Background: Traditional occupational health surveillance has focused primarily on occupation rath... more Background: Traditional occupational health surveillance has focused primarily on occupation rather than on industry. With the new NIOSH National Occupational Research Agenda (NORA), there is an urgent need for detailed health-related data for US Workers in the NORA Industry Sectors. The National Health Interview Survey (NHIS) provides a large and nationally representative sample of all US civilian workers. Methods: Using the currently available 1986-2008 NHIS database for >700,000 US workers >18 years (representing >120 million US workers/yr), after adjustment for sample design, several Monographs have been created on morbidity, disability, mortality, and quality of life issues by NORA subgroup and demographic variables. Results: Differences in the distribution of the demographic factors between NORA Sectors are associated with increased disability and morbidity risks. For example, NORA Sectors with less insurance and access to medical care (e.g. Construction, Agriculture/...
Methods: People aged 25 to 64 in both the National Health Interview Survey (with 2-year mortality... more Methods: People aged 25 to 64 in both the National Health Interview Survey (with 2-year mortality follow-up) and the Medical Expenditure Panel Survey were examined to estimate the contribution of sociodemographic, health, and health behavior characteristics on insured persons' quality-adjusted life years (QALYs) and healthcare costs. Parameter estimates from these regression models were used to predict QALYs and costs associated
ABSTRACT Background: Traditional occupational health surveillance has focused primarily on occupa... more ABSTRACT Background: Traditional occupational health surveillance has focused primarily on occupation rather than on industry. With the new NIOSH National Occupational Research Agenda (NORA), there is an urgent need for detailed health-related data for US Workers in the NORA Industry Sectors. The National Health Interview Survey (NHIS) provides a large and nationally representative sample of all US civilian workers. Methods: Using the currently available 1986-2008 NHIS database for >700,000 US workers >18 years (representing >120 million US workers/yr), after adjustment for sample design, several Monographs have been created on morbidity, disability, mortality, and quality of life issues by NORA subgroup and demographic variables. Results: Differences in the distribution of the demographic factors between NORA Sectors are associated with increased disability and morbidity risks. For example, NORA Sectors with less insurance and access to medical care (e.g. Construction, Agriculture/Forestry/Fishing) were more likely to report both less healthcare utilization and less diagnosis of medical conditions, but also experienced higher mortality rates. With the exception of obesity, Healthcare/Social Assistance workers were also more likely to report better health behaviors (e.g. less current smoking) compared to both Construction and Mining workers. Finally, quality-adjusted life years was lowest among workers in the Agriculture/Forestry/Fishing Sector. Conclusions: The surveillance of the NORA Industry Sector subgroups using the rich array of NHIS health indicators provides a comprehensive understanding of the working population's burden of disease, disability, and mortality, and allows for the identification of priority population sub-groups for workplace interventions designed to enhance worker health and well-being.
The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cr... more The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cross-sectional analysis of the US National Health and Nutrition Examination Survey (NHANES) 1999-2006. We included 10,276 adults aged ≥20 years. Diabetes mellitus was defined by physician diagnosis or fasting plasma glucose (≥126 mg/dl) or glycated hemoglobin (≥6.5%). Social risk factors (low family income, low education level, minority racial/ethnic group status, and single-living status) and health-related behaviors (physical activity and dietary intake) were self-reported. Social risk factors were combined in a cumulative social risk index (range 0 to ≥3) and logistic regression used to assess the association of cumulative social risk and diabetes, taking into account complex survey design and sampling weights. Of 10,276 participants, 1515 (weighted proportion - 10%) had diabetes, 3295 (32.3%) and 1830 (9.0%) were exposed to ≥1 adverse social risk factor and ≥3 social risk factors, respectively. Diabetes was associated with increasing cumulative social risk in a graded manner (p for trend <0.001). Compared with a cumulative social risk score of 0, the age- and sex-adjusted diabetes odds for a cumulative social risk score of ≥3 was 2.84 (95% confidence interval: 2.23-3.62), and 2.72 (95% confidence interval: 2.05-3.60) after further adjustment for family history of diabetes, body mass index, smoking, dietary intake and leisure time physical activity. Health behaviors and adiposity only partially influenced the cumulative social risk and diabetes relationship. Simultaneous exposure to several adverse social risk factors significantly influences the odds of diabetes. Better prevention and control of diabetes needs accounting for all aspects of social disadvantage.
International Journal of Health Services Planning Administration Evaluation, 2011
To examine indicators of health care access and utilization among children of working and nonwork... more To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.
Journal of Epidemiology and Community Health, 2004
Study objectives: To determine the validity of physical and mental unhealthy days as summary meas... more Study objectives: To determine the validity of physical and mental unhealthy days as summary measures for county health status and to forward a method for examining county level health trends using a single year of data from the Behavioral Risk Factor Surveillance System (BRFSS).Design: The study analysed geographical variation in physical and mental unhealthy days at the state and county
Many US workers are increasingly delaying retirement from work, which may be leading to an increa... more Many US workers are increasingly delaying retirement from work, which may be leading to an increase in chronic disease at the workplace. We examined the association of older adults' health status with their employment/occupation and other characteristics. National Health Interview Survey data from 1997 through 2011 were pooled for adults aged 65 or older (n = 83,338; mean age, 74.6 y). Multivariable logistic regression modeling was used to estimate the association of socioeconomic factors and health behaviors with 4 health status measures: 1) self-rated health (fair/poor vs good/very good/excellent); 2) multimorbidity (≤1 vs ≥2 chronic conditions); 3) multiple functional limitations (≤1 vs ≥2); and 4) Health and Activities Limitation Index (HALex) (below vs above 20th percentile). Analyses were stratified by sex and age (young-old vs old-old) where interactions with occupation were significant. Employed older adults had better health outcomes than unemployed older adults. Physic...
Objective: Research on the diet of workers is limited. We examined occupational differences in di... more Objective: Research on the diet of workers is limited. We examined occupational differences in diet using nationally-representative US data. Methods: Data from 1999-2004 National Health and Nutrition Examination Survey were pooled for workers >20 years (n=7,251). Values were calculated in percentage of total calories from macronutrients (i.e., fat, protein, carbohydrate, and fiber), intake of certain minerals (e.g., calcium and sodium), and cholesterol by employment status, type of occupation, gender, education, race/ethnicity, and body mass index. Results: Carbohydrate, fat, and protein intake were not different across occupational groups. However, calories per day (1,702 kcal in Textile, apparel, and furnishings machine operators compared to 2,938 kcal in Farm operators, managers, and supervisors) and fiber per day (12.4 g in Miscellaneous food preparation and service occupations vs. 19.8 g in Engineers, architects, and athletes) varied. In addition, daily consumption of sodium...
Background: Population aging and delayed job retirement are rapidly augmenting the number of olde... more Background: Population aging and delayed job retirement are rapidly augmenting the number of older US workers, increasing the risk for workplace injuries due to their likely high prevalence of sensory impairment. The present study evaluated the proportion of older (>65 years of age) US workers reporting vision and/or hearing impairment by occupational groups. Methods: Analyses of self-reported visual impairment (VI), hearing impairment (HI), either VI or HI, and concurrent impairment (HI+VI) by occupation were conducted on 5,590 older workers representing approximately 3.9 million older US workers in the 1997-2004 nationally representative National Health Interview Survey. Results: The majority of workers reported their race as White (86.5%) with approximately equal proportions of females and males. Nearly half of these workers reported having more than a high school education (46.8%). The overall prevalence rates of HI were approximately three times those of VI (33.4 % vs. 10.2%...
Background: Traditional occupational health surveillance has focused primarily on occupation rath... more Background: Traditional occupational health surveillance has focused primarily on occupation rather than on industry. With the new NIOSH National Occupational Research Agenda (NORA), there is an urgent need for detailed health-related data for US Workers in the NORA Industry Sectors. The National Health Interview Survey (NHIS) provides a large and nationally representative sample of all US civilian workers. Methods: Using the currently available 1986-2008 NHIS database for >700,000 US workers >18 years (representing >120 million US workers/yr), after adjustment for sample design, several Monographs have been created on morbidity, disability, mortality, and quality of life issues by NORA subgroup and demographic variables. Results: Differences in the distribution of the demographic factors between NORA Sectors are associated with increased disability and morbidity risks. For example, NORA Sectors with less insurance and access to medical care (e.g. Construction, Agriculture/...
Methods: People aged 25 to 64 in both the National Health Interview Survey (with 2-year mortality... more Methods: People aged 25 to 64 in both the National Health Interview Survey (with 2-year mortality follow-up) and the Medical Expenditure Panel Survey were examined to estimate the contribution of sociodemographic, health, and health behavior characteristics on insured persons' quality-adjusted life years (QALYs) and healthcare costs. Parameter estimates from these regression models were used to predict QALYs and costs associated
ABSTRACT Background: Traditional occupational health surveillance has focused primarily on occupa... more ABSTRACT Background: Traditional occupational health surveillance has focused primarily on occupation rather than on industry. With the new NIOSH National Occupational Research Agenda (NORA), there is an urgent need for detailed health-related data for US Workers in the NORA Industry Sectors. The National Health Interview Survey (NHIS) provides a large and nationally representative sample of all US civilian workers. Methods: Using the currently available 1986-2008 NHIS database for >700,000 US workers >18 years (representing >120 million US workers/yr), after adjustment for sample design, several Monographs have been created on morbidity, disability, mortality, and quality of life issues by NORA subgroup and demographic variables. Results: Differences in the distribution of the demographic factors between NORA Sectors are associated with increased disability and morbidity risks. For example, NORA Sectors with less insurance and access to medical care (e.g. Construction, Agriculture/Forestry/Fishing) were more likely to report both less healthcare utilization and less diagnosis of medical conditions, but also experienced higher mortality rates. With the exception of obesity, Healthcare/Social Assistance workers were also more likely to report better health behaviors (e.g. less current smoking) compared to both Construction and Mining workers. Finally, quality-adjusted life years was lowest among workers in the Agriculture/Forestry/Fishing Sector. Conclusions: The surveillance of the NORA Industry Sector subgroups using the rich array of NHIS health indicators provides a comprehensive understanding of the working population's burden of disease, disability, and mortality, and allows for the identification of priority population sub-groups for workplace interventions designed to enhance worker health and well-being.
The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cr... more The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cross-sectional analysis of the US National Health and Nutrition Examination Survey (NHANES) 1999-2006. We included 10,276 adults aged ≥20 years. Diabetes mellitus was defined by physician diagnosis or fasting plasma glucose (≥126 mg/dl) or glycated hemoglobin (≥6.5%). Social risk factors (low family income, low education level, minority racial/ethnic group status, and single-living status) and health-related behaviors (physical activity and dietary intake) were self-reported. Social risk factors were combined in a cumulative social risk index (range 0 to ≥3) and logistic regression used to assess the association of cumulative social risk and diabetes, taking into account complex survey design and sampling weights. Of 10,276 participants, 1515 (weighted proportion - 10%) had diabetes, 3295 (32.3%) and 1830 (9.0%) were exposed to ≥1 adverse social risk factor and ≥3 social risk factors, respectively. Diabetes was associated with increasing cumulative social risk in a graded manner (p for trend <0.001). Compared with a cumulative social risk score of 0, the age- and sex-adjusted diabetes odds for a cumulative social risk score of ≥3 was 2.84 (95% confidence interval: 2.23-3.62), and 2.72 (95% confidence interval: 2.05-3.60) after further adjustment for family history of diabetes, body mass index, smoking, dietary intake and leisure time physical activity. Health behaviors and adiposity only partially influenced the cumulative social risk and diabetes relationship. Simultaneous exposure to several adverse social risk factors significantly influences the odds of diabetes. Better prevention and control of diabetes needs accounting for all aspects of social disadvantage.
International Journal of Health Services Planning Administration Evaluation, 2011
To examine indicators of health care access and utilization among children of working and nonwork... more To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.
Journal of Epidemiology and Community Health, 2004
Study objectives: To determine the validity of physical and mental unhealthy days as summary meas... more Study objectives: To determine the validity of physical and mental unhealthy days as summary measures for county health status and to forward a method for examining county level health trends using a single year of data from the Behavioral Risk Factor Surveillance System (BRFSS).Design: The study analysed geographical variation in physical and mental unhealthy days at the state and county
Many US workers are increasingly delaying retirement from work, which may be leading to an increa... more Many US workers are increasingly delaying retirement from work, which may be leading to an increase in chronic disease at the workplace. We examined the association of older adults' health status with their employment/occupation and other characteristics. National Health Interview Survey data from 1997 through 2011 were pooled for adults aged 65 or older (n = 83,338; mean age, 74.6 y). Multivariable logistic regression modeling was used to estimate the association of socioeconomic factors and health behaviors with 4 health status measures: 1) self-rated health (fair/poor vs good/very good/excellent); 2) multimorbidity (≤1 vs ≥2 chronic conditions); 3) multiple functional limitations (≤1 vs ≥2); and 4) Health and Activities Limitation Index (HALex) (below vs above 20th percentile). Analyses were stratified by sex and age (young-old vs old-old) where interactions with occupation were significant. Employed older adults had better health outcomes than unemployed older adults. Physic...
Objective: Research on the diet of workers is limited. We examined occupational differences in di... more Objective: Research on the diet of workers is limited. We examined occupational differences in diet using nationally-representative US data. Methods: Data from 1999-2004 National Health and Nutrition Examination Survey were pooled for workers >20 years (n=7,251). Values were calculated in percentage of total calories from macronutrients (i.e., fat, protein, carbohydrate, and fiber), intake of certain minerals (e.g., calcium and sodium), and cholesterol by employment status, type of occupation, gender, education, race/ethnicity, and body mass index. Results: Carbohydrate, fat, and protein intake were not different across occupational groups. However, calories per day (1,702 kcal in Textile, apparel, and furnishings machine operators compared to 2,938 kcal in Farm operators, managers, and supervisors) and fiber per day (12.4 g in Miscellaneous food preparation and service occupations vs. 19.8 g in Engineers, architects, and athletes) varied. In addition, daily consumption of sodium...
Background: Population aging and delayed job retirement are rapidly augmenting the number of olde... more Background: Population aging and delayed job retirement are rapidly augmenting the number of older US workers, increasing the risk for workplace injuries due to their likely high prevalence of sensory impairment. The present study evaluated the proportion of older (>65 years of age) US workers reporting vision and/or hearing impairment by occupational groups. Methods: Analyses of self-reported visual impairment (VI), hearing impairment (HI), either VI or HI, and concurrent impairment (HI+VI) by occupation were conducted on 5,590 older workers representing approximately 3.9 million older US workers in the 1997-2004 nationally representative National Health Interview Survey. Results: The majority of workers reported their race as White (86.5%) with approximately equal proportions of females and males. Nearly half of these workers reported having more than a high school education (46.8%). The overall prevalence rates of HI were approximately three times those of VI (33.4 % vs. 10.2%...
The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cr... more The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cross-sectional analysis of the US National Health and Nutrition Examination Survey (NHANES) 1999-2006. We included 10,276 adults aged ≥20 years. Diabetes mellitus was defined by physician diagnosis or fasting plasma glucose (≥126 mg/dl) or glycated hemoglobin (≥6.5%). Social risk factors (low family income, low education level, minority racial/ethnic group status, and single-living status) and health-related behaviors (physical activity and dietary intake) were self-reported. Social risk factors were combined in a cumulative social risk index (range 0 to ≥3) and logistic regression used to assess the association of cumulative social risk and diabetes, taking into account complex survey design and sampling weights. Of 10,276 participants, 1515 (weighted proportion - 10%) had diabetes, 3295 (32.3%) and 1830 (9.0%) were exposed to ≥1 adverse social risk factor and ≥3 social risk factors, respectively. Diabetes was associated with increasing cumulative social risk in a graded manner (p for trend <0.001). Compared with a cumulative social risk score of 0, the age- and sex-adjusted diabetes odds for a cumulative social risk score of ≥3 was 2.84 (95% confidence interval: 2.23-3.62), and 2.72 (95% confidence interval: 2.05-3.60) after further adjustment for family history of diabetes, body mass index, smoking, dietary intake and leisure time physical activity. Health behaviors and adiposity only partially influenced the cumulative social risk and diabetes relationship. Simultaneous exposure to several adverse social risk factors significantly influences the odds of diabetes. Better prevention and control of diabetes needs accounting for all aspects of social disadvantage.
Adults in the United States (U.S) can be simultaneously exposed to more than one social risk fact... more Adults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults. The study included 8745 adults (aged ≥ 40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers. Deaths from all-cancers combined (P for trend = 0.001), tobacco-related cancers (P for trend = <0.001), and lung cancer (P for trend = 0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR = 1.8, 95 % CI = 1.3-2.4), tobacco-related cancers (HR = 2.6, 95 % CI: 1.6-4.0), and lung cancer (HR = 2.3, 95 % CI = 1.3-4.1). U.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality.
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Papers by Peter Muennig