Group Title: BMC Public Health
Title: Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987–1998
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Title: Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987–1998
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Language: English
Creator: Horwitz, Irwin
Kammeyer-Mueller, John
McCall, Brian
Publisher: BMC Public Health
Publication Date: 2002
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Abstract: BACKGROUND:Occupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL.METHOD:Occupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987–1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed.RESULTS:The claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants).CONCLUSIONS:In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common.
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BMC Public Health Central


Research article


Workers' compensation claims related to natural rubber latex
gloves among Oregon healthcare employees from 1987-1998
Irwin B Horwitz* 1, John Kammeyer-Mueller2 and Brian P McCall1


Address: Industrial Relations Center, University of Minnesota, Minneapolis, USA and 2Department of Management, University of Florida,
Gainesville, USA
E-mail: Irwin B Horwitz* ihorwitz@csom.umn.edu; John Kammeyer-Mueller kammeyjd@notes.cba.ufl.edu;
Brian P McCall bmccall@csom.umn.edu
* Corresponding author


Published: 18 September 2002 Received: 17 June 2002
BMC Public Health 2002, 2:21 Accepted: 18 September 2002
This article is available from: http://www.biomedcentral.com/1471-2458/2/21
2002 Horwitz et al; licensee BioMed Central Ltd. This article is published in Open Access: verbatim copying and redistribution of this article are permitted
in all media for any purpose, provided this notice is preserved along with the article's original URL.


Keywords: latex, latex allergy, workers' compensation, NRL gloves


Abstract
Background: Occupational reaction to natural rubber latex (NRL) glove use by healthcare
employees has been an area of increasing concern. Unfortunately, there is little data demonstrating
the prevalence and severity of actual reactivity to NRL.
Method: Occupational reaction to NRL was estimated using workers' compensation claims filed
by healthcare employees in Oregon for the period of 1987-1998. For the first ten years, these
claims were estimated by source and conditions consistent with NRL glove reactions, while in the
last two years a specific code developed in 1997 for NRL glove reactions was also employed.
Results: The claim rate was on average 0.58 per 10,000 healthcare workers annually, which
constituted 0.29% of all workers' compensation claims. The most common condition experienced
was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority
of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions
were minor in nature, although one fatality was reported. The average NRL claim cost was
$8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per
year. The occupational groups with the highest number of claims were nurses (30.8% of claimants)
and nursing aides and orderlies (24.6% of claimants).
Conclusions: In comparison with other workers' compensation claims filed by healthcare
workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare
incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or
conjunctival reactions to NRL gloves are common.



Background concentrated on data collected using clinical methodolo-
Questions regarding the prevalence and severity of health- gies, such as in vitro assays testing for the prevalence of IgE
care worker reactions to natural rubber latex (NRL) due to antibodies or direct exposure tests including skin prick
occupational exposure to NRL gloves have generated a and skin patch tests. The results of these efforts have pro-
considerable body of research. To date, most studies have duced varying and inconsistent results, estimating the rate

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of healthcare worker sensitivity between 2.9 % to 22% [1-
7]. These methods do not adequately address reactions ac-
tually experienced on the job by healthcare workers, be-
cause sensitization does not equate to reactivity [8]. As
sensitization data does not provide any information re-
garding reactivity, these data do not provide information
regarding the type or severity of reactions, nor the associ-
ated costs.

One method that has recently been used to examine reac-
tions to NRL gloves in healthcare settings has been the
analysis of workers' compensation data. Unlike the varied
results of sensitization findings, results from workers'
compensation research have been more consistent across
studies. The number of claims per 10,000 healthcare
workers in the states previously examined have ranged
from a low of 0.71 in Minnesota to a high of 2.66 in
Washington State, with average annual costs ranging from
a low of $0.08 in North Dakota to a high of $0.74 in
Washington State per covered healthcare worker [9-11].

While these results are compelling, further research is
needed to verify the generalizability of results across
states, given the variability of workers' compensation sys-
tems, which are administered on the state level. The cur-
rent study extends this past research by investigating
claims from the state of Oregon over a 12-year period.
This makes this study the longest period over which NRL
workers' compensation claims have been examined. Addi-
tionally, Oregon's workers' compensation system adopted
a specific category for NRL glove reactions beginning in
1997, making this the first state analyzed with a code spec-
ifying reactions to NRL.

Methods
Accepted healthcare worker workers' compensation claim
data were provided by the Oregon Department of Con-
sumer and Business Information and Management Divi-
sion for the period of 1987-1999. Records were kept for
all claims that were disabling or potentially disabling (i.e.
those which have either potential or actual lost work time
involved), although records were available for some
claims that did not actually result in disability. Because
the claim data for 1999 was incomplete due to insufficient
claim maturation, and consequently had missing data
fields, it was excluded from the analysis in this report. Or-
egon began specific coding for NRL glove workers' com-
pensation claims in June 1997 and retroactively re-coded
some 1996 claims as NRL related after the coding change,
so the estimation method for earlier years was supple-
mented with a specific code for NRL reactions in these lat-
er years. Data on costs for potential NRL allergy claims for
1997 and 1998 were provided by the Oregon Department
of Business Information and Management Division from


the ongoing data files and thus may not represent final-
ized costs for those two years.

The data set included information on claimant occupa-
tion, claimant demographics (age and gender), nature of
reported injury, body part reported affected, time off tak-
en by claimants, and cost of claims. It should be noted
that the claims provided by the state are confined to those
which resulted in either some form of medical payment
and/or where there was lost time from work as a result of
the reported condition. All dollar amounts coded in these
extracts are amounts paid out and do not include sched-
uled but unpaid amounts. All denied claims were exclud-
ed from analysis. Data on the Oregon healthcare worker
population was collected from the Oregon Labor Market
Information System's Archival Current Employment Sta-
tistics website.

As Oregon did not specifically code for NRL reactions due
to glove use for most of this time period, it was necessary
to estimate these conditions. The first method for identi-
fying relevant claims was to identify claims whose source
was potentially allergic reactions due to glove use. The rel-
evant source codes in the Oregon database were: unspeci-
fied items of clothing; belts, gloves, neckties, and scarves;
and the aforementioned specific code for NRL reactions.
The former two methods for identifying source of injury
information may capture claims unrelated to NRL glove
use, and thus may overestimate the number of NRL glove
claims. As all three might have captured claims attributed
to gloves, but not due to NRL reactions, the nature of the
condition associated with the claim was examined as well.
Associated claim code numbers for these conditions are
listed in the Appendix (see Additional File 1: Appendix).

NRL glove reactions have been classified by medical re-
searchers into three basic categories [12,13 Irritant con-
tact dermatitis, which is not an allergic reaction, results in
dry, swollen, and/or irritated skin. This is the most com-
mon type of condition. The two remaining reaction types
are allergic in nature. Those allergic reactions related to
chemicals used in glove processing are classified as Type
IV, and may result in eczema, open lesions, and swelling.
Allergic reactions that result from IgE mediated antibody
response to specific NRL allergens, are classified as Type I,
and may result in angioedema, asthma, rhinitis, urticaria
(hives), and rarely, anaphylaxis. The nature of injury
codes from the Oregon worker's compensation database
was investigated for any claim potentially attributable to
NRL glove reaction. When the nature of injury was de-
scribed as toxic effects, non-viral conjunctivitis, any respi-
ratory condition not definitively attributable to infections
or genetic conditions, and any disorders of the skin not
definitively attributable to infections, the claims were in-
cluded as potentially resulting from NRL glove use. Thus,


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Table 1: Potential NRL claims as a percentage of HCW population and total healthcare workers' compensation


Year Estimated
Number of
Claims


Estimated HCW
Population


Percentage Filing
Potential NRL Claims


Claims per
10,000
HCW's


Total Number of
Healthcare W.C.
Claims Reported


Potential NRL Claims as a Percentage
of All Healthcare W.C. Claims


Average 5.42


claims were excluded only when the nature of injury was
clearly not related to NRL glove reaction, such as infec-
tions, parasitic diseases, sprains, dislocations, or carpal
tunnel syndrome. The nature of injury codes used in the
estimates or that were used to specifically exclude claims
are listed in the Appendix.

Examination of the probability of filing a claim was tested
through the use of logistic regression, treating each year as
a sample and using the total healthcare worker popula-
tion in a given year as a weighting variable. To test wheth-
er there was an increase in expected claim costs over time,
the natural logarithm of costs was regressed on year of
claim filing, gender, age, and a series of dichotomous var-
iables for occupation. To test whether there was an in-
crease in expected claim duration over time, the natural
logarithm of time off work was regressed on year of claim
filing, gender, age, and a series of dichotomous variables
for occupation. Due to the small number of cases and the
possibility for collinearity in the predictor set, subset re-
gressions were also run first with only age and year en-
tered, then only gender and year entered, then only the set
of occupational dummies and year entered. The logarith-
mic transformation was necessary to normalize the distri-
bution of the dependent variables, both of which were
right skewed. This transformation resulted in the elimina-
tion of a small number data points for which the depend-
ent variables equaled zero. Logistic regression using the
subsets was used to predict the zero values for these de-
pendent variables, and none of the regressions were sig-
nificant. All models were estimated using Stata 6 software.


Results
For the entire 1987-1998 period, there were 65 total esti-
mated NRL glove claims reported. These claims demon-
strated an average frequency of 5.24 per year, from an
average healthcare worker population of 89,923, and rep-
resented an overall average claim rate of 0.0058 percent or
0.58 claims per 10,000 Oregon healthcare workers over
the 12-year period examined. Additionally, during this
time, the average overall claim rate for all occupational
conditions experienced by healthcare workers during this
time was 2,207 annually, of which the estimated NRL
claim rate constituted 0.29 percent of those claims. Table
1 presents the breakdown of number of claims per year
over this time period as contrasted against number of
healthcare workers and number of workers' compensa-
tion claims.

To test if changes in claim rates were indicative of a trend,
weighted logistic regression for grouped data was em-
ployed to determine if there was a change in the log-odds
ratio for claim filing over time with year of claim as a pre-
dictor and the size of the healthcare worker population as
a weighting variable. The odds ratio for year was 1.11
(95% C.I. = 1.03-1.20; p = 0.014), indicating a statistical-
ly significant increase in claims over time. These results
were checked for robustness using negative binomial
models to predict whether the number of claims were
changing over time (as opposed to the probability of fil-
ing a claim) and similar results were obtained with respect
to significance and estimated incidence rate ratios. How-
ever, because of fluctuations in claim rates across years
ranging from zero in 1995 to 0.000124 in 1998, relying
on this estimate to predict future claim rates is questiona-
ble.


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74,639
77,284
81,835
84,961
87,406
89,028
91,118
92,896
95,299
98,387
101,763
104,454
89,922.5


0.0027%
0.0065%
0.0012%
0.0024%
0.0046%
0.0090%
0.0033%
0.0097%
0.0000%
0.0091%
0.0088%
0.0124%
0.0058%


0.268
0.647
0.122
0.235
0.458
0.899
0.329
0.969
0.000
0.915
0.884
1.245
0.581


3,063
3,223
2,746
2,316
2,247
2,175
2,139
2,029
1,834
1,746
1,535
1,433
2,207


0.0653%
0.1551%
0.0364%
0.0864%
0.1780%
0.3678%
0.1403%
0.4436%
0.0000%
0.5155%
0.5863%
0.9072%
0.2902%


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12
12
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13


0 5 10 15 20 25
Number o Claims


30 35 40


Figure I
Nature of Condition


The highest proportion of estimated NRL glove claims, 31
(47.7%), were filed by employees who worked in general
medical and surgical hospitals. Workers in skilled nursing
care facilities filed the next highest number of claims, 13
(20%), followed by employees in the offices and clinics of
dentists with 10 (15.4%) claims, and employees in the of-
fices and clinics of doctors with 3 (4.6%) claims. Workers
in nursing/personal care facilities and in intermediate
nursing care facilities each filed 2 (3.1%) claims, while
workers employed in the offices and clinics of health prac-
titioners, specialty hospitals (non-psychiatric), medical
laboratories, and allied health services each filed 1 (1.5%)
claim.

With respect to occupation, nurses filed 20 claims
(30.8%), followed by nursing aides and orderlies, who
filed 16 claims (24.6%), dental assistants who filed 9


claims (13.8%), clinical laboratory technicians who filed
6 claims (9.2%), and maids/housemen who filed 3 claims
(4.6%). There were 2 claims (3.1%) for each of the occu-
pations of miscellaneous food preparers, and laundry
workers, and 1 claim each (1.5%) filed by therapists, gen-
eral office clerks, private household cleaners, cooks, and
personal service occupations. Two claims were filed with
no occupation listed.

The ages of claimants were widely distributed, with 2
claims (3.1%) made by healthcare workers between of
18-20 years of age, 16 claims (24.6%) by workers 21-30
years of age, 23 claims (35.4%) by workers 31-40 years of
age, 15 claims (23.1%) by workers 41-50 years of age,
and 9 claims (13.8%) by employees 51-60 years of age.





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Of all claimants, the majority 52 (80%) cited a form of
dermatitis as the primary nature of their condition. Of
these dermatitis cases, 34 reported unspecified dermatitis,
8 reported contact dermatitis, 8 reported allergic dermati-
tis, 1 reported unclassified dermatitis and 1 reported irri-
tant dermatitis. Of the remaining 13 claimants (20%), 3
(4.6%) reported disorders of the skin, 2 (3.1%) reported
urticaria, 2 (3.1%) reported a non-specified allergic reac-
tion, 2 (3.1%) reported extrinsic asthma, and there was 1
claim each (1.5%) specifying other unclassified skin dis-
orders, allergic rhinitis, poisoning and toxic effects, and
ill-defined symptoms. These data are summarized in Fig-
ure 1.

The most common body part reported affected was the
hands (55.4%), followed by multiple body parts (15.4%),
body system (10.8%), multiple upper extremities (9.2%),


Hards and arms

Hands and fingers


Iemal chest

Face, n.e.c.

5 Broncxhus

t Mu~file uppef extremibes
C.
Body yslerrin

Multipfe body parts


Hands, except fingers


bronchus (3.1%), internal chest (1.5%), hands and fin-
gers (1.5%), hands and arms (1.5%) and face (1.5%).
While 58 cases of skin-related disorders were estimated to
be attributable to NRL glove use over the 12-year period,
there were 97 other claims by healthcare workers of skin
disorders filed that were attributed to sources other than
NRL gloves. To this extent, NRL glove use only contribut-
ed to 37.4% of all healthcare worker claims citing skin dis-
order as nature of condition experienced. Only 2 cases of
asthma were reported from the use of gloves during the
12-year period, representing an average of 0.02 cases of
asthma per 10,000 healthcare workers employed in Ore-
gon per year. There were 62 claims of asthma from non-
NRL related sources reported during this time, and thus
potentially NRL related asthma claims represented 3.2%
of the total healthcare worker asthma claims. These data
are summarized in Figure 2.


0 5 10 15 20 25
Number of Claim


30 35 40


Figure 2
Body Part Reported Affected


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*I


36


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The mean number of days of lost work time for NRL glove
claims was 44.3, although the distribution of time off for
NRL glove claims was extremely right skewed, as shown
by the median number of 7 days off. Of all claimants, 8
(12.3%) took no time off, 22 (33.8%) took off between
one day and one week, 5 (23.3%) took off between eight
days and two weeks, 8 (12.3%) took off between 15 days
and three weeks, and 2 (3.1%) took off between twenty-
two days and one month. Of those who took over a
month off work, 4 (6.2%) took off between thirty-one
days and two months, 8 (12.3%) took off between 4 and
6 months, 2 (3.1%) took off between 7 months and 1
year, and 1 (1.5%) took off more than one year but less
than two years. There was 1 fatality reported during this
period (which is not included in the time off statistics). In
addition, there were 4 other claims in which time off in-
formation was not provided.

For the entire period of 1987-1998, the total costs associ-
ated with all estimated NRL glove claims was
$540,116.00. The mean claim cost was $8,309.48, with
the median claim cost equaling $2,682.00, and the stand-
ard deviation of the claim costs was $17,434.00. The sum-
mary of claim costs over time is provided in Table 2.

In total, the weighted average cost per healthcare worker
employed in the state of Oregon amounted to $0.50 an-
nually. Using only the years with finalized costs (1987-
1996), the weighted average cost per healthcare worker
was $0.44 annually. Because the NRL cost data was updat-
ed for 1997 and 1998, but the data of total healthcare
worker claim costs were not, total claim costs were com-
pared to NRL glove claim costs limited to the period of
1987 through 1996. During this time, the total claim cost
for all non-NRL related healthcare worker claim costs in
the state amounted to $150,150,242, while NRL costs
amounted to $380,068, and NRL costs thus represented
0.25% of all healthcare employee workers' compensation
costs accrued in the state for the 10-year period.

To determine if the severity of claims was predictable
based on when a claim was filed or by characteristics of
the claimants, multivariate regressions were estimated.
Claim costs and time off work (as proxies for condition se-
verity) were the dependent variables and year of claim fil-
ing, gender, age, and occupation were the predictors.
These predictors were not related to claim costs (overall
model p = 0.419) or time off work (overall model p =
0.899).

To examine how the claims from NRL glove use compared
to other commonly used items in Oregon healthcare set-
tings, the claims were contrasted against claims arising
from other sources of claims in the 1987-1998 period. It
was found that the number of NRL claims (65) were


slightly higher than for those made arising from the use of
office and business machinery (50), but less than those
from tanks, vats and bins (81), cleaning tools (125), ta-
bles and worktables (162), pots, pans and trays (258),
bags, sacks and totes (379), boxes, crates and cartons
(498), and carts, dollies and handtrucks (689).

Discussion
The results of the Oregon analysis extend the findings
from previous NRL workers' compensation studies con-
ducted in other states with different workers' compensa-
tion systems. Overall, there was an average of 0.58 claims
annually per 10,000 healthcare workers employed in the
state, which is similar to previous annual NRL glove claim
prevalence rates of between 0.71 and 2.66 claims per
10,000 workers. While there was some statistical evidence
of an increasing claim rate over time, the variation be-
tween years and small number of claims in any given year
(with the highest number being 13 in 1998) casts doubt
on whether this increase holds any predictive value. This
increase in workers' compensation claims in more recent
years is consistent with data from Minnesota, but is incon-
sistent with results from North Dakota, Washington, and
Rhode Island. Possible explanations for the slight increase
in claims over time include the greater number of health-
care workers regularly using gloves, dissemination of in-
formation on NRL allergy among healthcare workers, and
increased diagnosis of NRL reactions by physicians [9].

The annual cost per employed healthcare worker of $0.50
over the 12 years examined in Oregon was also similar to
previous NRL workers' compensation findings which
ranged from $0.08 to $0.74. The costs associated with
NRL glove claims were generally low, and although high
costs were associated with several claims, the mean cost
per claim was $2,682, averaged to just $0.50 per health-
care worker per year, and in total constituted only 0.25%
of all healthcare worker claim costs for the period of
1987-1996. Multivariate regression with controls for gen-
der, age, and occupation did not show an increasing trend
in cost per claim or time off work per claim. The evidence
thus does not support a hypothesis of increased reaction
severity, as indexed by claim costs and time off, over the
twelve years examined.

Consistent with past NRL workers' compensation studies,
most claimants reported experiencing some form of skin
condition, while only 2 cases of asthma were reported
over the 12-year period. While some researchers have hy-
pothesized that aerosolized NRL allergens bound to glove
powder may result in extensive allergic reactions (prima-
rily manifested as asthmatic response in healthcare envi-
ronments), other studies examining empirical data have
found little evidence of this effect [14-16]. The current
study, which specifically addresses reactivity rather than


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Table 2: Total claim costs


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Total claim Costs




$924.00
$11282.00
$1167.00
$33765.00
$33325.00
$54418.00
$50136.00
$27955.00
$0.00
$167096.00
$69589.00
$90459.00
$540116.00


Mean Cost per Median Cost per
Claim Claim


$460.00
$2256.40
$1167.00
$16882.50
$8331.25
$6802.25
$16712.00
$3106.11
$0.00
$18566.22
$7732.11
$6958.38
$8309.48


$462.00
$1743.00
$1167.00
$16882.50
$5716.00
$3449.50
$3935.00
$1331.00
$0.00
$1470.00
$1838.00
$4524.00
$2682.00


Standard Devia-
tion


Total Average
Cost per
Employed HCW


$138.59
$2255.51
n/a
$17645.85
$6154.01
$8515.11
$25272.62
$3497.64
$0.00
$39400.70
$12644.69
$1 1088.65
$17434.00


$0.01
$0.15
$0.01
$0.40
$0.38
$0.61
$0.55
$0.30
$0.00
$1.70
$0.68
$0.87
$0.50


sensitization, extends the previous findings showing a low
correspondence between NRL glove use and asthmatic re-
actions. Indeed, potential NRL-related asthma claims rep-
resented only 3.2% of all healthcare worker respiratory
claims and averaged less than 1 case per 500,000 health-
care workers per year in the state of Oregon. Workers'
compensation analyses in four other states have shown
similarly low rates of NRL-related respiratory claims.

Oregon is the only state to date where workers' compen-
sation data has recorded a fatality due to NRL reaction.
Consistent with previous studies in Minnesota and Wash-
ington State, there were a small number of serious reac-
tions. The majority of claims were relatively minor in
nature, with 12.3% of claimants reporting no time off
from work and 69.2% taking less than a month off work.
The NRL glove claims were also compared to different
sources of healthcare employee workers' compensation
claims, and not found to be a greater source of occupa-
tional injury than other products and items frequently
used in healthcare facilities.

Workers' compensation analyses have several inherent
limitations. First, it is possible that some individuals who
experienced a reaction to NRL did not file workers' com-
pensation claims, so these claim prevalence rates should
not be construed as direct estimates of reaction prevalence
rates. Given that many claimants had relatively low dollar
amounts for claims this may not be a substantial limita-
tion, as it appears that even in cases where minor costs
were incurred, claims were reported. Additionally, it is
possible that the claim rate may overstate the number of
true NRL reactions, because symptoms commonly report-


ed as NRL related are also potentially the result of other
causes. This is suggested by studies showing a low corre-
spondence between self-reported diagnosis of NRL reac-
tions and positive RAST or skin prick tests for NRL
sensitization [15,17,18]. Because Oregon primarily
records claims with lost work time, it is also possible that
individuals who may have experienced minor reactions
were not included. This may explain the discrepancy
found between Oregon and Washington State, which
does collect data on claims involving no lost work time.
An alternative explanation for the discrepancy is the fact
that Oregon has more specific coding for potential NRL
reactions.

Secondly, it should be noted that this paper deals exclu-
sively with medical and indemnity costs associated with
claims and does not reflect costs related to retraining and
other accommodations for NRL-reactive employees. It is
also possible that individuals who experienced a reaction
may have switched from the healthcare occupation (the
"healthy worker effect"). However, there is no reason to
believe that these individuals would not avail themselves
of workers' compensation for lost work time before
switching, so this healthy worker effect should not sub-
stantially affect the claim prevalence rates reported in this
study. The cost of turnover and replacement of these
workers, however, would not be captured in the data.

Conclusions
This study examined Oregon healthcare industry workers'
compensation data over a 12-year period to determine the
prevalence and costs associated with NRL glove claims.
This is the longest period of time over which workers'


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compensation data related to NRL reactions have been an-
alyzed. The results were similar to those obtained in other
analyses of workers' compensation data from other states.
As in these other states, there were generally few claims re-
lated to NRL reactions, and with few exceptions most
claims were not severe in nature. However, there were a
small number of more serious claims, including one re-
ported fatality. The results showed that the vast majority
of cases were dermal in nature, and little evidence was
found to suggest pervasive respiratory or ocular reactions
related to NRL. Future research should continue to exam-
ine workers' compensation data in assessing NRL allergy
because of the ability to determine number and types of
reactions, compare reaction outcomes across demograph-
ic categories, and eventually develop risk predictive mod-
els of NRL allergy with respect to actual reactivity. From
these results, potential cost-benefit analyses of NRL glove
use can be developed to aid in policy development and
implementation.

Competing interests
This study was funded by Allegiance Healthcare Corpora-
tion.

Author' contributions
IBH conceived of the study, procured the data and per-
formed statistical analyses. JDKM performed background
research, performed statistical analyses, and wrote parts of
the manuscript. BPM performed statistical analyses, and
wrote parts of the manuscript. All three authors participat-
ed in the study design and modification with regards to re-
viewer comments.

All authors read and approved the final manuscript.

Acknowledgements
The authors wish to thank Gary A. Helmer and the Oregon Department of
Consumer and Business Affairs' Information Services Division for their as-
sistance in providing data and helpful informational support for this re-
search endeavor.

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