Compensation Database Research Articles

Incidence and Risk of Work-Related Fracture Injuries: Experience of a State-Managed Workers’ Compensation System

Incidence rates of occupational fractures at various anatomic sites and associated risk factors have not been well documented. We identified 3490 work-related fractures from a West Virginia Workers Compensation database that occurred between July 1, 1994, and June 30, 1995. The annual incidence rate was 55 per 10,000 workers, which is substantially higher than the work-related fracture rates reported previously. The incidence rate of fracture was highest in the agricultural sector, followed by the mining, construction, and manufacturing sectors (202.0, 165.2, 116.7, and 88.0 per 10,000 workers, respectively). The age-specific gender distribution comparing fracture and non-fracture injuries showed a bimodal distribution, with greater proportions of female employees at the younger and older age groups. Fracture of the phalanges was the most common, followed by fractures of the foot bone and carpal bone (15.8, 9.5, and 7.9 per 10,000 workers, respectively). In a multiple logistic regression analysis, age, gender, occupation, caught in-between objects, fall, struck by or against object, and vehicle collision were significant independent predictors of fracture (all sites combined). We believe work-related fractures to be a bigger problem than previously reported. The association among gender, age, occupation, and causes of fractures identified in this study will be useful in developing gender- and occupation-specific prevention intervention.

Epidemiology of work-related burn injuries: experience of a state-managed workers' compensation system.

Population-based incidence rates of work-related burn injuries and associated risk factors specific to anatomic sites and degree of burn are not known. Using a state-managed workers' compensation database, we estimated incidence rates of work-related burn injuries and identified high-risk occupations and associated exposures. The annual incidence rate of occupational burn was 26.4 per 10,000 workers, with the highest rate observed in the manufacturing sector for males and in the service sector for females. Welders, cooks, laborers, food service workers, and mechanics had higher incidence rates of burn injury compared with other occupations. Wrist and hand burns accounted for a majority of burn injuries, with females experiencing greater incidence of these distal upper extremity burns (8.9 in females and 6.7 in males per 10,000 workers, respectively). Third-degree burns (incidence rate, 1.3 per 10,000 workers) were also most frequently observed in the upper extremities compared with other anatomic sites. The majority of wrist and hand burns were caused by hot liquids/ objects, whereas the majority of eye burns were associated with chemical exposures. Younger cooks and food service workers were at greater risk of burn than older coworkers. Specific occupations are associated with degree of burn, anatomic site, and exposures. This information will be useful for targeted intervention among high-risk occupations and work groups.

Prioritizing Back Injury Risk in Hospital Employees:

To identify high risk areas for back injury in a large teaching hospital, we calculated standard injury rates and newly developed composite statistics for nursing and non-nursing work groups. Data were extracted from the hospital's workers' compensation database. The hospital-wide total injury rate was 4.6 reports per 100 full-time equivalents (FTE); Compensation Case Rate, 1.4 cases per 100 FTE; Compensation Severity Rate, 76 days lost per 100 FTE; and the Cost Rate, $3742 per 100 FTE. The Total Injury Reports Rate for nursing varied from 14.2 per 100 FTE for Intensive Care Unit (ICU) Nursing to 3.8 per 100 FTE for Pediatric Nursing. Non-nursing areas also demonstrated increased rates for back injury. Individual statistical rates ranked areas differently in risk, whereas composite statistical measures consistently ranked ICU Nursing, Buildings and Grounds, and Orthopedics/Neurological Nursing as the top three. Patient handling was the precipitating event in the majority of nursing back injuries, indicating the need for ergonomic intervention. The use of combined statistical measures provided a more integrative measure for describing and following back injury risk over time.

Prognostic factors for time receiving workers' compensation benefits in a cohort of patients with low back pain.

Prospective inception cohort study. To develop a prognostic model that predicts time receiving workers' compensation benefits for low back pain claimants. As the cost and difficulty of managing low back pain escalate, any predictor of outcome is advantageous. To obtain the outcome and predictor variables, patient data from two separate databases were linked: a clinical database and an administrative (Ontario workers' compensation) database. Claimants injured between January 1 and December 31, 1994, were included and observed for 1 year from the date of accident. The outcome variable was cumulative number of calendar days receiving benefits. Multivariable Cox proportional hazards regression (forward stepwise) showed eight significant predictors; five were associated with increased time receiving benefits compared with their reference groups: 1) working in the construction industry, 2) older age, 3) lag time from injury to treatment, 4) pain referred into the leg, and 5) three or more positive Waddell nonorganic signs. Three predictors were associated with reduced time receiving benefits: 1) higher values of questionnaire score, 2) intermittent pain, and 3) a previous episode of back pain. A predictive score was calculated to categorize claimants as at high or low risk for chronicity. When an arbitrary cutoff point was set at the 75th percentile of predictive score, negative predictive value was 94%. This research identified eight factors for time receiving workers' compensation benefits among claimants with low back pain. This model discriminates between high- and low-risk claimants. Few low-risk claimants continued to receive benefits for more than 3 months.

Injuries in home health care workers: An analysis of occupational morbidity from a state compensation database

Injuries in home health care workers: An analysis of occupational morbidity from a state compensation database

Injuries in home health care workers: An analysis of occupational morbidity from a state compensation database

Background Home health services represent one of the fastest-growing segments of the US economy. Home health care workers (HHCWs) might be expected to have a high incidence and increased severity of injury because of inherent difficulty in control over their work environment, and the limited amount of research on injuries in home health care appears to support this hypothesis. Methods Using data on workers' compensation claims for 1995–1996 from a large state database, we calculated the incidence, frequency, and types of injuries occurring in this working population. Comparison data were drawn from nursing home (NH) and hospital-based nursing personnel. Results An incidence of 52 injuries per 1,000 workers per year was calculated; this rate lies between nursing home workers (132/1,000) and hospital-based workers (46/1,000). The percentage of indemnified (>3 days lost-time) injuries was increased over those occurring in nursing home personnel. Mean number of days lost from work by home health workers was 44, significantly increased from the average 18 and 14 days lost by NH and hospital nursing workers, respectively. Mean indemnity payment was $1,523 and mean medical costs were $1,276 per injury. Permanent partial disability awards were made to 19 (4.9%) of the injured HHCWs during the 2-year study period; back injuries accounted for 63% (12) of these awards. Overexertion injuries and falls accounted for 63% of total injuries in this group of workers, while 13.5% occurred as a result of motor vehicle accidents. The incidence of injury attributed to motor vehicles in HHCWs was 7 per 1,000 workers per year, an order of magnitude greater than in NH and hospital workers. Conclusions These data indicate that injuries to HHCWs, though less frequent than in their nursing home counterparts, result in greater lost time from work and accompanying costs, which may indicate greater severity of injury. Characteristics of home health work, including increased intensity and speed of work, adverse working conditions, and the necessity of motor vehicle transportation as a condition of work may be contributors to injury in this setting. Further investigation of determinants of accidents and injuries in home health care, both in the actual setting where the work takes place and in the way it is structured, is warranted. Am. J. Ind. Med. 35:295–301, 1999. © 1999 Wiley-Liss, Inc.

Injuries in home health care workers: an analysis of occupational morbidity from a state compensation database.

Home health services represent one of the fastest-growing segments of the US economy. Home health care workers (HHCWs) might be expected to have a high incidence and increased severity of injury because of inherent difficulty in control over their work environment, and the limited amount of research on injuries in home health care appears to support this hypothesis. Using data on workers' compensation claims for 1995-1996 from a large state database, we calculated the incidence, frequency, and types of injuries occurring in this working population. Comparison data were drawn from nursing home (NH) and hospital-based nursing personnel. An incidence of 52 injuries per 1,000 workers per year was calculated; this rate lies between nursing home workers (132/1,000) and hospital-based workers (46/1,000). The percentage of indemnified (> 3 days lost-time) injuries was increased over those occurring in nursing home personnel. Mean number of days lost from work by home health workers was 44, significantly increased from the average 18 and 14 days lost by NH and hospital nursing workers, respectively. Mean indemnity payment was $1,523 and mean medical costs were $1,276 per injury. Permanent partial disability awards were made to 19 (4.9%) of the injured HHCWs during the 2-year study period; back injuries accounted for 63% (12) of these awards. Overexertion injuries and falls accounted for 63% of total injuries in this group of workers, while 13.5% occurred as a result of motor vehicle accidents. The incidence of injury attributed to motor vehicles in HHCWs was 7 per 1,000 workers per year, an order of magnitude greater than in NH and hospital workers. These data indicate that injuries to HHCWs, though less frequent than in their nursing home counterparts, result in greater lost time from work and accompanying costs, which may indicate greater severity of injury. Characteristics of home health work, including increased intensity and speed of work, adverse working conditions, and the necessity of motor vehicle transportation as a condition of work may be contributors to injury in this setting. Further investigation of determinants of accidents and injuries in home health care, both in the actual setting where the work takes place and in the way it is structured, is warranted.

Evaluation of Occupational Injuries among Young Workers in West Virginia

We compared workplace injuries between young (16 to 19 years of age) and adult workers using West Virginia Workers' Compensation database. All workers injured between January 1 and December 31, 1995 were included in the analysis. The industry-specific injury incidence rates between young and adults workers were significantly different with lower rates of injury in young workers in all sectors except service sector. In the service sector the young workers had significantly higher injury rates than adults (rate ratios for young workers were 2.28, 1.92, and 2.94 when compared with age groups 20-24, 25-34, and >34, respectively). Estimates of the proportional injury ratio (PIR) indicated significantly greater risk of finger (PIR 1.62) and hand (PIR 1.66) injuries and burns (PIR 3.27) and lacerations (PIR 1.69) in the young workers. The proportion of injuries occurring in the summer months was higher in the young than in the adults (35.2% vs. 27.0%), particularly in the service sector (79.6% vs. 25.9%). Higher injury rates in young workers compared to adults in the service sector may be explained by the seasonal employment of young workers in West Virginia.

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.

Injury and illness in the American workplace: A comparison of data sources

Setting priorities for workplace health and safety research depends upon accurate and reliable injury and illness data. All occupational health databases have limitations when used to summarize the national scope of workplace hazards. The comparison of data from multiple sources may produce more credible estimates of the leading occupational injuries and illnesses. The purpose of this paper is to describe the strengths and weaknesses of six data collection systems that record occupational injuries and illnesses on a national level and to compare the leading estimates from these systems for 1990. The six systems are: 1) National Traumatic Occupational Fatalities database, 2) the Bureau of Labor Statistics Census of Fatal Occupational Injuries, 3) The Bureau of Labor Statistics Annual Survey data, 4) a large workers' compensation database, 5) the National Council on Compensation Insurance data, and 6) The National Electronic Injury Surveillance System. Occupational injuries, as defined herein, predominate over illnesses in terms of the number of cases and the overall costs. Databases that provide information on the antecedents of injuries suggest how these injuries may be prevented and warrant more attention and refinement. © 1996 Wiley-Liss, Inc.

Patterns and Risk Factors for Sprains and Strains in Ontario, Canada 1990: An Analysis of the Workplace Health and Safety Agency Data Base

This study presents the results of analyses performed to generate hypotheses concerning the general patterns of risk factors for occupational sprains and strains, using Ontario workers' compensation data housed in the Workplace Health and Safety Agency (WHSA) data base. Historically, the largest percentage of lost-time injuries in Ontario, Canada, have been sprains and strains. In 1990, there were 171,047 compensated lost-time injuries with a known nature of injury, of which 50.43% were sprains and strains. From cross-tabulations, a number of statistics such as odds ratios (ORs), 95% confidence intervals, P values, attributable risks and number of injuries attributable, were calculated. Results indicate that occupational sprains and strains are related to the time of the day and, in particular, time into the workshift. They occur more frequently than expected (based on the occurrence of non-sprain and non-strain injuries) in the morning hours and in the first 4 hours of the workshift. They are not found to be related to the starting or ending time or the length of the workshift. They occur more frequently than expected during the early part of a week, especially on Mondays, and the early part of a year (January to May). With respect to age, workers 30 to 59 years old have an increased risk of sprains and strains, whereas workers less than 30 years of age, or 60 or more years of age, have a decreased risk. Workers who are not single, and female workers, have a higher risk of sprains and strains than expected. With respect to occupations, nurses and truckers have a higher-than-expected risk. A number of work environments and activities, such as overexertion, bodily reaction from involuntary motions, running and stretching, and slippery surfaces, are associated with a high risk of occurrence of sprains and strains. These results suggest that significant reduction in the number of occupational sprains and strains could be achieved by targeting prevention programs to reduce excess risks encountered in the first 4 hours of the workshift, on Mondays, and during the first 5 months of the year, and by workers 30 to 59 years of age, female workers, and nurses and truck drivers. It is estimated that, with proper interventions to avoid sprains and strains, a large percentage of sprain and strain injuries could be avoided each year: ie 82.49% of injuries due to bodily reaction from involuntary motions, 89.43% of overexertions in lifting objects, 84.64% of running, stretching, and related injuries, and 76.64% of injuries resulting from loss of balance on slippery surfaces. This study uses an internal comparison, ie comparing the risk of sprains and strains to the risk of all other injuries for various risk categories of interest. As a result, an increased OR may mean an increased risk of sprains and strains, or it may mean a decreased risk of all other injuries for a particular risk category. There are also limitations in the use of workers' compensation data base for epidemiologic studies. Therefore, findings in this study are only suggestive for further investigations and should await confirmations before prevention programs are designed.

Industrial Injury Cost Analysis by Occupation in an Electric Utility

The objective of this study was to establish a cost base of industrial injuries by occupations at the Southern California Edison Company (SCE). The cost base is a risk management tool to project future costs of current injuries by occupation. It provides an estimation of anticipated cost for use in strategic program development. The SCE workers' compensation database of industrial injuries was used in this study. Cost data from 1980 to 1987 were converted to 1993 dollars. Several years must elapse for the total cost data to accrue for complex medical lost time injury cases. The total average cost per injury for the 46 occupations was $5173. The occupational total average injury cost range was $300-$19 500, a difference in total average injury cost of more than $19 000. The costing model developed included three major cost categories: lost productivity, medical, and indemnity. It is a conservative estimate of the actual cost of an average injury event. Reducing injury rates in high total average injury cost occupations offers the maximum potential for cost savings.

Occupational carpal tunnel syndrome in Washington State, 1984-1988.

There are no published population-based studies of occupational carpal tunnel syndrome (OCTS) using a strict case definition. Most studies are either industry specific or present patient self-report of symptoms. We conducted a population-based incidence study of OCTS using the Washington State Workers' Compensation database. Incident OCTS claims were identified with paid bills for physician reported ICD codes 354.0 and 354.1. There were 7,926 incident OCTS claims identified for the years 1984-1988, which yields an industry-wide incidence rate of 1.74 claims/1,000 FTEs. The mean age (37.4 years) and female/male ratio (1.2:1) in this population differ from those reported in nonoccupational carpal tunnel studies (mean age, 51 years; female/male ratio, 3:1). The female-specific OCTS incidence rate increased significantly during the study period. The highest industry specific OCTS rates were found in the food processing, carpentry, egg production, wood products, and logging industries. Demographic differences and industry-specific rates consistent with workplace exposures suggest that OCTS is distinct from CTS occurring in nonoccupational settings. Workers' compensation data proved useful in identifying high risk industries.