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Oral Session 22 – Occupational injury 1

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O22.1 FACTORS AFFECTING RETURN TO WORK AFTER WORK RELATED WRIST AND ANKLE FRACTURES REPORTED TO THE ALBERTA WORKERS’ COMPENSATION BOARD, 1998–2002

J. Beach, K. Seland, N. Cherry.Occupational Health, Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada

Introduction: Factors that predict duration of work disability following work related injury remain unclear.

Objective: To use an existing administrative database to develop a predictive model of duration of disability following work related wrist and ankle fractures.

Methods: Claims information for all wrist and ankle fractures between 1998 and 2002 was acquired from the Alberta Workers Compensation Board (WCB). All claims that had sustained one or more days of temporary disability (TD) were included. Analyses of TD duration were undertaken using Cox multivariate survival analysis. Three models were developed on the basis of the temporal nature of the variables. Model 1 included pre-injury factors (age, sex, sector, occupation, ‘partners in injury reduction scheme’ participation, worker insurable earnings, industry rate), Model 2 included peri-injury factors (accident description, fracture site), and Model 3 included post-injury factors (provision of modified work, provision of rehabilitation). A fourth model included all these factors. Subsequent models were also developed including medical aid costs within 30 days of injury as a proxy for severity.

Results: Lower probability of successful return to work at any given time was associated with older age, female sex, work in the construction sector, smaller company size, higher industry rates, a fall/jump from height, ankle fractures (compared with wrist fractures), and the provision of rehabilitation. Shorter TD duration was associated with fractures due to ‘overexertion’ and the provision of modified work. Inclusion of the proxy for severity in the models reduced the significance of work in construction, and increased the relationship between female sex and longer periods away from work.

Conclusions: These factors could potentially be used to identify those workers at greatest risk of prolonged work disability following fractures of the wrist or ankle fracture. Severity may be a critical effect modifier but does not appear to be appropriately captured in the administrative databases available.

O22.2 ASSOCIATIONS OF SAFETY ENVIRONMENT, TRAINING, AND INDIVIDUAL CHARACTERISTICS WITH OCCUPATIONAL INJURIES: A CASE–CONTROL STUDY

A. Bhattacherjee1, A. K. Ghosh2, N. Chau3.1Indian Institute of Technology, Kharagpur, India; 2National institute of Technology, Rourkela, India; 3National Institute for Health and Medical Research (INSERM), Unit 420, Vandoeuvre-lès-Nancy, France

Introduction: Work conditions and individual characteristics can influence occupational injuries.

Objective: To assess the relationships of age, poor safety environment, risk taking behaviour, emotional instability, job stress, job dissatisfaction, poor safety performance of workers, low level of education, big family size, high income group, and low level of safety training with occupational injuries in underground coal mines.

Methods: A case–control study was conducted on 202 coal miners with at least one occupational injury and 202 controls with no occupational injury during a 5 year period. The cases and controls were matched for job. They were randomly selected from a population of 2900 coal miners employed in three underground coal mines located in the eastern part of India. A standardised questionnaire including validated measurement instruments, which was administered to the subjects by individual interview, was used. The association of risk factors with occupational injuries was assessed by adjusted odds ratio (OR) through multivariate logistic regression models.

Results: The annual incidence of occupational injuries in these mines was 5.4%. The factors with significant odds ratios (ORs) found were poor safety environment (2.52; 95% confidence interval 1.37 to 4.63), emotional instability (1.91; 1.01 to 3.61), poor safety performance of the workers (2.71; 1.50 to 4.89), large family size (1.85; 1.19 to 2.87), and high income group (1.64; 1.0 to 2.67). Compared with the younger age group of <30 years, the age groups of 30–45 years and >45 years had ORs of 1.58 (0.87 to 2.88) and 1.72 (0.80 to 3.71) respectively. The OR for the subjects with job stress was found to be 1.75 (0.89 to 3.43). No significant ORs were found for risk taking behaviour (1.25; 0.68 to 2.31) or job dissatisfaction (1.31; 0.67 to 2.53). No significant odds ratios were found for low level of education (1.11; 0.68 to 1.80) and safety training (1.28; 0.57 to 2.86). By using the backward logistic regression procedure, the following factors were found to be significant: poor safety environment (2.77; 1.56 to 4.92), emotional instability (2.00; 1.09 to 3.66), job stress (2.03; 1.10 to 3.77), poor safety performance of the workers (2.70; 1.50 to 4.86), large family size (1.87; 1.22 to 2.89), and high income group (1.92; 1.24 to 2.95).

Conclusion: The study has demonstrated that work conditions, particularly the safety environment, and some individual characteristics play significant roles in occupational injuries in underground coal mines. Safety training had no significant effect in reducing occupational injuries. This information would help in implementing prevention programs through enhancement of safety environment, site-specific focussed safety training, and positive psychological traits of the workers. Workers with negative psychological traits should be placed in less demanding jobs.

O22.3 INVESTIGATING THE LONG TERM CONSEQUENCES OF INJURIES AMONG YOUNG WORKERS

M. Koehoorn1, F. C. Breslin2, F. Xu1.1Department of Health Care and Epidemiology, University of British Columbia, Vancouver BC, Canada; 2Institute for Work & Health, Toronto, ON, Canada

Objective: To further our understanding of the longer-term health consequences of injured young workers (aged 15–24 years).

Methods: In this population based database study, we linked workers’ compensation claim data for young workers in the province of British Columbia with general medical services data to create a person specific, longitudinal (1985–2001) database for research purposes. Rates of healthcare contacts (beyond workers’ compensation covered services) before and after the initiation of a work injury among claimants were compared with those of a matched group of non claimants.

Results: A total of 76 916 young workers had an accepted short term disability claim during the follow up period. The mean age at the time of claim was 20.4 years (2.1). There were 70.5 % men and 29.5% women. The most common injuries were lacerations (22.9%), non-back strains (20.4%), and back strains (17.7%). Claimants had significantly higher rates of healthcare utilisation compared with non-claimants, over and above compensation benefits. For 15 and 16 year olds just entering the workforce, the average number of physician visits in the year preceding the injury date was 4.2 visits compared with 3.4 visits among the non-claim population. In the year immediately following the injury, the number of visits increased to 5.6 among claimants but remained the same among non-claimants. Visits remained elevated among claimants to the end of follow up (4.8/year) compared with non-claimants (3.8/year). The observed differences were attributable to ICD9 diagnoses for symptoms, signs, and ill defined conditions.

Conclusions: Young workers may seek medical attention beyond the compensation system for a number of reasons, including a lack of awareness of procedures for filing a workers’ compensation healthcare claim or the procedures for re-opening a claim if symptoms reoccur. Young workers may also not want to take time off work to recover for fear of repercussions and seek medical assistance instead through the public system.

O22.4 RACIAL PREJUDICE AND NON-FATAL WORK ACCIDENTS IN URBAN BRAZIL

V. S. Santana1, D. Loomis2.1Program of Environmental and Workers’ Health (PISAT), Institute of Collective Health, Federal University of Bahia, Brazil 2Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, NC, USA

Introduction: Few studies have formally addressed the relations between race and occupational health. In this cross sectional study, the hypothesis that perceived racial prejudice is positively associated with non-fatal occupational accidents was examined.

Methods: The study was carried out in a large urban area, the city of Salvador, capital of Bahia State, Brazil. The study population comprised 3255 subjects from 18 to 65 years of age. One stage random cluster area sampling was used to select 2512 families. Data were collected by individual household interviews and work accidents, and history of racial prejudice experience were identified from self reported data.

Results: Black individuals comprised 60% of the study population, and of these, 22% reported experiencing racial prejudice. Work accidents were about twice as frequent in the group that reported experience of racial prejudice (age, sex and socioeconomic status adjusted incidence rate ratio, 1.9 (95% confidence interval 1.4 to 2.7). History of racism was also more common among those reporting hazards in the worksite or having less skilled jobs (p<0.05).

Conclusions: Because of the study’s cross sectional design, conclusions are limited, but racial prejudice may be linked to assignment of more dangerous occupation independently of age, sex, and socioeconomic status, which needs to be further evaluated.

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