Search

Abstract. Background: Around the globe, 800,000 people die from suicide every year. Despite being one of the leading causes of death, suicide remains a low public health priority. Korea has the second highest total suicide rate among Organisation for Economic Co-operation and Development (OECD) countries. Aims: The aim of this study was to explore how changes of job status influence suicidal risk in Korea, which lags behind other OECD countries in job security because temporary and part-time jobs are more prevalent in Korea. Method: We made use of a large longitudinal dataset, the Korea Health Panel (KHP). Results: Our findings revealed that a negative change in employment status increased the risk of suicide, but only for males. Limitations: Some individuals might intentionally change their job status, but the data do not indicate why the job status of an individual changes. Conclusion: These findings provide useful insights regarding the Korean labor market. In particular, tackling the issue of job stability, providing training polices for the unemployed and under-employed, and considering social insurance schemes may help to reduce suicide risk.

Few population-based studies have used an econometric approach to understand the association between two cancer risk factors, obesity and stress. This study investigated sociodemographic differences in the association between obesity and stress among Korean adults (6,546 men and 8,473 women). Data were drawn from the Korean National Health and Nutrition Examination Survey for 2008, 2009, and 2010. Ordered logistic regression models and propensity score matching methods were used to examine the associations between obesity and stress, stratified by gender and age groups. In women, the stress level of the obese group was found to be 27.6% higher than the nonobese group in the ordered logistic regression; the obesity effect on stress was statistically significant in the propensity score-matched analysis. Corresponding evidence for the effect of obesity on stress was lacking among men. Participants who were young, well-educated, and working were more likely to report stress. In Korea, obesity causes stress in women but not in men. Young women are susceptible to a disproportionate level of stress. More cancer prevention programs targeting young and obese women are encouraged in developed Asian countries.

We investigated Supplemental Nutrition Assistance Program (SNAP) participation among citizen, documented and undocumented immigrant hired crop farmworkers for ten recent years. We analyzed population representative data from the National Agricultural Workers Survey for 2003–2012 (N = 18,243 households). Time-chart, simple mean differences, and logistic regressions described farmworker household participation in SNAP. The 2008 financial crisis almost doubled SNAP-participation by agriculture households (6.5% in 2003–2007 vs. 11.3% in 2008–2012). The increasing SNAP-participation was found for citizen, documented and undocumented immigrant households. We found low participation among documented (OR 0.67, 95% CI 0.56–0.8) and undocumented immigrants (OR 0.63, 95% CI 0.54–0.74) compared to citizens. Low odds ratios (OR 0.70, 95% CI 0.55–0.89) were found for Hispanic-citizens as compared with non-Hispanic white-citizens. Our results may help inform the debate surrounding the effects of the financial crisis on SNAP-participation and on differences in participation among citizens, immigrants, Hispanics and non-Hispanics, the latter suggesting ethnic farmworker disparities in SNAP-participation.

To assess potential reductions in premature mortality that could have been achieved in 2008 to 2012 if the minimum wage had been $15 per hour in New York City.Using the 2008 to 2012 American Community Survey, we performed simulations to assess how the proportion of low-income residents in each neighborhood might change with a hypothetical $15 minimum wage under alternative assumptions of labor market dynamics. We developed an ecological model of premature death to determine the differences between the levels of premature mortality as predicted by the actual proportions of low-income residents in 2008 to 2012 and the levels predicted by the proportions of low-income residents under a hypothetical $15 minimum wage.A $15 minimum wage could have averted 2800 to 5500 premature deaths between 2008 and 2012 in New York City, representing 4% to 8% of total premature deaths in that period. Most of these avertable deaths would be realized in lower-income communities, in which residents are predominantly people of color.A higher minimum wage may have substantial positive effects on health and should be considered as an instrument to address health disparities.

Background Few autism spectrum disorder (ASD) studies have estimated non-medical costs for treatment or addressed possible differences in provision of services across gender, race-ethnic, age or demographic or expenditure categories, especially among adults. Methods The California Department of Developmental Services (CDDS) provides services to residents with developmental disabilities. CDDS provided aggregate data on primarily non-medical spending for fiscal year 2012–2013 for persons with ASD with or without intellectual disability (ID) (main sample, n = 42,274), and two sub-samples: ASD only (n = 30,164), and ASD+ID (n = 12,110). Demographic variables included sex, age and race-ethnicity. Spending categories included Employment Support, Community Care Facilities, Day Care, Transportation, and in-home and out-of-home Respite. Results Per-person spending for males and females were approximately the same: $10,488 and $10,791 for males and females for ages 3–17 and $26,491 and $26,627 for ages 18+. Among race/ethnicity categories, the ranking from highest to lowest among ages 3–17 was white non-Hispanics ($11,480), Asian non-Hispanics ($11,036), “Others” ($11,031), Hispanics ($9,571), and African-American non-Hispanics ($9,482). For ages 18+, the ranking was whites ($31,008), African-Americans ($26,831), “Others” ($25,395), Asians ($22,993), and Hispanics ($18,083). The ASD+ID sub-sample exerted disproportionate influence on findings from the main sample for persons 18+. Combining all ages, the top two expenditure categories for per-person spending were Community Care Facilities ($43,867) and Day Care ($11,244). For most adult age groups, the percentage of recipients participating were highest for Day Care (44.9% - 62.4%) and Transportation (38.6% - 50.9%). Per-person spending for Day Care, Transportation, and Employment Support was relatively low for children but relatively high for adults. Conclusion White non-Hispanics received the highest per-person spending and Hispanics among the least. Amounts within spending categories varied considerably across age groups. Our estimates may be useful as baseline measures for stakeholders preparing for increasing ASD prevalence, especially among adults.

Decreasing the use of high-cost tests may reduce health care costs.To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests.Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician.A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male.All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers.Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (P0.0001). Total costs were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239.Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.

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.

The average costs of Musculoskeletal Disorder (MSD) and odds ratios for filing medical claims related to MSD were examined. The medical claims were identified by ICD 9 codes for four US Census regions within retail trade. Large private firms' medical claims data from Thomson Reuters Inc. MarketScan databases for the years 2003 through 2006 were used. Average costs were highest for claims related to lumbar region (ICD 9 Code: 724.02) and number of claims were largest for low back syndrome (ICD 9 Code: 724.2). Whereas the odds of filing an MSD claim did not vary greatly over time, average costs declined over time. The odds of filing claims rose with age and were higher for females and southerners than men and non-southerners. Total estimated national medical costs for MSDs within retail trade were $389 million (2007 USD).

Debate surrounds the provision of Women, Infants, and Children (WIC) benefits to undocumented immigrants. Few studies are available to estimate use of WIC services by documented and undocumented households using nationally representative data. The authors analyzed data from the National Agricultural Workers Survey (NAWS) annual cross-sections from 1993 through 2009 (N = 40,896 person-years). Household documentation status is defined by the status of the adults in the household, not children. Simple mean differences, logistic regressions, and time charts described household participation in WIC over 2-year intervals. Without adjustments for covariates, 10.7% of undocumented farm workers' households and 12.4% of documented households received WIC benefits, yielding an odds ratio of 0.84 (95% confidence interval [CI]: 0.76-0.94). Logistic regressions revealed that for the same number of children in the household, participation by undocumented persons was higher than participation by documented persons. Time charts and logistic regressions with interaction terms showed a stronger correspondence between participation in WIC and number of children

Few US estimates of the economic burden of autism spectrum disorders (ASD) are available and none provide estimates for 2015 and 2025. We forecast annual direct medical, direct non-medical, and productivity costs combined will be $268 billion (range $162-$367 billion; 0.884-2.009 % of GDP) for 2015 and $461 billion (range $276-$1011 billion; 0.982-3.600 % of GDP) for 2025. These 2015 figures are on a par with recent estimates for diabetes and attention deficit and hyperactivity disorder (ADHD) and exceed the costs of stroke and hypertension. If the prevalence of ASD continues to grow as it has in recent years, ASD costs will likely far exceed those of diabetes and ADHD by 2025.

BACKGROUND Despite considerable debate surrounding the use of Medicaid by undocumented immigrants, few studies address the extent of this use or estimate differences in the use between documented and undocumented households. METHOD We analyzed data from the National Agricultural Workers Survey annual cross sections from 1993 through 2009, N = 41,342. Simple mean differences and logistic regressions predicted participation in Medicaid over 2-year intervals. RESULTS Without adjustments for covariates, 12.2% of undocumented farm workers' households and 22.6% of documented households received Medicaid benefits, corresponding to an odds ratio of 0.48 (95% confidence interval, 0.33 to 0.69). By adding only covariates reflecting presence of children in the household, the odds ratio increased to 0.86 (95% confidence interval, 0.73 to 1.02). CONCLUSIONS Undocumented farm workers' households were roughly half as likely to use Medicaid as documented households, and undocumented households' participation was especially responsive to the presence of children.

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

The Early Intervention Program (EIP) is California's publicly funded human immunodeficiency virus (HIV) care and treatment program with 30 sites throughout the state. Our objective for this study was to examine the number of days from first HIV-positive result until enrollment into EIP by race/ethnicity, behavioral risk, and other characteristics, with data from clients who enrolled in an EIP site after the availability of highly active antiretroviral therapies. For Model I, logistic regression distinguished clients diagnosed with HIV and enrolled in EIP on the same day (0 days) from those with values of 1+ days; linear regression was then used on the log transformation of days for the majority of clients not diagnosed and enrolled on the same day. For Model II, logistic regression was used to identify client characteristics related to enrollment in EIP over 6 weeks from the date of HIV diagnosis. We found that Latinos were more likely than whites to enroll in EIP on the day they were diagnosed with HIV. For clients not diagnosed and enrolled in EIP on the same day, no differences across racial and ethnic groups were found for days until enrollment in HIV care and treatment. However, clients with a history of injection drug use took longer from the day they were diagnosed with HIV to enroll in EIP. The California EIP represents a model for programs seeking equity in access to HIV care and treatment across racial and ethnic groups. Getting injectors into timely HIV care and treatment represents a challenge.

Objective: To estimate the number of annual deaths, as well as the direct and indirect costs of occupational COPD and asthma, in the United States in 1996. Design: Aggregation and analysis of national data sets collected by the National Center for Health Statistics, the Health Care Financing Administration, and other government bureaus and private firms. To assess mortality, we reviewed data from national surveys and applied a population attributable risk (PAR) of 15% for both asthma and COPD. We use a lower age limit of 35 years for occupational COPD and 20 years for occupational asthma. To calculate costs, we use the human capital method that decomposes costs into direct categories, such as medical expenses, as well as indirect categories, such as lost earnings and lost home production. We calculated proportionately adjusted costs for other plausible PARs. Results: The 15% PARs result in costs of $5.0 billion for COPD and $1.6 billion for asthma. For COPD, 56% of costs were direct and 44% were indirect; for asthma, 74% were direct and 26% indirect. These estimates are conservative since we ignored costs associated with pain and suffering as well as the value of care rendered by family members. The proportionately adjusted costs for 10 to 20% PARs are $3.3 to $6.6 billion for COPD and $1.1 to $2.1 billion for asthma. Conclusions: The estimated $6.6 billion cost of occupational COPD and asthma in 1996 is likely to rise with the increasing prevalence of these diseases and warrants preventive intervention. (CHEST 2002; 121:264 –272)

To describe occupational illness data in two large data sets, two national data sets were aggregated, and the numbers, percentages, and rates of cases of occupational illnesses were determined. Job-related illness data were from Bureau of Labor Statistics documents containing Annual Survey and Census of Fatal Occupational Injury data. A severity index was created to assess the overall burden of a disease. The index multiplies the number of cases times the median days lost. Circulatory disease accounted for 85% of the deaths in the Census and at least 80% in the Annual Survey. More fatal myocardial infarctions occurred on Monday than on any other day. Low-paying occupations had the most myocardial infarctions: operators, laborers, and truck drivers; high-paying occupations had the least: executives, administrators, and managers. Carpal tunnel syndrome and hearing loss accounted for more morbidity, measured by cases and days lost, than any other illness. Persons at great risk for carpal tunnel syndrome included dental hygienists, butchers, sewing machine operators, and dentists. Mental disorders generated more morbidity than is generally acknowledged. Neurotic reactions to stress were highest in the transportation and public utility industries, as well as in finance, insurance, and real estate. Manufacturing contributed far more cases than any other industry. Industries generating significant asbestos-related deaths included construction and boat building. Ninety-three percent of all illness fatalities were among men. Few African Americans died from coal-workers' pneumoconiosis. Illness cases increased much faster than injury cases in recent years. The two data sets provide insights into the incidences and prevalences of occupational illnesses, but underestimate the burden of job-related illnesses.

Objective: Socio-economic status (SES) is strongly correlated with hypertension. But SES has several components, including income and correlations in cross-sectional data need not imply SES is a risk factor. This study investigates whether wages—the largest category within income—are risk factors. Methods: We analysed longitudinal, nationally representative US data from four waves (1999, 2001, 2003 and 2005) of the Panel Study of Income Dynamics. The overall sample was restricted to employed persons age 25–65 years, n = 17 295. Separate subsamples were constructed of persons within two age groups (25–44 and 45–65 years) and genders. Hypertension incidence was self-reported based on physician diagnosis. Our study was prospective since data from three base years (1999, 2001, 2003) were used to predict newly diagnosed hypertension for three subsequent years (2001, 2003, 2005). In separate analyses, data from the first base year were used to predict time-to-reporting hypertension. Logistic regressions with random effects and Cox proportional hazards regressions were run. Results: Negative and strongly statistically significant correlations between wages and hypertension were found both in logistic and Cox regressions, especially for subsamples containing the younger age group (25–44 years) and women. Correlations were stronger when three health variables—obesity, subjective measures of health and number of co-morbidities—were excluded from regressions. Doubling the wage was associated with 25–30% lower chances of hypertension for persons aged 25–44 years. Conclusions: The strongest evidence for low wages being risk factors for hypertension among working people were for women and persons aged 25–44 years.

Data from the National Health and Nutrition Examination Survey I, 1971–1975 (NHANES I) were used to analyze associations among highest education level and arthritis. The dependent variables indicated whether the respondent had ever been diagnosed with any form of arthritis by a physician (10,678 women and 7243 men) or whether physician X-ray readings suggested arthritis of the knee (3491 women and 3119 men). These variables did not distinguish between osteo- and rheumatoid arthritis. It is likely that the great majority of the sample reporting or diagnosed with arthritis had osteoarthritis. There were strong univariate correlations between answers to the general arthritis question and the knee question on the one hand and gender, age, body mass, schooling, income and employment on the other. Respondents' education level was found to be strongly and negatively associated with self-reported arthritis in the larger samples both before and after controls were entered for employment, income and potential biological risk factors. The association between self-reported arthritis or arthritis of the knees and education was weaker for men, but not for women after employment and income were accounted for. When body mass was accounted for, the association between self-reported arthritis or arthritis of the knees and education was weaker among women but not men. Long-run preventive strategies to combat osteoarthritis ought to consider investments in education.

The allocation of scarce health care resources requires a knowledge of disease costs. Whereas many studies of a variety of diseases are available, few focus on job-related injuries and illnesses. This article provides estimates of the national costs of occupational injury and illness among civilians in the United States for 2007.This study provides estimates of both the incidence of fatal and nonfatal injuries and nonfatal illnesses and the prevalence of fatal diseases as well as both medical and indirect (productivity) costs. To generate the estimates, I combined primary and secondary data sources with parameters from the literature and model assumptions. My primary sources were injury, disease, employment, and inflation data from the U.S. Bureau of Labor Statistics (BLS) and the Centers for Disease Control and Prevention (CDC) as well as costs data from the National Council on Compensation Insurance and the Healthcare Cost and Utilization Project. My secondary sources were the National Academy of Social Insurance, literature estimates of Attributable Fractions (AF) of diseases with occupational components, and national estimates for all health care costs. Critical model assumptions were applied to the underreporting of injuries, wage-replacement rates, and AFs. Total costs were calculated by multiplying the number of cases by the average cost per case. A sensitivity analysis tested for the effects of the most consequential assumptions. Numerous improvements over earlier studies included reliance on BLS data for government workers and ten specific cancer sites rather than only one broad cancer category.The number of fatal and nonfatal injuries in 2007 was estimated to be more than 5,600 and almost 8,559,000, respectively, at a cost of $6 billion and $186 billion. The number of fatal and nonfatal illnesses was estimated at more than 53,000 and nearly 427,000, respectively, with cost estimates of $46 billion and $12 billion. For injuries and diseases combined, medical cost estimates were $67 billion (27% of the total), and indirect costs were almost $183 billion (73%). Injuries comprised 77 percent of the total, and diseases accounted for 23 percent. The total estimated costs were approximately $250 billion, compared with the inflation-adjusted cost of $217 billion for 1992.The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers' compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job-related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed.

Three methodological problems are commonly faced by researchers investigating relationships between severity and duration of illness among patients with rheumatoid arthritis (RA). (1) Linear regression techniques yield biased estimates when measures of severity are continous but range between and include limiting values such as 0 and 3. (2) Data from the same patient over time are typically pooled together with data from different patients at the same time and over time. Models are then used that do not account for the statistical problems that can result from pooling. (3) Persons with varying years of duration of disease are typically combined and analyzed without any special attention to cohort effects. Changes in severity over time for cohorts of patients with fewer than 10 years of duration may be different from changes in severity of patients with more than 20 years of duration from the onset of the disease. In this study, severity is measured by the 0–3 disability scale in the Stanford Health Assessment Questionnaire (HAQ). Duration is measured by self-report of the onset of symptoms by subjects. Popular techniques are borrowed from econometrics—Tobit, Fixed Effects, and dummy variables for Cohort Models—that were developed to address three analogous problems in economic data. The three economic techniques are applied separately and together using data collected by Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) on 330 RA patients in 1981 who were followed until 1989. Although the Tobit technique does not appear to be especially useful with these data, Fixed Effects and Cohort Models do appear to be useful. This study illustrates how methods used in economics to address three problems of censoring, panel data, and cohort effects can be applied to medical data. These three problems are often ignored in medical studies.

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.

Background Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. Methods In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. Results In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (−$24.36), internal medicine (−$24.27), family medicine (−$23.70), and other pediatric subspecialties (−$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Conclusions Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

Background: Little is known about statistical associations between occupation and hypertension for persons more than age 65. Methods: We analyzed cross-sectional data from the 2004 Health and Retirement Survey. We drew 12 gender-specific sub-samples (age 65+; age 70+; age 75+ ) who reported at least 1 year or 10 years tenure in the same occupation. For 65+ with at least 1 year tenure, n = 3645 men and n = 3644 women. Hypertension was self-reported based on physician diagnosis. Logistic regressions controlled for demographic variables and risk factors. Results: After adjusting for control variables, including education, race, income, smoking, drinking, body mass, and number of comorbidities, the following occupations were significantly (P < 0.05) more likely than managers to report hypertension in at least two of the six sub-samples for women: professionals, salespeople, private household cleaning service workers, and personal service workers. Statistically significant occupations in at least two of the six sub-samples for men included: salespersons, personal service workers, mechanics, construction trades, precisions production workers, and operators. Conclusion: Current and especially pre-retirement occupations were risk factors for hypertension among seniors.

Background Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options. Methods We analyzed cross-sectional data from 6,590 physicians (response rate, 53%) in Round 4 (2004-2005) of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions Results After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349); geriatric medicine (0.323); other pediatric subspecialties (0.270); neonatal/prenatal medicine (0.266); internal medicine and pediatrics (combined practice) (0.250); pediatrics (0.250); dermatology (0.249);and child and adolescent psychiatry (0.203). The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707); pulmonary critical care medicine (-0.273); nephrology (-0.206); and obstetrics and gynecology (-0.188). We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites. Conclusion Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they appear to be in critical areas of medicine.

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.

To construct a semi-Markov model to compare health outcomes and medical costs associated with warfarin and a second anticoagulant over 1- and 5-year periods.We posited a hypothetical cohort of 10,000 identical 70-year-old patients with atrial fibrillation. We posited 20 scenarios for events that included four possibilities for ischemic strokes (mild, moderate, severe, death) and 16 possibilities for hemorrhages. The model allowed for four levels of International Normalized Ratio. Event rates were based on outcomes in clinical trials and observational studies. Costs were estimated from the perspective of the third-party payer.The greatest cost-generating events were virtually the same for the two drugs and included severe stroke ($1,758,548 for 1 year for both drugs), moderate stroke ($380,355 for 1 year for both drugs), and severe lower gastrointestinal (GI) hemorrhage ($193,804 for 1 year for warfarin and $193,474 for second drug). The least costly events for both drugs were mild intracranial or intracerebral hemorrhage ($7584 for warfarin and $4314 for second drug) and fatal upper GI hemorrhage ($16,781 and $16,752). Total costs for adverse events over 5 years were similar: $18,330,662 for warfarin and $17,102,847 for the second drug. Fatalities for 5 years were 123 for warfarin and 101 for the non-warfarin drug. Varying assumptions for nursing home care and numbers of ischemic strokes and hemorrhages generated the widest variation in costs.We did not account for out-of-pocket expenses, 'pain and suffering' costs, or variation across practice settings.There was substantial variation in numbers and costs of adverse events across 20 scenarios, and for fatalities between the two drugs, but variation in costs between the two drugs was modest.

Background Physicians, nurses, and others are at risk of needlesticks, yet little national information is available regarding incidence across demographic and occupational categories. Methods Analysis was conducted on national data on occupational injuries for 1992-2003 from the Bureau of Labor Statistics (BLS). Because BLS data were limited to cases with 1 or more days of work loss, and reasons related to reporting of incidents, the data only reflected a subset of all needlesticks. Nevertheless, the data were internally consistent across categories so that relative magnitudes were reliable. Statistical tests for differences in proportions were conducted that compared needlesticks with all other occupational injuries and employment. Results Cases with 1 or more days of work loss numbered 903 per year, on average, from 1992 through 2003. Women comprised 73.3% (95% CI: 72.5%-74.2%) of persons injured. For those reporting race, white, non-Hispanic comprised 69.3% of the total (95% CI: 68.1%-70.4%); black, non-Hispanic, 14.8% (95% CI: 13.9%-15.6%); and Hispanic, 13.8% (95% CI: 12.9%-14.6%). The age bracket 35 to 44 years had the highest percentage of injuries at 34.0% (95% CI: 33.1%-34.9%). Ages over 54 years reported smaller percentages of needlestick injuries than either all other injuries or employment. Occupations with greatest frequencies included registered nurses, nursing aides and orderlies, janitors and cleaners, licensed practical nurses, and maids and housemen. Occupations with greatest risks included biologic technicians, janitors and cleaners, and maids and housemen. Almost 20% (95% CI: 18.88%-20.49%) of needlesticks occurred outside the services industry. Seven percent (95% CI: 6.56%-7.53%) of needlesticks resulted in 31 or more days of work loss in contrast to 20.46% (95% CI: 20.44%-20.48%) of all other injuries. Conclusion In this nationally representative sample, the most frequent demographic and occupational categories were women; white, non-Hispanic; ages 35 to 44 years; and registered nurses.

We used longitudinal data and instrumental variables (IVs) in a prospective design to test for the causal effects of wages on smoking prevalence among current and past smokers.Nationally representative U.S. data were drawn from the 1999-2009 waves of the Panel Study of Income Dynamics. Our overall sample was restricted to full time employed persons, aged 21-65 years. We excluded part time workers and youths because smoking and wage correlations would be complicated by labor supply decisions. We excluded adult never smokers because people rarely begin smoking after the age of 20 years. IVs were created with state-level minimum wages and unionization rates. We analyzed subsamples of men, women, the less educated, the more educated, quitters, and backsliders. Validity and strength of instruments within the IV analysis were conducted with the Sargan-Hansen J statistic and F tests.We found some evidence that low wages lead to more smoking in the overall sample and substantial evidence for men, persons with high school educations or less (13 years of schooling), and quitters. Results indicated that 10% increases in wages lead to 5.5 and 4.6 percentage point decreases in smoking for men and the less educated; they also increased the average chance of quitting among base-year smokers from 17.0% to 20.4%. Statistical tests suggested that IVs were strong and valid in most samples. Subjects' other family income, including spouses' wages, was entered as a control variable.Increases in an individual's wages, independent of other income, decreased the prevalence of smoking among current and past smokers.

Background: California's workers' compensation law experienced an historic change on January 1, 2005. Previous methods used to rate permanent disability were replaced by new methods to rate permanent impairment. We sought to estimate the difference in ratings under the old and new law. Methods: We obtained 218 reports on injured workers from attorneys who represented injured workers. A disability expert rated disability and 15 physicians rated impairment. Results: Average percentage point ratings for impairment under the 2005 law were approximately one third the size of ratings for disability under the old law. This estimate showed little variation across demographic groups, physician-evaluators, or injured body part. Conclusion: Because cash benefits are keyed to impairment ratings, benefits for permanently disabled workers may decrease as much as 60 % under the new law.

Knowledge of costs is essential to allocate medical resources efficiently. The authors' goal was to estimate and compare costs across occupations, industries, gender, race, and types of nonfatal injuries and illnesses. This is an incidence study of nationwide data, 1993. Nonfatal incidence data were drawn from the Bureau of Labor Statistics Annual Survey. Medical costs were from the Detailed Claims Information data set. Productivity (wage) costs were calculated using the Current Population Survey. Pain and suffering costs were estimated from data on jury verdicts. Injuries and illnesses to nursing aides and orderlies cost 2,200 million dollars; costs were 900 million dollars for registered nurses and 40 million dollars for licensed practical nurses. The ranking of health services industries in terms of costs was: hospitals (52 percent of all costs), nursing care facilities (38 percent), home care services (6 percent), physicians' offices (4 percent), and laboratories (

While the U.S. elderly population uses a disproportionate amount of healthcare resources, there is limited knowledge from prospective studies regarding the impact of lifestyle-related factors on costs in this group. The association was examined between smoking, drinking, exercise, body mass index (BMI), and changes in these risk factors, and healthcare costs after 4 years among 68- to 95-year-olds.A total of 1323 participants completed annual surveys providing information on lifestyle factors (1986-1994) and health utilization (1994-1998). Healthcare costs in nine categories were ascertained from validated utilization. The relationships between risk factors and costs were examined in 2004 using linear regression models.Fewer cigarette pack-years and lower BMI were the most significant predictors of lower total costs in 1998 (p0.001), controlling for baseline sociodemographic factors, costs, and conditions. Associations with smoking were strongest for hospitalizations, diagnostic tests, and physician and nursing-home visits. Those who reduced smoking by one pack per day experienced cost savings of 1160 dollars (p0.05). The costs for normal weight compared to minimally obese seniors were approximately 1548 dollars lower, with diagnostic testing, physician visits, and medications accounting for much of this difference. Daily walking, measured at baseline, also predicted lower costs for hospitalizations and diagnostic testing.Seniors who were leaner, smoked fewer cigarettes over a lifetime, reduced their smoking, or walked farther had significant subsequent cost savings compared to those with less-healthy lifestyle-related habits.

The objective of this study was to estimate occupational injury and illness costs per worker across states. Analysis was conducted on injury data from the Bureau of Labor Statistics and costs data from workers' compensation records. The following states were at the top of the list for average cost (cost per worker): West Virginia, Alaska, Wyoming, Kentucky, and Mississippi. The following states were at the bottom: South Carolina, Delaware, Minnesota, Massachusetts, and New Hampshire. The following variables (and signs on regression coefficients comparing this industry with manufacturing) were important in explaining the variation across states: employment in farming (+), agricultural service, forestry, fishing (+), mining (+), transportation and public utilities (+), wholesale trade (-), and finance, insurance, real estate (-). Southern and especially Western states were disproportionately represented in the high cost per worker list. A significant amount of the variation in cost per worker across states was explained by the composition of industries.

Objectives This study estimated the annual medical costs associated with 14 occupational illnesses in the United States in 1999. Methods National data sets collected by the National Center for Health Statistics, the Health Care Financing Administration, and the Agency for Healthcare Research and Quality were aggregated and analyzed. The cost assessment began with estimates of national health expenditures. These included categories for hospital care, professional services, nursing homes, and medical products, including drugs, administration, public health activities, research and construction. The total disease burden was assessed from estimates of hospital days and number of outpatient visits. The occupational disease burden was assessed by multiplying the total disease burden by a given percentage of the proportionate attributable risk for the disease in question. The occupational burden was then combined with costs for each disease. Adjustments were made for unique inpatient and outpatient costs. Results In the preferred model, the 14 diseases generated USD 14.5 billion in medical costs in 1999. Roughly USD 10.7 billion was attributed to men and USD 3.8 billion to women. The diseases generating the most costs were as follows: circulatory diseases in the age group 24-64 years (USD 4.7 billion), cancer (USD 4.3 billion), chronic obstructive pulmonary disease (USD 2.2 billion), and asthma (USD 1.5 billion). A sensitivity analysis generated alternative estimates. An upper age limit of 74 years increased the circulatory disease estimate by USD 3.7 billion. The range of the sensitivity analysis was USD 9.6-19.7 billion. Conclusion This study significantly improves over the methodology of previous literature. Our methods were transparent. Occupational illnesses were a major contributor to the total cost of medical care.

Background The career satisfaction and dissatisfaction physicians experience likely influence the quality of medical care. Objective To compare career satisfaction across specialties among US physicians. Methods We analyzed data from the Community Tracking Study of 12 474 physicians (response rate, 65%) for the late 1990s. Data are cross-sectional. Two satisfaction variables were created: very satisfied and dissatisfied. Thirty-three specialty categories were analyzed. Results After adjusting for control variables, the following specialties are significantly more likely than family medicine to be very satisfying: geriatric internal medicine (odds ratio [OR], 2.04); neonatal-perinatal medicine (OR, 1.89); dermatology (OR, 1.48); and pediatrics (OR, 1.36). The following are significantly more likely than family medicine to be dissatisfying: otolaryngology (OR, 1.78); obstetrics-gynecology (OR, 1.61); ophthalmology (OR, 1.51); orthopedics (OR, 1.36); and internal medicine (OR, 1.22). Among the control variables, we also found nonlinear relations between age and satisfaction; high satisfaction among physicians in the west north Central and New England states and high dissatisfaction in the south Atlantic, west south Central, Mountain, and Pacific states; positive associations between income and satisfaction; and no differences between women and men. Conclusions Career satisfaction and dissatisfaction vary across specialty as well as age, income, and region. These variations are likely to be of interest to residency directors, managed care administrators, students selecting a specialty, and physicians in the groups with high satisfaction and dissatisfaction.

This study tests for the presence of education-frailty correla- tions among 1,176 Mexican Americans, 522 Cuban Americans, and 560 Puerto Ricans, 50 years and older, in the Hispanic Health and Nutrition Examination Survey. Hispanics with the least schooling (less than 7 years) were found to have the highest frailty rates, and those with the most (more than 12 years of schooling) were found to have the lowest frailty rates. Similar, but somewhat weaker, correlations were discovered after a measure of self-efficacy was accounted for.

Background: Although psychiatric disturbances are highly prevalent among traumatically injured inpatients, few investigations have assessed the impact of these disorders on surgical length of stay (LOS) and cost. Methods: The authors identified all trauma-registry recorded psychiatric diagnoses among patients admitted to University of California Davis Medical Center between January 1993 and December 1996. Linear and logistic regressions were used to assess the unique effects of psychiatric diagnoses on inpatient LOS and cost. Results: A total of 29% of patients had one or more registry-recorded psychiatric diagnosis. Patients with alcohol abuse diagnoses demonstrated 10% to 12% decreases in LOS and cost (p < 0.01), whereas patients with stress disorders, delirium, and psychoses demonstrated 46% to 103% increases in LOS and cost (p < 0.01). Conclusion: Patients with recognized psychiatric disorders uniquely impact inpatient trauma surgery LOS and cost. Additional investigations of the processes and outcomes of care could lead to cost-effective performance improvement efforts that target the amelioration of comorbid psychiatric disorders among physically injured trauma survivors.

According to the Compression of Morbidity (CM) hypothesis, people who exercise, eat nutritiously, do not smoke, and maintain good weight, i.e., people who practice healthy habits, will be more likely to live free of disabling diseases and injuries up until the last few months or years of life. The Increasing Misery (IM) hypothesis, on the other hand, holds that preventive health measures will extend life expectancy but will also increase the number of infirm years. The CM theory implies that curves of morbidity or disability with age should become increasingly “rectangular” for groups who practice healthy habits in the broadest sense. The IM theory does not. This Rectangularization hypothesis is examined with cross-sectional data measuring disability from the Epidemiological Follow-up to the National Health and Nutrition Examination Survey, I (NHEFS), using years of schooling as the independent variable proxy representing favored health status, and examining interactions with age. A modified version of the Disability Index (DI) from the Stanford Health Assessment Questionnaire (HAQ) is used to measure disability. In some analyses, deceased subjects were assigned the worst disability score. Four subsamples of women and men, fifty years old and over, alive and deceased in 1982–84, were analyzed. Female, and especially male, subsamples which included the deceased provided evidence for the CM hypothesis. Results for the subsamples of those remaining alive in 1982–84 were ambiguous. However, lifetime (over age 50) cumulative disability was 21 to 60 percent less for the more educated than the less educated, depending upon whether deceased were included or excluded. If higher education level is an appropriate surrogate for the effect of good health practices, then extending such practices will result in less, rather than more, lifetime disability.

In this exploratory and descriptive study, data are drawn from a sample of 1,864 Bank of America retirees collected in 1987 to investigate correlations among healthy habits, age, gender, and education. Findings include: 1) Health habits are strongly and positively associated with each other and negatively associated with unhealthy habits. 2) Age is statistically significant and positively associated with fiber, fat consumption, and lack of exercise, but negative associated with cigarette use. 3) Women are more likely than men to smoke, use seat belts, and eat foods high in fiber. Men are more likely than women to exercise and drink excessively. 4) Education is statistically significant and positively associated only with fiber in the diet and no other habit. 5) Fiber consumption emerges as the healthy habit most consistently associated with all other habits.

Data from recent international publications are used to analyze physician incomes across countries. U.S. incomes are the highest among 14 countries, even after adjusting for the average standard of living within each country.

This study reports on research which looks for employee and job characteristics which correlate with absenteeism. A large cross-sectional national probability sample of workers employed for at least 20 hr per week is analyzed (n = 1308). The dependent variable is the number of self-reported absences during the past 14 days. Thirty-seven independent variables are considered. Ordinary Least Squares (multiple regressions), two-limit Tobits, and two-part models are used to assess the statistical and practical significance of possible covariates. Statistically significant predictors included health variables such as being overweight, complaining of insomnia, and hazardous working conditions; job characteristics such as inflexible house; and personal variables such as being a mother with small children. Variables reflecting dangerous working conditions appear to be the strongest correlates of absenteeism. Notable variables which do not predict absenteeism include age, race, wages, and job satisfaction. Future research should direct attention toward workers' health and working conditions as covariates of absenteeism, since they are strongly significant in this study and have been neglected by most absenteeism investigators.

To estimate the direct and indirect costs of the hepatitis C virus (HCV) in the United States in 1997.Aggregation and analysis of national data sets collected by the National Center for Health Statistics, the Health Care Financing Administration, and other government bureaus and private firms. To estimate costs, we used the human capital method, which decomposes costs into direct categories, such as medical expenses, and indirect categories, such as lost earnings and lost home production. We consider HCV that results in chronic liver disease separate from HCV that results in primary liver cancer.We estimate $5.46 billion as the cost of HCV in 1997. Costs are split as follows: 33% for direct and 67% for indirect costs. Hepatitis C virus that results in chronic liver disease contributes roughly 92% of the costs, and HCV that results in primary liver cancer contributes the remaining 8%. The total estimate of $5.46 billion is conservative, because we ignore costs associated with pain and suffering and the value of care rendered by family members.To our knowledge, only one estimate of the annual costs of HCV in the 1990s has appeared in the literature, $0.6 billion. However, that estimate was not supported by an explanation of the methods. Our estimate, which relies on detailed methods, is nearly 10 times the original estimate. Our estimate of $5.46 billion is on a par with the cost of asthma ($5.8 billion [1994]).

There has been limited research on occupation health hazards and heart disease. With the exception of the effects of noise, even less research has been conducted on occupational safety hazards, however. This study takes an initial look at interrelationships between safety hazards and heart disease. Fatal injury rates within industries are taken as proxies for safety hazards; fatal heart attack rates are taken as proxies for heart disease. Holding age, race, and gender constant evidence is found which is consistent with the hypothesis that safety hazards, through their effects on stress, either cause or exascerbate heart disease.

Information was gathered from a Department of Labor (DOL) publication on firm size and occupational injuries and illnesses. Twenty-eight large industries were selected which contained information on injury and illness rates for all eight categories of firm sizes. The injury and illness information was matched to data on percent of production workers, percent women, weekly earnings and weekly hours in the 28 industries. After controlling for gender, earnings, hours and percent production workers, as well as idiosyncratic effects of the particular industries, the evidence suggests that very small firms (1-19 employees) and very large firms (1,000 employees or more) have the fewest injuries and illnesses, and medium sized firms, 20 to 999 employees, have the most.

This study asks whether individual or job characteristics are better predictors of industrial accidents. Data include a subset of employees drawn from the nationally-based Panel Study of Income Dynamics for 1978 and 1979. Individuals are classified as suffering a new accident if they began receiving workers' compensation during the study year. Evidence is produced that job characteristics such as frequent overtime, operative or laborer occupational categories, length of time with the job and hazardous working conditions are better predictors of industrial accidents than are personal characteristics such as age, marital status and schooling.

This conference concerns economic, psychosocial, preventive, and medical aspects of the care of an indigent, unemployed, 22-year-old mother of three who died of an invasive, large cell, nonkeratinizing cervical cancer 35 months after her last Pap smear, 19 months after the onset of vaginal discharge, 12 months after consulting a physician, 10 months after an exploratory laparotomy, nine months after initiation of radiation therapy, five months after performance of a colostomy, four months after initiation of chemotherapy, and three months after treatment of small bowel obstruction with hyperalimentation and resection. We discuss the cost effectiveness of preventive programs.

Two national probability samples are used to investigate four empirical questions associated with estimating the value-of-life using coefficients from wage regressions. The four questions pertain to whether wage regression coefficients on fatality rate variables are sensitive to (1) including or excluding women from the sample, (2) definitions of the fatality rate which include estimates of either male only or female only deaths, (3) removing the influence of firm size from the fatality rate or the wage rate, (4) respondents' inaccuracies in reporting their three-digit industry. Problems associated with (3) and (4) are found to be minimal. Problems associated with (1) and (2) also appear to be small if the goal is to estimate the value-of-life for men.