Industrial Injuries in the U.S.: A 14-Year Analysis of Characteristics, Trends and Health Care Costs

By Robin E. Kobayashi, J.D. and Karen C. Yotis, Esq.

An ambitious new study that examines industry-related injuries in the U.S. for the period 1998 to 2011 has shed some light on the characteristics of occupational injuries as well as the resultant costs that burden the shoulders of the employer/worker/society triumvirate supporting the “grand bargain.” According to the study, we’re talking about an estimated $250 billion in 2007 alone for injuries that relate to an array of risk factors that are difficult to pinpoint and even harder to predict or fully understand. The authors used the National Inpatient Sample (NIS) database, a tool developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS in turn is part of the Healthcare and Cost and Utilization Project (HCUP), the “Nation’s most comprehensive source of hospital data, including information on in-patient care, ambulatory care, and emergency department visits.”

The study, “Industry-Related Injuries in the United States From 1998 to 2011: Characteristics, Trends, and Associated Health Care Costs,” published in the Journal of Occupational and Environmental Medicine (Vol. 57, No. 7 July 2015), used the ICD-9 clinical modification codes to zero in on occupational injuries and accidents. Using joinpoint regression modeling—which is a statistical method that describes changing trends over successive segments of time, and the amount of increase or decrease within each segment—the study analyzes the frequency, prevalence, and trends of industrial injuries, the sociodemographic, behaviorial, and hospital-level characteristics associated with disparities in rates and trends, and the health care utilization, costs of direct medical care, and in-hospital mortality associated with the different types of industrial injuries.

A Curiosity Cabinet of Key Findings

The study’s findings show some of what we’ve come to expect based on prior studies, as well as a few surprises. Some of the more noteworthy highlights reveal that:

•  357,716 inpatient hospitalizations are attributable to industrial injuries in the U.S., which averages out to an astonishing 25,000 admissions per year;

•  Fractures (48.1%) followed by open wounds (25.4%) were the most common type of industrial injury;

•  Poisoning (2.4%) and injuries involving foreign bodies and orifices (0.5%) are relatively uncommon, which is awfully good to know;

•  Extremities (51.7%) take most of the impact when it comes to the various areas to the anatomy, with isolated injury working its way inward towards the trunk and head (at 9.1% each);

•  Injury occurs on multiple anatomy sites only 14.3% of the time;

•  Fractures, sprains and strains increased along with a worker’s age;

•  The opposite is true with burns, which tend to decrease with an increase of age;

•  More men (28.0%) than women (12.6%) experienced open wound injuries;

•  More men (21.8%) than women (9.7%) suffered internal/crushing injuries;

•  More men (14.9%) than women (6.6%) experienced poisoning injuries in circumstances of documented drug or alcohol use;

•  The injury rate for males (154.1%) was more than five times higher than females (27.9%);

•  The injury rate for Hispanics (228.1%) was likewise more than four times higher than the rate for non-Hispanic blacks (51.8%) and three times higher than the rate for non-Hispanic whites (78.0%);

•  Injuries were most likely to occur on a weekday (92.8%) compared to a weekend (64.2%);

•  Most hospitalizations occurred after injury visits to the Emergency Room;

•  The injury rate for the Western region of the U.S. (191.7%) was more than double the rate for any other region;

•  The rate of injuries that resulted in hospitalization was 1.4 times higher in urban areas (90.7%) compared to rural areas (67.0%);

•  The occurrence of industrial injuries has decreased approximately 1.4% per year;

•  The rate of hospitalization for patients 65 years and up increased 8.9% per year;

•  The rate of hospitalization for patients 14 years or younger increased 4.7% per year;

•  The mean length of inpatient stays was 4.2 days, with 4.5% of hospitalizations exceeding 13 days, and injuries involving multiple areas of the body having the longest mean (6.4 days);

•  The mortality rate was 1 in-hospital death per 132 admissions, with head injuries associated with the highest in-hospital death rate;

•  The mean cost of a hospital admission was $12,849, with injuries involving multiple areas of the body having a mean of $22,361;

•  The overall costs of inpatient care during the timeframe for the study was more than $3.7 billion which is $341 million annually; injuries to the extremities accounted for the highest total cost ($142 million annually) with fractures accounting for $186 million annually.

Targeted Strategies to Inform the Future

The study confirms findings from prior studies, in addition to underscoring those issues and trends upon which policymakers need to focus when developing prevention strategies and allocating limited resources to the understanding and prevention of industrial-related injuries. In particular, the authors recommend examining additional details on the following topics:

•  Businesses that operate the Western region of the U.S.

•  Male workers, as well as elderly and young workers on both ends of the age spectrum

•  Serious injuries involving hospitalization that follow a visit to ER

•  Women working in heavy manufacturing and other high-risk occupations

•  Head and multiple-site injuries

•  Injuries caused by burns, freezing, heat stroke, electrocutions

Limitations and Next Steps

While this study has broken new ground by examining the data and trends from a lengthy swath of 14 years, its authors point out that the ICD-9 captures only those cases where the injured worker obtains medical assistance on an in-patient basis. This of course means that we’ve been presented with a study that underestimates not only the overall prevalence of these types of injuries, but the prevalence of lethal and major and minor nonlethal injuries that occur while employees are in the workplace. ICD-9 also fails to capture a significant portion of the societal costs associated with injuries that do not lead to in-patient hospitalizations. While suggesting that some of the study’s identified trends may reflect increased OSHA enforcement, the authors nevertheless recommend—as these authors often do—additional research with particular emphasis into the role that age plays on occupational injuries. Here’s hoping that the inevitable influx of data on injury type and severity, on racial and ethnic trends, and on indirect and tangible costs such as reduced productivity, premature mortality and increased absenteeism, will help to protect all workers—especially the aging ones—by reducing their risk of being hurt at work.

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