Leigh J P, Markowitz S B, Fahs M, Shin C, Landrigan P J
Department of Economics, San Jose State University, CA, USA.
Arch Intern Med. 1997 Jul 28;157(14):1557-68.
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.
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.
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.
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.
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.
估算1992年美国与职业伤害和疾病相关的年发病率、死亡率以及直接和间接成本。
对美国劳工统计局、国家赔偿保险委员会、国家卫生统计中心、医疗保健财务管理局以及其他政府部门和私人公司收集的全国性和大型区域性数据集进行汇总和分析。
为评估职业伤害和疾病的发病率及死亡率，我们查阅了全国性调查数据并应用归因风险比例法。为评估成本，我们使用人力资本法，将成本分解为直接类别，如医疗和保险管理费用，以及间接类别，如收入损失、家庭生产损失和附加福利损失。部分成本估算取自文献，其他则在本研究中得出。总成本通过将平均成本乘以每个诊断类别的伤害和疾病数量来计算。
估计美国民用劳动力每年约有6500例与工作相关的伤害死亡、1320万例非致命伤害、60300例疾病死亡以及862200例疾病。直接成本（650亿美元）加间接成本（1060亿美元）总计估计为1710亿美元。伤害成本为1450亿美元，疾病成本为260亿美元。这些估计可能偏低，因为它们忽略了与疼痛和痛苦相关的成本以及家庭成员提供的家庭护理成本，并且职业伤害和疾病的数量可能被低估。
职业伤害和疾病的成本很高，这与公众对其预防和改善的有限关注以及社会资源形成鲜明对比。职业伤害和疾病对美国医疗保健总成本的贡献未得到充分重视。
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