Introduction

Injuries, sicknesses or fatalities resulting from industrial injuries or exposures are classified as occupational injuries.1 2 Globally, occupational injuries have long been a major concern, affecting hundreds of millions of employees who are victims of industrial injury and occupational exposure to hazardous substances.3 4 Recently, there has been growing recognition that the impact of these injuries transcends mere physical harm. Labour market outcomes have been considerably affected, resulting in job losses, lower incomes and reduced wealth.5 6 According to estimates from the WHO and the International Labour Organization, occupational risk factors and health outcomes were accountable for 1.88 million fatalities and 88.72 million disability-adjusted life years (DALYs) in 2016. Among these, injuries constituted 29.5% (26.44 million) of the DALYs and 19.3% (0.36 million) of the deaths.7 Occupational injury mortality, accounting for approximately 750 000 deaths, was primarily influenced by extended working hours (greater than 55 hours/week). As industrialisation and urbanisation progress, the dynamics and circumstances of occupational injuries change, thus emphasising the need to address this issue. Therefore, understanding the patterns and factors contributing to occupational injuries is crucial for developing effective policies and intervention strategies.

Numerous studies have investigated the intricacies of occupational injuries across different regions and sectors. Construction sites experience a substantially higher frequency of occupational injuries than other work environments.8 Al-Thani and colleagues observed that young male workers were more susceptible to occupational injuries.9 Despite some advancements, there are continuing challenges in improving workplace safety and addressing inequalities in injury prevention globally.10 Although these studies provide beneficial insights, a lack of research provides a comprehensive, global perspective on occupational injuries, spanning various countries, historical periods and underlying causes.

This research aimed to analyse the impact of occupational injuries on DALYs and global, regional and national prevalence rates and identify the factors that contribute to these statistics. We examined variations in worldwide prevalence and DALYs associated with occupational injuries from 1990 to 2019. Additionally, we assessed the burden by demographic factors, including the Socio-demographic Index (SDI), age, gender, region and country. Our results provide information for public health initiatives and establish the foundation for a global approach to addressing the prevalent issue of occupational injuries.

MethodsOverview and data sources

Global Burden of Disease (GBD) research was conducted to provide thorough and comparative analyses of the international causes of mortality, illness and associated risk factors. In addition to 87 risk variables and risk factor clusters, the 2019 GBD report estimated the prevalence, mortality, incidence, years lived with disability, years of life lost and DALYs of 369 causes of death and disability. Estimates were prepared for 204 countries and territories at the international, regional and national levels.11–13 Rates are calculated using the GBD global population standard and presented as rates per 100 000 person-years that are age standardised.14 From 1990 to 2019, data on fatalities, DALYs, age-standardised mortality rates (ASMR) and age-standardised DALY rates (ASDR) were gathered for 204 nations and territories, categorised by age, gender, SDI and area. The Global Health Data Exchange platform at https://vizhub.healthdata.org/gbd-results/ was used in the 2019 GBD research. The search criteria used were as follows: ‘Risk factor’ for the GBD estimate; ‘deaths, DALYs’ for measure; ‘number and rate’ for metric; ‘Occupational injuries’ for risk; ‘injuries, animal contact, drowning, exposure to mechanical forces, falls, fire, heat, and hot substances, foreign body, other transport injuries, other unintentional injuries, poisonings, and road injuries’ for cause; and ‘1990–2019’ for year.

Definition

Occupational injuries refer to the percentage of injuries among the working age population, which can be directly attributed to their occupation. This was determined by analysing the rates of fatal injuries across 17 economic sectors, including forestry, agriculture, fishing, mining, manufacturing, quarrying, electricity, gas, water, wholesale and retail trade/repair, construction, hospitality, financial intermediation, transport, storage, communication, real estate, renting and public administration. Furthermore, occupational injuries can be attributable to 10 causes, including animal contact, drowning, exposure to mechanical forces, falls, fire, heat and hot substances, foreign bodies, other transport injury, other unintentional injuries, poisonings and road injuries.15

GBD 2019 estimated the SDI of each nation, which is a composite measure of social and economic factors influencing health outcomes in an area.16 The SDI summarises a country’s development status by calculating the geometric average of total fertility, per capita income and average years of schooling. The classification of nations and territories was based on five SDI classes: high, high-middle, middle, low-middle and low. The SDI values range from 0 to 1, where 0 represents the lowest degree of development, and 1 represents the highest level of development.14 17

Estimation methods

The GBD Study 2019 evaluated a range of behavioural, environmental, occupational and metabolic hazards. Risk-outcome pairs were selected according to predetermined standards of evidence. Data on occupational injuries were obtained from various sources, such as insurance records, establishment surveys, labour inspectorate records, labour force surveys, business registers, economic censuses, official estimates, employer organisation records and other administrative and related data sources. The following equation was applied to estimate the number of occupational injuries:

where EAP=economically active population, c=country, y=year, EA=economic activity, a=age, s=sex.

Occupational injury population attributable fractions were calculated using the following formula:

where c=country, a=age, y=year, s=sex.

Statistical analysis

We illustrated global temporal trends from 1990 to 2019 in the number of deaths, DALYs, ASMR and ASDR associated with occupational injuries by gender. The data are analysed and illustrated using R statistical software (V.4.1.2). To emphasise the geographical variances in 2019, maps depicting occupational injury-related fatalities, ASMR and ASDR were generated. Descriptive analyses of mortality and DALYs were performed using SDI and region for various age groups. We also demonstrated the age distribution of the burden attributed to the 10 causes of occupational injury in 2019. To show changes by region from 1990 to 2019, we calculated the percentage changes in the number of deaths, mortality rate, DALYs and DALY rate; the percentage changes are defined as .

ResultsThe burden of occupational injuries in global and SDI region

Analysis of global trends from 1990 to 2019 revealed a declining number of deaths, DALYs, ASMR and ASDR associated with occupational injuries. Notably, the middle SDI region recorded the highest number of deaths and DALYs, considerably surpassing other areas, whereas the high SDI region registered the lowest. Conversely, the low SDI region gradually increased deaths and DALYs during the study period. Furthermore, ASMR and ASDR decreased across all regions, with the low SDI region displaying the highest rates and the highest SDI region the lowest (figure 1).

Figure 1

Temporal trends of occupational injury death number (A), DALY number (B), ASMR (C) and ASDR (D) in global, high SDI, high-middle SDI, middle SDI, low-middle SDI and low SDI from 1990 to 2019. ASDR, age-standardised DALY rate; ASMR, age-standardised mortality rate; DALYs, disability-adjusted life years; SDI, Socio-demographic Index.

Regarding specific injury causes, the low-middle SDI region recorded the highest number of deaths due to animal contact in 2019 at 4202.4 (95% CI 2917.2 to 5523.0); however, a decline was observed in all regions since 1990. The high-middle SDI region experienced the most substantial decrease in animal contact deaths, dropping by 62.80% from 1990 to 2019. For drowning-related fatalities, the low-middle SDI reported the highest numbers in 2019 with 6791.1 deaths (95% CI 5586.0 to 8627.0), and all regions observed reductions in drowning mortality throughout the period.

The middle SDI region had the most deaths in 2019 from several causes: mechanical force exposure (5251.8 (95% CI 3863.1 to 6484.9)), falls (13 189.6 (95% CI 10 578.3 to 15 771.6)), foreign bodies (1581.4 (95% CI 1413.9 to 1824.4)), poisonings (2464.0 (95% CI 1754.2 to 3066.9)) and road injuries (58 145.0 (95% CI 50 892.9 to 67 414.1)). In contrast, the low SDI region was the only region to observe increases in deaths due to mechanical forces, falls, fire/heat/hot substances, foreign bodies and poisoning from 1990 to 2019, underscoring an exceptional upward trajectory in injury burden. Specifically, road injury deaths in the low SDI group rose by 37%, making it the sole region with an upward trend (online supplemental table 1).

National burden of occupational injuries

Figure 2 delves deeper into the burden of occupational injuries by comparing data from various countries in recent years. China (61 779.9 (44 974.4–84 045.0)) and India (60 640.3 (43 774.9–83 106.8)) emerged as countries with the most significant number of deaths due to occupational injuries, far surpassing those of other countries. At the other end of the spectrum, Niue and Tokelau reported no deaths from occupational injuries, marking them as countries with the fewest fatalities (figure 2A and online supplemental table 2). Somalia led the list with an ASMR of 18.03 (14.61–21.82), followed by the Central African Republic at 16.54 (13.75–19.60), the Democratic Republic of the Congo at 13.39 (11.12–15.86) and Venezuela at 10.74 (8.80–12.99). Notably, each of these countries has an ASMR exceeding 10. In stark contrast, the UK reported the lowest ASMR at 0.34 (0.25–0.44) (figure 2B and online supplemental table 3). Furthermore, in terms of ASDR, Somalia stood out with the highest rate at 1101.47 (871.81–1347.03), while Trinidad and Tobago had the lowest ASDR recorded at 29.81 (23.48–38.48) (figure 2C and online supplemental table 4).

Figure 2

Global distribution of occupational injury burden in terms of death number (A), ASMR (B) and ASDR (C) in 2019. ASDR, age-standardised DALY rate; ASMR, age-standardised mortality rate; DALYs, disability-adjusted life years.

Age distribution of the burden of occupational injuries

Figure 3 presents an age-stratified analysis of occupational injuries across the different age groups. Males consistently exhibited higher numbers and rates of deaths and DALYs due to occupational injuries than females across all age groups. In terms of the number of deaths, the age group of 25–29 years recorded the highest number of deaths. The age groups of 25–29 and 30–34 years emerged as the most affected by DALY numbers. Furthermore, when analysing deaths and DALY rates, four age groups, specifically 25–29, 30–34, 35–39 and 40–44 years, displayed the highest rates. Road injuries were the leading cause of occupational injuries, particularly among males, with the burden of road injuries considerably surpassing that of the other nine causes.

Figure 3

Age distribution of the burden of occupational injuries attributed to 10 causes by sex in terms of deaths and DALYs in 2019. (A) Death number. (B) Death rate (per 100 000). (C) DALY number. (D) DALY rate (per 100 000). DALYs, disability-adjusted life years.

Change in burden of occupational injuries by region

Figure 4A,B provide an in-depth analysis of global trends in occupational injuries, specifically focusing on the number of deaths and rates for the years 1990 and 2019. A discernible observation is the significant decrease in both death numbers and rates in 2019 compared with the data from 1990. East Asia, South Asia and Southeast Asia emerged as the regions with the highest number of deaths in both years. However, Central sub-Saharan Africa consistently had the highest death rates. Figure 4C,D further explore the DALY numbers and rates. South Asia recorded the highest number of DALYs, whereas Central sub-Saharan Africa had the highest rate. From the SDI perspective, the middle SDI region had the highest number of deaths and DALYs in 2019. In contrast, the low SDI region reported the highest death and DALY rates.

Figure 4

Change in burden of occupational injuries by region, 1990 vs 2019. Columns and error bar representing the central estimates and 95% uncertainty interval of death number (A), age-standardised death rate (B), DALY number (C) and age-standardised DALY rates (D) in all-age population, respectively. DALYs, disability-adjusted life years; SDI, Socio-demographic Index.

Occupational injuries caused by causes in 21 regions

In 2019, South Asia recorded the highest number of animal contact deaths (5529.8 (95% CI 3803.3 to 7370.7)). From 1990 to 2019, the largest increase in animal contact deaths occurred in Andean Latin America (446.2%), Southern Latin America (287.5%) and the Caribbean (233.3%), whereas East Asia showed an 88.3% decline. Regarding drowning deaths in 2019, South Asia again led with 7150.7 (95% CI 5451.7 to 9788.8), while the Caribbean displayed significant growth in deaths (66.90%), ASMR (15%) and ASDR (14.20%). Under exposure to mechanical forces, East Asia had the highest number of deaths, with 4128.9 (2660.1–5904.1) in 2019. Oceania’s deaths increased by 41% from 1990 to 2019, while the high-income Asia Pacific declined by 83.70%. For the ASDR, the Caribbean was the only region with an increase of 32.80%. Fall-related deaths in 2019 were highest in South Asia (12 414.4 (95% CI 8988.8 to 17 281.6)) and East Asia (9426.5 (95% CI 6006.6 to 13 535.0)). The Caribbean observed major increases from 1990 to 2019 in fall-related deaths (202.60%), ASMR (74.20%) and ASDR (93.20%). Regarding deaths from fire, heat and hot substances in 2019, South Asia led with 2224.7 (95% CI 1550.0 to 2805.6), and Oceania’s deaths increased by 58.90% from 1990 to 2019. Eastern sub-Saharan Africa had the highest number of deaths due to foreign bodies (980.7 (95% CI 854.5 to 1138.9)), with the Caribbean experiencing a 79.50% increase from 1990. East Asia had the highest number of poisoning deaths in 2019 (2942.3 (95% CI 2042.1 to 3984.6)), although high-income Asia Pacific and Central Europe saw substantial declines.

Road injury deaths in 2019 were the highest in South Asia (39 116.3 (95% CI 26 981.9 to 49 224.6)) and East Asia (36 616.6 (95% CI 26 981.9 to 49 224.6)). Road deaths in Andean Latin America rose by 68.40% from 1990 to 2019, whereas the high-income Asia Pacific declined by 86%. All 21 regions witnessed reductions in both ASMR and ASDR, with the high-income Asia Pacific leading to a decline of 86% in ASMR and 83.80% in ASDR (online supplemental table 1).

Discussion

This study comprehensively assesses the global, regional, national and age-specific burdens of occupational injuries from 1990 to 2019. The results indicate that although the overall number of deaths and DALYs from occupational injuries has declined since 1990, the patterns vary significantly across different regions and countries at varying development levels. Low SDI and low-middle SDI regions shouldered a disproportionate burden compared with high SDI and high-middle SDI regions, underscoring persisting challenges and inequities in occupational safety. Within specific age groups, young adult males, especially those aged 25–44 years, experienced the highest toll of occupational injuries. Road traffic injuries have emerged as the predominant cause of injuries across these age groups. Furthermore, populous and rapidly industrialising countries, such as China and India, have reported the largest absolute number of occupational injury deaths. Meanwhile, countries such as Somalia and the Central African Republic have exhibited the highest mortality rates. These findings highlight the need for priority interventions to enhance occupational health systems worldwide.

Despite a general decline in the global burden of occupational injuries between 1990 and 2019, notable differences exist among sociodemographic regions. The middle SDI region bears the greatest burden in mortality and DALYs, followed by the low-middle SDI region. Alternatively, for both measures, the region with the highest SDI score had the lowest occupational injury burden. In contrast to the four regions that exhibited declines, occupational injury deaths and DALYs increased in the low SDI region. One probable explanation for the high rate of occupational injuries in the middle SDI regions could be the large number of workers in risky industries, including manufacturing, construction, mining and agriculture.18 These industries frequently involve low wages, poor working conditions, a lack of protective equipment and exposure to various physical, chemical, biological and ergonomic hazards.19 Furthermore, they may increase the risk of violence, conflict and instability, making workers more vulnerable to injury. In contrast, the high-economic growth and social welfare level in regions with high SDI may provide improved healthcare access, education and social protection for workers. These factors can assist in minimising hazard exposure and vulnerability through appropriate occupational safety rules and enforcement. In addition, they can increase awareness and compliance by fostering a culture of prevention among employees, employers and public officials. In regions with a low SDI, substantial informal and unregulated employment may be generated through urbanisation and rapid population growth in street vending, collecting trash, domestic service and small workshops.20

National occupational injury loads varied significantly, reflecting different settings. China and India accounted for the majority of deaths overall, which may have been caused by their large populations, rapid economic development and industrialisation, exposing many workers to high-risk industries such as mining, agriculture, fishing and construction.21 Furthermore, occupational safety interventions in these nations may be hampered by inequalities, governance challenges and limited resources. For example, inadequate enforcement of traffic regulations, congestion and substandard infrastructure can contribute to many fatal road injuries. Meanwhile, nations such as the Central African Republic, Somalia, the Democratic Republic of the Congo and Venezuela had the highest death and disability rates, most likely due to underdevelopment, conflict and instability that increased vulnerability in addition to compromised governance capabilities, weapons, explosives and vehicles used during disturbance compromise occupational safety. For instance, mechanical force injuries are common in these countries, highlighting the dangers associated with violence.

Numerous significant trends in the burden of occupational injuries across age groups were observed in the age-stratified analysis. Throughout all age groups, males consistently sustained greater fatalities and disabilities due to occupational injuries than females. This underscores the need for protective interventions specifically designed to target male worker groups. Among specific age groups, those aged 25–29 and 30–34 had the greatest burden in terms of absolute deaths and DALYs. When the age-adjusted rates were examined, people aged 25–44 had the highest prevalence of occupational injuries. Road traffic injuries significantly surpassed other causes of injury among young adults, constituting a substantial contributor to this high burden. Multiple factors contribute to the increased vulnerability of young adults, particularly males, to occupational injuries. In addition to the lack of experience and engaging in riskier behaviour, young workers are frequently subjected to exploitation and hazardous exposures.22 There may be an association between occupational driving without sufficient training, supervision or protective equipment and the high incidence of road injuries.23 Policy interventions to enhance working conditions for young adults through infrastructure enhancements, training and regulation should be given precedence, given that they constitute an essential productive demographic. Additionally, social support and targeted safety education programmes for young male workers may aid in reducing avoidable risks.

Different hazard exposures were reflected in the varied causes of occupational injuries across the regions. Multiple causes of injury, including animal contact, drowning, falls, fire/heat and road injuries, were consistently highest in South Asia. South Asian workers are expected to face hazards because of rapid economic expansion, resource demands and inadequate safety governance. For example, unprotected construction and farm work at heights may result in fall-related deaths. East Asia also experienced a rise in deaths caused by vehicles, machinery and chemicals, partially brought on by rapid industrialisation without adequate modern protection. Additionally, the Caribbean has shown notable increases in most occupational injury causes. This could be attributed to the region’s small, dispersed population’s substantial reliance on tourism, agriculture and unregulated industries, along with its limited safety resources and vulnerability to natural disasters.24

Governance, economic and social factors can interact to generate and intensify occupational hazards. Context-specific interventions, such as infrastructure enhancements and safety training, are required to protect vulnerable worker groups. Governments across the globe must give utmost importance to this significant public health concern and maintain their position of ‘leaving no worker behind’. It is crucial to engage in the ongoing surveillance of regional occupational injury dynamics, identify risk factors and develop individualised policies and programmes. Meanwhile, international organisations should develop regional cooperation to share experiences, increase resource usage efficiency and prevent and control occupational injuries. Furthermore, future research must identify the elements contributing to the high injury burden in specific industries or worker groups. Additional studies focusing on distinguishing the causes of occupational injuries may reveal intervention protocols and more effective preventive measures.

Conclusion

In summary, global occupational injury mortality and DALYs decreased between 1990 and 2019, yet there were discrepancies between sociodemographic areas. The region characterised by the highest middle SDI held the greatest burden, followed by the low-middle SDI suit, and the high SDI bearing the lightest. Unlike other regions, occupational injury deaths and DALYs increased in areas with a low SDI. The causes of injuries varied considerably across the 21 world regions due to varying occupational hazard exposures and susceptibilities. South Asia consistently ranks first in terms of deaths resulting from road injuries, animal contact, drowning, falls, fire/heat and falls. Mechanical forces, poisoning and road injuries have caused a great deal of mortality in East Asia. The Caribbean region experienced the most significant increase in most occupational injury indicators. Across all age categories, males experienced more occupational injury deaths and DALYs than females, with road traffic being the leading cause. These findings highlight the need to strengthen global, regional and national occupational injury research and prevention. Many social, economic, environmental and cultural factors may influence occupational injury frequency and extent across regions and countries. Addressing this serious public health concern requires comprehensive context-specific methods that involve diverse stakeholders. Local development status, safety policies, working conditions and population norms should be incorporated into intervention strategies. The global burden of occupational injuries can be reduced through continuous monitoring and specialised precautions for vulnerable worker populations.