Jacob Etches

Suicide mortality by occupation in Canada, 1991-2001

Objective: To describe the association between occupation and risk of suicide among working-age men and women in Canada. Method: This study of suicide mortality over an 11-year period is based on a broadly representative 15% sample of the noninstitutionalized population of Canada aged 30 to 69 years at cohort inception. Age-standardized mortality rates (ASMRs) and rate ratios were calculated for men and women in 5 categories of skill level and 80 specific occupational groups, as well as for people not occupationally active. Results: The suicide mortality rate was 20.1/100 000 person years for occupationally active men (during 9 600 000 person years of follow-up) and 5.3/100 000 person years for occupationally active women (during 8 100 000 person years of follow-up). Among occupationally active men, elevated rates of suicide mortality were observed for 9 occupational groups and protective effects were observed for 6 occupational groups. Among women, elevated rates of suicide were observed in 4 occupational groups and no protective effects were observed. For men and women, ASMRs for suicide were inversely related to skill level. Conclusions: The limited number of associations between occupational groups and suicide risk observed in this study suggests that, with few exceptions, the characteristics of specific occupations do not substantially influence the risk for suicide. There was a moderate gradient in suicide mortality risk relative to occupational skill level. Suicide prevention strategies in occupational settings should continue to emphasize efforts to restrict and limit access to lethal means, one of the few suicide prevention policies with proven effectiveness.

Mortality following unemployment in Canada, 1991-2001

BackgroundThis study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians.MethodsWe conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30–69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women.ResultsFor persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991–1996 and 1997–2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age.ConclusionsConsistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.

Time trends in musculoskeletal disorders attributed to work exposures in Ontario using three independent data sources, 2004-2011

Objective Work-related musculoskeletal disorders (MSDs) are the leading cause of work disability in the developed economies. The objective of this study was to describe trends in the incidence of MSDs attributed to work exposures in Ontario over the period 2004–2011. Methods An observational study of work-related morbidity obtained from three independent sources for a complete population of approximately six million occupationally active adults aged 15–64 in the largest Canadian province. We implemented a conceptually concordant case definition for work-related non-traumatic MSDs in three population-based data sources: emergency department encounter records, lost-time workers’ compensation claims and representative samples of Ontario workers participating in consecutive waves of a national health interview survey. Results Over the 8-year observation period, the annual per cent change (APC) in the incidence of work-related MSDs was −3.4% (95% CI −4.9% to −1.9%) in emergency departments’ administrative records, −7.2% (−8.5% to −5.8%) in lost-time workers’ compensation claims and −5.3% (−7.2% to −3.5%) among participants in the national health interview survey. Corresponding APC measures for all other work-related conditions were −5.4% (−6.6% to −4.2%), −6.0% (−6.7% to −5.3%) and −5.3% (−7.8% to −2.8%), respectively. Incidence rate declines were substantial in the economic recession following the 2008 global financial crisis. Conclusions The three independent population-based data sources used in this study documented an important reduction in the incidence of work-related morbidity attributed to non-traumatic MSDs. The results of this study are consistent with an interpretation that the burden of non-traumatic MSDs arising from work exposures is declining among working-age adults.

Work-attributed Illness Arising From Excess Heat Exposure in Ontario, 2004-2010

ObjectiveTo describe the incidence of occupational heat illness in Ontario.MethodsHeat illness events were identified in two population-based data sources: work-related emergency department (ED) records and lost time claims for the period 2004–2010 in Ontario, Canada. Incidence rates were calculated using denominator estimates from national labour market surveys and estimates were adjusted for workers’ compensation insurance coverage. Proportional morbidity ratios were estimated for industry, occupation and tenure of employment.ResultsThere were 785 heat illness events identified in the ED encounter records (incidence rate 1.6 per 1,000,000 full-time equivalent (FTE) months) and 612 heat illness events identified in the lost time claim records (incidence rate 1.7 per 1,000,000 FTE months) in the seven-year observation period with peak incidence observed in the summer months. The risk of heat illness was elevated for men, young workers, manual workers and those with shorter employment tenure. A higher proportion of lost time claims attributed to heat illness were observed in the government services, agriculture and construction sectors relative to all lost time claims.ConclusionsOccupational heat illnesses are experienced in Ontario’s population and are observed in ED records and lost time claims. The variation of heat illness incidence observed with worker and industry characteristics, and over time, can inform prevention efforts by occupational health services in Ontario.RésuméObjectifDécrire l’incidence des maladies professionnelles liées à la chaleur en Ontario.MéthodeLes épisodes de maladies liées à la chaleur ont été recensés dans deux sources de données populationnelles: les dossiers des services médicaux d’urgence (SMU) concernant les travailleurs et les réclamations avec interruption de travail pour la période de 2004 à 2010 en Ontario (Canada). Les taux d’incidence ont été calculés à l’aide d’estimations dans le dénominateur tirées d’enquêtes nationales sur le marché du travail, et ces estimations ont été ajustées selon la couverture d’assurance indemnisant contre les accidents du travail. Des ratios proportionnels de morbidité ont été estimés par industrie, par profession et par durée d’emploi.RésultatsSur notre période d’observation de sept ans, 785 épisodes de maladies liées à la chaleur ont été recensés dans les dossiers des SMU (taux d’incidence: 1,6 p. 1 000 000 mois équivalents temps plein [ETP]), et 612 épisodes du même type dans les réclamations avec interruption de travail (taux d’incidence: 1,7 p. 1 000 000 mois ETP), avec des pics observés durant les mois d’été. Le risque de maladie liée à la chaleur était élevé chez les hommes, les jeunes travailleurs, les travailleurs manuels et les personnes ayant eu une durée d’emploi plus courte. Une proportion supérieure de réclamations avec interruption de travail imputées aux maladies liées à la chaleur a été observée dans les secteurs des services gouvernementaux, de l’agriculture et du bâtiment comparativement à l’ensemble des réclamations avec interruption de travail.ConclusionsIl y a des cas de maladies professionnelles liées à la chaleur dans la population ontarienne; ils sont observés dans les dossiers des SMU et dans les réclamations avec interruption de travail. On constate des écarts dans l’incidence des maladies liées à la chaleur selon les caractéristiques des travailleurs et des industries; au fil du temps, ces écarts peuvent éclairer les efforts de prévention des services de santé au travail en Ontario.

Diverging Trends in the Incidence of Occupational and Nonoccupational Injury in Ontario, 2004–2011

OBJECTIVES We describe trends in occupational and nonoccupational injury among working-age adults in Ontario. METHODS We conducted an observational study of adults aged 15 to 64 over the period 2004 through 2011, estimating the incidence of occupational and nonoccupational injury from emergency department (ED) records and, separately, from survey responses to 5 waves of a national health interview survey. RESULTS Over the observation period, the annual percentage change (APC) in the incidence of work-related injury was -5.9% (95% confidence interval [CI] = -7.3, -4.6) in ED records and -7.4% (95% CI=-11.1, -3.5) among survey participants. In contrast, the APC in the incidence of nonoccupational injury was -0.3% (95% CI=-0.4, 0.0) in ED records and 1.0% (95% CI=0.4, 1.6) among survey participants. Among working-age adults, the percentage of all injuries attributed to work exposures declined from 20.0% in 2004 to 15.2% in 2011 in ED records and from 27.7% in 2001 to 16.9% in 2010 among survey participants. CONCLUSIONS Among working-age adults in Ontario, nearly all of the observed decline in injury incidence over the period 2004 through 2011 is attributed to reductions in occupational injury.

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation

Objective This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes Work disability episode incidence and duration. Results Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group.