Disparities in Unintentional Occupational Injury Mortality between High-Income Countries and Low- and Middle-Income Countries: 1990⁻2016

Prevalence and factors associated with occupational injuries among building construction workers in the Gambia

BACKGROUND

Although occupational injuries among building construction workers are a major public health concern, limited studies have focused on the prevalence and factors associated with injuries among building construction workers in sub-Saharan Africa. Accordingly, this study investigates the prevalence and factors associated with occupational injuries among building construction workers in the Gambia.

METHOD

Using a cross-sectional design, 504 building construction workers with more than 12 months of work experience in the construction industry and aged ≥18 years were recruited from 22 registered companies in the Kanifing Municipality of the Gambia. Data were collected using a structured questionnaire and an observational checklist.

RESULTS

More than 56% of the building construction workers reported sustaining work-related injuries in the past 12 months. Majority of injuries reported were abrasions/lacerations (28.2%), followed by cuts (26.6%), backaches (23.8%) and piercing/punctured wounds (22.8%). Results of the multivariate logistic regression analysis showed that being male worker (adjusted OR (aOR), 3.06; 95% CI 1.31 to 7.19), had <8 hours of work daily (aOR 3.46, 95% CI 1.44 to 7.78), smoke tobacco (aOR 1.97; 95% CI 1.36 to 2.85) and consume alcohol (aOR 0.27; 95% CI 0.08 to 0.95) were significantly associated with injuries from building construction work.

CONCLUSION

Our findings show that injuries among building construction workers are prevalent in the Gambia. Male gender, work hours, tobacco use and alcohol consumption were associated with occupational injuries in building construction. Introducing and enforcing workplace safety policies in the building construction industry may help reduce occupational injury among construction workers in the Gambia.

Social Determinants of Health Impact Spinal Cord Injury Outcomes in Low- and Middle-Income Countries: A Meta-Epidemiological Study

BACKGROUND AND OBJECTIVES

Traumatic spinal cord injuries (SCI), which disproportionally occur in low- and middle-income countries (LMICs), pose a significant global health challenge. Despite the prevalence and severity of SCI in these settings, access to appropriate surgical care and barriers to treatment remain poorly understood on a global scale, with data from LMICs being particularly scarce and underreported. This study sought to examine the impact of social determinants of health (SDoH) on the pooled in-hospital and follow-up mortality, and neurological outcomes, after SCI in LMICs.

METHODS

A systematic review was conducted in adherence to the Preferred Reporting in Systematic Review and Meta-Analysis-guidelines. Multivariable analysis was performed by multivariable linear regression, investigating the impact of the parameters of interest (patient demographics, country SDoH characteristics) on major patient outcomes (in-hospital/follow-up mortality, neurological dysfunction).

RESULTS

Forty-five (N = 45) studies were included for analysis, representing 13 individual countries and 18 134 total patients. The aggregate pooled in-hospital mortality rate was 6.46% and 17.29% at follow-up. The in-hospital severe neurological dysfunction rate was 97.64% and 57.36% at follow-up. Patients with rural injury had a nearly 4 times greater rate of severe in-hospital neurological deficits than patients in urban areas. The Gini index, reflective of income inequality, was associated with a 23.8% increase in in-hospital mortality, a 20.1% decrease in neurological dysfunction at follow-up, and a 12.9% increase in mortality at follow-up.

CONCLUSION

This study demonstrates the prevalence of injury and impact of SDoH on major patient outcomes after SCI in LMICs. Future initiatives may use these findings to design global solutions for more equitable care of patients with SCI.

Sex differences in adolescents' occupational aspirations: Variations across time and place

We investigated sex differences in 473,260 adolescents’ aspirations to work in things-oriented (e.g., mechanic), people-oriented (e.g., nurse), and STEM (e.g., mathematician) careers across 80 countries and economic regions using the 2018 Programme for International Student Assessment (PISA). We analyzed student career aspirations in combination with student achievement in mathematics, reading, and science, as well as parental occupations and family wealth. In each country and region, more boys than girls aspired to a things-oriented or STEM occupation and more girls than boys to a people-oriented occupation. These sex differences were larger in countries with a higher level of women’s empowerment. We explain this counter-intuitive finding through the indirect effect of wealth. Women’s empowerment is associated with relatively high levels of national wealth and this wealth allows more students to aspire to occupations they are intrinsically interested in. Implications for better understanding the sources of sex differences in career aspirations and associated policy are discussed.

Health inequalities and income for people with spinal cord injury. A comparison between and within countries

Income and health are related in a bi-directional manner, whereby level of income affects health and vice versa. People in poorer households tend to experience worse health status and higher mortality rates than people in wealthier households, and, at the same time, having poor health could restrict workability leading to less income. This gap exists in almost every country, and it is more pronounced in more unequal countries and in vulnerable populations, such as people experiencing disability. The goal of this paper is to estimate the health-income gap in people with a Spinal Cord Injury (SCI), which is a chronic health condition often associated with multiple comorbidities that leads to disability. As data on mortality is inexistent, to estimate the health-income gap for persons with SCI, this paper uses two health outcomes: the number of years a person has lived with the injury, and a comorbidity index. Data was obtained from the International Spinal Cord Injury survey (InSCI), which is the first worldwide survey on community-dwelling persons with SCI. To compare across countries, the health outcomes were adjusted through hierarchical models, accounting for country fixed-effects, individual characteristics such as age and gender, and injury characteristics (cause, type and degree). Our results suggest that for the years living with SCI, the gap varies from 1 to 6 years between the lowest and the highest income groups. The main driver of such a difference is the cause of injury, where injuries caused by work accidents showed the biggest gap. Similarly, for the comorbidity index, persons with SCI in poorer deciles reported significantly more comorbidities, forty times more, than people in richer deciles.

Orthodox or traditional medicine? Private or public healthcare? Exploring treatment pathways for occupational health problems among informal automobile artisans

Even though informal workers in developing countries have the most hazardous jobs, there is a sheer neglect for the treatment of their occupational health problems (OHP) in practice and by policies. This qualitative study explored how informal automobile artisans from Nigeria sought care for their OHP. It focused on their choice between orthodox and traditional medicine, between self-care and professional care, and between private and public health-care providers. 43 informal automobile artisans were purposively interviewed. The treatment sought depended on the type, the severity, and the perceived cause of the OHP. The distinction between rational and non-rational explanations of the causes of OHP usually determined the treatment endpoint. The financial means of the artisans and the cost of different treatments were also important factors. The study concluded that in order to develop safer working conditions in the sector, policy makers and artisanal associations should be aware of the considerations that informed the artisans' choices on how to treat OHP .

Evaluating the effectiveness of labor protection policy on occupational injuries caused by extreme heat in a large subtropical city of China

On March 1, 2012, the Chinese government implemented the Administrative Measures on Heatstroke Prevention (AMHP2012) to combat the occupational health impacts of extreme heat, and reducing occupational injury was one of the main purposes. This study aimed at quantifying the intervention effects of the AMHP2012 on extreme heat-related occupational injuries and subsequent insurance payouts in Guangzhou, China. Data on occupational injuries and insurance payouts were collected from March 1, 2011, to February 28, 2013, from the occupational injury insurance system of Guangzhou. A quasi-experimental design with before-after control was adopted. Interrupted time series analysis was performed to quantify the change of occupational injuries and insurance payouts after policy implementation. The distributed lag non-linear model was used to explore whether injury claims and insurance payouts due to extreme heat decreased. A total of 9851 injury claims were included in the analysis. After policy implementation, the risk of occupational injuries and insurance payouts decreased by 13% (RR = 0.87, 95%CI: 0.75, 0.99) and 24% (RR = 0.76, 95% CI: 0.58, 0.94), respectively. The attributable fraction of extreme heat-related occupational injuries decreased from 3.17% (95%eCI: 1.35, 4.69) to 1.52% (95%eCI: -0.36, 3.15), which contributed to 0.86 million USD reduction of insurance payouts. Both males and females, low-educated, young and middle-aged workers, workers at small or medium-sized enterprises, engaging in manufacturing, and with both minor and severe injuries were apparently associated with decreased rates of extreme heat-related occupational injuries. The AMHP2012 policy contributed to the reduction of extreme heat-related occupational injuries and insurance payouts in Guangzhou, China, and this research provided novel evidence for decision-makers to better understand the necessity of implementing health protection policies among laborers under climate change.

Mortality and Disease Burden of Injuries from 2008 to 2017 in Anhui Province, China

Objective

To investigate the temporal trends in mortality and disease burden of injuries in Anhui province from 2008 to 2017, so as to provide reference for injury control and prevention.

Methods

Data of mortality were collected from 9 national surveillance points in Anhui province during 2008-2017 in the Information System for Death Cause Register and Management. The surveillance data were analyzed by using crude mortality, standardized mortality rate (SMR), potential year of life lost (PYLL), PYLL rate (PYLLR), and average of year life lost (AYLL).

Results

There were a total of 44855 people died from injury, accounted for 9.44% of the all-cause mortality, ranked as the fifth leading cause of deaths in the whole population, and denoted the first leading cause of deaths in the 0-44 year's group. The leading causes of injury deaths were road traffic accidents, suicide, accidental falls, drowning, and poisoning. Road traffic accidents was the primary cause of injury deaths among the male population, while suicide was the dominate cause of injury deaths among the female population. Drowning, traffic accidents, and suicide accounted for the most injury deaths among the population aged 0-14 years, 15-64 years, and above 60 years, respectively. The road traffic accidents accounted for the largest proportion of injury PYLL and PYLLR, and drowning caused the highest AYLL among injury deaths.

Conclusion

In Anhui province, road traffic accidents, suicide, accidental falls, drowning, and poisoning were the top five causes of injury deaths that harm the health of local residents; corresponding injury prevention strategies should be formulated.

Mortality and Years of Life Lost Due to Occupational Injury in Iran (2012-2016)

BACKGROUND

Occupational injury is a cause of premature mortality, mainly in low- and middle-income countries. Occupational injuries estimated to kill more than 300,000 workers worldwide every year. We estimated the years of life lost (YLL) of fatal unintentional occupational injuries in Iran for the five years of 2012-2016.

STUDY DESIGN

A cross-sectional study.

METHODS

To estimate the YLL, registered deaths due to occupational unintentional injury were identified from the Iranian Legal Medicine Organization. Estimated YLL was calculated according to Global Burden of Disease 2010 guideline. Population life expectancy in each corresponding years was retrieved from the national health database. All data collected entered into Excel software for calculations.

RESULTS

In 2012-2016, fatal unintentional occupational injuries were the cause of 8,606 deaths in Iran, resulting in 4.6 prematurely lost life yr per 1000 males and 0.3 yr per 1000 females among workers, every year. 98.7% of the deaths occurred in males. Males from 15 to 19 yr of age and females from 10 to 14 yr of age showed the highest YLL rates. The rate of YLLs per 1,000 workers per year was 3.99 overall, 4.6 in males, and 0.4 in females.

CONCLUSION

Premature mortality due to occupational injury is still a serious problem in the Iranian population. Our findings may be useful from a health policy perspective for designing and prioritizing interventions focused on the prevention of premature loss of life. Known prevention strategies need to be implemented widely to diminish avoidable injuries in the workplace.

Occupational Accidents Assessment by Field of Activity and Investigation Model for Prevention and Control

The rate of occupational accidents is increasing, leading to a number of organizational deficiencies. For European Union (EU), the non-fatal accident number in 2017 was 3,315,101. An increase in the number of accidents is recorded in many of the member states. In addition, the increase in accidents tends to focus on certain sectors and is due more to the increase in the incidence rate than the increase in the workforce. Companies in these industry sectors have also implemented less intensive prevention practices than firms in other sectors. Performing a statistical evaluation of non-fatal and fatal accidents is an important one. This assessment helps managers understand the importance of implementing prevention and control methods across organizations. For this research, we used series of data obtained from the Romanian National Institute of Statistics (NIS), Labor Inspection in Romania, and Eurostatof the European Commission. Data series evaluations were conducted for the EU and Romania. A qualitative assessment of the industry data series had been carried out. Furthermore, T-tests and analysis of variance analysis (ANOVA) were performed to identify the relationships between the frequency index of fatal and non-fatal accidents, and the categories chosen. The values obtained for men were significantly higher than those of female workers. Based on the results of the qualitative assessment and European and national strategies, an experimental model for the prevention and control of occupational accidents is proposed. At the end of the paper, the situation of labor accidents in Romania and Bulgaria, two EU member states, is assessed in the agriculture, forestry and fishing, manufacturing, construction and transport, and storage sectors. A series of trends are presented for the period 2018–2020. The results obtained from the evaluation of the data series represent an important core of the Romanian Labor Inspectorate for the development of strategic actions.

Posttraumatic Stress Disorder, Depression, and Prolonged Grief Disorder in Families Bereaved by a Traumatic Workplace Death: The Need for Satisfactory Information and Support

The impact of traumatic workplace death on bereaved families, including their mental health and well-being, has rarely been systematically examined. This study aimed to document the rates and key correlates of probable posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and prolonged grief disorder (PGD) in family members following a workplace injury fatality. The hidden nature of the target population necessitated outreach recruitment techniques, including the use of social media, newspaper articles, radio interviews, and contact with major family support organizations. Data were collected using a cross-sectional design and international online survey. The PCL-C (PTSD), the PHQ-8 (MDD), and PG-13 (PGD) were used to measure mental health disorders. All are well-established self-report measures with strong psychometric qualities. Participants were from Australia (62%), Canada (17%), the USA (16%), and the UK (5%). The majority were females (89.9%), reflecting the gender distribution of traumatic workplace deaths (over 90% of fatalities are male). Most were partners/spouses (38.5%) or parents (35%) and over half (64%) were next of kin to the deceased worker. Most deaths occurred in the industries that regularly account for more than 70 percent of all industrial deaths-construction, manufacturing, transport, and agriculture forestry and fishing. At a mean of 6.40 years (SD = 5.78) post-death, 61 percent of participants had probable PTSD, 44 percent had probable MDD, and 43 percent had probable PGD. Logistic regressions indicated that a longer time since the death reduced the risk of having each disorder. Being next of kin and having a self-reported mental health history increased the risk of having MDD. Of the related information and support variables, having satisfactory support from family, support from a person to help navigate the post-death formalities, and satisfactory information about the death were associated with a decreased risk of probable PTSD, MDD, and PGD, respectively. The findings highlight the potential magnitude of the problem and the need for satisfactory information and support for bereaved families.

The Relationship between Free Press and Under-Reporting of Non-Fatal Occupational Injuries with Data from Representative National Indicators, 2015: Focusing on the Lethality Rate of Occupational Injuries among 39 Countries

The epidemiology of occupational injuries is reported worldwide, but suspicions of under-reporting prevail, probably associated with free press. We examined the association between freedom of the press and lethality rate of occupational injuries based on the most comprehensive International Labour Organization database on labour statistics (ILOSTAT) among 39 countries. The occupational injury indices, national indicators, and information on freedom of the press in 2015 were sourced from ILOSTAT, World Bank open data, World Health Organization and Freedom House. The lethality rate was the number of fatal occupational injuries per 10,000 total occupational injuries. The relationship among fatal and total occupation injury rates, lethality rate, and national statistics were analysed using Spearman's rank correlation coefficients. Multivariable linear regression models with bootstrap estimation to manage non-normality determined freedom of the press associated with lethality rate. Freedom of the press was significantly correlated with fatal and total occupational injury rate and lethality rate of occupational injuries. Adjusting for national indicators, only freedom of the press was associated with lethality rate per 10,000 occupational injuries in the report of ILOSTAT. The lethality rate of occupational injury reported by each country might not reflect the actual lethality, but under-reported nonfatal occupational injuries, probably relating to freedom of the press.