Medical care utilization for work-related injury health conditions in the United States 2002-2006

1. Medical care utilization for work-related injury health conditions in the United States2002-2006 By Terceira A. Berdahl, PhDAgency for Healthcare Research and QualityEmail: terceira.berdahl@ahrq.hhs.gov and Marc Zodet, MSAgency for Healthcare Research and QualityEmail: marc.zodet@ahrq.hhs.gov

2. Focus of our talk Workplace injuries and medical care Provide descriptive estimates of medical care for work injuries Examine racial-ethnic/gender disparities in work injuries Exploring racial-ethnic/gender disparities in health care utilization

3. Background 24 percent of workers experience work injuries at some point in their mid-careers. Work injuries are common and account for 30% of medically treated injuries in the United States. Of the millions of workers who are injured on the job each year, many seek healthcare.

4. Background Prior research on occupational health disparities finds inconsistent patterns of racial-ethnic and gender differences. Minority workers earn lower wages, disproportionately employed in low skilled jobs, overrepresented in the most dangerous occupations.

5. Medical Care for Work Injuries A large body of prior research documents racial-ethnic/gender disparities in healthcare access and utilization. Little research on healthcare access/use disparity patterns for injured workers.

6. Current study We examine work injuries and healthcare utilization. Nationally representative survey data from the Medical Expenditure Panel Survey (2002-2006). Sample includes broad age ranges, occupations, and industries.

7. Research Questions: Current Study What kinds of healthcare do individuals use when they suffer from work-related health problems? Do racial-ethnic/gender disparities exist for reporting a work-injury related health problem? Do racial-ethnic/gender disparities exist for treatment seeking among individuals who report being bothered by a work-related injury?

8. Data and Sample Medical Expenditure Panel Survey (MEPS). National probability sample survey that is representative of the U.S. civilian noninstitutionalized population. Workers aged 18 and older. To enhance the statistical power of the study we pooled cross-sectional MEPS data from years 2002-06. Thus, our findings represent the average annual odds of reporting a workplace injury and seeking treatment. We also present estimates of the total dollars spent on healthcare associated with these work-related injuries across all 5 years.

9. Outcome measures Descriptive Medical Expenditures. Total expenditures and types of treatment. Modeling Workplace Injury. A dichotomous measure of having any workplace accident/injury related condition in the past year. Healthcare Utilization. A dichotomous measure that is coded “1” if the person had any office-based, outpatient, emergency department, or inpatient services for a work injury and coded “0” if otherwise.

10. Independent Variables Race-ethnicity/sex subgroups. Race, ethnicity, and sex were used to create eight analysis subpopulations: White non-Hispanic men; black non-Hispanic men; other non-Hispanic men; Hispanic men; white women; black women; other race women; Hispanic women. Age. Four age categories: 18-24 years, 25-44 years, 45-64 years, and 65+ years. Education. Three categories: less than high school, high school, or more than high school. Occupation & Industry. Occupation consists of US Census 9-category occupation codes and 14-category industry codes. Insurance Status. Individuals are coded as having private insurance, public insurance, or no health insurance.

11. Analysis We perform descriptive and multivariate statistical analysis using STATA 10.0. Descriptive statistics on healthcare use, types of use, total expenditures for work injuries. Two sets of logistic regression models predicting 1) the odds of work injury 2) the odds of seeking treatment at selected points of service All estimates are weighted using the appropriate year sample weight and all estimates include standard errors adjusted for complex survey design.

12. Descriptive Findings Work related injuries comprised approximately 17% of all injury related medical conditions. Of workers aged 18 and over, 6% reported being bothered by a work-related health problem. Individuals with work injury-related conditions spend $1,843 on average per year for those medical expenses.

13. Descriptive findings… During the years 2002-2006, a total of $85.9 billion were spent on office-based, outpatient, emergency department, and inpatient services for workplace injuries. Among people with work injuries, nearly 40% of their total healthcare expenses were for work-related conditions.

14. What kinds of healthcare do individuals use when they suffer from work-related health problems?

15. Multivariate Findings Logistic regression models predicting The odds of reporting a work injury The odds of seeking treatment among those with work injuries

16. Do racial-ethnic/gender disparities exist for reporting a work injury related health problem?

17. Variables associated with work injury Education: higher educated workers had lower risk. Age: middle age categories are significantly more likely to be injured compared to young adults (age 18-24). Occupation: decreased risk for manager, services, sales and professional, increased risk for construction. Industry: increased risk for natural resources, construction, decreased risk for finance, professional and service work.

18. Do racial-ethnic/gender disparities exist for treatment seeking among individuals who report being bothered by a work-related injury?

19. Variables associated with healthcare use Age: the odds of seeking treatment oldest workers (age +65) were 46% lower compared to young adult workers (age 18-24) to seek treatment. Education: had no significant association with treatment seeking Occupation: had no significant association with treatment seeking Industry: had no significant association with treatment seeking Health Insurance: The odds of seeking treatment for uninsured workers were 33% lower compared to privately insured workers. We found no statistically significant difference between publicly and privately insured workers.

20. Discussion We find some evidence of racial-ethnic/gender disparities in reporting work-related health conditions. White men have greatest risk of injury. Black and Hispanic men had significantly lower risk. Women had significantly lower risk.

21. Discussion Health care use for workplace injury conditions. Less evidence of racial-ethnic gaps. White women more likely to see a doctor compared to white men. Older workers with work injuries less likely to seek treatment. Uninsured workers do not seek treatment at comparable rates—this may be an indicator of health care access barriers for workers without health insurance.

22. Conclusion Work injuries are costly to the health care system. Most workers with work-related injuries seek some form of healthcare treatment. Our utilization findings are exploratory first step. They suggest that access disparities may influence how people seek treatment for work-injury health problems. Given persistent disparities in employment outcomes and healthcare access, it is important to examine how racial-ethnic/gender differences shape work injury risk and healthcare use.