Racial disparities in occupational injury: obscured by administrative data?

Details

• Personal Author:
  Boden LI ; Hashimoto D ; Hopcia K ; Sabbath EL ; Sorensen, Glorian ; Williams JAR
• Description:
  Statement of the problem: Minority and otherwise marginalized workers are disproportionately exposed to dangerous working conditions. As a result, health outcomes associated with adverse working conditions often occur along social and economic gradients. Although occupational health disparities overall are well-documented, barriers remain to understanding the true nature of injury reporting disparities, most as a result of the limitations of administrative injury data. Thus, the extent of differential injury undercount by demographic group is unknown. Our aim was to determine whether reporting discrepancies between self-reported and administratively-reported injuries varied by racial and ethnic groups by comparing self-reported and administrative injury data on the same workers over the same time period. We hypothesized that we would detect greater racial and ethnic disparities in injury using self-reported rather than administrative data. Procedures: The study took place in a cohort of patient care workers employed in two large hospitals in the Boston area. In September 2012, 2,000 workers were randomly sampled for the survey; of those, 1,594 (79%) responded and were included. We eliminated participants missing data on self-reported race and ethnicity (n=15) or self-reported injury (n=11) for a final n of 1,568. Occupational injury was measured by both self-report and through administrative data. On the self-report survey, respondents were asked, "During the past 12 months, including sharps injuries, were you injured seriously enough while performing your job that you got medical advice or treatment or lost time from work?" To capture administratively-reported injuries, we used data on OSHA-reportable injuries from the hospital's administrative injury database (hereafter referred to as "administrative data" or "administratively-reported injuries") and merged those data with survey data at the worker level using secure study ID numbers. In the survey, workers were asked, "Do you consider yourself Latino or Hispanic?" They were then asked "How would you describe your race? Please check all that apply" (response options: Native American or Alaska Native; Asian, Asian American; Native Hawaiian or Pacific Islander; Black, African-American; White; and Other). We recoded the preceding variables into a single race/ethnicity variable with categories Hispanic; non-Hispanic White; non-Hispanic black; mixed race/other. Analyses: We first examined distribution of the two types of injury outcomes overall and by race/ethnicity. We used logistic regression to model two these two binary outcomes-self-reported injury and administratively-reported injury-adjusting progressively for demographic/personal and then occupational covariates. Results: Approximately 81% of the sample identified as non-Hispanic white (n=1266); 4% (n=64) identified as Hispanic, 8% (n=131) identified as non-Hispanic black, and 7% (n=107) identified as mixed-race or other. Overall, 16% of workers reported on the survey that they were injured during the year prior; self-admitted reporting practices varied significantly (p<0.001) by race and ethnicity. We also examined injury patterns using administratively-reported injuries from the database, finding that the overall injury rate was 8% with no significant variation by race/ethnicity. In models adjusted for age, sex, immigration status, personal financial distress, worksite, shift, and job title, for self-reported injury, black workers had an elevated risk of injury compared with white workers (OR 1.91, 95% CI 1.04,3.49), but Hispanic workers did not (OR 1.27, 95% CI 0.60,2.72). In contrast, in adjusted models for administratively-reported injury, neither black workers (OR 1.22, 95% CI 0.54,2.77) nor Hispanic workers (OR 1.01, 95% CI 0.39,2.66) were at significantly greater risk than white workers. Conclusions and practical implications: Compared with white workers, black workers had significantly increased risk of injury when asked via self-report, but not when using administrative injury data. Findings suggest that undercounting of injuries in employers' administrative data (on which national injury data are based) may be relatively higher among black workers, obscuring racial disparities in injury risk. This study raises two key questions. First, why do administrative and self-report data present different pictures of racial disparities in occupational injury? Second, why, after reducing barriers to reporting as in a confidential survey versus an administrative report, do black workers have higher injury rates than white workers? The practical implications of this study are twofold: first, that hospitals need to reduce barriers to injury reporting, especially among minority workers, because administrative injury data is used for surveillance and policymaking at both the institutional and state levels; and second, that workplaces should address underlying reasons that minority workers, particularly black workers, may be injured at higher rates than white workers. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Epidemiology Healthcare Disparities Health Personnel Minority Health Occupational Health Race Factors Safety
• Keywords:
  TWH; Total Worker Health; Health disparities; Racial factors; Minority health; Injuries; Cohort studies; Epidemiology; Health care workers
• Publisher:
  American Psychological Association
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• Place as Subject:
  Kansas ; Massachusetts ; Minnesota ; OSHA Region 1 ; OSHA Region 5 ; OSHA Region 7
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-2
• NIOSHTIC Number:
  nn:20065685
• Citation:
  Work, Stress and Health 2017: Contemporary Challenges and Opportunities, The 12th International Conference on Occupational Stress and Health, June 7-10, 2017, Minneapolis, Minnesota. Washington, DC: American Psychological Association, 2017 Jun; :1-2
• Contact Point Address:
  Erika L. Sabbath, ScD, School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
• Email:
  erika.sabbath@bc.edu
• Federal Fiscal Year:
  2017
• NORA Priority Area:
  Healthcare and Social Assistance ; Construction
• Performing Organization:
  Harvard University, Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20070901
• Source Full Name:
  Work, Stress and Health 2017: Contemporary Challenges and Opportunities, The 12th International Conference on Occupational Stress and Health, June 7-10, 2017, Minneapolis, Minnesota
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:94c9259b5cf9dbc274c2d2c92d88911969847b57228e37861dedc8503286894681946950d31015d3504dfefc551704822fb6176671650c6959106254aa11f0f3
• Download URL:
  https://stacks.cdc.gov/view/cdc/249509/cdc_249509_DS1.pdf
• File Type:
  [PDF - 232.25 KB ]