Effects of residential location and work-commuting on long-term work disability.

PURPOSE: Little is known about the independent effect of workers' residential location and work-commuting on their long-term disability due to work-related injuries. We examined 149,110 incident claims while adjusting for multiple risk factors in a large, population-based sample of Washington State workers' compensation State Fund claims during 2002-2008. METHODS: Claimants' residential addresses were geocoded with census tract and aggregated into four category classification of the Rural Urban Commuting Area Codes (RUCAs) which takes into account for tract-level work-commuting. We used logistic regressions to assess the association between RUCAs and whether or not a person was off work for more than 180 days due to injury; Quantile regressions to predict various percentiles of cumulative lost workdays by RUCAs. RESULTS: Compared to those who live in the Urban Core, workers in other areas experienced longer average paid time loss days due to work-related injury. The association between residential location and long-term disability was significant, odds ratio (OR) 1.19 (95 % confidence interval (CI) 1.11-1.27) for residents of Small Town and Isolated Rural and OR 1.17 (95 % CI 1.12-1.22) for those of Sub Urban, and persisted after controlling for injury nature, socio-demographic, employment-related, and claim administrative characteristics. The impact of residential location and work-commuting elevated as the duration of disability increased. CONCLUSIONS: This study shows that residential location and work-commuting has a significant and time-varying impact on duration of work disability. Workers living in Sub Urban and Small Town and Isolated Rural areas represent a particularly vulnerable group with respect to risk of long-term work disability.

The impact of regulatory enforcement and consultation visits on workers' compensation claims incidence rates and costs, 1999-2008.

BACKGROUND: Studies of regulatory effectiveness have shown mixed evidence of impact of inspections on injury rates. We examine changes in workers compensation claims rates and costs for Washington employers having either an inspection, with or without citation, or a voluntary consultation activity. METHOD: We merge 10 years of enforcement and consultation activity with workers compensation records at the individual workplace level for stable firms with a single business location and at least 10 full-time employees. The change in claims incidence rates (CIRs) was estimated, controlling for workplace claims rate history, size, and industry. Separate analyses were performed for non-musculoskeletal and musculoskeletal (MSD) CIRs, claims costs and for enforcement activities with citation and without citation. RESULTS: Enforcement activities are associated with a significant reduction in CIRs and costs. Similar results may also be attributable to consultations. Inspections were associated with a 4% decline in time-loss claims rates relative to uninspected workplaces. The effect strengthens when MSD claims are excluded. Citations for non-compliance are associated with a 20% decline in non-MSD CIRs relative to uninspected workplaces. There is also some evidence for a reduction in MSD claims rates beginning in the second year following inspection. Enforcement and consultation activity is associated with substantial decreases in claims costs. CONCLUSIONS: Enforcement activities make a significant contribution to reducing CIRs and costs. Similar results following consultations may also exist. Inspections with citations are more effective than those without. Claims rates for non-MSD injuries, related to hazards covered by specific standards, are more affected in the year following the visit, while those for MSDs take longer to begin falling.

The persistent gap in health-care coverage between low- and high-income workers in Washington State: BRFSS, 2003-2007.

OBJECTIVES: We examined the disparities in health-care coverage between low- and high-income workers in Washington State (WA) to provide support for possible policy decisions for uninsured workers. METHODS: We examined data from the WA Behavioral Risk Factor Surveillance System 2003-2007 and compared workers aged 18-64 years of low income (annual household income <$35,000) and high income (annual household income ≥$35,000) on proportions and sources of health-care coverage. We conducted multivariable logistic regression analyses on factors that were associated with the uninsured. RESULTS: Of the 54,536 survey respondents who were working-age adults in WA, 13,922 (25.5%) were low-income workers. The proportions of uninsured were 38.2% for low-income workers and 6.3% for high-income workers. While employment-based health benefits remained a dominant source of health insurance coverage, they covered only 40.2% of low-income workers relative to 81.5% of high-income workers. Besides income, workers were more likely to be uninsured if they were younger; male; Hispanic; less educated; not married; current smokers; self-employed; or employed in agriculture/forestry/fisheries, construction, and retail. More low-income workers (28.7%) reported cost as an issue in paying for health services than did their high-income counterparts (6.7%). CONCLUSION: A persistent gap in health-care coverage exists between low- and high-income workers. The identified characteristics of these workers can be used to implement policies to expand health insurance coverage.