Search

Cost estimates are essential to decision makers attempting to wisely allocate scarce health care resources. Cost-of-illness studies for many diseases continue to proliferate (Foster et al. 2006; Petersen and American Diabetes Association 2008; Rosamond et al. 2007, 2008), with cost estimates for coronary heart disease, stroke, cancer, and hypertension updated annually (Rosamond et al. 2007, 2008). By contrast and despite its importance, the generation of information about the costs of occupational injury and illness has not kept pace, as the most recent comprehensive estimate for U.S. costs applies to 1992 (Leigh et al. 1997). Nevertheless, there are several less than comprehensive and related studies. The National Academy of Social Insurance annually updates its estimates of the costs of workers’ compensation (Sengupta, Reno, and Burton 2009). But workers’ compensation data are incomplete. Bonauto and colleagues (2010) found that workers’ compensation records miss from 23 to 53 percent of all medically attended nonfatal injuries, and Leigh and Robbins (2004) found that workers’ compensation missed at least 91 percent of occupational disease deaths. Although Corso and colleagues (2006) generated national estimates for injuries in 2000, they did not separate those that were job related. Biddle (2009) provided cost estimates for occupational injury deaths, but not for nonfatal injuries or diseases. The National Safety Council (NSC 2009) calculates the costs of occupational injuries but excludes assaults, murders, and all illnesses. Finally, the national cost estimates for circulatory disease, cancer, and chronic obstructive pulmonary disease (COPD) do not estimate the portions of these diseases attributed to job-related exposures. The aim of this study is to estimate the national costs of occupational injuries and illnesses among civilians in 2007. To achieve that aim, I have calculated the numbers and costs of fatal and nonfatal injuries and illnesses. Costs are divided into medical and indirect categories. I use broad methodologies such as the cost of illness, incidence, prevalence, and societal perspective that are standard in studies of nonoccupational diseases and injuries. Numbers and costs for all categories are combined to produce the overall most probable estimate of approximately $250 billion for 2007. Finally, a sensitivity analysis investigates the effects of consequential assumptions. This study introduces numerous methodological advances over one that I and my colleagues conducted earlier (Leigh et al. 1997). For example, first, the previous study estimated injuries for state and local government employees by extrapolating from private-sector employees, whereas this study uses new U.S. Bureau of Labor Statistics (BLS) data from government employees. Second, the current study estimates those injuries for the self-employed and agricultural workers that are not simply averages of those in all other private-sector workers. Third, I rely on recent epidemiologic evidence for fractions of diseases such as cancer and COPD that are attributable to workplace exposures. Fourth, I use hospital costs per hospital stay rather than simply days in the hospital to estimate medical costs. Additional advances are discussed as well. These estimates should help inform the debate about the relative costs associated with occupational injuries and illnesses versus other diseases, as well as estimate costs not covered by workers’ compensation. These estimates may also inform decisions by occupational safety and health stakeholders regarding the allocation of resources to prevent injuries versus diseases.

Background We hypothesized that low socioeconomic status, employer-provided health insurance, low wages, and overtime were predictors of reporting workers compensation indemnity claims. We also tested for gender and race disparities. Methods Responses from 17,190 (person-years) Americans participating in the Panel Study of Income Dynamics, 1997–2005, were analyzed with logistic regressions. The dependent variable indicated whether the subject collected benefits from a claim. Results Odds ratios for men and African-Americans were relatively large and strongly significant predictors of claims; significance for Hispanics was moderate and confounded by education. Odds ratios for variables measuring education were the largest for all statistically significant covariates. Neither low wages nor employer-provided health insurance was a consistent predictor. Due to confounding from the “not salaried” variable, overtime was not a consistently significant predictor. Conclusion Few studies use nationally representative longitudinal data to consider which demographic and job characteristics predict reporting workers compensation indemnity cases. This study did and tested some common hypotheses about predictors. Am. J. Ind. Med. 54:758–770, 2011. © 2011 Wiley-Liss, Inc.

BACKGROUND: Little is known about cost differences for demographic groups or across occupational injuries and illnesses. METHODS: In this incidence study of nationwide data for 1993, an analysis was conducted on fatal and non-fatal injury and illness data recorded in government data sets. Costs data were from workers' compensation records, estimates of lost wages, and jury awards. RESULTS: The youngest (age /= 65) workers had exceptionally high fatality costs. Whereas men's costs for non-fatal incidents were nearly double those for women, men's costs for fatal injuries were 10 times the costs for women. The highest ranking occupation for combined fatal and non-fatal costs-farming, forestry, and fishing-had costs-per-worker ($5,163) over 18 times the lowest ranking occupation-executives and managers ($279). The occupation of handlers, cleaners, and laborers, ranked highest for non-fatal costs. Gunshot wounds generated especially high fatal costs. Compared to whites, African-Americans had a lower percentage of costs due to carpal tunnel syndrome, circulatory, and digestive diseases. CONCLUSIONS: Costs comparisons can be drawn across age, race, gender, and occupational groups as well as categories of injuries and illnesses.A� Language: en

Mortality rates were drawn from the California Occupational Mortality Study (COMS) to analyze liver cirrhosis deaths within occupations and industries from 1979 to 1981. Age-adjusted Standardized Mortality Rates (SMRs) were made available by the State of California for separate analyses of women, men, blacks and whites. Rankings of occupations with narrow confidence intervals were strikingly similar for blacks and whites. Within occupations, the highest female SMRs were for waitresses, telephone operators, cosmetologists, dress makers, hospital orderlies, textile workers, and laborers. The lowest female SMRs were for skilled crafts workers and teachers. High male occupations included water transportation workers, bartenders, loggers, laborers, roofers, construction workers, farm workers, iron workers, and painters. Low male occupations included teachers, physicians and dentists, managers, factory supervisors, business sales workers, heavy equipment operators, and other professionals. High female industries included eating and drinking places, laundry/dry cleaning, nursing and personal care facilities, aerospace, beauty shops, and entertainment. Low female industries included wholesale trades and education. High male industries included water transportation, military, guard services, eating and drinking places, iron and steel mills, and railroads. Low male industries included research/engineering labs, education, and computer manufacturing. This study was descriptive. It remains unknown whether certain jobs cause excessive drinking and cirrhosis, or whether people who are prone to develop cirrhosis select certain jobs.

Objective. To determine if marital status is associated with differences in rates of progression of functional disability in patients with rheumatoid arthritis (RA). Methods. A community cohort of 282 persons with RA was followed prospectively for up to 9.5 years. The progression of functional disability over time was determined using the Health Assessment Questionnaire Disability Index, which was completed by study participants every 6 months. Results. At study entry, the Disability Index was 1.1 ± 0.8 (mean ± 1 SD) (possible range 0–3) among the 188 married participants and 1.3 ± 0.9 among the 94 unmarried participants. Over time, the rate of progression of functional disability was generally higher among unmarried participants. However, the extent of this difference varied somewhat over the disease course, with rates of progression higher among unmarried than among married participants during years 5–7 and years 17–29 of RA. Overall estimated rates of progression, adjusted for the effects of other sociodemographic factors, were 0.03 Disability Index units per year in unmarried participants and 0.01 Disability Index units per year in married participants (P < 0.0001). Conclusion. Marriage, possibly reflecting the influence of social support, is associated with a lower rate of progression of functional disability in persons with RA.

This study combines new estimates of occupational mortality with industry death rates from the Bureau of Labor Statistics to test for compensating wages associated with job hazards. The new estimates apply to 347 three-digit occupations in the United States. An unexpected result emerges: Evidence for compensating wages is apparent only when the BLS industry death rates are used; evidence is absent with the new occupational death rates.

The strong associations between education level and prevalence and severity of arthritis have recently been investigated, with some suggestion that the relationships might be causal. Data from 4 national probability samples were analyzed, in which occupation and income were measured currently and prior to the development of arthritis. These data indicate that previous studies overestimated the strength of the association between schooling and arthritis because income and, especially, occupation were not analyzed as separate covariates. The overestimate appears to be especially high for persons currently employed, for men, and for persons employed in dangerous jobs. Health policy strategies directed toward reducing arthritis rates require not simply a focus on education, but the additional socioeconomic status dimensions of income and occupational safety and health.