Open Access

Prioritizing industries for occupational injury prevention and research in the Services Sector in Washington State, 2002–2010

Journal of Occupational Medicine and Toxicology20149:37

https://doi.org/10.1186/s12995-014-0037-2

Received: 26 February 2014

Accepted: 9 October 2014

Published: 9 November 2014

Abstract

Background

The Services Sector, as defined by the National Occupational Research Agenda (NORA), is comprised of a diverse industry mix and its workers face a variety of occupational exposures and hazards. The objective of this study was to identify high-risk industry groups within the Services Sector for prevention targeting.

Methods

Compensable Washington State workers’ compensation claims from the Services Sector from 2002 through 2010 were analyzed. A “prevention index” (PI), the average of the rank orders of claim count and claim incidence rate, was used to rank 87 Services Sector industry groups by seven injury types: Work- Related Musculoskeletal Disorders (WMSDs), Fall to Lower Level, Fall on Same Level, Struck By/Against, Caught In/Under/Between, Motor Vehicle, and Overexertion. In the PI rankings, industry groups with high injury burdens appear higher ranked than industry groups with low counts or low rates of injury, indicating a need for prioritizing injury prevention efforts in these groups.

Results

In the Services Sector, these 7 injury types account for 84% of compensable claims in WA. The industry groups highest ranked by PI across the injury types included: Services to Buildings and Dwellings; Executive, Legislative, and Other General Government Support; and Waste Collection. WMSDs had the highest compensable claims rates.

Conclusions

Services is a large sector of the economy, and the substantial number, rate, and cost of occupational injuries within this sector should be addressed. Several Services Sector industry groups are at high risk for a variety of occupational injuries. Using a PI to rank industry groups based on their injury risk provides information with which to guide prevention efforts.

Keywords

Surveillance NORA sector Workers’ compensation Traumatic injury Work related musculoskeletal disorder Falls Motor vehicle Occupational health Safety

Background

Occupational injuries and illnesses are common, costly, and a burden to workers and employers. Resources for prevention are limited, and there is a need for information to better focus research and prevention activities to maximize their impact. Other than the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses [1], there is relatively little published surveillance data comparing occupational injury and illness rates across industries [2]-[5]. In order to effectively prevent occupational injuries, employers, policymakers, healthcare providers, and researchers must know which injuries are occurring, where, and to what extent (magnitude, associated costs and time-loss). Analyzing injuries by industry can identify workers at high-risk for occupational injuries, and industry groups with the greatest need for prevention activities, safety and health programs, and further research.

The second-decade National Occupational Research Agenda (NORA) [6] is a partnership program between the National Institute for Occupational Safety and Health (NIOSH) [7] and businesses, universities, labor and other stakeholders, to promote and improve occupational health and safety research and workplace practices. The North American Industry Classification System (NAICS) classifies establishments into industries based on their business activities (and similarity in processes used to produce goods or services) [8]. NORA aggregates the 20 NAICS 2-digit Industry sectors into 10 Sector groups [9].

The Services Sector, as defined by NORA, includes diverse industries that face a range of exposures and hazards (e.g. offices, banks, educational establishments, auto repair shops, science and technical work, restaurants, fast food, hotels and motels, waste collection and the performing arts) and vary in establishment size and work organization. The Services Sector encompassed approximately 65 million workers in 2011, or more than 50% of the total U.S. workforce [10]. The scope and diversity of this Sector makes targeting occupational safety, prevention and research efforts difficult. Workers in the Services Sector may also face a higher burden of occupational injury and illness [5] and of occupational fatalities [11].

Previous efforts in Washington State (WA) used workers’ compensation (WC) data to prioritize WA industries for injury prevention by ‘prevention index’ (PI) rankings for common costly occupational injury types and identified several NAICS industry groups that ranked highly on the prevention index [2],[12]. The prevention index is calculated as the average of the industry’s rank order of WC compensable claim count and compensable claims rate. In other words, the PI ranks industries by equally weighting how common injuries are and how high a worker’s risk for injury is. Industry groups that are ranked higher by PI are those with a greater burden or risk of injuries. PI rankings indicate which industry groups should be prioritized in targeting research and prevention.

In one study, Anderson, Bonauto, and Adams [12] used PI methodology to rank all industry groups in WA (limited to State Fund claims) between 2002–2010. Of the 262 industry groups that met the inclusion criteria, 5 of the top 25 industry groups represented were from the Services Sector (Table 1). Two Services Sector industry groups, Services to Buildings and Dwellings (NAICS 5617) and Waste Collection (NAICS 5621) were in the top 5 by claim rate or count overall. These findings identified the Services Sector as a candidate for more in-depth characterization.
Table 1

Top 25 NAICS industry groups by prevention index for WA State fund (all sectors, all injury types), 2002-2010

NORA sector

4-digit NAICS (Industry group)

NAICS industry group description

FTE

# Compensable claims (COUNT)

Compensable claim rate/10,000 FTE (RATE)

Median compensable cost

Median days TL

Severity TL (days/10,000 FTE)

Rate rank (All SF)

Count rank (All SF)

Overall SF PI rank

C

2381

Foundation, structure, and building exterior contractors

137,685

9,312

676.3

$13,196

68

161,159

2

3

1

C

2361

Residential building construction

186,292

9,792

525.6

$11,280

57

129,804

10

2

2

C

2383

Building finishing contractors

160,942

8,281

514.5

$13,697

71

136,950

11

4

3

U

4841

General freight trucking

89,627

4,985

556.2

$10,779

55

137,877

8

11

4

C

2382

Building equipment contractors

276,061

12,495

452.6

$17,782

77

105,487

18

1

4

H

6232

Residential mental retardation, mental health and substance abuse facilities

48,764

3,251

666.7

$6,354

33

115,168

3

19

6

A

1133

Logging

35,322

2,642

748.0

$14,347

66

204,306

1

26

7

C

2389

Other specialty trade contractors

123,197

5,456

442.9

$13,214

62

111,986

21

9

8

U

4842

Specialized freight trucking

46,765

2,685

574.2

$9,130

49

116,432

7

25

9

S

5617

Services to buildings and dwellings

192,258

7,860

408.8

$7,489

43

82,849

30

5

10

H

6231

Nursing care facilities

122,719

4,437

361.6

$6,649

33

63,675

41

12

11

S

5621

Waste collection

21,310

1,316

617.6

$7,665

34

90,504

5

53

12

M

3219

Other wood product manufacturing

48,441

2,032

419.5

$8,869

30

74,729

26

32

12

C

2373

Highway, street, and bridge construction

45,004

1,880

417.7

$30,101

108

109,069

27

35

14

H

6243

Vocational rehabilitation services

55,612

2,179

391.8

$5,206

28

60,168

35

30

15

C

2371

Utility system construction

57,242

2,147

375.1

$19,443

78

96,020

38

31

16

C

2362

Nonresidential building construction

108,886

3,580

328.8

$25,025

94

72,752

54

16

17

S

9221

Justice, public order, and safety activities

137,032

4,149

302.8

$9,360

30

37,377

65

13

18

M

3211

Sawmills and wood preservation

26,888

1,131

420.6

$9,902

34

83,822

24

58

19

S

8111

Automotive repair and maintenance

132,964

3,730

280.5

$10,053

45

65,058

73

15

20

T

4244

Grocery and related product merchant wholesalers

194,917

5,187

266.1

$9,441

43

48,304

81

10

21

M

3323

Architectural and structural metals manufacturing

45,395

1,572

346.3

$10,914

41

57,173

49

44

22

H

6233

Community care facilities for the elderly

96,742

2,740

283.2

$7,686

39

56,851

71

24

23

U

2213

Water, sewage and other systems

109,958

3,060

278.3

$9,755

26

30,818

74

22

24

S

5613

Employment services

245,383

6,118

249.3

$5,687

42

44,743

92

8

25

NORA Sector key: A = Agriculture, Forestry & Fishing; C = Construction; H = Healthcare & Social Assistance; M = Manufacturing; S = Services; U = Transportation, Warehousing & Utilities; T = Wholesale & Retail Trade. Services Sector industry groups (bold).

There were 262 NAICS Industry Groups ranked in the PI for All Injury Types (State Fund only).

FTE = (hours/2000); Severity TL = (TL days/10,000 FTE).

This study uses the established PI methodology to rank industry groups within the Services Sector by injury type for compensable WC claims between 2002 and 2010. The objective of this study was to identify and prioritize high-risk industry groups in the Services Sector by seven common, high-cost injury types for research and prevention efforts. Looking at PIs for each injury type allows for further tailoring of prevention efforts, as some industry groups may be at high-risk for specific injury types and not others. Industry groups that rank highly by PI across several injury types should be a top priority for those engaged in occupational health and safety.

Materials and methods

Washington’s workers’ compensation system

In Washington State, non-federal employers are required to obtain workers’ compensation insurance through the Department of Labor and Industries’ (L&I) industrial insurance system, unless they qualify to self-insure, or are covered by an alternative WC system (e.g. Longshore and Harbor Workers’ Compensation Program). L&I administers the State Fund (SF), an industrial insurance program that provides coverage for approximately two-thirds of the 3.3 million workers in WA. The SF generally does not mandate WC insurance for self-employed workers, though elective coverage is available. Outside of the SF, there are approximately 450 self-insured (SI) entities (individual companies or groups of companies) that are not included in the State Fund insurance pool who employ nearly one-third of the workforce. Data from both SF and SI programs are collected and maintained in centralized databases at L&I.

Claim coding & data

In WA, a physician and worker initiate a WC claim by filing a Report of Industrial Injury or Occupational Disease (RIIOD) form, which includes the workers’ demographic information, employment and wage information, and a brief description of the incident. The physician provides a medical diagnosis (with ICD-9) code, subjective and objective information regarding the diagnosis, and a diagnostic and treatment plan.

Workers’ compensation administrative data include: codes characterizing the injury or illness; costs associated with disability payments, wage replacement, and pensions; billing information for health care providers, procedures, and treatment; and physician diagnosis codes. Information on SI claims is often incomplete; therefore cost data is only reported for SF claims in this analysis.

Claim costs for closed claims reflect actual paid costs. For claims that are not closed, costs reflect actual totals paid to date plus actuarial estimates for future costs associated with the claim. Indirect costs (to the employer and worker, e.g. lost or reduced productivity, employee turnover, and morale) and the administrative costs of managing claims are not included in the claim costs.

All WA WC SF claims are coded for nature, part of body affected, source and secondary source, and event or exposure leading to injury or illness according to the Occupational Injury and Illness Classification System (OIICS) [13] from the information on the RIIOD form. OIICS codes are only assigned at the beginning of a claim, and represent a description of the injury or illness at that point in time.

Each employer is assigned a NAICS 2002 code [14] identifying the firm’s industry. NAICS groups ‘economic activity’ into 20 sectors (two digit code), 100 subsectors (three digit code) and 317 NAICS industry groups (four digit code) [14]. The Services Sector, as defined by NORA, is comprised of industries within 11 NAICS Sectors: Information (NAICS 51); Finance and Insurance (NAICS 52); Real Estate, Rental, Leasing (NAICS 53); Professional, Scientific, and Technical (NAICS 54); Management of Companies and Entities (NAICS 55); Administrative Support and Waste Management (NAICS 56); Education (NAICS 61); Arts, Entertainment and Recreations (NAICS 71); Accommodations and Food Services (NAICS 72); Other Services (NAICS 81); and Public Administration (NAICS 92).

In WA, the Services Sector accounted for 48.5% of the SF workforce between 2002 and 2010 [12]. The 2010 BLS Geographic Profile of Employment & Unemployment for Washington State provides percentages of employment by certain industry groups; an estimated 62.2% of the WA workforce in 2010 was employed in the Services Sector (based on aggregate estimates from the industry groups that comprise the Services Sector as defined by NORA) [15].

Data ascertainment

We identified all WC claims within the Services Sector with dates of injury or illness from January 1, 2002 through December 31, 2010. Claims were extracted on December 19, 2012. Data extracted for each claim included claim identification number, claim status (medical only; compensable), OIICS codes for nature, part of body, source, and event or exposure of injury or illness, costs associated with the claim and time loss information. In WA, WC premiums are based on hours of exposure. Employers report hours on a quarterly basis for premium payment. Hours by NAICS industry group were obtained by WC account aggregated over the nine year study period.

A claim is considered a ‘compensable’ claim if it is categorized by the WC system as a ‘compensable’, ‘kept on salary’, ‘total permanent disability’, ‘fatal’ or ‘loss of earning power’ claim. A claim qualifies as ‘compensable’ if it involves payment for time lost from work. Wage replacement payments for time loss commence on the first missed workday following a three day waiting period which does not include the day of injury.

Injury type

Using OIICS codes, injuries were described by event code (alone or in combination with OIICS nature or body part affected codes and/or ICD-9 codes) and grouped into seven aggregated injury types, which have been described previously [12]. When referring to these aggregated injury type groups in this report, the term “injury type” is used. Claims were analyzed by 7 common injury types that were previously identified as accounting for the majority of compensable claims across all sectors and having significant costs. The injury types were: 1) Work- Related Musculoskeletal Disorders (WMSDs), 2) Fall to Lower Level, 3) Fall on Same Level, 4) Struck By/Against, 5). Caught In/Under/Between, 6) Motor Vehicle, and 7) Overexertion.

Certain injury types were excluded because they each comprised less than 2% of compensable claims (Exposure to Loud Noises; Extreme Temperatures; Bodily Reaction; Abraded; Electrical; Explosion; and Violence). Claims assigned an injury type of ‘Other’ tend to be poorly defined as ‘unclassified/insufficient data’, or ‘accident type not elsewhere classified’, and were also excluded from analysis. SI claims were more frequently coded as ‘Other’. The term “All Injury Types” refers to all injuries, outside of categorization by injury types.

Data analysis

Descriptive analyses were conducted on compensable claims. A full time equivalent employee (FTE) was defined as working 2,000 hours per year (40 hours per week for 50 weeks per year). Claim rates are expressed as cases per 10,000 FTE. In some instances, a rate of time loss days (TL) per 10,000 FTE was included as a severity measure.

We utilized a prevention index (PI) to rank industries within the Services Sector for prevention and intervention purposes, by 7 high-cost, common occupational injury types. The PI evaluates the frequency and prevalence of claims within an industry group: claim count - how common are the injuries, and claim incidence rate - how high is the worker risk within that industry. The PI is the average of the rank orders of the claim count and claim incidence rate:
PI = Frequency Rank + Incidence Rank 2

In case of tie, rate rank was used as the tiebreaker. Industry groups that have high counts and rates (higher injury burden) appear higher ranked in the resultant tables than industry groups with lower counts and rates (lower injury burden).

For determination of the PI for each injury type and to avoid unstable estimates, NAICS industry groups were limited to those who had reported hours in 6 or more years of the study period, with ≥45 compensable WC claims over the period of the study and ≥100 FTE per year during the study period, from 2002 to 2010. There were 87 NAICS Service Sector Industry Groups that met the criteria for inclusion for ‘All Injury Types.’ The top 25 industry groups are presented for ‘All Injury Types’, and the Top 15 are presented for the remaining injury types.

Results

Overall description (data not shown)

Between 2002–2010 there were 410,006 compensable claims in WA WC data. Of these 410,006 compensable claims, 267,581 were in the State Fund. Compensable claims in the WA SF between 2002–2010 amounted to $9,923,849,314 dollars in direct WC costs.

Seven common, high cost injury types were analyzed – WMSD, Fall to Lower Level, Fall on Same Level, Struck By/Against, Caught In/Under/Between, Motor Vehicle and Overexertion. These 7 injury types account for 86% of all (SF) compensable claims and 89% of all compensable claim costs (SF only). In the Services Sector, these 7 injury types account for 84% of (combined SF and SI) compensable claims in WA.

In the 87 industry groups that met the ranking criteria in the Services Sector, there were 132,673 compensable claims during the study period. There were 85,183 State Fund compensable claims accounting for 15,937,396 days of time loss (TL) with a median cost of $7,753 (mean cost $35,259). There were 47,490 self-insured compensable claims during the study period.

All injury types

Within the study period, there were 87 industry groups (4-digit NAICS) within the Services Sector that met the inclusion criteria for ranking for All Injury Types. The top 5 industry groups ranked for All Injury Types (Table 2) were Executive, Legislative, and Other General Government Support (NAICS 9211); Services to Buildings and Dwellings (NAICS 5617); Waste Collection (NAICS 5621); Justice, Public Order, and Safety Activities (NAICS 9221); and Employment Services (NAICS 5613). These were followed closely (tie for 5th rank) by Automotive Repair and Maintenance (NAICS 8111). These industry groups were consistently ranked in the top 12 by PI for all 7 injury types.
Table 2

Top 15 industry groups by prevention index for all injury types within the services sector in WA (SF + SI), 2002 - 2010

4-digit NAICS (industry group) & industry group description

State fund only

All (State fund + Self insured)

Median comp claim cost (SF Only)

Median days TL (SF only)

Severity TL (days/10,000 FTE)

FTE (SF + SI)

# Compensable claims (COUNT) (SF + SI)

Compensable claim rate/10,000 FTE (RATE) (SF + SI)

Count rank (SF + SI)

Rate rank (SF + SI)

PI rank

9211

Executive, legislative, and other general government support

$9,049.00

36

28533.8

655654

24136

368.1

1

4

1

5617

Services to buildings and dwellings

$6,760.00

43

84570

215906

8696

402.8

3

3

2

5621

Waste collection

$6,576.00

34

92058.3

38768

2252

580.9

10

1

3

9221

Justice, public order, and safety activities

$8,618.00

29

38268

137032

4155

303.2

7

8

4

5613

Employment services

$5,031.00

42

45339.6

289788

7315

252.4

6

11

5

8111

Automotive Repair and maintenance

$9,095.00

45

66582.6

132964

3732

280.7

8

9

5

5311

Lessors of real estate

$8,764.00

46

50760.4

78429

1888

240.7

12

12

7

6111

Elementary and secondary schools

$9,596.00

37

20605.4

875087

16169

184.8

2

22

7

7211

Traveler accommodation

$5,792.00

38

43325.8

162269

3497

215.5

9

17

9

7221

Full-Service restaurants

$4,371.00

24

24673

499789

7879

157.6

4

32

10

5629

Remediation and other waste management services

$14,560.00

72

89842.2

95755

1764

184.2

13

23

10

7139

Other amusement and recreation industries

$6,329.00

33

26585.7

120372

2068

171.8

11

26

12

8113

Commercial and industrial machinery and equipment (except automotive and electronic) repair and maintenance

$8,447.00

43

74734.6

27780

876

315.3

31

7

13

7223

Special food services

$6,427.00

37

47563.6

56334

1223

217.1

24

16

14

7112

Spectator sports

$8,258.00

63

77654.1

13226

649

490.7

41

2

15

5622

Waste treatment and disposal

$6,804.00

31

65461.2

13378

484

361.8

45

5

18

7222

Limited-Service eating places

$4,578.00

27

15293.1

722327

7681

106.3

5

49

20

There were 87 NAICS Industry Groups ranked in the PI for All Injury Types.

FTE = (hours/2000); Severity TL = (TL days/10,000 FTE).

Included are industry groups in the Top 5 by Count or Rate Rank (bold) but not in the Top 15 by Prevention Index.

Waste Collection (NAICS 5621) had the highest compensable claim rate per 10,000 FTE for All Injury Types (580.9; Table 2) and the highest severity rate (TL days/10,000 FTE). For SF compensable claims, Remediation and Other Waste Management Services (NAICS 5629) had the highest median cost per compensable claim, $14,560 and highest median time loss (Table 2).

Work-Related Musculoskeletal Disorder (WMSD)

WMSDs (Table 3) account for approximately 41% of compensable claims in the Services Sector, and had the highest compensable claim rates. For WMSD compensable claims, there were 79 industry groups that met the inclusion criteria. Executive, Legislative, and Other General Government Support (NAICS 9211) was ranked the highest for WMSD compensable claims. Waste Collection (NAICS 5621) had the highest compensable claim rate per 10,000 FTE. In SF compensable claims, the highest median compensable claim cost, median days TL, and severity rate were all found in Remediation and Other Waste Management Services (NAICS 5629) (data not shown). Both Waste Collection and Remediation fall in the 3-digit NAICS subsector 562 - Waste Management and Remediation Services. Subsector 811 - Repair and Maintenance, also has several industry groups, including Automotive Repair and Maintenance, ranked in the Top 15 for WMSD.
Table 3

Top 15 industry groups by prevention index for Work-Related Musculoskeletal Disorders (WMSD) within the services sector in WA (SF + SI), 2002 - 2010

4-digit NAICS (industry group) & industry group description

FTE

# Compensable claims (COUNT)

Compensable claim rate/10,000 FTE (RATE)

Count rank

Rate rank

PI rank

9211

Executive, legislative, and other general government support

655,654

10,247

156.3

1

4

1

5617

Services to buildings and dwellings

215,906

3,393

157.2

3

3

2

5621

Waste collection

38,768

1,031

265.9

10

1

3

9221

Justice, public order, and safety activities

137,032

1,735

126.6

7

8

4

5613

Employment services

289,788

3,003

103.6

4

13

5

8111

Automotive repair and maintenance

132,964

1,566

117.8

9

10

6

5311

Lessors of real estate

78,429

846

107.9

11

12

7

7211

Traveler accommodation

162,269

1,574

97.0

8

15

7

6111

Elementary and secondary schools

875,087

6,345

72.5

2

26

9

5629

Remediation and other waste management services

95,755

845

88.2

12

18

10

8121

Personal care services

76,800

690

89.8

16

17

11

7223

Special food services

56,334

522

92.7

23

16

12

8123

Drycleaning and laundry services

32,347

364

112.5

31

11

13

8113

Commercial and industrial machinery and equipment (except automotive and electronic) repair and maintenance

27,780

345

124.2

33

9

13

8114

Personal and household goods repair and maintenance

20,813

301

144.6

38

5

15

7112

Spectator sports

13,226

215

162.6

44

2

17

7222

Limited-service eating places

722,327

2,897

40.1

5

52

23

There were 79 NAICS Industry Groups ranked in the PI for Work-Related Musculoskeletal Disorders.

FTE = (hours/2000).

Included are industry groups in the Top 5 by Count or Rate Rank (bold) but not in the Top 15 by Prevention Index.

Fall to lower level

For Fall to Lower Level compensable claims (Table 4), there were 39 industry groups that met the inclusion criteria. The median costs, median days TL, and severity rates were higher in Fall to Lower Level than in the other 6 injury types (data not shown), particularly in Personal and Household Goods Repair and Maintenance (NAICS 8114), which includes workers engaged in repair and maintenance of home and garden equipment, appliances, upholstery and furniture, and footwear and leather goods. Both NAICS 811 - Repair and Maintenance and NAICS 531 - Real Estate, which includes renting/leasing real estate and property management and appraisal services, had multiple industry groups represented in Fall to Lower Level.
Table 4

Top 15 industry groups by prevention index for fall to lower level within the services sector in WA (SF + SI), 2002 - 2010

4-digit NAICS (industry group) & industry group description

FTE

# Compensable claims (COUNT)

Compensable claim Rate/10,000 FTE (RATE)

Count rank

Rate rank

PI rank

5617

Services to buildings and dwellings

215,906

918

42.5

2

2

1

9211

Executive, legislative, and other general government support

655,654

1,169

17.8

1

10

2

8111

Automotive repair and maintenance

132,964

256

19.3

7

8

3

5311

Lessors of real estate

78,429

186

23.7

11

5

4

5613

Employment services

289,788

464

16.0

4

14

5

5313

Activities related to real estate

110,988

200

18.0

10

9

6

9221

Justice, public order, and safety activities

137,032

236

17.2

8

12

7

5621

Waste collection

38,768

126

32.5

18

4

8

6111

Elementary and secondary schools

875,087

877

10.0

3

20

9

7211

Traveler accommodation

162,269

227

14.0

9

16

10

7139

Other amusement and recreation industries

120,372

171

14.2

12

15

11

8114

Personal and household goods repair and maintenance

20,813

75

36.0

25

3

12

7112

Spectator sports

13,226

69

52.2

28

1

13

5616

Investigation and security services

83,931

135

16.1

16

13

13

5324

Commercial and industrial machinery and equipment rental and leasing

36,810

79

21.5

24

7

15

7222

Limited-service eating places

722,327

355

4.9

5

37

19

There were 39 NAICS Industry Groups ranked in the PI for Fall to Lower Level.

FTE = (hours/2000).

Included are industry groups in the Top 5 by Count or Rate Rank (bold) but not in the Top 15 by Prevention Index.

Fall on Same Level

For Fall on Same Level (Table 5) compensable claims, there were 50 industry groups that met the inclusion criteria. Services to Buildings and Dwellings (NAICS 5617) was ranked highest overall by PI and for claim rate. NAICS Subsector 722 - Food Services and Drinking Places and NAICS 561 - Administrative and Support Services (which includes Employment Services and Investigative and Security Services) are the subsectors with the most representation in the Top 15 for Fall on Same Level.
Table 5

Top 15 industry groups by prevention index for fall on same level within the services sector in WA, 2002 - 2010

4-digit NAICS (industry group) & industry group description

FTE

# Compensable claims (COUNT)

Compensable claim rate/10,000 FTE (RATE)

Count rank

Rate rank

PI rank

5617

Services to buildings and dwellings

215,906

1,006

46.6

5

1

1

7211

Traveler accommodation

162,269

617

38.0

6

4

2

9211

Executive, legislative, and other general government support

655,654

2,180

33.2

2

8

2

6111

Elementary and secondary schools

875,087

2,629

30.0

1

10

4

9221

Justice, public order, and safety activities

137,032

536

39.1

8

3

4

7221

Full-service restaurants

499,789

1,526

30.5

3

9

6

7139

Other amusement and recreation industries

120,372

361

30.0

9

11

7

7223

Special food services

56,334

193

34.3

18

6

8

5621

Waste collection

38,768

160

41.3

23

2

9

8111

Automotive repair and maintenance

132,964

324

24.4

10

16

10

5613

Employment services

289,788

597

20.6

7

20

11

5616

Investigation and security services

83,931

206

24.5

15

15

12

5313

Activities related to real estate

110,988

235

21.2

12

18

12

5311

Lessors of real estate

78,429

204

26.0

16

14

12

7222

Limited-service eating places

722,327

1,329

18.4

4

26

12

5321

Automotive equipment rental and leasing

25,744

93

36.1

34

5

17

There were 50 NAICS Industry Groups ranked in the PI for Fall on Same Level. SF Data not shown for SF industry groups that do not meet the inclusion criteria alone (without the addition of SI data).

FTE = (hours/2000).

Included are industry groups in the Top 5 by Count or Rate Rank (bold) but not in the Top 15 by Prevention Index.

Struck By/Against

For Struck By/Against (Table 6) compensable claims, there were 48 industry groups that met the inclusion criteria. Employment Services (NAICS 5613) was ranked the highest for Struck By/Against compensable claims, followed by Services to Buildings and Dwellings (NAICS 5617); these groups are both in the NAICS 561 - Administrative and Support Services subsector. NAICS Subsector 722 - Food Services and Drinking Places was also represented by 3 industry groups in the Top 15.
Table 6

Top 15 industry groups by prevention index for struck by/against within the services sector in WA, 2002 - 2010

4-digit NAICS (industry group) & industry group description

FTE

# Compensable claims (COUNT)

Compensable claim rate/10,000 FTE (RATE)

Count rank

Rate rank

PI rank

5613

Employment services

289,788

1,515

52.3

4

5

1

5617

Services to buildings and dwellings

215,906

1,363

63.1

5

4

1

9211

Executive, legislative, and other general government support

655,654

2,222

33.9

1

12

3

5621

Waste collection

38,768

274

70.7

11

2

3

8111

Automotive repair and maintenance

132,964

651

49.0

7

8

5

7221

Full-service restaurants

499,789

1,537

30.8

3

14

6

8113

Commercial and industrial machinery and equipment (except automotive and electronic) repair and maintenance

27,780

185

66.6

16

3

7

5311

Lessors of real estate

78,429

269

34.3

13

10

8

9221

Justice, public order, and safety activities

137,032

382

27.9

9

16

9

7211

Traveler accommodation

162,269

430

26.5

8

17

9

7112

Spectator sports

13,226

134

101.3

26

1

11

6111

Elementary and secondary schools

875,087

1,681

19.2

2

25

11

7139

Other amusement and recreation industries

120,372

305

25.3

10

19

13

7223

Special food services

56,334

184

32.7

17

13

14

7224

Drinking places (alcoholic beverages)

67,862

199

29.3

15

15

14

There were 48 NAICS Industry Groups ranked in the PI for Struck By/Against.

FTE = (hours/2000).

Fall on Same Level and Struck By/Against are widely distributed, and were the most common occupational injury types following WMSD, making up approximately 13% of compensable claims respectively. These injury types (Tables 5 and 6) also had the 2nd and 3rd highest numbers of industry groups that met the inclusion criteria (groups that report these injury types regularly).

Caught in/under/between

For Caught In/Under/Between (Table 7) compensable claims, there were 13 industry groups that met the inclusion criteria. Rates and counts for these claims were the lowest among the 7 identified injury types. Employment Services (NAICS 5613) was ranked the highest for Caught/In/Under Between compensable claims overall and by count. Waste Collection (NAICS 5621) ranked the highest by compensable claim rate.
Table 7

Industry groups by prevention index for caught in/under/between within the services sector in WA, 2002 - 2010

4-digit NAICS (industry group) & industry group description

FTE

# Compensable claims (COUNT)

Compensable claim rate/10,000 FTE (RATE)

Count rank

Rate rank

PI rank

5613

Employment services

289,788

422

14.6

1

2

1

5617

Services to buildings and dwellings

215,906

243

11.3

3

3

2

9211

Executive, legislative, and other general government support

655,654

347

5.3

2

6

3

5621

Waste collection

38,768

71

18.3

8

1

4

8111

Automotive repair and maintenance

132,964

135

10.2

5

4

4

6111

Elementary and secondary schools

875,087

226

2.6

4

10

6

5111

Newspaper, periodical, book, and directory publishers

82,937

64

7.7

10

5

7

9221

Justice, public order, and safety activities

137,032

68

5.0

9

7

8

7222

Limited-service eating places

722,327

134

1.9

6

12

9

7221

Full-service restaurants

499,789

115

2.3

7

11

9

7139

Other amusement and recreation industries

120,372

55

4.6

11

8

11

7211

Traveler accommodation

162,269

52

3.2

12

9

12

5413

Architectural, engineering, and related services

262,812

46

1.8

13

13

13

There were 13 NAICS Industry Groups ranked in the PI for Caught In/Under/Between. SF Data not shown for SF industry groups that do not meet the inclusion criteria alone (without the addition of SI data).

FTE = (hours/2000).

Motor vehicle

For Motor Vehicle (Table 8) compensable claims, there were 20 industry groups that met the inclusion criteria. Executive, Legislative, and Other General Government Support (NAICS 9211) was ranked the highest for Motor Vehicle compensable claims. Automotive Equipment Rental and Leasing (NAICS 5321) had the highest compensable claim rate.
Table 8

Top 15 industry groups by prevention index for motor vehicles within the services sector in WA SF, 2002 - 2010

4-digit NAICS (industry group) & industry group description

FTE

# Compensable claims (COUNT)

Compensable claim rate/10,000 FTE (RATE)

Count rank

Rate rank

PI rank

9211

Executive, legislative, and other general government support

655,654

1,367

20.8

1

3

1

5617

Services to buildings and dwellings

215,906

417

19.3

3

4

2

5621

Waste collection

38,768

96

24.8

8

2

3

9221

Justice, public order, and safety activities

137,032

172

12.6

4

6

3

5321

Automotive equipment rental and leasing

25,744

75

29.1

11

1

5

5616

Investigation and security services

83,931

98

11.7

6

7

6

6111

Elementary and secondary schools

875,087

436

5.0

2

12

7

8111

Automotive repair and maintenance

132,964

93

7.0

9

9

8

9261

Administration of economic program

50,494

67

13.3

13

5

8

5614

Business support services

168,586

78

4.6

10

13

10

7222

Limited-service eating places

722,327

166

2.3

5

18

10

5613

Employment services

289,788

97

3.3

7

16

10

9241

Administration of environmental quality programs

50,862

48

9.4

17

8

13

8129

Other personal services

90,669

51

5.6

16

10

14

5111

Newspaper, periodical, book, and directory publishers

82,937

46

5.5

18

11

15

There were 20 NAICS Industry Groups ranked in the PI for Motor Vehicle. SF Data not shown for SF industry groups that do not meet the inclusion criteria alone (without the addition of SI data).

FTE = (hours/2000).

Overexertion

For Overexertion (Table 9) compensable claims, there were 24 industry groups that met the inclusion criteria. Services to Buildings and Dwellings (NAICS 5617) ranked the highest overall. Waste Collection (NAICS 5621) had the highest compensable claim rate. The NAICS 811 subsector - Repair and Maintenance - was highly represented in the Top 15 for Overexertion.
Table 9

Top 15 industry groups by prevention index for overexertion within the services sector in WA, 2002 - 2010

4-digit NAICS (industry group) & industry group description

FTE

# Compensable claims (COUNT)

Compensable claim rate/10,000 FTE (RATE)

Count rank

Rate rank

PI rank

5617

Services to buildings and dwellings

215,906

357

16.5

3

4

1

9211

Executive, legislative, and other general government support

655,654

807

12.3

1

7

2

5621

Waste collection

38,768

111

28.6

9

1

3

5613

Employment services

289,788

353

12.2

4

8

4

8111

Automotive repair and maintenance

132,964

213

16.0

7

5

4

6111

Elementary and secondary schools

875,087

574

6.6

2

13

6

5311

Lessors of real estate

78,429

106

13.5

11

6

7

7211

Traveler accommodation

162,269

126

7.8

8

11

8

9221

Justice, public order, and safety activities

137,032

108

7.9

10

10

9

7221

Full-service restaurants

499,789

273

5.5

5

17

10

5313

Activities related to real estate

110,988

82

7.4

12

12

11

8113

Commercial and industrial machinery and equipment (except automotive and electronic) repair and maintenance

27,780

48

17.3

22

3

12

8114

Personal and household goods repair and maintenance

20,813

45

21.6

24

2

13

7223

Special food services

56,334

57

10.1

17

9

13

7222

Limited-service eating places

722,327

221

3.1

6

21

15

There were 24 NAICS Industry Groups ranked in the PI for Overexertion. SF Data not shown for SF industry groups that do not meet the inclusion criteria alone (without the addition of SI data).

FTE = (hours/2000).

Complete tables of industry group rankings for All Injury Types and each injury type, as well as expanded tables with compensable claim costs, time loss, and severity rates (SF compensable claims data only) are available upon request.

Discussion

Using the PI to rank industry groups within the Services Sector in WA identified industry groups that may most benefit from research and prevention activities. These injury types account for the majority of compensable claims, claims costs, and time loss. Industry groups or subsectors that appear highly ranked by PI across injury types have a higher burden of occupational injury. These injuries can be personally devastating and are associated with high costs, both in direct workers’ compensation claim costs and time loss wage replacement, and in costs to the worker, employer, health-care systems, and society. Several industry groups were consistently ranked highly (Table 10) across injury types, indicating that they warrant priority focus in overall injury prevention, including: Services to Buildings and Dwellings (NAICS 5617), Executive, Legislative, and Other General Government Support (NAICS 9211), Waste Collection (NAICS 5621), Employment Services (NAICS 5613) and Automotive Repair and Maintenance (NAICS 8111).
Table 10

Top 15 services sector industry groups that were highest ranked by prevention index for 7 common injury types, WA, 2002 - 2010

4-digit NAICS (industry group) & industry group description

Average of PI ranks

5617

Services to buildings and dwellings*

1.6

9211

Executive, legislative, and other general government support*

2.1

5621

Waste collection*

4.9

5613

Employment services*

5.6

8111

Automotive repair and maintenance*

6.0

9221

Justice, public order, and safety activities*

6.6

6111

Elementary and secondary schools*

7.6

7211

Traveler accommodation

7.7

5311

Lessors of real estate

8.0

9261

Administration of economic program

9.0

5616

Investigation and security services

10.7

7223

Special food services

12.0

7221

Full service restaurants*

12.3

8113

Commercial and industrial machinery and equipment (except automotive and electronic) repair and maintenance

12.3

5313

Activities related to real estate

13.2

7139

Other amusement and recreation industries*

14.3

7222

Limited service eating places*

15.9

*Indicates that industry group was ranked in the Top 25 overall and for all seven injury types.

Included are industry groups (bold) not in the Top 15, but ranked in the Top 25 overall and for all seven injury types.

Services to Buildings and Dwellings (NAICS 5617) was ranked in the top 2 in all 7 injury types (Tables 3, 4, 5, 6, 7, 8 and 9) and ranked highest by average of PI ranks (Table 10). Workers in this industry group are at high risk for occupational injury across the board and would benefit substantially from injury prevention and safety improvements. The Services to Buildings and Dwellings industry group includes: Exterminating and Pest Control Services, Janitorial Services, Landscaping Services, Carpet and Upholstery Cleaning Services, and Other Services to Buildings and Dwellings (e.g. chimney cleaning, drain cleaning). These workers may encounter multiple hazards, work alone, or work with hazardous tools or chemicals. They may also face low wages, and other job stresses in addition to risks for a variety of occupational injuries and illnesses [16]. Workers in Services to Buildings and Dwellings also reported the greatest number of occupational traumatic injury fatalities of industry groups within the NORA Services Sector during 2003–2007 [5]. Services to Buildings and Dwellings has been previously identified in WA [2],[12] as a high-risk industry group, and continued high rankings across injury types establish it as a group in need of prevention and intervention efforts.

Employment Services (NAICS 5613) includes establishments that provide staff or refer and/or place applicants, where work activities and control over workplace hazards is generally the responsibility of the hiring employer, but the workers compensation liability rests with the temporary agency. Temporary Help workers have been previously identified by WA as a group in need of research and prevention efforts, due to increased injury rates [17]-[19]. In the same NAICS Subsector (561), Investigative and Security Services (NAICS 5616), was also highly ranked by average of PI scores across injury types (Table 10) and was at high risk for Fall injuries and for Motor Vehicle incidents.

Two industry groups from NAICS 562 - Waste Management and Remediation Services, a subsector engaged in local hauling of waste materials, operating materials recovery facilities (including sorting), and providing remediation (cleaning contaminated buildings, mines, soil, water) and septic services, were identified as being especially high-risk for common and costly injuries. Waste Collection (NAICS 5621) had the highest rate and severity rate for All Injury Types and was consistently ranked highly (Table 10), especially by rate, for prevention efforts in each of the identified injury types. Waste Collection has been identified previously and is already targeted for research and prevention efforts in WA [12],[20], which identified WMSDs as a primary injury type for the waste management industry and ‘Containers’ as the most common source of injury [20]. Both Waste Collection and Remediation and Other Waste Management Services, along with another in this subsector, Waste Treatment and Disposal (NAICS 5622), have also been identified in the top 5 Services Sector Industry Groups by average annual DAFW rates [5].

Automotive Repair and Maintenance (NAICS 8111), which includes body shops and collision repair work, was ranked highly across all 7 injury types and was ranked 5th overall by average PI rank (Table 10). Collision repair shops, in addition to ranking highly for these seven occupational injury types, have been previously identified in WA for occupational respiratory illness (isocyanates asthma) prevention activities [21].

Additional industry groups may be targeted by specific injury type(s), such as Fall to Lower Level, which remains a leading cause of injury. A study of occupational ladder fall injuries (using the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII) data) reported that 29% of workers with occupational ladder fall injuries were in a Services industry [22]. Fall on Same Level injuries are also widespread in the Services sector. Accommodation and Food Services workers (NAICS 72, included in the NORA Services Sector) experienced the highest number of falls over a five-year period and had higher Fall on Same Level rates than the construction industry based on United States Bureau of Labor Statistics data [23]. Fall to Lower Level and Fall on Same Level together accounted for approximately 20% of compensable claims in the WA Services Sector between 2002–2010.

Subsectors NAICS 562 - Waste Management and Remediation and NAICS 811 - Repair and Maintenance, have several industry groups in the Top 15 for WMSDs (Table 3), and Repair and Maintenance is also highly represented in the Top 15 for Overexertion (Table 9). WMSDs and Overexertion can be caused or aggravated by work exposures and activities such as material handling, awkward postures, and repetitive or forceful exertions; prevention efforts in industry groups in these subsectors should be directed towards reducing such exposures.

Another factor in the health of Services Sector workers is that many of these jobs are low or minimum wage work. Data from the Bureau of Labor Statistics (BLS) in 2012 show that the industry with the highest proportion of hourly paid workers at or below the federal minimum wage was “Leisure and Hospitality” [24] which would include workers in NAICS 72 - Accommodation and Food Services and 71 - Arts, Entertainment, and Recreation. Five industry groups that are high-ranking across injury types by average PI (Table 10) are found in NAICS 71–72. A study of low socio-economic status (SES) workers found that they reported more chronic diseases, increased risk behaviors, and worse health; were disproportionately younger, single, non-white and Spanish speaking; and clustered in low-wage industries, two of which are Services Sector industries - Accommodation and Food Services and Administrative and Waste Services [25]. In the same study, half of Services Sector industries had median annual wages below $35,000 in 2008; including: Accommodation and Food Services; Arts, Entertainment, and Recreation; Administrative and Waste Services; Other Services; and Real Estate and Rental and Leasing [25]. Using BLS Occupational Employment Wage Estimates from May 2010, for median hourly wage and mean annual wage for the U.S. (national, all occupations) [26] compared with those industries in the Service Sector [27], this pattern remained. Industry groups from these sectors - Accommodation and Food Services, Arts, Entertainment, and Recreation, Administrative and Waste Services, Other Services, and Real Estate and Rental and Leasing - made up the majority of industry groups that were highly ranked for prevention across injury types (Table 10); only 4 industry groups (3 from NAICS 92 - Public Administration, and one from NAICS 61 - Educational Services) were from industry sectors with higher median hourly/mean annual wages. Accommodation and Food Services includes workers in Traveler Accommodation (NAICS 7221) which was also ranked highly by PI across several injury types (Table 10). Traveler Accommodation includes Hotels and Motels, Casino Hotels, and Other Traveler Accommodations (bed and breakfast inns, guest houses, cabins and cottages, tourist homes, hostels). Hotel workers in particular, have been identified as having higher injury rates, especially for females, housekeepers, and those of Hispanic ethnicity [28]. These jobs have also been found to be associated with cleaning tasks and high physical effort (strain, muscle load, postures, repetitive movement), low wages and low job control, among other risks [28]. Workers in Services to Buildings and Dwellings who may face similar risks include Janitors and Cleaners and Landscaping workers.

While many industries in the Services Sector have much higher median hourly and mean annual wages, these industries are not as strongly represented in the PI rankings for work-related injuries in WA. Low socioeconomic status is also associated with job insecurity and work organization hazards [29]. In contrast, those ranked lowest by PI (data not shown) for All Injury Types were clustered in the Finance and Insurance, Information, and Professional, Scientific, and Technical Services industries, which were among the industries with the highest reported wages in the Services Sector, according to the 2010 BLS data [27].

There are relatively few studies in the literature that rank industries by some measure of risk, count or cost of occupational injury and illness. A previous study [3] ranking industries (using Standard Industrial Classification System (SIC) codes [30]) for estimated high-cost fatal and non-fatal injuries and illnesses in the United States identified many industries similar to the findings in the WA Services Sector: including Services to Buildings, Personnel Supply Services, and Automotive Repair Shops. Okun et al. [4] used a ‘risk index score’ and also identified (by SIC code) landscape and horticultural services (SIC 078), which may be comparable to some workers in NAICS 5617 Services to Buildings and Dwellings (e.g. NAICS 561730 Landscaping Services). However, the study’s difference in classification system and the restriction to ‘small-business’ makes comparison difficult.

A recent study characterizing occupational injuries, illnesses and fatalities in Services Sector workers [5] using BLS data had results that were similar to the WA data. Industry groups were ranked by average annual rank of Days-Away-From-Work (DAFW) Injury Rates (for several years), and identified similar industry groups. The five highest ranked industry groups by DAFW were NAICS 5621 Waste Collection, 5622 Waste Treatment and Disposal, 5323 General Rental Centers, 5617 Services to Buildings and Dwellings, and 5629 Remediation and Other Waste Management [5]. The same study [5] also used a PI to rank Services Sector industry groups combining DAFW Injury and Illness Counts and Rates, and identified 5617 Services to Buildings and Dwellings and 5621 Waste Collection, ranked 1st and 3rd, respectively.

The PI results represent a portion of the data, and the difference between individual ranks does not reflect the magnitude of the actual difference in count or rate between industry groups. The difference between individual ranks is of less importance than which industry groups are consistently ranked highly (demonstrating higher burden of injury).

The particular combination of compensable claim rate and rank may suggest different prevention activities for the industry or industries at risk and facilitate decision making as to the approach for allocation of prevention resources. For example, in the WMSD PI (Table 3), Services to Buildings and Dwellings (NAICS 5617) has a high rate rank and high count rank, which indicates that it is a large, hazardous industry group that could benefit from an intensive multi-faceted approach using every available resource (consultation, enforcement, and education). In the same table (Table 3), Elementary and Secondary Schools (NAICS 6111) has the largest number of FTEs and is ranked 2nd for compensable claims but has one of the lower compensable claims rates of all the industry groups that met the inclusion criteria for this injury type. High count rank but low rate rank may indicate a large, but less hazardous, industry, with claims scattered across a large number of workplaces and it is unlikely that any single workplace has high risk; therefore, the industry group may be more suited to an education campaign in order to reach the large number of workplaces and employees. Conversely, smaller industry groups with low count but high rate, such as Waste Treatment and Disposal (NAICS 5622, Table 3) may be hazardous industries with concentrated risk; a focused inspection/consultation may be an effective approach. Industry groups with low claim count and low claim rate likely need minimal prevention resources or efforts, with injury and illness surveillance for any emerging hazards. Business size may also influence strategies for prevention, as employer size varies considerably in the Services Sector. Large organizations may have more resources to devote to occupational injury prevention, while small businesses may benefit from collaboration with intermediary organizations to help develop and spread health and safety interventions [31].

Several of the limitations associated with this PI methodology and the use of WC data have been previously discussed [2]. Generalizability of results is limited by the varying statutes of workers’ compensation in the United States, as well as by variations in industry distribution. Another limitation to this report is that the injury and illness rates reported in this study are dependent on the completeness of reporting of cases and employee work hours to the WC system. These may be incomplete for a variety of reasons (e.g. employer reporting practices, fear of retribution, administrative barriers, or the use of alternative medical insurance providers). The extent of underreporting to the WA WC system is unknown. Additionally, data coding in large administrative databases such as the WA WC system is not always complete or accurate and there is a chance for miscoding (for example, OIICS coding takes place at the initial assessment of the claim, and the injury or illness may be poorly defined on the initial claim form, and thus the coding may not reflect the true nature of the injury or illness associated with the claim). Future efforts to rank industry groups for prevention and intervention activities may include other elements (an expanded PI approach) such as severity measures based on TL and cost data, to better capture the magnitude of the burden of injury.

PI rankings provide evidence as to where research and prevention efforts can be most effectively targeted for maximum benefit in reducing common and costly injuries. Ranking industries by PI overall and by specific injury types provides data to prioritize industry groups, guide prevention efforts, and inform the setting of policy and research agendas that reflect the particular needs of workers in industry groups within the Services Sector.

Authors’ contributions

All authors conceived of the study and participated in its design and coordination, and helped to draft the manuscript. DA and NA participated in data acquisition, management, and analysis. NA and DB participated in the interpretation and presentation of results and discussion. All authors read and approved the final manuscript.

Declarations

Acknowledgements

This research was supported in part by Grant Number 5U60OH008487 from CDC – NIOSH. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH or the Centers for Disease Control and Prevention. The authors wish to thank Christina Rappin and Caroline Smith, MPH for their assistance in reviewing the manuscript.

Authors’ Affiliations

(1)
Washington State Department of Labor & Industries, Safety & Health Assessment & Research for Prevention (SHARP) Program

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