Economic Burden of Occupational Injury and Illness in the United States

Cost estimates are essential to decision makers attempting to wisely allocate scarce health care resources. Cost-of-illness studies for many diseases continue to proliferate (Foster et al. 2006; Petersen and American Diabetes Association 2008; Rosamond et al. 2007, 2008), with cost estimates for coronary heart disease, stroke, cancer, and hypertension updated annually (Rosamond et al. 2007, 2008). By contrast and despite its importance, the generation of information about the costs of occupational injury and illness has not kept pace, as the most recent comprehensive estimate for U.S. costs applies to 1992 (Leigh et al. 1997). Nevertheless, there are several less than comprehensive and related studies. The National Academy of Social Insurance annually updates its estimates of the costs of workers’ compensation (Sengupta, Reno, and Burton 2009). But workers’ compensation data are incomplete. Bonauto and colleagues (2010) found that workers’ compensation records miss from 23 to 53 percent of all medically attended nonfatal injuries, and Leigh and Robbins (2004) found that workers’ compensation missed at least 91 percent of occupational disease deaths. Although Corso and colleagues (2006) generated national estimates for injuries in 2000, they did not separate those that were job related. Biddle (2009) provided cost estimates for occupational injury deaths, but not for nonfatal injuries or diseases. The National Safety Council (NSC 2009) calculates the costs of occupational injuries but excludes assaults, murders, and all illnesses. Finally, the national cost estimates for circulatory disease, cancer, and chronic obstructive pulmonary disease (COPD) do not estimate the portions of these diseases attributed to job-related exposures. The aim of this study is to estimate the national costs of occupational injuries and illnesses among civilians in 2007. To achieve that aim, I have calculated the numbers and costs of fatal and nonfatal injuries and illnesses. Costs are divided into medical and indirect categories. I use broad methodologies such as the cost of illness, incidence, prevalence, and societal perspective that are standard in studies of nonoccupational diseases and injuries. Numbers and costs for all categories are combined to produce the overall most probable estimate of approximately $250 billion for 2007. Finally, a sensitivity analysis investigates the effects of consequential assumptions. This study introduces numerous methodological advances over one that I and my colleagues conducted earlier (Leigh et al. 1997). For example, first, the previous study estimated injuries for state and local government employees by extrapolating from private-sector employees, whereas this study uses new U.S. Bureau of Labor Statistics (BLS) data from government employees. Second, the current study estimates those injuries for the self-employed and agricultural workers that are not simply averages of those in all other private-sector workers. Third, I rely on recent epidemiologic evidence for fractions of diseases such as cancer and COPD that are attributable to workplace exposures. Fourth, I use hospital costs per hospital stay rather than simply days in the hospital to estimate medical costs. Additional advances are discussed as well. These estimates should help inform the debate about the relative costs associated with occupational injuries and illnesses versus other diseases, as well as estimate costs not covered by workers’ compensation. These estimates may also inform decisions by occupational safety and health stakeholders regarding the allocation of resources to prevent injuries versus diseases.