Hospital injury rates in relation to socioeconomic status and working conditions

Abstract

Objectives: To describe the risk of work injury by socioeconomic status (SES) in hospital workers, and to assess whether SES gradient in injury risk is explained by differences in psychosocial, ergonomic or organisational factors at work. Methods: Workforce rosters and Occupational Safety and Health Administration injury logs for a 5-year period were obtained from two hospitals in Massachusetts. Job titles were classified into five SES strata on the basis of educational requirements and responsibilities: administrators, professionals, semiprofessionals, skilled and semiskilled workers. 13 selected psychosocial, ergonomic and organisational exposures were assigned to the hospital jobs through the national O*NET database. Rates of injury were analysed as frequency records using the Poisson regression, with job title as the unit of analysis. The risk of injury was modelled using SES alone, each exposure variable alone and then each exposure variable 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 with the highest SES category (administrators); the risk was highest among semiskilled workers (RR 5.3, p,0.001), followed by nurses (RR 3.7, p,0.001), semiprofessionals (RR 2.9, p = 0.006) and skilled workers (RR 2.6, p = 0.01). 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 risk of injury (decision latitude, supervisor support, force exertion and temperature extremes), whereas 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 reported 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.

Should studies of risk factors for musculoskeletal disorders be stratified by gender? Lessons from the 1998 Québec Health and Social Survey

“…Visible minority status, language, cultural group, and immigration status are also associated with exposures to risk factors for musculoskeletal disorders and with reporting and receiving compensation for occupational disorders (46)(47)(48)(49)(50). Education and other indicators of socioeconomic status have also been linked to exposures and outcomes, and, in addition, such relationships differ according to gender (25,51). Stratifying for all of these at once is not usually possible with the sample sizes normally available.…”

Exposição dos trabalhadores de enfermagem às cargas de trabalho e suas consequências

“…Overall, studies have shown that the risk of disease among nursing technicians and assistants is much greater than that of nurses, especially in terms of musculoskeletal disorders. Furthermore, the risk of occupational injuries among less qualified nursing professionals is reported to be four times higher than in the nurse category (11)(12)(13)(14)(15)(16) . A study conducted in a public hospital found that the hiring of nursing technicians and assistants was higher than for nurses, who were hired at rates below those recommended by COFEN (17) .…”

Risk factors and impacts of occupational injury in healthcare workers: A critical review

“…Rather, rates are attenuated after adjusting for psychosocial and ergonomic workplace exposures, suggesting that workplace differences may be the true predictor 16,17 . Stress, fatigue, burnout and frustration play a crucial role in occupational injury, with job strain demonstrated to be the most important predictor of functional health status 18 .…”

“…The majority of overexertion injuries are the result of cumulative trauma and can manifest as symptoms of a poorly designed workplace, particularly considering an environment not conducive to safe patient handling tasks. No places to rest, hazardous equipment and noise levels have been identified as physical environment characteristics that lead to unsafe situations and dangers 16 . In one study, nurses in both high and low claim rate hospitals ranked the physical work environment as the second most important contributor of musculoskeletal injury, behind workload…”