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      Contribution of health status and prevalent chronic disease to individual risk for workplace injury in the manufacturing environment

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          An ‘information gap’ has been identified regarding the effects of chronic disease on occupational injury risk. We investigated the association of ischaemic heart disease, hypertension, diabetes, depression and asthma with acute occupational injury in a cohort of manufacturing workers from 1 January 1997 through 31 December 2007.


          We used administrative data on real-time injury, medical claims, workplace characteristics and demographics to examine this association. We employed a piecewise exponential model within an Andersen–Gill framework with a frailty term at the employee level to account for inclusion of multiple injuries for each employee, random effects at the employee level due to correlation among jobs held by an employee, and experience on the job as a covariate.


          One-third of employees had at least one of the diseases during the study period. After adjusting for potential confounders, presence of these diseases was associated with increased hazard of injury: heart disease (HR 1.23, 95% CI 1.11 to 1.36), diabetes (HR 1.17, 95% CI 1.08 to 1.27), depression (HR 1.25, 95% CI 1.12 to 1.38) and asthma (HR 1.14, 95% CI 1.02 to 1.287). Hypertension was not significantly associated with hazard of injury. Associations of chronic disease with injury risk were less evident for more serious reportable injuries; only depression and a summary health metric derived from claims remained significantly positive in this subset.


          Our results suggest that chronic heart disease, diabetes and depression confer an increased risk for acute occupational injury.

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          Most cited references 30

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          Direct medical cost of overweight and obesity in the USA: a quantitative systematic review.

          To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. PubMed (1968-2009), EconLit (1969-2009) and Business Source Premier (1995-2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. A total of 33 US studies met review criteria. Among the four highest-quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimates included use of national samples vs. more selected populations, age groups examined, inclusion of all medical costs vs. obesity-related costs only, and body mass index cut-offs for defining overweight and obesity. Depending on the source of total national healthcare expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs and use standard body mass index cut-offs. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.
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            Regression with frailty in survival analysis.

            In studies of survival, the hazard function for each individual may depend on observed risk variables but usually not all such variables are known or measurable. This unknown factor of the hazard function is usually termed the individual heterogeneity or frailty. When survival is time to the occurrence of a particular type of event and more than one such time may be obtained for each individual, frailty is a common factor among such recurrence times. A model including frailty is fitted to such repeated measures of recurrence times.
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              The impact of a workplace-based weight loss program on work-related outcomes in overweight male shift workers.

              The aim of this study was to evaluate the impact of a workplace-based weight loss program (Workplace POWER [Preventing Obesity Without Eating like a Rabbit]) for male shift workers on a number of work-related outcomes.

                Author and article information

                Occup Environ Med
                Occup Environ Med
                Occupational and Environmental Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                March 2014
                16 October 2013
                : 71
                : 3
                : 159-166
                [1 ]Quantitative Sciences Unit, Stanford University School of Medicine , Stanford, California, USA
                [2 ]Yale Occupational & Environmental Medicine, Yale School of Medicine , New Haven, Connecticut, USA
                [3 ]General Medical Disciplines, Stanford University School of Medicine , Stanford, California, USA
                Author notes
                [Correspondence to ] Dr Mark Cullen, General Medical Disciplines, Stanford University School of Medicine, 1265 Welch Road, MSOB X-338, Stanford, CA 94305-5411, USA; mrcullen@
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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