title: Marginal structural modelling of associations of occupational injuries with voluntary and involuntary job loss among nursing home workers.
abstract: OBJECTIVE
  Qualitative studies have highlighted the possibility of job loss following occupational injuries for some workers, but prospective investigations are scant. We used a sample of nursing home workers from the Work, Family and Health Network to prospectively investigate association between occupational injuries and job loss.
  
  
  METHODS
  We merged data on 1331 workers assessed 4 times over an 18-month period with administrative data that include job loss from employers and publicly available data on their workplaces. Workers self-reported occupational injuries in surveys. Multivariable logistic regression models estimated risk ratios for the impact of occupational injuries on overall job loss, whereas multinomial models were used to estimate OR of voluntary and involuntary job loss. Use of marginal structural models allowed for adjustments of multilevel lists of confounders that may be time varying and/or on the causal pathway.
  
  
  RESULTS
  By 12 months, 30.3% of workers experienced occupational injury, whereas 24.2% experienced job loss by 18 months. Comparing workers who reported occupational injuries to those reporting no injuries, risk ratio of overall job loss within the subsequent 6 months was 1.31 (95% CI 0.93 to 1.86). Comparing the same groups, injured workers had higher odds of experiencing involuntary job loss (OR 2.19; 95% CI 1.27 to 3.77). Also, compared with uninjured workers, those injured more than once had higher odds of voluntary job loss (OR 1.95; 95% CI 1.03 to 3.67), while those injured once had higher odds of involuntary job loss (OR 2.19; 95% CI 1.18 to 4.05).
  
  
  CONCLUSIONS
  Despite regulatory protections, occupational injuries were associated with increased risk of voluntary and involuntary job loss for nursing home workers.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Cassandra Adiba
authors.initials: CA
authors.lastname: Okechukwu
authors.affiliation: Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Janine
authors.initials: J
authors.lastname: Bacic
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Esther
authors.initials: E
authors.lastname: Velasquez
authors.affiliation: Department of Psychology, Portland State University, Portland, Oregon, USA.
authors.forename: Leslie B
authors.initials: LB
authors.lastname: Hammer
mesh_terms: D000328:Adult; D005260:Female; D033161:Government Regulation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009740:Nursing Staff; D060051:Occupational Injuries / Q000150:complications / Q000191:economics; D009790:Occupations; D016017:Odds Ratio; D011446:Prospective Studies; D012306:Risk; D011795:Surveys and Questionnaires; D014478:Unemployment; D014481:United States; D014937:Work; D017132:Workplace; D055815:Young Adult
keywords: nursing homes; occupational injuries; personnel turnover; vulnerable populations