Applied Economics Letters, 2002, 9, 595 ±600

The recurrence of occupational injuries:

estimates from a zero in¯ated count model
M I C H E L E C A M P O L I ET I
Division of Management, University of Toronto at Scarborough , Centre for Industrial
Relations, University of Toronto, Toronto, Ontario, M5S 2E8, Canada
E-mail: campolie@chass.utoronto.c a

Received August 28, 2001

The recurrence of workers’ compensation injuries is studied using data from the
unemployment histories of permanently disabled workers from Ontario, Canada.
Estimates are obtained with a zero in¯ated Poisson regression model and it is
found that employer accommodations can reduce the number of subsequent work
absences workers experience.

I. INTRODUCTION employers. Consequently, disability management strate-

Recent research has begun to put more emphasis on the
recurrent nature of many occupational injuries, which sug-
gests that work absences may be followed by subsequent
absences in the future. For example, Butler et al. (1995)
and Johnson et al. (1998) studied the additional work
absences of permanently disabled workers. However,
both of these papers studied these additional claims at a
fairly high level of aggregation. Speci®cally, they examined
the patterns of return-to-work they observed in the claim
histories of permanently disabled workers with a multi-
nomial logit model (e.g., single absence and successful
return-to-work, single absence and unsuccessful return-to-
work, multiple absence and successful return-to-work and
multiple absences and unsuccessful return-to-work).
The recurrence of these occupational injuries may be
particularly prevalent in musculoskeletal and soft tissue
injuries, where injured workers face a signi®cant probabil-
ity of re-injury that neither they nor their physician can
predict with any certainty (Johnson et al., 1998). 1 Since
these injuries are becoming increasingly common (NCCI,
1992; Butler et al., 1996) as well as being more costly than
other sorts of workers’ compensation claims (NCCI, 1992),
these subsequent work absences are becoming an increas-
ingly pressing issue for workers’ compensation insurers and
gies, such as what sort of accommodations should be pro-
vided to workers to help prevent further work absences
may be particularly important.
Grouping employment histories is not the only empirical
approach that could be used to study the recurrence of
occupational injuries. For example, a count data model,
such as Poisson regression model, could also be used to
model the number of subsequent work absences associated
with an injury. However, since some workers make a full
recovery, return-to-work and do not have a relapse of the
injury and others may su€ er a recurrence of their injury
after returning to work and, subsequently, ®le additional
claims, some modelling problems might arise when estimat-
ing some of the more common regression models for count
data. Speci®cally, the presence of large numbers of obser-
vations that take the value zero, i.e., no subsequent work
absences, might not be consistent with the underlying dis-
tribution ®t to the data. Fortunately, some count models
have been developed to accommodate an excess number of
zeros. These models are referred to as `zero in¯ated’ count
models and they allow for excess zeros in the data by mod-
elling the counts as a mixture of two distributions: a spike
at zero and a distribution that allows positive outcomes.
In this paper, an empirical investigation is conducted
of the number of subsequent work absences in an

1
Musculoskeletal and soft tissue injuries present diagnostic and treatment problems for health care providers (Agency for Health Care Policy and
Research, 1994).

Applied Economics Letters ISSN 1350±4851 print/ISSN 1466±4291 online # 2002 Taylor & Francis Ltd 595
http://www.tandf.co.uk/journals
DOI: 10.1080 /1350485011011120 7
596
employment history that are related to a workplace injury
using data from the Ontario Survey of Permanently
Disabled Workers, which was conducted by the Ontario
Workers’ Compensation Board. The investigation proceeds
empirically by estimating a zero in¯ated Poisson regression
model that accounts for the excess zeros in the data (i.e.,
individuals with no further absences) as well as the addi-
tional claims ®led by some workers. Particular attention is
paid to the e€ ect of accommodations on the number of
subsequent absences, determining which sort of accommo-
dation arrangements are better able to reduce the number
of subsequent work absences.
In the next section, the econometric model is described.
A description of the data is provided in Section III and the
empirical results in Section IV. Section V contains some
concluding remarks.
II. ECONOMETRIC MODEL
Count data models have long been used to study the occur-
rence of accidents and diseases (e.g., Greenwood and Yule,
1920). However, there have not been many applications of
these models to workers’ compensation data in the eco-
nomic literature.2 These count data models may be better
able to model the occurrence of subsequent work absences
than other methods. For example, rather than looking at
patterns in the claim history at a high level of aggregation,
with a multinational logit model, the exact number of work
absences that are observed can be used as an outcome vari-
able. This suggests that count data models will use more
information from the employment history and, conse-
quently, produce better estimates.3
If the data contain an excess number of zeros, standard
count data models, such as the Poisson, may be inade-
quate. Speci®cally, the `overdispersion’ caused by the
zeros may not be consistent with the baseline distribution
(e.g., the Poisson) ®t to the data. Since the econometric
model should be ¯exible enough to handle this aspect of
the data an alternative speci®cation should be used. These
models are referred to as `zero in¯ated’ count models and
model the excess zeros by using the mixture of a distri-
bution for positive outcomes (modelled as a Poisson distri-
bution in this paper) and the zeros.4
The zero in¯ated Poisson model is speci®ed as
yi ˆ 0; with probability ¿i ;
yi ¹ P‰yi Š; with probability 1 ¡ ¿i ;
2
Most of the applications that do exist study the e€ ects of experience rating programs on the occurrence of injuries (e.g., Ruser, 1991, 1993).
3
Butler et al. (1995) found 14 mutually exclusive patterns in the employment histories of the workers in their sample, but had to aggregate to four
categories to estimate their multinomial logit model.
4
The use of a zero in¯ated count model will be of particular importance in this paper because many of the workers in this sample did not have additional
work absences.
M. Campolieti
where P‰yi Š ˆ exp …¡¶i †¶yi i =¶i !, ¶i ˆ xi0 ­ , and ¿i ˆ
0
F …xi ®† ˆ exp …zi0 ®†=…1 ‡ exp …zi0 ®††, ¿i denotes a mixture
probability weight; P‰yi Š is a Poisson distribution; x and z
are vectors of explanatory variables. The model presented
in Equation 1 can be interpreted as a ®nite mixture model,
which includes a degenerate distribution with a mass point
at zero. There is a positive probability ¿i when no addi-
tional claims for individual i are observed. This probability
is parametrized as a logit CDF with a set of covariates zi
and parameters ®. The positive outcomes occur with prob-
ability 1 ¡ ¿i . This part of the mixture model is speci®ed as
a Poisson regression model.
The log-likelihood function for the zero in¯ated Poisson
can be written as
X
L…yi j ­ ; ®† ˆ ln ‰F …zi0 ®† ‡ …1 ¡ F …zi0®†† exp …ixi0 ­ †Š
i2S
X µ ln …1 ¡ F …zi0 ®†† ¡ xi0 ­ ¶
‡ …2†
‡ yi ln …xi0 ­ † ¡ ln …yi !†
i 62 S
where S is the set of outcomes for which yi ˆ 0. The like-
lihood function in Equation 2 is maximized with respect to
(­ ; ®) to obtain parameter estimates.
III. DATA
The model is estimated using data from the Ontario Survey
of Permanently Disabled Workers. This survey was a cen-
sus of all permanently disabled workers who received a
medical exam from the Ontario Workers’ Compensation
Board between 12 June 1989 and 31 August 1990, which
collected detailed information on the post-injury employ-
ment experiences of these workers. The data contains con-
trols for the demographi c characteristics of the claimants
(age, gender and marital status), educational attainment
(no high school, high school and post secondary), the
part of the body that was injured, the nature of the injury,
the worker’s union status and whether they received an
accommodation from their employer. In addition, the sur-
vey also contains detailed information about the nature of
the accommodation that was provided (reduced hours,
¯exible schedule, special training, modi®ed equipment,
light duties and other arrangements).
Just over 11 000 workers were interviewed for the sur-
vey. All workers who had accidents before 1979 and after
1989 were excluded as well as those who did not return to
…1† work after their injury, which leaves a sample of 7915 indi-
viduals. A subsequent absence is de®ned as a work absence
that was related to the worker’s injury after they re-entered
The recurrence of occupational injuries
Table 1. Frequency distribution of subsequent claims
Number of subsequent claims Individuals in sample (%)
0 49.84
1 39.14
2 8.96
3 1.42
4 0.51
5 0.14
the labour force. A frequency distribution of these sub-
sequent absences is presented in Table 1. About 50% of
the 7915 workers in the sample had at least one subsequent
absence that was related to their initial injury. Most of
these workers only had one additional absence from
work (39.14% of the total sample). A smaller proportion
of the workers (11.03% of the sample had two or more
subsequent absences from work, the majority of which
had only two additional absences (8.96% of the sample).
Only 0.65% of the workers had four or more work
absences that were related to their initial injury.
IV. EMPIRICAL RESULTS
The mixture probability in the zero in¯ated Poisson regres-
sion model is speci®ed as a function of the part of the body
that was injured (trunk, back, lower extremities, and mul-
tiple body parts), the nature of the injury (amputations,
sprains, and dislocations and fractures), age at the time
of the accident and gender. Two speci®cations were used
for the part of the model that deals with positive outcomes,
i.e., the Poisson regression model. The controls for age,
marital status, gender, education and union status are
referred to as the base controls. Speci®cation (1) includes
the base controls and a dummy variable controlling for
whether the worker was o€ ered an accommodation.
Speci®cation (2) also includes the base controls.
However, speci®cation (2) replaces the dummy variable
for accommodations with dummy variables for the type
of accommodation that was provided, since workers may
receive more than one accommodation from their employer
(for example, they may receive a ¯exible schedule as well as
light duties). The estimates from these speci®cations are
presented in Table 2.5;6
597
The Vuong test (Vuong, 1989) was used to check
whether the zero in¯ated model would be a suitable speci-
®cation for these data. The test statistics at the bottom of
Table 2 con®rm that the zero in¯ated Poisson model is
more appropriate than the standard Poisson model.7
A negative parameter estimate in the mixture probabil-
ities indicates that the covariate would be associated with a
decline in the probability of additional claims. In other
words, the covariates with negative coe cient estimates
are associated with increases in the probability of sub-
sequent claims. The estimates for the mixture probabilities
from speci®cations (1) and (2) in Table 2 are fairly consis-
tent in terms of the magnitude of the e€ ects. However, the
estimates on the controls for back injuries and sprains were
about a third larger in speci®cation (2), which included
information about the nature of the accommodations.
The estimates for age indicate that older workers are
more likely to have subsequent absences. On the other
hand, males are more likely to have no additional claims.
In addition, back injuries and multiple body parts were
associated with increases in the probability of further
absences that were statistically signi®cant. The estimates
on the controls for the other body parts were not statisti-
cally signi®cant. Finally, the controls for the nature of the
injury indicated that amputations and sprains were associ-
ated with statistically signi®cant increases, in the probabil-
ity of subsequent work absences.
The estimates from the Poisson regression component of
the mixture model indicates that older persons and males
were more likely to have fewer absences, for both speci®ca-
tions (1) and (2). The estimates on the control for gender
are consistent with Butler et al. (1995), who found that
women were more likely to have unstable employment his-
tories. The estimates from this paper tend to support the
hypothesis that older workers may be more experienced
and, consequently, be better able to reduce the number of
subsequent work absences. However, the estimates from
the mixture probabilities indicate that older workers were
more likely to have additional work absences. These ®nd-
ings are also similar to Butler et al. (1995), who found that
older workers would be more likely to have unstable
employment histories.
Higher levels of education were found to be associated
with fewer subsequent absences. Since individuals with
higher levels of education are more likely to make

5
These speci®cations including dummy variables were also estimated for industry type and obtained estimates that were almost identical to those presented
in Table 2.
6
A zero in¯ated negative binomial regression model was also estimated. The negative binomial distribution is a generalization of the Poisson distribution:
yi
P‰yi Š ˆ ‰¡…yi ‡ m†=¡…yi ‡ 1†¡…m†Špm 0
i …1 ¡ pi † where pi ˆ 1=1 ‡ ¬·i , m ˆ 1=¬ and ·i ˆ x i ­ . If ¬ ˆ 0, the negative binomial distribution simpli®es to a
Poisson distribution. Estimating a zero in¯ated negative binomial regression model, using the controls in speci®cations (1) and (2), produced estimates of ¬
that were about 1.E-7, and sometimes smaller, suggesting that the Poisson distribution would be a more appropriate functional form.
7
The Vuong test is a bidirectional speci®cation test that has been used to test the zero in¯ated models versus nonin¯ated count models. Large positive test
statistics support zero in¯ated models and large negative values of the test statistic indicate nonin¯ated models would be a more appropriate. Test statistics
less than the absolute value of two are inconclusive.
598 M. Campolieti
Table 2. Coe cient estimates zero in¯ated poisson model

Speci®cation 1 Speci®cation 2

Variable name Mixture probability Poisson regression Mixture probability Poisson regression

Age 70.0103 70.0033** 70.0107 70.0033**

(0.0081) (0.0015) (0.0080) (0.0015)
Male 1.1169** 70.1742** 1.1169** 70.1701**
(0.2944) (0.0318) (0.2916) (0.0316)
Married ± 0.0473 ± 0.0436
(0.0360) (0.0359)
Education (no High School)
High School ± 70.2254** ± 70.2210**
(0.0360) (0.0359)
Post secondary ± 70.2812** ± 70.2665**
(0.0492) (0.0491)
Union ± 70.0120 ± 70.0188
(0.0286) (0.0285)
Accommodation ± 70.2328** ± ±
(0.0286)
Reduced hours ± ± ± 70.0427
(0.0360)
Flexible schedule ± ± ± 70.2447**
(0.0501)
Special training ± ± ± 70.2396**
(0.0813)
Modi®ed equipment ± ± ± 70.0504
(0.0982)
Light duties ± ± ± 70.1295**
(0.0319)
Other arrangements ± ± ± 70.2683**
(0.0960)
Part of body injured (head, neck, arms, hands)
Trunk 0.4438 ± 0.4989 ±
(0.4813) (0.4896)
Back 717.598** ± 722.472** ±
(0.5000) (0.5075)
Lower extremities 70.4726 ± 70.4499 ±
(0.5260) (0.5356)
Multiple body parts 71.8268** ± 71.7492 ±
(0.9317) (0.9073)
Nature of injury (other, unspeci®ed)
Amputation 1.6884** ± 1.6697** ±
(0.3681) (0.3681)
Sprains 718.219** ± 723.136** ±
(0.3709) (0.3744)
Dislocations and fractures 0.0625 ± 70.0298 ±
(0.2510) (0.2518)
Constant 71.4838** 0.1060 71.5041** 0.1040
(0.6021) (0.0704) (0.6053) (0.0703)
Vuong test statistic 8.41 8.45
{0.000} {0.000}
Log-likelihood 76623.21 76608.46

Notes: Variable name(s) in square brackets denotes excluded dummy variable(s); standard errors are presented in parentheses; double asterisk (**) denotes
the estimate is statistically signi®cant at 5% level. Curly braces indicate p-value for the Vuong test for Zero In¯ated Poisson Distribution versus a Poisson
distribution.

investments in their health, they should be less susceptible
to relapses of an injury than workers with lower levels of
education (Butler et al. 1995). The estimates on the control
for union status indicate that members of unions are likely
to have fewer additional work absences, but these estimates
were not statistically signi®cant.
The estimate on the dummy variable for accommoda-
tions from speci®cation (1) in Table 2 indicates that accom-
modations are associated with a decline in the number of
subsequent work absences. Similarly, the coe cient esti-
mates from speci®cation (2), which replaces the accommo-
dation dummy with dummy variables for the type of
The recurrence of occupational injuries 599
Table 3. E€ ects of accommodation on expected number of subsequent work absences

Speci®cation 1 Speci®cation 2

Number % Number %

Expected number of claims 0.4236 ± 0.4229 ±

Change in expected number of claims associated with a discrete change
Accommodation 70.0526 76.04 ± ±
Reduced hours ± 70.0001 70.02
Flexible schedule ± 70.0544 712.86
Special training ± 70.0533 712.60
Modi®ed equipment ± 70.0116 72.74
Light duties ± 70.0294 76.95
Other arrangements ± 70.0593 714.02

Notes: Expected number of claims computed as

¶· z 0 ®†
exp …·
E…T† ˆ …1 ¡ F·† £ ; F· ˆ and ¶· ˆ x· 0 ­ ;
1 ¡ exp …¶·† 1 ‡ exp …· z 0 ®†
where x- and z-bar denote the means of the vectors x and z.

accommodation that was provided, were all negative and
associated with a decline in the number of subsequent work
absences. However, only the accommodations that
involved ¯exible schedules, special training, light duties
and other arrangements were statistically signi®cant.
These estimates are also consistent with Butler et al.
(1995) and Johnson et al. (1998) who found that accom-
modations were associated with increases in the probability
of more stable employment histories.
To determine the magnitude of the e€ ects of accommo-
dations on the number of subsequent absences, the e€ ects
of accommodations on the expected number of subsequent
absences were computed,
¶ of subsequent claims.
E…T † ˆ …1 ¡ F † £ ;
1 ¡ exp …¡¶†
for a worker can reduce the expected number of subsequent
absences by 0.1077 or 25.5 percent.
V. CONCLUDING REMARKS
In this paper, a model that examined the number of sub-
sequent work absences for a sample of permanently dis-
abled workers has been estimated. The estimates suggest
that accommodations could be used to reduce the number
of subsequent absences from work. In particular, disability
management strategies that include accommodations such
as ¯exible schedules, special training, and other arrange-
ments may be especially e€ ective in reducing the frequency

where
0 This research was supported by the Connaught Fund (New
exp …z ®†
Fˆ and ¶ ˆ x 0­ :
1 ‡ exp …z 0 ®†
In Table 3, the expected number of subsequent absences for
both speci®cations, evaluated at the means, was about 0.42.
The estimate from speci®cation (1) suggests that o€ ering an
accommodation, reduces the expected number of sub-
sequent absences by 0.053 or 12.4 percent. The estimates
from speci®cation (2) provide more detailed information
about the e€ ects of di€ erent accommodation arrangements
on the expected number of subsequent claims. In particu-
lar, providing ¯exible schedules, special training and other
arrangements can reduce the number of subsequent
absences by 0.053 to 0.059 claims or 12.6 to 14.0 percent
(see Table 3). The other bene®t of the Table 3 is that it
provides an indication of the e€ ects of a combination of a
number of di€ erent types of accommodations. For ex-
ample, providing a ¯exible schedule and special training
ACKNOWLEDGEMENTS
Sta€ Start-Up and New Sta€ Matching grants) at the
University of Toronto.
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M. Campolieti
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