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October 2005, Vol. 128, No. 10
Work-related hospitalizations in Massachusetts: racial/ethnic differences
Phillip R. Hunt, Jong Uk Won, Allard Dembe, and Letitia Davis
In Massachusetts, as in the United States as a whole, the fatal occupational injury rate for Hispanic workers (3.3 per 100,000 workers per year) is higher than that for white workers (2.2 per 100,000 workers per year).1 Although some information about the risk of nonfatal occupational injuries among racial and ethnic groups is available nationally,2 data for Massachusetts are limited. The workers’ compensation data set maintained by the Massachusetts Department of Industrial Accidents does not include information about workers’ race and ethnicity. By contrast, race and ethnicity information is a data element in the Bureau of Labor Statistics (BLS) Survey of Occupational Injuries and Illnesses,3 but it is only an optional feature there, and it is missing from more than 25 percent of the cases reported in the Massachusetts BLS survey.4 This article reports on the use of statewide hospital discharge data to describe patterns of serious occupational injuries (that is, injuries requiring hospitalization) among racial and ethnic groups in Massachusetts.
In Massachusetts, discharge records from all acute-care nongovernment hospitals5 are collected quarterly by the Massachusetts Division of Health Care Finance and Policy, as mandated by regulation.6 The records are then compiled into the annual Hospital Discharge Data set. Each discharge record contains information about patient demographics, including age, gender, race/Hispanic ethnicity, and zip code of residence; administrative information, including hospital charges and expected source of payment; and clinical information, including primary and up to 14 supplementary diagnoses, length of stay, and procedures administered during the hospitalization. Race and Hispanic ethnicity in this data set are mutually exclusive categories: individuals are classified as white, black, Asian, American Indian, Hispanic, and other or unknown. Race/ethnicity information may be collected upon admission or through health-care provider notes in the medical record and may be based on either observation of the patient or the patient’s self-report. Diagnoses are coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).7 Acute poisonings are classified as injuries in this system.
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1 See Fatal Occupational Injuries in Massachusetts, 1991–1999 (Massachusetts Department of Health, September 2002); Scott Richardson, John Ruser, and Peggy Suarez, "Hispanic Workers in the United States: An Analysis of Employment Distributions, Fatal Occupational Injury Data, and Non-fatal Occupational Injury and Illnesses," in Safety Is Seguridad (Washington, DC, National Research Council of the National Academies, 2003); and Xiuwen Dong and James W. Platner, "Occupational Fatalities of Hispanic Construction Workers from 1992 to 2000," American Journal of Industrial Medicine, January 2004, pp. 45–54.
2 See Allard E. Dembe, Judith A. Savageau, Benjamin C. Amick, III, and Steven M. Banks, "Racial and Ethnic Variations in Office-Based Medical Care for Work-Related Injuries and Illnesses," Journal of the National Medical Association, April 2005, pp. 498–507; Allard E. Dembe, "Access to Medical Care for Occupational Disorders: Difficulties and Disparities," Journal of Health and Social Policy, December 2001, pp. 19–33; and Gordon S. Smith, Helen M. Wellman, Gary S. Sorock, Margaret Warner, Theodore K. Courtney, Glenn S. Pransky, and Lois A. Fingerhut, "Injuries at Work in the U.S. Adult Population: Contributions to the Total Injury Burden, "American Journal of Public Health, July 2005, pp. 1213–19.
3 Richardson, Ruser, and Suarez, "Hispanic Workers in the United States."
4 Massachusetts Survey of Occupational Injuries and Illnesses, 1997–2003.
5 The number of hospitals reporting varies over time due to mergers and reorganizations. During the period of the study, between 80 and 87 hospitals reported data.
6 Code of Massachusetts Regulations, 114.1CMR 17.00, Requirement for the Submission of Hospital Case Mix and Charge Data.
7 International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) (Geneva, World Health Organization, 1979).
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