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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 direct and indirect costs associated with occupational injuries and illnesses in the United States in 1992.

Design
Aggregation and analysis of national and large regional data sets collected by the Bureau of Labor Statistics, the National Council on Compensation Insurance, the National Center for Health Statistics, the Health Care Financing Administration, and other governmental bureaus and private firms.

Methods
To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from national surveys and applied an attributable risk proportion method. To assess costs, we used the human capital method that decomposes costs into direct categories such as medical and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from the literature while others were generated within this study. Total costs were calculated by multiplying average costs by the number of injuries and illnesses in each diagnostic category.

Results
Approximately 6500 job-related deaths from injury, 13.2 million nonfatal injuries, 60 300 deaths from disease, and 862 200 illnesses are 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 $145 billion and illnesses $26 billion. These estimates are likely to be low, because they ignore costs associated with pain and suffering as well as those of within-home care provided by family members, and because the numbers of occupational injuries and illnesses are likely to be undercounted.

Conclusions
The costs of occupational injuries and illnesses are high, in sharp contrast to the limited public attention and societal resources devoted to their prevention and amelioration. Occupational injuries and illnesses are an insufficiently appreciated contributor to 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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