Role of working conditions in the explanation of occupational inequalities in work injury: findings from the national French SUMER survey

BACKGROUND Social inequalities in work injury have been observed but explanations are still missing. The objectives of this study were to evaluate the contribution of working conditions in the explanation of social inequalities in work injury in a national representative sample of employees. METHODS The study was based on the cross-sectional sample of the national French survey SUMER 2010 including 46,962 employees, 26,883 men and 20,079 women. The number of work injuries within the last 12 months was studied as the outcome. Occupation was used as a marker of social position. Psychosocial work factors included various variables related to the classical job strain model, psychological demands, decision latitude, social support, and other understudied variables related to reward, job insecurity, job promotion, esteem, working time and hours and workplace violence. Occupational exposures of chemical, biological, physical and biomechanical nature were also studied. Weighted age-adjusted Poisson regression analyses were performed. RESULTS Occupational gradients were observed in the exposure of most psychosocial work factors and occupational exposures. Strong occupational differences in work injury were found, blue-collar workers being more likely to have work injury. Chemical, biological, physical and biomechanical exposures contributed to explain the occupational differences in work injury substantially. Noise, thermic constraints, manual materials handling, postural/articular constraints and vibrations had significant contributions. Psychosocial work factors also contributed to explain the differences especially among women. CONCLUSION Prevention policies oriented toward chemical, biological, physical, biomechanical and psychosocial work exposures may contribute to reduce the magnitude of occupational differences in work injury.