Epidemiological Profile of Fatal Work Accidents Reported in the State of São Paulo Between 2009 and 2020: An Observational Study

Abbreviations

ILO: International Labor Organization; GDP: Gross Domestic Product.

Introduction

While playing a vital role in social subsistence, health, and well-being, work can also lead to accidents, illnesses, suffering, and even deaths, particularly when associated with precarious working conditions and processes. Infortunistics, the branch of forensic medicine that studies work-related accidents, occupational diseases, and related issues, is of paramount importance [1]. According to the International Labor Organization (ILO), an estimated 2.78 million workers die each year due to work-related accidents or diseases, resulting in a loss of 4% of the Gross Domestic Product (GDP) annually [2].

Article 19 of Law No. 8,213 of July 24, 1991, defines an occupational accident as one that occurs during the performance of work for a company or domestic employer or during the performance of work by insured persons referred to in item VII of art. 11 of this Law [3], causing bodily injury or functional disturbance that causes death or the loss or reduction, permanent or temporary, of the capacity to work. Article 21 of the same Law also specifies that accidents occurring on the way from home to the workplace, or from the workplace to the former, are considered occupational accidents [3]. Among occupational accidents, the most serious, the fatal, is the one that leads to death immediately after its occurrence or that results in death later, at any time, in a hospital environment or not, as long as the fundamental, intermediate, or immediate cause of death is due to the accident [4].

According to data from the Digital Observatory for Health and Safety at Work of the Public Ministry of Labor (MPT), Brazil ranks fourth worldwide in workplace accidents. Between 2012 and 2018, 4,738,886 workplace accidents were reported, representing an estimated one incident every 49 seconds, of which 17,315 resulted in fatalities. During the same period, 370,174,000 days of social security absence were recorded, resulting in Social Security incurring approximately R$83 billion in accident benefits [5].

São Paulo is the national economic center, and its population of approximately 46 million inhabitants includes around 21 million economically active individuals, representing one-fifth of the country’s workforce. Work accidents are often predictable and preventable public health issues. This study presents the epidemiological profile of fatal work accidents in São Paulo.

Methods

Our study is a quantitative, descriptive ecological epidemiological study based on data from the Notifiable Injuries Information System (SINAN) database, provided by the São Paulo State Health Department through a request to the Technical Division of Occupational Health Surveillance – Workers’ Health Reference Center (DVST- CEREST). The analysis included information on fatal, typical, and commuting accidents identified from the “death due to serious work accident” records in the “case progress” section of the Work Accident Notification/Investigation Form, which occurred in the State of São Paulo between 2009 and 2020. The information came in a .xlsx file. We processed the data in Microsoft Excel 2010 and presented the results in tables, graphs, and frequency distributions. The socioeconomic variables studied included age, sex, pregnancy status, race or ethnicity, education, occupation, and labor-market status. The accident profile was composed by investigating the affected body parts and the type of accident (typical or commuting). We excluded data that was missing or incomplete from the analysis.

Based on secondary data from publicly available databases that do not pose a risk of identifying individuals, this study did not require approval from a Human Research Ethics Committee.

Results and Discussion

The total number of fatal work accidents reported in São Paulo from 2009 to 2020 was 4,741. There was an annual increase between 2009 and 2011, with a peak in notifications in 2011. After this year, there was a decrease, more pronounced in 2015 and 2016, followed by an increase in 2017, but a new progressive decline continued until 2020. The characteristics of the Brazilian labor market can partly explain the distribution of fatal work accident notifications over the study period. According to the Brazilian Institute of Geography and Statistics (IBGE), the number of unemployed people in the country increased in 2009 as a result of a national and international scenario of declining economic activity due to the global economic and financial crisis of 2008 [6], which would explain the lower reporting of fatal work accidents in 2009. In turn, in 2015, the employed population decreased, accompanied by a further decline in reporting and due to economic disruptions caused by the SARS-CoV-2 pandemic, reported cases decreased in 2020.

Most fatal work accidents affected adult workers, with the predominant age group being 30 to 39 years (24.3%), followed by 40 to 49 years (22.5%), 20 to 29 years (21.9%), 50 to 59 years (18.4%), over 60 years (9.2%), and under 20 years (3.7%). There were thirty-two cases of fatal accidents among children under 17 years of age. Many studies show that young adults experience more serious work accidents because they are highly productive and often employed in high-risk activities [7, 8, 9, 10, 11, 12].

Men accounted for 93% of work-related accident deaths. There were 4,418 fatal cases in the male population and 323 in the female population, with a resulting sex ratio of 13.7 men for every woman. The predominance of men in this population is also evident in the literature [13, 14, 15], which suggests that the highest-risk jobs are still predominantly occupied by men [13]. The lower incidence of fatal accidents among women can be attributed to their more significant presence in the tertiary sector and industries that involve lower risk levels [14].

There were two deaths of pregnant workers during the period, one in the first trimester and the other in the second trimester of pregnancy. The low number of deaths at work involving pregnant women can be explained by the existence of legislation that protects them, such as Article 394-A of the Consolidation of Labor Laws [15, 16, 17, 18], which determines that in cases of unhealthy activities, pregnant and lactating workers must be reassigned to another activity or, if this is not possible, must be removed from work.

The workers assessed comprised 69.07% white individuals, 23.88% mixed-race individuals, 6.33% black individuals, 0.69% Asian individuals, and 0.02% indigenous individuals. Notably, this proportion depends on the population distribution across states in the country. According to the 2010 census conducted by the IBGE, 63.9% of São Paulo’s inhabitants identified as white, 29.1% as mixed-race, 5.5% as black, 1.4% as Asian, and 0.1% as indigenous. In all Brazilian states, this composition is distinct, with most of the population being black or brown (55.2%) [19]. Analyses carried out in the state of Bahia, for example, indicate that the majority of workers who suffered accidents are black [8, 20].

Regarding education, 1,493 workers (50%) had completed elementary education, 1,235 (41%) had completed high school, 231 (8%) had completed higher education, and 25 (1%) had no education. Among the workers evaluated, the majority had completed elementary education, which varied from the literature of other regions in the country, where a predominance of high school completion was reported [17, 18, 19]. Our analysis also reveals an association between lower education and a higher incidence of fatal work-related events.

Bricklayers were the professional category that contributed most to fatal accidents in the study population (9.24%), followed by truck drivers (8.75%), construction workers (2.89%), installation electricians (2.46%), small- volume motorcyclists (2.36%), construction painters (1.74%), agricultural workers (1.59%), driver’s assistants (1.47%), agricultural tractor drivers (1.34%), and production line feeders (1.34%). The construction (20.85%), transportation (14.55%), services (5.88%), industry (3.82%), agriculture (3.7%), domestic services (0.87%), and security forces (0.7%) sectors accounted for 50% of all fatal work accidents. The high incidence of fatalities in the construction industry is typical of the presence of a wide variety of activities performed by workers, the hiring of low- skilled labor, and the operation of multiple contractors on the same project, which reduces the responsibilities of each individual [13]. The second most frequent category is that of truck drivers. The construction and transportation sectors are among the main sectors in other studies on fatal work accidents [7, 20, 21].

Regarding the situation in the labor market, the majority were registered employees (65.5%), followed by self-employed workers (18.7%), unregistered employees (5.1%), statutory public servants (4.1%), casual workers (1.2%), others (1.1%), retirees (1.0%), employers (0.9%), cooperative members (0.8%), temporary workers (0.7%), civil servants (0.7%) and unemployed (0.2%). The predominance of workers with a formal employment contract was also observed in other studies [20, 22, 23].

Fatal work accidents mostly involved head injuries, with 1,836 cases (28.1%), and injuries to the entire body, with 1,831 (27.9%). The other parts of the body were affected in less significant proportions: chest with 896 (13.7%), abdomen with 523 (8%), lower limb with 372 (5.7%), other with 343 (5.2%), upper limb with 315 (4.8%), neck with 267 (4.1%), hand with 67 (1%), eye with 61 (0.9%) and foot with 40 (0.6%). The most frequently affected body parts, which together account for 56% of the occurrences, were the head and multiple regions of the body, which would justify the severity of the event when it affects vital organs, in addition to the fact that trauma involving the entire body involves high-energy trauma.

Regarding the type of accident, typical accidents predominated, with 3,096 notifications (69%), while commuting accidents accounted for 1,397 occurrences (31%). The proportion varies according to the study considered, but always shows a predominance of typical accidents, ranging from 52% to 86.2% of the total [23, 24, 25].

There are some limitations in the data obtained, such as the existence of information filled out incorrectly or incompletely, which prevented the use of some variables, such as the economic activity sector according to the National Classification of Economic Activities (CNAE) of the company, time worked in the occupation, hours and minutes after the start of the workday when the accident occurred. Therefore, it is necessary to train health professionals more effectively to complete the data submitted to SINAN and to monitor the quality of the information adequately. The adequate use of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in the coding of the underlying, subsequent, and immediate causes of death, in the notification of injuries and diseases and hospital records is also of fundamental importance for obtaining reliable information, monitoring the health situation and studying the morbidity and mortality profile of the population.

Conclusion

The epidemiological profile of fatal work accidents reported to SINAN in the state of São Paulo between 2009 and 2020 is characterized by the involvement of white men, adults aged 30 to 39, with complete elementary education, bricklayers, registered employees under the CLT, in typical accidents caused by various types of trauma, mainly affecting the head and entire body.

Work accidents have a direct impact on both health and the economy. They entail significant healthcare and social security costs and prematurely shorten the productive period of the economically active population, incurring substantial costs for government and society. Highlighting the epidemiological profile of fatal work accidents is fundamental for obtaining subsidies to develop public policies and strategies organized by the Occupational Health Surveillance (VISAT) and the Ministry of Labor for their prevention and control.