Using injury severity to improve occupational injury trend estimates

Authors

  • Jeanne M. Sears PhD, MS, RN,

    Corresponding author
    1. Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
    • Correspondence to: Jeanne M. Sears, PhD, MS, RN, Department of Health Services, University of Washington, Box 354809, Seattle, WA 98195. E-mail: jeannes@uw.edu

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  • Stephen M. Bowman PhD, MHA,

    1. Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
    2. Center for Injury Research and Policy, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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  • Sheilah Hogg-Johnson PhD, MMath

    1. Institute for Work and Health, Toronto, Ontario, Canada
    2. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Disclosures
  • Authors: The authors declare no conflict of interest.
  • Reviewers: The reviewers declare no conflict of interest.
  • Editor of record: Steven Markowitz or Rodney Ehrlich or Paul Landsbergis declares no conflict of interest.
  • Funding source: This study was supported by National Institute for Occupational Safety and Health (NIOSH); Contract grant number: 1R21OH010307.
  • The authors state that the external funding sources had no decision-making role in the design, conduct, analysis, interpretation or decision to publish with regard to this study.

Abstract

Background

Hospitalization-based estimates of trends in injury incidence are also affected by trends in health care practices and payer coverage that may differentially impact minor injuries. This study assessed whether implementing a severity threshold would improve occupational injury surveillance.

Methods

Hospital discharge data from four states and a national survey were used to identify traumatic injuries (1998–2009). Negative binomial regression was used to model injury trends with/without severity restriction, and to test trend divergence by severity.

Results

Trend estimates were generally biased downward in the absence of severity restriction, more so for occupational than non-occupational injuries. Restriction to severe injuries provided a markedly different overall picture of trends.

Conclusions

Severity restriction may improve occupational injury trend estimates by reducing temporal biases such as increasingly restrictive hospital admission practices, constricting workers' compensation coverage, and decreasing identification/reporting of minor work-related injuries. Injury severity measures should be developed for occupational injury surveillance systems. Am. J. Ind. Med. 57:928–939, 2014. © 2014 Wiley Periodicals, Inc.

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