Workplace injuries will vary by nature of the work performed. While injury rates and severity may be influenced by certain non-modifiable risk factors, such as age, gender, height, and to a lesser extent weight, it would not be expected that race would be such a variable. This study found that in a cohort of 134 workers from the Minneapolis-St. Paul (Twin cities) area of Minnesota, there was a considerable increase in abrasion/laceration and sprain/strain injuries among African American (Black) workers in healthcare and social assistance job sectors, when compared to other races (Non-black) in that job sector. The job sector was identified via the North American industry classification system (NAICS), in this case, the standard occupational classification (SOC) section 62; and the type of injury was determined by the occupational illness and injury classification system (OIICS). Specifically, 35.1% of overall injuries were from the black group, which was above national averages. Additionally, most injured workers were female in both the black and non-black groups, and the black group demonstrated a greater proportion of general educational development (GED), associate’s/bachelor’s degree attainment as their highest level of education, compared to the non-black group. This study highlights a known association between certain types of work and common injuries seen in that sector; however, it also discovers that certain demographics, in this case, African Americans, may be more vulnerable to injuries.

Racial disparities, Healthcare workers, Social assistance workers, Work-related injuries, Workers compensation.

Workplace injuries in the healthcare and social assistance sector are preventable. There is growing evidence of racial or ethnic inequalities amongst occupational injuries in healthcare and social assistance sectors. Riester et al. found evidence of higher rates of work injuries in black workers in the healthcare and social assistance sector was 32% injured compared to 15% non-black workers in Minneapolis.[1] Similarly, Simpson and Severson determined that black hospital workers had higher incidence rates of injury compared to white hospital workers (4.2/100 black workers vs. 3.5/100 white workers).[2] Additionally, another study found that black women working in the healthcare industry had the highest injury rate compared to other occupations where black women work (black healthcare workers ‘ work-related injury rate 5.1/100 vs. black workers’ annual work-related injury rate 2.6/100). Common occupational injuries are due to physical exertion from heavy lifting and contact with objects.[3] The leading source of injury in healthcare workers is from lifting or moving patients.[4]

The U.S. Bureau of Labor Statistics (BLS) data collected in 2019, black workers make up only 17.7% of the total employees within the healthcare and social assistance sector, and of injured workers in this sector, 14.8% are black.[3-7] The Minneapolis-St. Paul metropolitan area of Minnesota, USA (known as the Twin Cities) has a racially diverse population, with 26.8% of the metro population being non-white.[1] In the Twin Cities, MN, the healthcare and social assistance sector has 31.5% of jobs filled by non-white workers and predominantly black workers.[8] One study has found a 2.3 times higher risk of injury in black hospital workers compared to their white counterparts.[2]

A variety of healthcare inequities exist in this diverse population and may contribute to workplace injuries, including zip code or geography, race, and income level.[9] There are a variety of jobs within the healthcare and social assistance sector, ranging from direct patient care by nurses and physicians to medical assistants and home health aides. Healthcare occupations have a different injury risk profile that may include injuries from exposure to body fluids or chemicals, musculoskeletal strains related to heavy or awkward lifting from transferring patients, injuries due to violence from patients, and even mental health injuries due to stress, burnout, and odd working hours. The work environment and job titles within the sector may lead to varied rates of workplace injury.[10,11]

There is a paucity of research exemplifying injury rates for different races and ethnicities of healthcare workers. Studies that focus on healthcare and social assistance occupational injuries emphasize the mechanism of injury, but lack comprehensive surveillance to delve into demographic variables that may be influencing the individuals who are more likely to get injured within the healthcare and social assistance workplace. Several studies have shown noticeable differences in rates of injury, hospitalization, and return to work among different demographics.[12-14] Studies that focus on healthcare and social assistance occupational injuries emphasize the mechanism of injury, but lack a comprehensive review or comparison of risk factors impacting different populations.[15-18] The purpose of this study is to compare predisposing injury risk factors, occupational differences, and injury characteristics of black and non-black healthcare and social assistance workers presenting with a new work injury in the occupational and environmental medicine clinic in the twin cities.

This study is a subset from a previous cross-sectional observational study conducted based on data collected from four HealthPartners occupational and environmental medicine clinics located in the twin cities metropolitan area of Minnesota. Patients with new work injuries who were presented to the occupational medicine clinic from May 2019 to March 2020 were asked to voluntarily participate in the study by completing a survey consisting of questions about demographics, occupation, and injury information. This data was then entered manually into the research electronic data capture (REDCap) tool and collected NAICS to classify occupation, with sector 62 representing “healthcare and social assistance” workers, OIICS was used to classify the nature of the injury the participant described in the survey. Workers in the NAICS sector 62 were collected and included. Variables collected and reported include age, race, education, occupation as coded by SOC, and for the nature of injury, body part, and injury event/exposure by OIICS coding. Several of these codings were condensed and grouped based on complexity and similarity for summary purposes. Data analysis included a two-sample t-test for continuous variables and a chi-squared test for categorical variables with the statistical online platform (Statistical Analysis System (SAS)).

In the original study, 773 patients (69.1% of 1,118 new work injuries during the study period) completed the demographic form, of which 18.9% (n=146 of 773) were black and 47.1% were women (n=364). Women comprised 56.8% (n=83 of 146) of black workers compared with 44.8% (n=281 of 627) of women non-black workers in the study population.

In our subset study, the healthcare and social assistance (NAICS sector 62) included 134 individuals with work injuries. Fifteen of the patients of the 149 declined to answer their race and were excluded from the analysis, with 134 (89.9%) included of which 47 (35.1% were black (n=47) and 64.9% were non-black (n=87) with white n=65, hispanic n=10, asian n=12.  Please refer to the demographics and injury summary in table 1.

Table 1: Demographics table for healthcare workers and social assistance workers

The patient age population ranged from 22-68 years of age and was statistically significantly different (p=0.013). There were younger non-black workers aged 20-29 injured at 23% compared with 4.3% of black workers in the same age category. There were greater injuries in black workers from the 30-30 and 40-49 years categories of 34.0% and 31.9%, respectively, compared to non-black workers, 29.9% and 17.2%, respectively. Most black and non-black workers in NAICS sector 62 were women, with women comprising 83.0% (n=39) of black workers, and 80.5% (n=70) of non-black workers in this sector.

Demographic data collected related to the level of education showed that there was a higher proportion of black workers who obtained a high school diploma or GED (42.5%) compared to 21.4% of non-black. Additionally, there were higher injuries of 32.2% in non-black workers with a bachelor’s degree or an advanced degree compared to 12.8% of non-black workers with a bachelor’s or an advanced degree.

Job titles coded by SOC were documented for all and were statistically significant (p=0.038) for injuries, with black healthcare support/personal care support (nursing or care assistants) having the highest injuries. The occupational group of “healthcare support” included 51.1% of Black workers in this industrial sector and 35.6% of non-black workers, while “healthcare practitioners” was 17.0% of black workers versus 27.6% of non-black workers in sector 62.

Coded OIICS data for the nature of injury was statistically significant (p=0.036) and demonstrated that the most common injuries were sprains/strains, with black workers having 73.8% (n=31) compared with non-black workers at 61.3% (n=49). Body fluid or chemical exposures were reported more commonly in non-black workers at 21.2% compared with black workers at 4.8%. The body parts injured were not clinically significantly different (p=0.28). The most common two body parts with injury were the wrist/ankle, leg/arm, knee/elbow, shoulder, hip (black 38.3%, n=18; non-black 33.3%, n=28), and trunk (black 40.4%, n=19; non-black 32.1%, n=27) for both populations. The most common events that lead to injuries as described by OIICS coding categories were “struck by/kicked/collision” and “overexertion” with these events/exposures at 37.8% and 33.3% each (n=17 and 15) in the black population compared with 33.3% (n=29) and 32.2% (n=28), respectively, in the non-black population (p=0.18). Incidentally, these were also the two highest event categories for non-blacks.

This study explored racial inequities in potential work-related injury risk factors among healthcare and social assistance workers presenting to occupational and environmental medicine clinics within the twin cities, Minnesota. Occupational and environmental medicine is unlikely that the patient population would be the same as that of an urgent care or a primary care clinic due to the outpatient setting, and hence, the population and injury severity of patients should be accounted for.

The proportion of injuries in NAICS sector 62, BLS 2018 data is 17.2% (n=155,570 of 900,380), with black workers having 14.8% (n=23,010 of 155,570 in NAICS sector 62) injuries. Our data found black workers accounted for 35.1% (n=47 of 134) of new work injuries, which was higher than national data. This may be due to an over-representation of black workers in the healthcare and social assistance sectors presenting to HealthPartners Occupational and Environmental Medicine clinics for a variety of reasons, such as proximity or due to contract agreements with employers. With respect to the demographic data collected on age, there was a significant difference between the black and non-black injured populations working in the healthcare and social assistance sector, with younger (age 20-29 and 60+ non-black workers presenting more, and with black workers 30-59 presenting greater).

In education, the black workers in NAICS sector 62 in this study showed lower levels of educational attainment, with increased proportions of high-school/GED education compared to increased proportions of college-level or advanced education (Bachelor, associate, or advanced degrees) in the non-black population. This study demonstrated a high proportion of women in NAICS sector 62 (81.3%, n=109). The results in this study are consistent with the results of Chen and Hendricks, as women make up most of the injured workforce data collected within sector 62.[4]

The coded OIICS injury data from this study are consistent with what is known in the literature regarding injuries in healthcare workers. Razenberger et al.[6] found that sprain injuries were common for healthcare support workers, consistent with the OIICS nature of injury data in the present study. The findings in this study, as demonstrated by OIICS coding of body parts, are congruent with previous research that lumbar and shoulder injuries are commonly seen in healthcare workers.[18] These physical hazards are often caused by the lifting and lowering of patients and/or unintentional physical contact with the patient being moved.[18] This study’s OIICS injury source data demonstrated that the most frequent injuries within the healthcare and social assistance sector occurred in relation to patient care. Nursing assistants and home health aides are healthcare support staff that tend to move patients more frequently and have more physical contact with patients, have lower compensation, and have a high school education or less, consistent with this study’s job title/SOC coding, OIICS event/exposure data, and demographic data on educational attainment in the black workers in sector 62. Similarly, these same nursing assistants have increased interactions and movement of patients than other healthcare support, also consistent with the OIICS event and exposure data in the black injured healthcare workers in this study.[19,20]

Strengths and limitations:  This study is limited by the demographic region of the Twin Cities, MN (Minneapolis and St. Paul, with possibly surrounding suburbs depending on unknown commuting patterns) and may not be representative of or generalizable to healthcare and social assistance workers elsewhere. OIICS categorization is very tedious with exhaustive specified categories that are not practical for data analysis in smaller sample sizes and require more broad categories.  Since the study and Minnesota workers’ compensation cannot control who seeks medical treatment and where it is sought, there is a possibility that there are patients who have not been documented within this study that have had injuries within the healthcare and social assistance sector. Due to the lack of available data, the results cannot confirm if the injury risk within the black and non-black population is representative of all injuries that occur within the workplace. The results also cannot confirm if injured black workers within sector 62 preferentially sought treatment at these clinics as compared to non-black workers.

Because of these limitations, there are potential trends that may not be observable in the present study data. An additional limitation of this study is that subpopulations of races and ethnicities of workers in sector 62 were unable to be analyzed due to low sample sizes of specific subpopulations, and this can be overcome in a larger study with similar methods.

A strength of this study was the detailed demographic data collection, allowing the ability to provide data that suggests black workers in the healthcare and social assistance sector are getting injured at a higher rate in healthcare assistant and personal care assistant jobs than non-black workers within the same sector. Furthermore, the strength of this study is that it attempts to use standardized OIICS and SOC surveys to categorize job titles and injury events.

Future research should explore the education of new workers on workers’ compensation and discover where healthcare and social assistance workers are reporting injuries, if not in occupational medicine clinics. This study raises the question of why black workers are getting more back injuries, sprains, and strains than non-black workers within sector 62.  Future research needs to determine how race influences the risk of injury of healthcare workers with higher body mass index (BMI).[20] Few studies have separated black women and men into subgroups to determine further risk factors that pertain to a higher injury rate within the healthcare sector.[21]

The results in this study demonstrate that there is a higher risk of specific injuries (abrasions/lacerations and strains/sprains) in black healthcare and social assistance workers in the Twin Cities, Minnesota. This data set was derived from a larger data set from Reister et al.[1] The current study is unable to fully answer questions about the reasons black healthcare and social assistance workers have a higher injury risk than non-black workers. This research study was not designed to investigate other factors that may have contributed to the results found in this study, such as hours worked, other jobs, time of scheduled hours worked, previous injuries, disabilities, or population differences within the healthcare and social assistance sector that are remaining uninjured.

Not reported

Not reported

Corresponding Author:
Dominik S Dabrowski
Department of Occupational and Environmental Medicine
School of Public Health, University of Minnesota, USA
Email: dabrowskidom@gmail.com

Co-Authors:
Ashley M Nadeau, James G Lo, Race A Creeden, Zeke J McKinney
Department of Occupational and Environmental Medicine
School of Public Health, University of Minnesota, USA

All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.

Clinical work for this study was performed within HealthPartners occupational and environmental medicine. Institutional review board (IRB) oversight for these institutions is conducted within the HealthPartners institute. No IRB approval/review nor informed consent was obtained or required institutionally for this case, given that this work was deidentified and only studied at the population level, after data was collected for a previous study several years prior. The writers of this paper never had direct patient contact with patients from data collection, and were deriving results from pre-existing data sources.

The authors declare no conflicts of interest.

None

https://doi.org/10.63096/medtigo3062316

Dominik SD, Ashley MN, James GL, Race AC, Zeke JM. Comparison of Black Healthcare and Social Assistance Workers with New Work-Related Injuries in Occupational Medicine. medtigo J Med. 2025;3(1):e3062316. doi:10.63096/medtigo3062316 Crossref