Ethnic Disparities in Occupational Injury Hospitalization Rates

A study of five states shows Latinos are significantly more likely to have a work-related traumatic injury hospitalization

Roger Rabb, J.D., Special Correspondent for the LexisNexis Workers’ Compensation eNewsletter

In establishing its Healthy People 2020 initiative four years ago, the U.S. Department of Health and Human Services listed as one of its stated objectives to “achieve health equity, eliminate disparities, and improve the health of all groups.” While “Occupational Health” is one topical area given a focus in this national initiative, there is apparently little actual “population-based data” on ethnic disparities in occupational injuries. However, the authors of a new study published in the American Journal of Industrial Medicine, “Disparities in Occupational Injury Hospitalization Rates in Five States (2003-2009),” try to provide some new data to fill this void to help employers and others with their surveillance and prevention efforts.

However, getting usable statistics in this area has proven tricky. The authors note that state workers’ compensation databases generally lack information on race and ethnicity. Moreover, while the national Survey of Occupational Injuries and Illnesses does include race and ethnicity as optional data elements, the data often goes unrecorded. The authors settled on using primarily hospital discharge data for five states—Arizona, California, Florida, New Jersey, and New York—collected from 2003 through 2009 to examine their topic, as hospital databases often include race or ethnicity information. The study was limited to “occupational traumatic injury hospitalizations” for non-Latino/White, Latino/Hispanic, Black/African-American, Asian/Pacific Islander, Native American, and Other/Multiple, and in order to make the link between injury and employment, as no occupation or industry was provided for patients, the authors limited their study to hospitalizations that listed workers’ compensation as the primary payer.

Findings

For this particular study, the authors sought to prove that Latinos suffer a disproportionate number of traumatic occupational injuries and that over time this “disproportionate burden” has been getting worse. Despite major limitations with the data available to them, the authors of the study concluded that there is some data to support their hypotheses. They concluded that Latinos were “significantly more likely to have a work-related traumatic injury hospitalization,” with state variations “ranging from 1.42 times more likely in [Florida] to 2.29 times more likely in [New Jersey].”

With the information available, the authors were also able to reach some conclusions with respect to cause of injuries. They found that the disparity for Latinos was the largest for machinery-related injuries, with Latinos also disproportionately more likely to require hospitalizations for fall-related injuries. They also noted that while the data did not show an overall disproportionately higher rate of occupational injury hospitalizations for African-Americans, that group did show a significantly higher likelihood for assault-related injuries requiring hospitalization.

The authors also found some evidence to support their hypothesis that “the degree of disparity in injury burden for Latinos has increased over time,” but only in New York. In that state alone, they found a mean annual increase of 4.8% in the disparity for Latinos in traumatic injury hospitalizations, with the mean annual increase jumping to 7.2% in disparity for severe traumatic injury hospitalizations. While the authors could not find a significant change in the disparity rates for Latinos over time in the other four states targeted in the study, in a previous study in Washington State, they had identified a 5% annual increase in disparity in severe work-related traumatic injuries for Latinos.

Study Limitations

The study’s reliance on hospital discharge records to test for ethnic disparities in traumatic occupational injuries does have some drawbacks that may have resulted in both undercounting and skewed results. As noted, the lack of a specific data entry indicating that an injury was related to employment required the use of expected payer information to identify work-relatedness. However, prior research has demonstrated that use of payer information results in some actual work-related injuries not being counted. Perhaps even more significant, however, is that the expected payer information on the discharge record might not end up being the actual payer. For example, earlier research in Washington and Illinois indicated that a higher percentage of Latinos listed workers’ compensation as an expected payer, which the authors note could be because as a group they are less likely to have other insurance coverage. However, it might result in more injuries to Latinos being classified as work-related than should actually be the case.

There are other limitations caused by the use of hospital discharge records. For example, some patients may have been admitted to the hospital more than once for the same injury, effectively skewing the actual injury count.

The study also omitted certain types of injuries, including burns and those from motor vehicle accidents, because of reliability issue with the data. With respect to MVAs, this might result in omission of otherwise-relevant “work-related injuries from collisions involving snow vehicles or off-road vehicles, or occurring in parking lots, ramps, airfields, farms, industrial premises, mines, quarries, private driveways/grounds, etc.”

The authors also cautioned that there was still a substantial amount of missing data on race and ethnicity in the records used, and that the data that was provided in the records may have been collected differently in different locations, resulting in a lack of consistent reporting. For example, in some hospitals, race or ethnicity information may be added by hospital staff from observation alone, not necessarily accurately, and in other hospitals it may be self-reported by the patients.

Conclusion

Recognizing that “occupational injury surveillance involves efforts to accurately characterize trends in the extent and burden of work-related injuries, and is critical to monitoring our state and national progress toward prevention of occupational injuries,” the authors of this study provide at least a step, despite some obvious problems with the available data, toward identifying at least one area of potential disparity worthy of further research and some areas for improvement in data collection.

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