Occupational injury surveillance pyramid description and association of medical care utilization with low income among work-related injuries.

Abstract

A more comprehensive characterization of total work-related injury burden would ideally include all levels of medical care. Additionally, studies have suggested differential utilization of medical care among various socioeconomic groups, and it is unclear how this translates to work-related injuries. The 2004-2016 National Health Interview Survey data were used to estimate all levels of care utilized by the individual for each injury episode. A multivariable logistic regression model based on 2004-2014 data was developed to investigate the relationship of low income and level of medical care used by the injured worker. Around 53.1% of occupational injury were exclusively treated outside of a hospital setting and never captured by hospital/emergency department data systems, which comprises 40% (3.0 million) of total missed days of work and 44% ($452 million) of total cost of lost productivity among full-time workers. Patients with work-related injuries are less likely to stay overnight in hospital compared with those with nonwork-related injuries (adjusted odds ration [aOR]: 0.6, 95% confidence interval [CI]: 0.5-0.7), however among work-related injuries, low-income patients are more likely to use medical care in a hospital setting compared with patients with income higher than poverty threshold (hospitalization: aOR: 1.9, 95% CI: 1.1-3.3; emergency room: aOR: 1.5, 95% CI: 1.1-2.0). These "minor work-related injuries" exclusively treated outside hospital tend to be ignored when defining national injury prevention priorities, but this analysis indicates that such an approach fails to capture a large portion of injuries significant enough to result in missed days of work and cost of lost productivity.