Z. Joyce Fan

Underreporting of work-related injury or illness to workers' compensation : Individual and industry factors

Objective: We quantified the underreporting of work-related injury or illness to workers’ compensation (WC). Methods: Using data from 2612 wage-earning respondents who participated in the 2002 Washington State Behavioral Risk Factor Surveillance System, we assessed work-related injury or illness in the previous year and identified the factors associated with WC claim filing by logistic regression. Results: The self-reported rate of work-related injury or illness of respondents was 13%. Among those who had a work-related injury or illness, 52% filed a WC claim. After adjustment for age, gender, and race, those who filed WC claims were more likely to be overweight and married. WC claim filing varies considerably across industry and occupation groups holding all other measured factors constant. Conclusions: Individual and industry/occupation factors are related to underreporting of work-related injury or illness to the WC system.

Rotator cuff syndrome: personal, work-related psychosocial and physical load factors.

Objective: To identify factors associated with rotator cuff syndrome (RCS) among active workers. Methods: Seven hundred thirty-three workers in 12 worksites participated in a cross-sectional study with individual structured physical and psychosocial health interviews, physical examinations, and exposure assessments of biomechanical factors. Work organization, including job content or structural constraints, was assessed at the departmental level. Multivariable logistic modeling was used. Results: Fifty-five subjects (7.5%) had RCS. Cases were more likely to report low job security (P < 0.04) and to have very high job structural constraints (P < 0.03). Age and body mass index were marginally significant. Upper arm flexion ≥ 45° ≥ 15% of time and either duty cycle of forceful exertions ≥9% time (odds ratio = 2.43, 95% CI = 1.04 to 5.68) or forceful pinch >0% [odds ratio = 2.66, 95% CI = 1.26 to 5.59] were significant risk factors. Conclusions: Long duration of shoulder flexion and forceful exertion (especially pinch) in a job are significant risk factors for RCS. Work organization may impact physical and psychosocial exposures and should be further explored.

Quantitative exposure-response relations between physical workload and prevalence of lateral epicondylitis in a working population.

BACKGROUND Lateral epicondylitis is a common work-related musculoskeletal disorder. The objective of this study was to identify risk factors associated with lateral epicondylitis among active workers. METHODS Seven-hundred thirty-three workers in 12 Washington worksites participated in structured interviews, physical examinations, and individual exposure assessments of biomechanical and psychosocial factors. Multivariable logistic modeling was used. RESULTS Thirty-eight subjects (5.2%) had lateral epicondylitis. Age (36-50 years-old), being female, and low social support at work were significant risk factors. Frequency of forceful exertion (> or =5 vs. < 1 times/min (OR 5.17, 95%CI 1.78-15.02), and > or =1 to <5 vs. <1 (OR 4.47, 95%CI 1.57-13.71)) and forearm supination at > or =45 degrees for > or =5% of the time with high lifting force (OR = 2.98, 95% CI 1.18-7.55) were significant physical load factors. CONCLUSIONS Frequency of forceful exertion or a combination of forearm supination and forceful lifting were significant physical factors and should be considered for prevention strategies.

Assessing Validity of the QuickDASH and SF-12 as Surveillance Tools among Workers with Neck or Upper Extremity Musculoskeletal Disorders

The purpose of this article was to assess validity of the regional Disabilities of Arm, Shoulder, and Hand (QuickDASH) and Short-Form 12 (SF-12) for surveillance purpose. We compared the predictive, discriminate, and concurrent validity of the QuickDASH and SF-12 among 231 workers with specific clinical diagnoses of neck or upper extremity musculoskeletal disorders (UEMSDs) and 175 workers with symptoms only. Compared to those with symptoms only, the odds of being any neck or UEMSD case were 1.45 (95% confidence interval [95% CI]: 1.24-1.70) and 0.66 (95% CI: 0.48-0.91) with every 10-point increase in QuickDASH disability and physical component scale (PCS-12) scores, respectively. The clinical cases had significantly higher QuickDASH disability (23.0 vs. 14.3, p<0.0001) and lower PCS-12 scores (44.8 vs. 47.3, p=0.0133) than those with symptom only. The QuickDASH disability scores were moderately correlated with the PCS-12 scores (rho=-0.40) among the clinical cases. Either QuickDASH or PCS-12 can be used as a simple surveillance tool in an active working population.

OBESITY PREVALENCE BY OCCUPATION IN WASHINGTON STATE, BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM

Introduction Data that estimate the prevalence of and risk factors for worker obesity by occupation are generally unavailable and could inform the prioritization of workplace wellness programs. The aims of this study were to estimate the prevalence of obesity by occupation, examine the association of occupational physical activity and a range of health behaviors with obesity, and identify occupations in which workers are at high risk of obesity in Washington State. Methods We conducted descriptive and multivariable analyses among 37,626 employed Washington State respondents using the Behavioral Risk Factor Surveillance System in odd numbered years, from 2003 through 2009. We estimated prevalence and prevalence ratios (PRs) by occupational groups adjusting for demographics, occupational physical activity level, smoking, fruit and vegetable consumption, and leisure-time physical activity (LPTA). Results Overall obesity prevalence was 24.6% (95% confidence interval [CI], 24.0–25.1). Workers in protective services were 2.46 (95% CI, 1.72–3.50) times as likely to be obese as workers in health diagnosing occupations. Compared with their counterparts, workers who consumed adequate amounts of fruits and vegetables and had adequate LTPA were significantly less likely to be obese (PR = 0.91; 95% CI, 0.86–0.97 and PR = 0.63; 95% CI, 0.60–0.67, respectively). Workers with physically demanding occupational physical activity had a lower PR of obesity (PR = 0.83; 95% CI, 0.78–0.88) than those with nonphysically demanding occupational physical activity. Conclusion Obesity prevalence and health risk behaviors vary substantially by occupation. Employers, policy makers, and health promotion practitioners can use our results to target and prioritize workplace obesity prevention and health behavior promotion programs.

Associations between workplace factors and carpal tunnel syndrome: A multi-site cross sectional study.

BACKGROUND Few large epidemiologic studies have used rigorous case criteria, individual-level exposure measurements, and appropriate control for confounders to examine associations between workplace psychosocial and biomechanical factors and carpal tunnel syndrome (CTS). METHODS Pooling data from five independent research studies, we assessed associations between prevalent CTS and personal, work psychosocial, and biomechanical factors while adjusting for confounders using multivariable logistic regression. RESULTS Prevalent CTS was associated with personal factors of older age, obesity, female sex, medical conditions, previous distal upper extremity disorders, workplace measures of peak forceful hand activity, a composite measure of force and repetition (ACGIH Threshold Limit Value for Hand Activity Level), and hand vibration. CONCLUSIONS In this cross-sectional analysis of production and service workers, CTS prevalence was associated with workplace and biomechanical factors. The findings were similar to those from a prospective analysis of the same cohort with differences that may be due to recall bias and other factors.

Psychosocial Factors and Shoulder Symptom Development Among Workers

BACKGROUND Shoulder injuries are a common cause of pain and discomfort. Many work-related factors have been associated with the onset of shoulder symptoms. The psychosocial concepts in the demand-control model have been studied in association with musculoskeletal symptoms but with heterogeneous findings. The purpose of this study was to assess the relationship between the psychosocial concepts of the demand-control model and the incidence of shoulder symptoms in a working population. METHODS After following 424 subjects for approximately 1 year, 85 incident cases were identified from self-reported data. Cox proportional hazards modeling was used to assess the associations between shoulder symptoms and demand-control model quadrants. RESULTS Cases were more likely to be female and report other upper extremity symptoms at baseline (P < 0.05). From the hazard models, being in either a passive or high strain job quadrant was associated with the incidence of shoulder symptoms. Hazard ratios were 2.17, 95% CI 1.02-4.66 and 2.19, 95% CI 1.08-4.42, respectively. CONCLUSIONS Using self-reporting to determine demand-control quadrants was successful in identifying subjects at risk of developing work-related shoulder symptoms. Research is needed to determine if this relationship holds with clinically diagnosed shoulder and other upper extremity musculoskeletal disorders. This may be part of a simple tool for assessing risk of developing these UEMSDs.

The impact of regulatory enforcement and consultation visits on workers' compensation claims incidence rates and costs, 1999-2008

BACKGROUND Studies of regulatory effectiveness have shown mixed evidence of impact of inspections on injury rates. We examine changes in workers compensation claims rates and costs for Washington employers having either an inspection, with or without citation, or a voluntary consultation activity. METHOD We merge 10 years of enforcement and consultation activity with workers compensation records at the individual workplace level for stable firms with a single business location and at least 10 full-time employees. The change in claims incidence rates (CIRs) was estimated, controlling for workplace claims rate history, size, and industry. Separate analyses were performed for non-musculoskeletal and musculoskeletal (MSD) CIRs, claims costs and for enforcement activities with citation and without citation. RESULTS Enforcement activities are associated with a significant reduction in CIRs and costs. Similar results may also be attributable to consultations. Inspections were associated with a 4% decline in time-loss claims rates relative to uninspected workplaces. The effect strengthens when MSD claims are excluded. Citations for non-compliance are associated with a 20% decline in non-MSD CIRs relative to uninspected workplaces. There is also some evidence for a reduction in MSD claims rates beginning in the second year following inspection. Enforcement and consultation activity is associated with substantial decreases in claims costs. CONCLUSIONS Enforcement activities make a significant contribution to reducing CIRs and costs. Similar results following consultations may also exist. Inspections with citations are more effective than those without. Claims rates for non-MSD injuries, related to hazards covered by specific standards, are more affected in the year following the visit, while those for MSDs take longer to begin falling.

Occupation and the prevalence of current depression and frequent mental distress, WA BRFSS 2006 and 2008

BACKGROUND Workers with depression and frequent mental distress (FMD) have lost work productivity. Limited systematic comparisons exist for the prevalence of depression and FMD across occupational groups. METHODS Using a state-added question for occupation coupled to measures of depression and FMD on the Washington State (WA) 2006 and 2008 Behavioral Risk Factor Surveillance System survey, we estimated the prevalence and odds ratios (ORs) among the 20,560 WA workers. RESULTS The prevalences of current depression and FMD were 5.2% and 7.5%, respectively. The prevalence varied considerably across occupations. Compared with Management occupation, Truck drivers had significantly increased odds for both current depression [OR = 6.18, 95% confidence interval (CI): 2.52-15.16] and FMD (OR = 1.85, 95% CI: 1.01-3.41). Cleaning/Building services (OR = 1.95, 95% CI: 1.11-3.40) and Protective services (OR = 1.97, 95% CI: 1.19-3.27) were associated with increased FMD. CONCLUSIONS These findings demonstrate the need for research on possible sources of the differences for current depression and FMD across occupations.

Responsiveness of the QuickDASH and SF-12 in Workers with Neck or Upper Extremity Musculoskeletal Disorders: One-Year Follow-Up

Introduction Questionnaires that measure functional status such as the Disability of the Arm, Shoulder and Hand (QuickDASH) and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) can quantify the impact of health on performance. Little is known about whether these questionnaires can be used as a tool for measuring disabilities among workers. We compare the responsiveness of these two functional status questionnaires to changes in clinical outcomes of neck or upper extremity musculoskeletal disorders (UEMSD) among active workers in a longitudinal study. Methods We evaluated the effect size (ES) and standardized response means (SRM) of the QuickDASH and the SF-12 for 148 workers who were divided into four subgroups based on the diagnosis status change between baseline and 1-year visit. Results The ES and SRM for QuickDASH scores were 0.6/0.6 for the 50 subjects who became incident symptomatic neck or UEMSD cases, 1.3/1.0 for the 18 subjects who became incident clinical cases of neck or UEMSD, −1.0/−1.1 for the 46 subjects who recovered from having neck or UEMSD symptoms, and −1.1/−1.1 for the 34 subjects who recovered from being neck or UEMSD clinical cases. The correspondent ES/SRM for the QuickDASH work module were 0.4/0.3, 0.7/0.5, −0.6/−0.4, and −1.0/−0.8, respectively. The correspondent ES/SRM for the physical component scores of SF-12 (PCS12) for the four subgroups were 0.2/0.2, −0.9/−0.6, 0.3/0.2, and 0.3/0.3, respectively. Conclusions The QuickDASH scores were responsive to changes among active workers who were neck or UEMSD symptomatic or clinical case. PCS12 scores were sufficient only for use in clinical case status change.