? = -3.54; 95%CI = -5.60, -1.47; p 0.002), hospital bed density (? = -2.47; 95%CI = -4.54, -0.41; p 0.021), and rural population ratio (? = -2.19; 95%CI = -4.25, -0.13; p 0.039) decreased the CFR.ConclusionsThe pandemic hits population-dense cities. Available hospital beds should be increased. Test capacity should be increased to enable more effective diagnostic tests. Older patients and patients with obesity and their caregivers should be warned about a potentially increased risk.
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Project description:BackgroundSocial vulnerability indices were created to measure resiliency to environmental disasters based on socioeconomic and population characteristics of discrete geographic regions. They are composed of multiple validated constructs that can also potentially identify geographically vulnerable populations after injury. Our objective was to determine if these indices correlate with injury fatality rates in the US.MethodsWe evaluated three social vulnerability indices: The Hazards & Vulnerability Research Institute's Social Vulnerability Index (SoVI), the Center for Disease Control's Social Vulnerability Index (SVI), and the Economic Innovation Group's Distressed Community Index (DCI). We analyzed SVI subindices and common individual census variables as indicators of socioeconomic status. Outcomes included age-adjusted county-level overall, firearm, and motor vehicle collision deaths per 100,000 population. Linear regression determined the association of injury fatality rates with the SoVI, SVI, and DCI. Bivariate choropleth mapping identified geographic variation and spatial autocorrelation of overall fatality, SoVI, and DCI.ResultsA total of 3,137 US counties were included. Only 24.6% of counties fell into the same vulnerability quintile for all three indices. Despite this, all indices were associated with increasing fatality rates for overall, firearm, and motor vehicle collision fatality. The DCI performed best by model fit, explanation of variance, and diagnostic performance on overall injury fatality. There is significant geographic variation in SoVI, DCI, and injury fatality rates at the county level across the United States, with moderate spatial autocorrelation of SoVI (Moran's I, 0.35; p < 0.01) and high autocorrelation of injury fatality rates (Moran's I, 0.77; p < 0.01) and DCI (Moran's I, 0.53; p < 0.01).ConclusionWhile the indices contribute unique information, higher social vulnerability is associated with higher injury fatality across all indices. These indices may be useful in the epidemiologic and geographic assessment of injury-related fatality rates. Further study is warranted to determine if these indices outperform traditional measures of socioeconomic status and related constructs used in trauma research.Level of evidenceEpidemiological, level IV.
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Project description:Quantifying occupational risk factors for SARS-CoV-2 infection among healthcare workers can inform efforts to improve healthcare worker and patient safety and reduce transmission. This study aimed to quantify demographic, occupational, and community risk factors for SARS-CoV-2 seropositivity among healthcare workers in a large metropolitan healthcare system. We analyzed data from a cross-sectional survey conducted from April through June of 2020 linking risk factors for occupational and community exposure to COVID-19 with SARS-CoV-2 seropositivity. A multivariable logistic regression model was fit to quantify risk factors for infection. Participants were employees and medical staff members who elected to participate in SARS-CoV-2 serology testing offered to all healthcare workers as part of a quality initiative, and who completed a survey on exposure to COVID-19 and use of personal protective equipment. Exposures of interest included known demographic risk factors for COVID-19, residential zip code incidence of COVID-19, occupational exposure to PCR test-positive healthcare workers or patients, and use of personal protective equipment. The primary outcome of interest was SARS-CoV-2 seropositivity. SARS-CoV-2 seropositivity was estimated to be 5.7% (95% CI: 5.2%-6.1%) among 10,275 healthcare workers. Community contact with a person known or suspected to have COVID-19 (aOR=1.9, 95% CI:1.4-2.5) and zip code level COVID-19 incidence (aOR: 1.4, 95% CI: 1.0-2.0) increased the odds of infection. Black individuals were at high risk (aOR=2.0, 95% CI:1.6-2.4). Overall, occupational risk factors accounted for 27% (95% CI: 25%-30%) of the risk among healthcare workers and included contact with a PCR test-positive healthcare worker (aOR=1.2, 95% CI:1.0-1.6). Community risk factors, including contact with a COVID-19 positive individual and residential COVID-19 incidence, are more strongly associated with SARS-CoV-2 seropositivity among healthcare workers than exposure in the workplace.
| S-EPMC7654898 | biostudies-literature
Project description:Importance:The high cost of self-injectable epinephrine autoinjectors may represent a barrier to community anaphylaxis management. Value-based pricing can provide a benchmark for rational epinephrine autoinjector costs. Objective:To define value-based pricing of community epinephrine autoinjectors. Design, Setting, and Participants:In an economic evaluation study using a cost-effectiveness birth cohort model over an extended 80-year time horizon, Markov simulations of children with peanut allergy evaluated cost ceilings for value-based epinephrine prices in peanut allergy. Simulation inputs included all-cause age-adjusted mortality (2013 US life tables), 2013 published food allergy fatality rates, 2017 rates of autoinjector device carriage, and 2016 published market costs of self-injectable epinephrine. All costs were expressed in 2018 US dollars and discounted at 3% per annum. Exposures:Cohorts of children with peanut allergy prescribed epinephrine autoinjectors were compared with those not receiving personal epinephrine prescriptions. Children without epinephrine autoinjectors assumed 10-fold to 100-fold fatality risk increases. Costs were evaluated from a societal perspective. Main Outcomes and Measures:Fatality risk, quality-adjusted life-years, and incremental cost-effectiveness ratio. Results:A total of 100?000 simulated infants with peanut allergy entered each strategy, with two-thirds of the group receiving annual personal epinephrine prescriptions and using those devices appropriately when indicated. Over the time horizon, the cost of anaphylaxis preparedness and treatment in those with personal epinephrine devices was $25?478 (95% CI, $25?399-$25?557) compared with $654 (95% CI, $645-$663) for those without personal epinephrine, resulting in an average food allergy fatality of 0.00056 (95% CI, 0.000414-0.000706) per patient prescribed self-injectable epinephrine and 0.00148 (95% CI, 0.001242-0.001718) in those not prescribed self-injectable epinephrine. The value-based price (incremental cost-effectiveness ratio, $100?000 per quality-adjusted life-year) for personal epinephrine based on 10-fold fatality risk difference was $24. At a market cost of $715 per twin pack, the autoinjector incremental cost-effectiveness ratio was $2?742?697 per quality-adjusted life-year. If a hypothetical fatality risk protection from personal epinephrine was modeled at 100-fold, the value-based price ceiling for a personal autoinjector was $264. Conclusions and Relevance:In a simulation of children with peanut allergy, a value-based epinephrine cost has a ceiling of $24 for a personal autoinjector, even at an exaggerated fatality risk.
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Project description:Background:Work might cause severe physical stress associated with emotional overload, especially among hospital employees. Objective:To identify risk factors for cardiovascular diseases and occupational stress among employees of a teaching hospital. Method:Cross-sectional study conducted with 45 employees of a philanthropic health institution in the central area of Rio Grande do Sul, Brazil. Data collection was performed to analyze anthropometric variables, blood pressure, biochemical markers and indicators of health and occupational stress. Results:60.0% of the participants reported sedentary behavior. Analysis of non-modifiable risk factors showed that 55.6% of the sample had family history (mother and father) of hypertension, 22.2% of myocardial infarction and stroke and 13.3% of diabetes. Body mass index categories overweight and obesity predominated (55.5%); 73.4% of the sample was categorized as with moderate-to-high risk to health based on the waist-to-hip ratio; the body fat percentage was above normal or indicated tendency to obesity for 73.3% of the participants. About 71.1% of the sample exhibited excellent or normal blood pressure. Total cholesterol was high or borderline for 88.9% of the sample. On assessment of occupational risk, 55.5% of the participants were categorized as with intermediate degree of exposure. Conclusion:The results point to the relevance of health policies to promote lifestyle changes in and outside the workplace with consequent impact on the physical and mental state of workers.
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Project description: Not available
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