Using the Functional Comorbidity Index with Administrative Workers’ Compensation Data: Utility, Validity, and Caveats

Details

• Personal Author:
  Franklin GM ; Fulton-Kehoe D ; Hogg-Johnson S ; Rundell SD ; Sears JM
• Description:
  Background: Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data.The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. Methods: WC data were linked to a prospective survey in Ohio (N= 512) and Washington (N= 2,839). Workers were interviewed 6 weeks and 6 months after work- related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes. Results: The WC based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC based FCI moved the estimate away from null (8.95% change). Conclusions: The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC based FCI in studies involving multiple states. [Description provided by NIOSH]
• Subjects:
  Chronic Disease Epidemiology Occupational Health Safety
• Keywords:
  Author Keywords: Administrative Data Chronic Diseases Chronic Health Conditions Functional Comorbidity Index Injuries Surveillance Workers' Compensation Workers Compensation
• ISSN:
  0271-3586
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Ohio ; OSHA Region 10 ; OSHA Region 5 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  99-109
• Volume:
  67
• Issue:
  2
• NIOSHTIC Number:
  nn:20068816
• Citation:
  Am J Ind Med 2024 Feb; 67(2):99-109
• Contact Point Address:
  Jeanne M. Sears, Department of Health Systems and Population Health, University of Washington, Box 357660, Seattle, WA 98195
• Email:
  jeannes@uw.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20220930
• Source Full Name:
  American Journal of Industrial Medicine
• End Date:
  20240929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:daa11e24a229a8497469c4124298034499add6a1dec0e01d60b7eae5839925149091f9132f35a156062ab891654f8e512ec2ac0132e737b525c6423b36dadd8c
• Download URL:
  https://stacks.cdc.gov/view/cdc/207391/cdc_207391_DS1.pdf
• File Type:
  [PDF - 653.93 KB ]