Medical expenditures of work-related injuries among immigrant workers in USA

Transcription

1 Medical expenditures of work-related injuries among immigrant workers in USA Huiyun Xiang, MD, MPH, PhD Associate Professor Director for International Programs Center for Injury Research and Policy The Ohio State University College of Medicine 2011 SAVIR Conference, Iowa

2 1 st Question to You? What comes to your mind when the term immigrant workers is mentioned to you?

3 2nd Question to You? In terms of unintentional work-related injuries, do you think immigrants have higher or lower injury prevalence compared with native-born?

4 Outline of My Presentation Part 1: Behavioral risk factors and unintentional injuries among immigrant adults in the U.S.A Part 2: Work-related injuries among immigrant workers Part 3: Comparison of medical expenditures of work-related injuries between US-born and immigrant individuals

5 Our Research Project 1 Behavioral Risk Factors and Unintentional Injuries Among US Immigrant Adults (Xiang H, Yu S, Zhang X, Scurlock S, Smith GA, and Stallones L. Risk behavioral factors and unintentional injuries among US immigrant and US-born adults. Ann Epidemiol 2007; 17(11): )

6 National Epidemiologic Survey on Alcohol and Related Conditions N= 43,093 Nationallyrepresentative survey Response rate: 81%

7 Injury Question In the past 12 months, how many injuries have you had that caused you to seek medical help or to cut down your usual activities for more than half a day?

8 Injury Prevalence (%) US-born Immigrants Prevalence Ratio Gender Males 20.9% 14.4% 1.45 ( )** Females 17.8% 12.4% 1.43 ( )**

9 Injury Prevalence (%) US-born Immigrants Prevalence Ratio Age % 12.7% 1.81 ( )** % 13.0% 1.54 ( )** % 14.6% 1.06 ( )

10 10 Injury-related Risk Behaviors in NESARC 1. Tobacco Use 2. Drug abuses 3. Alcohol drinking 4. Heavy alcohol drinker 5. Drinking & driving 6. Heavy drinking (3+ drinks) & driving 7. Rode in vehicle of drinking driver 8. Reckless driving (ever) 9. Driver s license suspended 10. Do things easily hurt him/herself or others

11 Behavioral Risk Factors & Injury % Injury% Total Number of Risk Behaviors (out of 10 Risk Behaviors)

12 Injury Prevalence (%) Behavioral Risk Factors and Injuries US-born males Immigrant males Number of Behavioral Risk Factors for Injury

13 Injury Prevalence (%) Behavioral Risk Factors and Injuries US-born females Immigrant females Number of Behavioral Risk Factors for Injury

14 Injury Prevalence (%) Behavioral Risk Factors and Injuries US-born White-NonHispanic Immigrant White-NonHispanic Num ber of Behavioral Risk Factors for Injury

15 Injury Prevalence (%) Behavioral Risk Factors and Injuries 40 US-born Black-NonHispanic Number of Behavioral Risk Factors for Injury

16 Injury Prevalence (%) Behavioral Risk Factors and Injuries US-born Hispanic Immigrant Hispanic Num ber of Behavioral Risk Factors for Injury

17 Injury Prevalence (%) Behavioral Risk Factors and Injuries US-born Asian Immigrant Asian Num ber of Behavioral Risk Factors for Injury

18 Comparison of Risk Behaviors Between USborn and Immigrant Adults US-Born Immigrants 1. Current tobacco Use (%) 28.0% 15.3% 2. Current drug abuses 6.3% 2.9% 3. Current alcohol drinker 64.7% 52.9% 4. Heavy alcohol drinker 40.6% 30.4% 5. Drinking & driving 5.8% 2.5% Note: All P-value of difference statistical tests <0.01

19 Comparison of Risk Behaviors Between USborn and Immigrant Adults US-born Immigrants 6. Heavy drinking (3+ drinks) & driving 15.9% 8.9% 7. Rode in vehicle of drinking driver 8.6% 4.6% tickets for reckless driving 8.2% 4.3% 9. Driver s license suspended 8.0% 4.4% 10. Do things easily hurt himself/other 13.7% 3.7% Note: All P-value of difference statistical tests <0.01

20 Conclusions 1) Immigrants generally had a lower injury prevalence than US-born individuals 2) Immigrants were less likely to had risk behaviors, which might explain why they had a lower injury prevalence

21 Our Research Project 2 Work-related Injuries Among Immigrant Workers (Zhang X, Yu S, Wheeler K, Kelleher K, Stallones L, and Xiang H. Workrelated Injuries among Foreign-born Workers: Findings from the U.S. National Health Interview Survey. Am J Ind Med 2009; 52(1):25-36.)

22 National Health Interview Survey - A national probability survey of civilian, noninstitutionalized population - A complex survey design involving stratification, clustering, and oversampling of certain population subgroups

23 Immigrant status A respondent was categorized as an immigrant if the birthplace was outside the USA Q: About how long have been in the USA?

24 Definition of Work-related Injuries Q1: Any injury that occurred during the three months prior to the interview that was serious enough to require medical care. Q2: What were you doing when the injury happened? Working at a paid job : work-related injuries

25 Work-related injury rate (per 10,000 workers) US-born Immigrant Rate Ratio Workers Workers Gender Males ** Females **

26 Work-related injury rate (per 10,000 workers) US-born Immigrant Rate Ratio Workers Workers Agegroup (yrs) ** ** **

27 Work-related injury rate (per 10,000 workers) US-born Immigrant Rate Ratio Workers Workers Industry Construction ** Agriculture ** Manufacture ** Transportation ** Wholesale/retail ** Service ** Other **

28 Injury - Multivariate Logistic Regression Odds Ratio (95% CI) Model 1: Immigrant Status US-born 1.00 (reference group) Immigrant 0.50 ( ) ** Model 2: Years in US US-born 1.00 (reference group) < ( ) ** ( ) ** ( ) ** ( ) ** Note: adjusted for gender, age, race, education, poverty, family size, insurance and alcohol

29 Results: Work-related injury rate (per 10,000 workers)

30 Characteristics of Work-related Injuries Immigrant US-born Workers Workers External Cause of Injuries 1 Fall Overexertion 2 Overexertion Fall 3 Cut/pierce Cut/piece 4 Struck by Struck by 5 Machinery Machinery

31 Medical Care of Work-related Injuries Immigrant Workers US-born Workers Hospitalized over night (%) Yes 5.4% 2.8% No 94.6% 97.2% P-value from Chi-square test < 0.05

32 Medical Care of Work-related Injuries Immigrant Workers US-born Workers Hospitalized nights (%) None 94.6% 97.2% 1 2.2% 1.0% % 1.0% % 0.8% P-value from Chi-square test > 0.05

33 Work Days Missed Immigrant Workers US-born Workers Work days missed (%) None 30.0% 36.6% <1 12.1% 12.4% % 26.8% % 24.3% P-value from Chi-square test < 0.01

34 Our Research Project 3 Medical Expenditures Associated with Nonfatal Occupational Injuries among Immigrant and US-born Workers (Manuscript Under Review)

35 Medical Expenditure Panel Survey - Sponsored by Agency for Healthcare Research and Quality - It provides national estimates of health care use, insurance coverage, medical expenditures, and sources of payment for the civilian non-institutionalized population

36 Definition of Work-related Injuries MEPS uses five rounds of interviews over 2.5 year- period to collected data on medical conditions, medical expenditures, and sources of payments When an individual 16 years or older reports an injury in the MEP, a question is asked Whether the injury occurred at work?

37 Individuals Who Reported Work-related Injuries in MEPS US-born (N=4785) Immigrants (N=1066) Gender Males 2890 (63.4%) 727 (68.1%) Females 1895 (36.6%) 339 (31.9%) P-value = 0.027

38 Individuals Who Reported Work-related Injuries in MEPS US-born (N=4785) Immigrants (N=1066) Age (Years) (9.7%) 61(5.9%) (48.4%) 579(55.2%) (26.5%) 273 (25.0%) (15.4%) 153(13.9%) P-value = 0.002

39 Odds Ratio of Having Any medical Expenditures (Logistic Regression) Odds Ratio (95% CI) Males 1.00 Females 0.66 ( ) ( ) ( ) ( ) US-born 1.00 Immigrant 1.52( )

40 Odds Ratio of Having Any medical Expenditures (Logistic Regression) Odds Ratio (95% CI) Medical Insurance Private 1.00 Public 0.87( ) No insurance 0.33( )* * P-value = 0.01

41 Annual Mean Expenditures (Bootstrap Methods) US-born (N=4785) Immigrants (N=1066) $2066 ($1881-$2252) $1956($1626-$2285)

42 Proportion of Expenditures by Types of Services US-born Immigrant Office-based 38.1% 52.3% Outpatient 18.0% 11.5% ER 8.1% 9.9% Inpatient 26.7% 18.8% Home health care 1.3% 2.0% Prescribed medicine %

43 Conclusions (1) The annual mean expenditures of work-related injuries between immigrant and US-born workers were comparable (2) Weighted % of out-of-pocket payments were comparable for immigrant and US-born workers by gender, age, and medical insurance coverage (3) A significantly higher % of medical expenditures in immigrant workers were office-based, compared with US-born workers

44 Acknowledgements Dr. Bo Lu, Assistant Professor, Division of Biostatistics, OSU Dr. John Wilkins, Professor, Division of Epidemiology, OSU Dr. Gary A. Smith, Professor, Center for Injury Research and Policy (CIRP) Yan Yang, Former Research Assistant, CIRP Krista Wheeler, Senior Research Associate, CIRP Dr. Weiyan Zhao, Senior Research Associate, CIRP

45 Acknowledgements Our research projects are funded by a research grant from the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (PI: H. Xiang, Grant Number: R01OH ).

46 Contact Information Center for Injury Research and Policy Nationwide Children s Hospital College of Medicine & Division of Epidemiology College of Public Health The Ohio State University huiyun.xiang@nationwidechildrens.org Phone: