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Occupational Medicine Advance Access originally published online on February 1, 2006
Occupational Medicine 2006 56(3):187-190; doi:10.1093/occmed/kqj016
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Determinants of accident proneness: a case–control study in railway workers

G. C. Gauchard1,2, J. M. Mur1, C. Touron3, L. Benamghar1, D. Dehaene4, P. Perrin1,2 and N. Chau1,5

1 Inserm, U420, World Health Organization Collaborative Centre, Faculty of Medicine, University Henri Poincaré, Nancy 1, Vandoeuvre-lès-Nancy, France
2 Balance Control and Motor Performance, UFR STAPS, University Henri Poincaré, Nancy 1, Villers-lès-Nancy, France
3 Département des Services Médicaux, Direction des Ressources Humaines, SNCF, Paris, France
4 Département des Conditions du Travail et Facteurs Humains, Direction des Ressources Humaines, SNCF, Paris, France
5 Inserm, U669, PSIGIAM, Maison de Solenn, Paris, France

Correspondence to: Nearkasen Chau, Inserm, U669, PSIGIAM, Faculty of Medicine, BP 184, 54505 Vandoeuvre-lès-Nancy Cedex, France. Tel: +33 3 83 57 61 46; e-mail: nearkasen.chau{at}wanadoo.fr


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background Accident proneness or workers who have more frequent occupational injuries is common but the role of occupational and individual factors has rarely been studied.

Aim To assess the relationships of certain occupational and individual characteristics with frequency of occupational injuries.

Method This case–control study included 1305 male workers with occupational injuries during 1999–2000 and 1305 controls from a railway company. A standardized questionnaire was completed by the occupational physician in the presence of the subject. The data were analysed using logistic regression.

Results Having more than one injury was associated with short service in the present job, younger age, sleep disorders, smoking, requesting a job change, physical disability and lack of physical activity. Safety training was negatively related to injury frequency. Short service in the present job was the only significant factor for single injuries.

Conclusion This study identified a number of work and individual factors that predicted occupational injury frequency and may be useful in designing preventative measures. Occupational physicians could assist workers to be more aware of the risks and to find remedial measures.

Keywords      Case-referent; experience; physical activities; repeated occupational injuries; request for job change; sleep disorders; smoker


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Occupational injuries result in severe socio-economical consequences [1]. The annual incidence of injuries for workers from the French National Railway Company (SNCF) is ~4%. Occupational injuries are mainly caused by work conditions [2–4], but some individual characteristics also increase the risk [5–8].

Some workers have more than one injury during a short period. It is thus important to identify risk factors which might be useful in accident prevention. Unfortunately, there has been limited research concerning accident proneness. This study assessed the roles of a number of individual and occupational factors in the frequency of occupational injuries in railway workers.


   Methods
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 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
 References
 
A voluntary case–control study was conducted on male workers who had worked for ≥3 years in the SNCF. The methods used were described in an earlier study conducted by the authors [7]. In that study, the cases were recruited by occupational physicians at the time of medical consultations before they returned to work following occupational injury, and the controls were recruited at the time of routine annual medical examinations. Occupational physicians play an important role as they examine workers during annual medical examinations and in consultations before returning to work after disease or injury and note their workplaces and work conditions. The cases were workers with at least one lost time injury between March 1999 and February 2000. The controls were workers who did not experience any injury during the preceding 3 years. They were matched to cases on both job and establishment. In total, 1305 cases and 1305 controls were recruited. Of the cases, 355 subjects had two or more lost time injuries (‘frequent injury’ group) and 950 subjects experienced only one lost time injury (‘single injury’ group) during the previous 3 years.

A questionnaire, filled in by the occupational physician in the presence of the subject, was used. It recorded birth date, weight, height, educational level, post-vocational training and vocational safety training during the previous 5 years, type of job, years in present job, recent work environment change, request for job change (except for promotion), smoking habit, alcohol consumption, sporting activities, do-it-yourself and gardening activities, sleep disorders, physical disabilities, hearing disorders, vision disorders, the number of lost time occupational injuries during the previous 3 years and description of the last injury for the cases. The hazard period considered was that of the last injury. Weight and height were measured at the time of interview. The Commission Nationale de l'Informatique et des Libertés approved the study protocol, questionnaire and consent form. Informed consent was obtained from the subjects.

The {chi}2 independence test and the McNemar {chi}2 test for matched data were used to assess the relationships between job, type of injuries and factors associated with frequent and single injuries. Then, conditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for all factors considered.


   Results
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 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
The sample included 1305 cases–controls. Frequent injuries represented 27% of the cases. The characteristics of the subjects are shown in Table 1. Frequent injuries were more common in mechanical maintenance operators, and were mainly caused by handling tools, mechanical repairs and maintenance, collision with/by objects and falling objects.


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  		Table 1. Characteristics of workers with single injuries or more frequent injuries and their controls

 
Table 2 shows those factors with significant ORs for frequent injuries. These were ≤5 years in present job, sleep disorders, smoking and no do-it-yourself and no gardening activity. Safety training was negatively related with frequent injuries. Five years or less in the present job was the only significant factor for single injuries.


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  		Table 2. Adjusted ORsa and 95% CIs for various factors

 

   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
This study found that an increased incidence of frequent injuries was associated with certain individual and occupational factors. These were the first year in the present job, younger age, requesting a job change, having a sleep disorder or a physical disability, smoking and not carrying out any physical activity. The job role was not investigated because it was a matched factor. The hazard period considered was that of the last injury for all factors except for body mass index which was determined at the time of interview. We believe that it did not greatly vary between the periods of injuries and the time of interview for most of the subjects as only 14% of the cases had sick leave for >30 days. According to our experience, it does not greatly change in a 3-year period for most subjects.

This study found that shorter service (≤5 years in present job) and younger age were associated with frequency of injury. The role of younger age in occupational injuries is known [5,6]. Both factors are associated with lack of experience which increases injury risk [9]. Thus, prevention is important for workers in their first year of a job. This is significant as many workers change jobs during their careers. Requesting a job change also influenced injury frequency. Previous work has shown that it results in altered cognitive processes, work abilities, risk assessment and increased stress [10].

Our study found that sleep disorders, smoking and lack of physical activity were strongly associated with frequent injuries but not with single injuries. Their roles are known [5–7], but it appears that they represent long-term risks for frequent injuries. Sleep disorders and smoking alter health status and work ability, and may lead to fatigue and altered risk perception which increase injuries [11]. The role of physical activity in injury risk reduction was expected as it improves work ability and balance control [12]. Similarly, the increased risk associated with physical disability was expected. The negative role reported for safety training was not expected. It reveals that this training, in which workers with the highest hazard exposure participate, cannot eliminate injuries when the risk is high [3].

Our study does not reveal alcohol consumption as a risk factor. Similar results were observed in one study [5] but an effect was shown for excess alcohol use in another [6]. However, alcohol consumption has been found to influence injuries due to certain falls [7].

The main findings of our study are that first year in a job, younger age, sleep disorders, smoking, requesting a job change, physical disability and lack of physical activity are long-term risk factors for more frequent injuries. Preventive action should target work conditions and encourage physical activity. Occupational physicians could help workers to be more aware of the risks and to find remedial measures.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

  1. Dembe AE. The social consequences of occupational injuries and illnesses. Am J Ind Med 2001;40:403–417.[Medline]

  2. Melamed S, Yekutieli D, Froom P, Kristal-Boneh E, Ribak J. Adverse work and environmental conditions predict occupational injuries. The Israeli cardiovascular occupational risk factors determination in Israel (CORDIS) study. Am J Epidemiol 1999;150:18–26.[Abstract/Free Full Text]

  3. Ghosh AK, Bhattacherjee A, Chau N. Relationships of working conditions and individual characteristics with occupational injuries: a case-control study in coal miners. J Occup Health 2004;46:470–480.[CrossRef][Medline]

  4. McGwin G, Taylor AJ, MacLennan PA, Rue LW III. Unusual job activities as a risk factor for occupational injuries. Occup Med (Lond) 2005;55:66–68.

  5. Chau N, Mur JM, Benamghar L et al. Relationships between some individual characteristics and occupational accidents in the construction industry: a case-control study on 880 victims of accidents occurred during a two-year period. J Occup Health 2002;44:131–139.[CrossRef]

  6. Bhattacherjee A, Chau N, Otero Sierra C et al. Relationships of job and some individual characteristics with occupational injuries in employed people: a community-based study. J Occup Health 2003;45:382–391.[CrossRef][Web of Science][Medline]

  7. Gauchard GC, Chau N, Touron C et al. Role of certain individual characteristics in occupational accidents due to disequilibrium: a case-control study in the employees of a railway company. Occup Environ Med 2003;60:330–335.[Abstract/Free Full Text]

  8. Zwerling C, Whitten PS, Davis CS, Sprince NL. Occupational injuries among workers with disabilities: the national health interview survey, 1985–1994. J Am Med Assoc 1997;278:2163–2166.[Abstract/Free Full Text]

  9. Gabel CL, Gerberich SG. Risk factors for injury among veterinarians. Epidemiology 2002;13:80–86.[CrossRef][Web of Science][Medline]

  10. Lawler KA, Schmied LA. The relationship of stress, type A behavior and powerlessness to physiological responses in female clerical workers. J Psychosom Res 1987;31:555–566.[CrossRef][Web of Science][Medline]

  11. Ulfberg J, Carter N, Edling C. Sleep-disordered breathing and occupational accidents. Scand J Work Environ Health 2000;26:237–242.[Web of Science][Medline]

  12. Gauchard GC, Gangloff P, Jeandel C, Perrin PP. Influence of regular proprioceptive and bioenergetic physical activities on balance control in elderly women. J Gerontol A Biol Sci Med Sci 2003;58:M846–M850.[Abstract/Free Full Text]


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