Srinivas Konda

The epidemiology of fatal occupational traumatic brain injury in the U.S.

BACKGROUND Although traumatic brain injury (TBI) is one of the leading causes of death and disability in the U.S., work-related TBI has not been well documented. PURPOSE The aim of this study was to describe the epidemiologic characteristics and temporal trends of fatal occupational TBI in the U.S between 2003 and 2008. METHODS A cross-sectional analysis of the Census of Fatal Occupational Injury database was performed. Both the Occupational Injury and Illness Classification System nature of injury codes and body part codes were used to define TBIs. Fatality rates were calculated using denominators derived from the Current Population Survey. Fatality rates were compared among industries, cause of death, and demographics with rate ratios (RRs) and 95% CIs. Poisson regression was used to assess trends in fatality rates. Data were analyzed in 2009-2010. RESULTS Nearly 7300 occupational TBI deaths occurred between 2003 and 2008, for an average fatality rate of 0.8 per 100,000 workers per year. The leading causes of occupational TBI death were as follows: motor vehicle (31%); falls (29%); assaults and violent acts (20%); and contact with objects/equipment (18%). Fatality rates were 15 times higher in men compared with women (RR=15, 95% CI=13.7, 16.3). Workers aged ≥65 years experienced the highest TBI fatality rate of all age groups (2.5 per 100,000 per year). Construction, transportation, and agriculture/forestry/fishing industries recorded nearly half of all TBI fatalities (n=1828, n=825, n=761, respectively). Occupational TBI death rates declined 23% over the 6-year period (p<0.0001). CONCLUSIONS This study provides the first national profile of fatal TBIs occurring in the U.S. workplace. Prevention efforts should be directed at those industries with the highest frequency and/or highest risk. The construction industry had the highest number of TBIs, and the agriculture, forestry, and fishing industry had the highest rates. Additionally, workers aged >65 years in all industries would be a good target for future prevention efforts.

Suicide in U.S. workplaces, 2003-2010: a comparison with non-workplace suicides

INTRODUCTION Suicide rates have risen considerably in recent years. National workplace suicide trends have not been well documented. The aim of this study is to describe suicides occurring in U.S. workplaces and compare them to suicides occurring outside of the workplace between 2003 and 2010. METHODS Suicide data originated from the Census of Fatal Occupational Injury database and the Web-Based Injury Statistics Query and Reporting System. Suicide rates were calculated using denominators from the 2013 Current Population Survey and 2000 U.S. population census. Suicide rates were compared among demographic groups with rate ratios and 95% CIs. Suicide rates were calculated and compared among occupations. Linear regression, adjusting for serial correlation, was used to analyze temporal trends. Analyses were conducted in 2013-2014. RESULTS Between 2003 and 2010, a total of 1,719 people died by suicide in the workplace. Workplace suicide rates generally decreased until 2007 and then sharply increased (p=0.035). This is in contrast with non-workplace suicides, which increased over the study period (p=0.025). Workplace suicide rates were highest for men (2.7 per 1,000,000); workers aged 65-74 years (2.4 per 1,000,000); those in protective service occupations (5.3 per 1,000,000); and those in farming, fishing, and forestry (5.1 per 1,000,000). CONCLUSIONS The upward trend of suicides in the workplace underscores the need for additional research to understand occupation-specific risk factors and develop evidence-based programs that can be implemented in the workplace.

Workplace homicides among U.S. Women: the role of intimate partner violence

PURPOSE Intimate partner violence (IPV) is an important public health issue with serious consequences for the workplace. Workplace homicides occurring to U.S. women over a 6-year period, including those perpetrated by an intimate partner, are described. METHODS Workplace homicides among U.S. women from 2003 to 2008 were categorized into type I (criminal intent), type II (customer/client), type III (co-worker), or type IV (personal relations) events using the Census of Fatal Occupational Injuries. Fatality rates were calculated and compared among workplace violence (WPV) types, occupations, and characteristics including location of homicide, type of workplace, time of day, and weapon used. RESULTS Between 2003 and 2008, 648 women were feloniously killed on the job. The leading cause of workplace homicide for U.S. women was criminal intent, such as robbing a store (n = 212; 39%), followed by homicides perpetrated by a personal relation (n = 181; 33%). The majority of these personal relations were intimate partners (n = 142; 78%). Over half of workplace homicides perpetrated by intimate partners occurred in parking lots and public buildings (n = 91; 51%). CONCLUSIONS A large percentage of homicides occurring to women at work are perpetrated by intimate partners. WPV prevention programs should incorporate strategies to prevent and respond to IPV.

Workplace violence among Pennsylvania education workers: differences among occupations.

PROBLEM The purpose of this study was to measure the prevalence and characteristics of physical and non-physical WPV in a state-based cohort of education workers. METHOD A sample of 6,450 workers was drawn using de-identified union membership lists, stratified on gender, occupation, and school location. A cross-sectional survey was mailed to participants. RESULTS An estimated 7.8% (95%CI=6.6-9.1) of education workers were physically assaulted and 28.9% (95%CI=26.4-31.5) experienced a non-physical WPV event during the 2009-2010 school year. Special education teachers were significantly more likely to be physically assaulted and experience a non-physical WPV event compared to general education teachers (Prevalence Rate Ratio=3.6, 95% 2.4-5.5; PRR=1.4, 95%CI=1.1-1.8). DISCUSSION Special education teachers were at the highest risk for both physical and non-physical WPV. If not already present, schools should consider implementing comprehensive WPV prevention programs for their employees. IMPACT ON INDUSTRY Special education teachers have unique workplace hazards. Strategies that protect the special education teacher, while still protecting the special education student should be considered.

Occupational Injuries among U.S. Correctional Officers, 1999–2008

OBJECTIVE This study describes fatal and nonfatal occupational injuries among U.S. correctional officers. METHODS Fatal injuries were obtained from the Census of Fatal Occupational Injuries; nonfatal injuries were identified from the National Electronic Injury Surveillance System- Occupational Supplement. RESULTS From 1999-2008, there were 113 fatalities and an estimated 125,200 (CI=±70,100) nonfatal injuries were treated in emergency departments. Assaults and violent acts (n=45, 40%) and transportation related fatalities (n=45, 40%) were the two primary fatal injury events. Assaults and violent acts (n=47,500 (CI=±24,500), 38%) and bodily reaction and exertion (n=25,400 (CI=±16,800), 20%) were the leading events resulting in nonfatal injuries. CONCLUSIONS While workplace violence is the primary cause of both fatal and nonfatal injuries among correctional officers, transportation events and bodily reactions are also leading causes of occupational injury. Future research is needed to identify risk factors unique to these events and develop appropriate prevention and intervention efforts. IMPACT ON INDUSTRY This study adds to the literature on occupational injuries among correctional officers and provides a national level description of fatal and nonfatal injuries across a 10-year period. Given that assaults and violent acts, transportation events, and bodily reaction and exertion were significant injury events, future research should describe detailed injury circumstances and risk factors for correctional officers unique to these events. This would allow appropriate prevention and control efforts to be developed to reduce injuries from these events.

Disparities in work-related homicide rates in selected retail industries in the United States, 2003–2008

PROBLEM Segments within the retail industry have a substantially higher rate of work-related fatality due to workplace violence compared to the retail industry overall. Certain demographic subgroups may be at higher risk. METHOD National traumatic injury surveillance data were analyzed to characterize the distribution of fatality rates due to workplace violence among selected retail workers in the United States from 2003 through 2008. RESULTS Overall, the highest fatality rates due to work-related homicide occurred among men, workers aged ≥65years, black, Asian, foreign-born and Southern workers. Among foreign-born workers, those aged 16-24years, non-Hispanic whites and Asians experienced substantially higher fatality rates compared to their native-born counterparts. CONCLUSIONS The burden of work-related homicide in the retail industry falls more heavily on several demographic groups, including racial minorities and the foreign-born. Further research should examine the causes of these trends. Interventions designed to prevent workplace violence should target these groups.

Fatal traumatic brain injuries in the construction industry, 2003−2010

BACKGROUND Research on fatal work-related traumatic brain injuries (TBIs) is limited. This study describes fatal TBIs in the US construction industry. METHODS Fatal TBIs were extracted from the Bureau of Labor Statistics Census of Fatal Occupational Injuries. RESULTS From 2003 to 2010, 2,210 fatal TBIs occurred in construction at a rate of 2.6 per 100,000 full-time equivalent (FTE) workers. Workers aged 65 years and older had the highest fatal TBI rates among all workers (7.9 per 100,000 FTE workers). Falls were the most frequent injury event (n = 1,269, 57%). Structural iron and steel workers and roofers had the highest fatal TBI rate per 100,000 FTE workers (13.7 and 11.2, respectively). Fall-related TBIs were the leading cause of death in these occupations. CONCLUSIONS A large percentage of TBIs in the construction industry were due to falls. Emphasis on safety interventions is needed to reduce these fall-related TBIs, especially among vulnerable workers.

Physical Assaults Among Education Workers: Findings From a Statewide Study

Objective: Enumerate and describe physical assaults occurring to Pennsylvania education workers. Methods: A cross-sectional survey was mailed to a random sample of 6450 workers, stratified on gender, occupation, and region. Logistic regression was used to examine risk factors for physical assault. Results: During the 2009–2010 school year, 309 of 2514 workers were assaulted 597 times. Special education teachers, urban workers, and those in their first 3 years of employment were at an increased risk. Most assaults did not lead to medical care or time away from work; however, those assaulted were significantly more likely to find work stressful, have low job satisfaction, and consider leaving the education field (adjusted odds ratio [AOR] = 2.5 [95% CI = 1.5 to 4.1]; AOR = 2.4 [95% CI = 1.5 to 3.9]; AOR = 10.7 [95% CI = 4.1 to 28.1]). Conclusions: Although education workers experienced few serious physical assaults, the impact of this violence was considerable.

Non-fatal work-related traumatic brain injuries treated in US hospital emergency departments, 1998–2007

Purpose Little is known about work-related traumatic brain injuries (WRTBI). This study describes non-fatal WRTBIs treated in US emergency departments (ED) from 1998 through 2007. Methods Non-fatal WRTBIs were identified from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work) using the diagnoses of concussion, internal organ injury to the head and skull fracture. WRTBI rates and rate ratios were calculated, and the trend in rates was assessed. Results An estimated 586 600 (95% CI=±150 000) WRTBIs were reported during the 10-year period at a rate of 4.3 (CI=±1.1) per 10 000 full-time equivalent (FTE) workers (1 FTE=2000 h per year). From 1998 through 2007, the rate of WRTBIs increased at an average of 0.21 per 10 000 FTE per year (p<0.0001) and the rate of fall-related WRTBIs increased at an average of 0.10 per 10 000 FTE (p<0.0001). During the same period, the annual rate of WRTBIs resulting in hospitalisation increased 0.04 per 10 000 FTE (p<0.0001). Ten percent of WRTBIs were hospitalised, compared with hospitalisation of 2% all NEISS-Work injuries. Also, workers with highest fall-related TBI rates per 10 000 FTE were the youngest (2.4; CI=±1.4) and oldest (55 and older) workers (1.9; CI=±0.8). Conclusions Non-fatal WRTBIs are one of the most serious workplace injuries among ED-treated work-related injuries. Non-fatal WRTBIs are much more likely to result in hospitalisation compared with other types of injuries. The upward trend of WRTBI rates from 1998 through 2007 underscore the need for more directed effective prevention methods to reduce WRTBI injuries.

Occupational Burns Treated in Emergency Departments

BACKGROUND Despite reported declines, occupational burn injuries remain a workplace safety concern. More severe burns may result in costly medical treatment and long-term physical and psychological consequences. METHODS We used the National Electronic Injury Surveillance System-Occupational Supplement to produce national estimates of burns treated in emergency departments (EDs). We analyzed data trends from 1999 to 2008 and provided detailed descriptions of 2008 data. RESULTS From 1999 to 2008 there were 1,132,000 (95% CI: ±192,300) nonfatal occupational burns treated in EDs. Burn numbers and rates declined approximately 40% over the 10 years. In 2008, men and younger workers 15-24 years old had the highest rates. Scalds and thermal burns accounted for more than 60% of burns. Accommodation and food service, manufacturing, and construction industries had the largest number of burns. CONCLUSIONS Despite declining burn rates, emphasis is needed on reducing burn hazards to young food service workers and using job specific hazard analyses to prevent burns.