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European Journal of Public Health, Vol. 35, No. 1, 91–100 © The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. https://doi.org/10.1093/eurpub/ckae197 Advance Access published on 4 December 2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to prevent 3 million deaths worldwide: a systematic review of occupational accident research—a factor- and cost-based approach Rosa Mar�ıa Ca~naveras Perea�, �Angel Tejada Ponce, Mar�ıa Pilar S�anchez Gonz�alez��
Department of Business Administration, Faculty of Economic and Business Sciences, University of Castilla-La Mancha, Albacete, Spain
�Corresponding author. Department of Business Administration, Faculty of Economic and Business Sciences, University of Castilla-La Mancha, Plaza de la Universidad, 1. Albacete 02071, Spain. E-mail: [email protected] ��She is member of “Asociaci�on de Econom�ıa de la Salud” (AES), which in turn is part of SESPAS, which is a member society of EUPHAS. ID Member: 1656.
Abstract Occupational accidents have emerged as a global concern, necessitating a comprehensive examination of their determinants and associated costs. This review aims to summarize, synthesize, and organize the factors and cost drivers of occupational accidents, exploring whether there is a gender perspective. Adhering to PRISMA guide- lines, we performed a narrative synthesis to systematically review relevant literature. A systematic search was conducted in the electronic databases PubMed, Web of Science, and Scopus. Two researchers screened all records to eliminate any duplicates, and they selected the articles for full review. A third researcher was consulted to resolve discrepancies and reach a consensus. The analysis of 15 studies revealed diverse perspectives; in terms of determinants, studies on organizational aspects and the theory of human error were grouped together, while in cost drivers, the human capital model and willingness to pay were the most frequently used. Gender, meanwhile, is identified as a determinant variable for accident rate. Additionally, limitations such as data underestimation were noted in the existing literature. The review highlights the need for empirical studies capable of addressing both determinants and cost drivers. It also provides guidelines for researchers to design studies that are more comparable across different contexts, including the gender debate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction
W ithin the framework of the 2030 Sustainable Development Goals (SDGs), two key targets related to occupational health
are emphasized: Good health and well-being (SDG 3), and Decent work for all (SDG 8). However, each year, exposure to occupational hazards in nearly 3 million fatalities [1]. These incidents place a significant strain on healthcare systems and reduce productivity, leading to substantial costs that go far beyond ‘mere’ business and hospital expenses, affecting society as a whole. To effectively address this public health issue, it is essential to understand its underlying determinants and their economic valuation. There is growing advo- cacy for integrating a gender perspective into various aspects of occupational accidents [2]. Nevertheless, these approaches remain relatively scarce and are seldom evaluated in conjunction. Therefore, the main objective of this review is to summarize, synthesize, and organize the patterns in the literature on these three approaches, analysing and categorizing the conclusions and limitations reported. Additionally, this review seeks to provide valuable information and scientific evidence for health professionals, researchers, and policymakers.
Methods
Search strategy The guidelines outlined in the PRISMA statement for reporting sys- tematic reviews and meta-analyses [3], along with those from the Joanna Briggs Institute (JBI) [4], were followed when conducting this systematic review. The literature search was conducted in
November 2023, encompassing the entire available publication period for a comprehensive analysis. Given the multidisciplinary nature of the review, three databases were consulted: PubMed, Web of Science, and Scopus. Table 1 displays the search strategy and the terms included, as well as the exclusion and inclusion criteria.
Study selection The study selection and data extraction process consisted of three phases (see Fig. 1). First, two researchers (R.M.C.P. and �A.T.P.) initially screened all records to eliminate duplicates. Next, both researchers independently reviewed the titles, abstracts and key- words of the 2415 studies retrieved. They selected only complete articles. At this stage, the results were compared, and a third re- searcher (M.P.S.G.) was consulted to resolve possible discrepancies in the inclusion criteria and to reach an objective consensus. In the third phase, the two researchers (R.M.C.P. and �A.T.P.) read all the articles selected after applying the inclusion and exclusion criteria. The full text of 59 articles was reviewed. Of these, 47 were excluded based on the exclusion criteria. Again, the third researcher (M.P.S. G.) was involved in resolving any doubts or conflicts. To ensure no relevant studies were missed in the initial search, the references of the 12 accepted articles were reviewed, resulting in the identification of 3 additional studies. Thus, a total of 15 articles were included in the review.
Results Due to the broad range of knowledge areas and the varied aspects of occupational accidents addressed in the review articles, the resulting
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Table 1. Search strategy
Category Criteria Details
Keywords Inclusion (‘occupational accidents’ OR ‘occupational injuries’ OR ‘accidents at work’ OR ‘workplace accidents’ OR ‘workplace injuries’) AND (‘determinants’ OR ‘factors’ OR ‘cost’ OR ‘expenditure’ OR ‘gender’ OR ‘sex’)
Exclusion NOT (‘ergonomics’ OR ‘epidemiologic’ OR ‘epidemiology’ OR ‘epidemiological’ OR ‘control’ OR ‘surveillance’ OR ‘unions’ OR ‘system’ OR ‘protocol’ OR ‘safety culture’ OR ‘fall’ OR ‘falls’ OR ‘falling’ OR ‘traumatic’ OR ‘heart’ OR ‘eye’ OR ‘musculoskeletal’ OR ‘back’ OR ‘neck’ OR ‘arm’ OR ‘elbow’ OR ‘hand’ OR ‘foot’ OR ‘time lost’ OR ‘HIV’ OR ‘rehabilitation’)
Inclusion criteria Language Only English Article type Original research articles Focus Study of determinants and costs of occupational accidents, particularly related to gender or sex
Exclusion Criteria (i) Body parts Focus on specific body part injuries (ii) Factors/costs Lack of information on explanatory factors or costs (iii) Ergonomics Solely focused on ergonomics or rehabilitation (iv) Safety issues Focus only on safety environment issues
Further Discarding (a) Global accidents Focused on a single globally known accident (b) Specific sectors Concentrated on injuries within specific sectors or professions (c) Single determinants Focused solely on one determinant, excessively specific cases, or did not meet inclusion criteria for
study design (d) Descriptive Studies Excluded purely descriptive articles lacking statistical methodologies (e) Related topics Did not directly address the chosen topic of the review or solely focused on study design
We understand determinant as a collective or individual risk factor (or set of factors) that is causally related to a health condition, outcome, or other defined characteristic [5].
Figure 1. PRISMA flowchart.
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data for analysis are inherently heterogeneous. Therefore, we chose for a narrative synthesis methodology to summarize the findings. A narrative approach, or qualitative systematic review, is suitable in this context, as meta-analysis of reported studies would be unsuit- able given the wide heterogeneity of data.
The narrative synthesis of the literature highlights both common- alities and disparities, providing insights for future research in this field. The results are presented in tables to enhance comprehension of the studies, methodologies, and key findings (see Tables 2 and 3).
Discussion The synthesis offers a comprehensive overview of the literature, delineating between determinants and costs. It facilitates the iden- tification of consensus, contradictions, and limitations.
Determinant studies The literature on determinants has been investigated using two types of sources: Primary sources [6, 7] and secondary sources [8–10].
Primary sources (surveys, questionnaires and/or interviews) re- quire a significant investment of time and resources on the part of the researchers, as the reliability of the study depends on adherence to very strict protocols that must be followed. Moreover, the need for these studies to be evaluated by an ethics committee is becoming increasingly common, given that they deal with data sensitive to the privacy of the participants. Furthermore, the authors of the articles that have used a survey emphasize that the interpretation of the results requires caution due to the presence of a possible selection bias and the use of a self-administered questionnaires. Additionally, the samples must focus on a more specific population than those using official data, and therefore, the results may be even less extrap- olable and comparable. However, it allows for the measurement of variables that cannot be observed as comprehensively and directly way as with official databases, such as alcohol consumption.
The second option commonly chosen by researchers is to utilize secondary sources, typically official records. The primary advantage of secondary sources is that they tend to be comprehensive, especially when combined to gather as much information as possible. However, this does not eliminate biases in sampling or data recording in official records. Furthermore, these sources often lag in publication and sometimes lack availability of all variables within the study range.
This review has identified the two main approaches in studies on determinants of occupational accidents [7]:
Firstly, the occupational approach, which includes organizational- level analyses. The resources and organizational structure of finan- cial companies are considered significant predictors of accidents and illnesses. Similarly, this approach includes macroeconomic factors that impact the company and its accidents, such as the economic cycle. A considerable portion of the studies reviewed in this review has attempted to explain whether there is such a relationship be- tween accidents and the economic cycle. Economic fluctuations af- fect many factors related to occupational safety. These authors emphasize that, although many studies of this kind have been con- ducted, there is still insufficient scientific evidence to confirm the relationship between economic situation and the rate of occupation- al accidents [8, 10].
Secondly, the human error theory includes studies based on per- sonal characteristics or moral attitudes towards worker safety, among other factors. This knowledge is important as it demonstrates that preventive measures related to these factors can be applied across all professional sectors, not just limited to specific industries. In fact, the authors converge on a common point: the need to devise and plan occupational risk prevention campaigns tailored to workers exposed to greater risks or those more vulnerable to occupational injuries.
Regarding the limitations of this type of study, they primarily stem from the fact that this literature focuses on a problem, occu- pational accidents, within a specific location and time period.
Therefore, it is possible that the findings may not correspond to patterns observed in other countries or at different times.
Also, studies that aim to assess the business cycle need to include control variables related to work organization and the worker, as job fatigue or firm size which cannot be directly measured at the macro level. However, these variables are often represented by explanatory constructs, and gaps or biases may arise between the constructs and the proxies. At times, the identified associations do not provide sufficient evidence to draw firm conclusions about the mechanisms involved and only allow speculation regarding the reasons behind the relationships between economic situation and occupational accidents [10].
There are also other limitations such as the configuration or def- inition of variables. For example, in incidence rates, the increasing prevalence of part-time employment would lead to a downward bias in injury rates if the denominator of such a series were simply based on the number of employed persons. Similarly, when comparing productive sectors, divergences could arise due to differences in occupational risk structures.
Gender studies In articles that have focused on gender as a differentiating and deter- mining factor in occupational accidents, different trends have been observed depending on the gender evaluated. Thus, gender is under- stood as a predictive and explanatory factor for accidents [6, 7]. Likewise, studies that omit its consideration conclude that it is im- portant to account for it alongside other worker characteristics [7].
It is essential to clarify that the terms ‘gender’ and ‘sex’ are often used interchangeably in the literature. However, gender and sex are not the same. According to the WHO, ‘sex’ refers to the biological and physiological attributes that define men and women, while ‘gender’ refers to the socially constructed roles, behaviours, activ- ities, and attributes that a given culture considers appropriate for men and women.
Cost driver studies The primary source of cost studies on accidents is secondary data, particularly government sources (accident surveys, compensation records, or jury verdicts). Through these sources, authors make a series of estimations to calculate the total cost of accidents. However, these sources may exclude certain factors, and most authors conclude that they often underestimate accident figures [11–13]. Similarly, some cost components, such as compensation payments, may be overestimated. In fact, some authors combine quantitative approaches with qualitative research methods to calculate the true economic or social costs of workplace accidents. In these studies, the three major categories of costs associated with occupational inju- ries and illnesses are typically recognized: direct costs, indirect costs, and quality-of-life costs [11]. Direct costs generally include payments for hospital services, medical services, and related expenses [13]; in- direct costs refer to the productivity losses due to worker injuries [11]; and quality-of-life costs relate to the pain and suffering experi- enced by the worker and their family. When any of these categories are not accounted for, it is considered a significant limitation in cost studies [13].
Different economic models are increasingly utilized in the litera- ture to calculate these costs:
The Friction Cost method limits productivity losses to the friction period, which refers to the time required to restore productivity to its pre-accident level [14, 15]. However, while this method is men- tioned in the literature, it was not employed in any of the reviewed articles.
The Market Pricing model is a standard approach in calculating accident costs [16]. This method only considers direct and indirect costs, overlooking the intrinsic value of life, which cannot be mon- etarily measured. As a result, the costs are often underestimated. Despite this limitation, the market pricing model offers advantages such as straightforward documentation of calculations, avoidance of
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Ta b
le 2
. R
es u
lt s
o f
th e
sy st
em at
ic r
ev ie
w :
d et
er m
in an
ts
ID A
u th
o r
G eo
g ra
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es So
u rc
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et h
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va ri
ab le
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in an
ts Se
x/ g
en d
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as a
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to r?
Sy n
th es
is o
f re
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si o
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1 B
h at
ta ch
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[6 ]
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(L o
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M ay
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o
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a lc
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u la
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sy ch
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ic
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es en
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ea se
. W
o rk
c o
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it io
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an d
b
u si
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s fa
ct o
rs :
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ev io
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ri es
.
Y es
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x, y
o u
th ,
sm o
ki n
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vy a
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ve r-
w ei
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se o
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sy ch
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in fl
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d o
cc u
p at
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i n
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en y
o u
n g
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iv id
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al s,
s m
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h ea
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re g
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sy -
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tr o
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an d
th
o se
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ff er
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m
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h
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Pr ev
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ve m
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fo cu
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g o
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co
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it io
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r is
k as
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ss m
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j o
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aw ar
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s sh
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ld b
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rg et
m en
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w o
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m o
ke rs
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co h
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o
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w o
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sy ch
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ic
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s.
2 K
ir sc
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b au
m
et a
l. [7
] Is
ra el
19 98
Pr im
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g re
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d
b u
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-
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b co
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cc id
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p
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3 C
h an
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t al
. [ 8]
Ta iw
an 20
02 –1
4 Se
co n
d ar
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o ff
ic ia
l so
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es R
eg re
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; G
ra n
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c au
sa lit
y te
st ;
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sk al
- W
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t.
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d en
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at e
o f
o cc
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p at
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al i
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r- an
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ay m
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va
ri o
u s
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f ac
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: -
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si n
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cy cl
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at o
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p o
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la -
b o
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cc id
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, es
p ec
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m
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, w
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st at
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t lin
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t o
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cr o
ss s
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st ri
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c o
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it io
n s
af fe
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a cc
id en
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te s;
l ab
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fo rm
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w
as a
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ex te
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, in
cl u
d in
g e
co n
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fl u
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at io
n s. (c o
n ti
n u
ed )
94 Ca~naveras Perea et al. D
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Ta b
le 2
. C
o n
ti n
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[9 ]
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it ed
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in g
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m 19
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ar y:
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ff ic
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rc es
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la ce
i n
ju ri
es
cl as
si fi
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y se
ve ri
ty Ec
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rc en
ta g
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. -
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ju ri
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re p
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re n
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af fe
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b
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m an
u fa
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re
af fe
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b y
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fl
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s.
- B
ar g
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in g
p o
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a n
d
re p
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b eh
av io
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ar e
re la
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t o
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in ju
ry r
at es
.
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lic ie
s sh
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ld i
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p ro
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tr ai
n in
g ,
m o
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w o
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, an
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s o
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cr ea
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d u
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g
p ra
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re n
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to e
n su
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o cc
u p
at io
n al
ac
ci d
en ts
p
er e
m p
lo ye
e
Ec o
n o
m ic
f ac
to rs
: -
G ro
ss D
o m
es ti
c Pr
o d
u ct
p er
c ap
it a.
-
A ve
ra g
e ea
rn in
g s.
-
U n
em p
lo ym
en t
ra te
. -
C o
n st
ru ct
io n
p er
m it
s.
W o
rk c
o n
d it
io n
s an
d
b u
si n
es s
fa ct
o rs
: -
Em p
lo ym
en t
in h
az -
ar d
o u
s co
n d
it io
n s.
-
C o
m p
an y
si ze
.
Y es
- O cc
u p
at io
n al
a cc
id en
ts
in P
o la
n d
s h
o w
ed
p ro
cy cl
ic al
b eh
av io
u r
(m o
re a
cc id
en ts
d u
r- in
g e
co n
o m
- ic
e xp
an si
o n
s) .
- A
t ig
h te
r re
la ti
o n
sh ip
b
et w
ee n
e co
n o
m ic
si
tu at
io n
a n
d o
cc u
p a-
ti o
n al
a cc
id en
ts w
as
fo u
n d
f o
r m
en a
n d
th
e g
en -
er al
p o
p u
la ti
o n
. -
W o
m en
’s r
el at
io n
sh ip
w
as n
o t
al w
ay s
si g
- n
if ic
an t,
a s
th ey
o ft
en
cr is
is -r
es is
ta n
t se
ct o
rs .
- M
en h
ad a
h ig
h er
e x-
p o
su re
, an
d t
h er
e w
er e
al so
d if
fe re
n ce
s in
t h
e co
ef fi
ci en
t o
f te
m p
o ra
l tr
en d
. -
A h
ig h
er p
er ce
n ta
g e
o f
m ed
iu m
-s iz
ed c
o m
- p
an ie
s co
rr el
at ed
w it
h
lo w
er a
cc id
en t
ra te
.
D u
ri n
g p
er io
d s
o f
in cr
ea se
d l
ab o
u r
in -
te n
si ty
, em
p lo
ye rs
sh
o u
ld f
o cu
s o
n p
ro -
vi d
in g
t ra
in in
g a
n d
su
p er
vi si
o n
f o
r in
ex -
p er
ie n
ce d
w o
rk er
s an
d e
n su
re e
xp er
i- en
ce d
e m
p lo
ye es
h
av e
su ff
ic ie
n t
re co
v- er
y ti
m e.
A systematic review of occupational accident research 95 D
ow nloaded from
https://academ ic.oup.com
/eurpub/article/35/1/91/7916607 by guest on 21 February 2025
Ta b
le 3
. R
es u
lt s
o f
th e
sy st
em at
ic r
ev ie
w :
co st
d ri
ve rs
Id A
u th
o r
G eo
g ra
p h
ic al
D at
es So
u rc
e Ec
o n
o m
ic
co st
m o
d el
? C
o st
d ri
ve rs
C u
rr en
cy Sy
n th
es is
o f
re su
lt s
C o
n cl
u si
o n
s
6 Le
ig h
e t
al .
[1 1]
U n
it ed
S ta
te s
19 93
Se co
n d
ar y:
o
ff ic
ia l
so u
rc es
W ill
ig n
es s
to p
ay M
ed ic
al c
o st
W
ag e
lo ss
H
o u
se h
o ld
p ro
d u
ct io
n l
o ss
Pa
in a
n d
s u
ff er
in g
l o
ss
U SD
Fa ta
l ac
ci d
en ts
a cc
o u
n t
fo r
o n
e- fi
ft h
o f
to ta
l co
st s
($ 77
b ill
io n
). H
ig h
es t
co st
s ar
e am
o n
g w
o rk
er s
ag ed
1 7
an d
u n
d er
; m
al es
i n
cu r
h ig
h er
c o
st s
th an
f em
al es
; A
g ri
cu lt
u re
, fi
sh in
g a
n d
f o
re st
ry h
ad
th e
h ig
h es
t co
st p
er e
m p
lo ye
d w
o rk
er
o f
al l
o cc
u p
at io
n al
g ro
u p
s an
d t
h e
h ig
h es
t p
er ce
n ta
g e
o f
co st
s as
f at
al it
ie s.
St
ra in
s an
d s
p ra
in s
re p
re se
n te
d t
h e
g re
at es
t ec
o n
o m
ic b
u rd
en ,
ac co
u n
ti n
g
fo r
m o
re t
h an
o n
e th
ir d
o f
th e
to ta
l co
st s.
Th
e co
st s
o f
p ai
n a
n d
s u
ff er
in g
w er
e co
n si
d er
ab le
a n
d e
xc ee
d ed
t h
e b
en e-
fi ts
p ai
d b
y w
o rk
er s'
c o
m p
en sa
ti o
n .
In cr
ea si
n g
c o
st s
in fl
u en
ce d
eb at
es
o n
O cc
u p
at io
n al
S af
et y
an d
H
ea lt
h a
n d
w o
rk er
s’ c
o m
p en
sa -
ti o
n p
o lic
ie s
am o
n g
st
ak eh
o ld
er s.
7 K
im [
12 ]
So u
th K
o re
a 20
13 Se
co n
d ar
y:
o ff
ic ia
l so
u rc
es
W ill
in g
n es
s to
p ay
Lo ss
o f
in co
m e
C o
m p
en sa
ti o
n p
ay m
en ts
N
o n
-f in
an ci
al h
u m
an c
o st
s C
o st
s to
m ai
n ta
in p
ro d
u ct
io n
M
ed ic
al C
o st
A
d m
in is
tr at
iv e
co st
s
U SD
- To
ta l
es ti
m at
ed c
o st
s o
f lo
ss es
: U
S$ 27
.2 24
b ill
io n
( 2.
1% o
f th
e G
D P
o f
So u
th K
o re
a) ;
in d
iv id
u al
s (7
9. 5%
) b
ea r
th e
m o
st ,
fo llo
w ed
b y
em p
lo ye
rs
(2 0.
4% )
an d
g o
ve rn
m en
t (0
.1 %
).
- M
ai n
c o
st s:
in d
iv id
u al
s fo
cu s
o n
i n
co m
e lo
ss ;
em p
lo ye
rs o
n c
o m
p en
sa ti
o n
, g
o v-
er n
m en
t o
n n
at io
n al
i n
su ra
n ce
a n
d
p en
si o
n p
re m
iu m
s.
- Th
es e
co st
s fa
ci lit
at e
th e
ca lc
u la
- ti
o n
o f
lo ss
es i
n cu
rr ed
d u
e to
i n
- d
u st
ri al
a cc
id en
ts a
t th
e co
rp o
ra te
o r
g o
ve rn
m en
ta l
le ve
l. -
Th e
lo ss
c o
st s
ca n
b e
u se
d b
y th
e g
o ve
rn m
en t
as b
as ic
d at
a to
e s-
ta b
lis h
i n
d u
st ri
al s
af et
y an
d
h ea
lt h
p o
lic ie
s o
r to
p ro
m o
te i
n -
d u
st ri
al s
af et
y aw
ar en
es s
in K
o re
a.
8 Th
ep ak
so rn
a n
d
Po n
g p
an ic
h [
13 ]
Th ai
la n
d
(B an
g ko
k) 20
08 Se
co n
d ar
y:
o ff
ic ia
l so
u rc
es
N o
M ed
ic al
c o
st
R eh
ab ili
ta ti
o n
c o
st s,
Fu
n er
al c
o m
p en
sa ti
o n
c o
st s
C o
m p
en sa
ti o
n p
ay m
en ts
Lo
ss o
f in
co m
e
U SD
- O
cc u
p at
io n
al i
n ju
ri es
a n
d i
lln es
se s
co n
- tr
ib u
te d
t o
t o
ta l
h ea
lt h
c ar
e co
st s
an d
lo
st p
ro d
u ct
iv it
y in
B an
g ko
k.
- W
o rk
er s'
c o
m p
en sa
ti o
n c
o ve
re d
l es
s th
an o
n e
h al
f to
o n
e te
n th
o f
th e
co st
s o
f o
cc u
p at
io n
al i
n ju
ri es
a n
d i
lln es
se s
co m
p ar
ed t
o S
SO p
ay m
en ts
f o
r n
o n
- o
cc u
p at
io n
al i
n ju
ri es
a n
d i
lln es
se s
($ 24
6 m
ill io
n ).
-
N o
n -f
at al
o cc
u p
at io
n al
i n
ju ri
es a
n d
i ll-
n es
se s
to ta
l d
ir ec
t co
st s
o f
$1 3.
87 m
il- lio
n :
71 %
w er
e fo
r m
ed ic
al c
ar e
co st
s an
d 2
9% f
o r
co m
p en
sa ti
o n
f o
r lo
st e
ar n
in g
s.
- Th
es e
co st
s ex
cl u
d ed
i n
d ir
ec t
co st
s re
la te
d t
o p
ai n
a n
d s
u ff
er in
g o
r h
o m
e h
ea lt
h c
ar e.
Th er
e is
a n
ee d
t o
i m
p ro
ve t
h e
q u
al it
y o
f w
o rk
er s’
c o
m p
en sa
- ti
o n
h ea
lt h
ca re
s er
vi ce
s, i
n cl
u d
- in
g m
o re
o cc
u p
at io
n al
c lin
ic s
an d
p h
ys ic
ia n
s in
p ro
vi n
ce s.
9 Le
b ea
u e
t al
. [1
4] C
an ad
a
(Q u
� eb ec
) 20
05 –0
7 Se
co n
d ar
y:
o ff
ic ia
l so
u rc
es
D A
LY ,
w ill
- in
g n
es s
to
p ay
, an
d
h u
m an
ca
p it
al
M ed
ic al
c o
st s
Fu n
er al
c o
st s
W ag
e co
st s
A d
m in
is tr
at iv
e co
st s
Pa in
a n
d s
u ff
er in
g c
o st
s Pr
o d
u ct
iv it
y lo
ss es
U SD
- Es
ti m
at ed
c o
st s
o f
o cc
u p
at io
n al
in ju
ri es
/ d
is ea
se s
in Q
u eb
ec :
$4 .6
2 b
ill io
n a
n n
u -
al ly
( 20
05 –0
7) ;
ap p
ro xi
m at
el y
$1 .7
8 b
il- lio
n w
as a
llo ca
te d
t o
f in
an ci
al c
o st
s an
d
$2 .8
4 b
ill io
n t
o h
u m
an c
o st
s.
Th e
st u
d y
u n
d er
sc o
re s
th e
fi n
an ci
al
b u
rd en
o f
w o
rk p
la ce
i n
ci d
en ts
o
n e
m p
lo ye
rs a
n d
t h
e h
ea lt
h -
ca re
s ys
te m
, h
ig h
lig h
ti n
g t
h e
h u
m an
c o
st s
an d
s ec
to rs
n ee
d -
in g
i n
cr ea
se d
p re
ve n
ti o
n e
ff o
rt .
(c o
n ti
n u
ed )
96 Ca~naveras Perea et al. D
ow nloaded from
https://academ ic.oup.com
/eurpub/article/35/1/91/7916607 by guest on 21 February 2025
Ta b
le 3
. C
o n
ti n
u ed
Id A
u th
o r
G eo
g ra
p h
ic al
D at
es So
u rc
e Ec
o n
o m
ic
co st
m o
d el
? C
o st
d ri
ve rs
C u
rr en
cy Sy
n th
es is
o f
re su
lt s
C o
n cl
u si
o n
s
- Se
ct o
rs s
u ch
a s
m in
in g
, co
n st
ru ct
io n
, fo
re st
p ro
d u
ct s
an d
t ra
n sp
o rt
at io
n
st an
d o
u t
as h
av in
g s
ig n
if ic
an t
co st
s as
so ci
at ed
w it
h w
o rk
p la
ce i
n ci
d en
ts .
- N
o is
e ex
p o
su re
i s
th e
ca u
se o
f th
e h
ig h
es t
av er
ag e
co st
s p
er c
as e,
t ra
d -
it io
n al
in d
ic at
o rs
s u
ch a
s fr
eq u
en cy
a n
d
d u
ra ti
o n
m ay
n o
t fu
lly c
ap tu
re t
h e
tr u
e im
p ac
t o
f su
ch e
xp o
su re
s.
10 B
ad - u
n [
15 ]
C ro
ac ia
20 15
Se co
n d
ar y:
o
ff ic
ia l
so u
rc es
W ill
in g
n es
s to
p ay
M ed
ic al
c o
st s,
Ph
ys ic
al d
is ab
ili ty
co
m p
en sa
ti o
n ,
A d
m in
is tr
at iv
e co
st s
Le g
al c
o st
s d
is ab
ili ty
p en
si o
n s
C o
st s
ar is
in g
f ro
m c
o m
p lia
n ce
w
it h
h ea
lt h
a n
d s
af et
y re
g u
la ti
o n
s Pr
o d
u ct
iv it
y lo
ss es
, C
o st
s ar
is in
g f
ro m
c o
m p
lia n
ce
w it
h h
ea lt
h a
n d
s af
et y
re g
u la
ti o
n s.
H R
K O
n ly
t h
e fi
n an
ci al
c o
st s
o f
th e
g o
ve rn
- m
en t
(2 97
) an
d e
m p
lo ye
rs (
60 4.
6) i
n
20 15
o f
ar o
u n
d H
R K
9 00
m ill
io n
( 0.
3%
o f
G D
P) .
Em p
lo ye
rs i
n ve
st s
ig n
if ic
an t
fu n
d s
in p
re ve
n ti
n g
o cc
u p
at io
n al
i n
ju -
ri es
a n
d i
lln es
se s,
y et
f in
an ci
al
co st
s re
m ai
n h
ig h
. Th
is s
it u
at io
n
u n
d er
sc o
re s
th e
n ee
d f
o r
th e
g o
ve rn
m en
t to
e va
lu at
e th
e ef
- fe
ct iv
en es
s o
f th
e ex
is ti
n g
l eg
al
fr am
ew o
rk f
o r
o cc
u p
at io
n al
sa
fe ty
a n
d h
ea lt
h .
11 R
o g
n st
ad [
16 ]
N o
rw ay
19 90
Se co
n d
ar y:
O
ff ic
ia l
so u
rc es
M ar
ke t
p ri
ce
m o
d el
(g
ro ss
o
u tp
u t
o r
h u
m an
ca
p it
al
ap p
ro ac
h )
M at
er ia
l d
am ag
e.
Si ck
p ay
R
eh ab
ili ta
ti o
n ,
H ea
lt h
i n
su ra
n ce
, M
ed ic
al t
re at
m en
t.
Th e
in d
iv id
u al
l o
ss o
f in
co m
e M
ed ic
al c
o st
Ti
m e
o ff
w o
rk .
Ti m
e lo
st b
y co
lle ag
u es
an
d m
an ag
em en
t R
ep la
ce m
en t
o f
th e
w o
rk er
.
N O
K A
n n
u al
c o
st s
ar o
u n
d N
O K
4 0
b ill
io n
(6
.4 %
o f
G D
P) .
Pu b
lic s
ec to
r co
ve rs
80
% o
f co
st s,
w h
ile c
o m
p an
ie s
p ri
- m
ar ily
h an
d le
a cc
id en
t an
d d
is ab
ili ty
cl
ai m
s. I
n d
iv id
u al
s b
ea r
th e
co st
s o
f lo
st i
n co
m e
d u
e to
p er
m an
- en
t in
ca p
ac it
y.
- Th
e m
ar ke
t m
o d
el i
s in
ad eq
u at
e fo
r m
an ag
em en
t d
ec is
io n
s o
n s
e- cu
ri ty
i n
ve st
m en
ts .
- R
ef o
rm i
s n
ee d
ed t
o s
h if
t co
st s
fr o
m p
u b
lic t
o b
u si
n es
s se
ct o
rs ,
en co
u ra
g in
g in
ve st
m en
t in
s af
et y
m an
ag em
en t
to r
ed u
ce w
o rk
- p
la ce
a cc
id en
ts
- A
c le
ar d
ef in
it io
n o
f o
cc u
p at
io n
al
d is
ea se
s is
n ee
d ed
. -
Im p
o rt
an ce
o f
p ro
ac ti
ve
sa fe
ty m
ea su
re s.
-
N ee
d f
o r
b et
te r
co st
in g
m o
d el
s an
d t
h e
im p
o rt
an ce
o f
ef fe
ct iv
e sa
fe ty
m an
ag em
en t
to p
re ve
n t
o cc
u p
at io
n al
a cc
id en
ts a
n d
d is
- ea
se s
in t
h e
w o
rk p
la ce
. 12
Sh al
in i
[1 7]
M au
ri ti
u s
Ju ly
2 00
2– Ju
n e
20
03 M
ix ed
H u
m an
ca
p it
al M
ed ic
al c
o st
( tr
an sf
er t
o h
o s-
p it
al þ
ad m
is si
o n
t o
h o
s- p
it al
þ m
ed ic
al s
ta ff
þ o
th er
m
ed ic
al r
es o
u rc
es )
O cc
u p
at io
n al
H ea
lt h
a n
d
Sa fe
ty I
n ve
st ig
at io
n c
o st
s Lo
ss o
f in
co m
e b
ec au
se o
f d
ay s
o f
ab se
n ce
f ro
m w
o rk
Lo
ss o
f in
co m
e b
ec au
se o
f p
er m
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individual risk preferences, and awareness of the risks faced. Furthermore, this model is unaffected by the issue of incomplete or asymmetric information.
The Human Capital method similarly categorizes costs into direct ones. In the context of occupational injuries and illnesses, the Human Capital model calculates the economic impact by considering the potential loss of productivity and income resulting from these inci- dents. However, this method has been criticized for several reasons, including its failure to account for costs incurred by individuals who do not earn a salary, the underestimation of costs for women and minorities—whose wages are often lower due to discrimination- and its omission of substitution effects, inability to account for human capital investment, limited scope of analysis, neglect of the social perspective, and the sensitivity of its underlying assumptions [17].
The Human Capital approach is often supplemented by other methods to gain a more comprehensive understanding of the true costs and effects of injuries and illnesses. For instance:
Willingness to Pay is the most modern approach to calculating the cost of damage. It is based on estimating the amount of money that an individual or society is willing to pay, or accept, in exchange for reduced exposure to the risk of injury, illness, or death. This method is the most frequently chosen by authors to determine the value of a life [12, 17, 18].
The Quality-Adjusted Life Year or Disability-Adjusted Life Year (DALY) method evaluates changes in an individual’s health status. The Jury Awards method is gaining popularity in studies in the United States, based on the assumption that the costs of decreased quality of life can be estimated as the difference between the com- pensations awarded by a jury and the financial costs claimed by the victim [11].
At times, researchers combine various methods to obtain the most accurate estimates [15]. However, these approaches are criticized for their subjectivity in valuation. Assigning a monetary value to human life, health, and well-being can be ethically and morally controver- sial, as it may not fully reflect intangible costs, such as pain, suffer- ing, and reduced quality of life.
Overall, the choice of method to apply depends on the availability of data and the purpose for estimating costs. A complete estimation of the costs of occupational injuries and illnesses is not always ne- cessary. It is more useful to use a cost estimation method that produces results sufficiently reliable to serve as a basis for decision-making. Particularly, it is important to avoid double- counting when aggregating costs [15].
The main limitations of cost studies largely stem from unestimated cost components that and methodological decisions and limitations that can influence the estimates. These include, among others:
• The costs borne by society are not simply the sum of costs among various stakeholders. These assumptions may not necessarily be accurate, leading to either underestimation or overestimation of costs.
• The cost estimation methodology used in the study often relies on assumptions and the extrapolation of national data to reflect specific circumstances, which can introduce uncertainties into the estimates. Therefore, such studies are hardly extrapolatable and comparable.
In certain cost studies, there is a trend towards integrating cost studies with those on determinants [14, 19]. Specifically, costs are analysed depending on employee characteristics (age, gender, nationality), occu- pations, sectors, or specific injuries. However, the relationship between accident determinants and costs is not exhaustively studied.
Limitations of the review process Firstly, it is possible that some studies may have been excluded from the findings due to bias in setting selection criteria, using specific databases, and excluding of articles not written in English [21]. Additionally, variability in the terminology used to describe occu- pational accidents may have led to the omission of certain studies.
Publication bias may also have played a role, as there is a tendency to publish studies with significant findings, while those with less impactful or negative findings remain unpublished [22]. However, the secondary review helped mitigate these limitations, and articles from non-indexed journals were considered. Finally, a meta-analysis was not possible due to the heterogeneity of the included studies. Despite these limitations, the main strength of this work lies in the use of a systematic and structured search methodology, as well as a specific approach to developing the narrative synthesis.
Comprehending the determinants and costs of injuries is vital for policymakers, employers, and researchers to effectively manage oc- cupational safety and health risks, and to allocate resources efficient- ly for preventing workplace injuries and mitigating associated costs. However, many risks and costs remain insufficiently understood, resulting in their underestimation. Moreover, the review presented in this article offers key insights within these domains. Specifically, it highlights the primary perspectives and models employed in current research, which may shape the quality of future studies. The findings not only demonstrate advancements in occupational injury science but also reveal its limitations and areas for improvement. As a result, they suggest potential directions for further research, such as con- ducting studies that integrate both cost and determinant perspec- tives and producing more internationally and cross-sectorally comparable economic studies and evaluations.
Conflict of interest: None declared.
Funding Funded by the Support to Research Groups granted by the University of Castilla-La Mancha to the research group External and Internal Information Systems in Organizations: Corporate and Management Information.
Data availability The data supporting the findings of this study are available within the article.
Submission declaration statement All authors state that this article is not under consideration else- where or have not already been published, and that it will not be submitted for publication elsewhere without the agreement of the Managing Editor.
Information on rights Authors state that they observe the usual rules and practices regard- ing the reproduction of copyright material in their articles, assuming responsibility for obtaining permission where appropriate.
Key points
• Fifteen studies were ultimately included in this review; this research included results on determinants and cost- determinant studies.
• The included studies examined the relationship between accidents and personal characteristics or related factors of workers, as well as with economic cycles and organisational structure.
• The inclusion of the three types of costs—direct, indirect, and quality of life—is necessary for an accurate and appropriate economic valuation of occupational accidents.
• The sex of the worker is identified as a distinct and determining factor in occupational accidents.
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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. European Journal of Public Health, 2025, 35, 91–100 https://doi.org/10.1093/eurpub/ckae197 Original Manuscript
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- Active Content List
- Introduction
- Methods
- Results
- Discussion
- Funding
- Data availability
- Submission declaration statement
- Information on rights
- References
