The burden of occ injury: As bad as diabetes

Research reveals impact of work factors

Schulte PA. Characterizing the burden of occupational injury and disease. J Occup Environ Med 2005; 47:607-622.

Rosenman KD, Kalush A, Reilly MJ, et al. How much work-related injury and illness is missed by the current national surveillance system? J Occup Environ Med 2006; 48:357-365.

The burden of occupational injury and illness is much greater than commonly believed. In fact, at an estimated cost of more than $120 billion, we spend five times as much on direct and indirect costs related to occupational injury and illness as we do on HIV/AIDS and three times more than the cost of Alzheimer's disease.

That is the conclusion of researchers who are trying to quantify — and publicize — the impact of occupational morbidity and mortality. While other serious diseases gain the limelight, very little attention is paid to occupational exposures as contributing factors or as opportunities for prevention.

"People don't distinguish the occupational component from other components," says Paul Schulte, PhD, an epidemiologist and director of the Education and Information Division at National Institute for Occupational Safety and Health (NIOSH) in Cincinnati who conducted a review of 38 studies of the burden of occupational injury and illness.

Even primary care physicians too often overlook occupational issues, says Schulte. "Many general practicing physicians don't have the time or the training to take an occupational history. They don't necessarily consider occupation, unless it might be a signature kind of disease [such as pneumoconiosis among coal miners]."

In his literature review, Schulte found that the morbidity and mortality from occupational injury and illness ranks amid other well-recognized concerns, such as diabetes and motor vehicle accidents. Occupational factors contribute significantly to other diseases such as cardiovascular disease, cancer, and chronic obstructive pulmonary disease.

To look beyond workers' compensation claims data and reported occupational injury and illness, researchers calculated "attributable risk," the proportion of disease attribution to occupational factors. "It's still relatively new science to figure out the cost of occupational disease," says Schulte. "There are methodological assumptions that are made."

Schulte cites one researcher who attributes 55,000 deaths a year to occupational illness and injury. Another researcher estimates the worldwide burden to be 100 million injuries, 11 million diseases, and 800,000 deaths. "The World Health Organization has only recently started to examine the burden of disease for selected occupational risk factors," he notes. For example, the WHO found that 37% of low back pain and 11% of asthma can be attributed to occupational factors.

Injuries and illnesses also represent a significant psychosocial burden, he notes. NIOSH has been sponsoring research on the impact of work-related stress. For example, studies show a link between staffing, stress, and needlestick injuries. Conversely, occupational injury and illness can impact family dynamics and emotional health, Schulte notes.

If the burden of occupational injury and illness is underappreciated, it may be in part because of significant underreporting. "We don't have good surveillance of the prevalence of occupational disease and injury and the prevalence of exposure to the hazards related to these," says Schulte. "Until we have that, we will continue to have an underestimation."

That concern was highlighted in another study, in which Kenneth Rosenman, MD, and colleagues from Michigan State University in East Lansing compared the work-related injuries and illnesses in four databases with data from the Bureau of Labor Statistics. To prevent duplication, the researchers matched the cases in the varying databases by name, company, and other identifiers.

The database matching, which included workers' compensation data, indicated there were 79,400 injuries and illnesses that resulted in at least seven missed workdays in Michigan from 1999 to 2001. The BLS estimated there were 30,800 injuries and illnesses with seven missed workdays during that timeframe. The overall injuries and illnesses also were greatly underestimated: 869,034 injuries and illnesses per year in Michigan during the three-year period, according to the database analysis, compared with a BLS estimate of 281,567 per year. In comparing databases, the authors used person-to-person matching with Social Security numbers.

"The BLS estimate of work-related injuries and illness is equivalent to one in 15 workers a year in Michigan with a work-related injury or illness, whereas our estimate is one in five," the researchers noted.

They recommended the development of a more comprehensive surveillance system. A better understanding of the burden of occupational health and safety could influence the allocation of resources and the priorities, they noted.

Schulte says he concurs. "The more we can show that [occupational injury and illness] is a true risk factor in health care costs, the more we can support investments in that area," he says.