Ladder-related injuries treated in emergency departments in the United States, 1990-2005

BACKGROUND: Ladder use is involved in many occupational and non-occupational activities. Falls from ladders can result in serious injury and affect people of all ages. The purpose of this study was to comprehensively examine nonfatal ladder-related injuries on a national level. METHODS: Using the National Electronic Injury Surveillance System (NEISS) database, cases of nonfatal ladder-related injuries treated in U.S. emergency departments (EDs) from 1990 through 2005 were selected using NEISS ladder product codes. Analysis was conducted from June 2006 to August 2006. RESULTS: An estimated 2,177,888 (95% confidence interval [CI]=1,885,311-2,470,466) individuals ranging in age from 1 month to 101 years were treated in U.S. EDs for ladder-related injuries during the 16-year study period, yielding an average of 136,118 cases annually, an average of 49.5 per 100,000 people. Males predominated in ladder-related injuries (76.5%, 95% CI=75.8-77.2). Fractures were the most common type of injury (31.5%, 95% CI=30.5-32.6). The body parts most frequently injured were the legs and feet (30.4%, 95% CI=29.5-31.2). Nearly 10% of injuries resulted in hospitalization (8.5%, 95% CI=7.4-9.6) or transfer to another hospital (1.4%, 95% CI=1.1-1.8), approximately twice that of consumer product-related injuries overall. The number of ladder-related injuries increased by more than 50% from 1990 to 2005. Ladder-related injuries per 100,000 people rose almost 27% during the 16-year study period. Of the cases for which locale of injury was recorded, 97.3% occurred in non-occupational settings, such as homes and farms. CONCLUSIONS: Given the 50% increase in ladder-related injuries during the study period, the relatively high likelihood of hospital admission, and the predominance of injuries in non-occupational settings, increased efforts are needed to prevent ladder-related injuries.     

The relationship between work-related and non-work-related injuries

A case-control study of occupational injuries sustained by 914 male hourly workers employed in two Tenneco manufacturing divisions in 1987 was undertaken to examine the association between occupational and non-occupational injuries. Its aim was to evaluate whether employees who experienced a work-related injury were more likely to have sustained a previous non-work-related injury compared to individuals who did not experience a work-related injury.A statistically significant association between occupational injuries and past non-occupational injuries was seen when all workers compensation (WC) claims were analyzed (OR=1.41) and when claims involving indemnity for lost time were analyzed (OR=1.82). In addition, both workers who had occupational low-back injuries and workers who had occupational non-low-back injuries also had significantly higher risks of such injuries from a non-occupational origin (OR=1.91 for low-back injuries and OR=1.44 for non-low-back injuries).The findings suggest that elements other than workplace hazards (such as life-style and physical and psychological factors) may predispose an individual to both occupational and non-occupational injuries.Shan P. Tsai is Manager of Epidemiology and Health Research: Edward J. Bernacki is Vice President of Health, Environmental Medicine and Safety; Catherine M. Dowd is Research Analyst. Tenneco Inc., Health Environmental, Medicine and Safety, P.O. Box 2511, Houston, Texas 77252.We thank April K. Richardson for her skillful typing.     

Does occupation explain gender and other differences in work-related eye injury hospitalization rates?

OBJECTIVE: We sought to determine whether demographic differences in eye injury rates persist after adjusting for occupational exposure. METHODS: On-duty eye injury hospitalizations were linked to occupation among active-duty US Army personnel. RESULTS: Eye injury rates were higher for white soldiers, men, and for younger soldiers, even after adjusting for occupational group and specific job titles using multivariate models. CONCLUSIONS: This finding contrasts with studies of other injuries, suggesting that occupation does not fully account for variations in eye injury risk. Because protective eye-wear can prevent most serious eye injuries, we hypothesize that differences in protective eye-wear use between men and women may contribute to differences in eye injury rates, although follow-up studies are needed to confirm this. Prevention efforts should consider targeting high-risk demographic groups in addition to high-risk occupations.     

Traumatic deaths during U.S. Armed Forces basic training, 1977-2001

BACKGROUND: A Recruit Mortality Registry, linked to the Department of Defense Medical Mortality Registry, was created to provide comprehensive medical surveillance data for deaths occurring during enlisted basic military training. METHODS: Recruit deaths from 1977 through 2001 were identified and confirmed through redundant sources. Complete demographic, circumstantial, and medical information was sought for each case and recorded on an abstraction form. Mortality rates per 100,000 recruit-years were calculated by using recruit accession data from the Defense Manpower Data Center. RESULTS: There were 276 recruit deaths from 1977 through 2001 and age-specific recruit mortality rates were less than half of same-age U.S. civilian mortality rates. Only 28% (77 of 276) of recruit deaths were classified as traumatic (suicide, unintentional injury, and homicide), in comparison to three quarters in both the overall active duty military population and the U.S. civilian population (ages 15-34 years). The age-adjusted traumatic death rates were highest in the Army (four times higher than the Navy and Air Force, and 80% higher than the Marine Corps). The majority (60%) of traumatic deaths was due to suicide, followed by unintentional injuries (35%), and homicide (5%). The overall age-adjusted traumatic mortality rate was more than triple for men compared with women in all military services (rate ratio=3.9; p=0.01). CONCLUSIONS: There was a lower proportion of traumatic deaths in recruits compared to the overall active duty military population and same-age U.S. civilian population. This finding could be attributed to close supervision, emphasis on safety, and lack of access to alcohol and motor vehicles during recruit training.     

1983 occupational injury hospital admissions in Iowa: a comparison of the agricultural and non-agricultural sectors

An occupational injury surveillance project was conducted in 15 of Iowa's 99 counties. Trained abstractors reviewed the medical records of persons admitted for trauma to hospitals during 1983. Based on these chart reviews, subsequent mail-out questionnaires and phone contacts were made, and rate estimates for occupational injury hospitalization for farmers and non-farmers were generated. The 1980 U.S. census data for occupation and market area data for the sample hospitals were used for the rate calculations. Approximately 14.7% of hospitalizations for trauma in the sample area were for work-related injuries. Farmers were hospitalized for occupational injuries at a rate of 1,521/100,000 compared to non-farmers at a rate of 497/100,000. There were no significant differences in the mean number of days per hospitalization for farmers versus non-farmers, (7.4 days for farmers and 6.7 days for non-farmers). Based on the questionnaire data, farmers were much less likely to receive any form of remuneration for injury, (odds ratio = 0.26, p less than 5 x 10(-6]. Farmers also reported less time off from work, with a mean of 79 days compared to non-farmers with a mean of 289 days.     

Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan

Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational injury in manufacturing sectors, 2302 randomly selected workers aged 16-83 years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (p=0.025), 2.27 at work (p=0.015), and 3.08 at home (p=0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs (1.11-1.19). In contrast, current and former smoking men had significant increases in adjusted ORs (1.57-2.00). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men.     

Agricultural Youth Injuries: A Review of 2015-2017 Cases from U.S. News Media Reports

Background: The hazardous nature of the agricultural environment, reflected in the numerous injuries and deaths to children who live, work and play on farms, coupled with the lack of a comprehensive national surveillance system in the United States, highlights the need for making the best use of publicly available youth agricultural injury data.

Objective: The purpose of this study was to describe a 3-year collection of youth agricultural injuries using the publicly available injury and fatality data from AgInjuryNews.org and present recommendations for future injury prevention strategies.

Methods: Data were obtained from AgInjuryNews.org, a web-based collection of U.S. news reports of agricultural injuries. We analyzed cases from 2015 to 2017 for youth aged 0–17. We classified injuries as occupational and non-occupational related, based on the Farm and Agricultural Injury Classification (FAIC) code. Each case was also coded for source and event using the Occupational Injury and Illness Classification System (OIICS).

Results: Of the 348 injury reports reviewed, 51% were fatal, and about one-third of the victims were 6 years old or younger. Most injuries were non-occupational, and the most frequent injury sources were vehicles (includes tractors and all-terrain vehicles) and machinery. Youth operators, extra riders, roadway operations, and unsupervised youth playing near or in a worksite were four key contributing factors associated with vehicle and machinery related injuries.

Conclusions: This study reaffirms that youth agricultural-related injuries and fatalities are still a persistent problem in the United States. The hypothesis generating AgInjuryNews system can provide more current data than traditional surveillance datasets as a tool for understanding the sources of youth agricultural injuries, monitoring injury trends, and informing policy efforts and prevention strategies. Future studies should continue to explore and evaluate the comprehensiveness of this system’s data and the impact of its dissemination, as well as similar rural health informatics solutions for integration into sustainable interventions that can be customized and delivered domestically and abroad.     

Use of a national hospitalization register to identify industrial sectors carrying high risk of severe injuries: a three-year cohort study of more than 900,000 Danish men

BACKGROUND: Data indicates that Denmark has relatively high risks of occupational injuries. We evaluated all injuries resulting in hospitalization by occupation. METHODS: All gainfully employed men younger than 60 in 1990 were divided into 47 industrial groups and followed using the National Inpatient Registry, for hospitalized injuries 1991-1993. Following ICD-8, injuries were grouped into six categories: head, upper extremities, back, trunk, lower extremities and ruptures, sprains and strains. Standardized industrial hospitalization ratios (SHRs) were calculated and Pearson's independence test was performed for each category. RESULTS: Industrial differences were ascertained for each injury category. The highest associated injury category was upper extremity injuries ranging from SHR = 43 (fire services and salvage corps) to SHR = 209 (slaughterhouse industry). Carpentry, joinery, bricklaying and construction work had significantly high SHRs for all injury categories, whereas administrative work was significantly low throughout. CONCLUSIONS: Occupational surveillance systems based on hospitalized injuries can be used to identify high-risk industries, and thereby suggest where to direct prevention efforts.     

Occupation, industry, and fatal motor vehicle crashes in 20 states, 1986-1987.

BACKGROUND: Motor vehicles are a leading cause of injury on and off the job. METHODS: To describe the occurrence of fatal motor vehicle crashes in the working-age population, a case-control study was conducted among persons 15-64 years old who died in 1986 or 1987 in any of 20 states reporting death certificate occupational data to the National Center for Health Statistics. Cases were occupants of motor vehicles (excluding motorcycles) who died of injuries sustained in a crash (E810-E825, 9th revision International Classification of Diseases), and controls died of any other cause. RESULTS: Transportation-related occupations had more than the expected number of deaths for men (odds ratio = 1.6, 95% confidence interval = 1.4-1.9) and women (odds ratio = 2.1, 95% confidence interval = 1.0-4.5), as did managerial occupations (odds ratio = 1.3 and 1.7, 95% confidence interval = 1.1-1.5 and 1.3-2.2 for men and women, respectively). Men in mining and oil drilling occupations and the wholesale trade industry also had excess crash deaths. Among women, additional excesses were observed among professional specialists and in several groups with few deaths, including agriculture, construction, and the military, whereas homemakers had markedly fewer vehicle crash deaths than expected. CONCLUSIONS: These findings encourage further investigation of this important safety hazard, but also call attention to a need for more detailed studies and improved data.     

Impact of psychosocial job stress on non-fatal occupational injuries in small and medium-sized manufacturing enterprises

BACKGROUND: Workers involved in manufacturing are known to comprise a high-risk population for occupational injury, and this risk is greater in small and medium-sized enterprises (SMEs). The purpose of this study was to examine the association between psychosocial job stress and occupational injuries among workers in SMEs. METHODS: One thousand forty-nine men and 721 women from 244 SMEs participated in this study. Perceived job stress was evaluated with the Japanese version of the generic job stress questionnaire, which covered 14 job stress variables. Occupational injury was assessed by self-report during the last 1-year period. RESULTS: Workers with high quantitative workload (odds ratio [OR] = 1.55 for men, 1.62 for women), high cognitive demands (OR = 1.70 for men, 1.53 for women), and low job satisfaction (OR = 1.33 for men, 1.93 for women) had a significantly increased risk of occupational injury in the multivariate model. High variance in workload (OR = 1.70) and high job future ambiguity (OR = 1.35) in men, and low job control (OR = 2.04) and high intragroup conflict (OR = 1.66) in women were significantly associated with occupational injury. In manufacturing/production workers, high quantitative workload (OR = 1.91), high variance in workload (OR = 2.02), and high depressive symptoms (OR = 1.55) were significantly associated with injury in men, while low social support from colleagues (OR = 2.36) or family (OR = 2.51) was related to injury in women. CONCLUSIONS: These data point to an independent relationship between psychosocial job stress and self-reported occupational injury in SMEs.     

Depression and occupational injury: results of a pilot investigation

OBJECTIVE: Even mild clinical depression can cause decreased vigilance, attention span, increased irritability, and insomnia-all well-known precursors to occupational injury. This pilot project explores the relationship between occupational injury and depression. METHOD: One hundred twenty-one individuals with recent work-related injuries and 140 without work-related injuries completed a self-administered depression screening instrument (PHQ-9). We compared the two groups using bivariate analyses. The impact of depression on injury was examined using logistic regression analysis controlling for employment history, marital status, age, and sex. RESULTS: Overall, injured workers in this study were not more likely to be depressed than a comparison group of uninjured workers. However, injured women had significantly higher depression scores than non-injured women (P = 0.04); no such difference was found for men. CONCLUSIONS: These data suggest that depression may serve as a precursor to occupational injury for women.     

Injury and disability in matched men's and women's intercollegiate sports.

Eight matched men's and women's intercollegiate varsity teams were studied prospectively for one academic year to determine the incidence of athletic injury and resulting disability. Sports in which both men and women participated in a comparable manner were chosen: basketball, fencing, gymnastics, swimming, tennis, indoor track, outdoor track, and volleyball. Men (232) and women (150) were injured at comparable rates, 42 percent versus 39 percent. When adjusted for exposure time, seven of the eight sports continued to show similar injury rates. Women gymnasts, however, experienced .82 injuries per 100 person-hours of exposure as compared to .21 injuries for the men (p = .0001). Disability was greater in women gymnasts, 7.44 days per 100 person-hours versus 1.15 days for men (p = .0004). Percent of season lost to injury was also greater for women gymnasts. Types and sites of injury were similar for men and women, with sprains and strains accounting for over half of all injuries. We found no evidence for gender differences in matched sports except for gymnastics, in which technically diverse events may have accounted for the differences observed.     

Self-reported occupational injuries among industrial beef slaughterhouse workers in the Midwestern United States

Although workers in meatpacking facilities in the U.S. experience high rates of occupational injury, their injury experiences have received limited research attention. Prior research indicates underreporting in injury rates in this industry as well significant variation in injury rates among facilities. To add detail to the rates and circumstances surrounding occupational injury among meatpacking workers, we conducted a cross-sectional study of workers employed at an industrial beefpacking plant in Nebraska (n = 137) and interviewed workers about recent injury experiences. We assessed frequency, cause and nature of self-reported injury. We estimated annual incidence rates of self-reported injuries using the OSHA formula and compared these rates to industry-wide data. We also evaluated psychological distress in this workforce as measured by the Kessler-6 scale to assess whether distress was associated with recent occupational injury. In this study, 15.1% of workers experienced occupational injuries that required time off work, job transfer, or restriction during the past three months. The estimated annual incidence rate was 15.2 injuries per 100 full-time workers for these injuries at this plant. Rushing was identified as the cause of nearly 50% of injuries, and repetitive work as the cause of an additional 20% of injuries. Use of metal mesh sleeves (POR: 0.10 (p = 0.008)) and metal mesh gloves (POR: 0.41 (p = 0.05) were associated with reduced risk of injury. Use of a carbon steel for knife sharpening (POR: 5.2 (p = 0.02)) was associated with elevated risk of moderate and severe injury. There were no associations between self-reported occupational injury and overall measures of psychological distress. Self-reported incidence rate of severe injury in this plant was more than twice official industry estimates. Worker self-reports may illustrate key areas for injury prevention.     

Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service

PURPOSE: Research suggests that posttraumatic stress disorder (PTSD) may be associated with later medical morbidity. To assess this, we examined all-cause and cause-specific mortality among a national random sample of U.S. Army veterans with and without PTSD after military service. METHODS: We used Cox proportional hazards regressions to examine the causes of death among 15,288 male U.S. Army veterans 16 years after completion of a telephone survey, approximately 30 years after their military service. These men were included in a national random sample of veterans from the Vietnam War Era. Our analyses adjusted for race, Army volunteer status, Army entry age, Army discharge status, Army illicit drug abuse, intelligence, age, and, additionally -- for cancer mortality -- pack-years of cigarette smoking. RESULTS: Our findings indicated that adjusted postwar mortality for all-cause, cardiovascular, cancer, and external causes of death (including motor vehicle accidents, accidental poisonings, suicides, homicides, injuries of undetermined intent) was associated with PTSD among Vietnam Theater veterans (N = 7,924), with hazards ratios (HRs) of 2.2 (p < 0.001), 1.7 (p = 0.034), 1.9 (p = 0.018), and 2.3 (p = 0.001), respectively. For Vietnam Era veterans with no Vietnam service (N = 7,364), PTSD was associated with all-cause mortality (HR = 2.0, p = 0.001). PTSD-positive era veterans also appeared to have an increase in external-cause mortality as well (HR = 2.2, p = 0.073). CONCLUSIONS: Our study suggests that Vietnam veterans with PTSD may be at increased risk of death from multiple causes. The reasons for this increased mortality are unclear but may be related to biological, psychological, or behavioral factors associated with PTSD and warrant further investigation.     

What is the risk associated with being a qualified military parachutist?

Military parachuting has been recognized as a hazardous activity since it was first introduced in World War II. Other risks associated with military service include actual war-fighting, training with weapons and explosives, operating with armoured vehicles or deployment to climatic extremes. These other hazards should be considered in any assessment of the additional risk associated with military parachuting. The aim of this study was to identify the risk attributable to parachuting amongst US Army enlisted soldiers. This study identified a cohort of infantry soldiers who served between 1990-94. They were separated by receipt of parachute hazardous duty pay. There was a total of 329,794 person-years (PY) available for study of which 18% were in the exposed group. The rate of hospitalization was very similar in both groups [123.9 per 1,000 PYs for the exposed group, 127 in the non-exposed group: relative risk (RR) = 0.98, 95% confidence interval (CI) = 0.96-1.00). The exposed group was 1.49 times (CI = 1.42-1.57) more likely to be admitted as a result of an injury as compared with the non-exposed group. Military parachuting was 20 times (CI = 16.6-24.3) more likely to be the cause of an injury. This study has shown that receipt of hazardous duty pay for military parachuting can be used as a marker in identifying significant additional risks to the health of infantry soldiers associated with military parachuting. This was reflected in an increased incidence of admission for acute injury and musculoskeletal trauma (particularly a trauma pattern associated with parachuting) as a result of military parachuting. Other risks, which are associated with parachute pay, are admission for the effects of heat, battle injury and helicopter accidents.     

Risk factors for physical assault. State-managed workers' compensation experience

BACKGROUND: The estimation of incidence and evaluation of risk factors associated with nonfatal occupational assault injuries have rarely been documented in a statewide population context. A state-managed workers' compensation system can provide estimates of incidence of such injuries and allow evaluation of risk factors. METHODS: Using claims data from the state-managed West Virginia Workers' Compensation, the incidence rates of workplace injuries resulting from physical assault were estimated for the period 1997-1999. Data on potential risk factors were obtained from the claim-related electronic data files, and the risk associated with each factor was assessed using proportional injury ratios (PIRs). RESULTS: During the study period, 2122 compensated injuries were associated with workplace violence. The incidence of assault injuries was 108.2 cases per 100,000 employee years. Women sustained a higher incidence than men. Healthcare workers, public safety workers, and teachers accounted for almost 75% of all assault injuries. Workers in these occupations also differed from each other with regard to seasonality and timing of assault, perpetrator-victim relationship, and types of injury. Evidence of gender-occupation interaction indicated higher risk of assault injury in men compared to women across the three leading occupations. Nighttime work shifts were associated with greater risk of assault for female healthcare workers (PIR=1.8; 95% confidence interval, 1.09-2.87). CONCLUSIONS: The healthcare sector sustained the bulk of assault injuries in West Virginia. Although the majority of healthcare-sector employees were women, the risk of assault injuries was higher in male employees. Risk factors and injury characteristics identified in this study, particularly for three high-risk occupations, should help develop strategies for preventing workplace violence. Protecting female healthcare workers on night-shift duty, especially in nursing home settings, appears to be an important target for intervention.     

4172例伤害住院病人直接经济负担趋势性分析

目的 了解伤害病人住院病种及费用变化趋势。方法 采取整群抽样方法,抽取某省级医院1994年至2000年伤害病人病案,进行平均住院日、平均住院费用趋势性分析。结果 7年间伤害住院病人平均增长速度7．89％,他杀增长速度12．64％,交通事故增长速度11．98％;前四位伤害构成依次为他杀27．85％,交通事故26．20％,意外跌落22．28％,自然和环境因素所致伤害18．41％;伤害平均住院日减少速度为2．02％,住院费用平均增长速度为17．54％,年度与平均住院日呈负相关,与住院费用呈正相关,60岁年龄段住院费用增长速度最快,达24．21％。结论 伤害不仅造成早死、伤残,同时给家庭和社会带来了很大经济损失。     

Association of active and passive smoking with occupational injury in manual workers: a cross-sectional study of the 2011 Korean working conditions survey

This study was conducted to investigate the relationship of active and passive smoking with occupational injury among manual workers. Data from the 2011 Korean Working Conditions Survey were analyzed for 12,507 manual workers aged ≥15 yr. Overall, 60.4% of men and 5.8% of women were current smokers. The prevalence of injury was higher among never smokers who were exposed to secondhand smoke (SHS) (7.7% in men and 8.1% in women) than current smokers (4.2% in men and 4.1% in women). After controlling for potential confounders, in men, compared to those who never smoked and were not exposed to SHS, people who never smoked and were exposed to SHS (adjusted odds ratio (aOR)=3.7, 2.2–6.4) and current smokers (aOR=2.5, 1.6–3.8) were more likely to experience injury. Among women, the aORs of occupational injury were 8.4 (4.2–16.7) for never smoking women with occasional exposure to SHS and 3.5 (95% CI: 1.4–8.7) for current smokers, in comparison to never smoking women who were never exposed to SHS at work (reference group). The present study suggests that exposure to SHS is a possible risk factor of occupational injury for never smoking men and women.     

军人训练伤危害程度的秩和比分析

目的了解部队广大官兵训练伤构成,并分析其危害程度,为合理安排军人训练课目,制定科学的训练方法提供依据。方法从住院疾病分类年报表的指标中以构成比、病死率、平均住院日、人次平均住院费高而治愈率低作为疾病危害程度的标准,采用秩和比法（Ran k sum ration,RSR）进行分析评价。结果对部队广大官兵危害程度最严重的训练伤是脊柱骨折、股骨骨折、肱骨骨折,危害比较严重的训练伤依次是胫腓骨折、脱位、扭伤和劳损、前臂骨折、骨性关节炎、手腕部骨折、开放性创伤和血管损伤。结论提高部队对训练伤疾病的认识,加强训练伤防治知识的学习,科学施训参训,预防和减少训练伤。