Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Occupational injuries among construction workers by age and related economic loss: findings from Ohio workers' compensation, USA: 2007-2017
Kaur H , Wurzelbacher SJ , Bushnell PT , Bertke S , Meyers AR , Grosch JW , Naber S , Lampl M . Saf Health Work 2023 14 (4) [Epub ahead of print] Background: This study examined age-group differences in the rate, severity, and cost of injuries among construction workers to support evidence-based worker safety and health interventions in the construction industry. Methods: Ohio workers' compensation claims for construction workers were used to estimate claim rates and costs by age group. We analyzed claims data auto-coded into five event/exposure categories: transportation incidents; slips, trips, and falls (STFs); exposure to harmful substances and environments (EHS); contact with objects and equipment (COB); and overexertion and bodily reaction. American Community Survey data were used to determine the proportion of workers by age group. Results: From 2007-2017, among 72,416 accepted injury claims for 166,000 construction full-time equivalent (FTE) per year, nearly half were caused by COB, followed by STFs (20%) and overexertion (20%). Claim rates related to COB and EHS were highest among those 18-24 years old, with claim rates of 313.5 and 25.9 per 10,000 FTE, respectively. STFs increased with age, with the highest claim rates for those 55-64 years old (94.2 claims per 10,000 FTE). Overexertion claim rates increased and then declined with age, with the highest claim rate for those 35-44 years old (87.3 per 10,000 FTE). While younger workers had higher injury rates, older workers had higher proportions of lost-time claims and costs per claim. The total cost per FTE was highest for those 45-54 years old ($1,122 per FTE). Conclusion: The variation in rates of injury types by age suggests age-specific prevention strategies may be useful. |
Workers' Compensation costs for occupational hearing loss claims in the United States, 2009-2013
Masterson EA , Wurzelbacher SJ , Bushnell PT , Tseng CY . Semin Hear 2023 44 (4) 412-436 This study estimated the average annual number of U.S. workers' compensation (WC) claims for occupational hearing loss (OHL) and their associated cost and identified the industry/occupation classifications with the highest numbers of OHL claims. The most recent U.S. cost estimate ($242 million) was based on data from one state in 1 year (1991). WC data from the National Council on Compensation Insurance, Inc. (35 states) and two additional individual states were examined, incorporating data from 37 states and the District of Columbia. Costs and numbers of claims were estimated for the 13 missing states to develop estimates for the United States. Sensitivity analyses were also performed to develop ranges for the point estimates. The estimated U.S. average annual OHL claim cost fell within the range of $49 to $67 million during 2009-2013, with a point estimate of $60 million (2013 dollars). The estimated average annual number of OHL claims ranged from 4,114 to 5,986, with a point estimate of 4,965 claims. Based on data available from 36 states and DC, 18 of the 40 industry/occupation classifications with ≥50 OHL claims were in the manufacturing sector. WC data underestimate the true burden of OHL. Most OHL cases are not compensated. WC laws, industry composition and other factors vary widely by state, so estimates must employ data for many states. This study incorporated data from most states and utilized sensitivity and comparative analyses to obtain estimates. Workers in a wide range of industry/occupation classifications need special attention to prevent OHL. © 2023. Thieme. All rights reserved. Thieme Medical Publishers, Inc. |
Injuries that happen at work lead to more opioid prescriptions and higher opioid costs
Asfaw A , Quay B , Bushnell T , Pana-Cryan R . J Occup Environ Med 2022 64 (12) e823-e832 OBJECTIVES: 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. 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 two-part regressions. RESULTS: Controlling for covariates and compared to 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. CONCLUSION: 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 forOccupational Safety and Health
Bushnell PT , Pana-Cryan R , Howard J , Quay B , Ray TK . Am J Ind Med 2022 65 (5) 323-342 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. |
The impact of a state-based workers' compensation insurer's risk control services on employer claim frequency and cost rates
Wurzelbacher SJ , Bertke SJ , Lampl MP , Bushnell PT , Robins DC , Naber SJ , Moore LL . J Occup Environ Med 2022 64 (7) 562-572 OBJECTIVE: This study evaluated the impact of a state workers' compensation (WC) insurer's onsite risk control (RC) services on insured employers' WC claim frequency and cost. METHODS: We used two methods to model 2004-2017 claims data from 4,606 employers that received RC visits over time and compare this claims experience to matching employers that did not receive RC services. RESULTS: Relative total WC claim rates increased slightly after RC services, while relative lost-time claims rates either remained similar or decreased and WC cost rates decreased. The impact of RC services on reducing WC costs was cumulative up to the fourth visit but diminished thereafter. CONCLUSIONS: The insurer RC consultation program was effective in reducing WC cost rates for serviced employers. This is consistent with other research conducted on insurer RC services and related regulatory visits. |
Workers compensation claim counts and rates by injury event/exposure among state-insured private employers in Ohio, 2007-2017
Wurzelbacher SJ , Meyers AR , Lampl MP , Bushnell PT , Bertke SJ , Robins DC , Tseng C-Y , Naber SJ . J Safety Res 2021 79 148-167 Introduction: This study analyzed workers compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury. Methods: A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state's unemployment insurance (UI) data to identify the employer's industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE. Results: 140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified. Conclusions: Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research. 2021 |
Introduction, Transmission Dynamics, and Fate of Early SARS-CoV-2 Lineages in Santa Clara County, California.
Villarino E , Deng X , Kemper CA , Jorden MA , Bonin B , Rudman SL , Han GS , Yu G , Wang C , Federman S , Bushnell B , Wadford DA , Lin W , Tao Y , Paden CR , Bhatnagar J , MacCannell T , Tong S , Batson J , Chiu CY . J Infect Dis 2021 224 (2) 207-217 We combined viral genome sequencing with contact tracing to investigate introduction and evolution of SARS-CoV-2 lineages in Santa Clara County, California from January 27 to March 21, 2020. Of 558 persons with COVID-19, 101 genomes from 143 available clinical samples comprised 17 different lineages including SCC1 (n=41), WA1 (n=9, including the first 2 reported deaths in the United States, diagnosed post-mortem), D614G (n=4), ancestral Wuhan Hu-1 (n=21), and 13 others (n=26). Public health intervention may have curtailed the persistence of lineages that appeared transiently during February-March. By August, only D614G lineages introduced after March 21 were circulating in SCC. |
Workers' Compensation Claim Rates and Costs for Musculoskeletal Disorders Related to Overexertion Among Construction Workers - Ohio, 2007-2017
Kaur H , Wurzelbacher SJ , Bushnell PT , Grosch JW , Tseng CY , Scholl JC , Meyers AR , Lampl M . MMWR Morb Mortal Wkly Rep 2021 70 (16) 577-582 Overexertion is a leading cause of work-related musculoskeletal disorders (WMSDs) among construction workers. Nearly 90% of construction jobs require manual handling of materials for approximately one half of the worker's time (1). In 2015, overexertion from lifting and lowering materials caused 30% of WMSDs among construction workers; overexertion involving pushing, pulling, holding, carrying, and catching materials caused an additional 37% of WMSDs (1). This study examined the rate and cost of WMSD claims from overexertion among Ohio construction workers during 2007-2017. Workers' compensation claims related to overexertion that were submitted to the Ohio Bureau of Worker's Compensation (OHBWC) by workers in the construction industry for injuries and illnesses occurring during 2007-2017 were analyzed. Rates and costs of allowed claims were measured by age group. Workers aged 35-44 years experienced the highest claim rate: 63 per 10,000 full-time employees (FTEs) for WMSDs from overexertion. However, claims by workers aged 45-54 years and 55-64 years were more costly on average and resulted in more days away from work. Ergonomic design improvements and interventions are needed to ensure that the majority of construction workers can safely perform jobs throughout their careers. Age-specific WMSD prevention and risk communication efforts also might be helpful. |
Genomic surveillance reveals multiple introductions of SARS-CoV-2 into Northern California.
Deng X , Gu W , Federman S , du Plessis L , Pybus OG , Faria N , Wang C , Yu G , Bushnell B , Pan CY , Guevara H , Sotomayor-Gonzalez A , Zorn K , Gopez A , Servellita V , Hsu E , Miller S , Bedford T , Greninger AL , Roychoudhury P , Starita LM , Famulare M , Chu HY , Shendure J , Jerome KR , Anderson C , Gangavarapu K , Zeller M , Spencer E , Andersen KG , MacCannell D , Paden CR , Li Y , Zhang J , Tong S , Armstrong G , Morrow S , Willis M , Matyas BT , Mase S , Kasirye O , Park M , Masinde G , Chan C , Yu AT , Chai SJ , Villarino E , Bonin B , Wadford DA , Chiu CY . Science 2020 369 (6503) 582-587 The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has spread globally, with >52,000 cases in California as of May 4, 2020. Here we investigate the genomic epidemiology of SARS-CoV-2 in Northern California from late January to mid-March 2020, using samples from 36 patients spanning 9 counties and the Grand Princess cruise ship. Phylogenetic analyses revealed the cryptic introduction of at least 7 different SARS-CoV-2 lineages into California, including epidemic WA1 strains associated with Washington State, with lack of a predominant lineage and limited transmission between communities. Lineages associated with outbreak clusters in 2 counties were defined by a single base substitution in the viral genome. These findings support contact tracing, social distancing, and travel restrictions to contain SARS-CoV-2 spread in California and other states. |
Restaurant characteristics associated with the use of specific food-cooling methods
Ree K , Brown L , Ripley D , Hedeen N , Nicholas D , Faw B , Bushnell L , Nair P , Wickam T . J Environ Health 2020 82 (10) 8-13 Pathogen growth caused by improper or slow cooling of hot foods was a contributing factor in 504 of restaurant- and deli-related outbreaks in the U.S. from 1998-2008. Little is known, however, about restaurant cooling practices. To fill this gap, the Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted an observational study to identify and understand factors that might determine which methods restaurants follow to rapidly cool food. These methods include refrigerating food at <=41 degreesF, at shallow depths, and in containers that are ventilated, unstacked, and have space around them. EHS-Net personnel collected data through manager interviews and observation of cooling processes in 420 randomly selected restaurants. Regression analyses revealed characteristics of restaurants most likely to use the cooling methods assessed. These characteristics included ownership by restaurant chains, manager food safety training and certification, few foods cooled at a time, many meals served daily, and a high ratio of workers to managers. These findings suggest that regulatory food safety programs and the retail industry might improve cooling methods-and reduce outbreaks-by providing and encouraging manager food safety training and certification, and by focusing intervention efforts on independent and smaller restaurants. |
Degree of integration between occupational safety and health programs and wellness programs: First-year results from an insurer-sponsored wellness grant for smaller employers
Meyers AR , Al-Tarawneh IS , Bushnell PT , Wurzelbacher SJ , Lampl MP , Tseng CY , Turner DM , Morrison CA . J Occup Environ Med 2019 61 (9) 704-717 OBJECTIVE: The aim of this study was to describe levels of integration between occupational safety and health (OSH) and workplace wellness programs/practices/policies ("programs") among participants in an insurer-sponsored wellness grant program. METHODS: We analyzed survey responses about year 1 of an insurer-sponsored grant to start a wellness program from 220 small- and medium-sized employers. Responses yielded 25 indicators of OSH-wellness integration, and 10 additional indicators to summarize multiple responses. RESULTS: At least half of the employers (N = 220) reported some level of integration within five of seven categories of OSH-wellness integration. Employers sometimes considered ergonomics, safety, or substance exposure hazards while designing their wellness program (15%) or reduced such hazards to support their wellness program (24%). Few meaningful differences were observed by employer size. CONCLUSION: Although high levels of integration were unusual, some degree of integration was common for most indicator categories. |
Workers' compensation injury claims among workers in the private ambulance services industry - Ohio, 2001-2011
Reichard AA , Al-Tarawneh IS , Konda S , Wei C , Wurzelbacher SJ , Meyers AR , Bertke SJ , Bushnell PT , Tseng CY , Lampl MP , Robins DC . Am J Ind Med 2018 61 (12) 986-996 BACKGROUND: Ambulance service workers frequently transfer and transport patients. These tasks involve occupational injury risks such as heavy lifting, awkward postures, and frequent motor vehicle travel. METHODS: We examined Ohio workers' compensation injury claims among state-insured ambulance service workers working for private employers from 2001 to 2011. Injury claim counts and rates are presented by claim types, diagnoses, and injury events; only counts are available by worker characteristics. RESULTS: We analyzed a total of 5882 claims. The majority were medical-only (<8 days away from work). The overall injury claim rate for medical-only and lost-time cases was 12.1 per 100 full-time equivalents. Sprains and strains accounted for 60% of all injury claims. Overexertion from patient handling was the leading injury event, followed by motor vehicle roadway incidents. CONCLUSIONS: Study results can guide the development or improvement of injury prevention strategies. Focused efforts related to patient handling and vehicle incidents are needed. |
Research methodologies for Total Worker Health(R): Proceedings from a workshop
Tamers SL , Goetzel R , Kelly KM , Luckhaupt S , Nigam J , Pronk NP , Rohlman DS , Baron S , Brosseau LM , Bushnell T , Campo S , Chang CC , Childress A , Chosewood LC , Cunningham T , Goldenhar LM , Huang TT , Hudson H , Linnan L , Newman LS , Olson R , Ozminkowski RJ , Punnett L , Schill A , Scholl J , Sorensen G . J Occup Environ Med 2018 60 (11) 968-978 OBJECTIVE: There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs. METHODS: Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise. RESULTS: TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature. CONCLUSIONS: This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research. |
Applying Machine Learning to Workers' Compensation Data to Identify Industry-Specific Ergonomic and Safety Prevention Priorities: Ohio, 2001 to 2011.
Meyers AR , Al-Tarawneh IS , Wurzelbacher SJ , Bushnell PT , Lampl MP , Bell JL , Bertke SJ , Robins DC , Tseng CY , Wei C , Raudabaugh JA , Schnorr TM . J Occup Environ Med 2017 60 (1) 55-73 OBJECTIVE: This study leveraged a state workers' compensation claims database and machine learning techniques to target prevention efforts by injury causation and industry. METHODS: Injury causation auto-coding methods were developed to code more than 1.2 million Ohio Bureau of Workers' Compensation claims for this study. Industry groups were ranked for soft-tissue musculoskeletal claims that may have been preventable with biomechanical ergonomic (ERGO) or slip/trip/fall (STF) interventions. RESULTS: On the basis of the average of claim count and rate ranks for more than 200 industry groups, Skilled Nursing Facilities (ERGO) and General Freight Trucking (STF) were the highest risk for lost-time claims (>7 days). CONCLUSION: This study created a third, major causation-specific U.S. occupational injury surveillance system. These findings are being used to focus prevention resources on specific occupational injury types in specific industry groups, especially in Ohio. Other state bureaus or insurers may use similar methods. |
Unexplained variation for hospitals' use of inpatient rehabilitation and skilled nursing facilities after an acute ischemic stroke
Xian Y , Thomas L , Liang L , Federspiel JJ , Webb LE , Bushnell CD , Duncan PW , Schwamm LH , Stein J , Fonarow GC , Hoenig H , Montalvo C , George MG , Lutz BJ , Peterson ED , Bettger JP . Stroke 2017 48 (10) 2836-2842 BACKGROUND AND PURPOSE: Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. METHODS: We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. RESULTS: Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). CONCLUSIONS: There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov.Unique identifier: NCT02284165. |
CDC Grand Rounds: Public health strategies to prevent and treat strokes
George MG , Fischer L , Koroshetz W , Bushnell C , Frankel M , Foltz J , Thorpe PG . MMWR Morb Mortal Wkly Rep 2017 66 (18) 479-481 Worldwide, stroke is the second leading cause of death and a leading cause of serious long-term disability. In the United States, nearly 800,000 strokes occur each year; thus stroke is the fifth leading cause of death overall and the fourth leading cause of death among women. Major advances in stroke prevention through treatment of known risk factors has led to stroke being considered largely preventable. For example, in the United States, stroke mortality rates have declined 70% over the past 50 years, in large part because of important reductions in hypertension, tobacco smoking, and more recently, increased use of anticoagulation for atrial fibrillation. Although the reduction in stroke mortality is recognized as one of the 10 great public health achievements of the 20th century, gains can still be made. Approximately 80% of strokes could be prevented by screening for and addressing known risks with measures such as improving hypertension control, smoking cessation, diabetes prevention, cholesterol management, increasing use of anticoagulation for atrial fibrillation, and eliminating excessive alcohol consumption. |
Development of methods for using workers' compensation data for surveillance and prevention of occupational injuries among state-insured private employers in Ohio
Wurzelbacher SJ , Al-Tarawneh IS , Meyers AR , Bushnell PT , Lampl MP , Robins DC , Tseng CY , Wei C , Bertke SJ , Raudabaugh JA , Haviland TM , Schnorr TM . Am J Ind Med 2016 59 (12) 1087-1104 BACKGROUND: Workers' compensation (WC) claims data may be useful for identifying high-risk industries and developing prevention strategies. METHODS: WC claims data from private-industry employers insured by the Ohio state-based workers' compensation carrier from 2001 to 2011 were linked with the state's unemployment insurance (UI) data on the employer's industry and number of employees. National Labor Productivity and Costs survey data were used to adjust UI data and estimate full-time equivalents (FTE). Rates of WC claims per 100 FTE were computed and Poisson regression was used to evaluate differences in rates. RESULTS: Most industries showed substantial claim count and rate reductions from 2001 to 2008, followed by a leveling or slight increase in claim count and rate from 2009 to 2011. Despite reductions, there were industry groups that had consistently higher rates. CONCLUSION: WC claims data linked to employment data could be used to prioritize industries for injury research and prevention activities among State-insured private employers. |
Hearing Impairment Among Noise-Exposed Workers - United States, 2003-2012
Masterson EA , Bushnell PT , Themann CL , Morata TC . MMWR Morb Mortal Wkly Rep 2016 65 (15) 389-94 Hearing loss is the third most common chronic physical condition in the United States, and is more prevalent than diabetes or cancer (1). Occupational hearing loss, primarily caused by high noise exposure, is the most common U.S. work-related illness (2). Approximately 22 million U.S. workers are exposed to hazardous occupational noise (3). CDC compared the prevalence of hearing impairment within nine U.S. industry sectors using 1,413,789 noise-exposed worker audiograms from CDC's National Institute for Occupational Safety and Health (NIOSH) Occupational Hearing Loss Surveillance Project (4). CDC estimated the prevalence at six hearing impairment levels, measured in the better ear, and the impact on quality of life expressed as annual disability-adjusted life years (DALYs), as defined by the 2013 Global Burden of Disease (GBD) Study (5). The mining sector had the highest prevalence of workers with any hearing impairment, and with moderate or worse impairment, followed by the construction and manufacturing sectors. Hearing loss prevention, and early detection and intervention to avoid additional hearing loss, are critical to preserve worker quality of life. |
Musculoskeletal disorders and associated healthcare costs among family members of injured workers
Asfaw A , Pana-Cryan R , Bushnell T , Sauter S . Am J Ind Med 2015 58 (11) 1205-16 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. |
The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs
Wurzelbacher SJ , Bertke SJ , Lampl MP , Bushnell PT , Meyers AR , Robins DC , Al-Tarawneh IS . Am J Ind Med 2014 57 (12) 1398-412 BACKGROUND: This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. METHODS: Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. RESULTS: For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. CONCLUSIONS: The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. |
Prevalence rates for depression by industry: a claims database analysis
Wulsin L , Alterman T , Bushnell TP , Li J , Shen R . Soc Psychiatry Psychiatr Epidemiol 2014 49 (11) 1805-21 PURPOSE: To estimate and interpret differences in depression prevalence rates among industries, using a large, group medical claims database. METHODS: Depression cases were identified by ICD-9 diagnosis code in a population of 214,413 individuals employed during 2002-2005 by employers based in western Pennsylvania. Data were provided by Highmark, Inc. (Pittsburgh and Camp Hill, PA). Rates were adjusted for age, gender, and employee share of health care costs. National industry measures of psychological distress, work stress, and physical activity at work were also compiled from other data sources. RESULTS: Rates for clinical depression in 55 industries ranged from 6.9 to 16.2 %, (population rate = 10.45 %). Industries with the highest rates tended to be those which, on the national level, require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity. CONCLUSIONS: Additional research is needed to help identify industries with relatively high rates of depression in other regions and on the national level, and to determine whether these differences are due in part to specific work stress exposures and physical inactivity at work. CLINICAL SIGNIFICANCE: Claims database analyses may provide a cost-effective way to identify priorities for depression treatment and prevention in the workplace. |
Frequency of inadequate chicken cross-contamination prevention and cooking practices in restaurants
Brown LG , Khargonekar S , Bushnell L . J Food Prot 2013 76 (12) 2141-5 This study was conducted by the Environmental Health Specialists Network (EHS-Net) of the Centers for Disease Control and Prevention. The purpose was to examine restaurant chicken preparation and cooking practices and kitchen managers' food safety knowledge concerning chicken. EHS-Net members interviewed managers about chicken preparation practices in 448 restaurants. The study revealed that many restaurants were not following U.S. Food and Drug Administration Food Code guidance concerning cross-contamination prevention and proper cooking and that managers lacked basic food safety knowledge about chicken. Forty percent of managers said that they never, rarely, or only sometimes designated certain cutting boards for raw meat (including chicken). One-third of managers said that they did not wash and rinse surfaces before sanitizing them. Over half of managers said that thermometers were not used to determine the final cook temperature of chicken. Only 43% of managers knew the temperature to which raw chicken needed to be cooked for it to be safe to eat. These findings indicate that restaurant chicken preparation and cooking practices and manager food safety knowledge need improvement. Findings from this study could be used by food safety programs and the restaurant industry to target training and intervention efforts to improve chicken preparation and cooking practices and knowledge concerning safe chicken preparation. |
Incidence and costs of family member hospitalization following injuries of workers' compensation claimants
Asfaw A , Pana-Cryan R , Bushnell PT . Am J Ind Med 2012 55 (11) 1028-36 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. (Am. J. Ind. Med. 55:1028-1036, 2012. (c) 2012 Wiley Periodicals, Inc.) |
Group medical claims as a source of information on worker health and potentially work-related diseases
Bushnell PT , Li J , Landen D . J Occup Environ Med 2011 53 (12) 1430-41 OBJECTIVE: To help address underrecognition of occupational illnesses and support planning of workplace health initiatives. METHODS: Data from Highmark Inc., a health care insurer headquartered in Pittsburgh and Camp Hill, Pennsylvania, was used to calculate age and gender-adjusted rates of 15 diseases by industry and broad industry sector. RESULTS: Significant industry differences in disease rates were observed, some corresponding to known differences in workplace risk factors. CONCLUSION: Group medical claims offer timely, relatively low cost, longitudinal data on rates of physician-diagnosed cases and costs of many diseases for large populations. Limitations of medical claims data include inaccuracies in industry coding, lack of occupation codes, and lack of key variables that affect health. Yet, some elevated industry rates suggest potential new targets for wellness programs and evaluation of possible workplace health risks. |
Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association
Mosca L , Benjamin EJ , Berra K , Bezanson JL , Dolor RJ , Lloyd-Jones DM , Newby LK , Pina IL , Roger VL , Shaw LJ , Zhao D , Beckie TM , Bushnell C , D'Armiento J , Kris-Etherton PM , Fang J , Ganiats TG , Gomes AS , Gracia CR , Haan CK , Jackson EA , Judelson DR , Kelepouris E , Lavie CJ , Moore A , Nussmeier NA , Ofili E , Oparil S , Ouyang P , Pinn VW , Sherif K , Smith SC Jr , Sopko G , Chandra-Strobos N , Urbina EM , Vaccarino V , Wenger NK . Circulation 2011 123 (11) 1243-62 Substantial progress has been made in the awareness, treatment, and prevention of cardiovascular disease (CVD) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association (AHA) in 1999.1 The myth that heart disease is a “man’s disease” has been debunked; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30% in 1997 to 54% in 2009.2 The age-adjusted death rate resulting from coronary heart disease (CHD) in females, which accounts for about half of all CVD deaths in women, was 95.7 per 100 000 females in 2007, a third of what it was in 1980.3,4 Approximately 50% of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major randomized controlled clinical trials such as the Women’s Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant, as have the scientific and medical achievements. | Despite the gains that have been made, considerable challenges remain. In 2007, CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths, more women’s lives than were claimed by cancer, chronic lower respiratory disease, Alzheimer disease, and accidents combined.6 Reversing a trend of the past 4 decades, CHD death rates in US women 35 to 54 years of age now actually appear to be increasing, likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts (286.1/100 000 versus 205.7/100 000). This disparity parallels the substantially lower rate of awareness of heart disease and stroke that has been documented among black versus white women.2,6–8 Of concern is that in a recent AHA national survey, only 53% of women said the first thing they would do if they thought they were having a heart attack was to call 9-1-1. This distressing lack of appreciation by many women for the need for emergency care for acute cardiovascular events is a barrier to optimal survival among women and underscores the need for educational campaigns targeted to women.2 |
Work schedules and health behavior outcomes at a large manufacturer
Bushnell PT , Colombi A , Caruso CC , Tak S . Ind Health 2010 48 (4) 395-405 There is evidence that work schedules may influence rates of unhealthy behaviors, suggesting that addressing work schedule challenges may improve health. Health Risk Assessment (HRA) survey responses were collected during 2000-2008 in a multinational chemical and coatings manufacturer. Responses of 26,442 were sufficiently complete for analysis. Rates of smoking, lack of exercise, moderate to high alcohol use, obesity (BMI >= 30), and short sleep duration were compared by work schedule type (day, night, or rotating shift) and daily work hours (8, 10, or 12 h). Prevalence rate ratios (RRs) were calculated, adjusting for age group, sex, marital/living status, job tenure, and occupational group. The reference group was 8-h day shift employees. Overall prevalence rates were: sleep duration of 6 h or less per night 47%, smoking 17.3%, no exercise 22.0%, BMI >= 30 28.3%, and moderate to heavy alcohol consumption 22.2%. Statistically significant RRs include the following: Short sleep duration: 10 h rotating shift (RR=1.6), 12 h day and 12 h rotating shifts (RR=1.3); Smoking: 12 It day and rotating shifts (RR=1.6), 10 and 12 h night and 8 h rotating shift (RR=1.4); No exercise: 8, 10, and 12 h rotating shifts (RR=1.2 to 1.3), 12 h day schedules (RR=1.3). Obesity (BMI >= 30): 8 and 10 h night shifts (RR=1.3 and 1.4, respectively). |
Relationship of work injury severity to family member hospitalization
Asfaw AG , Bushnell PT , Ray TK . Am J Ind Med 2010 53 (5) 506-13 BACKGROUND: Working while under stress due to a family health event may result in injuries of greater severity. Work leave might mitigate such consequences. DATA AND METHODS: Workers' compensation data for 33,817 injured workers and inpatient medical data for 76,077 members of their families were extracted from the 2002-2005 Thomson Reuters Medstat MarketScan Health and Productivity Management (HPM) and Commercial Claims and Encounter (CCE) datasets. Using a probit model, the impact of family hospitalization on the probability that a subsequent injury would be severe (above average indemnity costs) was estimated, adjusting for age, sex, hourly versus salaried status, industry sector, state, and family size. RESULTS: Family hospitalization within 15 days before injury increased the likelihood that the injury would be severe (from 12.5% to 21.5%) and was associated with 40% higher indemnity costs and 50% higher medical costs. Hospitalizations over 30 days before injury had no impact. CONCLUSION: The observed higher severity of work injuries following family hospitalizations suggests additional analyses may find higher injury rates as well, and that timely family leaves might help prevent severe workplace injuries. Am. J. Ind. Med. (c) 2010 Wiley-Liss, Inc. |
Tomato handling practices in restaurants
Kirkland E , Green LR , Stone C , Reimann D , Nicholas D , Mason R , Frick R , Coleman S , Bushnell L , Blade H , Radke V , Selman C , EHS-Net Working Group . J Food Prot 2009 72 (8) 1692-8 In recent years, multiple outbreaks of Salmonella infection have been associated with fresh tomatoes. Investigations have indicated that tomato contamination likely occurred early in the farm-to-consumer chain, although tomato consumption occurred mostly in restaurants. Researchers have hypothesized that tomato handling practices in restaurants may contribute to these outbreaks. However, few empirical data exist on how restaurant workers handle tomatoes. This study was conducted to examine tomato handling practices in restaurants. Members of the Environmental Health Specialists Network (EHS-Net) observed tomato handling practices in 449 restaurants. The data indicated that handling tomatoes appropriately posed a challenge to many restaurants. Produce-only cutting boards were not used on 49% of tomato cutting observations, and gloves were not worn in 36% of tomato cutting observations. Although tomatoes were washed under running water as recommended in most (82%) of the washing observations, tomatoes were soaked in standing water, a practice not recommended by the U.S. Food and Drug Administration (FDA), in 18% of observations, and the temperature differential between the wash water and tomatoes did not meet FDA guidelines in 21% of observations. About half of all batches of cut tomatoes in holding areas were above 41 degrees F (5 degrees C), the temperature recommended by the FDA. The maximum holding time for most (73%) of the cut tomatoes held above 41 degrees F exceeded the FDA recommended holding time of 4 h for unrefrigerated tomatoes (i.e., tomatoes held above 41 degrees F). The information provided by this study can be used to inform efforts to develop interventions and thus prevent tomato-associated illness outbreaks. |
Impact of publicly sponsored interventions on musculoskeletal injury claims in nursing homes
Park RM , Bushnell PT , Bailer AJ , Collins JW , Stayner LT . Am J Ind Med 2009 52 (9) 683-97 BACKGROUND: The rate of lost-time sprains and strains in private nursing homes is over three times the national average, and for back injuries, almost four times the national average. The Ohio Bureau of Workers' Compensation (BWC) has sponsored interventions that were preferentially promoted to nursing homes in 2000-2001, including training, consultation, and grants up to $40,000 for equipment purchases. METHODS: This study evaluated the impact of BWC interventions on back injury claim rates using BWC data on claims, interventions, and employer payroll for all Ohio nursing homes during 1995-2004 using Poisson regression. A subset of nursing homes was analyzed with more detailed data that allowed estimation of the impact of staffing levels and resident acuity on claim rates. Costs of interventions were compared to the associated savings in claim costs. RESULTS: A $500 equipment purchase per nursing home worker was associated with a 21% reduction in back injury rate. Assuming an equipment life of 10 years, this translates to an estimated $768 reduction in claim costs per worker, a present value of $495 with a 5% discount rate applied. Results for training courses were equivocal. Only those receiving below-median hours had a significant 19% reduction in claim rates. Injury rates did not generally decline with consultation independent of equipment purchases, although possible confounding, misclassification, and bias due to non-random management participation clouds interpretation. In nursing homes with available data, resident acuity was modestly associated with back injury risk, and the injury rate increased with resident-to-staff ratio (acting through three terms: RR = 1.50 for each additional resident per staff member; for the ratio alone, RR = 1.32, 95% CI = 1.18-1.48). In these NHs, an expenditure of $908 per resident care worker (equivalent to $500 per employee in the other model) was also associated with a 21% reduction in injury rate. However, with a resident-to-staff ratio greater than 2.0, the same expenditure was associated with a $1,643 reduction in back claim costs over 10 years per employee, a present value of $1,062 with 5% discount rate. CONCLUSIONS: Expenditures for ergonomic equipment in nursing homes by the Ohio BWC were associated with fewer worker injuries and reductions in claim costs that were similar in magnitude to expenditures. Un-estimated benefits and costs also need to be considered in assessing full health and financial impacts. Am. J. Ind. Med. 52:683-697, 2009. (c) 2009 Wiley-Liss, Inc. |
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