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Workplace
Original research
Increased all-cause mortality following occupational injury: a comparison of two states
  1. Leslie I Boden1,
  2. Abay Asfaw2,
  3. Andrew Busey3,
  4. Yorghos Tripodis4,
  5. Paul K O'Leary5,
  6. Katie M Applebaum6,
  7. Andrew C Stokes7,
  8. Matthew P Fox8
  1. 1 Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
  2. 2 National Institute for Occupational Safety and Health, Washington, District of Columbia, USA
  3. 3 NERA Economic Consulting, Boston, Massachusetts, USA
  4. 4 Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
  5. 5 Office of Retirement and Disability Policy, U.S. Social Security Administration, Washington, District of Columbia, USA
  6. 6 Department of Environmental and Occupational Health, George Washington University, Milken Institute School of Public Health, Washington, District of Columbia, USA
  7. 7 Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
  8. 8 Departments of Epidemiology and Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Professor Leslie I Boden, Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts 02118, USA; lboden{at}bu.edu

Abstract

Objectives To measure the impact of lost-time occupational injuries on all-cause mortality in Washington State and, using the same data elements and study design, to determine whether the estimated impact was similar to previous estimates for New Mexico.

Methods We linked injuries in the Washington workers’ compensation system with Social Security Administration data on earnings and mortality. We estimated Cox survival models of mortality for women and men with lost-time compared with medical-only injuries, adjusting for age, pre-injury earnings and industry. We used quantitative bias analysis to account for confounding by pre-injury smoking and obesity.

Results The estimated mortality HR was 1.24 for women (95% CI 1.21 to 1.28) and 1.22 for men (95% CI 1.20 to 1.24). After adjusting for unmeasured pre-injury smoking and obesity, the estimated HR for women was 1.10, 95% simulation interval (SI) 1.00 to 1.21; for men, it was 1.15, 95% SI 1.04 to 1.27.

Conclusions All-cause mortality for Washington workers with lost-time injuries was higher than for those with medical-only injuries. Estimated HRs for Washington were consistent with those previously estimated for New Mexico, a less populous state with lower median wages and a different workers’ compensation insurance mechanism. This suggests that the relationship between workplace injury and long-term mortality may be generalisable to other US states. These findings support greater efforts to enhance safety and to investigate factors that improve postinjury employment opportunities and long-term health. This association should be examined in additional locations, with different study conditions, or using additional data on pre-injury risk factors.

  • mortality
  • occupational health
  • public health
  • epidemiology

Data availability statement

No data are available. Social Security Administration (SSA) data are not available to researchers who are not SSA employees. National Death Index and Washington and New Mexico Workers’ Compensation data may be available with written agreement with the relevant state agencies. NHANES and PSID data are publicly available.

http://dx.doi.org/10.1136/oemed-2022-108481

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    Data availability statement

    No data are available. Social Security Administration (SSA) data are not available to researchers who are not SSA employees. National Death Index and Washington and New Mexico Workers’ Compensation data may be available with written agreement with the relevant state agencies. NHANES and PSID data are publicly available.

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    Footnotes

    • Contributors LIB is the guarantor. He participated in the (a) conception or design of the work; (b) acquisition, analysis and interpretation of data for the work; (c) drafting the work and revising it critically for important intellectual content; (d) final approval of the version to be published and (e) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AA participated in the (a) analysis and interpretation of data for the work; (b) revising the work critically for important intellectual content; (c) final approval of the version to be published and (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AB participated in the (a) analysis and interpretation of data for the work, (b) revising the work critically for important intellectual content; (c) final approval of the version to be published and (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. YT participated in the (a) analysis and interpretation of data for the work; (b) drafting the work and revising it critically for important intellectual content; (c) final approval of the version to be published and (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PKO'L participated in the (a) conception or design of the work (b) acquisition, analysis and interpretation of data for the work; (c) drafting the work and revising it critically for important intellectual content; (d) final approval of the version to be published and (e) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. KMA participated in the (a) conception or design of the work; (b) analysis and interpretation of data for the work; (c) drafting the work and revising it critically for important intellectual content; (d) final approval of the version to be published and (e) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. ACS participated in the (a) analysis and interpretation of data for the work; (b) final approval of the version to be published and (c) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MPF participated in the (a) conception or design of the work; (b) analysis and interpretation of data for the work; (c) drafting the work and revising it critically for important intellectual content; (d) final approval of the version to be published and (e) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding We thank the SSA and the States of Washington and New Mexico for providing access to their data. The National Institute for Occupational Safety and Health (grants R21 OH010555 and R01 OH011511) supported this work. The Boston University Medical Center Institutional Review Board (number H-32401) and the Washington State Institutional Review Board (number D-110618-L) approved this study. Data use agreements have been signed by Boston University and the Social Security Administration for the use of data from the National Center for Health Statistics, the Washington State Department of Labor and Industries and the New Mexico Workers’ Compensation Administration.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.