AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 58:299–307 (2015)

Gender Differences in
Occupational Injury Incidence

Janneke Berecki-Gisolf, PhD,1
Peter M. Smith, PhD,2 Alex Collie, PhD,

3

and Roderick J. McClure, PhD4,5,6

Objectives To describe the frequency and distribution of workplace injury claims by

gender, and quantify the extent to which observed gender differences in injury claim rates
are attributable to differential exposure to work-related factors.
Methods WorkSafe Victoria (Australia) workers’ compensation data (254,704 claims
with affliction onset 2004–2011) were analysed. Claim rates were calculated by combining
compensation data with state-wide employment data.
Results Mental disorder claim rates were 1.9 times higher among women; physical injury
claim rates were 1.4 times higher among men. Adjusting for occupational group reversed
the gender difference in musculoskeletal and tendon injury claim rates, i.e., these were
more common in women than men after adjusting for occupational exposure.
Conclusions Men had higher rates of physical injury claims than women, but this was
mostly attributable to occupational factors. Women had higher rates of mental disorder
claims than men; this was not fully explained by industry or occupation. Am. J. Ind. Med.
58:299–307, 2015. ß 2015 Wiley Periodicals, Inc.

KEY WORDS: work-related injury; epidemiology; mental health; workers’

compensation; incidence; gender

INTRODUCTION to the person, the energy involved, and the social and
physical environment. Occupational injury is well recog-
The epidemiological model of injury prevention [Kraus nised as a setting in which each of the person, energy and
and Robertson, 1992] characterises the causation of injury environmental components play an important role. The
and strategies for its prevention according to factors relating relative contribution of these factors needs to be delineated
for the development of effective strategies for injury
prevention.
1
Monash Injury Research Institute, Monash University, Melbourne, Overall, men have substantially higher rates of
Victoria, Australia
2
School of Public Health and Preventive Medicine, Monash University, occupational injury than women [Salminen, 1994; Islam
Melbourne,Victoria, Australia et al., 2001; Smith and Mustard, 2004; Berdahl, 2008; Fan
3
Institute for Safety, Compensation and Recovery Research, Monash University, et al., 2012; Wirtz et al., 2012]. Although this has been
Melbourne,Victoria, Australia
4
Harvard Injury Control Research Center, Harvard School of Population Health, observed and reported, little is known about the origin of this
Boston, Massachusetts gender difference and how the relative overrepresentation of
5
Institute for Work & Health,Toronto, ON, Canada occupational injuries among men might be addressed. The
6
Dalla Lana School of Public Health, University of Toronto, ON, Canada
Contributorship Statement: All authors contributed to the conception and design most straightforward explanation is an underlying gender
of the study, drafting, and revising of the manuscript and all authors approved the difference in exposure to occupational safety hazards.
final submitted version. Occupational exposure is not the only factor, however:


Correspondence to: Janneke Berecki-Gisolf, MD, PhD, Monash Injury Research
Institute,Building 70 Clayton Campus,Monash University 3800 Melbourne, Australia. reported male/female differences vary depending on the
E-mail: janneke.berecki-gisolf@monash.edu.au study population age group, setting and injury type. For
example, workplace bone fracture incidence increases with
Accepted18 November 2014
DOI10.1002/ajim.22414. Published online14 January 2015 in Wiley Online Library age among female but not among male workers [Fan et al.,
(wileyonlinelibrary.com). 2012]. Among workers in manual occupations, women have

ß 2015 Wiley Periodicals, Inc.

300 Berecki-Gisolf et al.
higher rates of musculoskeletal injuries than men [Smith and
Mustard, 2004]; a similar pattern has been observed among
workers in the service industry [Islam et al., 2001]. Generally
the reported male/female difference in occupational injury
appears to decrease with increasing worker age [Kachan
et al., 2012].
Some of the observed differences in injury rates may be
explained by male/female differences in muscle coordination
and movement strategies [Cote, 2012], and in the propensity
for certain comorbid conditions. The high prevalence of
osteoporosis among older women increasing the risk of bone
fractures is an example of this. Furthermore, personal
protective equipment is generally designed on the basis of
biometrics derived from the average male body and thus may
not be as effective for women. And finally, under reporting of
risks and injuries by women as well as dismissal of women’s
complaints and concerns by managers are well documented
[Curtis Breslin et al., 2007].
These explanations can be broadly categorised as work
related (occupational exposure) and worker related (biolog-
ical and behavioural), or a combination of both. The relative
contribution of occupation and industry to gender difference
in injury rate has not been well quantified to date. The aim of
this study is therefore to describe the frequency and
distribution of workplace injury claims by gender, and to
quantify the extent to which observed gender differences in
injury claim rates are attributable to differential exposure to
work-related factors. Work-related exposure was analysed in
terms of occupation and industry, in separate models.
METHODS
Workplace injury claim rates were determined from
retrospective database analysis of workers’ compensation
claims records combined with labour force estimates of the
population at risk for (compensable) work injuries.
Study Population and Setting
WorkSafe Victoria provides workers’ compensation
insurance for employers in Victoria, Australia. Following a
workplace injury or disease, workers may be eligible to
receive income replacement, and medical and rehabilitation
expenses, regardless of who was at fault. The employer is
liable to pay weekly payments for the first 10 days that an
injured worker is absent and the first AU$629 of medical and
like services (the amount is inflation indexed; the figure
given is correct for 2012). Alternatively, employers can elect
the excess buyout option: by paying an additional loading on
their premium, the employer no longer has to pay the medical
excess or the first 10 days of work absence. This is the case
only in 5–7% of claims. Approximately 85% of the Victorian
workforce is covered by WorkSafe Victoria. The other 15%
are either sole traders (who do not need to register for
workers’ compensation in Victoria), employees of self-
insurers (mostly large employers), or workers covered under
the Comcare workers’ compensation scheme (mainly federal
government employees).
Study Sample
Workers with an occupational injury or illness for which
they claimed workers’ compensation were included if the
injury or illness started between July 1, 2003 and June 30,
2011 (‘affliction date’).
Data Sources: (a) Workers’
Compensation Claims
The injury data used in this study were based on the
Compensation Research Database (CRD) held by the
Institute for Safety, Compensation and Recovery Research
in Melbourne, Australia. The CRD contains WorkSafe
workers’ compensation administrative claims data with
information on the occupation and industry, worker
demographics, injury type, claim cost and records of
payments made. Prior to the data being made available to
researchers, the records were stripped of identifying
information including claim numbers and claimant name
and contact details. Non-identifying claim ID and claimant
ID numbers were assigned to each claim in the database.
Data Sources: (b) Labour Force
Statistics
The labour force data used in this study was based on the
Safe Work Australia National Dataset for Compensation-
Based Statistics (NDS). Sole traders and Commonwealth
government employees are excluded from the labour force
data, as these groups are not covered by WorkSafe Victoria.
Self-insurers, who are not covered by WorkSafe Victoria
[WorkSafe Victoria, 2013], were not excluded from the
labour force data as they are distributed across multiple
industry groups, making it not technically possible to remove
them. The labour force data spanned from July 1, 2003 and
July 1, 2011 to match the workers’ compensation claim
sample. Two sets of aggregate data were used: the first
contained employment counts and summed hours worked in
Victoria (Australia), stratified by year, gender, age group and
industry. The second contained employment counts and
summed hours worked, stratified by year, gender, age group
and occupational group. Labour force data stratified by year,
gender, age, occupational group and industry in one dataset
could not be made available because it would have resulted in
low cell-counts.
 Gender Differences in Occupational Injury 301

Variables Workplace injury claim rates were calculated by

combining the claims data with the employment data,
Occupational Injury (claims data)
dividing the number of claims by the number of workers per
year. Repeat claims, i.e., more than one claim made by a
In the claims database, the primary injury or illness on
worker during the study period, are therefore captured in the
which the workers’ compensation claim was based was
results; however, repeat claims were not analysed separately.
categorised into major groups according to VCODE: The
For insight into how much of the gender difference in claim
nature of injury/disease classification system for Victoria,
rates is attributable to gender differences in working hours,
Australia [WorkSafe Victoria, 2008]. To establish which
workplace injury claim rates were also calculated as the
fractures were potentially attributable (depending on age) to
number of claims per hours worked per year. These
osteoporosis, fractures were further distinguished as hip,
calculations were conducted for each major injury group
forearm or vertebral fractures (without spinal cord involve-
to calculate the rate for different injury types, and stratified
ment); and all other fractures: hip, forearm and vertebral
by age, gender, occupation and industry.
fractures can be considered typical osteoporotic fractures
To test if potential gender differences in injury claim
[Sambrook and Cooper, 2006].
rates are due to men and women working in different
occupations and industries, logistic regression models were
Employment (labour force data)
used. The dependent variable was claims/hours worked, and
independent variables were gender, industry and occupation.
‘Employed persons’ refers to the total number of
Age and gender interactions were tested using interaction
employees, stratified by year, age, gender, etc. Hours worked
plots; because of strong interaction effects the models were
refers to the total sum of hours worked, stratified by year,
stratified by age group (PROC LOGISTIC in SAS was used,
age, gender etc. The employment data from SafeWork
with model statement: count/hours ¼ gender; by age group).
Australia was provided with relative standard errors.
Industry and occupational group were tested in separate
Employment or hours worked estimates with relative
models because they were not available in the same stratified
standard errors of greater than 50% were suppressed because
labour force dataset.
the accuracy of the estimate was considered to be
insufficient.
Ethics Statement
Year (claims data and labour force
data) Institutional ethics approval was gained from the
Monash University Human Research Ethics Committee for
In all datasets used, year was coded as the financial year: use and disclosure of the claims information.
for example, 2011 refers to the period from July 1, 2010 until
June 30, 2011.
Results
Age and gender (claims data and labour
Between 2003/04 and 2010/11, there were 254,704 new
force data)
workers’ compensation claims made by 206,372 workers. Of
the claims, 48,332 (19%) were repeat claims; i.e., claims made
Ages were grouped as <25, 25–34, 35–44, 45–54, and
by workers with more than one claim during the study period.
55 years.
Of all claims, 66% were made by men and 34% by women.
The number of claims per year gradually decreased from
Industry and occupation (claims data
34,428 in 2003/04 (financial year) to 31,188 in 2010/11. The
and labour force data)
proportion of claims made by women gradually increased
from 33% in 2003/04 to 36% in 2010/11. The most common
Industry was categorised according to the Australian and
injury types were musculoskeletal (39%); wounds (16%);
New Zealand Standard Industrial Classification (ANZSIC)
traumatic tendon (15%); mental disorders (9%); and fractures
[Australian Bureau of Statistics and Statistics New Zealand,
(8%), which together accounted for 87% of claims.
2006]. Occupational group was classified according to the
The number of workers in Victoria (excluding sole
Australian Standard Classification of Occupations (ASCO)
traders and federal government employees) grew from 2.16
[McLennan, 1997].
million in 2003/04 to 2.66 million in 2010/11; participation
of women remained relatively stable at 47–48%. The total
Statistical Analysis number of hours worked increased from 2,158 million in
2003/04 to 2,561 million in 2010/11; women’s share of the
All analyses were carried out using SAS 9.2 software. hours worked remained relatively stable at 39–41%.
302 Berecki-Gisolf et al.

TABLE I. Number of Claims Per Injury Type, Claim Rates per 1000 Person-Years and Claim Rates Per 106 Hours Worked for Victorian Workers’
Compensation Claims in 2004^2011.

Number of claims Rate per 1000 employed person-year Rate per 10 6 worked hours
Female Male Female Male RR * (F vs. M) Female Male RR* (F vs. M)
All claims 85,982 168,722 9.36 16.86 0.55 6.76 8.97 0.75
Types of injury
Musculoskeletal system 38,483 61,402 4.19 6.15 0.68 3.03 3.27 0.93
Wounds 9,246 30,457 1.00 3.05 0.33 0.72 1.62 0.44
Traumatic tendon 12,623 25,246 1.37 2.53 0.54 0.99 1.34 0.74
Mental disorders 12,909 10,346 1.42 1.03 1.38 1.03 0.55 1.87
Fractures 5,724 14,007 0.62 1.40 0.44 0.45 0.75 0.60
All other afflictions 6,997 27,264 0.75 2.70 0.28 0.54 1.44 0.38

F, female; M, male.
*
Claim rate ratios (RR) are given; these are calculated as the injury claim rate among women divided by the injury claim rate among men.

The overall claim rate in 2003/04 to 2010/11 was 13.2
claims per 1000 person-years, or 8.1 claims per 106 hours
worked. The claim rates for each injury type are shown in
Table I. Per worker-year, men were 1.8 times as likely to
make a claim, but per hours worked, men were only 1.3 times
as likely to make a claim, because on average women worked
fewer hours than men. In absolute numbers as well as rates,
most injury types were more common among men, with the
exception of mental health claims which were more common
among women.
Of the five most common injury types, fractures, tendon
trauma and musculoskeletal injuries occurred more commonly
with increasing age, in claims per hours worked. Wounds were
most common at age under 25 years, and the claims per hours
worked remained steady from age 25 years onwards. The
mental disorders claims per hours worked increased with
increasing age, but reached a maximum at age 45–54 years and
decreased slightly after age 55 years.
Claim rates per occupational group for the five most
common injury types are shown in Table II. Claim rates

TABLE II. TheTotal Number of Hours Worked by Men and Women in Each Occupational Group in Victoria in 2004^2011*, and the Workplace Injury
Claim Rate, for the Five Most Common Afflictions.

Hours worked Musculoskeletal Traumatic Mental

(x10 6 ) system Wounds tendon Fractures disorders

By Claim F vs. M Claim F vs. M Claim F vs. M Claim F vs. M Claim F vs. M
Total women (%) rate a RR [95% CI]b rate a RR [95% CI] b rate a RR [95% CI] b rate a RR [95% CI] rate a RR [95% CI] b
Managers and administrators 3006 (23) 1.00 1.9[1.8^2.1] 0.39 1.1[1.0^1.3] 0.45 1.6[1.4^1.7] 0.28 1.5[1.3^1.8] 0.59 3.3[3.0^3.6]
Professionals 7210 (49) 1.79 2.7[2.6^2.8] 0.47 1.8[1.7^1.9] 0.66 2.0[1.9^2.2] 0.30 2.3[2.1^2.6] 0.84 2.4[2.3^2.5]
Associate professionals 4259 (38) 2.05 1.1[1.0^1.1] 0.62 0.8[0.7^0.8] 1.02 0.7[0.6^0.7] 0.39 0.8[0.7^0.9] 0.98 1.2[1.1^1.3]
Tradespersons and related 3717 (7) 5.02 1.3[1.2^1.4] 3.25 0.7[0.6^0.7] 1.89 1.1[1.0^1.2] 1.18 1.0[0.9^1.1] 0.36 3.7[3.3^4.2]
workers
Advanced clerical and 861 (89) 1.29 0.9[0.7^1.0] 0.27 1.0[0.7^1.6] 0.39 0.9[0.6^1.2] 0.26 0.7[0.5^1.0] 0.80 0.9[0.7^1.1]
service workers
Intermediate clerical 4853 (66) 2.46 2.0[1.9^2.1] 0.60 1.1[1.0^1.2] 0.82 1.4[1.3^1.6] 0.34 1.5[1.3^1.7] 0.82 1.7[1.5^1.8]
Intermediate production and 2726 (11) 6.79 1.1[1.0^1.1] 2.54 0.6[0.5^0.6] 2.59 0.8[0.8^0.9] 1.39 0.5[0.4^0.5] 0.71 1.2[1.1^1.4]
transport workers
Elementary clerical 2130 (61) 2.07 1.2[1.1^1.3] 0.71 0.6[0.6^0.7] 0.75 0.8[0.8^0.9] 0.41 0.6[0.5^0.7] 0.61 1.1[1.0^1.3]
Labourers and related 2258 (31) 8.52 1.1[1.1^1.1] 3.70 0.6[0.5^0.6] 3.02 0.9[0.9^1.0] 1.68 0.6[0.6^0.7] 0.76 2.0[1.8^2.2]
workers

F, female; M, male.
*
Sole traders and federal government employees excluded.
a
The workplace injury claim rate per106 hours worked.
b
Claim rate ratios (RR) for female vs. male are given with 95% confidence intervals.
TABLE III. TheTotal Number of Hours Worked by Men and Women in Each Industry in Victoria in 2004^2011* and the Workplace Injury Claim Rate for the Five Most Common Afflictions.

Hours worked Musculoskeletal Traumatic Mental

(x10 6 ) system Wounds tendon Fractures disorders
By women Claim F vs. M RR Claim F vs. M RR Claim F vs. M RR Claim F vs. M RR Claim F vs. M RR
Total (%) rate a [95% CI] b rate a [95% CI]b rate a [95% CI]b rate a [95% CI] b rate a [95% CI]b
A Agriculture, Forestry, and Fishing 581 (19) 2.77 1.4[1.3^1.6] 1.81 0.8[0.7^0.9] 1.21 1.0[0.8^1.2] 1.38 1.0[0.9^1.2] 0.23 3.1[2.2^4.3]
B Mining 122 (3) 1.95 1.14 0.88 0.51 0.23
C Manufacturing 4460 (24) 4.64 0.9[0.8^0.9] 2.28 0.4[0.3^0.4] 1.55 0.7[0.7^0.8] 0.74 0.5[0.4^0.5] 0.44 1.6[1.4^1.7]
D Electricity, Gas, Water, and Waste Services 427 (20) 2.34 0.6[0.5^0.7] 0.78 0.3[0.2^0.4] 1.04 0.5[0.3^0.6] 0.44 0.5[0.3^0.7] 0.47 1.8[1.3^2.4]
E Construction 2321 (9) 3.97 0.3[0.3^0.4] 2.35 0.1[0.1^0.2] 1.76 0.2[0.2^0.3] 1.24 0.2[0.2^0.3] 0.27 2.3[1.9^2.9]
F Wholesale Trade 1681 (28) 4.56 0.9[0.8^0.9] 1.57 0.5[0.4^0.5] 1.56 0.9[0.8^1.0] 0.77 0.6[0.5^0.7] 0.59 2.2[2.0^2.5]
G Retail Trade 3189 (47) 1.68 1.0[0.9^1.0] 0.66 0.6[0.6^0.7] 0.55 0.8[0.8^0.9] 0.30 0.7[0.6^0.8] 0.33 2.3[2.0^2.6]
H Accommodation and Food Services 1663 (47) 1.66 2.0[1.8^2.1] 0.98 1.0[0.9^1.1] 0.60 1.6[1.4^1.8] 0.40 1.4[1.2^1.6] 0.35 2.3[1.9^2.7]
I Transport, Postal, and Warehousing 1522 (20) 4.92 0.5[0.5^0.5] 1.81 0.3[0.3^0.4] 2.15 0.4[0.4^0.5] 1.27 0.3[0.3^0.4] 0.87 0.9[0.8^1.1]
J Information Media and Telecommunications 663 (36) 1.30 2.0[1.8^2.3] 0.29 1.1[0.8^1.5] 0.41 1.4[1.1^1.7] 0.21 1.6[1.2^2.3] 0.48 2.3[1.9^2.9]
K Financial and Insurance Services 1284 (45) 0.48 3.0[2.5^3.6] 0.11 2.1[1.5^2.9] 0.17 2.0[1.5^2.6] 0.09 2.1[1.5^3.1] 0.34 2.9[2.4^3.7]
L Rental, Hiring, and Real Estate Services 517 (38) 1.64 0.5[0.5^0.6] 0.73 0.3[0.2^0.4] 0.57 0.6[0.4^0.8] 0.53 0.6[0.4^0.8] 0.56 3.0[2.0^3.2]
M Professional, Scientific, and Technical Services 2469 (40) 0.96 1.7[1.6^1.9] 0.30 1.1[1.0^1.3] 0.35 1.3[1.1^1.5] 0.20 1.6[1.3^1.9] 0.32 2.4[2.1^2.8]
N Administrative and Support Services 1388 (41) 2.07 1.3[1.2^1.4] 1.08 0.4[0.4^0.5] 0.82 0.9[0.8^1.0] 0.45 0.8[0.7^0.9] 0.44 2.0[1.7^2.4]
O Public Administration and Safety 1451 (46) 4.39 0.7[0.7^0.8] 1.29 0.5[0.4^0.5] 2.38 0.5[0.5^0.5] 0.75 0.5[0.4^0.6] 2.64 0.8[0.7^0.8]
P Education and Training 2635 (65) 2.17 1.1[1.1^1.2] 0.75 0.9[0.9^1.0] 0.91 0.9[0.9^1.0] 0.53 1.5[1.4^1.7] 1.20 1.2[1.1^1.3]
Q Health Care and Social Assistance 3110 (76) 5.41 1.5[1.5^1.6] 0.95 1.3[1.2^1.4] 1.64 1.2[1.2^1.3] 0.49 1.5[1.3^1.7] 1.79 1.0[1.0^1.1]
R Arts and Recreation Services 481 (42) 6.05 0.7[0.7^0.8] 2.15 0.7[0.6^0.8] 3.06 0.7[0.6^0.8] 2.02 0.8[0.7^0.9] 0.98 1.6[1.3^1.9]
S Other Services 1151 (35) 3.46 0.7[0.6^0.7] 2.12 0.3[0.2^0.3] 1.35 0.6[0.5^0.7] 0.76 0.4[0.4^0.5] 0.66 2.8[2.4^3.2]

F, female; M, male.
*
Sole traders and federal government employees excluded.
a
The workplace injury claim rate per106 hours worked.
b
Claim rate ratios (RR) for female vs. male are given with 95% confidence intervals.
Gender Differences in Occupational Injury
303
304 Berecki-Gisolf et al.

TABLE IV. Age Stratified Modelling of the Claim Rate Per Hours Worked.

Univariate Adjusted for industry* Adjusted for occupation a

Injury type Age group (years) OR [95% CI] OR [95% CI] OR [95% CI]
Musculoskeletal
<25 F vs. M 0.70 [0.67^0.73] 0.78 [0.74^0.82] 1.37 [1.30^1.44]
25^34 F vs. M 0.74 [0.71^0.76] 0.81 [0.79^0.84] 1.38 [1.33^1.42]
35^44 F vs. M 0.94 [0.91^0.96] 0.99 [0.96^1.01] 1.37 [1.33^1.41]
45^54 F vs. M 1.14 [1.12^1.17] 1.20 [1.17^1.23] 1.52 [1.49^1.57]
55 F vs. M 1.02 [0.99^1.06] 1.06 [1.03^1.10] 1.44 [1.38^1.49]
Wounds
<25 F vs. M 0.23 [0.21^0.24] 0.31 [0.29^0.33] 0.58 [0.55^0.63]
25^34 F vs. M 0.34 [0.32^0.35] 0.45 [0.43^0.48] 0.73 [0.68^0.77]
35^44 F vs. M 0.50 [0.47^0.52] 0.60 [0.57^0.64] 0.81 [0.77^0.86]
45^54 F vs. M 0.63 [0.60^0.66] 0.75 [0.71^0.79] 0.94 [0.89^0.99]
55 F vs. M 0.71 [0.67^0.76] 0.86 [0.80^0.91] 1.11 [1.03^1.19]
Tendon
<25 F vs. M 0.58 [0.55^0.63] 0.68 [0.63^0.74] 1.09 [1.00^1.18]
25^34 F vs. M 0.60 [0.57^0.64] 0.67 [0.63^0.70] 1.07 [1.01^1.13]
35^44 F vs. M 0.73 [0.70^0.76] 0.77 [0.73^0.81] 1.03 [0.98^1.08]
45^54 F vs. M 0.89 [0.85^0.92] 0.94 [0.90^0.99] 1.16 [1.11^1.22]
55 F vs. M 0.84 [0.80^0.89] 0.90 [0.85^0.96] 1.18 [1.11^1.26]
Fractures
<25 F vs. M 0.33 [0.30^0.36] 0.46 [0.42^0.51] 0.71 [0.64^0.78]
25^34 F vs. M 0.36 [0.34^0.39] 0.48 [0.44^0.52] 0.70 [0.64^0.76]
35^44 F vs. M 0.48 [0.45^0.52] 0.59 [0.54^0.64] 0.73 [0.67^0.79]
45^54 F vs. M 0.76 [0.72^0.81] 0.95 [0.89^1.02] 1.08 [1.01^1.15]
55 F vs. M 1.36 [1.27^1.45] 1.56 [1.45^1.68] 1.91 [1.77^2.06]
Mental
<25 F vs. M 2.57 [2.27^2.92] 2.34 [2.04^2.70] 3.01 [2.59^3.50]
25^34 F vs. M 2.04 [1.91^2.18] 1.64 [1.53^1.75] 2.22 [2.06^2.38]
35^44 F vs. M 1.95 [1.86^2.05] 1.47 [1.4^1.55] 1.91 [1.81^2.01]
45^54 F vs. M 1.81 [1.73^1.89] 1.27 [1.21^1.34] 1.65 [1.57^1.74]
55 F vs. M 1.88 [1.76^2.00] 1.22 [1.14^1.32] 1.74 [1.62^1.87]

F, female; M, male.
*
Industry, sex, and year of affliction are independent variables.The model is stratified by age group.
a
Occupation, sex, and year of affliction are independent variables.The model is stratified by age group.

varied across occupational groups. Musculoskeletal system
claims were most common among labourers, and rates were
slightly higher among female than male labourers. Among
professionals, musculoskeletal claim rates were much higher
among women than men. Wounds and fracture claims were
also most common among labourers; particularly among
male labourers. Mental disorder claims were most common
among female managers and administrators, female pro-
fessionals and female tradespersons.
Table III shows the claim rates per industry for the five
most common injury types. The highest rate of musculoskel-
etal system claims were in Arts and Recreational Services,
particularly by male workers, followed by women working in
Health Care and Social Assistance and men working in
Transport, Postal and Warehousing. Wounds were common
among men working in manufacturing and construction.
Traumatic tendon claims were most frequent among men
working in Arts and Recreational Services and Public
Administration and Safety. Both men and women working in
Agriculture, Forestry and Fishing had high fracture claim
rates, but men working in Arts and Recreational Services had
the highest fracture claim rates. Mental disorder claims were
most common in Public Administration and Safety; men
working in that industry had the highest mental disorder
claim rate, followed by women working in that sector (not
shown). The next highest rate of mental disorder claims was
seen among both men and women working in Health Care
and Social Assistance.

FIGURE1. The female: male ratio of the number of hip, forearm, and vertebral fracture
claims (dashed line, open circles) and the female: male ratio of the number of other
fracture claims (solid line, solid circles).
Workplace injury claim rates were modelled as a
function of gender, adjusting for (1) industry and (2)
separately, occupational group. Because of substantial age
and gender interaction effects, the models were age-
stratified. The results are shown in Table IV. In the univariate
analyses, men had higher musculoskeletal, traumatic tendon,
wounds and fractures claim rates at age <45 years, but as
men and women aged this gender difference diminished.
Women overtook men in musculoskeletal disorder and
fracture claim rates after the age of 45 and 55 years,
respectively. Adjusting for industry did not substantially alter
this pattern. Adjusting for occupational group, however,
reversed the gender difference in musculoskeletal and tendon
injury claim rates below the age of 45 years, i.e., these were
more common in women than men after adjusting for
occupational exposure. Adjusting the fracture models for
occupational exposure did not alter the greater claim rate
among older women. Most of the gender differences in
musculoskeletal and tendon injury claim rates among young
workers were explained by occupation; higher rates of
wound claims among men were not explained by occupation
or industry. After adjusting for occupational exposure,
fractures were more likely to occur in younger male workers
and female workers over the age of 45 years.
To explore the potential role of osteoporosis in the
fracture claim rates, the gender distribution of hip/forearm/
vertebral fractures per age group was compared with the
gender distribution of other fractures per age group (Fig. 1).
Of the 19,731 claims for fractures, 4,262 (22%) were for hip/
forearm/vertebral fractures, which are typical of osteoporo-
sis. Fractures among men outnumbered fractures among
women for both fracture types, with the exception of
fractures commonly associated with osteoporosis for the age
group of 55–59 years: there were more women than men who
Gender Differences in Occupational Injury 305
sustained this type of fracture. The workplace fracture claim
rate model adjusted for occupation was repeated for fractures
typical of osteoporosis, and for ‘other’ fractures. In the age
groups below 45 years, female sex was negatively associated
with ‘other’ fractures, and not statistically significantly
associated with fractures typical for osteoporosis. At 45–54
and 55 years, female sex was associated with ‘other’
fractures with odds ratio [95% confidence interval] of 1.02
[0.94–1.10] and 1.67[1.53–1.83], respectively, and female
sex was associated with fractures typical for osteoporosis
with OR[95%CI] of 1.29[1.12–1.48] and 2.71[2.34–3.14],
respectively.
The modelling of mental disorder claims as a function of
age and gender showed a very different pattern: women had
higher claim rates than men. Adjusting for industry slightly
reduced the gender difference; adjusting for occupation did
not. In other words, some of the gender difference in mental
disorder claim rate is explained by industry but not by
occupational exposure.
Discussion
Physical injuries commonly leading to a workers’
compensation claim (musculoskeletal system, tendon injury,
wounds and fractures) were more frequent among men than
women. Claims for mental disorders were more common
among women. However, the gender difference in musculo-
skeletal and tendon injury claim rate was largely explained
by differences in the distribution of gender across occupa-
tional groups, but not by distribution of gender across
industries. Adjusting for occupational group in fact reversed
the gender difference below the age of 45 years: musculo-
skeletal and tendon injuries were more common in women
than men after adjusting for occupational exposure. The
gender difference in fracture claim rates was age-dependent,
and the high number of fractures typical for osteoporosis
among women aged over 54 years suggests that osteoporosis
contributes to the age-related gender difference in fracture
claim rate. Work-related wounds were more common among
(young) men than women and not fully explained by
occupational or industry exposure.
The main strength of the study is the use of large datasets
of workplace injury and employment in a defined region; i.e.,
the state of Victoria, Australia. Because the data were not
restricted to a particular injury, occupation or industry, we
were able to analyse the impact of industry and occupation on
various injury claim rates. The main study limitation was the
reliance on workers’ compensation claims records to
determine injury claim rates as a proxy for work-related
injury rates, which introduces an injury severity threshold:
since the employer is liable to pay weekly payments for the
first 10 days an injured worker is absent, workers who were
absent up to 10 days and did not meet the medical
306 Berecki-Gisolf et al.
expenditure threshold were not included. This would have
resulted in a selection bias with underrepresentation of
workers with injuries that do not usually result in prolonged
sick leave, for example wounds, cuts and abrasions. Not all
injured workers claim compensation, and a possible gender
and age bias in the decision to claim compensation (for
example, under-reporting of injuries by women and by
younger workers) could impact the result of this study. There
are barriers to claiming compensation, particularly for
mental disorders [Guthrie et al., 2010], but there is also
evidence from Québec that women face more barriers getting
musculoskeletal injuries compensated [Lippel, 2003]. Fur-
ther study of determinants of claim behaviour is needed to
describe and quantify this possible bias.
A further study limitation relating to the use of claims
data was a slight mismatch between the numerator and
denominator data. Self-insurers are not covered by WorkSafe
Victoria and were therefore missing from the workplace
injury claims data (numerator), but we were not able to
remove self-insurers from the employment data (denomina-
tor). This mismatch is not likely to impact the reported
associations between age, gender and claim rates because
self-insurers are distributed across all industry and occupa-
tion groups. The overall workplace injury claim rates
presented in this study are, however, an underestimate of
the actual rates among all workers in Victoria. Finally, the
15% of the labour force who were not covered by workers’
compensation were not included in the analyses: the results
of this study are therefore limited to the insured Victorian
labour market.
Age-dependent gender differences in workplace claim
rates observed in this study support those reported in the
literature. Injuries have been found previously to be most
common in young male workers [Salminen, 1994; Kachan
et al., 2012] and the gender differences have been reported to
decrease with age [Kachan et al., 2012]. Fan and colleagues
reported gender-specific associations between age and risk of
severe injury among workers in British Columbia, Canada
[Fan et al., 2012]. They showed that these patterns persisted
after adjusting for occupational group, in contrast with our
findings that age and gender differences in musculoskeletal
and tendon injury claim rate were substantially diminished
after adjusting for occupation. However, in the study by Fan
et al., part of the definition for severe injuries was having had
either 28 days away from work, or equivalent to 28 days of
wage replacement, following the injury. In our study injured
workers with at least 10 days of work or substantial medical
expenses were included; therefore the injuries may have been
less severe on average. The findings of Fan and colleagues
could also be due to differences in the occupational
classification systems used in our paper (based on the
ANZSCO) and their paper (based on the Canadian National
Occupational Classification). Support for our finding that
differences in job tasks (exposure) accounted for gender
differences in occupational injury can be found elsewhere
in the literature [Mergler et al., 1987; McDiarmid et al.,
2000].
Our results showed a gender specific pattern of injury
that differed per injury type. This is in agreement with
previous reports of musculoskeletal disorders [Islam et al.,
2001; Smith and Mustard, 2004], sprains and strains [Saleh
et al., 2001], and carpal tunnel [McDiarmid et al., 2000;
Islam et al., 2001] occurring more frequently in women,
whereas cuts and abrasions were reported to occur more
frequently in men [Saleh et al., 2001]. In our study the most
distinct pattern was that of work-related bone fractures. After
adjusting for occupational group, the age and gender pattern
remained that of increased fractures among older women.
This is consistent with the onset of osteoporosis and fracture
susceptibility in women. Future study could explore a
potential role for bone mineral density screening and falls
prevention to prevent fractures in older workers, particularly
women.
Gender difference in mental disorder claim rates have
been less well documented than differences in physical
injury claim rates. Workers’ compensation claims data are
not ideally suited for determining the total burden of mental
health disorders related to the workplace, because of limited
access to workers’ compensation for mental health problems
resulting from working conditions [Lippel and Sikka, 2010]
and barriers to claim acceptance[Guthrie and Jansz, 2006]. In
our study setting, the worker first has to demonstrate that the
work was the predominant cause of the condition before
being eligible for compensation for the mental health
condition, and claim acceptance rates are still relatively
low. The relatively high rates of mental health disorder
claims among women in the current study could be related to
overrepresentation of women in industries such as primary
school teaching and community service work, where stress
claims are known to be common [Guthrie and Jansz, 2006],
or to differences between men and women in the perceived
stigma associated with reporting a mental stress claim for
workers’ compensation.
Conclusions
In conclusion, men had higher rates of physical injury
claims than women, but this was mostly attributable to
occupational factors: male/female differences in muscu-
loskeletal and tendon injury claim rates appeared to be
due to differential exposure to work-related hazards,
whereas fracture risk was dependent on age and gender
even after adjusting for work-related exposure. Women
had higher rates of mental disorder claims than men;
women working in management and workers in health
care and public administration are at greatest risk for
mental health claims.

ACKNOWLEDGMENTS
This study is based on administrative claims data from
the Compensation Research Database held at the Institute for
Safety, Compensation and Recovery Research (Victoria,
Australia).
The study was funded by the Transport Accident
Commission (TAC) and WorkSafe Victoria via the
Institute of Safety, Compensation and Recovery Research
(ISCRR): the corresponding author was supported by an
ISCRR Early Career Fellowship. There is no conflict of
interest.
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