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Childhood motor vehicle occupant injuries.

Motor vehicle occupant trauma is the major cause of mortality among the pediatric population. The mortality rate for adolescents is approximately 10 times that of the younger age groups. Despite enactment of child passenger safety laws in all states and mandatory seat belt use laws in two thirds of the states, mortality rates have not decreased to the extent expected. Additional interventions targeted at the adolescent driver, substance use and driving, and improved occupant protection for all children will be required to further decrease occupant trauma. Lack of comprehensive trauma data is a major roadblock to the calculation of morbidity and disability rates.

Accident Prevention↗

Women in the U.S. construction industry: an analysis of fatal occupational injury experience, 1980 to 1992.

Analysis of 139 deaths to U.S. female construction workers identified from a death certificate-based surveillance system during 1980-1992 showed that female workers in transportation and material moving had 59 and 85% higher mortality rates than male construction workers in the same occupation from motor vehicles (the leading cause of occupational injury death for women, 43.2%) and machinery (the second leading cause of occupational injury death for women, 15.8%), respectively. Female handlers, equipment cleaners, helpers, and laborers had 73% higher mortality rates than their male counterparts from motor vehicles. Two-thirds of women in construction killed by motor vehicles were pedestrians, compared with an average of 19.2% of women in all industries. Half the female pedestrian decedents in construction were flaggers, compared with 3.4% of construction men killed by motor vehicles. Construction women had higher cause-specific years of potential life lost (to age 65 years) than construction men from motor vehicles (33 vs. 24.8), machinery (29 vs. 24.8), homicide (26.1 vs. 24.6), and falls (31.9 vs, 24.7). Over half (53.2%) the female fatalities occurred before age 35 years, compared with 46% for males. The average fatality rate of 1.80 per 100,000 workers for female construction workers was higher than the rate for women in any other industry. The average rate per 100,000 workers for all industries was 0.77. Further studies are required to explore factors contributing to differences in leading causes of death between female and male construction workers. Development and evaluation of prevention measures, such as effective traffic control in highway construction work zones, fall protection training, and machinery-operation training, could reduce the risks for fatal occupational injuries for construction workers, regardless of gender.

Accidental Falls↗

Comparison of two fatal occupational injury surveillance systems in the United States.

INTRODUCTION: Using different methods, two national systems compile fatal occupational injury data in the United States: the National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system, and the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). The NTOF uses only death certificates, while CFOI uses multiple sources for case ascertainment. METHODS: Through overall and case-by-case comparisons, this study compares these systems and evaluates counts for the nation and by state for worker and case characteristics. RESULTS: From 1992 through 1994, NTOF reported an average of 84% of the number of traumatic occupational fatalities reported in CFOI. This percentage changed somewhat when a case-by-case comparison was conducted--88% of the NTOF cases were matched directly to the CFOI cases. Although CFOI captured a larger number of fatalities annually, the additional fatalities did not follow a discernable pattern. IMPACT ON INDUSTRY: By understanding the distribution of fatalities, targeted efforts to reduce them will benefit all industries.

Accidents, Occupational↗

Alaska's model program for occupational injury prevention: applying surveillance for effective public health practice.

BACKGROUND: NIOSH established its Alaska Field Station in Anchorage, Alaska, in 1991, after identifying Alaska as America's highest-risk state for traumatic worker fatalities. Since then, NIOSH established comprehensive occupational injury surveillance in Alaska, and formed and facilitated interagency working groups (of state and federal agencies) and industry, labor, and professional organizations to address major factors leading to occupational death and injury in the state. STUDY DESIGN: Descriptive epidemiologic study of registry surveillance data obtained via direct on-site investigation of incidents and data-sharing with jurisdictional agencies. METHODS: We established a surveillance system, obtaining information via data-sharing with jurisdictional agencies and from direct on-site investigation of incidents. Also, we collaborate with state and regional government agencies, industry, workers, and non-governmental organizations to develop interventions. RESULTS: During 1991-1999, Alaska experienced a 50-percent overall decline in work-related deaths, including a substantial decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. These efforts have lead to major national and international government-industry collaborative efforts in improving the safety of helicopter lift operations, and a concomitant improvement in fishing industry mortality rates among workers fishing Alaskan seas. CONCLUSIONS: Using surveillance data as information for action, these collaborative efforts have contributed to reducing Alaska's high occupational fatality rate. This reduction has been most clearly demonstrated in the rapidly expanding helicopter logging industry. The application of surveillance data also has played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry--historically, Alaska's (and America's) most dangerous industry, and the worst killer of Alaskan workers. Results suggest that extending Alaska's approach to occupational injury surveillance and prevention to other parts of the country, and application of these strategies to the entire spectrum of occupational injury hazards, could have a broad impact on reducing occupational injuries.

Accidents, Occupational↗

Fatal occupational injuries among electric power company workers.

Surveillance data suggest high rates of electrocutions and fatal falls among workers in electric utility companies, who may be exposed to electric current, heights, flammable agents, and frequent motor vehicle travel. To characterize the occurrence of fatal injuries among electric utility workers, we studied workers in five electric power companies in the United States. A cohort of 127,129 men hired between 1950 and 1986 was followed through 1988. Injuries at work were identified through manual review of death certificates. The occurrence of occupational injuries was analyzed with directly adjusted rates and Poisson regression. The overall rate of fatal occupational injuries was 13.20 per 100,000 person-years (n = 192), with 76% due to electric current, homicide, and falls from heights. Deaths were concentrated in a few groups with elevated injury rates, notably linemen (rate ratio (RR) 3.33), electricians (RR 2.79), and painters (RR 3.27). Occupations requiring daily work on elevations or frequent, direct contact with energized electrical equipment experienced markedly higher rates of fatal injury from falls and electrocutions with rate ratios of 21.8 (95% confidence interval (CI) 11.4-41.5) and 16.7 (95% CI 6.6-42.6), respectively, independent of worker age and seniority. Although fatal injury rates in this industry have declined in recent decades, significant numbers of deaths still occur. Based on the premise that all injuries are preventable, a need for continued vigilance and efforts at prevention is indicated.

Accidental Falls↗

Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994.

OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries. METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers. RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios. CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.

Accidents, Occupational↗

Alternative approaches to analytical designs in occupational injury epidemiology.

In this paper, we discuss the theoretical framework upon which observational studies of occupational injuries are based. Following a general description of how causal effects are estimated, the challenges faced by researchers working in this area are outlined, with an emphasis on case-control studies. These challenges include defining the at-risk period for workers whose tasks change over time and whose hazard period may be very brief, evaluating the underreporting of both exposures and injuries, and considering the effects of multiple injuries per individual on study design and data analysis. We review both the theoretical and practical considerations in the design and conduct of traditional case-control studies, based on the collection of individual level data, as well as other approaches, such as using information culled from administrative and descriptive databases, and case-control studies in which the plant or work site is the unit of analysis. The case-crossover design is also reviewed and its utility for reducing confounding due to differences between individuals by self-matching is highlighted. While this design has not yet been applied to the work setting, its potential for increasing our understanding of the causes of acute-onset occupational injuries seems promising. Finally, a variety of hybrid designs are discussed, including combinations of case-control, case-crossover, and cohort designs.

Accidents, Occupational↗

Risk factors for occupational injuries among older workers: an analysis of the health and retirement study.

OBJECTIVES: This study examined risk factors for occupational injury among older workers. METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old. RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47). CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.

Accidents, Occupational↗

Fatal occupational injuries in the construction sector in Kocaeli, Turkey, 1990--2001.

In Turkey, the construction sector is responsible for the largest number of work-related fatalities among all industries. This study's objective is to determine the characteristics of the fatalities in the construction sector in Kocaeli Province. The study was carried out retrospectively by investigating the records of occupational deaths between 1990 and 2001 in the Kocaeli District of Turkey. Fatal occupational injuries in the construction sector were investigated in detail by evaluating the records. The analysis was based on data from 153 deaths. The incidence of occupational injuries was found overall to be 4.5% in Kocaeli, while the annual mortality rate was 60.4 in Kocaeli and 79.0 in Turkey per 100,000 workers over the entire time period. On the other hand, the fatality rate of occupational injuries was found to be 12.0 per 1,000 in Turkey and 6.4 per 1,000 in Kocaeli. The evaluation of the type of injuries in construction sector has revealed that in 69 of cases (45.1%) fell down from high altitude, in 22 cases (14.4%) vehicle accident, and in 22 (14.4%) electrocution were the cause of death. The leading causes of death have been found to be blunt-force trauma (37.9%) and head trauma (25.5%). Fourty one percent of those who had occupational accidents have had less than one year work experience. Only in 7.8% of deaths, the cause was determined through an autopsy.

Accidents, Occupational↗

Establishment size and risk of occupational injury.

For many years, the annual survey of occupational injuries and illnesses by the Federal Bureau of Labor Statistics (BLS) has consistently reported, without explanation, that injury rates in the smaller establishments (< 50 employees) are substantially lower than those for midsize establishments (100-499 employees). Also during those years, a remarkable increase has been reported in the injury rate in large companies, following the imposition of stiff fines for failure to keep required injury records. The rate patterns are identical for Michigan and the country in general. We investigated possible causes for lower injury rates in small establishments since such rates are inconsistent with reports of higher fatality rates in small establishments in the mining, construction, manufacturing, and transportation industries and higher, or at least comparable, injury rates for small establishments in the mining industry. They are also inconsistent with increased turnover and decreased availability of occupational safety services in small companies. Moreover, injury severity, as measured by missed worktime, is greater for workers in small establishments. We investigated the possibility that interactions of workforce or injury characteristics with establishment size could explain the rate differences. We also reviewed the available literature to see whether differences in labor turnover rates could explain the BLS findings. Graphical and statistical analyses of the 1988 CPS Annual Demographic File, a sample of employed persons in the U.S. workforce, failed to identify any associations between workforce characteristics and enterprise size that would explain the lower rates. Similarly, graphical and statistical analyses of all Michigan workers incurring a compensable injury in 1986 failed to indicate any associations between injury characteristics and establishment size that would explain the lower rates. The potential role of labor turnover on the injury rate was analyzed from data in the literature on turnover rate by establishment size and risk of injury by time on the job. None of these analyses explains the lower injury rates reported for small establishments. This leaves underreporting of injuries from small establishments as a substantial possibility. If small establishments were subject to the same injury incidence rates as midsize establishments, then the 1986 survey for Michigan may have missed as many as 54,000 injuries (and far more nationally). We suggest that BLS undertake methodological studies to validate the completeness of reporting from small establishments.

Absenteeism↗

Nonfatal occupational injuries and illnesses among workers treated in hospital emergency departments--United States, 2003.

CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on nonfatal occupational injuries and illnesses through the National Electronic Injury Surveillance System (NEISS), an emergency department (ED)-based surveillance system. This report summarizes data for 2003. The overall number and rate of occupational injuries and illnesses did not change substantially during the 5-year period since data were last reported in 1998. In 2003, age-, sex-, and diagnosis-related patterns of injury and illness among workers treated in EDs (ED-treated injuries/illnesses) were similar to those reported in 1998. To achieve substantial decreases in these injuries and illnesses, prevention efforts must focus on effective, targeted workplace-safety interventions for diverse occupations.

Accidents, Occupational↗

Heavy drinking and the risk of occupational injury.

This study evaluated the association between the frequency of heavy drinking and the risk of occupational injury, using nationally representative data from the 1988 National Health Interview Survey (NHIS). The sample consisted of 29,192 adults who were employed at some time during the year preceding the NHIS interview. Overall, 7.2% reported an on-the-job injury during the preceding year, but the rates were higher--about 13%--for those employed as skilled or unskilled laborers or who reported engaging in repeated strenuous physical activity at work. Slightly more than one-fourth of the employed adults reported at least one occasion of drinking five or more drinks during the preceding year. After adjusting for the effects of age, gender, education, occupation, and strenuous job activity, the odds of occupational injury increased with frequency of heavy drinking, with odds ratios varying from 1.08 (one occasion of heavy drinking) to 1.74 (daily heavy drinking). Odds ratios were decreased slightly by the inclusion of smoking as a control variable, indicating that some of the excess risk of injury among heavy drinkers may reflect their greater propensity to take health-related risks rather than direct effects of ethanol. The odds ratios also were slightly lower when the analysis was restricted to current drinkers, suggesting that the risk of work injury was increased by light or moderate as well as heavy drinking.

Accidents, Occupational↗

Establishing guidelines for the identification of occupational injuries: a systematic appraisal.

The workplace is a significant contributor to injuries and injury fatalities in the United States. Unfortunately, the systems in place for collecting and coding injury data suffer from a number of limitations that make it difficult, if not impossible, to enumerate accurately the true scope and import of occupational injuries and injury fatalities. At present, there are no nationally agreed upon standards for defining, reporting, and recording occupational (and nonoccupational) injuries. This article examines and evaluates the major surveillance systems for the collection and recording of data on occupational injuries and injury fatalities and presents guidelines for establishing a model system of occupational injury surveillance. These guidelines should be valuable in designing a national data system that can measure the impact and effectiveness of injury prevention and control programs in the United States.

Accidents, Occupational↗

Occupational injuries with captive lance-headed vipers (Bothrops moojeni): experience from a snake farm in Brazil.

We studied occupational injuries with captive lance-headed vipers (Bothrops moojeni) that occurred in a snake farm in south-eastern Brazil from February 1981 to May 1999. The risk of injury, taking into account 13 cases of snake-associated injuries (12 of them snake bites) was 2.73 per 10,000 person-days of work, and 3.51 per 100,000 venom extractions. Thirteen cases of injury occurred in seven workers, whereas 18 workers were never injured, suggesting that some individuals have a higher risk of injury than others perhaps due to lack of concentration or overconfidence. Eight episodes of occupational injuries occurring in four technicians, including a case of eye injury due to splashed venom during extraction, are reported. Assessment of whether envenoming occurred was facilitated by knowledge of the snake species and size, history of recent venom extraction and snake feeding, and examination of snake venom glands. Hypersensitivity reactions (anaphylaxis and serum sickness) to antivenom are a risk particularly to those workers who were bitten more than once and medicated previously. Antivenom therefore should not be administered to these individuals unless there is clear evidence that envenoming occurred or is likely to have occurred. Hypersensitivity to the venom is also a health concern for workers from snake farms.

Accidents, Occupational↗

Relationships of job, age, and life conditions with the causes and severity of occupational injuries in construction workers.

OBJECTIVES: To assess the relationships of job, age, and life conditions with the causes and severity of occupational injuries in male construction labourers. METHODS: The sample included 880 male construction workers having had at least one occupational injury with subsequent sick leave. The survey used a standardised questionnaire, filled in by the occupational physician in the presence of the subject: socio-demographic data, job, safety training, smoking habit, alcohol consumption, sporting activities, physical disabilities, hearing, vision, and sleep disorders. Statistical analysis was via the logistic regression method. RESULTS: Logistic models showed that falls and injuries from the handling of objects or hand tools was similar for all jobs, while masons, plumbers and electricians had a higher risk of injury from moving objects, and carpenters, roofers and civil-engineering workers were more exposed to injury from construction machinery and devices. Age <30 was related to injury from hand tools [adjusted OR (95%CI) 2.20 (1.28-3.79)]; sleep disorders and hearing disorders to those from moving objects [ORs 2.29 (1.27-4.12) and 1.85 (1.01-3.41) respectively]; no sporting activity to those from the handling of objects [OR 1.54 (1.09-2.17)]; and being overweight to falls on the same level [OR 2.04 (1.30-3.21)] and falls to a lower level [OR 1.55 (1.13-2.13)]. Injuries from the handling of objects were less frequent in overweight workers [OR 0.62 (0.46-0.84)]. Injuries with hospitalisation or sick leave > or =60 days were associated with age > or =30 and hearing disorders. CONCLUSIONS: The causes of injuries were related to jobs. Prevention through working conditions could be made against the revealed risks. The risks for each worker depended on age, body mass index, hearing disorders, sleep disorders, and sporting activities. The occupational physician could inform the workers of these risks and encourage them to practise sporting activities and reduce their hearing disorders and sleep disorders.

Adult↗

From strategy to reality: 25 years of planning and progress in occupational injury research.

Injury as a major public health problem, although noted as early as the 1930s, was not widely accepted by the public health community until the 1980s. Over recent decades, there have been a number of strategic plans developed to prevent and control occupational injuries. These plans have been remarkably consistent in that many of the same recommendations surfaced despite different planners from different eras. The recommendations also generally align with the steps in the public health approach. Although recognition of the relevance of the public health approach to traumatic occupational injury came decades ago, significant barriers have inhibited its full implementation. Today, these barriers are being overcome, due to improved surveillance, increased collaborations among disciplines, increasing partnerships with industry, improved prevention evaluation methods, cost analysis models, and increasing funding. Of course, many of the experiences in the United States are paralleled in other countries in the Western world, and even in some developing countries. Substantial progress has been made in recent years in identifying problems and developing solutions, in addressing the recommendations of decades of planning, and of building the scientific foundation necessary to guide prevention. As a result, traumatic occupational injury research must begin to increase focus on bringing the public health process full circle, including the implementation and evaluation of preventive strategies and interventions. Now, the final steps of the process need our attention-evaluating the effectiveness of these solutions and then getting knowledge and products onto the shop floor, the construction site, and the farm, the convenience store, and the delivery truck; getting effective prevention into the workplace. Now is the time to close the loop, from science to prevention.

Humans↗

Fatal occupational injuries of women, Texas 1975-84.

A review of Texas death certificates for 1975-84 identified 348 cases of fatal occupational injuries of civilian females. Homicides accounted for 53 per cent and motor vehicle-related injuries accounted for 26 per cent of the deaths. Injuries from firearms caused 70 per cent of the homicides. One hundred thirty-three deaths occurred to women employed in the retail trade industry; of these, 77 per cent resulted from homicide. Women workers in gasoline service stations, food-bakery-and-dairy stores, and eating-and-drinking places had especially high risks of homicide. Texas female heavy-truck drivers had the highest fatal-injury rate, with motor-vehicle-related injuries causing 89 per cent of their deaths. These results indicate that effective strategies to prevent fatal occupational injuries of Texas women will need to address the problems of workplace violence and the hazards posed by motor vehicles.

Accidental Falls↗

The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States.

AIMS: To analyse the impact of overtime and extended working hours on the risk of occupational injuries and illnesses among a nationally representative sample of working adults from the United States. 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 jobs involving overtime and extended hours.

Accidents, Occupational↗