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Abstract

Background Under-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures.

Objective To estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013.

Methods Capture–recapture methods were applied using the national OIs register and records from a labour market insurance company. Employed workers 18–65 resident in Sweden in 2013 were included in the study (n=82 949 OIs). Precarious employment was operationalised using the national labour market register, while injury severity was constructed from the National Patient Register. Under-reporting estimates were computed stratifying by OIs severity and by sociodemographic characteristics, occupations and precarious employment.

Results Under-reporting of OIs followed a dose–response pattern according to the levels of precariousness (the higher the precarious level, the higher the under-reporting) being for the precarious group (22.6%, 95% CI 21.3% to 23.8%), followed by the borderline precarious (17.6%, 95% CI 17.1% to 18.2%) and lastly the non-precarious (15.0%, 95% CI 14.7% to 15.3%). Under-reporting of OIs, decreased as the injury severity increased and was higher with highest level of precariousness in all groups of severity. We also observed higher under-reporting estimates among all occupations in the precarious and borderline precarious groups as compared with the non-precarious ones.

Conclusions This is the first register-based study to empirically demonstrate in Sweden that under-reporting of OIs is 50% higher among precariously employed workers. OIs under-reporting may represent unrecognised injuries that especially burden precariously employed workers as financial, health and social consequences shift from the employer to the employee.

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This explored non-fatal accident underreporting between precarious and non-precarious employed workers in Sweden.

Precarious employment is characterised by “employment insecurity, income inadequacy and lack of rights and protection” (p4) and is said to be a “well-known social determinant of health and health inequalities and has been associated in the last decades with several adverse mental and physical health outcomes in workers” (p4).

Key findings below:

• Underreporting followed a dose-response pattern linked to the level of precariousness. Higher levels of precarious employment had higher underreporting, followed by borderline precariousness, then non-precarious employment. Specifically, underreporting was 50% higher for precariously employed compared to non-precarious/standardly employed workers
• Underreporting decreased as injury severity increased, as expected
• Underreporting was highest among females compared to males, younger versus older, and underreporting increased with increasing educational level
• On the above, underreporting was highest among the least educated and also the most educated. This is probably driven by different reasons: lower earning may not report in order not to lose their job whereas the highest earners probably have jobs they can continue while injured
• Precariously employed were more likely not to seek healthcare for injuries compared to non-precariously employed
• The occupation groups with highest rates of underreporting were: personal and protective services, extraction and building trades, sales and services, sales

Authors: Kreshpaj, B., Bodin, T., Wegman, D. H., Matilla-Santander, N., Burstrom, B., Kjellberg, K., … & Orellana, C. (2022), 79(1), 3-9.

Study link: http://dx.doi.org/10.1136/oemed-2021-107856

Link to the LinkedIn article: https://www.linkedin.com/feed/update/urn:li:ugcPost:6940060879644176384?updateEntityUrn=urn%3Ali%3Afs_updateV2%3A%28urn%3Ali%3AugcPost%3A6940060879644176384%2CFEED_DETAIL%2CEMPTY%2CDEFAULT%2Cfalse%29