McFalls, Matthew2024-01-052024-01-052023-06https://hdl.handle.net/11299/259773University of Minnesota Ph.D. dissertation. Jnne 2023. Major: Environmental Health. Advisor: Marizen Ramirez. 1 computer file (PDF); ix, 145 pages.Background: Older adults in the US are more often working past the age of 65, typically for financial reasons that prevent retirement. Many older adults still work full-time or physically demanding jobs that could compromise their health and safety. Detecting work-related injuries is challenging in this population, as injuries are less often covered by workers' compensation, a frequent source of surveillance data. This also has implications for the healthcare costs of older workers for whom workers' compensation coverage is inadequate or unavailable. Objective: The overall objective of this research is to further understand the burden of work-related injuries and healthcare costs to older adults, particularly those enrolled in Medicare, as well as understand how retirement barriers contribute to their risk of work-related injuries. Results may help to inform occupational injury research and surveillance methods, further understand the shifting healthcare costs of work-related injuries, and inform work practices to promote safety during the retirement transition. Manuscript 1: Aim: Measure the incidence and characterize the burden of work-related medically treated injuries in the 65 and older Medicare population. Methods: Identifying work-related injuries from 2016-2019 Medicare inpatient and outpatient claims data using payer-related and work-related ICD-10-CM codes to estimate the annual incidence of work-related injuries, describing demographic, injury, and healthcare encounter characteristics. Results: Estimated an average annual incidence of 27.6 work-related injury claims per 100,000 Medicare fee-for-service enrollees aged 65 and older. Overall 19% of injuries were hospitalized, and 72% of outpatient visits were in the emergency department. Falls, transportation, and machinery-related causes each accounted for approximately 20% of injuries, the next most common cause was being struck by/against an object (5%), followed by other causes (17%), or missing causes (18%). Manuscript 2: Aim: Estimate the impact of workers' compensation coverage on out-of-pocket healthcare costs following a work-related injury. Methods: Case-only study of work-related injuries from inpatient and outpatient Medicare claims, from 2016-2019. Followed up on work-related injuries to examine 90-day inpatient, outpatient, and skilled nursing facility costs incurred by enrollees. Used difference-in-differences, time series regression, and quantile regression to explore differences in claim costs and Medicare enrollee coinsurance/deductibles, based on workers' compensation (WC) coverage. Results: Of 13039 aged Medicare enrollees with a work-related injury, 16% had evidence of workers' compensation coverage from Medicare claims. The WC group averaged $452 (95% CI 395, 509) in excess out-of-pocket healthcare costs for inpatient, outpatient, and skilled nursing care following a work-related injury, compared to these costs in the 90 days before the injury. For those without WC coverage, these costs averaged $603 (95% CI 572, 634). At the 90th percentile of out-of-pocket spending, those without workers' compensation coverage incurred $601 in additional costs over the WC group (95% CI 398, 805). Manuscript 3: Aim: Estimate the longitudinal effect of job lock on the occupational injury incidence rate among older workers. Methods: Using 2010-2020 data from the Health and Retirement Study, identified two age-based cohorts of workers – those aged 55-64 and age 65 and older. Used repeated measures negative binomial regression models to estimate the longitudinal effect of job lock on occupational injuries. Explored effect modification of work status and self-employment on the effect of job lock. Results: Job lock increased the incidence rate of occupational injuries in the age 55-64 cohort (IRR 1.59, 95% CI 1.25-2.03), but not in the age 65 and older cohort (IRR 0.87, 95% CI 0.54-1.39). For the age 55-64 cohort, job lock did not have an effect on injuries for those who responded as self-employed or "partly-retired", but these effects were present in full-time (IRR 1.69, 95% CI 1.28-2.25) and part-time workers (IRR 1.89, 95% CI 1.06-3.37), as well as workers who were not self-employed (IRR 1.68, 95% CI 1.29-2.19). Conclusion: Work-related injuries appear to impact the health of older Medicare enrollees, and Medicare claims data can be a useful data source to study occupational injuries in this population, including healthcare costs. When available, workers' compensation seems to protect Medicare enrollees from incurring some out-of-pocket costs, but this coverage is not common. Since many older adults continue working for financial reasons, this raises concern that these healthcare costs may be financially detrimental to workers. Prior to age 65, job lock appears to effect occupational injury risk and can be a useful measure of retirement barriers if stratified on other aspects of the work arrangement. Taken together, the findings of this study provide further points to build on to understand the burden and costs of occupational injuries to older adults in the US, as well as areas of further study to improve both their workforce and retirement outcomes.encost of injuryinjury preventionmedicareoccupational injuryolder workerswork-related injuryThesis or Dissertation