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Does Size Count? Incidence and Reporting of Occupational
Disease by Size of Company
Tim Morse, Ph.D.ErgoCenter
UConn Health Center
Collaborators Charles Dillon, NHANES Joseph Weber, CT Labor Dept. Nick Warren, UCHC Heather Bruneau, UCHC Rongwei Fu, UCHC
NIOSH/OSHA Report higher rates for larger companies
0
50
100
150
1-10 11-49 50-249 250-999 1,000+
Incidence Rates for Occupational Illness, 1997, OSHA, NIOSH
Reasons for Correlation? Increased risk vs. better reporting Increased risk?
Biersner and Winn, 1998 More repetition in larger companies? Connected to industry segment or other co-variate
such as worker age? Better reporting?
Oleinick, et al. 1995 MSD is under-reported Occupational disease is primarily MSD Better recordkeeping? Less fear of reporting?
Why do we care? How do you best target industries?
Grants for small employer training Prioritize OSHA inspections
Other policy issues Recordkeeping by small employers
What is source of problem? Repetition, stress, other risk factors Need for and focus of internal training for
companies Under-estimate of Occupational Disease if
under-reporting
Under-reporting CUSP (CT Upper-Extremity
Surveillance Project) Data 9.1% of population with likely work-
related prevalent MSD 0.78% (95% CI 0.58-1.24%) doctor-
called incident cases 10.6-21.0% had filed workers’
compensation claims
Correlates of under-reporting (CUSP) Severity of MSD
Surgery (OR 3.5) Time off work (OR 4.5) Doctor diagnosis (OR 13.7)
Psycho-social factors Management cares (OR 2.0) Fear of reporting
Union (OR 4.1) Industry/Occupation
Manufacturing, transport, trade higher Hourly wage workers (OR 2.8)
Population-based telephone survey (CUSP) Random sample of 3,200 CT workers 78% interview response rate % with likely work-related MSD % of cases reported to workers’ comp Compare to BLS MSD figures by size
of company Size of company coded by CT Labor
Dept; additional coding by InfoUSA
Statistical methods Data reduction of risk factors by
factor analysis Tabular analysis of MSD by size of
company Partial correlations and Logistic
regression
ConnOSHA/BLS Survey Connecticut, 1996 Repetitive Trauma
61.6% of occupational illnesses 3.6% of all injuries and illnesses
3,711 cases of repetitive trauma 28.8 per 10,000 workers
CT BLS Repetitive trauma rates also increase by size of business
0
20
40
60
0-10 11-49 50-249 250-999 1000+
Repetitve Trauma by Size of Business, 1996, CT OSHA/BLS
Results: Coding for Size Only 64% of respondents could be coded for
size No major differences between coded and
uncoded for gender, age, and ethnicity Minor differences in education
33% (uncoded) vs. 27% (coded) High school grad 13% vs 20% for post-graduate
Differences in industry government (5.2% uncoded vs. 20.1% coded) service (60.2% vs. 50.7%) construction (8.1% vs. 4.1%)
Demographic characteristics by company size No difference in gender distribution Higher education in larger companies
chi-square=110.3, sig<.001 Blacks and Hispanics over-represented
in larger companies chi-square=39.6, sig=.006
Older workers in very large and very small companies chi-square=72.7, sig<.001
Risk Factors Factor analysis
Physical risk factor (push/pull,reach above, wrist bent, tool use)
Stress/computer factor (job stress, computer use)
Correlations with business size physical risk factor (r= -.14) stress/computer factor (.14)
Partial correlations Controlling for gender, race,
marriage, age, and education. Physical risk factor and Business
size-.078 (p=.001)
Stress/computer risk factor and business size .120 correlation (p<.001)
MSD % Prevalence by Company Size, CUSP, CT, 1996
7542733092934151157N =
company size code
1000+250-99950-24911-491-10Missing
95%
CI w
ork
-re
late
d c
ase
.18
.16
.14
.12
.10
.08
.06
.04
MSD by Company Size, CUSP, CT, 1996Chi-square=9.4, sig=.052
MSD CaseTotal % Low CI Upper CI1-10 43 415 10.4 7.4% 13.3%11-49 35 293 11.9 8.2% 15.7%50-249 24 309 7.8 4.8% 10.8%250-999 32 273 11.7 7.9% 15.5%1000+ 55 754 7.3 5.4% 9.2%Missing 103 1157 8.9 7.3% 10.5%Total 292 3201 9.1 8.1% 10.1%
% MSD by Size and Industry, CUSP, CT, 1996
0.05.0
10.015.0
20.025.0
30.035.0
1-10 11-49 50-249 250-999 1000+
ag,mine, const
manuf
govt
service
fin insur re
0.0
5.0
10.0
15.0
1-10 11-49 50-249 250-999
1000+
MSD CUSP Prev and BLS Incid, CT 1996
CUSP
BLS
0
2
4
6
8
1-10 11-4950-249 250-999
1000+
MSD CUSP Dr. Called Prev and BLS Incid, 1996, CT
BLS
CUSP Dr.
0.0
10.020.0
30.040.0
50.060.070.0
Push-pull Reach Bent wrist Tools
Risk factors by company size, CT, CUSP, 1996
1-10
11-49
50-249
250-999
1000+
0.010.020.030.040.050.060.070.080.0
Stress Computer
Risk factors by company size, CT, CUSP, 1996
1-10
11-49
50-249
250-999
1000+
Physical risk by MSD prevalence, by firm size, CUSP, CT, 1996
0.0
5.0
10.0
15.0
20.0
25.0
1-10 11-49 50-249 250-999 1000+
MSD Prev
Phys Risk rate
Logistic Regression MSD case on Size :
OR=0.91 CI 0.83-1.00
Doctor called MSD on Size OR=0.88 CI 0.78-0.99
Logistic Regression Entered: Company size, gender,
age, industry, occupation, married, race
Backward conditional regression
Logistic regression MSD
Stay in equation: Gender, age, race, occupation
Size marginally significant (OR=0.90; 0.81-1.00)
Larger companies have lower rates Doctor called:
Stay in regression: occupation, gender, race Size not significantly related to MSD
Cautions and limitations Self-reported data Prevalence, not incidence Just MSD Only 64% could be coded for size
Likely that sample under-represented smaller companies
Demographics similar between coded and uncoded
Not likely to systematically affect rate of MSD by size
Conclusions Business size is only weakly
related to MSD, in negative direction (in contrast to BLS reports)
Risk factors vary somewhat by size; largest companies have: Lowest physical risks, Highest stress and computer risks
Under-reporting Strong positive correlation in BLS
reports between MSD and company size most likely due to better reporting in larger companies
Appears to be large under-reporting for smaller companies