Non-fatal agricultural injury surveillance in the United States: A review of national-level survey-based systems

Cost of agricultural injuries in the United States: Estimates based on surveillance, insurance, and government statistics

BACKGROUND

Agriculture is a hazardous industry but the frequency and severity of agricultural injuries are not well documented as nonfatal injuries to self-employed farmers are excluded from national surveillance. The aim of this study was to provide new injury rate and cost estimates in US agriculture.

METHODS

Injury data were obtained from 2018 to 2020 Farm and Ranch Health and Safety Surveys. Responses from 7,195 farm/ranch operators included injury frequency, medical expense, and lost work time data. These injury rate and cost data were used to estimate national injury costs for self-employed farmers using Census of Agriculture operator count, injury costs for hired agricultural workers using Bureau of Labor Statistics (BLS) nonfatal injury count, and fatal injury costs using BLS count of fatal injuries.

RESULTS

The injury rate for self-employed farmers and ranchers was 15.25 injuries per 100 operators or 11.9 "recordable" injuries per 100 full time equivalent operators (FTE). Average costs for nonfatal injuries were: $10,878 for medical care, $4735 for lost work time, and $15,613 in total per injury case. The total national agricultural injury cost estimate was $11.31 billion per year; 11.3% higher than the earlier benchmark using 1992 data; both in March 2024 dollars. The cost burden was 2.1% of the US national gross farm income and 13.4% of the net farm income in 2019.

CONCLUSIONS

Injuries result in significant economic losses to farm and ranch operators, their family members, workers, and society. Preventive efforts should be scaled up to reduce the frequency and costs of agricultural injuries.

Profile and risk factors in farmer injuries: a review based on Haddon matrix and 5 E's risk reduction strategy

Farmers are considered a high-risk group for intentional and unintentional injuries. This review identified significant risk factors for agricultural injuries in farmers and explored injury prevention countermeasures based on the literature. Therefore, CiteSpace software was used to analyze the relevant literature in this field. Additionally, we identified both key risk factors and countermeasures using the Haddon matrix and the 5 E's risk reduction strategies conceptual framework, respectively. The risk factors were identified from four categories (host, agent, physical environment, and social environment) corresponding to three phases (pre-event, event, and post-event). Interventions of 5 E's risk reduction strategies including education, engineering, enforcement, economic, and emergency response have been proven effective in preventing injuries or reducing their severity. Our findings provide a comprehensive foundation and research direction for the study and prevention of injuries among farmers.

Counting Farm Injuries and Fatalities: An Assessment of Irish Occupational Health and Safety Surveillance Data Systems

OBJECTIVE

Generation of reliable data underpins the effectiveness of Occupational Health and Safety (OHS) surveillance systems. Despite the importance of understanding OHS data systems, there are few papers that provide overviews of their structure and/or content. This paper introduces a basic framework for assessing OHS data systems that will be of use to researchers internationally. We applied this approach to assess the Irish OHS data system by undertaking a data mapping exercise.

METHOD

We developed a checklist based on recommendations of monitoring and measurement of OHS proposed by the National Academies of Sciences, Engineering, and Medicine (USA). An assessment of published reports that present systematic OHS surveillance data was undertaken to identify the institutions or organisations responsible for collecting and curating the data, their remit, and, associated with this, their respective case definitions. We then provide an overview of the variables collected and these are then mapped against the checklist.

RESULTS

The assessment highlights that whilst the farm fatalities dataset provides complete coverage of all fatalities, regardless of age or employment status, the same is not true of the three non-fatal injuries datasets reviewed. There are important differences in the data collection methods and, associated with this, which populations are covered.

PRACTICAL APPLICATION

The assessment approach provides valuable insights into the strengths and weaknesses of a critical element of OHS surveillance systems, namely the production of datasets. This knowledge is important for researchers as understanding the data that informs their research is fundamental to good science. It is critical for policy-makers and other stakeholders to understand the strengths and weaknesses on which OHS policy, strategies, or education and training interventions are developed.

Injuries Among Hispanic/Latinx Agricultural Workers Seen in Illinois Hospitals

OBJECTIVE

Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs.

METHODS

Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care.

RESULTS

We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers' compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons.

CONCLUSION

The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.

Non-Fatal Agricultural Injuries and First Aid Self-Efficacy Among Greenhouse Workers in Turkey

OBJECTIVE

This study aimed to see if there was a link between first aid self-efficacy and the frequency of occupational accidents and non-fatal agricultural injuries in greenhouse agriculture workers.

METHODS

This cross-sectional study was conducted with 251 people in a district center. Sociodemographic, occupational accident, and injury questionnaires prepared by the researchers and the First Aid Self-Efficacy Scale were used to collect the data. SPSS 25.0 software was used to evaluate the data and descriptive statistics; the Mann-Whitney U test and Kruskal Wallis analysis of variance were applied in the analysis.

RESULTS

71.4% of the participants experienced an occupational accident by falling and slipping; 41.7% were slightly injured after the accident, and 63.2% experienced injuries in fractures, sprains, and crushes. We found that most injuries were in the lower extremities (33.2%), and 66.4% were admitted to the hospital. We ascertained that male workers' median first-aid self-efficacy scores were significantly higher than those of female workers (p < .05). We determined there was no significant difference between first-aid self-efficacy scores according to other sociodemographic variables, occupational accidents, or injury data (p > .05).

CONCLUSION

Occupational accidents and non-fatal agricultural injuries are common in greenhouse agriculture, and male workers have higher first-aid self-efficacy than female workers. Since greenhouse work is a hazardous line of work, providing simple medical first-aid training would be useful for those working in this field.

Do social influences, awareness, or experience matter? Toward a better understanding of Farm-related Injury Risk Perception among agricultural science college students in Ireland

Introduction

Formal farm safety education/training should be tailored, in terms of the approach, content and delivery, to students undertaking agriculture education and training to enhance Farm-related Injury Risk Perception (FIRP). To this end, this paper assesses factor(s) explaining or predicting levels of FIRP amongst students studying for a degree in agriculture science.

Methods

A cross-sectional online survey was conducted with a nationally representative sample of Bachelor of Agriculture Science (BAgrSc) students (N = 417) (aged 18-20) in Ireland. Descriptive [frequency and cross-tabulations) and inferential (Ordinal Logistic Regression (OLR)] analyses were applied to evaluate the effects of social influences, experience (of farming, of a near-miss or injury), and awareness (of others who were injured or killed on the farm) on FIRP.

Results

The study found that social influences negatively affected FIRP (P < 0.05). A relatively small number of students reported experiencing an injury (n = 56, 13.4%) that resulted in them being unable to participate in educational or social activities. A quarter of the respondents did, however, record experiencing a near-miss/close call (n = 106, 25.4%). A notable proportion (n = 144, 34.5%) of students had personal connections to someone who died as a consequence of a farm-related incident and 56.4% (n = 235) knew someone who was moderately or severely injured. OLR findings established that experiencing a severe injury, having a near-miss or close call, and awareness of a farm-related death or injury positively affects FIRP (P < 0.05).

Conclusions

Perception of farm risks amongst students in Ireland is low. Students who recorded higher levels of risk perception were, however, more likely to report experiencing a near-miss, close call or severe injury, or knowing someone who experienced a farm-related injury or fatality. Farmers, family or friends were found to negatively impact the FIRP and this reflects previous research findings. Our findings highlight the need for education and training programs to enhance opportunities for student peer-to-peer learning through sharing of experiences and/or knowledge of farm injuries and/or fatalities. Such activities will enhance awareness and understanding amongst the general population of students leading to increased FIRP and contribute to a reduction in risk-taking.

AgISM: A Novel Automated Tool for Monitoring Trends of Agricultural Waste Storage and Handling-Related Injuries and Fatalities Data in Real-Time

Availability of summarized occupational injury data is essential for establishing complete incident surveillance systems, targeting incident preventative efforts, assessing the efficacy of prevention programs, and enhancing workplace safety. There are currently limited automated injury monitoring systems for summarizing occupational injuries obtained from electronic news and other sources, or for visualizing real-time data through an output platform. A “near” real-time surveillance tool could enable researchers to visualize data as it is being collected and provide a more rapid monitoring method to identify patterns in injury data. An automated data pipeline method could provide more current, consistent, and reliable information for injury surveillance systems and injury prevention purposes. Such a system could help public policy makers, epidemiologists, and injury prevention professionals spend less time and effort on classifying cases, increase confidence in the data, and respond quicker to “patterns” of specific types of incidents. Currently, injury surveillance approaches generally rely on manual coding of injury data, resulting in inconsistencies in classification of incident, and contributing factors and considerable delays in publishing results. This study focused on developing and testing a more automated coding methodology for use with incident narratives for further data mining, analysis, and interpretation. The concept was tested on 491 documented fatalities or serious injuries involving agricultural waste storage, handling, and transport operations. The approach provided current and real-time summarization of incident data along with data analysis and visualization by using a standard questionnaire for record-keeping, Python data frames, and the MySQL database. Findings in this study provided evidence for the reliability of classifying injury news clipping narratives into external real-time incident categories. Results showed a very encouraging performance for the chosen model to monitor injury and fatality incidents with efficiency, simplicity, data quality, timeliness, and a consistent coding process.

Understanding occupational safety and health surveillance: expert consensus on components, attributes and example measures for an evaluation framework

BACKGROUND

Occupational safety and health (OSH) surveillance systems track work-related fatalities, injuries and illnesses as well as the presence of workplace hazards and exposures to inform prevention efforts. Periodic evaluation is critical to the improvement of these systems to meet the demand for more timely, complete, accurate and efficient data processing and analysis. Despite the existence of general guidance for public health surveillance evaluation, no tailored guidance exists for evaluating OSH surveillance systems to date. This study utilized the Delphi technique to collect consensus among experts in the United States on surveillance elements (components, attributes and measures) to inform the development of a tailored evaluation framework.

METHODS

A Delphi study approach with three survey rounds invited an expert panel to rate and comment on potential OSH surveillance evaluation framework elements, resulting in an optimal list of elements through the panel's consensus. Additionally, experts completed a review of OSH surveillance systems they worked with and answered questions regarding the development of an evaluation framework. Descriptive statistics of the ratings were compiled for the Delphi process. Major themes from experts' comments were further identified using content analysis to inform contextual information underlying their choices.

RESULTS

Fifty-four potential experts across the United States were contacted to participate in the Delphi study. Ten experts began the first survey round with eight then seven experts continuing in the subsequent rounds, respectively. A total of 64 surveillance components, 31 attributes, and 116 example measures were selected into the final list through panel consensus, with 134 (63.5%) reaching high consensus. Major themes regarding current OSH surveillance focused on resources and feasibility, data collection, flexibility, and the inter-relatedness among elements.

CONCLUSIONS

A Delphi process identified tailored OSH surveillance elements and major themes regarding OSH surveillance. The identified elements can serve as a preliminary guide for evaluating OSH surveillance systems. A more detailed evaluation framework is under development to incorporate these elements into a standard yet flexible approach to OSH surveillance evaluation.

What about the Rest of Them? Fatal Injuries Related to Production Agriculture Not Captured by the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI)

Surveillance of injuries in production agriculture is necessary to inform stakeholders about workplace hazards and risks in order to improve and advance injury prevention policies and practices for this dangerous industry. The most comprehensive fatal injury surveillance effort currently in the United States is the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), which covers occupational fatalities in all U.S. industries, including production agriculture. However, this surveillance does not include many categories of fatalities that occur during agricultural work or on production agriculture worksites. To better capture the human cost of production agriculture, the authors of this paper call for the collection of additional data with a broader scope that supplements, not replaces, the current CFOI. This paper describes challenges in surveillance, highlights key procedural gaps, and offers recommendations for advancing national surveillance of fatal traumatic injuries associated with production agriculture.

Occupational Injuries among Latino/a Immigrant Cattle Feedyard Workers in the Central States Region of the United States

Agriculture is a dangerous industry with high rates of occupational injuries. Immigrants comprise the majority of the hired agricultural workforce in the United States, and these workers may be at a higher risk for job-related injuries. This study addressed the frequency, characteristics, and risk factors of occupational injuries among Latino immigrant cattle feedyard workers. Data were collected through structured interviews with Latino immigrant cattle feedyard workers in Kansas and Nebraska (n = 243; 90.9% male). Descriptive statistics and logistic regression were used to identify risk factors for injury. Nearly three-fourths of participants (71.2%) reported having experienced one or more injuries in the past while working on a cattle feedyard. The most frequent types of reported injuries, including those not requiring medical care, were bruises/contusions (40%), cuts/lacerations (21%), and sprains/strains (12%). These injuries were mainly caused by animals/livestock (33%), chemicals (23%), falls (12%), and tools (9%). Significant risk factors for injury included male gender (OR 5.9), being over age 35 (OR 2.6), working on a large or an extra-large feedyard (OR 5.4), having 11 or more employees on the feedyard (OR 3.6), and working more than eight hours a day (OR 4.7). Having received safety training was also associated with greater risk of injury in a univariable model (OR 2.6). Cattle feedyard workers are at high risk for injury and require more effective preventive measures.

Farm Suicides in Wisconsin, 2017–2018: Preliminary Findings and a Call for Future Research

Studies across the last few decades have consistently found farmers and farmworkers at an elevated risk of death by suicide compared to other occupational groups in the United States. Still, there is currently no comprehensive national surveillance system for agricultural-related injuries or suicides. For this study, we analyzed Wisconsin death certificate data from 2017 and 2018 to identify the burden of suicide among farmers and farmworkers. In 2017 and 2018, 44 farm-related suicides were identified, or 14.3 per 100,000 farmers and farmworkers. The median age of victims was 51.5 ± 20, and six (13.6%) were female. As these suicide cases were cross-checked, we found that none were identifiable solely from previously published news media or obituaries, indicating: (1) a clear need for a multi-sourced suicide data approach and inter-agency collaborations for future research, and (2) the need for a deeper investigation into the reporting of farm-related suicides. These data are necessary for informing state and local level policy, resource prioritization, and the evaluation of intervention efforts.

Stakeholders’ Consumption of Agricultural Injury Reports from News Media: A Six-Year Analysis of Website Usage and Visitor Analytics

AgInjuryNews.org is a news report-based, online sentinel surveillance dataset that has provided publicly available news and media reports of agricultural injuries since early 2015. In the 6 years since its inception, AgInjuryNews.org has hosted 12,897 unique visitors and has collected 997 user account registrations. New users from geographic areas home to NIOSH-funded agricultural research centres were most prominent, with these centres returning in larger numbers, comparatively. Users were acquired mostly through web searches, collaborations with other agencies, and paid Facebook.com advertisements. Paid advertisements recruited 3792 visitors; however, retention, registrations, and on-site engagement from this source was low. This analysis shows that data consumption on AgInjuryNews.org is steadily growing. Similar self-hosted programs that provide data or digital resources to agricultural safety and health stakeholders should consider the integration of auditing and analytics tracking, including user registrations.

Road traffic injury mortality and morbidity by country development status, 2011-2017

PURPOSE

This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020.

METHODS

Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.

RESULTS

Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths.

CONCLUSION

Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Identifying Farmer Workplace Injury Risk Factors in Ireland Using Farm Accounts Data

Identification of occupational workplace injury risk factors is dependent on gaining sufficient and reliable data on both injury occurrence and associated workplace factors. Assessing workplace injury risk factors associated with farming is challenged by non-collection, non-reporting, or under-reporting by farmers, particularly those operating family farms in a self-employed manner. A supplementary (or add-on) farm operator (FO) workplace injury survey was undertaken in association with the Irish National Farm Survey (NFS), which is responsible for provision of Irish farm-level data to the European Commission (EC) Farm Accountancy Data Network (FADN). Data from this add-on survey were analyzed in association with farm and socio-economic data routinely collected by NFS as a component of the FADN. The combined data-set was analyzed using both descriptive and inferential statistical techniques including multivariate logistic regression to identify risk factors for occurrence of farm operator workplace injuries (FOWI). FOWI levels were significantly higher on farms where both the FO and their spouse engaged in Off Farm Employment (OFE). More generally, FO injury levels were associated with farm workload and investment levels. The study demonstrates how FADN farm and socio-economic data can be combined with additional FO workplace injury data to identify workplace injury risk factors. The study identifies a risk factor for FOWI occurrence where both FO and spouse engaged in OFE. More generally, it indicates that farm workplace injuries are associated with farm management-related factors.

Evaluating Oregon's occupational public health surveillance system based on the CDC updated guidelines

Background

The Oregon Occupational Public Health Program (OOPHP) monitors occupational health indicators (OHIs) to inform occupational safety and health (OSH) surveillance. In 2018, OOPHP evaluated the performance of the OSH surveillance system and identified areas for future improvement.

Methods

Following the Centers for Disease Control and Prevention (CDC) updated guidelines for evaluating public health surveillance systems, the OOPHP evaluation team engaged internal and external stakeholders using a mixed‐methods approach. Operational measures for ten surveillance attributes were developed. Multiple data collection methods resulted in credible evidence for evaluation conclusions. Analyses included summary statistics and qualitative analysis of interviews, a focus group, and online surveys.

Results

Twenty stakeholders took part in this evaluation, with an average participation rate of 55%. Results showed the Oregon OSH surveillance system was simple, flexible, and highly accepted by its stakeholders. Funding security presents challenges for stability. A lack of timeliness of OHIs, low relevance of OHIs to local OSH issues, and the system's ineffectual data dissemination all limit the usefulness of the OSH surveillance system. A review of key data sources for the system showed good data quality and predictive value positive, but relatively poor sensitivity and representativeness.

Conclusions

The evaluation team successfully adapted attributes and examples in the CDC guidelines to this Oregon OSH surveillance evaluation. The evaluation findings have informed the development of recommendations for improvements to OOPHP's OSH surveillance. Future research is needed to develop guidance specific to OSH surveillance evaluation.

Redesigning a Sentinel Surveillance System for Collecting and Disseminating Near Real-Time Agricultural Injury Reports: System Usability Study

Background

Injury data and reports provide valuable information for both public and private organizations to guide programming, policy, and prevention, but in the increasingly complex and dangerous industry of US agriculture, the injury surveillance needed to produce this data is lacking. To address the gap, AgInjuryNews was established in 2015. The system includes fatal and nonfatal injury cases derived from publicly available reports, including occupational and nonoccupational injuries, occurring in the agricultural, forestry, and fishing (AFF) industry.

Objective

The study aimed to develop a stakeholder-engaged redesign of the interactive, up-to-date, and publicly available dataset of US AFF injury and fatality reports.

Methods

Instructor-led heuristic evaluations within a 15-student undergraduate course, data from 8 student participants of laboratory-based usability testing and 2016 and 2017 AgInjuryNews-registered user surveys, coupled with input from the National Steering Committee informed the development priorities for 2018. An interdisciplinary team employed an agile methodology of 2-week sprints developing in ASP.NET and Structured Query Language to deliver an intuitive frontend and a flexible, yet structured, backend, including a case report input form for capturing more than 50 data points on each injury report.

Results

AgInjuryNews produced 17,714 page views from 43 countries in 2018 captured via Google Analytics, whereas 623 injury reports were coded and loaded, totaling more than 31,000 data points. Newly designed features include customizable email alerts, an interactive map, and expanded search and filter options. User groups such as the Bureau of Labor Statistics and the Agricultural Safety and Health Council of America have endorsed the system within their networks. News media have cited or referenced the system in national outlets such as the New York Times, Politico, and the Washington Post.

Conclusions

The new system’s features, functions, and improved data granularity have sparked innovative lines of research and increased collaborative interest domestically and abroad. It is anticipated that this nontraditional sentinel surveillance system and its dataset will continue to serve many purposes for public and private agricultural safety and health stakeholders in the years to come.