Search Results (27)

Introduction: Musculoskeletal conditions impose a substantial economic burden on the United States (U.S.) healthcare system, but contemporary national estimates of condition-specific spending for common orthopaedic conditions remain limited. This study utilized the 2023 Medical Expenditure Panel Survey (MEPS) to estimate the national prevalence, condition-specific expenditures, and payer distribution for treated knee injuries and shoulder disorders. Methods: Adults with treated knee injuries or shoulder disorders were identified using ICD-10-CM codes from the MEPS Medical Conditions File. Condition-specific expenditures were estimated by linking diagnoses to medical events and payments using the MEPS Condition–Event Link File. Expenditures were aggregated across inpatient, outpatient, office-based, emergency, home health, and prescribed medicine categories. Survey-weighted analyses were used to estimate national prevalence, mean expenditures, service-level spending patterns, and payer distributions. Survey-weighted Gamma generalized linear models with log link were used to examine patient characteristics associated with expenditures among the U.S. civilian noninstitutionalized population with positive condition-specific spending. Results: The analysis identified 2.55 million adults with treated knee injuries and 2.58 million adults with treated shoulder disorders. Mean annual condition-specific expenditures per person were higher for knee injuries ($10,552; 95% CI: $6128–$14,975) than for shoulder disorders ($4310; 95% CI: $3337–$5283). Knee injury expenditures were concentrated in inpatient and home health care, whereas shoulder disorder expenditures were concentrated in outpatient and office-based care. Private insurance, Medicare, out-of-pocket payments, and Worker’s Compensation each contributed to the financial burden, with payer distributions varying by condition. In adjusted models, fair/poor self-rated health and female sex were associated with higher knee injury expenditures, while no covariates were statistically significant for shoulder disorder expenditures. Conclusions: Treated knee injuries and shoulder disorders showed distinct condition-specific expenditure profiles across care settings and payer sources. These findings provide contemporary national benchmarks for orthopaedic spending and may support future research, utilization monitoring, and value-based reimbursement planning. Full article

Background/Objectives: The increasing prevalence of foot and ankle procedures in the United States has coincided with rising costs of care, exposing socioeconomic disparities within this area of orthopedics. Insurance payor status is one such factor that can affect the quality and accessibility of medical care and has been implicated in orthopaedic patient outcomes. While previous studies in other fields of orthopaedics have demonstrated an association between insurance status and access to treatment, length of hospital stay, post-operative outcomes and complication rates, no comprehensive review has yet explored this relationship in foot and ankle surgery. Thus, the goal of this study is to examine the association between insurance payor status and outcomes in foot and ankle procedures. Methods: A systematic review of five databases was conducted, focusing on the interplay between insurance coverage and foot/ankle procedures. Included studies reported on insurance payor status and patient outcomes following foot and ankle surgery. Extracted outcomes included time to be seen by a provider, complication and revision rates, post-operative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to work/activity, and follow-up. Meta-analyses were performed using the Revman 5.3 software. Studies that did not qualify for meta-analyses were described qualitatively. Results: Of 1401 studies identified, 24 texts met inclusion and exclusion criteria. Across the 24 studies, there were a total of 20,950 patients. Noninsured patients had a 59% higher risk of ED/urgent care utilization within 30 days of surgery compared to insured patients [Risk Ratio (RR) = 1.59, 95% Confidence Interval (CI) = 1.18 to 2.12, p < 0.05]. Privately insured patients were seen 3.65 days earlier than patients with government insurance [95% CI = 2.02 to 5.27, p < 0.0001]. Worker’s Compensation patients had statistically significant findings for poorer outcomes, higher pain scores, and lower functional scores. Similarly, Medicaid patients also fared worse on functional scores and had delayed access to appointments and treatments. Conclusions: Patients without private insurance have worse pain and functional outcomes, delayed access to care, and increased utilization of emergency resources following foot and ankle procedures. It is crucial for providers to be cognizant of these discrepancies when caring for patients. Further research is needed to better understand the nuances of these insurance-related disparities within foot and ankle subspecialties. Full article

Background/Objectives: Return to work (RTW) after an industrial accident is crucial for an individual’s well-being and socioeconomic recovery. This study investigated factors influencing RTW among workers who sustained physical or brain lesion-related disabilities following industrial accidents. Methods: Using five-year panel data (2018–2022) from the Panel Study of Workers’ Compensation Insurance of South Korea, we analyzed 340 individuals with physical or brain lesion-related disabilities sustained from industrial accidents. We used logistic regression models to identify factors associated with RTW and return to employed (RTE) status. Results: The RTW and non-RTW groups comprised 160 and 180 participants, respectively. Factors associated with non-RTW included female sex (adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.13–0.86; p = 0.023), injury caused by disease (aOR, 0.18; 95% CI, 0.05–0.66; p = 0.010), long recovery periods (aOR, 0.27; 95% CI, 0.10–0.72; p = 0.009), low self-confidence (aOR, 0.16; 95% CI, 0.07–0.35; p < 0.001), and older age (aOR, 0.08; 95% CI, 0.02–0.34; p = 0.001). Workers with no blood pressure problems (aOR, 2.21; 95% CI, 1.11–4.38; p = 0.024) and longer employment durations (aOR, 3.84; 95% CI, 1.15–12.81; p = 0.029) had a higher chance of RTW. Similar factors were associated with RTE, with more emphasis on older age, long recovery periods, low self-confidence, and injury caused by disease. Conclusions: Our findings contribute to developing targeted support services and informing policy decisions to improve RTW for workers with physical or brain lesion-related disabilities caused by industrial accidents. Full article

The Korean aquaculture sector relies heavily on foreign workers, who face elevated risks due to language barriers and limited safety training. This disparity necessitates data-driven safety interventions addressing specific worker vulnerabilities to ensure sustainable industry growth. This study quantitatively investigated accident characteristics and economic losses by nationality in Korean aquaculture by integrating 325 approved cases (2018–2022) from Industrial Accident Compensation Insurance (268 Korean; 57 foreign) and field survey data into the Formal Safety Assessment and Fault Tree Analysis frameworks recommended by the International Maritime Organization (IMO). The study revealed that entanglement during machinery operations accounted for 63.5% of the total cost among foreign workers. For Korean workers, slip and fall accidents were most frequent, while falls from height were the most severe in terms of unit cost and fatality. Based on the importance index and Human Element analysis, four risk control options were proposed: guarding and interlocks retrofit, multilingual training for foreign workers, and fall-protection upgrades and permit-to-work systems with lockout/tagout for Korean workers. Scenario analysis demonstrated consistent cost-saving effects. Both direct and indirect costs were incorporated into total loss estimation, with indirect costs calculated as 0.5–1.0 times the direct costs following the Ministry of Employment and Labor (2021). Full article

Worker safety has been relatively overlooked in the rapidly growing aquaculture industry. To address this gap, industrial accident compensation insurance data—mainly from floating cage and seaweed farming—were analyzed to quantify accident types and frequencies, with a focus on human elements as root causes. Basic causes were selected based on IMO Resolution A/Res.884 and assessed through a worker awareness survey. Fault Tree Analysis (FTA), a Formal Safety Assessment technique, was applied to evaluate risks associated with these causes. The analysis identified organization at the farm site (23.3%), facility and equipment factors (22.8%), and people factors (21.4%) as the primary causes. Among secondary causes, personal negligence (13.2%), aging gear and poor maintenance (11.4%), and insufficient risk training (10.4%) were the most significant. Selective removal of these causes reduced the probability of human element-related accidents from 64.6% to 48.6%. While limited in scope to Korean data and self-reported surveys, the study demonstrates the value of combining quantitative data with worker perspectives. It provides foundational data for developing tailored safety strategies and institutional improvements—such as standardized procedures, multilingual education, and inclusive risk management—for sustainable safety in aquaculture. Full article

Background/Objectives: The preventable trauma death rate (PTDR) reflects the quality of trauma management systems. In the Republic of Korea, the PTDR in Seoul, the capital city, decreased from 30.8% in 2015 to 20.4% in 2019. However, it remains the highest in the country. In contrast, Gyeonggi-Incheon, which includes Gyeonggi Province and Incheon Metropolitan City surrounding Seoul, had the lowest nationwide PTDR (27.4% in 2015 to 13.1% in 2019). This study aimed to investigate the characteristics and in-hospital mortality risk factors for patients with trauma in Seoul and Gyeonggi-Incheon. Methods: This retrospective cohort study used data from a 2016 to 2020 Community-Based Severe Trauma Survey. Among 237,616 patients, 24,448 were included in the study after applying the inclusion and exclusion criteria. Results: The proportions of the population with motor vehicle and workers’ compensation insurance increased with increasing injury severity in both regions. The injury severity score (ISS) was significantly higher in Gyeonggi-Incheon in the ISS < 9 and ISS 9–15 groups. Across all hospital levels, the proportion of patients who visited regional trauma centers in Seoul was low across all three ISS groups (0.2%[n = 26], 0.6%[n = 23], and 1.9%[n = 56] for ISS < 9, ISS 9–15, and ISS > 15, respectively). Conversely, in Gyeonggi-Incheon, the proportion of patients who visited regional trauma centers increased as injury severity increased across all three ISS groups (37.3%[n = 1404], 50.6%[n = 732], and 64.4%[n = 856] for ISS < 9, ISS 9–15, and ISS > 15, respectively). In Seoul, the identified in-hospital mortality risk factors included age, National Health Insurance (NHI) loss, other insurance, ISS, regional and local emergency centers or institutes, and the number of angioembolizations. In Gyeonggi-Incheon, the in-hospital mortality risk factors included age, ISS, falls and slippage, and the number of angioembolizations. Conclusions: The unique in-hospital mortality risk factors in Seoul compared with those in Gyeonggi-Incheon include transfers to regional emergency centers (ISS > 15), local emergency centers or institutes (ISS > 15), NHI loss (ISS 9–15 and ISS > 15), and the use of other insurance (ISS > 15). Full article

If electric power is distributed by an overhead network of cables, the ignition of wildland fires is unavoidable, although prudent management efforts can reduce the losses. The economic aspects of these fires are driven by tort litigation, which tends to create serious problems of social fairness. The present system does not contain adequate incentives towards minimizing these costs, nor appropriate measures to ensure that costs are allocated in a fair manner. The problems are universal, but a specific focus on the wildfire situation in California is assumed. The electric utilities there are regulated by the California Public Utilities Commission, and the regulations are almost wholly prescriptive. Striking is the absence of any benefit/cost considerations in the regulation of utilities. Regulations have also created distortions in the insurance market, notably subsidizing fire-unsafe behaviors. The legal and regulatory system should be changed to promote fire-safe behaviors. It should also be changed to more fairly apportion the cost burdens. A strategy which should be adopted more widely is that of Public Safety Power Shutoffs. The optimal solution is to enact legislation to create a no-fault system, similar to Workers’ Compensation. In such a system, tort-based liability litigation is replaced by a system which provides basic compensation to wildfire victims, irrespective of the cause and associated fault. However, reform of insurance regulation and zoning are also required. Full article

Unemployment insurance provides temporary cash benefits to eligible unemployed workers. Benefits are sometimes extended by discretion during economic slumps. In a model that features temporary benefits and sequential job opportunities, a worker’s reservation wages are studied when policymakers can make discretionary extensions to benefits. A worker’s optimal labor-supply choice is characterized by a sequence of reservation wages that increases with weeks of remaining benefits. The possibility of an extension raises the entire sequence of reservation wages, meaning a worker is more selective when accepting job offers throughout their spell of unemployment. The welfare consequences of misperceiving the probability and length of an extension are investigated. Properties of the model can help policymakers interpret data on reservation wages, which may be important if extended benefits are used more often in response to economic slumps, virus pandemics, extreme heat, and natural disasters. Full article

Introduction: Musculoskeletal injury (MSI) contributes to global health burdens. Effective MSI prevention is necessary. MSI risk factor screening tools can be used by employers to identify and mitigate occupational hazards. Rigorous synthesis of the effectiveness of these tools has not taken place. We synthesized literature on effectiveness of MSI risk factor screening tools for reducing injury through informing prevention interventions. Materials and Methods: A literature search of Medline, Embase, Cochrane Library (Trials), CINAHL, Scopus and PsycINFO databases was performed. Included studies required an analytic design, used an MSI risk factor screening tool to inform an intervention in a working-age population and reported an outcome of MSI development, injury or compensation/work absence. Data extraction and study quality rating (Downs and Black criteria) were completed. Studies were sub-categorized as having used a single MSI screening tool (single-tool) to inform an injury prevention intervention or involving multiple simultaneous screening tools (multiple-tool). Study outcomes were synthesized when possible. Results: Eighteen articles representing fourteen studies met our inclusion criteria. No high-quality studies were identified (maximum Downs and Black score of 19). Studies did not employ previously validated tools but instead, typically, those purpose-built for a single use. The results were inconsistent both when using tools alone and in combination with other tools. Outcome measure heterogeneity precluded meaningful meta-analysis. Conclusions: There is limited evidence regarding use of MSI risk factor screening tools for preventing injury. Rigorous studies that utilize previously validated tools are needed. Full article

COVID-19 is considered an occupational disease (OD), when infection occurs at the workplace for health workers (HW). Because of the increased infection risk of these workers, they were deemed to be a priority group when the vaccination campaign started in Germany in December 2020. By December 2021, more than 90% of HW had been vaccinated twice. We studied the number and the time trend concerning the severity of OD claims related to COVID-19. Workers’ compensation claims for OD are recorded in a standardized database of the Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW). We analyzed all notifiable COVID-19 related claims filed between 1 March 2020 and 30 September 2022. The proportion of severe cases was estimated by inpatient stays, injury benefit payments, rehabilitation measures, and deaths. The data analysis was descriptive. Due to COVID-19, 317,403 notifiable cases were reported to the BGW. Of these, 200,505 (63.2%) had thus far been recognized as OD. The number of notifiable cases was highest in 2022 and lowest in 2020. In total, 3289 insured individuals were admitted to rehabilitation management. This represented 1.6% of all recognized ODs due to COVID-19 at the BGW. The proportion of cases admitted to rehabilitation management decreased from 4.5% of all recognized ODs in 2020 to 3.2% in 2021 and to 0.1% of all recognized cases in 2022. For inpatient stays, injury benefit payment, and death, a similar trend was observed. Therefore, it might be concluded that the successful vaccination campaign mitigated the negative health effects of COVID-19 on HW. Even with vaccination, severe cases can occur. Therefore, infection prevention at the workplace remains paramount. Full article

Background: The aim of this study was to determine whether traumatic dislocation of the patella is provoked by the presence of predisposing factors and examine the role of the mechanism of injury. Methods: Cases diagnosed with dislocation of the patella and covered by the workers’ compensation program were identified and classified as traumatic based on insurance regulations. We examined predisposing factors (e.g., frontal axis, torsional deviation, trochlear dysplasia, patella alta) in case groups based on age at dislocation and trauma mechanism. Retrospective cohort study, level of evidence III. Results: Our sample size comprised 104 cases, consisting of 54 children and 50 adults. The most common mechanism of injury in children and adults was rotational trauma. Only 20% of the children and 21% of the adults exhibited no relevant predisposing factors. Group specifically, falls accounted for the highest number of cases exhibiting none of the defined anatomical predisposing factors. Children are more frequently affected by predisposition-related dislocations than adults. Conclusion: The proportion of predispositions is high. A fall, direct impact, or rotational trauma can be viewed as an adequate mechanism of trauma. For successful treatment, it is paramount to analyze the exact mechanism of the trauma and address any underlying predispositions. Full article

The main objective of this study is to highlight the internal risk factors associated with maritime transportation accidents and the important role of presenting them in the dataset at the time of the incident. Since the study period involves a pre- and post-pandemic timeline, we refer to COVID-19, although it is not part of our analysis. The issue at hand is the appropriate statistical analysis and investigation of the possible correlations between the cause of the incident and internal factors/indicators that may affect the safety of crews on sea routes. We developed a comprehensive study based on advanced econometric modeling, utilizing multifactorial models of robust regression, structural equation modeling (SEM), and Gaussian/mixed-Markov graphical models (GGMs, MGMs) and applying them to a newly compiled dataset covering the 2014–2022 period. Our results bring to the fore important factors that can determine the causes of various accidents and injuries suffered by workers, ranging from work location to work activity and even the rank of the seafarers on board. We do not consider the external factors associated with a maritime transportation accident, as the risk of an accident in this sector due to external factors (i.e., weather conditions, defaults, failures, etc.) is limited. Reducing the number of injuries to seafarers will result not only in better seafarer health but also a reduction in the operating costs of shipping companies due to the reduced insurance premiums they will have to pay. It will also lead to a reduction in the amounts disbursed by Protection and Indemnity (P&I) Clubs to compensate seafarers. In future research, we will use external factors to determine seafaring risks related to, for example, weather conditions, the quality of ships, technology, safety measures, regulations, and more. Full article

Since workers who have experienced industrial accidents may have a physical impairment, their workload is very likely to be less than before the industrial accident. This epidemiological study identified ICF-based predictive factors affecting the work performance of South Korean workers who were economically active after undergoing medical treatment (rehabilitation) related to injuries caused by industrial accidents by using the Panel Study of Worker’s Compensation Insurance (2018–2020) as a reference. We analyzed 1383 subjects who were engaged in economic activities. The explanatory variables included participation factors, activity factors, personal factors, physical function factors, and rehabilitation service factors. The outcome variables were defined by subjective evaluations of current job performance (0 and 10 points). This study analyzed the trajectory of change in work performance and change function predictors over time by using latent growth modeling (LGM). This study found mental activity, indoor activity, occupational activity, disability grade, socioeconomic status, the length of recuperation, self-esteem, and self-efficacy as significant predictors. The results of this study suggested that it would be necessary to prepare a systematic program that considers activity factors to support the independent daily life activities and social participation of workers injured by industrial accidents. Full article

Temporary staffing has an increasing role in world economies, contracting workers and dispatching them to work for leasing employers within countries and across borders. Using Illinois as a case study, co-authors have undertaken investigations to understand the occupational health, safety, and well-being challenges for workers hired through temporary staffing companies; to determine knowledge and attitudes of temp workers and temp staffing employers; and to assess temporary staffing at a community level. Temporary staffing workers in Illinois tend to be people of color who are employed in the most hazardous sectors of the economy. They have a higher rate of injury, are compensated less, and often lose their jobs when injured. Laws allow for ambiguity of responsibility for training, reporting, and compensation between the staffing agency and host employers. Our findings illustrate the ways in which principles of fairness and equity are violated in temporary staffing. Shared responsibility for reporting injuries, providing workers’ compensation insurance, and training workers should be mandated in law and required in contractual language between temporary staffing and host/contracting employers. Monitoring, enforcement, and adjustment of the law based on experience are required to “promote inclusive and sustainable economic growth, employment and decent work for all. Full article

Background: There is limited research on the heterogeneity of worker suicides. We compared differences in workers’ suicides by clustering suicide deaths. Methods: From 2010 to 2017, 353 suicide deaths were claimed in the Industrial Accident Compensation Insurance; variables were coded using a standardized methodology. A two-step cluster analysis classified the clusters based on demographic and employment conditions. Details of the suicide, clinical variables, personal stresses, and work-related stresses were compared using the chi-square test and one-way analysis of variance. Results: We identified five clusters and they differed particularly in work-related stress. “Responsibility-burdened type” experienced excessive responsibility as managers; “role-changed type” experienced a sudden and unpredictable role change as clerks or sales workers; “risk-exposed type” experienced physical risk factors at work (working alone, outdoors, and in shifts) as machine operating and assembling workers, or craft and related trades workers; “job-insecurity type” experienced unstable employment (irregular, nonpermanent) as elementary or service workers; “workplace-violence type” was mainly unmarried women who lived alone, and experienced interpersonal conflict and violence as professionals and related workers. There were no differences between clusters in clinical variables (except problem drinking) and personal stresses. Conclusion: Interventions to alleviate work-related stress in worker clusters are needed to prevent suicide in workers. Full article