Occupational Injury and Illness in the United States: Estimates of Costs, Morbidity, and Mortality

doi:10.1001/archinte.1997.00440350063006

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Vol. 157 No. 14, 28 JULY 1997

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Occupational Injury and Illness in the United States

Estimates of Costs, Morbidity, and Mortality

J. Paul Leigh, PhD; Steven B. Markowitz, MD; Marianne Fahs, PhD, MPH; Chonggak Shin, MBA; Philip J. Landrigan, MD, MSc

Arch Intern Med. 1997;157(14):1557-1568.

Abstract

Objective
To estimate the annual incidence, the mortality, and the directand indirect costs associated with occupational injuries andillnesses in the United States in 1992.

Design
Aggregation and analysis of national and large regional datasets collected by the Bureau of Labor Statistics, the NationalCouncil on Compensation Insurance, the National Center for HealthStatistics, the Health Care Financing Administration, and othergovernmental bureaus and private firms.

Methods
To assess incidence of and mortality from occupational injuriesand illnesses, we reviewed data from national surveys and appliedan attributable risk proportion method. To assess costs, weused the human capital method that decomposes costs into directcategories such as medical and insurance administration expensesas well as indirect categories such as lost earnings, lost homeproduction, and lost fringe benefits. Some cost estimates weredrawn from the literature while others were generated withinthis study. Total costs were calculated by multiplying averagecosts by the number of injuries and illnesses in each diagnosticcategory.

Results
Approximately 6500 job-related deaths from injury, 13.2 millionnonfatal injuries, 60 300 deaths from disease, and 862 200 illnessesare estimated to occur annually in the civilian American workforce.The total direct ($65 billion) plus indirect ($106 billion)costs were estimated to be $171 billion. Injuries cost $145billion and illnesses $26 billion. These estimates are likelyto be low, because they ignore costs associated with pain andsuffering as well as those of within-home care provided by familymembers, and because the numbers of occupational injuries andillnesses are likely to be undercounted.

Conclusions
The costs of occupational injuries and illnesses are high, insharp contrast to the limited public attention and societalresources devoted to their prevention and amelioration. Occupationalinjuries and illnesses are an insufficiently appreciated contributorto the total burden of health care costs in the United States.

Arch Intern Med. 1997;157:1557-1568

Author Affiliations

From the Department of Economics, San Jose State University, San Jose, Calif, and Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, Calif (Dr Leigh); Division of Environmental and Occupational Medicine (Drs Markowitz and Landrigan) and Division of Health Economics (Dr Fahs and Mr Shin), Department of Community Medicine and the International Longevity Center (Dr Fahs and Mr Shin), Mount Sinai School of Medicine, New York, NY. Dr Fahs and Mr Shin are now with the Health Policy Research Center, New School for Social Research, New York.

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