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Occupational ladder fall injuries - United States, 2011.

Socias-CM; Chaumont Menendez-CK; Collins-JW; Simeonov-P
MMWR 2014 Apr; 63(16):341-346
Falls remain a leading cause of unintentional injury mortality nationwide, and 43% of fatal falls in the last decade have involved a ladder (1). Among workers, approximately 20% of fall injuries involve ladders (2-4). Among construction workers, an estimated 81% of fall injuries treated in U.S. emergency departments (EDs) involve a ladder (5). To fully characterize fatal and nonfatal injuries associated with ladder falls among workers in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed data across multiple surveillance systems: 1) the Census of Fatal Occupational Injuries (CFOI), 2) the Survey of Occupational Injuries and Illnesses (SOII), and 3) the National Electronic Injury Surveillance System-occupational supplement (NEISS-Work). In 2011, work-related ladder fall injuries (LFIs) resulted in 113 fatalities (0.09 per 100,000 full-time equivalent* [FTE] workers), an estimated 15,460 nonfatal injuries reported by employers that involved >1 days away from work (DAFW), and an estimated 34,000 nonfatal injuries treated in EDs. Rates for nonfatal, work-related, ED-treated LFIs were higher (2.6 per 10,000 FTE) than those for such injuries reported by employers (1.2 per 10,000 FTE). LFIs represent a substantial public health burden of preventable injuries for workers. Because falls are the leading cause of work-related injuries and deaths in construction, NIOSH, the Occupational Safety and Health Administration, and the Center for Construction Research and Training are promoting a national campaign to prevent workplace falls (2). NIOSH is also developing innovative technologies to complement safe ladder use (6). The Bureau of Labor Statistics (BLS) administers the CFOI each year to enumerate all fatal occupational injuries using multiple data sources. BLS also implements the annual SOII§ to estimate injury and illness involving ?1 DAFW from a nationally representative sample of employer-collected records. The NEISS-Work surveillance system estimates work-related injuries treated annually in EDs. LFI cases were identified using the Occupational Injury and Illness Classification System,** where the injury source was a ladder and the injury event was a fall to a lower level. To calculate rates, labor force denominator estimates from the U.S. Current Population Survey (CPS) for workers aged >15 years were used. Confidence intervals for NEISS-Work estimates accounted for the variance arising from the stratified cluster sample. The number, percentage, and rate of LFIs from CFOI, SOII, and NEISS-Work in 2011 were compared across demographic, work, and injury characteristics where available. Men and Hispanics had higher rates of fatal and nonfatal LFIs compared with women and non-Hispanic whites and persons of other races/ethnicities. LFI rates increased with age, except for injuries treated in EDs. Fatality rates were substantially higher for self-employed workers (0.30 per 100,000 FTE workers) than salary/wage workers (0.06 per 100,000 FTE workers). Establishments with the fewest employees had the highest fatality rates. The construction industry had the highest LFI rates compared with all other industries. Across all industries, the highest fatal and nonfatal LFI rates were in the following two occupation groups: construction and extraction (e.g., mining) occupations, followed by installation, maintenance, and repair occupations. Head injuries were implicated in about half of fatal injuries (49%), whereas most nonfatal injuries involved the upper and lower extremities for employer-reported and ED-treated nonfatal injuries. Severity of nonfatal LFIs was assessed using median DAFW (for employer-reported injuries) and disposition after ED treatment. Those with the highest median DAFW included men (21 days), workers aged 45-54 years (25 days), Hispanics (38 days), and construction and extraction workers (42 days). Workers with lower extremity (22 days) and multiple body part (28 days) injuries had higher median DAFW compared with other injuries. The hospital admission rate for ED-treated LFIs was 14%, almost three times the estimated overall hospital admission rate of 5% in the NEISS-Work survey for 2011, suggesting that LFIs were more severe compared with all other ED-treated injuries. Fall height was documented for 82 of 113 fatalities and an estimated 11,400 of 34,000 nonfatal ED-treated LFIs. For nonfatal LFIs, nearly 90% were from heights <16 feet (<4.9 m) and fall heights of 6-10 feet (1.8-3.0 m) were most common, accounting for 50% of ED-treated LFIs. For fatal LFIs, fall heights of 6-10 feet (1.8-3.0 m) were most common but accounted for only 28% of all fatalities.
Fall-protection; Injuries; Mortality-rates; Morbidity-rates; Ladders; Construction; Workers; Work-environment; Traumatic-injuries; Statistical-analysis; Humans; Men; Women; Racial-factors; Adolescents; Surveillance
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Journal Article
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NIOSH Division
Priority Area
Transportation, Warehousing and Utilities
Source Name
Morbidity and Mortality Weekly Report
Page last reviewed: May 5, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division