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European Journal of Public Health, Vol. 35, No. 1, 91–100 © The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. https://doi.org/10.1093/eurpub/ckae197 Advance Access published on 4 December 2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to prevent 3 million deaths worldwide: a systematic review of occupational accident research—a factor- and cost-based approach Rosa Mar�ıa Ca~naveras Perea�, �Angel Tejada Ponce, Mar�ıa Pilar S�anchez Gonz�alez��

Department of Business Administration, Faculty of Economic and Business Sciences, University of Castilla-La Mancha, Albacete, Spain

�Corresponding author. Department of Business Administration, Faculty of Economic and Business Sciences, University of Castilla-La Mancha, Plaza de la Universidad, 1. Albacete 02071, Spain. E-mail: [email protected] ��She is member of “Asociaci�on de Econom�ıa de la Salud” (AES), which in turn is part of SESPAS, which is a member society of EUPHAS. ID Member: 1656.

Abstract Occupational accidents have emerged as a global concern, necessitating a comprehensive examination of their determinants and associated costs. This review aims to summarize, synthesize, and organize the factors and cost drivers of occupational accidents, exploring whether there is a gender perspective. Adhering to PRISMA guide- lines, we performed a narrative synthesis to systematically review relevant literature. A systematic search was conducted in the electronic databases PubMed, Web of Science, and Scopus. Two researchers screened all records to eliminate any duplicates, and they selected the articles for full review. A third researcher was consulted to resolve discrepancies and reach a consensus. The analysis of 15 studies revealed diverse perspectives; in terms of determinants, studies on organizational aspects and the theory of human error were grouped together, while in cost drivers, the human capital model and willingness to pay were the most frequently used. Gender, meanwhile, is identified as a determinant variable for accident rate. Additionally, limitations such as data underestimation were noted in the existing literature. The review highlights the need for empirical studies capable of addressing both determinants and cost drivers. It also provides guidelines for researchers to design studies that are more comparable across different contexts, including the gender debate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction

W ithin the framework of the 2030 Sustainable Development Goals (SDGs), two key targets related to occupational health

are emphasized: Good health and well-being (SDG 3), and Decent work for all (SDG 8). However, each year, exposure to occupational hazards in nearly 3 million fatalities [1]. These incidents place a significant strain on healthcare systems and reduce productivity, leading to substantial costs that go far beyond ‘mere’ business and hospital expenses, affecting society as a whole. To effectively address this public health issue, it is essential to understand its underlying determinants and their economic valuation. There is growing advo- cacy for integrating a gender perspective into various aspects of occupational accidents [2]. Nevertheless, these approaches remain relatively scarce and are seldom evaluated in conjunction. Therefore, the main objective of this review is to summarize, synthesize, and organize the patterns in the literature on these three approaches, analysing and categorizing the conclusions and limitations reported. Additionally, this review seeks to provide valuable information and scientific evidence for health professionals, researchers, and policymakers.

Methods

Search strategy The guidelines outlined in the PRISMA statement for reporting sys- tematic reviews and meta-analyses [3], along with those from the Joanna Briggs Institute (JBI) [4], were followed when conducting this systematic review. The literature search was conducted in

November 2023, encompassing the entire available publication period for a comprehensive analysis. Given the multidisciplinary nature of the review, three databases were consulted: PubMed, Web of Science, and Scopus. Table 1 displays the search strategy and the terms included, as well as the exclusion and inclusion criteria.

Study selection The study selection and data extraction process consisted of three phases (see Fig. 1). First, two researchers (R.M.C.P. and �A.T.P.) initially screened all records to eliminate duplicates. Next, both researchers independently reviewed the titles, abstracts and key- words of the 2415 studies retrieved. They selected only complete articles. At this stage, the results were compared, and a third re- searcher (M.P.S.G.) was consulted to resolve possible discrepancies in the inclusion criteria and to reach an objective consensus. In the third phase, the two researchers (R.M.C.P. and �A.T.P.) read all the articles selected after applying the inclusion and exclusion criteria. The full text of 59 articles was reviewed. Of these, 47 were excluded based on the exclusion criteria. Again, the third researcher (M.P.S. G.) was involved in resolving any doubts or conflicts. To ensure no relevant studies were missed in the initial search, the references of the 12 accepted articles were reviewed, resulting in the identification of 3 additional studies. Thus, a total of 15 articles were included in the review.

Results Due to the broad range of knowledge areas and the varied aspects of occupational accidents addressed in the review articles, the resulting

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Table 1. Search strategy

Category Criteria Details

Keywords Inclusion (‘occupational accidents’ OR ‘occupational injuries’ OR ‘accidents at work’ OR ‘workplace accidents’ OR ‘workplace injuries’) AND (‘determinants’ OR ‘factors’ OR ‘cost’ OR ‘expenditure’ OR ‘gender’ OR ‘sex’)

Exclusion NOT (‘ergonomics’ OR ‘epidemiologic’ OR ‘epidemiology’ OR ‘epidemiological’ OR ‘control’ OR ‘surveillance’ OR ‘unions’ OR ‘system’ OR ‘protocol’ OR ‘safety culture’ OR ‘fall’ OR ‘falls’ OR ‘falling’ OR ‘traumatic’ OR ‘heart’ OR ‘eye’ OR ‘musculoskeletal’ OR ‘back’ OR ‘neck’ OR ‘arm’ OR ‘elbow’ OR ‘hand’ OR ‘foot’ OR ‘time lost’ OR ‘HIV’ OR ‘rehabilitation’)

Inclusion criteria Language Only English Article type Original research articles Focus Study of determinants and costs of occupational accidents, particularly related to gender or sex

Exclusion Criteria (i) Body parts Focus on specific body part injuries (ii) Factors/costs Lack of information on explanatory factors or costs (iii) Ergonomics Solely focused on ergonomics or rehabilitation (iv) Safety issues Focus only on safety environment issues

Further Discarding (a) Global accidents Focused on a single globally known accident (b) Specific sectors Concentrated on injuries within specific sectors or professions (c) Single determinants Focused solely on one determinant, excessively specific cases, or did not meet inclusion criteria for

study design (d) Descriptive Studies Excluded purely descriptive articles lacking statistical methodologies (e) Related topics Did not directly address the chosen topic of the review or solely focused on study design

We understand determinant as a collective or individual risk factor (or set of factors) that is causally related to a health condition, outcome, or other defined characteristic [5].

Figure 1. PRISMA flowchart.

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data for analysis are inherently heterogeneous. Therefore, we chose for a narrative synthesis methodology to summarize the findings. A narrative approach, or qualitative systematic review, is suitable in this context, as meta-analysis of reported studies would be unsuit- able given the wide heterogeneity of data.

The narrative synthesis of the literature highlights both common- alities and disparities, providing insights for future research in this field. The results are presented in tables to enhance comprehension of the studies, methodologies, and key findings (see Tables 2 and 3).

Discussion The synthesis offers a comprehensive overview of the literature, delineating between determinants and costs. It facilitates the iden- tification of consensus, contradictions, and limitations.

Determinant studies The literature on determinants has been investigated using two types of sources: Primary sources [6, 7] and secondary sources [8–10].

Primary sources (surveys, questionnaires and/or interviews) re- quire a significant investment of time and resources on the part of the researchers, as the reliability of the study depends on adherence to very strict protocols that must be followed. Moreover, the need for these studies to be evaluated by an ethics committee is becoming increasingly common, given that they deal with data sensitive to the privacy of the participants. Furthermore, the authors of the articles that have used a survey emphasize that the interpretation of the results requires caution due to the presence of a possible selection bias and the use of a self-administered questionnaires. Additionally, the samples must focus on a more specific population than those using official data, and therefore, the results may be even less extrap- olable and comparable. However, it allows for the measurement of variables that cannot be observed as comprehensively and directly way as with official databases, such as alcohol consumption.

The second option commonly chosen by researchers is to utilize secondary sources, typically official records. The primary advantage of secondary sources is that they tend to be comprehensive, especially when combined to gather as much information as possible. However, this does not eliminate biases in sampling or data recording in official records. Furthermore, these sources often lag in publication and sometimes lack availability of all variables within the study range.

This review has identified the two main approaches in studies on determinants of occupational accidents [7]:

Firstly, the occupational approach, which includes organizational- level analyses. The resources and organizational structure of finan- cial companies are considered significant predictors of accidents and illnesses. Similarly, this approach includes macroeconomic factors that impact the company and its accidents, such as the economic cycle. A considerable portion of the studies reviewed in this review has attempted to explain whether there is such a relationship be- tween accidents and the economic cycle. Economic fluctuations af- fect many factors related to occupational safety. These authors emphasize that, although many studies of this kind have been con- ducted, there is still insufficient scientific evidence to confirm the relationship between economic situation and the rate of occupation- al accidents [8, 10].

Secondly, the human error theory includes studies based on per- sonal characteristics or moral attitudes towards worker safety, among other factors. This knowledge is important as it demonstrates that preventive measures related to these factors can be applied across all professional sectors, not just limited to specific industries. In fact, the authors converge on a common point: the need to devise and plan occupational risk prevention campaigns tailored to workers exposed to greater risks or those more vulnerable to occupational injuries.

Regarding the limitations of this type of study, they primarily stem from the fact that this literature focuses on a problem, occu- pational accidents, within a specific location and time period.

Therefore, it is possible that the findings may not correspond to patterns observed in other countries or at different times.

Also, studies that aim to assess the business cycle need to include control variables related to work organization and the worker, as job fatigue or firm size which cannot be directly measured at the macro level. However, these variables are often represented by explanatory constructs, and gaps or biases may arise between the constructs and the proxies. At times, the identified associations do not provide sufficient evidence to draw firm conclusions about the mechanisms involved and only allow speculation regarding the reasons behind the relationships between economic situation and occupational accidents [10].

There are also other limitations such as the configuration or def- inition of variables. For example, in incidence rates, the increasing prevalence of part-time employment would lead to a downward bias in injury rates if the denominator of such a series were simply based on the number of employed persons. Similarly, when comparing productive sectors, divergences could arise due to differences in occupational risk structures.

Gender studies In articles that have focused on gender as a differentiating and deter- mining factor in occupational accidents, different trends have been observed depending on the gender evaluated. Thus, gender is under- stood as a predictive and explanatory factor for accidents [6, 7]. Likewise, studies that omit its consideration conclude that it is im- portant to account for it alongside other worker characteristics [7].

It is essential to clarify that the terms ‘gender’ and ‘sex’ are often used interchangeably in the literature. However, gender and sex are not the same. According to the WHO, ‘sex’ refers to the biological and physiological attributes that define men and women, while ‘gender’ refers to the socially constructed roles, behaviours, activ- ities, and attributes that a given culture considers appropriate for men and women.

Cost driver studies The primary source of cost studies on accidents is secondary data, particularly government sources (accident surveys, compensation records, or jury verdicts). Through these sources, authors make a series of estimations to calculate the total cost of accidents. However, these sources may exclude certain factors, and most authors conclude that they often underestimate accident figures [11–13]. Similarly, some cost components, such as compensation payments, may be overestimated. In fact, some authors combine quantitative approaches with qualitative research methods to calculate the true economic or social costs of workplace accidents. In these studies, the three major categories of costs associated with occupational inju- ries and illnesses are typically recognized: direct costs, indirect costs, and quality-of-life costs [11]. Direct costs generally include payments for hospital services, medical services, and related expenses [13]; in- direct costs refer to the productivity losses due to worker injuries [11]; and quality-of-life costs relate to the pain and suffering experi- enced by the worker and their family. When any of these categories are not accounted for, it is considered a significant limitation in cost studies [13].

Different economic models are increasingly utilized in the litera- ture to calculate these costs:

The Friction Cost method limits productivity losses to the friction period, which refers to the time required to restore productivity to its pre-accident level [14, 15]. However, while this method is men- tioned in the literature, it was not employed in any of the reviewed articles.

The Market Pricing model is a standard approach in calculating accident costs [16]. This method only considers direct and indirect costs, overlooking the intrinsic value of life, which cannot be mon- etarily measured. As a result, the costs are often underestimated. Despite this limitation, the market pricing model offers advantages such as straightforward documentation of calculations, avoidance of

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