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METHODS: Multivariate analyses were conducted using data from 13 years (1987 to 2000) of the National Longitudinal Survey of Youth (NLSY) encompassing 110 236 job records and over 82 000 person-years of work experience. Cox proportional hazard regression techniques were used to derive hazard ratios comparing the relative risk of suffering a work-related injury among people working night, evening, rotating, split, and irregular shifts to the risks for those working conventional day shifts, after adjustment for age, gender, occupation, industry, and region. Incidence rates were normalized using a common denominator of 100 person-years of "at-risk time" to obtain valid comparisons.

RESULTS: All of the nonstandard shift schedules, except split shifts, were found to have a higher risk for occupational injuries and illnesses than conventional day shifts. After control for the selected covariates, the calculated hazard ratios were 1.43 for evening shifts [95% confidence interval (95% CI) 1.26-1.62], 1.36 for rotating shifts (95% CI 1.17-1.58), 1.30 for night shifts (95% CI 1.12-1.52), 1.15 for irregular shifts (1.03-1.30), and 1.06 for split shifts (0.71-1.58).

CONCLUSIONS: These findings suggest that nonstandard shifts are not more risky merely because of the concentration of hazardous jobs in those types of schedules or because of underlying differences in the characteristics of employees working nonstandard shifts. The results point to the need to extend targeted injury prevention programs not only to people working night shifts, but also to those who work evenings.

Methods: Responses from 10 793 Americans participating in the National Longitudinal Survey of Youth (NLSY) were used to evaluate workers' job histories, work schedules, and occurrence of occupational injury and illness between 1987 and 2000. A total of 110 236 job records were analysed, encompassing 89 729 person-years of accumulated working time. Aggregated incidence rates in each of five exposure categories were calculated for each NLSY survey period. Multivariate analytical techniques were used to estimate the relative risk of long working hours per day, extended hours per week, long commute times, and overtime schedules on reporting a work related injury or illness, after adjusting for age, gender, occupation, industry, and region.

Results/: After adjusting for those factors, working in jobs with overtime schedules was associated with a 61% higher injury hazard rate compared to jobs without overtime. Working at least 12 hours per day was associated with a 37% increased hazard rate and working at least 60 hours per week was associated with a 23% increased hazard rate. A strong dose-response effect was observed, with the injury rate (per 100 accumulated worker-years in a particular schedule) increasing in correspondence to the number of hours per day (or per week) in the workers' customary schedule.

Conclusions: Results suggest that job schedules with long working hours are not more risky merely because they are concentrated in inherently hazardous industries or occupations, or because people working long hours spend more total time "at risk" for a work injury. Strategies to prevent work injuries should consider changes in scheduling practices, job redesign, and health protection programmes for people working in jo bs involving overtime and extended hours.

Study Design: Retrospective cross-sectional analysis of two existing national population-based surveys: the National Ambulatory Medical Care Survey (NAMCS) and National Longitudinal Survey of Youth (NLSY). Pilot studies by us have demonstrated the usefulness of these databases in providing new information about occupational health care. This study will result in descriptive analyses of work-related cases from each database, including stratified sub-analyses comparing patient experiences among racial, ethnic, and socioeconomic patient groups, and selected multivariate analyses to assess the interactive effect of patient sociodemographic characteristics with employment experiences, medical services, and vocational outcomes.

Population Studied: The NAMCS covers physician-reported data for a nationally representative sample of 46,875 ambulatory medical care visits made in 1997-1998. 1,179 of those visits (2.5%) were for diagnosis and treatment of work-related conditions. Our analysis of the NLSY covers the experiences of 7,508 persons aged 33-4 who were interviewed in 1 998, of which 563 (7.5%) self-reported experiencing an occupational injury or illnesses in the 2-year period preceding the interview.

Principal Findings: Both analyses suggest that there are significant disparities among the social groups studied. In the NAMCS, Hispanics with work-related conditions required insurer authorization for care 57% more often than non-Hispanics, and Blacks 1 4% more often than whites. On average, Blacks saw a physician during their visit 6% less often than whites, and Hispanics 5% less often than non-Hispanics. Blacks had blood pressure measured at the visit 32% less often than whites, and Hispanics 11 % less often than non-Hispanics. The NLSY analysis indicated that following a work-related condition, Blacks were 1 6% more likely to miss work, had 28% more missed work days, and were 18% more likely to lose wages than non-Blacks. Similar patterns were observed among Hispanics compared to non-Hispanics, and low-SES (as indicated by educational attainment and family income) compared to high-SES workers.

Conclusions: Preliminary data from two national health care surveys indicates disparities in occupational health and health care for work-related conditions based on patients' race, ethnicity, and SES. These studies have demonstrated the usefulness of national survey databases as a novel source for collecting information about the health and vocational experiences of injured workers.

Implications for Policy, Delivery or Practice: This study helps demonstrate the barriers that Black, Hispanic, and low-SES workers face in accessing occupational health care, and their susceptibility to more severe vocational impacts following a work-related injury. These findings will help alert policymakers and public health advocates to the need to devise specific strategies for protecting the health and earning capacity of minority and low-wage workers.