[Monitoring the trend of occupational injuries: comparison between different indicators]. / Monitorare il trend degli infortuni sul lavoro: confronto tra diversi indicatori.

OBJECTIVES: to compare three injuries indicators to establish which are less affected by underreporting and therefore best suited for the monitoring of the occupational injuries time trend during economic crisis. DESIGN: open cohort. SETTING AND PARTICIPANTS: a national sample of employees in the private sector, blue collars, males aged 15-64 years, extracted from the Work History Italian Panel-Healt archive, which combines data about firms and employee from the National Social Security Institute (Inps) and occupational injuries data from the Italian National Institute for Insurance against Accidents at Work (Inail). MAIN OUTCOME MEASURES: annual injuries rates for the period 2001-2012 classified according to three severity definitions: • serious injuries according to the prognosis (IGP); • serious Injuries according to the type of lesion (IGL); • minor injuries. Time trends and their changes during the economic crisis (2008-2013) were analysed through negative binomial regression models, stratified by country of origin, macroarea of work, firm size, and economic activity. RESULTS: IGP rates decreased more than IGL and minor injuries rates during the economic crisis, highlighting their greater association with the economic cycle. Negatives and significant trend changes were observed in some subgroups: in manufacturing, among workers from high developed countries and Moroccans, in the Northern and Central macroareas of Italy, and in larger firms. CONCLUSIONS: variations in injuries rates were not so much influenced by the underreporting of injuries as by the changes in the working conditions following the economic crisis. To accurately monitor the injuries time trends, it is recommended to report at the same time at least one indicator based on minor injuries and one based on serious injuries.

Differences in work injury risk between immigrants and natives: changes since the economic recession in Italy.

BACKGROUND: It is known that occupational injury rates are higher for immigrant than for native workers, however the effects of the economic cycles on these differences has not been assessed to date. The aim of the paper is to test if the crisis has the same mechanism of selection in the two groups by comparing injury rates in 2005 (before the crisis) and in 2010 (after the crisis). METHODS: The Work History Italian Panel-Salute integrated database was interrogated to identify employment contracts in the metalworking and construction industries for the years 2005 and 2010 and the occupational injuries. A definition based on the type of injury, less likely to be biased by underreporting, was used to select serious events. Immigrants and natives were matched using the propensity score method and injury rates were calculated in the two years. Analyses were stratified by industry. RESULTS: In the metalworking industry injury rates slightly increased over time for both groups, and were higher among immigrant than native workers in both 2005 and 2010. In the construction industry the 2005 injury rate was the same in the two groups, and there was a negative trend over time in both groups. However the decline in the 2010 injury rate for Italian workers was much larger, which led to a considerable increase of the incidence rate ratio of immigrants with respect to native (IRR 3.83, 95% CI 2.52-5.75). CONCLUSIONS: The economic recession had an impact on the risk of workplace injury. Though the main observed factors (18 variables) usually reported in literature to explain the higher injury rates of the immigrant workers were controlled through the matching, there were still differences between immigrants and natives. The main reason is that immigrants continue to be assigned to the more dangerous jobs and the more dangerous tasks within these job. Furthermore, also differences in the perception of workplace injury risks, linguistic barriers, and cultural factors may have a role in explaining this gap.

[The health of foreign workers: an Italian and international priority.] / La salute dei lavoratori stranieri: una priorità italiana e internazionale.

About 5 million migrants are resident in Italy. Migrant workers are mainly employed in manual, unqualified jobs that Italians tend not to perform anymore. Compared to Italians, they tend to be more hired by precarious contracts. Migrants present a higher risk of work injuries and occupational illnesses than natives. This excess risk is linked to the concentration of migrants in the most dangerous jobs, greater risk tolerance, language and cultural barriers that reduce the effectiveness of any training actions. With the economic crisis, there has been a further worsening of the conditions of workers. Despite the decline in work injury rates, which follow the trend of the economic cycle, the distance between Italians and migrants has remained largely unaltered. The worst health conditions of migrants are not related to individual intrinsic factors, but to the way the economy exploits the social weakness of the migrant to gain profits. Better surveillance data is needed to improve the description and understanding the mechanisms by which migrants are systematically in worse health and safety conditions and to provide direction to effective public health interventions.

Migrant workers in Italy: an analysis of injury risk taking into account occupational characteristics and job tenure.

BACKGROUND: Migrants resident in Italy exceeded 5 million in 2015, representing 8.2% of the resident population. The study of the mechanisms that explain the differential health of migrant workers (as a whole and for specific nationalities) has been identified as a priority for research. The international literature has shown that migrant workers have a higher risk of total and fatal injury than natives, but some results are conflicting. The aim of this paper is to study the injury risk differentials between migrants, born in countries with strong migratory pressure (SMPC), and workers born in high income countries (HIC), taking into account individual and firm characteristics and job tenure. In addition to a comprehensive analysis of occupational safety among migrants, the study focuses on Moroccans, the largest community in Italy in the years of the analysis. METHODS: Using the Work History Italian Panel-Salute integrated database, only contracts of employment in the private sector, starting in the period between 2000 and 2005 and held by men, were selected. The analysis focused on economic sectors with an important foreign component: engineering, construction, wholesale and retail trade, transportation and storage. Injury rates were calculated using a definition of serious occupational injuries based on the type of injury. Incidence rate ratios (IRR) were calculated using a Poisson distribution for panel data taking into account time-dependent variables. RESULTS: Injury rates among SMPC workers were higher than for HIC workers in engineering (15.61 ‰ py vs. 8.92 ‰ py), but there were no significant differences in construction (11.21 vs. 10.09), transportation and storage (7.82 vs. 7.23) and the wholesale and retail sectors (4.06 vs. 4.67). Injury rates for Moroccans were higher than for both HIC and total migrant workers in all economic sectors considered. The multivariate analysis revealed an interaction effect of job tenure among both SMPC and Moroccan workers in the construction sector, while in the wholesale and retail trade sector an interaction effect of job tenure was only observed among Moroccan workers. CONCLUSIONS: Migrant workers have higher occupational injury rates than Italians in the engineering and construction sectors, after two years of experience within the job. Generally the risk differentials vary depending on the nationality and economic sector considered. The analysis of injury risk among migrant workers should be restricted to serious injuries; furthermore, job tenure must be taken into account.

Occupational injuries in times of labour market flexibility: the different stories of employment-secure and precarious workers.

BACKGROUND: The relationship between labour market flexibility, job insecurity and occupational injuries is not univocal. The literature generally focuses on the temporary character of work arrangements rather than on the precarity of careers. The aim of this paper is to identify, without defining a priori what a precarious career is, the most common professional profiles of young people who entered the labour market in the 2000s and to correlate them with occupational injury risks. METHODS: Using the Whip-Salute database, which combines individual work and health histories, we selected the subjects under 30 years of age whose first appearance in the database is dated after 2000. The occupational history of each individual between 2000 and 2005 was described according to 6 variables (type of entry contract, number of contracts, number of jobs, economic activities, work intensity and duration of the longest period of non-employment). Workers were grouped into homogeneous categories using cluster analysis techniques, which enable to identify different career profiles. Injury rates were calculated for each cluster, and compared within and between the groups. RESULTS: We selected 56,760 workers in the study period, who were classified in 6 main career profiles. About 1/3 of the subjects presented an employment-secure career profile, while about 45 % of them were classified into 3 clusters showing precarious career profiles with different work intensities. Precarious workers present significantly higher injury rates than those with secure careers, with an increase in risk between 24 and 57 % (p < 0.05). The comparison of injury rates at the beginning and at the end of the study period revealed a significant decrease in all clusters, but the gap between secure and precarious workers remained wide. CONCLUSIONS: Cluster analysis allowed to identify career patterns with clearly different characteristics. A positive association between injury risk and the level of career fragmentation was found. The association cannot be fully interpreted in a causal way, since reversed causality and selection processes may be in action. However the study indicates a disadvantage for precarious workers, who face significantly higher risks of both minor and severe injuries.

[Occupational injury risk in immigrant workers in Italy: differences in work characteristics and age]. / Rischio infortunistico nei lavoratori immigrati in Italia: differenze per caratteristiche lavorative e per età

OBJECTIVES: to describe occupational injury risk, comparing regular foreign workers with Italians, by main work characteristics and age. DESIGN: analysis of incidence and risk of total and severe occupational injury by Country of birth, stratified by economic activity, skill level, geographical area of work, firm size and age. SETTING AND PARTICIPANTS: sample of 7% of workers registered in the Italian National Institute of Social Insurance (INPS) database. The workers considered were male private sector employees aged from 16 to 55 years old who worked between 2000 and 2005 as apprentice or blue collar. Two groups were distinguished: immigrants from high migratory pressure Countries (PFPM) and immigrants from high-income Countries (PSA; Italians comprised). The three main nationalities considered were the most relevant in Italy: Moroccans, Albanians, and Romanians. MAIN OUTCOME MEASURES: all occupational injuries; severe occupational injuries based on the type of damage. RESULTS AND CONCLUSIONS: PFPM workers have a higher risk of injury compared to PSA both for total (Relative Risk - RR: 1.45) and severe ones (RR: 1.56), particularly in engineering (RR: 1.64) and trade (RR: 1.61). Moroccans have always the greatest risks (RR: 1.86); Romanians are protected on total injuries (RR: 0.80), but have excess of risk of severe injuries (RR: 1.31). Among young people there aren't differences by Country of birth, but the rate decreases as age increases in PSA, while in PFPM it increases as age increases. In this study, injury risk in regular foreign workers were measured more accurately than official statistics: Whip-Salute database can provide useful information for planning prevention programmes of immigrant work-related injuries.

Job tenure and work injuries: a multivariate analysis of the relation with previous experience and differences by age.

BACKGROUND: One of the consequences of the increasing flexibility in contemporary labour markets is that individuals change jobs more frequently than in the past. Indeed, in many cases, through collecting a lot of contracts, individuals work in the same economic sector or even in the same company, doing the same job in the same way as existing colleagues. A very long literature has established that newly hired workers--whatever the contract type--are more likely to be injured than those with longer job tenures. The objectives of this paper are: 1) to study the relationship between job tenure and injury risk taking into account past experience as a possible confounder; and 2) to evaluate how the effects of past experience and job tenure are modified by age. METHODS: Using a longitudinal national database, we considered only job contracts starting in 1998-2003 held by men working as blue collars or apprentices in the non-agricultural private sector. We calculated injury rates stratified by job tenure and age. Multivariate analyses were adjusted for background variables and previous experience accrued in the same economic sector of the current job. RESULTS: In the study period 58,271 workers who had experienced 10,260 injuries were observed. These people worked on 115,277 contracts in the six years observed (1.98 contracts per worker). Injury rates decrease with job tenure; the trend is the same in each age group; young workers have both the highest injury rate (9.20; CI 95%: 8.95-9.45) and the highest decrease with job tenure. Previous experience is associated with a decreasing injury rate in all age groups and for all job tenures. Multivariate analyses show that, even after checking for previous experience, workers with job tenure of less than 6 months show always higher relative risks compared with job tenure > 2 years: relative risk is 41% higher among under-thirty workers; it is 22% higher among people over forty. Previous experience is protective against injury risk in workers over thirty: after checking for all other variables, relative risk is lower in workers who have accumulated more than 5 years of experience. CONCLUSIONS: In a context in which career fragmentation is increasing, workers find themselves more and more in the "high risk" period and only individuals who are able to build their career with similar jobs may mitigate the higher risks thanks to their past experience. If institutions don't adopt appropriate prevention policies, injury risk is likely to increase, especially among young people.

[Temporary employment and health: a multivariate analysis of occupational injury risk by job tenure]. / Lavoro temporaneo e salute: un'analisi del rischio infortunistico per durata del contratto di lavoro.

OBJECTIVE: To study the relationship between job tenure and injury risk, controlling for individual factors and company characteristics. DESIGN: Analysis of incidence and injury risk by job tenure, controlling for gender, age, nationality, economic activity, firm size. SETTING: Sample of 7% of Italian workers registered in the INPS (National Institute of Social Insurance) database. PARTICIPANTS: Private sector employees who worked as blue collars or apprentices. MAIN OUTCOME MEASURES: First-time occupational injuries, all occupational injuries, serious occupational injuries. RESULTS AND CONCLUSIONS: Our findings show an increase in injury risk among those who start a new job and an inverse relationship between job tenure and injury risk. Multivariate analysis confirm these results. Recommendations for improving this situation include the adoption of organizational models that provide periods of mentoring from colleagues already in the company and the assignment to simple and not much hazardous tasks. The economic crisis may exacerbate this problem: it is important for Italy to improve the systems of monitoring relations between temporary employment and health.

A new Italian surveillance system for occupational injuries: characteristics and initial results.

BACKGROUND: Occupational injuries research and surveillance is important for prevention and public health protection. A new occupational surveillance system based on linkage of work histories calculated from the Italian National Social Security Institute (INPS) and occupational injuries provided by the National Insurance Institute for Occupational Injuries (INAIL) was created and assessed. METHODS: It has been extracted a 1% sample of individuals from INPS. For each subject, a detailed description of the career has been compiled between 1985 and 2004, and matched on an individual basis to work injuries between 1994 and 2003. It has been calculated injury rates and risks by economic activity, gender, age, job tenure, country of birth, and firm size. RESULTS: The linkage success is very high both in engineering than in the construction sector. The comparison with Eurostat statistics is very positive. The injury risks calculated by job tenure, country of birth, and firm size are consistent with literature. The high injury rate for short work contracts remain unvaried also after controlling by age. CONCLUSIONS: It is finally possible to describe injuries based on some main characteristics of the recent changes in the labor market, such as precarization, ageing of workers, migration, that databases currently available in Italy do not allow. The sample is longitudinal and can contribute to describing the development of the phenomena over time. The Ministry of Health is completing procedures to extend the sample and to increase the health outcomes for which a follow-up is available.