Trends and characteristics of compensated occupational cancer in Ontario, Canada, 1937-2003

BACKGROUND: In Canada, administrative databases maintained by provincial workers' compensation boards are often the best or the only available data source for describing trends and characteristics of occupational cancer. In Ontario, approximately 75% of the labor force is covered by the Ontario Workplace Safety and Insurance Board (WSIB) and allowed cancer claims date back to 1937. METHODS: The purpose of this study was to describe WSIB-allowed cancer claims by worker demographics, claim characteristics, year of filing, cancer type, and work exposure measures including workplace agent, occupation and industry. RESULTS: In total, claims were filed and compensated for one or more malignant neoplasms by, or on behalf of, 3,126 workers between 1937 and 2003. CONCLUSIONS: Results show trends in cancer compensation reflecting changes in the characteristics and prevalence of workers exposed to workplace carcinogens, as well as changes to WSIB adjudication policies over time.     

Development of an occupational illness and injury surveillance database for the electric energy sector

Currently available occupational injury and illness data for electric energy companies provide only overall summary rates. Specific information about types of injury or illnesses, rates by occupational or work environments, and injury costs and severity are generally not readily available. Relevant data such as personnel and claims information are frequently not integrated into a comprehensive health and safety surveillance system suitable for epidemiologic and health and safety research purposes. Epidemiological methods are valuable for identifying key risk factors for work-related injuries and illnesses and assessing their magnitude, as well establishing priorities for health and safety research. Application of such methods can result in long-term reductions in injury and illness rates and their attendant costs. Aggregation of relevant health and safety data across companies improves statistical power for the assessment of rare (yet costly) injuries or illness or specific at-risk subgroups within the electric energy sector. A pilot occupational injury and illness database has been developed that can incorporate and standardize data across a spectrum of companies of differing sizes and configurations. In illustrative data analyses, injury trends were summarized by company size, occupation, and demographic factors, among others. Trends observed in these illustrative analyses were consistent with results previously reported in the epidemiological literature, however, results are considered preliminary pending development of the full database. This study shows that development of a standardized surveillance occupational injury and illness database across companies with different database configurations is feasible. This database will ultimately provide a stable and accurate occupational health and safety assessment tool not currently available for this sector.     

Risk factors for physical assault. State-managed workers' compensation experience

BACKGROUND: The estimation of incidence and evaluation of risk factors associated with nonfatal occupational assault injuries have rarely been documented in a statewide population context. A state-managed workers' compensation system can provide estimates of incidence of such injuries and allow evaluation of risk factors. METHODS: Using claims data from the state-managed West Virginia Workers' Compensation, the incidence rates of workplace injuries resulting from physical assault were estimated for the period 1997-1999. Data on potential risk factors were obtained from the claim-related electronic data files, and the risk associated with each factor was assessed using proportional injury ratios (PIRs). RESULTS: During the study period, 2122 compensated injuries were associated with workplace violence. The incidence of assault injuries was 108.2 cases per 100,000 employee years. Women sustained a higher incidence than men. Healthcare workers, public safety workers, and teachers accounted for almost 75% of all assault injuries. Workers in these occupations also differed from each other with regard to seasonality and timing of assault, perpetrator-victim relationship, and types of injury. Evidence of gender-occupation interaction indicated higher risk of assault injury in men compared to women across the three leading occupations. Nighttime work shifts were associated with greater risk of assault for female healthcare workers (PIR=1.8; 95% confidence interval, 1.09-2.87). CONCLUSIONS: The healthcare sector sustained the bulk of assault injuries in West Virginia. Although the majority of healthcare-sector employees were women, the risk of assault injuries was higher in male employees. Risk factors and injury characteristics identified in this study, particularly for three high-risk occupations, should help develop strategies for preventing workplace violence. Protecting female healthcare workers on night-shift duty, especially in nursing home settings, appears to be an important target for intervention.     

Declining trends in work-related morbidity and disability, 1993-1998: a comparison of survey estimates and compensation insurance claims

OBJECTIVES: This study compared trends in the incidence of work-related morbidity and disability across 3 sources of surveillance data in a Canadian province. METHODS: Time series estimates of workplace injuries and work-related disability based on 2 panel surveys in the province of Ontario, Canada, for the period 1993-1998 were compared with rates of work-related injury and illness compensation claims during the same period. RESULTS: Lost-time compensation claims declined by 28.8% over this 6-year period. The incidence of self-reported work-related injury declined by 28.2%, and the self-reported incidence of work absence for work-related causes declined by 32.2%. CONCLUSIONS: Parallel reductions in work-related morbidity were seen in 3 independent data sources. These results support an interpretation that there has been an important reduction in injury risk in Ontario workplaces over the past decade.     

Hospital support services and the impacts of outsourcing on occupational health and safety

Background: Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors.

Objectives: This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach.

Methods: Worker’s compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups.

Results: Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P < 0.05) were observed in average costs per injury for cleaners post outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries.

Conclusions: This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.     

Trends in rates of occupational fatal injuries in the United States (1983-92)

OBJECTIVES: An updated version of a national surveillance system of traumatic occupational fatalities was used to explore adjusted and unadjusted trends in rates of fatal injury. METHODS: Data from the national traumatic occupational fatalities surveillance system were combined with data on employment from the United States Bureau of Labor Statistics. Poisson regression was then used to examine trends in rates of occupational fatality injuries while controlling for demographic and workplace characteristics. RESULTS: Adjusted annual changes in rates of fatal injuries ranged from a decline of 6.2% for workers in technical and administrative support occupations--for example, health, science, and engineering technicians, pilots, computer programmers--to an increase of 1.6% in machine operators, assemblers, and inspectors. For industries, annual changes ranged from a decline of 5.3% for workers in public administration--for example, justice, public order, and safety workers--to an increase of 2.6% for workers in the wholesale trade. By comparison, the annual decline over all industries and occupations was 3.1%. In many industries and occupations, an effect modification of annual trends by the age of the worker was also found with the oldest workers experiencing either no decline or a significant increase in rates of fatal injuries. CONCLUSIONS: This general pattern of decline, adjusted for the effects of demographic characteristics of the worker population, is encouraging; however, increases in rates of fatal injuries found in particular industries and occupations, suggest appropriate targets for increased injury prevention efforts.

 

     

Planning preventive occupational health services at the community level.

Socio-sanitary data on occupational injuries and disease-specific exposures were used to plan preventive occupational health services in the territory of a Community Health Department in an industrial sector of Montreal, Quebec. Information was obtained from two complementary sources: Worker's Compensation and plant surveys. For prevention of injuries, three groups of planning options were identified: territorial injury surveillance, protection of the extremities and eyes, and the ergonomic diagnosis of the workplace for prevention of non-accidental injuries. In the prevention of occupational diseases, medical screening and worker's registry were two possible options. These options were put in perspective with the type of resources needed and the kind of commitment required for planning these services.     

Surveillance and assessment of workplace assault injuries: analysis of Rhode Island workers' compensation claims 1998-2002

OBJECTIVE: To analyze workplace assault by rate, injury severity, and trends using Rhode Island workers' compensation claim data. METHOD: A total of 6402 workers' compensation assault claims from Rhode Island for the period of 1998 through 2002 was analyzed. Data from the U.S. Department of Labor was used to derive estimates of injury rates. RESULTS: An average rate of 27.7 assaults per 10,000 workers was found and varied only marginally across years. Females filed 75% of all assault claims, though injuries to males resulted in longer periods of indemnification. The total cost of workplace assaults was 7,025,997 dollars, averaging 1097 dollars per claim, and average indemnification duration was 16.8 days per claim. While the assault rate was relatively stable, a notable decline in both cost and indemnification periods over time was discovered. CONCLUSION: The assault rate found was among the highest reported to date, demonstrating that workplace violence remains a significant threat to employee safety. While a decline in incident severity was discovered over time, many outcomes were still serious. Preventive interventions to reduce incidents of workplace assaults among groups at the highest risk should be given highest priority.     

Sharp-device injuries to hospital staff nurses in 4 countries.

OBJECTIVE: To compare sharp-device injury rates among hospital staff nurses in 4 Western countries. DESIGN: Cross-sectional survey. SETTING: Acute-care hospital nurses in the United States (Pennsylvania), Canada (Alberta, British Columbia, and Ontario), the United Kingdom (England and Scotland), and Germany. PARTICIPANTS: A total of 34,318 acute-care hospital staff nurses in 1998-1999. RESULTS: Survey-based rates of retrospectively-reported needlestick injuries in the previous year for medical-surgical unit nurses ranged from 146 injuries per 1,000 full-time equivalent positions (FTEs) in the US sample to 488 injuries per 1,000 FTEs in Germany. In the United States and Canada, very high rates of sharp-device injury among nurses working in the operating room and/or perioperative care were observed (255 and 569 injuries per 1,000 FTEs per year, respectively). Reported use of safety-engineered sharp devices was considerably lower in Germany and Canada than it was in the United States. Some variation in injury rates was seen across nursing specialties among North American nurses, mostly in line with the frequency of risky procedures in the nurses' work. CONCLUSIONS: Studies conducted in the United States over the past 15 years suggest that the rates of sharp-device injuries to front-line nurses have fallen over the past decade, probably at least in part because of increased awareness and adoption of safer technologies, suggesting that regulatory strategies have improved nurse safety. The much higher injury rate in Germany may be due to slow adoption of safety devices. Wider diffusion of safer technologies, as well as introduction and stronger enforcement of occupational safety and health regulations, are likely to decrease sharp-device injury rates in various countries even further.     

Non-fatal occupational injuries among non-governmental employees in Malaysia

We analyzed data on non-fatal occupational injuries reported to Malaysia's social security organization from 2002 to 2006. There was a decrease in both the absolute number and the incidence rates of these injuries over time. About 40% of cases occurred in the manufacturing sector followed by the service (17%) and trading (17%) sectors. The agriculture sector reported the highest incidence rate (24.1/1,000), followed by the manufacturing sector subcategories of wood-product manufacturing (22.1/1,000) and non-metallic industries (20.8/1,000). Men age 40 to 59 and persons of Indian ethnicity had a greater tendency to sustain injuries. Government and non-governmental organizations should strive to develop strategies to reduce the occupational injuries targeting vulnerable groups. Enforcement of safety measures will further play an important role to ensure that both employees and employers take special precautions to address workplace hazards.     

Injuries to volunteer fire fighters in West Virginia

The distribution and characteristics of workplace injuries for West Virginia volunteer fire fighters (VFFs) are described using 1992 workers' compensation data. Most of the injuries occurred in VFFs who were less than 30 years of age (62%). The most common type of injuries were those in the category of lacerations and contusions (28.9%), with a notable percentage of injuries due to smoke inhalation and respiratory problems (13.7%). The proportional rates related to falls in VFFs were almost twice the national figures for the same year (39.3% versus 22.3%). County population density was found to be directly associated with injury rates, even when adjusted for number of responses. Claims statistics mirror a similar geographical trend in overall workers' compensation claims for all injuries in West Virginia. The results of this study provide a foundation for additional follow-up studies in order to develop improved occupational safety policies and target educational programs aimed at the prevention of injuries in volunteer fire fighters. Several findings have already resulted in programmatic recommendations.     

Nonfatal occupational injuries and illnesses--United States, 2004

Data collected through a National Electronic Injury Surveillance System occupational supplement (NEISS-Work) provide information on persons treated for nonfatal work-related injuries and illnesses in U.S. hospital emergency departments (EDs). CDC's National Institute for Occupational Safety and Health uses these data to monitor injury trends and aid prevention activities. This report summarizes 2004 NEISS-Work injury and illness surveillance data. In 2004, an estimated 3.4 million nonfatal ED-treated injuries and illnesses occurred among workers of all ages, with a rate of 2.5 cases per 100 full-time equivalent (FTE) workers aged > or =15 years. Workers aged <25 years had the highest injury/illness rates. More than three fourths of all nonfatal workplace injuries/illnesses were attributed to contact with objects or equipment (e.g., being struck by a falling tool or caught in machinery), bodily reaction or exertion (e.g., a sprain or strain), and falls. No substantial reduction was observed in the overall number and rate of ED-treated occupational injuries/illnesses during 1996-2004. To reduce occupational injuries/illnesses, interventions should continue to target workers at highest risk and reduce exposure to those workplace hazards with the greatest potential for causing severe injury or death. More emphasis should be placed on prevention-effectiveness studies and dissemination of successful interventions to reduce work-related injuries and illnesses.     

Exploring the relationship between development and road traffic injuries: a case study from India

BACKGROUND: Road traffic injuries (RTI) are a major cause of mortality and disability in the world. Only after significant losses have communities in developed nations taken necessary steps to prevent crashes and their consequences. Increase in road safety is related to increasing socio-economic development. We aim to study the trends in injury and death rates in a developing country, India, define sub-national variations, and analyse these trends in relation to economic and population growth. METHODS: Public sector data from India were used to develop a standardized database on traffic injuries and indicator of economic development. The data were analysed using linear regression models to test the a priori hypothesis of a positive relationship between net domestic product (NDP), and injury and death rates from road crashes across states. RESULTS: The absolute burden of RTI in India has been consistently rising over the past three decades. The reported rates are lower than those estimated by global health agencies and may reflect under-reporting. Population-based rates provide a better assessment of the public health burden of RTI than vehicle-based rates. There is an inverted U-shaped relationship between NDP and injury and death rates. Even with the limited data, Kuznets phenomenon is evident for within-country level comparisons. CONCLUSIONS: India and other developing countries could learn from the experience of highly motorized nations to avoid the expected rise in RTI and deaths with economic development, by currently investing in road safety and prevention measures.     

Healthcare use before and after a workplace injury in British Columbia, Canada

Objectives

There is growing evidence that occupational injuries influence workers'' emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers'' Compensation Board (WCB).

Methods

The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non‐injured = NI).

Results

LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics.

Conclusions

Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.     

Epidemiological research, operational planning, and intervention measures in workers' health

To improve intervention measures in workers' health involves the adoption of approaches aimed at implementing inspection of the workplace, using ethical interventions with impact on the Brazilian Health System. Instruments include risk assessment, information flows, and identification of workers' morbidity and mortality characteristics. Such measures are planned with four operational bases: trade unions, production sector, sentinel event, and microregion, establishing a new dynamic relationship between epidemiological investigations and health interventions aimed at changing the work process associated with occupational injuries and diseases.     

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual’s general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.     

Injuries and illnesses from wood framing in residential construction, Washington State, 1993-1999

The construction industry is associated with high rates of work-related injury. We used workers compensation data to describe the injuries and illnesses, claim rates, and claim costs associated with wood framing activities in construction. From 1993 to 1999, there were 33,021 accepted state fund workers compensation claims with direct costs of over $197 million. The average annual claim rate was 45 per 100 full-time equivalent. Statistically significant downward trends were noted in claim rates for all injuries and illnesses, compensable time loss claims, eye and fall injuries. However, these trends were not statistically significantly different from those observed in all other construction risk classes combined. The information in this report can be used to guide prevention efforts and to evaluate the effectiveness of Washington state initiatives to reduce injury and illness rates in wood frame construction.     

Traumatic occupational fatalities in South Carolina, 1989-90.

Death certificates for South Carolina for 1989 and 1990 were examined to identify deaths resulting from injury incurred in the workplace. There were 277 deaths in that category in the 2-year period, an average yearly rate for traumatic occupational fatalities of 8.84 per 100,000 workers. The groups of industries with the highest fatality rates were transportation-communication-utilities, construction, and agriculture-fishing-forestry. The leading causes of death were injuries from motor vehicle crash, homicide, and falls. The traumatic occupational fatality rate for men was about 13 times greater than that for women; however, a much higher proportion of women died from homicide on the job. The findings in general reflect trends reported in other studies. The death rates for workers in South Carolina for 1989-90, however, were higher than national averages for 1980-88. National data for 1989-90 were not available for comparison. The data suggest that more effective injury prevention efforts need to be applied to such causes of on-the-job injury as motor vehicle crash, homicide, and falls. Those three categories accounted for more than 56 percent of all traumatic occupational fatalities in South Carolina in 1989 and 1990. Motor vehicle crash prevention efforts particularly are needed in the transportation-communication-utilities industries. The findings show that particular efforts need to be directed to the retail trade category for prevention of homicide and to the construction industry for prevention of falls.     

Workers' compensation experience of Colorado agriculture workers, 2000-2004

BACKGROUND: Agriculture is among the most hazardous of occupations. The lack of information regarding agriculture injuries or fatalities has been recognized as an obstacle for effective injury prevention. Workers' compensation claims data for non-fatal injuries among agriculture and agri-business workers in the State of Colorado between the years of 2000 and 2004. METHODS: Workers' compensation claims are utilized to estimate injury claim incidence rates, determine the distributions of sources, causes, types and body locations of injuries, and estimate the costs of these injuries. RESULTS: Colorado agriculture and agri-business workers (e.g., cattle dealers, cattle or livestock raisers, dairy farmers) have high rates of injury claims, especially in sectors that involve interaction with animals or livestock. Grain milling operations had a high rate of injury claims among agri-business operations. Injuries related to animals, strains, machinery, and falls or slips were the most frequent among all occupations analyzed. CONCLUSIONS: Understanding the occurrence of injuries among Colorado agriculture and agri-business workers is critical to implementing and evaluating effective intervention programs for specific agriculture-related occupations. The development of safety interventions that address the worker-animal interface, fall protection systems, machinery usage, and overexertion prevention strategies is recommended.     

Illnesses and injuries reported by Latino poultry workers in western North Carolina

BACKGROUND: Poultry processing is the largest sector of the meat products industry. Many workers are immigrants; few data exist on their illness and injury rates and the impact of workplace safety environment. METHODS: Survey interviews were conducted with a representative sample of 200 Latino poultry workers employed by three different companies in western North Carolina; topics included symptoms, work-related illnesses and injuries, and plant safety climate. RESULTS: Most respondents were <35 years of age and had been in the US <10 years. Frequency of self-reported symptoms was high, particularly for musculoskeletal symptoms. Despite symptoms, workers reported not missing work or seeking medical care. Occupational injuries and illnesses and symptoms varied by company. Between-company differences in injury and illness rates were consistent with perceived safety and company provision of personal protective equipment. CONCLUSIONS: Symptoms reported exceeded rates reported by other community, clinical, and occupational samples. Findings suggest policy changes and research are needed to reduce the high rates of occupational illnesses and injuries in this vulnerable population.