An ecologic study of protective equipment and injury in two contact sports

BACKGROUND: Contact sports have high rates of injury. Protective equipment regulations are widely used as an intervention to reduce injury risk. The purpose of this study was to investigate the injury prevention effect of regulations governing protective equipment in two full-body contact sports. METHODS: Injury rates in US collegiate football were compared to New Zealand club Rugby Union. Both sports involve significant body contact and have a high incidence of injury. Extensive body padding and hard-shell helmets are mandated in collegiate football but prohibited in Rugby Union. RESULTS: The injury rate in football was approximately one-third the rugby rate (rate ratio [RR] = 0.35; 95% CI: 0.31-0.40). The head was the body site with the greatest differential in injury incidence (RR = 0.11; 95% CI: 0.08-0.16). Rugby players suffered numerous lacerations, abrasions, and contusions to the head region, but the incidence of these injuries in football was almost zero (RR = 0.01; 95% CI: 0.01-0.03). Injury rates were more similar for the knee (RR = 0.61; 95% CI: 0.43-0.87) and ankle (RR = 0.72; 95% CI: 0.46-1.13), two joints largely unprotected in both sports. CONCLUSIONS: The observed differences are consistent with the hypothesis that regulations mandating protective equipment reduce the incidence of injury, although important potential biases in exposure assessment cannot be excluded. Further research is needed into head protection for rugby players.     

Use of discretionary protective equipment and rate of lower extremity injury in high school athletes

Use of protective equipment is an important sports injury prevention strategy, yet use of protective equipment by high school athletes has seldom been studied. The authors analyzed data from a 3-year (1996-1999), stratified, two-stage cluster sample of athletes from 12 organized sports in 100 North Carolina high schools (n = 19,728 athlete-seasons). Information on each athlete's use of protective equipment and prior injury was collected during the preseason. Prospective information on injuries and weekly participation in games and practices was collected during the playing season. Use of lower extremity discretionary protective equipment tended to decrease the overall rate of lower extremity injury (rate ratio (RR) = 0.91, 95% confidence interval (CI): 0.72, 1.15). However, this slight protective effect was entirely due to kneepad use (for knee injury, RR = 0.44, 95% CI: 0.27, 0.74). Knee brace use and ankle brace use were associated with increased rates of knee injury (RR = 1.61, 95% CI: 1.08, 2.41) and ankle injury (RR = 1.74, 95% CI: 1.11, 2.72), respectively. This could be due to slippage of the brace during use, increased fatigue due to the energy cost of wearing a brace, or bias in the study. Further investigation into the effects of brace use is warranted.     

Use of mouthguards and headgear in organized sports by school-aged children.

Sports-related orofacial trauma is a serious problem that can be prevented by wearing protective mouthguards and headgear. While this equipment is available, few studies have been done of wearing practices. This study assesses the wearing practices using data from the Child Health Supplement of the 1991 National Health Interview Survey. Results indicate that football was the only sport in which the majority of children used mouthguards and headgear. While statistically significant differences (p<.05) were found in use of the equipment in all sports by grade level, gender, parent''s education, ethnicity, and by region of the the country, these differences were not consistent across sports. Healthy People 2000 calls for extending requirements for use of orofacial protective devices to all organizations sponsoring sports that pose risk to injury. Given the complex nature of the findings, multifaceted initiatives that include the promulgation of rules must be developed and tested to determine what approaches are effective in ensuring consistent use.     

Risk factors for injury among veterinarians.

Work-related injuries among veterinarians are a major problem, but little is known of the specific risk factors involved. The purpose of this nested case-control study, conducted from a comprehensive population-based study of practicing Minnesota veterinarians, was to identify risk factors for job-related injuries. We questioned cases (N = 193) on exposures occurring in the month before their injury, and we questioned controls (N = 495) on exposures occurring in a randomly selected month. We used logistic regression to model the dependence of veterinary work-related injury on each exposure of interest and associated confounders. We observed increased rates for prior injuries (RR = 1.7, 95% CI = 1.1-2.6), participation in sports (RR = 1.7, 95% CI = 1.05-2.6), no sharps boxes present (RR = 1.8, 95% CI = 1.01-3.2), current smoking (RR = 4.1, 95% CI = 1.8-9.1), and 6 or fewer hours of sleep (RR = 1.8, 95% CI = 1.0-3.3). We identified a dose response for lifting patients, as follows: lifting 41-75 lb (RR = 3.1, 95% CI = 1.6-5.9), lifting 76-100 lb (RR = 3.2, 95% CI = 1.6-5.9), and lifting more than 100 lb (RR = 6.1, 95% CI = 2.5-15.0). Decreased rates were observed for participation in aerobic activities (RR = 0.6, 95% CI = 0.4-0.99), perception of lower risk (RR = 0.4, 95% CI = 0.2-0.9), and experience (RR = 0.6, 95% CI = 0.4-0.9).     

Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace

BACKGROUND: Health care workers incur frequent injuries resulting from patient transfer and handling tasks. Few studies have evaluated the effectiveness of mechanical lifts in preventing injuries and time loss due to these injuries. METHODS: We examined injury and lost workday rates before and after the introduction of mechanical lifts in acute care hospitals and long-term care (LTC) facilities, and surveyed workers regarding lift use. RESULTS: The post-intervention period showed decreased rates of musculoskeletal injuries (RR = 0.82, 95% CI: 0.68-1.00), lost workday injuries (RR = 0.56, 95% CI: 0.41-0.78), and total lost days due to injury (RR = 0.42). Larger reductions were seen in LTC facilities than in hospitals. Self-reported frequency of lift use by registered nurses and by nursing aides were higher in the LTC facilities than in acute care hospitals. Observed reductions in injury and lost day injury rates were greater on nursing units that reported greater use of the lifts. CONCLUSIONS: Implementation of patient lifts can be effective in reducing occupational musculoskeletal injuries to nursing personnel in both LTC and acute care settings. Strategies to facilitate greater use of mechanical lifting devices should be explored, as further reductions in injuries may be possible with increased use.     

Severe injury among Hispanic and non-Hispanic white children in Washington state

OBJECTIVES: The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State. METHODS: Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged < or = 19 years. Ratios of overall and mechanism-specific injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury. RESULTS: In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged < or = 19 years (rate: 54 per 100,000 person-years) and for 2,123 non-Hispanic white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4). CONCLUSIONS: The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward these injury types are needed to identify the underlying preventable risk factors involved.     

Occupational injuries and illnesses among Washington State agricultural workers.

In Washington state 29,451 workers' compensation claims were filed by farm workers between 1982 and 1986. Five percent of claimants were under 18 years of age, including 1.3% under the age of 16. Agricultural workers were found to be at higher risk than other workers in the state for fatal injury (relative risk [RR] = 2.5, 95% confidence interval [CI] = 1.7-3.7), sprains and strains (RR = 1.4, CI = 1.3-1.4), fractures (RR = 2.3, CI = 2.2-2.4), dislocations (RR = 1.9, CI = 1.7-2.2), concussions (RR = 1.9, CI = 1.6-2.3), amputations (RR = 2.5, CI = 2.0-3.1), dermatitis (RR = 4.3, CI = 4.0-4.7), systemic poisoning (RR = 3.4, CI = 3.1-3.7), respiratory disease (RR = 1.7, CI = 1.0-2.9), and tendonitis (RR = 1.2, CI = 1.1-1.4).     

The influence of motor vehicle legislation on injury claim incidence

BACKGROUND: Although there have been numerous strategies to prevent motor vehicle collisions and their subsequent injuries, few have been effective in preventing motor vehicle injury claims. In this paper, we examine the role of legislation and compensation system in altering injury claim incidence. METHODS: The population base for our natural experiment was all Saskatchewan, Manitoba, British Columbia and Quebec residents who submitted personal injury claims to their respective motor vehicle insurance provider from 1990 to 1999. The provinces of Saskatchewan and Manitoba switched from Tort to pure No-Fault insurance on January 1, 1995 and on March 1, 1994 respectively. British Columbia maintained tort insurance and Quebec maintained pure no-fault insurance throughout the entire 10-year period. RESULTS: The conversion from tort insurance to pure no-fault motor vehicle insurance resulted in a five-year 31% (RR = 0.69; 95% CI 0.68-0.70) reduction in total injury claims per 100,000 residents in Saskatchewan and a five-year 43% (RR = 0.57; 95% CI 0.56-0.58) reduction in Manitoba. At the same time, the province of British Columbia retained tort insurance and had a five-year 5% reduction (RR = 0.95; 95% CI 0.94-0.99). Quebec, which retained pure no-fault throughout the entire 10-year period, had less than one third of the injury claims per 100,000 residents than the tort province of British Columbia. INTERPRETATION: The conversion from tort to pure no-fault legislation has a large influence in reducing motor vehicle injury claim incidence in Canada. Legislative system and injury compensation scheme have an observable impact on injury claim incidence and can therefore have significant impact on the health care system.     

Cervical spinal cord injury in rugby union and rugby league: are incidence rates declining in NSW?

OBJECTIVES: To estimate trends in incidence rates of rugby code-related severe cervical spinal cord injuries in New South Wales (NSW) from 1986 to 2003. To evaluate the Australian Spinal Cord Injury Register (ASCIR) for injury surveillance by comparison with two published studies. METHODS: Data were cases of complete and incomplete tetraplegia in rugby union and rugby league admitted to the two spinal units in NSW. Trends in incidence rates were estimated using Poisson regression modelling. RESULTS: There was a small, non-significant decline from 1986 to 2003 in the incidence rate of tetraplegia in rugby union (9.8 vs. 6.1 per 100,000 player-years; p = 0.378) and rugby league (2.3 vs. 1.6 per 100,000 player-years; p = 0.564). The most common causes of injury were scrums for rugby union (35%) and tackles for rugby league (78%). This did not change over time (rugby union, p = 0.118; rugby league, p = 0.288). The ASCIR identified more cases of tetraplegia than insurance claims data and at least 75% of the cases ascertained by medical record review. CONCLUSIONS: There remains an urgent need to further improve safety in rugby union and rugby league. Scrummage in union and tackles in league remain the leading causes of tetraplegia. Rates of tetraplegia were significantly higher and more variable in rugby union than in rugby league. IMPLICATIONS: The ASCIR is a useful tool to monitor trends in spinal cord injury incidence in both rugby codes. Its potential value is constrained by the lack of accurate estimates of player numbers.     

Single-vehicle and Multi-vehicle Accidents Involving Motorcycles in a Small City in China: Characteristics and Injury Patterns

IntroductionThere is a gap that involves examining differences between patients in single-vehicle (SV) versus multi-vehicle (MV) accidents involving motorcycles in Shantou, China, regarding the injury patterns and mortality the patients sustained. This study aims to address this gap and provide a basis and reference for motorcycle injury prevention.MethodMedical record data was collected between October 2002 and June 2012 on all motorcycle injury patients admitted to a hospital in the city of Shantou of the east Guangdong province in China. Comparative analysis was conducted between patients in SV accidents and patients in MV accidents regarding demographic and clinic characteristics, mortality, and injury patterns.ResultsApproximately 48% (n = 1977) of patients were involved in SV accidents and 52% (n = 2119) were involved in MV accidents. The average age was 34 years. Collision of a motorcycle with a heavy vehicle/bus (4%) was associated with a 34 times greater risk of death (RR: 34.32; 95% CI: 17.43–67.57). Compared to patients involved in MV accidents, those involved in SV accidents were more likely to sustain a skull fracture (RR: 1.47; 95% CI: 1.22–1.77), an open head wound (RR: 1.46; 95% CI: 1.23–1.74), an intracranial injury (RR: 1.39; 95% CI: 1.26–1.53), a superficial head injury (RR: 1.37; 95% CI: 1.01–1.86), an injury to an organ (RR: 2.01; 95% CI: 1.24–3.26), and a crushing injury (RR: 1.98; 95% CI: 1.06–3.70) to the thorax or abdomen. However, they were less likely to sustain a spinal fracture (RR: 0.58; 95% CI: 0.39–0.85), a pelvic fracture (RR: 0.22; 95% CI: 0.11–0.46), an upper extremity fracture (RR: 0.75; 95% CI: 0.59–0.96), or injuries to their lower extremities, except for a dislocation, sprain, or injury to a joint or ligament (RR: 0.82; 95% CI: 0.49–1.36).ConclusionThe relative risk of death is higher for patients involved in multi-vehicle accidents than patients in single-vehicle accidents, especially when a collision involves mass vehicle(s). Injury to the head dominated motorcycle injuries. Single-vehicle accidents have a higher correlation with head injury or internal injuries to the thorax or abdomen. Multi-vehicle accidents are more correlated with extremity injuries, especially to the lower extremities or external trauma to the thorax or abdomen.     

Injury risk in men's Canada West University football

Injury and participation information was collected over 5 years (1993-1997) on varsity men's football players in the Canada West Universities Athletic Association. The locations of acute time-loss injuries or neurologic injures were coded as head and neck, upper extremity (shoulder to hand), or lower extremity (hip to foot). Poisson regression-based generalized estimating equations were used to estimate rate ratios and 95% confidence intervals. Injury rates were higher during games as compared with practice periods (for the head and neck, rate ratio (RR) = 9.75 (95% confidence interval (CI): 7.50, 12.67); for upper extremities, RR = 5.76 (95% CI: 4.46, 7.45); and for lower extremities, RR = 7.06 (95% CI: 6.03, 8.25)). In dry-field game situations, head and neck injury rates were 1.59 times higher on artificial turf than on natural grass (95% CI: 1.04, 2.42). Lower extremity game injury rates were higher on artificial turf than on natural grass under both dry (RR = 1.83, 95% CI: 1.35, 2.48) and wet (RR = 2.31, 95% CI: 1.18, 4.52) field conditions. Injury rates increased with every additional year of participation. Past injury increased the rate of subsequent injury. The effect of an artificial field surface may be related to infrequent use. Risk factors for injury included participation in a game, playing on artificial turf, being a veteran player, and having a past injury.     

Physical activity and stroke. A meta-analysis of observational data

BACKGROUND: Based on studies published so far, the protective effect of physical activity on stroke remains controversial. Specifically, there is a lack of insight into the sources of heterogeneity between studies. METHODS: Meta-analysis of observational studies was used to quantify the relationship between physical activity and stroke and to explore sources of heterogeneity. In total, 31 relevant publications were included. Risk estimates and study characteristics were extracted from original studies and converted to a standard format for use in a central database. RESULTS: Moderately intense physical activity compared with inactivity, showed a protective effect on total stroke for both occupational (RR = 0.64, 95% CI: 0.48-0.87) and leisure time physical activity (RR = 0.85, 95% CI: 0.78-0.93). High level occupational physical activity protected against ischaemic stroke compared with both moderate (RR = 0.77, 95% CI: 0.60-0.98) and inactive occupational levels (RR = 0.57, 95% CI: 0.43-0.77). High level compared with low level leisure time physical activity protected against total stroke (RR = 0.78, 95% CI: 0.71-0.85), haemorrhagic stroke (RR = 0.74, 95% CI: 0.57-0.96) as well as ischaemic stroke (RR = 0.79, 95% CI: 0.69-0.91). Studies conducted in Europe showed a stronger protective effect (RR = 0.47, 95% CI: 0.33-0.66) than studies conducted in the US (RR = 0.82, 95% CI: 0.75-0.90). CONCLUSIONS: Lack of physical activity is a modifiable risk factor for both total stroke and stroke subtypes. Moderately intense physical activity is sufficient to achieve risk reduction.     

Occurrence and Risk Factors of Unintentional Injuries among 12- to 18-Year-Old Finns – A Survey of 8219 Adolescents

The aim of this study was to evaluate the incidence, nature, and risk factors of unintentional injuries among 12-, 14-, 16- and 18-year-old Finnish adolescents. Of the 8219 respondents (response rate 75%) 5.5% reported an injury that had required medical attention during the past month. The total number of injuries was 506 and the incidence of injuries 62 per 1000 person-months. Boys had a slightly higher injury occurrence rate than girls (OR: 1.33; 95% CI: 1.13-1.59). The most common injuries were sprains (27%), fractures (26%) and wounds (16%) of the upper and lower limbs. In multivariate logistic regression analysis the strongest risk factors of injury were: having experienced violence during past month (OR: 3.6; 95% CI: 2.8-4.6), daily leisure time exercise in sports club (OR: 3.3; 95% CI: 2.3-4.6), having several somatic health complaints weekly (OR: 2.2; 95% CI: 1.7-2.9) and having chronic disease (OR: 2.0; 95% CI: 1.5-2.6). In conclusion, injuries were an important cause of morbidity among our 12-18-year-old adolescents. Adolescents' school success and their parents' education, occupation and employment status were not associated with injuries. The finding that several health and health behaviour variables are important risk factors for injuries challenges the researchers and the society to identify and treat the risk factors that can be modified to reduce the number of adolescent injuries.     

Injury mortality rates in Native and non-Native children: a population-based study

OBJECTIVES: To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated. METHODS: An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk. RESULTS: Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR = 17.0), accidental poisoning (RR = 15.4), homicide by piercing objects (RR = 15.4), and suicide by hanging (RR = 13.5). CONCLUSION: The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.     

Effect of education on overall and cause-specific mortality in injecting drug users, according to HIV and introduction of HAART

BACKGROUND: We assessed the impact of education on long-term overall and cause-specific mortality among 6575 injecting drug users (IDUs) according to HIV status and introduction of highly active antiretroviral therapy (HAART). METHODS: Community-based cohort study of IDUs recruited in three AIDS prevention centres (1987-1996). Causes of death were ascertained in clinical centres and Mortality Registry and classified as AIDS, drug use related, injuries, or liver diseases. Poisson regression models including education and calendar period interaction and adjusted by sex, age, and HIV were used. RESULTS: In 73 901 person-years of follow-up, there were 1493 deaths (20.2/1000 person-years): 761 related to AIDS, 234 to drug use, 179 to injuries, and 93 to liver diseases. IDUs with university studies had a lower risk of death (RR 0.52; 95% CI 0.36-0.77) than those without studies: this difference was higher after (RR 0.45; 95% CI 0.25-0.80) than before 1997 (RR 0.68; 95% CI 0.41-1.13). Compared to before 1997, while decreases in the risk of AIDS mortality were seen during 1997-2004 for both lower (RR 0.49; 95% CI 0.41-0.58) and higher (RR 0.33; 95% CI 0.23-0.48) educated, only those higher educated experienced a reduction in drug-use mortality (RR 0.54; 95% CI 0.28-1.05) and death from injuries (RR 0.52; 95% CI 0.23-1.21). CONCLUSIONS: Independently of HIV status, lower education predicts a higher risk of death in IDUs and its impact is stronger after 1997. Education has a protective effect on most causes of death and it cannot be entirely attributable to the access or use of HAART.     

Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi

Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.     

Effects of safety and health training on work-related injury among construction laborers

OBJECTIVES: This study was designed to evaluate the effects of safety and health training on work-related injury in the construction industry. METHODS: Union health insurance records, union training records, and workers compensation data for 1993 and 1994 were analyzed for more than 8000 construction laborers in Washington State. RESULTS: After controlling for demographic factors, laborers who received safety and health training during the study period were 12% (95% confidence interval [CI] = 0.75-1.02) less likely than nontrained laborers to file for workers compensation. Among workers 16 to 24 years old, training was associated with a 42% (95% CI = 0.35-0.95) reduction in claims. CONCLUSIONS: These findings provide evidence of the effectiveness of safety and health training in preventing occupational injuries among construction laborers, particularly among younger workers. However, the results cover only a limited time and the long-term effects remain unclear.     

Work-related assault injuries among nurses.

Work-related violence is a major public health problem; however, there is a serious deficiency in the knowledge of risk factors for this problem. The purpose of this case-control study was to identify risk factors for work-related assault injuries among nurses. We used unconditional logistic regression to model the dependence of work-related assault injuries on each exposure of interest and the respective confounders. We found a decreased rate for the presence of security personnel (RR = 0.40; 95% CI = 0.19-0.82). We found increased rates for the following factors: the perception that administrators considered assault to be part of the job (RR = 8.14; 95% CI = 3.76-17.60); having received assault prevention training in the current workplace (RR = 4.64; 95% CI = 2.33-9.23); a high (>5) vs. low (<2) patient/personnel ratio (RR = 2.54; 95% CI = 1.13-5.70); working predominantly with patients with mental illness (RR = 3.5; 95% CI = 1.41-8.85); and working with patients who had more than 1- to 4-week and more than 4-week lengths of stay in the institution vs. <1 day (RR = 8.85; 95% CI = 1.58-49.52 and 4.25; 95% CI = 1.17-15.39, respectively).     

Adverse work and environmental conditions predict occupational injuries. The Israeli Cardiovascular Occupational Risk Factors Determination in Israel (CORDIS) Study.

This study was designed to test whether the total objective adverse work and environmental conditions, expressed as the ergonomic stress level (ESL), would predict occupational injuries over a 2-year period. The study population consisted of 4,096 men from 21 factories in six industrial sectors who were studied as part of the Israeli Cardiovascular Occupational Risk Factors Determination in Israel (CORDIS) Study, 1985-1987. The ESL (assigned four levels, 1-4) was based on an ergonomic assessment which covered 17 risk factors pertaining to safety hazards, overcrowding, cognitive and physical demands, and environmental stressors. The ESL was found to be a highly reliable measure and stable over a period of 2-4 years. The incidence of injuries among workers in low ESL conditions (level 1) was 10.3%. It increased with higher ESL's: 11.7% in level 2 (relative risk (RR) = 1.13, 95% confidence interval (CI) 0.86-1.50); 21.6% in level 3 (RR = 2.09, 95% CI 1.68-2.62); and 23.8% in level 4 (RR = 2.31, 95% CI 1.85-2.88). After adjustment for age, job experience, educational level, managerial status, and occupational status (white/blue collar), injury occurrence was significantly elevated for those at level 3 (adjusted odds ratio (OR) = 1.46, 95% CI 1.12-1.91) and level 4 (adjusted OR = 1.81, 95% CI 1.39-2.37) but not for level 2 (adjusted OR = 0.87, 95% CI 0.65-1.18). The authors conclude that adverse work and environmental conditions, objectively assessed, can predict occurrence of occupational injuries.