Secondary Injuries among U.S. Workers with Disabilities

描述(由申请人提供)：目前美国有4000万至5000万残疾人，预计未来几年残疾成年人的数量将会上升。尽管过去十年的研究表明，残疾人非致命性伤害的风险要高得多，但关于残疾工人的职业性和非职业性伤害的风险和模式仍有许多需要了解。该项目的长期目标是研究先前存在的残疾与二次伤害之间的联系，并调查美国残疾工人的医疗费用和支付方式。中心假设是：(1)残疾工人发生职业性和非职业性伤害的风险比非残疾工人高得多，(2)残疾工人每年与这些伤害相关的医疗费用要高得多。这项拟议研究的基本原理是，了解先前存在的残疾和二次伤害之间的关系，并确定伤害模式，将有助于为美国残疾工人制定更好的循证政策和安全计划。因此，拟议的研究将有助于促进NIOSH任务，以解决特殊人群中的职业安全和健康差距。将分析来自两个具有代表性的大型全国性调查--1997-2004年全国健康访谈调查和2002-2006年医疗支出小组调查--的数据，以实现三个具体目标：1)比较美国残疾和非残疾工人的职业伤害和非职业伤害；2)比较美国残疾和非残疾工人治疗职业伤害和非职业伤害的医疗服务成本；以及3)比较美国残疾和非残疾工人在职业伤害和非职业伤害医疗方面的支付来源和自付支出。在我们强大的初步数据的指导下，这项研究将使用几种创新的统计方法。将使用控制人口和社会经济伤害风险因素的多变量Logistic回归和泊松回归模型来研究先前存在的残疾与职业伤害和非职业伤害之间的关系。我们将使用Bootstrap方法和两部分回归模型来比较残疾和非残疾美国工人的职业伤害和非职业伤害的医疗费用。这项拟议研究的结果可能会为美国残疾工人的职业安全和伤害预防相关的重要政策决策提供亟需的科学证据。 公共卫生相关性：《2010年健康人》和2005年《美国卫生局局长改善残疾人健康和福祉行动号召》都将促进健康和个人融入社区列为国家优先事项。这项研究将回答有关美国残疾工人中职业伤害和非职业伤害的风险、模式和医疗成本的几个基本问题。我们的研究将促进NIOSH的使命，以解决特殊人群中的职业安全和健康差距，并针对2010年健康人的几个部分(第20.2节：减少因工受伤导致的医疗、工作时间损失或限制工作活动；第6节：促进残疾人的健康，预防继发性疾病，并消除残疾人与非残疾人之间的差异)。健康人目标包含几个职业安全目标。然而，这些目标缺乏针对残疾工人的具体目标。健康人2020残疾与健康工作组正在制定一个新的目标，以消除儿童、青年以及报告接受医疗治疗的非致命性意外伤害的残疾和非残疾成年人的比例差异。我们提出的关于职业伤害的研究对于帮助增长残疾、意外伤害和职业安全等交叉领域的科学知识至关重要。这项研究的发现有可能转化为更好的基于证据的政策和安全计划，从而促进美国残疾工人的职业安全和健康。

DESCRIPTION (provided by applicant): There are currently 40 to 50 million individuals living with disabilities in the U.S. and the number of adults with disabilities is expected to rise in the coming years. Although studies over the last decade have demonstrated that individuals with disabilities are at a significantly higher risk for nonfatal injuries, much remains to be learned about the risks and patterns of occupational and non-occupational injuries in workers with disabilities. The long-term goal of this project is to study associations between pre-existing disabilities and secondary injuries and to investigate the medical costs and methods of payments among U.S. workers with disabilities. The central hypotheses are (1) that workers with disabilities are at a significantly higher risk for occupational and non-occupational injuries than workers without disabilities, and (2) that the annual costs associated with medical care for these injuries are significantly higher in workers with disabilities. The rationale for the proposed research is that understanding the relationship between pre-existing disability and secondary injury and identifying injury patterns will allow for the development of better evidence-based policies and safety programs for U.S. workers with disabilities. Thus, the proposed research will help promote the NIOSH mission to address occupational safety and health disparities in special populations. Data from two large representative national surveys - the 1997-2004 National Health Interview Survey, and the 2002-2006 Medical Expenditure Panel Survey, will be analyzed to pursue three specific aims: 1) To compare occupational injuries and non-occupational injuries among U.S. workers with and without disabilities; 2) To compare the medical service costs for treating occupational injuries and non- occupational injuries among U.S. workers with and without disabilities; and 3) To compare sources of payments and out-of-pocket expenditures for the medical treatment of occupational injuries and non- occupational injuries among U.S. workers with disabilities and without disabilities. Guided by our strong preliminary data, this study will use several innovative statistical approaches. Association between pre-existing disabilities and occupational injuries and non-occupational injuries will be studied using multivariable logistic regression and Poisson regression models controlling for demographic and socioeconomic injury risk factors. Medical costs of occupational injuries and non- occupational injuries will be compared between U.S. workers with and without disabilities using bootstrap methods and a two-part regression model. Findings from the proposed research could provide much-needed scientific evidence for informing important policy decisions relevant to occupational safety and injury prevention among U.S. workers with disabilities. PUBLIC HEALTH RELEVANCE: Both Healthy People 2010 and the 2005 U.S. Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities identified health promotion and the integration of individuals into the community as national priorities. This study will answer several fundamental questions about risks, patterns, and medical costs of occupational injuries and non-occupational injuries among U.S. Workers with disabilities. Our research will promote the NIOSH mission to address occupational safety and health disparities in special populations and addresses several sections of Healthy People 2010 (Section 20.2: to reduce work-related injuries resulting medical treatment, lost time from work, or restricted work activities; Section 6: To promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities). Healthy People Objectives contains several occupational safety objectives. However, those objectives lack specific objectives for workers with disabilities. The Healthy People 2020 Disability and Health Workgroup is developing a new objective to "eliminate disparities in the percentage of children, youth, and adults with and without disabilities who report medically treated nonfatal unintentional injuries." Our proposed study on occupational injury is of utmost importance to help grow the scientific knowledge in the crosscutting fields of disability, unintentional injury, and occupational safety. Findings from this study have the potential to translate into better evidence-based policies and safety programs that will promote occupational safety and health among Workers with disabilities in the United States.