Abstract

An occupational accident is an unexpected and unplanned occurrence arising out of or in connection with work which results in one or more workers incurring a personal injury, disease or death. As occupational accidents are to be considered also travel, transport or road traffic accidents in which workers are injured and which arise out of or in the course of work.


Work migration in Italy has increate during the recent decades, especially after the enlargement of the UE in 2004 and the aimof this study is to evaluate the difference in the incidence rate of Emergency Department (ED) accesses for occupational injuries between Italian and foreign workers.


A retrospective analysis comparing incidence rate was carried out in Veneto Region using anonymous ED regional database including all accesses in the period 2008-2015.


Among about 15 milions ED accesses, 700,781 (5%)were for occupational injuries.


The incidence rate ratio of ED accesses for occupational injuries was 42‰, significantly higher in males (OR: 1.68; CI95%: 1.68-1.69; p<0.05), and confirmed the higher risk of injuries in foreign workers compared to italians (OR: 1.94; CI95%: 1.93-1.95; p<0.05).

Introduction:

In the recent decades, the phenomenon of globalisation and the enlargement of the European Union (EU) in 2004 have been responsible for a remarkable increase in migration flow towards western Europe, implying a substantial impact from the economic, political and social perspective.

Most of migrants in Europe live in Germany, United Kingdom and France, countries with an established tradition in the reception of the migrations flows, but also in Spain and Italy, more recently.

In Italy, between 2011 and 2015 the foreign population increased by 1.4 million units (+38%). Currently, foreign citizens living in Italy are more than 5 million, representing the 8.3% of the whole population.

From a demographic point of view, foreign population is overall younger than Italian population: 1 9% are 1 4 years old or less, 33% between 15 and 34 years old, 45% between 35 and 64 years old, 3% are 65 years old or more [ 1 ] . Foreign citizens play, thus, a substantial role in the social and cultural fabric and are a consistent part of the workforce as defined by the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families in 1990 “a person who is to be engaged, is engaged or has been engaged in a remunerated activity in a State of which he or she is not a national” [ 2 ]

As reported by the Italian Social Security Institute in the same 5-year period, foreigners were 10% of the total workforce but 14% of all occupational accidents occurred to them, showing a higher risk compared to Italian workers (OR: 1.45; 95%CI: 1.44-1.46; p<0.05). The annual incidence of work accidents in foreign workers was 40.5‰ (28.2‰ in Italian workers).

A higher risk of occupational accidents in foreign workers could be partly explained by cultural and linguistic barriers, a higher level of temporary employment and lower degree of job security, as well as a lower perception of risks.

The aim of this study was to estimate the incidence and the impact in the foreign population by measuring the admissions to the Emergency Department (ED) due to occupational accidents in the period 2008-2015 in Veneto Region (5 million inhabitants, Northeast Italy). Differences between the Italian and the foreign workforce were investigated.

Material and methods:

Data concerning demographic characteristics of the population were provided by the National Institute of Statistics, while health data were retrieved from the regional database of ED admissions managed by the regional health authority.

Occupational accidents occurring both on work-site and during travel to work were included. The annual rates of ED admissions due to work-related conditions were calculated for each year in the period considered. Demographic characteristics of the population and the outcome after ED admission were also included in the analysis.

Results:

As shown in Table 1 , admissions for occupational accidents, both on work-site and during travel to reach the workplace, were 5% of all ED admissions in the period considered. However, subsequent hospitalisation rates were generally low, despite this chance was higher after injuries occurring during travel rather than on work-site (OR: 1.39; 95%CI: 1.35-1.43; p<0.05). Also in terms of mortality, accidents during travel showed a significant higher risk (OR: 1.80; 1.21-2.67; p<0.05). However, hospitalisation rates were enormously lower compared with hospital admissions following ED access not related with work accidents.

Between 2008 and 2015, the overall employment rate declined by 4.2%, as shown in Table 2 . On the contrary, it increased in the foreign population, especially with respect to female employment (+35%). The proportion of foreign workforce increased from 9.5% to 11.9% over a period of eight years.

Overall, the incidence of work accidents decreased, although accidents on work-site (-25%) and in foreign workers (-52%) showed a more marked decrease.

As well as could be expected after considering the composition of the workforce, occupational accidents occurred more frequently in males (70%). Mean age was slightly higher in females compared to males (42.8± 15.1 years old Vs 41.8 ± 13.6) and foreigners were around five years younger than Italians (38.3± 8.6 years old Vs 42.9 ± 14.3) regardless of the gender.

As reported in Table 3 , despite the risk of getting admitted to ED because of a work accident was higher in foreign workers (OR: 1.94; 95%CI: 1.93-1.95; p<0.05), the subsequent hospitalisation rate was lower and ED admissions coded as ‘severe condition’ after triage were less compared with Italians.

Conclusions :

In the context of a reduction in the level of employment in the Italian population, in the recent years the proportion of foreign workers increased, especially for positions like unskilled worker, craftsperson or qualified worker [ 3 ] ; moreover, a consistent increase in female employment occurred in the foreign population mostly because of caregiving activities oriented to elderly resident population. Female employment in foreigners and Italians, thus, overlapped.

Our findings confirmed a consistent decrease in the incidence of occupational injuries in the recent years and reaffirmed a disadvantaged working condition in foreign workers also as regards the safety at work [ 4 ,5,6,7] . The study highlighted a reduction of occupational injuries more marked in foreigners in Veneto Region, while this has not been reportedin a national analysis [ 8 ] .

A limitation of our study arose from the source of information used: the database of ED admissions, indeed, does not include lethal occupational accidents, giving an underestimated specific mortality rate.

Interestingly, ED admissions in foreign workers were characterized by a lower clinical severity code and were less frequently followed by hospitalisation: this result conflicts with the commonly accepted notion that occupational injuries and diseases are underreported because of the fear of job loss and a low acknowledge of rights in foreign workers in the host country [ 9 ] . Further investigations are desirable in this regard.

On one hand, the examination of patient flow in the Emergency Department is a powerful tool for a preliminary analysis of the phenomenon since it provides a real-time perspective. On the other hand, information about how the accident had occurred is missing as well as the domain of work. This information could be relevant, considering that foreign workers are largely employed in fields where Italians almost do not work anymore [ 10 ] . Moreover, social networks of helpful of countrymen and women often lead to patterns that link nationality to a specific job area.

Occupational injuries and outcome after admission to ED: a comparison between Italian and foreigner workers.

Occupational injuries (‰)
  Total Italians Foreigners
During travel to work n n n OR 95% CI p
- males 53,866 5.5 41,993 4.8 11,873 11.1 2.31 2.26-2.35 <0.05
- females 46,592 6.7 39,946 6.5 6,646 9.1 1.41 1.37-1.45 <0.05
- total 100,458 6.0 81,939 5.5 18,519 10.3 1.87 1.84-1.90 <0.05
On worksite              
- males 435,982 44.7 347,544 40.1 88,438 82.6 2.16 2.14-2.18 <0.05
- females 164,341 23.7 141,692 22.9 22,649 30.9 1.36 1.34-1.38 <0.05
- total 600,323 36.0 489,236 32.9 111,087 61.6 1.93 1.92-1.94 <0.05
 
Outcome after admission to ED
  Total Italians Foreigners
During travel to work n n n OR 95% CI p
- hospital admissions 4,922 5 4,120 5 802 4 0.86 0.79-0.92 <0.05
- death 17 0.02 16 0.02 1 0.01 NS
- coded as ‘severe condition’ after triage 12,599 13 10,229 12 2,370 13 NS
On worksite                
- hospital admissions 20,667 3 17,414 4 3,253 3 0.82 0.79-0.85 <0.05
- death 69 0.01 56 0.01 13 0.01 NS
- coded as ‘severe condition’ after triage 39,034 7 33,554 7 5,480 5 0.70 0.68-0.73 <0.05