Relative risks of ladder fatalities increase precipitously by age compared to other work fatalities in the US

Objectives: To compare the impact of age on the relative risk of mortality from work-related ladder falls relative to other types of occupational injuries in the US.

Methods: We used the US Census of Fatal Occupational Injuries (CFOI) research file for 1992-2003 to identify ladder falls and code fall height and circumstances from investigation narratives. Age-specific rates and relative risks were calculated using estimates of employed population and hours worked.

Results: Among 1423 ladder falls (98% male) fatality rates were 0.3, 0.6, 1.9, and 4.0/million workers for ages 16-24, 25-34, 55-64, and 65+ years, respectively. Relative risks (RR) for older workers (65+) compared to 16-24 year olds were significantly higher for ladder falls (RR 13.9, 95%CI: 10.5-18.4) than for other work fatalities (RR 4.0, 95%CI: 3.9-4.2) including other falls from elevation (RR 4.4, 95%CI: 3.9-4.9) and differences persisted using 35-44 years as the reference group (RR 5.3 vs. 3.1 & 3.1). Relative risks by age were even greater adjusting for hours worked. Fall circumstances were similar across all age groups; although, fatalities in older workers occur from lower heights (mean in feet: 16 for ages 55+ vs. 29 for ages 16-34).

Discussion: Increased risks for falls was much greater for ladders when compared to other fatal injuries, including falls from elevations not involving ladders. Because fall circumstances are similar across age groups, interventions that provide more stable work platforms, including safer alternatives to ladder use will protect all workers, not just older workers.