Article Text

Download PDFPDF

Original article
Contribution of health status and prevalent chronic disease to individual risk for workplace injury in the manufacturing environment
  1. Jessica Kubo1,
  2. Benjamin A Goldstein1,
  3. Linda F Cantley2,
  4. Baylah Tessier-Sherman2,
  5. Deron Galusha2,
  6. Martin D Slade2,
  7. Isabella M Chu3,
  8. Mark R Cullen3
  1. 1Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
  2. 2Yale Occupational & Environmental Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  3. 3General Medical Disciplines, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Mark Cullen, General Medical Disciplines, Stanford University School of Medicine, 1265 Welch Road, MSOB X-338, Stanford, CA 94305-5411, USA; mrcullen{at}


Objectives An ‘information gap’ has been identified regarding the effects of chronic disease on occupational injury risk. We investigated the association of ischaemic heart disease, hypertension, diabetes, depression and asthma with acute occupational injury in a cohort of manufacturing workers from 1 January 1997 through 31 December 2007.

Methods We used administrative data on real-time injury, medical claims, workplace characteristics and demographics to examine this association. We employed a piecewise exponential model within an Andersen–Gill framework with a frailty term at the employee level to account for inclusion of multiple injuries for each employee, random effects at the employee level due to correlation among jobs held by an employee, and experience on the job as a covariate.

Results One-third of employees had at least one of the diseases during the study period. After adjusting for potential confounders, presence of these diseases was associated with increased hazard of injury: heart disease (HR 1.23, 95% CI 1.11 to 1.36), diabetes (HR 1.17, 95% CI 1.08 to 1.27), depression (HR 1.25, 95% CI 1.12 to 1.38) and asthma (HR 1.14, 95% CI 1.02 to 1.287). Hypertension was not significantly associated with hazard of injury. Associations of chronic disease with injury risk were less evident for more serious reportable injuries; only depression and a summary health metric derived from claims remained significantly positive in this subset.

Conclusions Our results suggest that chronic heart disease, diabetes and depression confer an increased risk for acute occupational injury.

  • chronic disease
  • heart disease
  • diabetes
  • occupational accidents

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles