NYS Occupational Injury/Illness Priority Index. Presented at NYS Occupational Health Surveillance Workgroup Meeting January 2008

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1 NYS Occupational Injury/Illness Priority Index Presented at NYS Occupational Health Surveillance Workgroup Meeting January 2008

2 Introduction There were over 700,000 work-related injuries & illnesses in NYS between 2003 & NYS Workers Compensation paid out more than 9 billion dollars in claims between 2003 & The most severe work-place injuries & illnesses resulted in over 40,000 hospitalizations & over 700 deaths between 2003 & Majority of work-related injuries & illnesses are preventable.

3 NYS Data Sources NYS Work-related injury & illness data: - Bureau of Labor & Statistics (BLS): Survey of Occupational Injuries & Illnesses (SOII) - NYS Workers Compensation Board Injury & Illness Indemnity Claims NYS Occupational fatality data: - BLS: Census of Fatal Occupational Injuries (CFOI) NYS Work-related hospitalizations: - New York State Statewide Planning and Research Cooperative System (SPARCS) US Employment Projections: - BLS % Employment change from (NYS not available by industry)

4 NYS Data Sources BLS data: - record events that result in death, loss of consciousness, days away from work, restricted work, or medical treatment beyond first-aid. SOII: - Probability sample (not a census of all employers). - Employers only required to report on 30 cases of work-related injury with days away from work. - Excludes: Military, self-employed, farms with < 11 employees, & Federal agencies (NYS does collect public data). Workers Compensation: - All indemnity claims accepted by NYS workers compensation board in accident year 2004.

5 NYS Data Sources CFOI - Decedents occupation, work environment, equipment involved in death, and the event are collected. - Relies on records obtained from independent secondary sources (e.g: news papers/ reports, death certificates, workers compensation). - Cases are substantiated with two or more independent sources. - Record fatalities by the state in which the accident occurred, not state of residence, while rate calculation is based on the state of residence.

6 NYS Data Sources SPARCS: - Collects diagnoses (ICD-9), primary payer, demographic information, place & cause (Ecode) on every hospital discharge in NYS. - Work-relatedness = having an expected primary payer of workers compensation for the admission, is possible the primary diagnosis is not related to workers compensation claim. - Hospitalization suggests these are the most severe work-related injuries & illnesses (subject coding inconsistencies). - Industry and occupation of person admitted is not included.

7 Work-related Injuries/Illnesses: Calculating Priority in NYS - Occupational injuries & illnesses obtained from SOII for by major industry group. - Number & incidence rate were obtained by major industry group, for: All Injuries & Illnesses Injuries & Illnesses with Days Away from Work Injuries & Illnesses with Job Transfer - Number of cases and incidence rates per industry group were sorted in ascending order & ranked.

8 Work-related Injuries/Illnesses: Calculating Priority in NYS - Numeric rank for the number of cases and incidence rates were added together = priority score. - Priority score was then sorted in ascending order & ranked, with 1 being the lowest priority. - Overall Priority: -Indices for 3 inj/ill categories & Workers Compensation were adjusted by severity & summed = Priority Score. -Priority Score was adjusted by estimated growth in industry for U.S. = Adjusted Priority Score. -Adjusted Priority Score ranked, with 1 being lowest priority.

9 Work-related Injuries/Illnesses: All in NYS Industry Mean Count Count Rank Mining Agriculture/Forestry/Fishing Utilities 1,300 1,700 1,600 1,533 3 Education 3,500 4,300 3,900 3,900 4 Other Services 4,100 4,000 3,700 3,933 5 Information 4,000 4,500 3,500 4,000 6 Financial Activities 5,800 6,300 6,200 6,100 7 Wholesale Trade 9,400 10,400 9,800 9,867 8 Professional/ Business 13,100 9,200 12,800 11,700 9 Construction 11,300 13,300 11,800 12, Transportation 14,000 12,100 13,300 13, Leisure/ Hospitality 13,500 13,000 13,800 13, Retail Trade 23,700 26,000 25,400 25, Manufacturing 28,100 24,600 23,500 25, Health Care 39,500 36,500 46,300 40, Data derived from SOII for NYS.

10 Work-related Injuries/Illnesses: All in NYS Industry Mean IR IR Rank Financial Activities Professional/ Business Information Other Services Education Mining Wholesale Trade Leisure/ Hospitality Retail Trade Utilities Construction Manufacturing Health Care Agriculture/Forestry/Fishing Transportation Data derived from SOII for NYS. IR = incidence rate based on 100 full time workers.

11 Work-related Injuries/Illnesses: All in NYS Industry Count Rank IR Rank Priority Score Priority Index Mining Financial Activities Education Other Services Information Professional/ Business Utilities Wholesale Trade Agriculture/Forestry/Fishing Leisure/ Hospitality Construction Retail Trade Transportation Manufacturing Health Care Note: A Priority Index score of 1 is lowerst priority. Data Derived from SOII for NYS. Priority Score = Count Rank + IR Rank.

12 Work-related Injuries/Illnesses: Days Away from Work in NYS Industry Mean Count Count Rank Mining Agriculture/Forestry/Fishing Utilities Education 1,700 1,700 1,400 1,600 4 Other Services 2,300 2,000 1,900 2,067 5 Information 2,300 2,900 2,200 2,467 6 Financial Activities 3,100 3,100 3,300 3,167 7 Leisure/ Hospitality 6,000 4,400 4,200 4,867 8 Wholesale Trade 5,000 6,000 6,000 5,667 9 Professional/ Business 6,600 4,500 6,000 5, Construction 6,300 7,500 6,400 6, Transportation 9,700 7,600 7,700 8, Manufacturing 11,500 10,800 9,900 10, Retail Trade 10,600 12,800 12,000 11, Health Care 21,600 18,200 21,200 20, Data derived from SOII for NYS.

13 Work-related Injuries/Illnesses: Days Away from Work in NYS Industry Mean IR IR Rank Financial Activities Professional/ Business Education* Other Services Information Leisure/ Hospitality Mining Wholesale Trade Utilities Manufacturing Retail Trade Health Care Construction Agriculture/Forestry/Fishing Transportation Data derived from SOII for NYS. IR = incidence rate based on 100 full time workers.

14 Work-related Injuries/Illnesses: Days Away from Work in NYS Industry Count Rank IR Rank Priority Score Priority Index Education Mining Financial Activities Other Services Information Utilities Professional/ Business Leisure/ Hospitality Agriculture/Forestry/Fishing Wholesale Trade Manufacturing Construction Retail Trade Transportation Health Care Note: A Priority Index score of 1 is lowerst priority. Data Derived from SOII for NYS. Priority Score = Count Rank + IR Rank.

15 Work-related Injuries/Illnesses: w/job Transfer in NYS Industry Mean Count Count Rank Mining* Information* Agriculture/Forestry/Fishing* Education Leisure/ Hospitality* Other Services Financial Activities* Utilities Construction Professional/ Business Health Care* Wholesale Trade , Transportation , Retail Trade , Manufacturing , Data derived from SOII for NYS. * Number of cases is < 15 and is assigned a zero value.

16 Work-related Injuries/Illnesses: w/job Transfer in NYS Industry Mean IR IR Rank Information* Financial Activities* Professional/ Business* Education* Leisure/ Hospitality* Health Care* Other Services* Construction Mining* Wholesale Trade Retail Trade Agriculture/Forestry/Fishing Transportation Manufacturing Utilities Data derived from SOII for NYS. * Incidence rate is < 0.05 and is assigned a zero value. IR = incidence rate based on 100 full time workers.

17 Work-related Injuries/Illnesses: w/job Transfer in NYS Industry Count Rank IR Rank Priority Score Priority Index Information Education Leisure/ Hospitality Financial Activities Mining Other Services Professional/ Business Agriculture/Forestry/Fishing Construction Health Care Wholesale Trade Utilities Retail Trade Transportation Manufacturing Note: A Priority Index score of 1 is lowest priority. Data Derived from SOII for NYS. Priority Score = Count Rank + IR Rank.

18 Injury & Illness Claims to Workers Compensation in NYS Industry 2004 Indemnity Cases Count Rank Mining 78 1 Agriculture/Forestry/Fishing Utilities Other Services 1,751 4 Information 1,931 5 Financial Activites 3,330 6 Wholesale Trade 4,118 7 Leisure/Hospitality 4,531 8 Professional/Business 4,736 9 Construction 6, Manufacturing 9, Education 5, Transportation 6, Retail Trade 7, Health care 14, Data derived from NYS Workers' Compensation data for accident year 2004.

19 Work-related Injuries/Illnesses: NYS Overall Industry All Days Away* Job Transfer** WC Claims*** Priority Score Growth Adj. Adj. Priority Score Priority Index Mining % Financial Activities % Information % Agriculture/Forestry/Fishing % Other Services % Education % Utilities % Professional/ Business % Leisure/ Hospitality % Whoesale Trade % Construction % Manufacturing % Retail Trade % Transportation % Health Care % Note: A priority index score of 1 is lowest priority WC Claims = NYS Workers' Compensation Accepted Indemnity Claims for Accident Year 2004 Priority Score = All + Days Away* + Job Transfer**+ Workers' Comp Growth Adj. = Estimated Growth in Industry between ( Adjusted Priority Score = Priority Score + (Growth Estimate x Priority Score). * The rank for those injuries and illnesses with days away from work were weighted: Rank x 1.25 **The rank for those injuries and illnesses that required job transfer were weighted: Rank x 1.75 ***The rank for those injuries and illnesses that had accepted claims from NYS workers' compensation were weighted: Rank x 2.0

20 Work-related Fatalities: Calculating Priority in NYS Occupational fatalities obtained from CFOI for by major industry group for NYS. Number of fatalities each year was summed & adjusted by the estimated growth of that industry for U.S.= priority score. Priority scores were sorted in ascending order & ranked, with 1 being the lowest priority. Performed separately for NYC & NYS w/o NYC (results not shown here).

21 Work-related Fatalities: NYS Industry Mean Deaths Priority Score Growth Estimate** Adjusted Priority Score Priority Index Mining* % Utilities* % Information* % Education* % Health Care % Financial Activities % Manufacturing % Wholesale Trade % Agriculture/Forestry/Fishing % Other Services % Leisure/ Hospitality % Retail Trade % Professional/ Business % Transportation % Construction % Data Derived from CFOI for NYS. Note: A priority index score of 1 is lowest priority Priority Score = Ordinal Rank of Mean deaths Adjusted Priority Score = Priority Score + (Growth Estimate x Priority Score). * Zero cells indicate no data or data that did not meet CFOI publication criteria (< 3 deaths). **Growth Estimate based on U.S BLS projections (

22 Work-related Hospitalizations: Calculating Priority in NYS Injury & illness defined as work-related if expected primary payer was workers compensation. Number of admissions, median length of stay, and median $/day were all sorted in ascending order & their ranks were summed = priority score. Priority score was sorted in ascending order = priority index, with a 1 being lowest priority. Priority Index was created for major diagnosis, injuries/poisonings, cause of injury & place injury occurred.

23 Work-related Hospitalizations: Major Diagnosis in NYS Major Diagnosis Groups Mean Count Count Rank Sensory Organ Disease Diseases of the Blood Neoplasms Infectious/Parasitic Disease Genitourinary System Disease Endocrine/Metabolic Disease Nervous System Disease Respiratory Sysytem Disease Mental Disorders Digestive System Disease Skin Disease Ill-defined Conditions Circulatory System Disease Injury/Poisoning 4,912 5,005 4,783 4, Musculoskeletal Disease 5,610 5,804 5,496 5, Data derived from NYS SPARCS.

24 Work-related Hospitalizations: Major Diagnosis in NYS Major Diagnosis Groups 2003* 2004* 2005* Mean LOS LOS Rank Ill-defined Conditions Sensory Organ Disease Nervous System Disease Digestive System Disease Circulatory System Disease Genitourinary System Disease Injury/Poisoning Musculoskeletal Disease Skin Disease Diseases of the Blood Endocrine/Metabolic Disease Respiratory Sysytem Disease Mental Disorders Neoplasms Infectious/Parasitic Disease * Median value for this Year Data derived from NYS SPARCS.

25 Work-related Hospitalizations: Major Diagnosis in NYS Major Diagnosis Groups 2003* 2004* 2005* Mean $/day $/day Rank Mental Disorders 1,315 1,226 1,253 1,265 1 Skin Disease 2,314 2,474 2,783 2,523 2 Respiratory Sysytem Disease 2,578 2,884 3,033 2,832 3 Genitourinary System Disease 2,905 3,114 3,203 3,074 4 Endocrine/Metabolic Disease 2,785 3,342 3,144 3,090 5 Sensory Organ Disease 3,394 2,592 3,571 3,186 6 Infectious/Parasitic Disease 3,069 3,242 3,861 3,391 7 Diseases of the Blood 3,053 2,197 5,341 3,531 8 Neoplasms 3,161 3,386 4,075 3,540 9 Digestive System Disease 3,578 4,211 4,193 3, Ill-defined Conditions 3,801 4,305 4,777 4, Circulatory System Disease 3,669 4,495 4,827 4, Nervous System Disease 3,999 4,081 5,021 4, Injury/Poisoning 4,069 4,497 5,246 4, Musculoskeletal Disease 5,860 6,920 7,899 6, * Median value for this Year Data derived from NYS SPARCS.

26 Work-related Hospitalizations: Major Diagnosis in NYS Major Diagnosis Groups Count Rank LOS Rank $/day Rank Priority Score Priority Index Sensory Organ Disease Genitourinary System Disease Diseases of the Blood Skin Disease Endocrine/Metabolic Disease Respiratory Sysytem Disease Nervous System Disease Mental Disorders Digestive System Disease Ill-defined Conditions Neoplasms Infectious/Parasitic Disease Circulatory System Disease Injury/Poisoning Musculoskeletal Disease Data derived from NYS SPARCS. Priority Score = Count Rank + LOS Rank + $/day Rank.

27 Work-related Hospitalizations: Injuries/Poisonings in NYS Injury/ Poisoning Groups Mean Count Count Rank Nonmedicinal Toxic Effect Spinal/ Nerve Injury Unspecified Traumatic Complications Dislocation Internal Damage Crushing Injury Skull Fracture Intracranial Injury Burns Sprains/Strains Neck Fracture Open Wound Upper Limb Fracture Medical Complications Lower Limb Fracture 1,041 1, , Note: Those injuries/poisonings with a mean of < 20 cases between 2003 and 2005 were not prioritized: Foreign body injuries, Injured blood vessels, Late effects of accident, Poisoning, & Superficial wounds. Data derived from NYS SPARCS.

28 Work-related Hospitalizations: Injuries/Poisonings in NYS Injury/ Poisoning Groups 2003* 2004* 2005* Mean LOS LOS Rank Nonmedicinal Toxic Effect Sprains/Strains Unspecified Crushing Injury Dislocation Intracranial Injury Open Wound Upper Limb Fracture Spinal/ Nerve Injury Lower Limb Fracture Medical Complications Skull Fracture Internal Damage Neck Fracture Burns Traumatic Complications * Median value for this Year Note: Those injuries/poisonings with a mean of < 20 cases between 2003 and 2005 were not prioritized: Foreign body injuries, Injured blood vessels, Late effects of accident, Poisoning, & Superficial wounds. Data derived from NYS SPARCS.

29 Work-related Hospitalizations: Injuries/Poisonings in NYS Injury/ Poisoning Groups 2003* 2004* 2005* Mean $/day $/day Rank Unspecified 4,132 3,739 4,206 4,026 1 Neck Fracture 3,501 4,106 4,558 4,055 2 Crushing Injury 3,618 3,754 4,858 4,077 3 Lower Limb Fracture 3,686 4,147 4,869 4,234 4 Nonmedicinal Toxic Effect 4,537 3,745 4,608 4,297 5 Open Wound 3,921 4,235 4,840 4,332 6 Internal Damage 3,761 4,161 5,191 4,371 7 Traumatic Complications 4,563 3,778 4,936 4,426 8 Medical Complications 3,936 4,491 5,145 4,524 9 Skull Fracture 4,168 5,149 5,553 4, Spinal/ Nerve Injury 3,431 4,635 7,259 5, Burns 4,572 5,540 5,392 5, Intracranial Injury 4,423 5,136 5,967 5, Upper Limb Fracture 4,672 4,883 6,245 5, Dislocation 4,565 5,542 7,175 5, Sprains/Strains 5,162 6,489 6,120 5, * Median value for this Year Note: Those injuries/poisonings with a mean of < 20 cases between 2003 and 2005 were not prioritized: Foreign body injuries, Injured blood vessels, Late effects of accident, Poisoning, & Superficial wounds. Data derived from NYS SPARCS.

30 Work-related Hospitalizations: Injuries/Poisonings in NYS Injury/ Poisoning Groups Count Rank LOS Rank $/day Rank Priority Score Priority Index Unspecified Nonmedicinal Toxic Effect Crushing Injury Spinal/ Nerve Injury Open Wound Dislocation Internal Damage Neck Fracture Traumatic Complications Intracranial Injury Sprains/Strains Lower Limb Fracture Skull Fracture Upper Limb Fracture Medical Complications Burns Note: Those injuries/poisonings w ith a mean of < 20 cases betw een 2003 and 2005 w ere not prioritized: Foreign body injuries, Injured blood vessels, Late effects of accident, Poisoning, & Superficial w ounds. Priority Score = Count Rank + LOS Rank + $/day Rank. Data derived from NYS SPARCS.

31 Work-related Hospitalizations: Injury/Poisonings by Cause in NYS Injury/Poisoning Cause Mean Count Count Rank Accidental Poisoning by Other Substance Late Effects of Accident Accident Caused by Environmental Factors Motor Vehicle Nontraffic Accident Accidents Caused by Fire Homicide/Violence by Other Person Motor Vehicle Traffic Accident Medical Complications Other Accident 1,423 1,541 1,411 1,458 9 Accidental Fall 1,587 1,533 1,441 1, Note: Those injuries/poisonings with a mean of < 20 cases between 2003 and 2005 were not prioritized: Accidental poisoning by drugs, Adverse drug/medicinal/biological effect, Air/Space transport accident, Legal intervention, Misadventures in surgery/medical care, Missing E-code, Other road vehicle accident, Railway accident, Submersion/Suffocation/Foreign Body, Suicide/Self-inflicted injury, Terrorism, Unknown if self-inflicted or accidental injury, Vehicle accident NEC, War, & Water transport accident. Data derived from NYS SPARCS.

32 Work-related Hospitalizations: Injuries/Poisonings by Cause in NYS Injury/Poisoning Cause 2003* 2004* 2005* Mean LOS LOS Rank Accidental Poisoning by Other Substance Accident Caused by Environmental Factors Other Accident Homicide/Violence by Other Person Motor Vehicle Nontraffic Accident Motor Vehicle Traffic Accident Accidental Fall Late Effects of Accident Medical Complications Accidents Caused by Fire * Median value for this Year Note: Those injuries/poisonings with a mean of < 20 cases between 2003 and 2005 were not prioritized: Accidental poisoning by drugs, Adverse drug/medicinal/biological effect, Air/Space transport accident, Legal intervention, Misadventures in surgery/medical care, Missing E-code, Other road vehicle accident, Railway accident, Submersion/Suffocation/Foreign Body, Suicide/Self-inflicted injury, Terrorism, Unknown if self-inflicted or accidental injury, Vehicle accident NEC, War, & Water transport accident. Data derived from NYS SPARCS.

33 Work-related Hospitalizations: Injuries/Poisonings by Cause in NYS Injury/Poisoning Cause 2003* 2004* 2005* Mean $/day $/day Rank Accident Caused by Environmental Factors 3,102 2,834 4,277 3,405 1 Accidental Poisoning by Other Substance 3,510 3,680 5,570 4,254 2 Homicide/Violence by Other Person 3,704 4,065 5,183 4,317 3 Other Accident 4,046 4,479 4,982 4,502 4 Medical Complications 3,908 4,492 5,144 4,514 5 Motor Vehicle Nontraffic Accident 3,762 5,083 4,747 4,531 6 Accidental Fall 4,066 4,430 5,207 4,568 7 Late Effects of Accident 5,809 5,414 4,253 5,159 8 Motor Vehicle Traffic Accident 4,444 4,856 6,370 5,223 9 Accidents Caused by Fire 4,805 5,793 6,187 5, * Median value for this Year Note: Those injuries/poisonings with a mean of < 20 cases between 2003 and 2005 were not prioritized: Accidental poisoning by drugs, Adverse drug/medicinal/biological effect, Air/Space transport accident, Legal intervention, Misadventures in surgery/medical care, Missing E-code, Other road vehicle accident, Railway accident, Submersion/Suffocation/Foreign Body, Suicide/Self-inflicted injury, Terrorism, Unknown if self-inflicted or accidental injury, Vehicle accident NEC, War, & Water transport accident. Data derived from NYS SPARCS.

34 Work-related Hospitalizations: Injuries/Poisonings by Cause in NYS Injury/Poisoning Cause Count Rank LOS Rank $/day Rank Priority Score Priority Index Accidental Poisoning by Other Substance Accident Caused by Environmental Factors Homicide/Violence by Other Person Motor Vehicle Nontraffic Accident Other Accident Late Effects of Accident Medical Complications Motor Vehicle Traffic Accident Accidental Fall Accidents Caused by Fire Note: Those injuries/poisonings with a mean of < 20 cases between 2003 and 2005 were not prioritized: Accidental poisoning by drugs, Adverse drug/medicinal/biological effect, Air/Space transport accident, Legal intervention, Misadventures in surgery/medical care, Missing E-code, Other road vehicle accident, Railway accident, Submersion/Suffocation/Foreign Body, Suicide/Self-inflicted injury, Terrorism, Unknown if self-inflicted or accidental injury, Vehicle accident NEC, War, & Water transport accident. Priority Score = Count Rank + LOS Rank + $/day Rank. Data derived from NYS SPARCS.

35 Conclusions Top 5 Industries for Work-related Injuries & Illnesses: 1- Health Care 2- Transportation 3- Retail Trade 4- Manufacturing 5- Construction

36 Conclusions Top 5 Industries for Work-related Fatalities: 1- Construction 2- Transportation 3- Professional/ Business 4- Retail Trade 5- Leisure/ Hospitality

37 Conclusions Top 5 Work-related Major Diagnoses Hospitalizations: 1- Musculoskeletal Disease 2- Injury/ Poisoning 3- Circulatory System Disease 4- Infectious/ Parasitic Disease 5- Neoplasms

38 Conclusions Top 5 Work-related Injury/ Poisoning Hospitalizations: 1- Burns 2- Medical Complications 3- Upper Limb Fracture 4- Skull Fracture 5- Lower Limb Fracture

39 Conclusions Top 5 Work-related Causes of Injury/ Poisoning Hospitalizations: 1- Accidents Caused by Fire 2- Accidental Falls 3- Motor Vehicle Traffic Accident 4- Medical Complications 5- Late Effects of Accident

40 Conclusions < 1% of injuries/poisonings had a missing cause code. ~33% of injuries/poisonings had a missing place code. Unable to adequately prioritize place of injury/poisoning due to high proportion of missing place codes.

41 Recommendations Use priority index method to target work-related injury and illness prevention on lower levels (e.g., geography, race, age). Utilize scientific and clinical partners to target interventions to high priority industries.

42 Future Research Study the reliability and validity of using the expected payer Workers Compensation as an indicator of workrelatedness when prioritizing work-related hospitalizations in NYS. Analyze the priority indices over time.

43 Questions? Are they ways to improve these indices? Do you know of any other data sources that could be used to refine these indices? Should this index be applied to our prevention efforts, and if so how?

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