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On the Job: Fewer Injuries, More Deaths?

Friday, May 11, 2012

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Here’s a puzzler: Why would employers who report fewer injuries have more deaths on the job—and fewer deaths in workplaces that see more injuries?

That is the question now occupying RAND Corporation researchers, who have identified the unexpected trend in a new study focusing on construction—industry’s deadliest profession.

 John Mendeloff
“We were surprised by the relationship between fatal and nonfatal injuries,” said John Mendeloff, Director of the RAND Center for Health and Safety in the Workplace.

States with low non-fatal injury rates have high fatality rates and vice-versa,” published recently in the American Journal of Industrial Medicine, found two surprising trends:

• The low-injury/high-death correlation (and vice versa); and

• Strong regional differences in employer reporting trends.

Unexpected Relationship

Using data from the federal Bureau of Labor Statistics, Mendeloff and co-author Rachel Burns examined fatal and nonfatal injuries in the construction sector on a state-by-state basis for the years 2003 to 2005 and 2006 to 2008.

They found that states reporting low numbers of nonfatal injuries among construction workers tended to have high rates of fatal injuries, while those with low death rates tended to report more injuries.

“We were surprised by the relationship between fatal and nonfatal injuries,” said lead author John Mendeloff, who heads the nonprofit RAND Center for Health and Safety in the Workplace.

Although some might argue that the rates should not be linked because many causes of deaths are different than the causes of injuries, Mendeloff said few experts would have expected an inverse relationship.

Regional Differences

States with the highest number of injuries and lowest number of deaths were Arizona, California, Maine, Oregon, Washington and Wisconsin. States with the highest number of deaths and lowest number of nonfatal accidents were Alabama, Arkansas, Georgia, Kentucky, Louisiana and Tennessee.

Researchers spied something regional in those results.

Their theory: The states with more deaths but fewer reported injuries tended to be in the South, where workers’ compensation and wages tend to be lower and unions more scarce. In contrast, states that report more injuries but fewer death tended to be in the West, pay higher benefits and wages, be more strongly unionized, and carry out more workplace inspections.

“One key factor influencing injury trends seems to be the scope of benefits offered by a state’s workers’ compensation program, but that explains only part of what we found,” said Mendeloff.

Does Reporting Pay?

Researchers found that better workers’ comp was associated with higher injury reports, largely because such benefits provide more incentive for workers to report injuries. It may also be that paying higher premiums for better benefits provides a strong incentive for those employers to prevent injuries.

 The construction industry has the largest number of deaths among all industrial sectors.


The construction industry has the largest number of deaths among all industrial sectors. The Occupational Safety and Health Administration is making a new push for injury and illness prevention.

Workers’ compensation, however, is unlikely to be the whole story, the study says.

Researchers note, for example, that 21 states have their own Occupational Safety and Health Administration programs, including several that vary significantly from the federal OSHA programs. States also differ in their labor markets, union influences, and levels of unemployment and wages, as well as cultural factors such as habits of compliance with government regulations.

Measuring Safety

The disparities raise another question, Mendeloff notes: If the reporting rates diverge so sharply, which measure—injury or death—offers a better indicator to assess safety and health?

Researchers give the nod to death rates, which are measured “quite accurately,” according to RAND.

If that’s the case, however, states reporting high death rates and fewer injuries “are probably underreporting” their injuries, the researchers suggest.

Not only that, but reporting more injuries may actually be a sign of a better worker safety program, Mendeloff said.

He compared the phenomenon to reporting of medical errors by hospitals: Higher reporting levels often mean more honest reporting and more opportunities to learn from the errors.


Tagged categories: Accidents; Construction; Health and safety

Comment from M. Halliwelll, (5/14/2012, 10:59 AM)

I'll agree with the experience has been that the job sites that encourage and expect injuries, incidents and near misses to be reported are often the ones who do something about what is reported and have a more active safety program. Those who sweep things under the carpet and don't want to be bothered by the "little stuff" are often the ones who get bitten badly when the little stuff turns big.

Comment from Brian Gingras, (5/15/2012, 12:29 PM)

I agree also with Mr. Mendeloff. In my past experience as a safety officer I witnessed what happens when you don't report, unsafe acts/conditions and behaviors are not deemed to be important enough to take action. Just read up on the "accident pyramid" and you get a good idea of how by not intervening and taking corrective action on minor accidents/incidents results in more serious incidents and subsequently death or serious injury.

Comment from Gregory Stoner, (5/17/2012, 7:41 AM)

In addition if there is underreporting, then those injuries are being paid for by individuals health insurance(which increases health insurance across the board) and worse yet if they happen to be listed as independant contractors rather than employees, so that the contractor isn't paying into workers compensation or unemployment insurance, they could be on government health insurance programs and we are paying for it. That is why enforcement of regulations is so important. In the unionized construction industry the various labor organizations are making the case for the government in many cases. Rather than taxpayers funding the apprehension of law breakers it is put on the backs of unionized workers. This goes well beyond OSHA safety violations. Education is the key!

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