Surveillance of Construction Workers in North Carolina, Ohio, and Missouri  (Summary of Final Report to CPWR : January 2001)

John M. Dement, PhD, CIH
Hester Lipscomb, PhD
Carol Epling, MD, MPH
Tejas Desai, MS
Leiming Li, MS
Barbara De Larco, BS
Duke University Medical Center (Division of Occupational and Environmental Medicine)


A study of North Carolina records of deaths over 10 years found that construction workers have a high risk of deaths from accidental falls from elevations, transportation injuries (as drivers, passengers, and pedestrians), and electrocutions, mostly when equipment contacts a power line or other electrical source (see table 1).

In the death records of 43,900 men for whom construction was listed as the usual occupation, even if they had retired, the analysis found a high risk of deaths for some trades for lung illnesses (such as lung cancers, asbestosis, emphysema, or silicosis) and diseases such as cirrhosis of the liver and mouth cancer, which are tied to a combination of factors, including tobacco use, alcohol use, and exposures to some solvents or metals (table 2).

John Dement and five coworkers at the Duke University Medical Center, in North Carolina, looked at all causes of deaths, not just those listed as work-related. That approach is important because no one knows how many construction workers die each year from illnesses that may have come from their jobs. The problem is workers may not get sick for many years after they've been exposed on the job to hazards like metal fumes that can cause cancer or to silica.

The authors used PMRs (proportionate mortality ratios), statistics that show the risk of death for construction workers compared with all men in North Carolina matched by race, age, and sex. For instance, roofers had a PMR for respiratory tuberculosis of 453, more than four times the usual risk.

In addition, injury claims were compared for three groups – residential construction in North Carolina, residential construction in St. Louis, and union carpenters in Ohio. "Struck by/against" and overexertion (sprains and strains) were the first and second most common cause of injury for each of the three groups. Falls from elevations were also a common problem for the groups.

In terms of costs, in North Carolina, of 9,205 homebuilder claims, falls were the most costly claims for six of the trades: carpenters, drywall installers, insulators, masons, painters, and plumbers; roofers were not included in the data (table 7). Falls were the most expensive of 838 carpenter claims in St. Louis (table 8).(Costs were not calculated for the Ohio claims.)

The authors looked closely at 553 injuries by nail guns – "struck by" injuries – and found that pneumatic nail guns caused more than 4% of workers' compensation claims. The tools caused 97% of puncture wounds in residential work, two-thirds of the time after a trigger mechanism safety doesn't work or is bypassed, causing an unwanted discharge or misfire.

Among the authors' recommendations:

• Careful compliance with OSHA standards to protect workers from exposures to silica and asbestos
• Research to prevent falls, transportation injuries, electrocutions (from contact with power lines), and "struck by" injuries, including those from nail guns
• Interventions to reduce sprains and strains from heavy and repetitive lifting, often in awkward postures
• Programs to prevent smoking and alcohol abuse.

Besides Dement, the researchers were Hester Lipscomb, Carol Epling, Tejas Desai, Leiming Li, and Barbara De Larco. For statistical reasons, the study focused on men, although some women who worked in construction were killed or injured. The work was done as part of CPWR's cooperative agreement with the National Institute for Occupational Safety and Health, NIOSH, which is part of the CDC.

For more information, contact CPWR, at 301-578-8500.

1. Selected causes of deaths, male construction workers, North Carolina, 1988-97

2. Selected causes of deaths, by trade, male construction workers, North Carolina, 1988-97

• Falls from elevations (carpenters, drywall installers, insulators, masons, painters, plumbers)
• Overexertion (electricians, concrete and terrazzo, mechanics, engineers and managers)
• Struck by (operating engineers)

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