Risk factors for injury among construction workers at Denver International Airport

Sustainable Risk Assessment through the Analysis of Financial Losses from Third-Party Damage in Bridge Construction

Due to the recent introduction of innovative construction methods and technologies, construction projects increasingly require sustainability in their high degrees of specialization and complex work processes. This is due to a wide variety of new risk factors associated with construction projects that can lead to extensive and severe damage. When an accident occurs during a construction project, it can cause material, property, or bodily damage not only within the actual construction site but also outside, affecting third parties. This study analyzed the record of such third-party damage and the subsequent financial losses in bridge construction management, to identify the objective and quantified relationship of risk indicators related to the damage and losses. In order to assess the actual losses in construction projects, we adopted the loss claim payout data as recorded and provided by a major Korean insurance company, and conducted a multiple regression analysis to identify the loss indicators and to develop a loss estimation model. In this study, the analysis of the data indicated that the superstructure type, the foundation type, floods, and company ranking by the amount of the contract were the four statistically significant risk indicators that affected financial losses from third-party damage, among the nine variables used as independent variables, which included the superstructure type, foundation type, superstructure construction method, maximum span length, floods, typhoons, total construction cost, total construction period, and company ranking. As this study focused on identifying the risk factors and producing a loss assessment model quantified in numerical values, the results provide important references for assessing and minimizing the risks to third parties and the consequential financial losses in bridge construction, while promoting sustainability objectives.

Comparing disability and return to work outcomes between alternative and traditional workers' compensation programs

BACKGROUND

The Union Construction Workers' Compensation Program (UCWCP) was developed in 1996 as an alternative workers' compensation arrangement. The program includes use of a preapproved medical and rehabilitation network and alternative dispute resolution (ADR), and prioritizes a quick and safe return-to-work. The aim of this study is to determine if differences in recovery-related outcomes exist between UCWCP and the statutory workers' compensation system (SWCS).

METHODS

Claims data from 2003 to 2016 were classified as processed through UCWCP or SWCS. Outcomes included: temporary total disability (TTD), vocational rehabilitation (VR), claim duration and costs, and permanent partial disability (PPD). The relative risk of incurring TTD, VR, and PPD in UCWCP vs SWCS was calculated using log-binomial regression. Linear regression examined the relationship between programs and continuous outcomes including costs and duration. Estimates were adjusted for age, sex, wage, and severity.

RESULTS

The UCWCP processed 15.8% of claims; higher percentages of UCWCP claimants were older and earned higher wages. Results point to positive findings of decreased TTD incidence and cost, lower risk of TTD extending over time, higher likelihood of VR participation, and less attorney involvement and stipulation agreements associated with UCWCP membership. Differences were more apparent in workers who suffered permanent physical impairment.

CONCLUSION

Findings suggest that the defining programmatic elements of the UCWCP, including its medical provider and rehabilitation network and access to ADR, have been successful in their aims. Claims with increased severity exhibited more pronounced differences vs SWCS, potentially due, in part, to greater use of programmatic elements.

The Effect of Long Working Hours and Overtime on Occupational Health: A Meta-Analysis of Evidence from 1998 to 2018

There has been no subsequent meta-analysis examining the effects of long working hours on health or occupational health since 1997. Therefore, this paper aims to conduct a meta-analysis covering studies after 1997 for a comparison. A total of 243 published records were extracted from electronic databases. The effects were measured by five conditions, namely, physiological health (PH), mental health (MH), health behaviours (HB), related health (RH), and nonspecified health (NH). The overall odds ratio between long working hours and occupational health was 1.245 (95% confidence interval (CI): 1.195-1.298). The condition of related health constituted the highest odds ratio value (1.465, 95% CI: 1.332-1.611). The potential moderators were study method, cut-point for long weekly working hours, and country of origin. Long working hours were shown to adversely affect the occupational health of workers. The management on safeguarding the occupational health of workers working long hours should be reinforced.

Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk?

INTRODUCTION

It is not known whether out-of-province Canadians, who travel to Alberta for work, are at increased risk of occupational injury.

METHODS

Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under-reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta.

RESULTS

Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12-0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out-of-province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00-0.40).

CONCLUSION

Differential rates of under-reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time-loss 1 to 30 days.

Comparing recall vs. recognition measures of accident under-reporting: A two-country examination

A growing body of research suggests that national injury surveillance data significantly underestimate the true number of non-fatal occupational injuries due to employee under-reporting of workplace accidents. Given the importance of accurately measuring such under-reporting, the purpose of the current research was to examine the psychometric properties of two different techniques used to operationalize accident under-reporting, one using a free recall methodology and the other a recognition-based approach. Moreover, in order to assess the cross-cultural generalizability of these under-reporting measures, we replicated our psychometric analyses in the United States (N=440) and Italy (N=592). Across both countries, the results suggest that both measures exhibited similar patterns of relationships with known antecedents, including job insecurity, production pressure, safety compliance, and safety reporting attitudes. However, the recall measures had more severe violations of normality and were less correlated with self-report workplace injuries. Considerations, implications, and recommendations for using these different types of accident measures are discussed.

Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders

INTRODUCTION

Insurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders.

METHODS

Workers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

Compared no LP contact, one contact was associated with a 27% reduction of risk (HR=0.73, CI=0.65-0.82), two with a 41% (HR=0.59, CI=0.51-0.68), and three or more contacts with a 28% reduction of risk (HR=0.72, CI=0.65-0.81).

CONCLUSIONS

LP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries.

PRACTICAL APPLICATIONS

Reduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff.

Workers’ Age and the Impact of Psychological Factors on the Perception of Safety at Construction Sites

The safety of construction workers is always a major concern at construction sites as the construction industry is inherently dangerous with many factors influencing worker safety. Several studies concluded that psychological factors such as workload, organizational relationships, mental stress, job security, and job satisfaction have significant effects on workers’ safety. However, research on psychological factors that are characteristic of different age groups have been limited. The aim of this study was to examine the impact of psychological factors on the perception of worker safety for two different age groups. After an extensive literature review, different psychological factors were identified, and a hypothetical research model was developed based on psychological factors that could affect workers’ perception of safety. A survey instrument was developed, and data were collected from seven different construction sites in Pakistan. Structural equation modeling (SEM) was employed to test the hypothetical model for both age groups. The results revealed that workload and job satisfaction are significantly dominant factors on workers’ perception of safety in older workers, whereas organizational relationships, mental stress, and job security are dominant factors for younger workers at construction sites.

Age, human performance, and physical employment standards

The proportion of older workers has increased substantially in recent years, with over 25% of the Canadian labour force aged ≥55 years. Along with chronological age comes age-related declines in functional capacity associated with impairments to the cardiorespiratory and muscular systems. As a result, older workers are reported to exhibit reductions in work output and in the ability to perform and/or sustain the required effort when performing work tasks. However, research has presented some conflicting views on the consequences of aging in the workforce, as physically demanding occupations can be associated with improved or maintained physical function. Furthermore, the current methods for evaluating physical function in older workers often lack specificity and relevance to the actual work tasks, leading to an underestimation of physical capacity in the older worker. Nevertheless, industry often lacks the appropriate information and/or tools to accommodate the aging workforce, particularly in the context of physical employment standards. Ultimately, if appropriate workplace strategies and work performance standards are adopted to optimize the strengths and protect against the vulnerability of the aging workers, they can perform as effectively as their younger counterparts. Our aim in this review is to evaluate the impact of different individual (including physiological decline, chronic disease, lifestyle, and physical activity) and occupational (including shift work, sleep deprivation, and cold/heat exposure) factors on the physical decline of older workers, and therefore the risk of work-related injuries or illness.

The relationship between worker, occupational and workplace characteristics and whether an injury requires time off work: a matched case-control analysis in Ontario, Canada

BACKGROUND

The objective of this study was to examine individual, occupational, and workplace level factors associated with time loss following a similar injury.

METHODS

Seven thousand three hundred and forty-eight workers' compensation claims that did not require time off work were matched with up to four claims that required time off work on the event, nature, and part of body injured as well as injury year. Conditional logistic regression models examined individual, occupational, and workplace level factors that were associated with the likelihood of not requiring time off work.

RESULTS

Employees from firms with higher premium rates were more likely to report no time loss from work and workers in more physically demanding occupations were less likely to report no time loss from work. We observed no association between age or gender and the probability of a time loss claim submission.

CONCLUSIONS

Our results suggest that insurance costs are an incentive for workplaces to adopt policies and practices that minimize time loss following a work injury.

Pressure to produce=pressure to reduce accident reporting?

Each year, more than 4 million U.S. workers are injured on the job - several thousand die (Bureau of Labor Statistics, 2008). Despite these staggering numbers, research suggests that they are gross underestimates of the true volume of workplace related illnesses and injuries due to accident under-reporting. Although accident under-reporting has been well-documented, less is known regarding why this occurs. The current study suggests that under-reporting may in part be due to high levels of perceived production pressure. Specifically, this study tested the hypotheses that production pressure would be related to more experienced accidents overall and more negative attitudes toward reporting accidents. Further, we expected that production pressure would exacerbate the under-reporting of accidents. Survey data were collected from a sample of 212 copper mining workers located in the southwestern United States. The survey measured employee perceptions regarding production pressure, attitudes toward reporting accidents, perceived consequences of reporting accidents, and actual reporting behaviors (e.g., types and numbers of accidents experienced vs. reported). As predicted, the average number of experienced accidents per employee was significantly higher (M=2.84) than the number of reported accidents (M=.49). In addition, production pressure was related to more negative reporting attitudes. Individuals who had positive reporting attitudes were injured less frequently; however, when an incident occurred, they were more likely to report it. Finally, higher levels of production pressure were related to greater accident under-reporting. Additionally, employees who perceived high levels of production pressure not only experienced more accidents overall, they also reported fewer of them to the organization. Implications for occupational safety initiatives--particularly in the current economic climate--are discussed, as are methodological challenges of conducting research in this area.

Age in relation to worker compensation costs in the construction industry

BACKGROUND

A better understanding of how workers' compensation (WC) costs are affected by an aging US workforce is needed, especially for physically demanding industries, such as construction.

METHODS

The relationship between age and injury type on claim costs was evaluated using a database of 107,064 Colorado WC claims filed between 1998 and 2008 among construction workers.

RESULTS

Mean WC costs increased with increasing age for total cost (P < 0.0001), medical costs (P < 0.0001), and indemnity costs (P < 0.0001). For each one-year increase in age, indemnity, and medical costs increased by 3.5% and 1.1%, respectively. For specific injury types, such as strains and contusions, the association between age and indemnity costs was higher among claimants aged ≥65 compared to claimants aged 18-24.

CONCLUSIONS

Our findings suggest that specific injury types may be partially responsible for the higher indemnity costs among older construction workers, compared with their younger coworkers.

Injury rates, severity, and drug testing programs in small construction companies

PROBLEM

Construction work is hazardous and workers consistently rank in the top of all occupations and industries for illicit drug and heavy alcohol use.

METHODS

Drug-testing programs were classified into three categories: no program, pre-employment/post-accident, and pre-employment/post-accident/random/suspicion. We analyzed workers' compensation claims from 1,360 construction companies over a six-year period to assess the possible association of testing program with injury rate.

RESULTS

Compared to no program, results respectively were RR=0.85 (CI=0.72-1.0) and RR=0.97 (CI=0.86-1.10) for all injuries, and RR=0.78 (CI=0.60-1.03) and RR=1.01 (CI=0.86-1.19) for lost-time injuries. Variability of results was exhibited across trade and union status, among other categories.

SUMMARY

Drug-testing programs may be associated with lower, non-significant, injury rates in this population.

IMPACT ON INDUSTRY

Drug-testing programs may be associated with lower injury rates, but care should be exercised to ensure accurate injury reporting, characterize underlying safety practices of a company, and to determine quality and consistency of testing.

Comparing the risk factors associated with serious versus and less serious work-related injuries in Ontario between 1991 and 2006

BACKGROUND

The objective of this study was to examine and compare the demographic and labor market risks for more serious and less serious work-related injuries and illnesses.

METHODS

Secondary analysis of accepted workers' compensation claims in Ontario, combined with labor force estimates for the period 1991 to 2006. Serious injuries and illnesses were claims resulting in wage replacement. Less serious injuries and illnesses were claims only requiring health care. Regression models examined the relationship between demographic and labor market characteristics (age, gender, industry, job tenure, and unemployment) and claim type.

RESULTS

Relative risk estimates for serious and less serious claims were not concordant across age, gender and industry employment groups. For example, while the mining and utilities and the construction industry had an increased probability of reporting NLTCs, they had a decreased probability of reporting LTCs.

CONCLUSIONS

The risk for serious and less serious work-related injury and illness claims differ by demographic and labor market groups. The use of composite measures that combine wage-replacement and health care only claims should be considered when using compensation data for surveillance and primary prevention targeting strategies.

An aging workforce and injury in the construction industry

The relatively large birth cohort between 1946 and 1964, combined with the economic recession in the first decade of the 21st century, have led to an increase in the proportion of older workers in the US workplace. Understanding the health and safety needs of an aging workforce will be critical, especially in the construction industry, where physical job demands are high. This paper reviews the epidemiologic literature on the impact of age on injury among workers in the construction industry in terms of cause, type, and cost. PubMed was searched by using the following terms: older workers, construction, construction industry, injury, and age. The available studies reported that, among the construction industry workforce, older age at injury was related to higher injury costs but not to number of injuries. The higher injury costs associated with worker age are likely due in part to the severity of the injuries sustained by older workers. Identification of injury trends and subsequent analytical research efforts designed to ascertain factors associated with injury among older construction workers are needed for employers to effectively manage a health and safety program that addresses the needs of the aging worker.

Impact of organization on occupational injury risk: evidence from high-speed railway construction

BACKGROUND

The construction industry is at the top of the list of priorities for surveillance and research, although it is often difficult to perform detailed analysis of the risk factors. In mid-2002, construction work started on the Torino to Novara high-speed railway line. A Regional Epidemiological Observatory developed a standardized data collection system that provided a rare opportunity for researchers in Italy to analyze risk factors for occupational injury in a large cohort of workers involved in a single major construction project. The aim of this study is to describe the characteristics of a cohort of workers employed at construction sites of the high-speed Torino to Novara railway between 2003 and 2005, analyze the main determinants of occupational injury risk and estimate incidence rates.

METHODS

Frequency rates of occupational injury were calculated by characteristics of workers and firms and relative risks were estimated using a Poisson model.

RESULTS

Annual injury incidence decreased over the period and was higher than the Italian construction industry rate. The risk was highest among workers performing the least skilled jobs and with the shortest contracts. Moreover the risk was higher in large enterprises.

CONCLUSIONS

Although calculated within a specific context, the results provide information applicable to all construction sites. The high risk of occupational injury associated with short-term contracts suggests, at such large and long-term construction sites, to engage workers on a permanent basis for the duration of the construction project.

Effectiveness of the training program for workers at construction sites of the high-speed railway line between Torino and Novara: impact on injury rates

BACKGROUND

There are very few published studies evaluating the impact of safety and health training on injury outcomes in the construction industry. The aim of this study was to assess the impact of the training program on injury rates at a major railway construction project.

METHODS

The population consisted of 2,795 workers involved in a safety training program at the construction sites of the high-speed railway line Torino-Novara. Two types of analyses were carried out in order to assess the effectiveness of the training program in reducing the number of injuries: (i) a pre-post analysis, which took into account the fact that workers were enrolled at different times and the training intervention did not occur at the same time for all subjects; (ii) an interrupted time-series model, which corrected for the time trend and considered the autocorrelation between individual observations.

RESULTS

Twenty-nine percent of workers who spent at least 1 day at the construction sites attended at least one training module. Pre-post analysis: At the end of the training program, the incidence of occupational injuries had fallen by 16% after the basic training module and by 25% following the specific modules. Time-series model: Training led to a 6% reduction in injury rates, which was not statistically significant.

CONCLUSIONS

The training program that was implemented had a moderately positive impact on the health of workers. Further studies are being conducted to obtain a more complete assessment of the actual effectiveness of the program in reducing the incidence of injuries.

Livestock-handling injuries in agriculture: an analysis of Colorado workers' compensation data

BACKGROUND

Previous studies have reported that livestock-handling injuries are among the most severe of agricultural injuries. This study identifies the costs, characteristics, and contributing factors associated with livestock-handling injuries among Colorado dairy farmers, cattle/livestock raisers, and cattle dealers.

METHODS

A 10-year (1997-2006) history of Colorado's workers' compensation claims data was used for analysis. Descriptive analyses of livestock-handling injury claims were performed. Claim cost analysis was also conducted. The agent-host-environment epidemiological model was used to analyze injury event descriptions.

RESULTS

A total of 1,114 livestock-handling claims were analyzed. Claims associated with milking parlor tasks represented nearly 50% of injuries among dairy workers. Claims associated with riding horseback, sorting/penning cattle, and livestock-handling equipment represented high proportions of livestock-handling injuries among cattle/livestock raisers and cattle dealers. Claims associated with livestock-handling represented the highest percentage of high-cost and high-severity injuries in all three sectors.

CONCLUSIONS

Livestock-handling injuries are a significant problem, more costly, and result in more time off work than other causes of agricultural injuries. There is a strong and compelling need to develop cost-effective interventions to reduce the number of livestock-handling injuries in agriculture.

Under Pressure, Out of Control, or Home Alone? Reviewing Research and Policy Debates on the Occupational Health and Safety Effects of Outsourcing and Home-Based Work

The practice of outsourcing or subcontracting of work has grown rapidly in most countries over the past two decades. Outsourcing, de-institutionalization, and a range of other practices have also resulted in a growth of home-based work. Home-based workers, even when not part of a subcontracting process, operate in an isolated situation remote from their employer and other workers. Do such work arrangements expose workers to greater risk of injury, illness, or assault? The authors reviewed international studies of the occupational health and safety (OHS) effects of subcontracting and home-based work undertaken over the past 20 years. Of the 25 studies analyzed, 92 percent found poorer OHS outcomes. The studies were examined for clues about the reasons for these negative outcomes. The authors also identified similarities and differences between subcontracting and home-based work. Despite the evidence of poor OHS outcomes, research into outsourcing has stalled in recent years. With notable exceptions, governments have taken little account of findings on these work arrangements in their laws and policies, in part because neoliberal ideas dominate national and global policy agendas. The authors examine policy challenges and regulatory responses and make suggestions for future research and policy interventions.

Economic growth and the incidence of occupational injuries in Austria

OBJECTIVES

The aim of this paper was to analyze the impact of economic growth measured by real gross domestic product (GDP) on the incidence of occupational injuries in Austria.

METHODS

The relationship between GDP and the occupational injury rate of the wage-earning population between 1955 and 2004 was analyzed using an error correction model. The sample size increased from 1.568,371 persons in 1955 to 2.656,952 in 2004. Occupational injuries were divided into fatal and non-fatal injuries.

RESULTS

Occupational injuries (fatal and non-fatal) decreased from 8.59% to 4.08%: non-fatal injuries decreased from 8.56% to 4.07%; fatal injuries decreased from 0.03% to 0.01%. Austrian GDP increased from EUR 37.7 billion to EUR 202.8 billion (base year 1995). Statistical analysis clearly shows that a growing economy is associated with declining injury rates (fatal and non-fatal). Two mechanisms are discussed. Firstly, rising GDP is accompanied by greater investment in safer technologies and occupational safety measures. Secondly, booming economies are associated with a reduced risk of unemployment, which is already known to be a risk factor for occupational injuries.

CONCLUSIONS

Economic development appears to have an impact on the incidence of occupational injuries in Austria. Health policy should emphasize the necessity for safety at work particularly in phases of economic slowdown.

Extended work hours and risk of acute occupational injury: A case-crossover study of workers in manufacturing

OBJECTIVE

This study was designed to determine whether injury risk among manufacturing workers was related to hours worked during the previous week.

METHODS

A case-crossover design was utilized to contrast hours worked prior to an injury shift with those worked prior to a non-injury shift for hourly workers. Paired t-tests were used to determine significance of the difference. Conditional logistic regression was used to assess dose-response.

RESULTS

Hours worked prior to injury significantly exceeded hours during the control week. Workers who worked more than 64 hr in the week before the shift had an 88% excess risk compared to those who worked 40 hr or fewer, P < 0.05.

CONCLUSION

The study provides evidence that injury risk is related to time worked during the previous week. Control of overtime in manufacturing may reduce risk of worker injury.

Possible broad impacts of long work hours

The paper summarizes research linking long work hours to a wide range of risks to workers, families, employers, and the community. The risks are theorized to stem from less time to recover from work, longer exposure to workplace hazards, and less time to attend to non-work responsibilities. Risks to workers include sleep deprivation, poor recovery from work, decrements in neuro-cognitive and physiological functioning, illnesses, adverse reproductive outcomes, and injuries. Risks to families include delayed marriages and child bearing, and obesity in children. Risks to employers include reduced productivity and increases in workers errors. Mistakes by fatigued workers have broad reaching impacts to the community: medical errors, automobile crashes with other drivers on the road, and industrial disasters that damage the environment.

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.

Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers

AIMS

Most industrialised countries have public income maintenance programmes to protect workers in case of disability but studies addressing disability risk of specific professional groups are rare. The objective of this study was to establish a detailed pattern of the nature and extent of occupational disability among construction workers.

METHODS

A cohort study was set up including 14,474 male workers from the construction industry in Württemberg (Germany) aged 25-64 years who underwent occupational health exams between 1986 and 1992. The cohort was linked to the regional pension register of the manual workers' pension insurance institution to identify workers who were granted a disability pension during the 10 year follow up. All-cause and cause specific standardised incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using disability rates from the general workforce and from all blue collar workers in Germany as references.

RESULTS

In total, 2247 (16%) members of the cohort were granted a disability pension. Major causes of disability were musculoskeletal (45%) and cardiovascular diseases (19%). In comparison with the general workforce, construction workers experienced a higher risk of disability from cancer (SIR = 1.26; 95% CI 1.08 to 1.47), respiratory diseases (SIR = 1.27; 95% CI 1.03 to 1.55), musculoskeletal diseases (SIR = 2.16; 95% CI 2.03 to 2.30), injuries/poisoning (SIR = 2.52; 95% CI 2.06 to 3.05), and all causes combined (SIR = 1.47; 95% CI 1.41 to 1.53). When compared with the blue collar reference group, increased risks of disability among construction workers were found for musculoskeletal diseases (SIR = 1.53; 95% CI 1.44 to 1.63), injury/poisoning (SIR = 1.83; 95% CI 1.50 to 2.21), and all causes combined (SIR = 1.11; 95% CI 1.07 to 1.16).

CONCLUSIONS

Musculoskeletal diseases and external causes are major factors limiting the work capability of construction workers and lead to an increased proportion of occupational disability.

Assessing the annual economic burden of preventing and treating anogenital human papillomavirus-related disease in the US: analytic framework and review of the literature

The anogenital human papillomavirus (HPV) is estimated to be the most commonly occurring sexually transmitted infection in the US. Comprehensive estimates of the annual economic burden associated with the prevention and treatment of anogenital HPV-related disease in the US population are currently unavailable. The purpose of this paper is to (i) outline an analytic framework from which to estimate the annual economic burden of preventing and treating anogenital HPV-related disease in the US; (ii) review available US literature concerning the annual economic burden of HPV; and (iii) highlight gaps in current knowledge where further study is particularly warranted. Among eight US studies identified that describe the annual economic burden pertaining to one or more aspects of anogenital HPV-related disease, three met the review eligibility criteria (published between 1990 and 2004, examined multiple facets of annual anogenital HPV-related economic burden, and clearly articulated the data and methods used in the estimation process). All costs were adjusted to 2004 US dollars. Estimates of the annual direct medical costs associated with cervical cancer were comparable across studies (range 300-400 million US dollars). In contrast, there was a wide range across studies for estimates of the annual direct medical costs associated with cervical intraepithelial neoplasia (range 700 million US dollars-2.3 billion US dollars). Only one study reported direct medical costs for anogenital warts (200 million US dollars) and routine cervical cancer screening (2.3 billion US dollars). No studies examined direct medical costs attributable to HPV-related anal, penile, vaginal or vulvar cancers, or the work and productivity losses resulting from time spent receiving medical care, morbidity or mortality. Current economic burden estimates would suggest annual direct medical costs associated with the prevention and treatment of anogenital warts and cervical HPV-related disease of at least 4 billion US dollars. This figure would likely rise to at least 5 billion US dollars per year if direct medical costs associated with other disease entities caused by the sexual transmission of HPV were included, with further additions to the economic burden totalling in the billions of dollars if work and productivity losses were incorporated, a research priority for future studies.

Factors contributing to construction injury at Denver International Airport

BACKGROUND

Detailed information about factors contributing to construction injury is important to support design of safety programs directed at particular risks.

METHODS

We linked over 4,000 injury reports, including text describing injury events, with an administrative workers' compensation (WC) database, and, using Haddon's matrix as a framework, classified factors contributing to injury during construction of Denver International Airport (DIA).

RESULTS

Patterns of contributing factors varied according to injury mechanism and type of work: environmental factors contributed more than any other factor to slip/trip injuries, and building materials contributed to more than 40% of injuries to workers in carpentry, concrete construction, glass installation, and roofing. Rates at which factors contributed to injury also varied among types of work: environmental factors contributed at relatively high rates to injuries in glass installation, metal/steel installation and iron/steel erection >or= 2 stories, and victim factors contributed at high rates to conduit construction and metal/steel installation injuries. WC payment rates for different factors varied widely, ranging from $0.53/$100 payroll to $3.08/$100.

DISCUSSION

This approach allows systematic analysis of classes of injuries, contributing factors, types of work, and other variables to assist in setting prevention priorities.

Relationship of work schedules to gastrointestinal diagnoses, symptoms, and medication use in auto factory workers

BACKGROUND

Gastrointestinal (GI) complaints are common in shift workers. This study examines the relationship between work schedules and GI symptoms, medications, and diagnoses.

METHODS

In a cross-sectional survey of 343 US auto factory workers, four work schedule variables were examined: assigned shift, number of hours worked, number of night hours, and schedule variability. Multiple regression tested the relationship between GI outcomes and work schedule variables while controlling for covariates.

RESULTS

The evening shift was associated with more GI symptoms and GI diagnoses. Unexpectedly, more consistent work times were associated with having a GI diagnosis. As schedule variability increased the probability of GI medication use increased in low noise exposure.

CONCLUSION

Findings suggest that evening shift and widely varying work start and end times may increase risks for GI disturbances.

Disabling and fatal occupational claim rates, risks, and costs in the Oregon construction industry 1990-1997

This study estimated injury and illness rates, risk factors, and costs associated with construction work in Oregon from 1990-1997 using all accepted workers' compensation claims by Oregon construction employees (N = 20,680). Claim rates and risk estimates were estimated using a baseline calculated from Current Population Survey data of the Oregon workforce. The average annual rate of lost-time claims was 3.5 per 100 workers. More than 50% of claims were by workers under 35 years and with less than 1 year of tenure. The majority of claimants (96.1%) were male. There were 52 total fatalities reported over the period examined, representing an average annual death rate of 8.5 per 100,000 construction workers. Average claim cost was $10,084 and mean indemnity time was 57.3 days. Structural metal workers had the highest average days of indemnity of all workers (72. 1), highest average costs per claim ($16,472), and highest odds ratio of injury of all occupations examined. Sprains were the most frequently reported injury type, constituting 46.4% of all claims. The greatest accident risk occurred during the third hour of work. Training interventions should be extensively utilized for inexperienced workers, and prework exercises could potentially reduce injury frequency and severity.

All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up

BACKGROUND

Construction workers are potentially exposed to many health hazards, including human carcinogens such as asbestos, silica, and other so-called "bystander" exposures from shared work places. The construction industry is also a high risk trade with respect to accidents.

METHODS

A total of 19 943 male employees from the German construction industry who underwent occupational health examinations between 1986 and 1992 were followed up until 1999/2000.

RESULTS

A total of 818 deaths occurred during the 10 year follow up (SMR 0.71; 95% CI 0.66 to 0.76). Among those were 299 deaths due to cancer (SMR 0.89; 95% CI 0.79 to 1.00) and 312 deaths due to cardiovascular diseases (SMR 0.59; 95% CI 0.51 to 0.68). Increased risk of mortality was found for non-transport accidents (SMR 1.61; 95% CI 1.15 to 2.27), especially due to falls (SMR 1.87; 95% CI 1.18 to 2.92) and being struck by falling objects (SMR 1.90; 95% CI 0.88 to 3.64). Excess mortality due to non-transport accidents was highest among labourers and young and middle-aged workers. Risk of getting killed by falling objects was especially high for foreign workers (SMR 4.28; 95% CI 1.17 to 11.01) and labourers (SMR 6.01; 95% CI 1.63 to 15.29).

CONCLUSION

Fatal injuries due to falls and being struck by falling objects pose particular health hazards among construction workers. Further efforts are necessary to reduce the number of fatal accidents and should address young and middle-aged, semi-skilled and foreign workers, in particular. The lower than expected cancer mortality deserves careful interpretation and further follow up of the cohort.

Have young workers more injuries than older ones? An international literature review

PROBLEM

Two questions were posed in this global literature review: Do young workers have a higher occupational injury rate? Are the injuries of young workers more often fatal than those of older workers?

METHOD

The studies of nonfatal and fatal injuries were collected based on the following criteria: (a) published in peer-reviewed journals; (b) the young workers were under 25 years of age; (c) the injury rate or fatality rate of young workers and the overall rate was published; and (d) description of the population and the number of injuries was presented.

RESULTS

The majority of 63 nonfatal studies reported showed that young workers had a higher injury rate than older workers. Twenty-nine out of 45 studies on fatal occupational injuries indicated that young workers had a lower fatality rate than older workers. These results are clearer for men than for women.

IMPACT ON INDUSTRY

The results showed that young men were a risk group for occupational injuries. However, the injuries of young workers were reported as less often fatal than those of older workers.

The "Goldilocks model" of overtime in construction: not too much, not too little, but just right

PROBLEM

Little research exists on the relationship between working overtime and possible adverse health and safety outcomes for construction workers.

METHOD

Five focus-group discussions were conducted with construction workers from around the United States. From the analyzed transcripts, a model of overtime was developed.

RESULTS

The model includes three dominant themes: (1) work organization issues [(a) definitions of overtime, (b) scheduling, and (c) economic conditions], (2) why workers choose to work overtime [(a) management expectations, (b) career, and (c) money], and (3) the effects of working overtime [(a) health and safety, including sleep deprivation, injury, fatigue, and stress, and (b) productivity].

DISCUSSION

Health and safety is only one of the adverse outcomes related to working too much overtime. A list of worker-inspired recommendations for addressing overtime issues is provided.

IMPACT ON THE INDUSTRY

Both employers and workers need to better understand the potential adverse effects of working too much overtime.

The changing organization of work and the safety and health of working people: a commentary

Recent trends in the organization of work may affect worker health through a variety of pathways--by increasing the risk of stress-related illnesses, such as cardiovascular disease, musculoskeletal disorders, and psychological disorders, by increasing exposure to hazardous substances and violence on the job, or by affecting occupational health services and training programs. Much remains to be learned about the nature of changes in work organization, and how they affect worker health and safety. While available evidence is limited, such evidence suggests that recent trends in work organization may be increasing the risk of occupational illnesses. In a groundbreaking publication, the National Institute for Occupational Safety and Health has provided a concise summary of available knowledge and a detailed agenda for research and development.

Non-fatal work related injuries in a cohort of Brazilian steelworkers

OBJECTIVES

Workers in the steel industry are exposed to various severe hazards. This study investigated risk factors for non-fatal injury occurring in the workplace and during travel to and from work in steelworkers in Brazil.

METHODS

Non-fatal work related injuries during employment from January 1977 to September 1992 were analysed in a cohort of 21 732 male workers in the steel plant of USIMINAS, Brazil.

RESULTS

There were 14 972 non-fatal injuries during follow up, with 10 891 injuries in the workplace and 4081 during travel to and from work (travel to work injury). The rate of injury in the workplace was 5.6/100 person-years and that of travel to work injury was 2.1/100 person-years. The most common injuries were to hands, arms, and eyes, with 90% of the eye injuries caused by a foreign body. Both rates of workplace and travel to work injury increased significantly with the number of injuries previously experienced, and decreased with number of years in employment and calendar period. The rates of travel to work injury also seemed to decrease with age, but age was not an independent predictor of workplace injury when we controlled for duration of employment. The rate of workplace injury was increased eightfold for workers who had experienced more than six previous injuries compared with those with no previous workplace injuries after adjusting for duration of employment and calendar period. Labourers were most at risk of workplace injury, with about eight injuries per 100 person-years. Travel to work injury was most common among support workers, with nearly half of the travel to work injuries affecting the eyes.

CONCLUSION

The rate of injury was high in these steelworks, both for workplace and travel to work injuries. Characteristics of the work areas and the employees can identify high risk groups; protective measures, safety, health training, and injury programmes should concentrate particularly on these groups. Prevention of eye injury needs special attention in steelworks.

Analysis of construction injury burden by type of work

BACKGROUND

To lay groundwork for identifying patterns of injury etiology, we sought to describe injury experience associated with types of work performed at construction sites by examining workers' compensation (WC) claims for the 32,081 construction workers who built Denver International Airport (DIA).

METHODS

Injury rates and WC payment rates were calculated for 25 types of work based on claims and payroll data reported to DIA's owner-controlled insurance program according to National Council on Compensation Insurance job classifications. By linking DIA claims with corresponding lost-work-time (LWT) claims filed with Colorado's Workers' Compensation Division, we were also able to obtain and examine both total and median lost days for each type of work.

RESULTS

Injury experience varied widely among the types of construction work. Workers building elevators and conduits and installing glass, metal, or steel were at particularly high risk of both LWT and non-LWT injury. Median days lost by injured workers was highest (202 days) for driving/trucking. Median days lost for most types of work was much greater than previously reported for construction: 40 days or more for 18 of the 25 types of work analyzed. WC payment rates reflect both number and severity of injuries and were generally not significantly different from expected losses. They were, however, significantly higher than expected for driving/trucking, metal/steel installation, inspection/analysis, and elevator construction.

CONCLUSIONS

Analysis of injury data by type of work allows targeting of safety resources to high risk construction work and would be useful in prospective surveillance at large construction sites with centrally administered workers' compensation plans.

Distinctive emergency department usage for injury for workers' compensation cases in Utah in 1996

To compare emergency department services paid by worker's compensation (WC) with services paid by other payers, a state database of 72,747 emergency department visits for injured adults (ages 21 to 54) in 1996 in Utah was analyzed. WC visits accounted for 21.6% (15,704) of all adult injury visits. The mean emergency department charge for WC visits was $282, and the admission rate was 17 per 1000 visits. The mean charge for other payers was $334, and the admission rate was 43 per 1000 visits. Differences were also found between these groups for Injury Severity Scores and diagnoses. In summary, WC emergency department usage was associated with less severe injuries than was emergency department usage for other payers in Utah in 1996.

Contractor safety practices and injury rates in construction of the Denver International Airport

BACKGROUND

We sought to explain the variation in injury rates found for categories of companies and contracts involved in the construction of the Denver International Airport (DIA) by surveying contractors about company and contract-level safety practices.

METHODS

We conducted 213 telephone interviews (83% response) with representatives of contracts with payrolls of more than $250,000. We investigated the bivariate relationship between safety actions reported in the survey and injury occurrence by calculating the aggregate injury rates (lost work-time (LWT) rates and non-LWT rates) for the group of respondent contracts reporting always taking the action and for the group not always taking the action. Using Poisson regression, we examined the association between contract injury rates and contract safety practices while controlling for variables previously shown to affect contract-level injury rates.

RESULTS

In Poisson regression, two actions, 1) disciplinary action always resulting when safety rules were violated and 2) always considering experience modification ratings when selecting subcontractors, were associated with lower LWT injury rates. Three actions or contract characteristics resulted in lower non-LWT rates: management always establishing goals for safety for supervisors, conducting drug testing at times other than badging or after an accident, and completing the DIA contract on budget, rather than over budget. Reportedly consistent use of a number of accepted safety practices was associated with significantly higher injury rates in bivariate and multivariate analyses.

CONCLUSIONS

The pattern of counterintuitive results found in this study suggests that questions reflecting agreed-upon safety practices, when asked of the person responsible for all on-site construction activities, are likely to elicit normative responses. Objective validation of reported safety practices is critical to evaluating their efficacy in reducing injury rates, along with measures of both time at risk and outcome and control for prevailing risk of the work performed.