An in-depth research study of work-related musculoskeletal disorders in Washington state from 1990-1998 based on worker’s compensation claims.
Magnitude of Neck, Back and Upper Extremity Disorders in Washington State
This report describes the distribution of musculoskeletal disorders in Washington State between 1990-1998. The focus of the report is on the neck, back and upper extremity (shoulder-fingers) and more specifically for the soft tissue musculoskeletal disorders of non-traumatic origin. The lower extremity was excluded from this report because of inadequate consistency in coding of traumatic and non-traumatic disorders in the claims database. For the most part, the results will be presented first for the State Fund data (which is more complete) and then the compensable (4 or more days of lost time) Self Insured data, followed by combined State Fund and Self Insured compensable claims. Because we had no medical bill data with ICD-9 codes available for specific diagnoses (such as those in Table 1) for the Self-Insured data, direct comparisons between the two are not really possible. Information is presented by Standard Industrial Classification (SIC) codes so that it can be compared to national data by industry but also by Washington Risk Classification (WIC) because these codes are more specifically related to workplaces with relatively similar processes and exposures.
Overall Incidence and Cost
188.8.131.52 State Fund
There were 688,795 State Fund accepted musculoskeletal disorder (MSD) claims of the neck, back and upper extremities, costing $4.0 billion, 33.2 million lost days and representing 46.2% of all State Fund accepted claims over the 9-year period. The average number of these MSD claims was 76,533 per year averaging $5,941 per claim and 147 lost workdays per compensable claim. (Table 3). The claims incidence rate (CIR) was 622.2 per 10,000 full-time equivalent employees (FTEs).
There were 392,925 State Fund accepted non-traumatic soft-tissue (NTST) MSDs (see Tables 1, 2a-b for criteria) costing $2.6 billion in 1998 dollars, 20.5 million lost workdays and representing 26.4% of all State Fund accepted claims. The average number of State Fund non-traumatic soft-tissue MSDs was 43,658 per year averaging $5,923 per claim and 146 lost workdays per compensable claim. More than 36% of the NTST-MSD claims were compensable (lost time) claims, compared to 23.5% of all claims. The average claims incidence rate (CIR) was 355.0 per 10,000 FTEs for all NTST-MSDs and 129 per 10,000 for compensable claims. The CIRs for all claims, all musculoskeletal claims and all NTST-MSDs have decreased significantly between 1990-1997 (Figure 3). However the rate of decrease was less for the musculoskeletal claims (p<0.01) than for all non-musculoskeletal claims and the rate for the NTST-MSD claims was less than for all other claims including musculoskeletal disorders of traumatic origin (p=0.05), approximately 5.0% per year for compensable claims. The severity rate for NTST-MSDs was 18,403 lost workdays per 10,000 FTEs, representing 47% of all claims' lost workdays. The severity rate for compensable NTST-MSDs decreased about 10.6% per year between 1992- 1997 compared to 10.1% for all compensable claims. It should be noted that more recent claims are likely to still be open at the time of the data extract, particularly for NTST-MSDs (10.3% of 1998 claims still open) and, for example carpal tunnel syndrome (40.3% of 1998 claims still open), Figure 1.
There were 533,207 accepted claims between 1990-1998, 32.3% of them were compensable. Among the Self-Insured only compensable (4 or more lost workdays) claims were available for analysis and rate data available only for 1992-1998. Additionally, Self-Insured compensable claims data are not available for analysis until the claim has been closed. This may result in substantial underestimates of rates in the more recent years. There were 111,756 compensable MSD claims of the neck, back and upper extremity, representing 64.8% of all compensable claims. The average compensable CIR was 227.8 per 10,000 FTEs. For compensable NTST-MSDs, there were 80,230 claims, costing estimated $572 million in 1998 dollars (Table 21), representing approximately 46.5% of all compensable claims. The average compensable CIR was 164.1, with averages of $6,279 per compensable claim.
Approximately 32% of all Self-Insured claims are compensable. Although the total number (compensable and medical only) of NTST-MSD claims is not available, assuming a percentage between 32.3% and 36.6% (per cent compensable of State Fund NTST-MSD claims), the total number of NTST-MSD claims would range between 219,208 and 248,390, and the incidence rate would be approximately 570-650 per 10,000 FTEs. The claims incidence rate for compensable NTST-MSDs decreased only slightly, averaging 2.3% per year, compared to 5.0% for the State Fund NTST-MSD claims. On average, the severity rate decreased 9.8% (Table 35).
Combined State Fund and Self Insured Compensable Claims
Figure 2 presents the distribution of the 1997 combined State Fund and Self-Insured NTST-MSD compensable (lost time) claims by county and the rates per region. In this instance, the 1998 Washington State Population of working people (number of worker rather than FTEs based on hours) was used as the denominator. The highest rates are in King County and the “West Balance” region, followed by Spokane and Yakima -Tri-Cities county. The lowest rates were in the North Sound, Clark and "Eastern Balance” region.
3.2. Magnitude and Cost of Non-Traumatic Soft-Tissue Disorders by Body Region
3.2.1. State Fund
were 44,767 Neck NTST-MSD claims (49% of all neck MSDs) between
1990-1998 costing $88.7 million, 0.7 million lost days and 49% of them
compensable (4 or more lost workdays). The average claim had direct costs
of $6,536 and compensable claims averaged 162 lost days. The average claims
incidence rate was 40.5 and the severity rate was 600 lost workdays per
10,000 FTEs (Table 4).
There were 213,865 Back NTST-MSDs (77% of all back MSDs) with direct costs of $1.2 billion, 10.6 million lost workdays, and 40% resulting in 4 or more lost workdays. The average direct cost was $5,897 per claim and resulted in 133 lost workdays per compensable claim. The average claims incidence rate was 193.5 and the severity rate was 9,488 lost workdays per 10,000 FTEs.
There were 46,383 NTST-MSD claims affecting a combination of neck and upper or lower back, (39% of all neck/back MSDs) and 33% were compensable. The average claim had a direct cost of $6,085 and the average compensable claim resulted in 160 lost workdays. The claims incidence rate was 42.2 and severity rate was 2,196 lost workdays per 10,000 FTEs. A higher percentage of neck and multiple neck/back claimants were female (40-44%) than back injury claimants (29%) while median age was quite similar (33- 35).
were significant decreases in the claims incidence rates for all three
body regions between 1990-1997, with the combined neck/back claims rate
decreasing more than all other claims excluding NTST claims, (p<0.001),
The specific diagnosis of sciatica was identified in 5,468 claims (608 per year), Table 6. These claims, while infrequent (claims incidence rate of 4.9 per 10,000 FTEs), were extremely costly, averaging $39,371 and 421 lost workdays per claim. Almost 80% were compensable. The CIR has not significantly changed over the previous 8 years (Figure 6).
There were 129,656 accepted upper extremity NTST-MSD claims (45% of all upper extremity MSDs) between 1990-1998 resulting in direct costs of $721.4 million and 6.8 million lost workdays, 36% of these claims compensable. The average claim had a direct cost of $5,837 and the average compensable claim resulted in 162 lost workdays (Table 5). The claims incidence rate was 116.6 and the severity rate was 6,119 lost workdays per 10,000 FTEs. The majority of these NTST-MSDs were in the hand/wrist area (65,707), followed by the shoulder (42,715) and then the elbow/forearm area (21,586). The shoulder and hand/wrist areas had a slightly higher proportion of compensable claims compared to the elbow/forearm area (39% and 38% versus 34%). The shoulder and hand NTST-MSD claims resulted in more lost time (161 and 164 lost workdays respectively compared to 155 for compensable claims) and higher direct costs ($6,661 and $5,744 compared to $4,310) than the elbow/forearm area NTST-MSDs. While a greater percentage of hand/wrist NTST-MSD claimants were women (51% compared to 36% for shoulder and 38% for elbow/forearm), they were slightly younger (median of 34 years compared to 35 years for shoulder and 37 years for elbow/forearm). Unlike the back and neck, upper extremity NTST-MSD CIRs did not decrease significantly over the years (Figure 4). There was no significant decrease in CIR for either shoulder or elbow/forearm NTST-MSDs (Figure 5). While hand/wrist NTST-MSD claims decreased significantly over time, they decreased significantly less than the rate for all other claims excluding NTST-MSD claims (p<0.001).
We selected several specific diagnoses for closer examination, Table 6. There were 17,083 rotator cuff syndrome claims between 1990-1998, averaging 1,898 per year, with an average claims incidence rate of 15.3 and severity rate of 1,436 per 10,000 FTEs. The average direct cost was $15,226. Fifty-nine percent were compensable, averaging 236 lost workdays per claim. Epicondylitis was identified in 11,897 claims, averaging 1,322 per year with a claims incidence rate of 10.6 and severity rate of 499 per 10,000 FTEs. The average direct cost of an epicondylitis claim was $6,959. Forty-three percent were compensable, averaging 208 lost workdays per claim. There were 27,148 accepted carpal tunnel syndrome (CTS) claims between 1990-1998 averaging 3,016 per year, with an average claims incidence rate of 24.5 and severity rate of 2,524 per 10,000 FTEs. The average direct cost for a CTS claim was $12,627. Almost 2/3 were compensable and averaged 209 lost workdays per compensable claim. The median age for CTS claimants was 37 compared to 39 for rotator cuff and 40 for epicondylitis claimants.
A much higher percentage of CTS claimants were females (60.9%) than were rotator cuff syndrome (36.8%) or epicondylitis (44.6%) claimants. Claims incidence rates for rotator cuff syndrome did not change over time whereas the rate for epicondylitis increased (p<0.05) and the rate for CTS decreased (p<0.01) significantly. However the rate for CTS decreased statistically significantly less than for all claims excluding NTST-MSDs (P<0.001), Figure 6. The percent of CTS cases resulting in surgical release has decreased pretty steadily (2.7% per year) between 1990 (47.1%) and 1997 (38.2%), Figure 7. Overlapping diagnoses were identified in 1.3% of the allowed medical bills for the upper extremity claims, 0.6% for both carpal tunnel syndrome and epicondylitis, 0.4% for carpal tunnel syndrome and rotator cuff syndrome, 0.2% for epicondylitis and rotator cuff syndrome and 0.1% for all 3 diagnoses.
There were 2,541 compensable (lost time) Neck NTST disorder claims (63% of all neck MSDs). There were an average of 282 compensable claims per year, with a claims incidence rate of 5.1 per 10,000 FTEs. There were 42,592 Back compensable NTST-MSD claims (85.7% of all back MSD claims). The average compensable CIR was 85.9 per 10,000 FTEs. There were 8,283 Neck and Back compensable NTST -MSD claims (46.5% of all neck/back MSDs). There was an average of 920 compensable claims per year, with a compensable CIR of 17 per 10,000 FTEs. As with State Fund claimants, a higher proportion of NTST neck and neck/back claims were among women (55-57%) than NTST back injuries (42%) while age was basically the same (median of 37-38), Table 22.
were 26,812 compensable Upper Extremity NTST-MSD claims between
1990-1998 (67% of all upper extremity MSDs). There was an average of 2,979
compensable claims per year (average CIR= 56.2 per 10,000 FTEs) (Table
23). Hand/wrist NTST disorders accounted for almost half of these
(12,421) and 60% of all hand/wrist MSDs, averaging 1,380 claims per year.
The average compensable claims rate was 25.7 per 10,000 FTEs. Approximately
77% of the compensable Shoulder MSD claims (8,642/11,203) were
for NTST disorders, averaging 960 per year with an average claims rate
Approximately 61% of compensable Elbow/forearm MSDs were NTST disorders, averaging 300 per year with a compensable claims incidence rate of 5.7 per 10,000 FTEs. As with the State Fund claims, approximately 60% of the hand/wrist NTST-MSD claimants were women, compared to 46% for shoulder and elbow/forearm NTST-MSD claims. Claimants were slightly older compared to the State Fund claimants (39-40 years).
Distribution of Non-Traumatic Soft Tissue (NTST) MSDs by Industry
The workers compensation data were examined by industry sector, 3-digit standard industrial classification (SIC) to compare with national industry estimates and by Washington’s specific industrial risk classifications (WIC) which are based on more similar risk of any injury than commercial considerations (SIC). The analysis evaluated both the magnitude (number or count) of claims and the risk (incidence) of claims. The ranks of these two components were averaged into a “Prevention Index (PI)” and all tables were rank ordered by this index. For each table, the count of NTST-MSDs, the incidence rate and 95th upper and 95th lower bounds are provided along with the rate ratio (the incidence rate for a particular industry divided by the rate for all industries combined). Additionally, the count rank, the rate rank and the prevention index are included. Because the prevention index is an average of two ranks, it is possible that a very small industry (few hours) might have a very high claims incidence rate and thus would not be in the top 25 industries based on the prevention. The same could be true with an industry that has a very large population but a low incidence rate. When either of these events occurred, the top 3 industries by either count or rate are listed below the line in the table. SIC codes that had less than 200,000 hours per year (equivalent to 100 FTEs per year) were excluded from the more detailed analysis of 3-digit SICs. Similarly, 4- digit WIC classes with less than 50 full-time workers per year were excluded. The difference in exclusion criteria reflects the tradeoff between precision and stability.
Overall NTST-MSDs by Industry Sector
Table 7 shows that the State Fund Construction and Manufacturing sector are the first industries based on the prevention index followed by Transportation. Construction is 1st on the basis of claims incidence rate (CIR) and 4th on the basis of claim count (n=59,978). The CIR was almost twice that of the overall industry rate. For the Self-Insured compensable claims, Transportation is first on the prevention index, followed by Retail Trade and Manufacturing (Table 24). Transportation has the highest compensable CIR, about 1.8 times that of all Self-Insured industry. Self-Insured construction is 8th on the prevention index based on both compensable rate and compensable count with an incidence rate less than the overall industry rate.
Figures 8 and 9 show State Fund and Self Insured compensable claims incidence rates from 1992-1998. Analysis was for 1992-1997 because Self-Insured hours were not available before 1992 and there are many 1998 Self Insured open claims that are not available for analysis since they are not reported to L&I until they are closed. Although a strict comparison between the Self-Insured and State Fund compensable claims rates is not possible, because we do not have diagnostic (ICD-9) codes for the Self-Insured data, the differences in patterns are interesting. For the State Fund, the highest compensable claims incidence rate is for Construction which decreased dramatically through 1995 and then leveled off. For the Self Insured, Construction rates are considerably lower than other industries whereas Transportation is the highest and appears to be increasing. Finance and Public Administration have had the lowest CIRs and were relatively stable among State Fund employers whereas among the Self -Insured Public Administration employers, CIRs were higher than Services, Agriculture, Construction, Manufacturing, Wholesale Trade, and Finance. The only Self-Insured industries with relatively consistent downward trends in rates were Manufacturing, Wholesale and Retail Trade. With respect to severity rates (lost workdays per 10,000 FTEs), there was virtually no change over time in Self-Insured Transportation (average yearly decrease of 1.1% and overall change of 5.6%), compared to more than 12% per year for Agriculture, Construction and Manufacturing, Table 35. For the State Fund, severity rates decreased between 9.2 and 11.4% per year.
NTST-MSDs by Prevention Index (PI) and 3-Digit SIC Code
184.108.40.206. State Fund
Nursing and Personal Care Services (SIC 805) was the first industry of concern based on the State Fund Prevention Index (PI), Table 8. It was ranked first on claims incidence rate (1,194 per 10,000 FTEs) and second based on count rank (19,045 claims) and 3.4 times the overall industry rate. The top 10 3-digit SIC industries and their claims rate relative to overall industry (RR) were:
- Nursing and Personal Care Services (SIC 805) RR=3.4
- Masonry (SIC 174) RR=2.9
- Millwork (SIC 243) RR=2.5
- General Building Contractors-Residential (SIC 152) RR=2.1
- Sawmills (SIC 242) RR=2.7
- Roofing (SIC 176) RR=3.0
- Landscape (SIC 078) RR=2.3
- Trucking (SIC 421) RR=1.9
- Carpentry (SIC175) RR=2.2
- Plumbing (SIC 171) RR=1.9
While Eating Places
(SIC581) had the most claims, the rate rank was 205th, and less than the
overall industry rate (RR=0.8). Table 16 shows the SIC-3 industries for
compensable NTST-MSD claims, the top 10 industries by prevention index
- Nursing and Personal Care Services (SIC 805) RR=3.6
- Masonry (SIC 174) RR=3.7
- Trucking (SIC 421) RR=2.5
- General Building Contractors-Residential (SIC 152) RR=2.4
- Roofing (SIC 176) RR=3.7
- Carpentry (SIC175) RR=2.7
- Landscaping (SIC 078) RR=2.7
- Residential Care (SIC 386) RR=2.4
- Concrete work (SIC 177) RR=3.2
- Sawmills (SIC 242) RR=2.5
55.4% in roofers
7.7% in supervisors
6.6% in carpenters and apprentices
6.3% in construction laborers
4.1% in sheet metal workers and apprentices
of these, more than 50% were concentrated in one job:
- Roofing (SIC 176) 55% of claims were among roofers,
- Nursing Facilities (SIC 805) 70% were in nursing aides and orderlies,
- Intercity & Rural Bus Transportation (SIC 413) 69.1% were in bus drivers
- Landscape & Horticultural Services (SIC 078) 62% were in groundskeepers and gardeners
- Trucking and Courier services (SIC 421) 56% were in truck drivers
Back and Neck NTST-MSDs were congregated in industries characterized by manual handling activities.
For Neck NTST-MSDs, Nursing and Personal Care Services (SIC 805) was first on the PI and had a RR of 4.1 times the overall industry CIR. It was followed by Masonry (SIC 174), Residential Care (SIC 836), Rooming and Boarding Houses (SIC 702), Trucking (SIC 421), Hospitals (SIC 806), Roofing, Carpentry, Residential General Building Contractors and Millwork. Although Broadwoven Fabric Mills (SIC 222) had a high rate, it was a small industry with a small number of cases, Table 9. Although Eating Places had almost as many claims as Nursing Facilities, it was ranked 180 by claims rate (RR=0.8).
Back NTST-MSDs had much higher rates but a fairly similar industrial distribution as Neck NTST-MSDs. Nursing and personal care services, Masonry, Residential General Building Contractors, Carpentry and Millwork had the highest prevention indices, and unlike for the Neck NTST-MSDs, Landscape, Sawmills and Plumbing were in the top 10, Table 10. Similar industries were identified for sciatica with the inclusion of Heavy Construction (SIC 162), and Miscellaneous Special Trade Contractors (SIC 179), Table 12.
The distribution of Upper Extremity NTST-MSDs differed from back and neck NTST-MSDs, Table 11. Based on the Prevention Index, the top 10 industries and their rate ratios were:
- Nursing and Personal Services (SIC 805) RR=2.7
- Sawmills (SIC 242) RR=3.2
- Millwork (SIC 243) RR=2.7
- Masonry (SIC 174) RR=2.5
- Meat Products (SIC 201) RR=3.9
- Miscellaneous Food Preparation and Kindred Products (SIC 209) RR=2.5
- Groceries (SIC 514) RR=1.9
- Roofing (SIC 176) RR=2.6
- Residential General Contractors (SIC 152) RR=1.8
- Landscaping (SIC
078) RR=2.1. Again Broadwoven Fabric Mills and Footwear had high rates
but low counts. Eating Places had the highest number of claims (6,960)
but ranked 210 based on claims rate.
Based on the Prevention
Index, rotator cuff syndrome claims were more likely to be concentrated
in the manual handling industries similar to back claims with Masonry
(SIC 174) being first on the Prevention Index and rate ratio (RR=3.9),
Table 13. Epicondylitis also was primarily concentrated in industries
characterized by manual handling activities, Table 14, whereas carpal
tunnel syndrome (Table 15) was more focused in industries characterized
by repetitive work:
- Beauty Shops (SIC 723) RR=2.9
- Sawmills (SIC 242) RR=2.7
- Grocery Stores (SIC 541) RR=2.1
- Admin. of Social, Human Resource & Income Maintenance Programs (SIC 944) RR=2.3
- Meat Products (SIC 201) RR=4.1
- Masonry (SIC 174) RR=2.0
- Miscellaneous Food Preparation (SIC 209) RR=2.3
- Millwork (SIC 243) RR=2.0
- Groceries & related products (SIC 514) RR=1.6
- Miscellaneous Plastics Products (SIC 308)) RR=2.0 Footwear had the highest CIR and Eating Places had the highest number of CTS claims by SIC
Self-Insured Compensable NTST-MSDs
Self-Insured compensable claims incidence rates by industry are for years 1992-1998 because hours weren’t available to calculate rates prior to 1992. While Hospitals (SIC 806) ranked first based on the number of NTST-MSD compensable claims (Table 25), based on the Prevention Index, the following 3-digit SICs were identified:
- Trucking & Courier Services (SIC 421) RR=3.9
- Air Transportation (SIC451) RR=2.7
- Grocery Stores (SIC 541) RR=1.7
- Rolling, Drawing & Extruding Nonferrous Metals (SIC335) RR=2.2
- Groceries & Related Products (SIC 514) RR=2.2
- Variety Stores (SIC 533) RR=1.9
- Nursing & Personal Services (SIC 805) RR=2.1
- Personnel Supply Services (SIC 736) RR=1.6
- Local & Suburban Passenger Transportation (SIC 411) RR=2.6
- Services to Dwellings & Other Buildings (SIC 734) RR=1.9
Within 3-digit SICs
that had compensable NTST-MSD rates greater than 2.5 times the overall
industry rate, two thirds or more were in five or fewer occupations, Table
29. For example,
- Trucking (SIC 421): Truck drivers 52.5%, Freight/stock handlers 19.3%
- Miscellaneous Durable Goods: Molding and casting machine operators (SIC 509) 34.1%
- Air Transportation (SIC 451): Freight/stock handlers 43.0%, Public transportation attendants 29.4%
- Local & Suburban Passenger: Bus drivers 40.3%
- Transportation (SIC 411): Health Technicians 24.4%
There were no occupational
codes for 4246 (5.3%) claims.
Trucking & Courier Services and Air Transportation were 1st and 2nd on the PI for all body regions and Grocery Stores were in the top 10 (Tables 26-28). However, with respect to Neck NTST-MSDs, Hospitals (SIC 806) ranked 3rd and Executive (SIC 911) and Legislative (SIC 912) were included in the top 10. For Back NTST-MSDs, Beverages (SIC 208) ranked 9th and Hospitals ranked 10th .
For Upper Extremity
NTST-MSDs, Ship & Boat Building & Repair (SIC 373), Miscellaneous
Durable Goods (SIC 509), Dairy Products (SIC 202) and Paperboard Containers
& Boxes (SIC265) were also in the top 10 list (Table 28). The highest
rate ratio was for Miscellaneous Durable Goods (RR=5.4).
220.127.116.11 Combined State Fund and Self-Insured Compensable NTST-MSDs
The Construction sector was first on the Prevention Index (RR=1.9) followed by Manufacturing (RR=1.1) and Transportation (RR=1.6), Table 30. The top 10 3-digit SICs for all combined compensable NTST-MSDs (Table 31) were:
- Trucking (SIC 421) RR=3.0
- Nursing & Personal Care Facilities (SIC 805) RR=3.0
- Masonry (SIC 174) RR=3.4
- Air Transportation (SIC 451) RR=2.8
- General Building Contractors-Residential (SIC152) RR=2.1
- Roofing (SIC 176) RR=3.3
- Carpentry & Floor Work (SIC175) RR=2.4
- Residential Care (SIC 836) RR=2.2
- Grocery Stores (SIC 541) RR=1.8
- Concrete Work (SIC 177) RR=2.9
Grocery Stores ranked 1 st based on count while Masonry ranked 1st based on CIR. Between 1992-1997, the CIR decreased approximately 4.6% per year.
For compensable Neck
NTST-MSDs (Table 32), Nursing Homes ranked 1st and had a rate ratio
of 4.8 times the overall industry rate, followed by Masonry (RR=5.2).
Additionally, Rooming & Boarding Houses (SIC 702) with a RR=3.5, Misc.
Special Trade Contractors (SIC 179) with a RR=2.3, and Home Health Care
Services (SIC 808) with a RR=3.4, were in the top 10 group. Nursing homes
ranked 1st in Back NTST-MSDs (RR=3.6), followed by Trucking (RR=3.3),
and Masonry (RR=3.7), Table 33. Landscaping (RR=2.7) and Miscellaneous
Special Trade Contractors (RR=2.0) were also in the top 10 group for back
With respect to compensable Upper Extremity NTST-MSDs, Masonry (RR=3.0), Air Transportation (RR=2.6) and Trucking (RR=2.3) were the top 3 industries on the PI, followed by Grocery Stores (SIC 541) with RR=2.0 and Meat Products (SIC 201) with RR=3.0 (Table 34). Also included in the Top 10 that were not in the overall list were Sawmills (RR=2.3), Misc. Food Preparation (RR=2.2), Rolling Non Ferrous Metals (=2.8), and Millwork (RR=1.9). Very small industries with high CIRs excluded based on the Prevention Index include Footwear (RR=6.1), Broadwoven Fabric Mills (RR=4.0) and Musical Instruments, SIC 393 (RR=3.3).
NTST-MSDs by 4-Digit Washington Industrial Risk Classification (WIC) Code
The WIC codes allow a closer look at industries by similar types of processes or exposures for all injuries, not just MSDs. The utility of this analysis can be seen in the higher rate ratios (RR) than observed for the SICs. While in general, the results are similar to those based on SIC code, there are some high risk industries that do not show up in the SIC analysis.
18.104.22.168. State Fund
Based on the Prevention Index for all NTST-MSDs (Table 36), the top 10 industries were identified by WIC:
- Nursing Homes (WIC 6108) RR=3.8
- Wood Frame Bldg Construction (WIC 0610) RR=3.0
- Wood Products Manufacturing (WIC 2903) RR=3.0
- Roofing (WIC 0507) RR=5.2
- Wallboard Installation (WIC 0515) RR=6.3
- Temporary Help-Assembly (WIC 7114) RR=5.6
- Sawmills (WIC 1002) RR=3.3
- Building Construction Not otherwise classified (WIC 0518) RR=2.8
- Garbage Collection (WIC 4305) RR=3.7
- Moving Companies (WIC 6907) RR=4.5
Based on CIR, Reinforcing Steel Installation (WIC 0109) was 1 st (RR=9.7) followed by Shake Mills (WIC 1005) with RR=7.6.
For Neck NTST-MSDs (Table 37), additional industries identified include State Health Care Facilities (WIC 7201) with a RR=4.3, Home Health Care Nursing (WIC 6110) with an RR=3.3, and Trucking (WIC 1102) with an RR=2.3.As with the overall NTST-MSDs, Shake Mills (RR=12.5) and Reinforcing Steel Installation (RR=9.6) had the highest CIRs. For Back NTST-MSDs (Table 38), Beer Distributors (WIC 2105) with a RR=4.1 and Landscaping (WIC 0301) with a RR=3.1, join the top 10 list. Along with Reinforcing Steel Installation (RR=9.5), and Shake Mills (RR=8.2), Temporary Help-Vehicle Operation (WIC 7119), had a very high rate (RR=6.4) but small numbers.
For Sciatica, the following top 10 WICs were identified based on Prevention Index (Table 40):
- Nursing Homes (WIC 6108) RR=4.7
- Wood Frame Bldg Construction (WIC 0510) RR=3.0
- Building Construction Not otherwise classified (WIC 0518) RR=3.7
- Road Construction (WIC 0101) RR=3.3
- Trucking (WIC 1102) RR=2.9
- Roofing (WIC 0507) RR=6.8
- Heating, Ventilation and Air-Condition Systems (WIC 0307) RR=3.2
- Plumbing (WIC 0306) RR=3.1
- Wallboard Installation (WIC 0515) RR=8.2
- Preferred Workers (WIC 7204) RR=7.5
Bridge Construction was first based on CIR and Restaurants (RR=0.8) was first based on number of claims.
For Upper Extremity
NTST-MSDs (Table 39), additions to the top 10 list based on the Prevention
Index include Meat Dealers Wholesale (WIC 3304) with a RR=4.1 and Meat
Products Manufacturing (WIC 4301) with a RR=4.7. Based on CIR, Reinforcing
Steel (RR=10.7) and Temporary Help-Vehicle Operation (RR=10.1) were the
top two industries for the upper extremity.
For Rotator Cuff Syndrome (Table 41), the top 10 WICs based on the Prevention index include:
- Trucking NOC (WIC 1102) RR=3.0
- Wallboard Installation (WIC 0515) RR=9.5
- Wood Products Manufacturing (WIC 2903) RR=3.2
- Nursing Homes (WIC 6108) RR=2.9
- Garbage Collection (WIC 4305) RR=5.2
- Meat Dealers Wholesale (WIC 3304) RR=3.3
- Building Construction Not Otherwise Classified (0518) RR=3.1
- Sawmills (WIC 1002) RR=4.2
- Wood Frame Building Construction (WIC 0510) RR=2.7
- Plywood Manufacturing (WIC 2904) RR=5.4
Based on CIR, Reinforcing Steel Installation (RR=13.4) was 1 st and based on number of claims, Restaurants (RR=0.7) was 1st .
(Table 42), the top 10 WICs based on the Prevention Index include:
- Wood Frame Building Construction (WIC 0510) RR=3.6
- Wood Products Manufacturing (WIC 2903) RR=3.2
- Meat Dealer Wholesale (WIC 3304) RR=3.3
- Building Construction Not Otherwise Classified (0518) RR=3.2
- Wallboard Installation (WIC 0515) RR=8.1
- Roofing (WIC 0507) RR=4.6
- Aluminum Product Manufacturing (WIC 3404) RR=2.4
- Plastic Products Manufacturing (WIC 3510) RR=2.7
- Cabinet/ Countertop Manufacturing (WIC 2907) RR2.9
- Supermarkets (WIC 6402) RR=2.1 Wallboard Installation-Discounted (RR=11.7) ranked first based on CIR and Restaurants (RR=0.8) ranked first based on number of claims.
For Carpal Tunnel
Syndrome (Table 43), the top 10 WICs based on the Prevention Index
- Meat Dealer Wholesale (WIC 3304) RR=4.5
- Supermarkets (WIC 6402) RR=2.8
- Barber Shops (WIC 6501) RR=3.0
- Wood Products Manufacturing (WIC 2903) RR=2.9
- Sawmills (WIC 1002) RR=3.6
- Plastic Products Manufacturing (WIC 3510) RR=2.8
- Meat Products Manufacturing (WIC 4301) RR=4.6
- Logging (WIC 5001) RR=3.5
- Textile Manufacturing (WIC 3708) RR=3.1
- Wood Frame Building Construction (WIC 0510) RR=2.1
Once again Reinforcing Steel Installation (RR=16.9) and Shake Mills (RR=8.8) had the highest CIRs. Clerical Office Not Otherwise Classified had the largest number of claims (n=2,451), but had a RR=0.6 and ranked 176 based on claims incidence rate.
- Parcel Package Delivery (WIC 1101) RR=5.0
- Bus Companies (WIC 1404) RR=3.4
- Airlines, Ground Crew (WIC 6802) RR=4.7
- Trucking (WIC 1102) RR=3.2
- Schools, All Other Employees (WIC 6104) RR=2.4
- Warehouses, NOC (WIC 2102) RR=2.6
- Cities-All Other Employees NOC (0803) RR=2.5
- Airlines, Flight Crew (WIC 6801) RR=4.7
- Temporary Help Administrative Staff (WIC 7104) RR=21.0
- Wholesale Stores (WIC 6407) RR=1.8
Based on number of claims, Hospitals (WIC 6105) were first with a RR=1.4 followed by Aircraft Manufacturing (WIC 3403) with a RR=0.7. Based on CIR, Temporary Help Administrative Staff were followed by Beer distributors (RR=8.8) and Brick or Clay Products Manufacturing (WIC3501) with a RR=7.1. Although Temporary Help Administrative Staff should only have claims for staff of those large temporary help agencies, they also occasionally include temporary assembly, machine operator, etc. claimants that are sent to work in other companies.
For compensable Neck
NTST-MSDs (Table 45) based on the PI, Bus Companies and Parcel Package
Delivery were 1st (RR=5.3), others in the top 10 included Hospitals (RR=1.6)
and Fire Fighters (WIC 6904) with a RR=3.5. The highest rate was for Temporary
Help Administrative Staff (RR=25.7) and the highest count was for hospitals.
For Back NTST-MSDs (Table 46), based on the PI, Parcel Package
Delivery was 1st with a RR=6.0. Wholesale Stores was also in the top 10
based on the PI (RR=3.2). The highest CIR was in Temporary Help Administrative
Staff (RR=16.4) and the highest number was in Hospitals (RR=1.5).
For Upper Extremity NTST-MSDs, Parcel Package Delivery (RR=3.8) was 1st on the Prevention Index, Table 47. Additional top 10 industries included Supermarkets (WIC 6402) with a RR=2.1, Aluminum Product Manufacturing (WIC 3404) with a RR=2.4. The highest CIR was in Temporary Help Administrative Staff (RR=27.0) and the largest number was in Aircraft Manufacturing (RR=0.8).
Temporary Help Work
For the most part, the same industries were the top high-risk industries consistently throughout the nine-year period. However, a more recent trend that does not fully show up in the summary tables is the inclusion of temporary help agencies as high-risk industries. These agencies were separately classified by type of work (e.g., assembly, machine operator, construction, food processing, and health care) in Washington Industrial Codes (WIC) largely after 1989. Because their numbers were originally small but have been growing, it is useful to look at them by rank based on rate ratio.
For all State Fund NTST-MSDs, compared to overall industry rate:
- Temporary Help Vehicle Operation ranked 3rd, RR=7.4
- Temporary Help Assembly Work ranked 7th, RR=5.6
- Temporary Help Construction ranked 10th, RR=4.9
- Temporary Help Machine Operator ranked 15th, RR=4.0
For Back NTST-MSDs, based on rate ratio compared to the overall industry rate:
- Temporary Help Vehicle Operation ranked 3rd, RR=6.4
- Temporary Help Assembly Work ranked 10th, RR=5.1
- Temporary Help Construction ranked 14th, RR=4.3
- Temporary Help Vehicle Operation ranked 2nd, RR=10.1
- Temporary Help Assembly Work ranked 3rd, RR=6.9
- Temporary Help Construction ranked 6th, RR=6.1
- Temporary Help Machine Operator ranked 9th, RR=4.9
- Temporary Help Food Processing ranked 14th, RR=4.3
- Temporary Help-Administrative ranked 1st, RR=21.0
For the Self-Insured compensable NTST-MSD claims, temporary administrative staff (largely clerical) was a high risk category (RRs ranging from 16-27). Temporary workers who do not work through a temporary help agency were not included in these estimates.