Objectives: To describe the risk of work injury by socioeconomic status (SES) in hospital workers, and to assess if SES gradient in injury risk is explained by differences in psychosocial, ergonomic or organizational factors at work.
Methods: Workforce rosters and OSHA injury logs for a five-year period were obtained from two Massachusetts hospitals. Job titles were classified in five SES strata on the basis of educational requirements and responsibilities: administrators, professionals, semi-professionals, skilled and semi-skilled workers. Eleven selected psychosocial, ergonomic and organizational exposures were assigned to the hospital jobs through the national O*NET database. Injury rates were analyzed as frequency records using Poisson regression, with job title as the unit of analysis. The risk of injury was modeled using SES alone, each exposure variable alone, and then each exposure in combination with SES.
Results: An overall annual injury rate of 7.2 per 100 full-time workers was estimated for the two hospitals combined. All SES strata except professionals showed a significant excess risk of injury compared to the highest SES category (administrators); the risk was highest among semi-skilled workers (RR = 5.3), followed by registered nurses (RR = 3.7), semi-professionals (RR = 2.9) and skilled workers (RR = 2.6). The risk of injury was significantly associated with each exposure considered except pause frequency. When workplace exposures were introduced in the regression model together with SES, four remained significant predictors of the injury risk (decision latitude, supervisor support, force exertion, and temperature extremes), while the RR related to SES was strongly reduced in all strata, except professionals.
Conclusions: A strong gradient in the risk of injury by SES was observed in a sample population of hospital workers, which was greatly attenuated by adjusting for psychosocial and ergonomic workplace exposures, indicating that a large proportion of that gradient can be explained by differences in working conditions.
- health care sector
- socioeconomic status
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