Understanding the Impact Employee Health Can Have on Work Injuries

Michelle Hopkins

Work-related injuries. We live with them and their causes, which may include inattention, trauma and repetitive strain, machine malfunction, or plain old bad luck. You may be surprised to learn there’s another important cause of work-related injuries, and it’s one employees carry with them constantly: their health and lifestyle habits. In this article, we’ll see that research shows a correlation between work injury and:

  • Poor fitness
  • Obesity
  • Diabetes
  • Smoking

Before exploring each of these four aspects of employee health, let’s review a summary of work-related injuries that contains some surprising facts.

Work injuries that are costing lost workdays, big dollars

Musculoskeletal injuries – which affect bones, muscles, nerves, ligaments, joints, and tendons – are the single largest category of work injuries, costing employers and payors $50 billion in direct costs and as much as $250 billion in indirect costs each year, according to the U.S. Bureau of Labor Statistics (BLS). Musculoskeletal injuries account for about 30 percent of total workers’ compensation costs.1

Musculoskeletal injury incidence rates are highest in transportation and warehousing, followed by health care and social assistance, retail trade, wholesale trade, manufacturing, and construction, based on the 2018 data the BLS examined.

Ten occupational classifications were responsible for 40 percent of all musculoskeletal injury cases in 2018. Ranking them by median days away from work (DAFW), an indicator of injury severity, produces the list below.2


  1. Heavy and tractor-trailer truck drivers
  2. Light truck or delivery service drivers
  3. Stock clerks and order fillers
  4. Maintenance and repair workers
  5. Laborers, freight, stock, material movers
  6. First-line retail supervisors
  7. Maids and housekeeping
  8. Registered nurses
  9. Retail salespersons
  10. Nursing assistants

Median Days Away From Work (DAFW)

21 days
16 days
15 days
14 days
13 days
12 days
12 days
8 days
8 days
7 days

Even though the BLS analysis found that two groups, ages 45-54 and ages 55-64, had nearly identical work injury rates, there are important differences between older employees and their younger counterparts in the types of injuries experienced and length of time away from work due to injury. Here’s what we know from the National Safety Council:3

  • Older employees experience more overexertion injuries than younger employees (32 percent compared to 16 percent) while injuries are younger employees are more predominantly contact with an object or equipment-related injuries (44 percent compared to 20 percent of older employees).
  • Thirty-six percent of injuries experienced by older employees result in 31 or more DAFW, compared to 13 percent for younger employees.

It’s long been known that the lower back is a leading problem spot when it comes to musculoskeletal injury frequency, severity, and pain. Low back injuries produce high absenteeism, medical and economic costs, disability, and lost productivity, according to a 2020 published analysis of data from the Global Burden of Disease study.4

Given the prevalence of low back injury, employers should also be aware that researchers say COVID-19 lockdowns have increased low back pain intensity and prevalence in employees who worked from home. Pain intensity increased most for 35-to-49-year-old employees with:5

  • Obesity (body mass index of 30 or higher)
  • Higher levels of stress
  • Non-ergonomic working conditions
  • Extended sitting times
  • Low levels of physical activity

Poor fitness and work-related injuries

Employees significantly reduced their level of physical activity in 2020. Men and women highly dedicated to exercise, such as elite cyclists, also reduced their level of physical activity during COVID-19 lockdowns, even while boosting time spent in endurance training. Researchers drew these conclusions from a review of 66 studies involving 90,000 people.6 They said that reduced physical activity is detrimental to employee health because physical activity is associated with more favorable physical and mental health outcomes.

Six years before the pandemic, a study of Arizona firefighters provided insight into the fitness-work injury connection.7 Specifically, lower levels of fitness:

  • Increase injury risk by 2.2 times compared to high-fitness employees
  • Result in injury sooner than seen in fit employees – as much as two years sooner
  • Increase the likelihood of microtraumas, which are injuries that seem minor but, left untreated, can lead to more serious injury
  • Prolong recovery time, which means higher case costs and lost productivity

An athletic trainer – as part of an on-site program or as a standalone – is a valuable resource to address musculoskeletal injuries and low-fitness consequences proactively. Athletic trainers are highly skilled health care professionals. Seventy percent of athletic trainers have a master’s degree, a level of education that the Commission on Accreditation of Athletic Training Education says will be required in the future. Currently, an athletic trainer’s services frequently cost about 20 percent less than an occupational nurse.8

Obesity and work-related injuries

Lower levels of physical activity during pandemic lockdowns was accompanied, unsurprisingly, by a rise in sedentary behavior and, for many of your returning employees, that’s likely to mean weight gain.9 Having a more obese workforce than before lockdowns becomes a health concern because obesity is correlated with an increase in comorbidities and incidence of work-related injuries. In 2017-2018, 42.4 percent of all U.S. adults were obese, up from 30 percent in 1999. Even among younger employees, ages 20-39, obesity is a factor for 40 percent.10

It’s well known that obesity is associated with serious health risks and comorbidities.11 This includes:

  • Heart disease
  • Kidney disease
  • High blood pressure
  • Type 2 diabetes
  • Sleep apnea
  • Depression and anxiety

In addition, employees who are overweight or obese face a higher risk of injury at work – 1.4 times higher for a back injury and more than 1.5 times more for all other musculoskeletal injuries.12

The direct and indirect costs of obesity were calculated in 2019 by researchers using Optum Health Reporting and Insight employer claims (n=86,221) from January 2010 to March 2017. Employees with obesity had direct and indirect costs 188 percent higher than normal-weight employees.13  Cost per patient per year was $1,775 for employees with obesity and $617 for normal-weight employees.

Diabetes and work-related injuries

Imagine trying to work and stay focused while experiencing musculoskeletal pain, especially in a very physical job. This is the challenge that may confront adults with type 2 diabetes. A 10-year study compared 6,586 adults with type 2 diabetes with a control group of 32,930 adults without diabetes; all study participants were between the ages of 18 and 50.14

They found that adults with diabetes – particularly between ages 30 and 39 – had a higher risk of musculoskeletal pain and a higher average number of visits to the doctor because of their pain compared to adults without diabetes. The locations of pain for the group with diabetes were most commonly neck and shoulders, lumbar spine, back, and pelvis.

Another study found that adults with diabetes have a somewhat higher risk of occupational injury than adults without diabetes (25 percent compared to 20 percent). The association between work injury and diabetes was higher for women than men.15

So, what can be done? Researchers in the 10-year study said the evidence is building regarding links between metabolic diseases, such as type 2 diabetes, low-grade systemic inflammation, and musculoskeletal degeneration (which leads to musculoskeletal pain). They urged that more clinical attention be given to the musculoskeletal health of adults with diabetes and to offer appropriate recommendations, potentially including diet and lifestyle changes, weight loss, more physical activity, and strategies for better blood glucose control.16

Smoking and work-related injuries

Smoking is well known as a lifestyle behavior potentially linked to heart and respiratory diseases and to several cancers. A lesser-known effect of smoking is the impact on the musculoskeletal system – increasing the risk of injury, poor healing, and disease.17 The American Academy of Orthopedic Surgeons has reported these injury effects:

  • Rotator cuff (shoulder) tears in smokers are nearly twice as large as those in nonsmokers
  • Smokers are 1.5 times more likely to suffer overuse injuries, such as bursitis or tendonitis, than nonsmokers.
  • Smokers are more likely to suffer traumatic injuries, such as sprains or fractures.
  • Smoking is associated with a higher risk of low back pain and rheumatoid arthritis.

Smokers also have a higher risk of fractures and complications after surgery than non-smokers, as well as decreased physical performance because they experience shortness of breath three times more often than non-smokers.

Smoking can also weaken the bones and contribute to a greater risk of osteoporosis with age.


Providing your employees information about healthy lifestyle, nutrition, and physical activity recommendations and supporting their efforts to live healthy lifestyles not only promotes employee health but potentially helps reduce work-related injury, too, due to the correlation between work injury and fitness, obesity, diabetes, and smoking.

This is an ideal time to get an occupational health consultation to learn about the full array of products and services that are available from your local occupational health provider to reinforce your workforce health outlook, enhance productivity, and reduce costs.

Fact Sheet: Occupational injuries and illnesses resulting in musculoskeletal disorders May 2020. U.S. Bureau of Labor Statistics.  
2 Fact Sheet: Occupational injuries and illnesses resulting in musculoskeletal disorders May 2020. U.S. Bureau of Labor Statistics.   
3 Work Injuries and Illnesses by Age. Injury Incidence and Rates. National Safety Council. 2020.  
4 Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. March 2020; 8(6): 299.
5  Sagat P, Bartik P, Gonzalez PP, Tohanean DI, and Knjaz D. Impact of COVID-19 Quarantine on Low Back Pain Intensity, Prevalence, and Associated Risk Factors Among Adult Citizens Residing in Riyadh (Saudi Arabia): A Cross-Sectional Study. International Journal of Environmental Research and Public Health. October 6, 2020. 
6  Stockwell A, Trott M, Tully M, et al. Changes in physical activity and sedentary behaviors from before to during the COVID-19 pandemic lockdown: a systematic review. BMJ Open Sport & Exercise Medicine. BMJ Journals. January 2021; 7(1).  
7  Poplin GS, Roe DJ, Peate W, Harris RB, Burgess JL. The association of aerobic fitness with injuries in the fire service. 2014;179(2):149-55.  
Is an Athletic Trainer the Answer to Work Injury Déjà Vu? Concentra White Paper. September 2020.   
9  Clemmensen C, Petersen MB, Sorensen TIA. Will the COVID-19 pandemic worsen the obesity epidemic? Nature reviews endocrinology. July 8, 2020.
10 Prevalence of Obesity and Severe Obesity Among Adults, United States, 2017-2018. National Center for Health Statistics Brief No. 360. Centers for Disease Control and Prevention. February 2020.
11 The Health Effects of Overweight and Obesity. Centers for Disease Control and Prevention.
12  Finkelstein EA, DiBonaventura MD. Burgess SM, Hale BC. The Costs of Obesity in the Workplace. Journal of Occupational and Environmental Medicine. October 2010; 52(10):971-976.  
13 Ramasamy A, Laliberte F, et al. Direct and Indirect Cost of Obesity Among the Privately Insured in the United States. Journal of Occupational and Environmental Medicine. November 2019; 61(11): 877-886.
14 Type 2 Diabetes is Associated with a Higher Risk for Musculoskeletal Pain. Endocrineweb. May 22, 2018.
15 Kouvonen A, Kivimaki M, et al. Diabetes and risk of occupational injury: a cohort study. Diabetes Medicine. November 2017;34(11):1629-1636. 
16 Type 2 Diabetes is Associated with a Higher Risk for Musculoskeletal Pain. Endocrineweb. May 22, 2018. 
17 Smoking and Musculoskeletal Health. American Academy of Orthopedic Surgeons. May 2010.