Boston, MA: Massachusetts Department of Public Health, Technical Report OHSP-0501, 2005 Oct; :1-65
Analyses of Massachusetts hospital discharge data for calendar years 1996 to 2000 were performed to identify hospitalizations that were primarily for the treatment of work-related injuries and illnesses. It was hoped that examining the nature of these inpatient stays could provide information about the nature and extent of serious work-related health conditions that is not currently available from other sources. Expected payment by workers' compensation (WC) insurance was used as an indicator of probable work-relatedness of the patient's condition. Additional analyses were performed to examine data on inpatient stays that were not paid for by workers' compensation, but which involved health conditions that typically result from workplace exposure to hazardous substances. Some of the major findings of the study include: 1) There were 20,457 hospitalizations in Massachusetts for treatment of work-related injuries and illnesses paid for by workers' compensation insurance during the five-year period from 1996 through 2000. This represented 0.56% of all hospitalizations in the state and 1.2% of hospitalizations involving working-age adults (16-64 years of age). 2) Hospital charges for treatment of work-related injuries and illnesses totaled over $266 million. These work-related injuries and illnesses required almost 74,000 days of inpatient care, an average of 3.6 days per stay. 3) Over three-quarters of hospitalizations (77.7%) were among men and 22.3% were among women. The mean age of a patient receiving inpatient care for a work-related condition was 43.1 years old. Only 1.3% of work-related hospitalizations were for patients younger than 20 years old and 4.8 percent were for patients age 65 or older. About 84.4% of persons hospitalized for treatment of occupational injuries or illnesses were white, 4.4% were black, and 4.4% were Hispanic. 4) Musculoskeletal disorders were the most common type of work-related condition requiring hospitalization, representing 42.5% of all inpatient stays for work-related disorders. About half (49.2%) of these were for intervertebral disc disorders. On average, an inpatient stay for treatment of a work-related musculoskeletal disorder lasted 2.6 days and had an associated hospital charge of $11,292. Compared to hospitalizations for musculoskeletal disorders among working age (16-64 years old) patients paid for by sources other than workers' compensation, the work-related cases had a shorter average length of stay (2.6 vs. 3.6 days) and a lower average hospital charge ($11,220 vs. $13,832).) Acute injuries and poisonings accounted for 38.5% of all hospitalizations for work-related conditions. On average, an inpatient stay for treatment of an acute injury or poisoning lasted 4.3 days and had an associated hospital charge of $15, 909.) Fractures (50.3%), sprains and strains (14.1%) and open wounds (7.8%) were the most common types of work-related injuries and poisonings requiring hospitalization. Of these injuries, 41.5% were caused by falls and 12.2% were caused by the workers' interaction with machinery. 7) Burns had a comparatively high average hospital charge ($43,176) and length of stay (9.4 days). Burns accounted for a disproportionately large share of the total charges for work-related injuries and poisonings. Whereas burns comprised just 5.8% of the work-related injury and poisoning cases they accounted for 13.3% of the total hospital charges for these cases.) Sixty-one percent of hospitalized crushing injuries, 35.5% of hospitalized amputations, and 24.0% of hospitalized burns among working-age adults (16- 64 years) were work-related. Work-related inpatient stays paid by workers' compensation comprised 7.9% of all hospitalizations for injuries and poisonings among working-age adults. 9) Hispanic patients accounted for a disproportionately high percentage of the hospitalizations for certain types of work-related injuries: 15.4% of burns, 13.9% of amputations, 11.5% of crushing injuries, and 8.7% of open wounds. Hispanic patients accounted for 4.6% of all work-related hospitalizations and 6.5% of hospitalizations that were not work-related. This suggests that Hispanic workers are at greater risk for suffering these particular types of traumatic work-related injuries.) Among Massachusetts youths ages 14 to 17 years, there were 58 hospitalizations for treatment of work-related injuries and illnesses between 1996 and 2000. About half (46%) of the work-related conditions suffered by these teens were fractures, 14% were open wounds, 10% were burns, 10% were crushing injuries, and 10% were infections. 11) Numerous hospital inpatient stays not paid for by workers' compensation had diagnoses probably or possibly resulting from occupational exposures. These included 3,798 cases of pneumoconiosis of which 3,344 had asbestosis listed as either a primary or a secondary diagnosis. There were also 114 hospitalizations for allergic alveolitis and pneumonitis, and 637 inpatient stays resulting from unintentional exposure to chemicals of a type commonly used in industrial environments. Data limitations should be considered in interpreting these study findings: 1) Use of payment by workers' compensation as an indicator of work-relatedness likely underestimates the true extent of hospitalizations for work-related conditions. Some individuals injured at work, including the self-employed who comprise approximately 6% of the Massachusetts workforce, are not eligible for workers' compensation insurance. Others who are eligible may not file workers' compensation claims. 2) While external cause of injury codes (E-codes) are generally accurate for broad cause of injury categories, they may be less accurate for detailed causes of injury presented in this report (i.e., falls, burns, machinery injuries). 3) Hospitalizations presented in this report may include multiple hospitalizations for single individuals. The extent of repeated hospitalizations is addressed in an Appendix to this report. This exploratory examination of hospital discharge data has demonstrated that the data are useful in describing the nature and extent of serious work-related conditions in Massachusetts. The hospital data are readily available and contain a variety of information concerning the nature and cause of injury, patient characteristics, and types of medical services provided. Unlike many other data sources used for occupational health surveillance, the hospital discharge data set captures information about all injuries, work-related and non-work-related. It therefore allows assessment of the contribution of work-related injuries to the overall injury burden, fostering integrated approaches to prevention that cross public health disciplines (e.g. injury control and occupational health). While it is likely that not all hospitalizations for work-related conditions are identified using payment by workers' compensation as an indicator of work-relatedness, the outcomes of this study are sufficient to warrant periodic use of hospital inpatient data as a supplement to other occupational health surveillance activities. Possible strategies for further enhancing the usefulness of hospital discharge data for occupational health surveillance include: recording and collection of information about the work-relatedness of patient's condition; recording and collection of information about the patient's activity at the time of injury; inclusion of a dedicated E-code field to capture location where injury took place; ensuring accurate "E-code" information about the external cause of injuries; expanding the collection and reporting of information about the patient's employer; and linking the hospital discharge data with workers' compensation claims data from the state Department of Industrial Accidents.
Massachusetts Department of Public Health, Center for Health Information, Statistics, Research and Evaluation, Occupational Health Surveillance Program, 250 Washington Street, 6th Floor, Boston, MA 02108