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Reducing the Burden of Injury: Advancing Prevention and Treatment
leading cause (23 percent) of occupational injury deaths. Since 1980, homicide has been the second leading cause of occupational injury deaths, surpassing machine-related deaths (13 percent) (CDC, 1998). One in six occupational deaths in 1995 was a homicide, which was the leading cause of death for females in occupational settings, and accounted for 46 percent of fatal work injuries (Fingerhut and Warner, 1997). Occupations with the highest risk of fatal injury include truck drivers, fishermen, timber cutters, and airplane pilots.
Although information about nonfatal occupational injuries is not as comprehensive as that for deaths, they are estimated to number more than 13 million each year (Leigh et al., 1997). Nearly one-half (46 percent) of these injuries are disabling. Approximately one-third of nonfatal injuries are sustained by workers in eight industries (restaurants and bars, hospitals, nursing and personal care facilities, trucking and non-air courier services, grocery stores, department stores, motor vehicles and equipment, and hotels and motels), with the highest incidence rate (17.8 per 100 full-time workers) reported in persons employed in nursing and personal care facilities (BLS, 1997).
THE COST OF INJURY
The scope of the injury problem is measured primarily in terms of numbers and rates of death and in years of potential life lost (YPLL) due to premature death. It has become increasingly apparent over the past decade, however, that although death rates and YPLL are powerful indicators of the relative magnitude of the injury problem, they do not adequately measure the full burden of injuries on society. In 1996, unintentional injury was third in YPLL before age 75, following diseases of the heart and malignant neoplasms. In fact, all injury (including homicide and suicide) is the leading cause of YPLL before age 75 (Table 2.2) (NCHS, 1998). With few exceptions, the rank ordering of YPLL for injury follows the ordering for leading causes of injury death. Notably out of order, however, is the YPLL for fall-related deaths. Despite the fact that, overall, more injury deaths are attributed to falls than to suffocations, more YPLLs are associated with suffocations because they tend to occur at younger ages than deaths due to falls.
Totaling deaths and years of life lost, however, does not take into account the additional costs to federal, state, and local governments of public programs (e.g., Medicare, Medicaid, veterans' benefits); the costs to private insurance programs; and the costs accruing to injured individuals, their families, employers, and society in general. These are measured as both economic and quality-of-life factors of the cost of injury.