Graduation Year

2014

Document Type

Thesis

Degree

M.S.P.H.

Degree Granting Department

Public Health

Major Professor

Hamisu Salihu, MD, PhD

Committee Member

Muktar Aliyu, MD, MPH, DrPH

Committee Member

Eknath Naik, MD, PhD, MSPH

Keywords

Burns, Contusion, Dislocation, Fracture, HCUP occupational injuries data, Poisoning

Abstract

In order to describe the trend, characteristics, and cost of occupational injuries that occurred in industrial settings across the United States between 1998 and 2009, a cross sectional analysis based on hospital discharge data was conducted. The National Inpatient Sample (NIS) data from the Healthcare and Cost Utilization Project (HCUP)(1) was used. Identification of relevant injuries from the sample was performed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code E849.3 (industrial place and premises)(8).

A total of 307,586 (weighted) patients with industrial related injuries were discharged from hospitals in the United States during the period 1998-2009. They were largely male (81.8% vs. 16.6% female) and made up of 48.6% Non-Hispanic Whites, 18.2% Hispanic, and 6.2% Non-Hispanic Black. Two-thirds of patients were within the [25-54] years age group, broken down as 20.4%, 24.8% and 22.1% in the 25-34, 35-44, and 45-54 years age group respectively. Persons in the ≥65 age group also represented a sizable proportion at 7.3%.

The patients were mostly admitted from an Emergency Department (61.2%), followed by routine/standard admissions (22.2%). While they were for the most part discharged home (81.7%), 7.2% were released to a home care facility, 7.9% to another type of facility, and 0.7% died during their stay in the hospital. As for the geographical distribution, 38.9% were admitted in the West, 24.6% in the South, 19.5% in the Midwest, and 17% in the Northeast United States. Furthermore, 88.6% were admitted in a hospital in urban settings vs. 11.2% in rural settings.

The common injury sites were lower and upper extremities (52.6%), multiple locations (14.2%), trunk (9.3%), and head (8.9%). Of all admissions, 48.4% involved fractures, followed by open wounds (25.7%), internal crush injuries (19.4%), and superficial contusions (10.1%). "Foreign Body Entering through Orifice" (0.5%) and poisoning (2.3%) scored the lowest, while burns (5.8%), dislocations (3.9%), and crushing (5%) were noted as well.

The mean length of stay was 4.09 days (95% CI 3.92 - 4.22), while the 95th percentile was ≤13 days. When analyzed by injury site, persons with multiple injuries stayed the longest, averaging 6.21 days (95% CI 5.85 - 6.57) while those with injuries at extremities stayed the shortest, 3.53 days (95% CI 3.42 - 3.65). Patients admitted for burns stayed 7.21 days on average (95% CI 6.52 - 7.9) while those with sprain/strain injuries (2.87 days, 95% CI 2.71 - 3.02) and poisoning (2.92 days, 95% CI 2.69 - 3.16) stayed the shortest.

Overall, the mean cost of care (crude 2001-2009) was $10,153 per admission. Viewed from the injury site angle, the "multiple" category was the most costly at $17,518 and "extremity" the lowest ($8,269). Diagnostics of "Foreign Body Entering through Orifice" were the most expensive, costing on average ($17,036), closely followed by "burns" ($16,495), while "poisoning" was the least costly, with a mean cost of $6,077.

Using Joinpoint regression modeling, we found an overall annual percentage rate change (APC) decrease (-1.73%) over the course of the study. While this improvement was noted in most study sub-segments, it was reversed for women (1.53%), government insurance (Medicare/Medicaid) recipients (7.72%), and older workers (9.16%). The results also revealed a high annual percentage rate (APC) decrease for Hispanics (-9.65%) for the period 1998-2004, jumping to (-18.65%) from 2007 to 2009. A similar pattern with two models was noted for the younger [18-24] age group where the annual percentage rate decreased constantly by (-2.08%) during the period 1998-2007 and drastically jumped to (-18.34%) from 2007 to 2009.

In conclusion, a comprehensive trend analysis of industry-related occupational injuries recorded nationwide within the United States as presented in this study is useful to policy makers in formulating targeted strategies and allocation of resources as needed to address disparities found at various levels. Disparities found in trends observed from a gender angle calls for action to reverse the positive rate recorded for females (1.53%) when compared to males (-2.74%).

Similarly, there is a call for action to address the age demographic disparity for older worker, the "≥65" age group exhibiting an alarming rate of occupational injuries (9.16%), bucking an across-the-board general negative trend.

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