title: Prevalence and reporting of occupational illness by company size: population trends and regulatory implications.
abstract: BACKGROUND
  Reports of occupational disease using the Bureau of Labor Statistics (BLS)/OSHA survey have shown increasing rates with larger establishment size. The literature is divided on whether this pattern is an artifact of under-reporting in smaller businesses or is the result of differences in underlying risk factors.
  
  
  METHODS
  A population-based survey [the Connecticut Upper-Extremity Surveillance Project (CUSP)] assessing prevalence of likely work related musculoskeletal disorders (MSD) in CT, coded by establishment size, is compared to CT MSD incidence rates based on the BLS/OSHA survey.
  
  
  RESULTS
  When analyses were controlled for age, gender, physical risks, and occupation, there was a marginally significant association between business size and the rate of MSD [odds ratio (OR) = 0.91, CI 0.82-1.01], but in the opposite direction of the BLS/OSHA rates, with larger businesses having somewhat lower rates of MSD. Reported risk factors varied in a similar direction, though with mid-sized companies having the highest physical risks.
  
  
  CONCLUSIONS
  The increased rates of occupational illness in larger businesses reported in the BLS/OSHA survey does not appear to be due to actual incidence or distribution of risk factors, but appears more likely to be due to under-reporting in smaller businesses. Estimates based on the assumption that the ORs based on size are actually similar to the CUSP population survey results suggest that MSD incidence is approximately 3.6-times the reported rates.
authors.affiliation: Occupational and Environmental Medicine and Department of Community Medicine, University of Connecticut Health Center, Farmington, Connecticut 06030-6210, USA. tmorse@nso.uchc.edu
authors.forename: Tim
authors.initials: T
authors.lastname: Morse
authors.forename: Charles
authors.initials: C
authors.lastname: Dillon
authors.forename: Joseph
authors.initials: J
authors.lastname: Weber
authors.forename: Nick
authors.initials: N
authors.lastname: Warren
authors.forename: Heather
authors.initials: H
authors.lastname: Bruneau
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
mesh_terms: D003237:Connecticut / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007221:Industry / Q000145:classification*; D019221:Mandatory Reporting; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D009784:Occupational Diseases / Q000453:epidemiology*; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014489:United States Occupational Safety and Health Administration