Received: 23 August 2022 | Revised: 17 November 2022 | Accepted: 17 November 2022

DOI: 10.1002/ajim.23448

RESEARCH ARTICLE

Epidemiology of occupational injuries in construction workers

between 2009 and 2018 in South Korea

Saemi Jung MD1 | Tae‐Kyoung Kim MSc2 | Yoon‐Ji Kim PhD3 |

Young‐Ki Kim MD, PhD1,3 | Dongmug Kang MD, MPH, PhD1,3 |
Se‐Yeong Kim MD, PhD1,3

1
Department of Occupational and
Environmental Medicine, Pusan National Abstract
University Yangsan Hospital, Yangsan,
Background: This study aimed to investigate the characteristics of occupational
Republic of Korea
2
Medical Research Institute, Pusan National
injuries based on fatality, sex, and classification of occupations among construction
University, Yangsan, Republic of Korea workers using workers' compensation (WC) insurance data in South Korea.
3
Department of Preventive and Occupational Methods: We collected WC insurance data from the Korea Workers' Compensation
& Environmental Medicine, School of
Medicine, Pusan National University, Yangsan, & Welfare Service for all construction workers between 2009 and 2018. Data from
Republic of Korea 158,947 accepted claims for occupational injury were extracted, and the
demographic features, occupational injury types, and annual trends were analyzed
Correspondence
Se‐Yeong Kim, Department of Occupational & for fatal and nonfatal cases. The annual incidence and mortality trends of
Environmental Medicine, Pusan National
occupational injury were estimated using negative binomial regression and Poisson
University Yangsan Hospital, 20, Geumo‐ro,
Mulgeum‐eup, Yangsan‐si, Gyeongsangnam‐ regression models, for injury incidence and mortality respectively.
do, Republic of Korea.
Results: Among a total of 158,947 occupational injury cases, there were 155,772
Email: 30white@hanmail.net
(98%) nonfatal injuries and 3175 (2%) fatal injuries. For all occupational injuries,
Funding information Construction Elementary Workers (6th Korean Standard Classification of Occupa-
Occupational Safety and Health Research
Institute; Korea Occupational Safety and
tions (KSCO) 910; 45.7%) was the most frequent occupation, followed by
Health Agency in the Republic of Korea, Construction‐Related Technical Workers (6th KSCO 772; 39.2%). The most frequent
Grant/Award Number: 202204166DO‐00;
2021 Research Grant from Pusan National
injury type was a fracture, followed by ruptures or lacerations and contusions. The
University Yangsan Hospital incidence of all occupational injuries increased from 700.36 per 100,000 persons in
2009 to 1,195.98 per 100,000 persons in 2018. Further, deaths from injuries at
work followed a significantly increasing annual trend [mortality rate ratio 1.04 (95%
CI: 1.03–1.05)] from 2009 to 2018.
Conclusion: The over two‐thirds increased incidence of occupational injuries and
significantly increasing mortality trends for occupational injuries during the last 10
years indicate the need for aggressive intervention in occupational safety and health
management within the Korean construction industry.

KEYWORDS
incidence, Korean construction workers, mortality, occupational injury, workers' compensation
insurance data

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
© 2022 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.

Am J Ind Med. 2023;66:155–166. wileyonlinelibrary.com/journal/ajim | 155

156 | JUNG
1 | INTRODUCTION
Construction is an extremely hazardous industry with high risk of
occupational injuries. Fatal and nonfatal occupational injuries occur
most frequently in the construction industry.1–6 Work in this industry
involves complex tasks using various equipment, and construction
workers work under different physical hazards, such as extreme
temperature, heights, and equipment vibration.7,8 In Korea, the
construction industry is one of the industries with the largest number
of workers, and the rate of occupational injury in the construction
industry is 1.17%, higher than the average 0.57% in all industries,
according to 2020 workers' compensation (WC) data. Moreover, the
number of deaths due to occupational accidents accounted for 51.9%
of all deaths (882), ranking highest of all mortality causes; the
mortality rate due to occupational injury per 10,000 persons was
2.48, compared to the average 1.09 of all industries.9
Despite the knowledge that construction workers have a high
rate of occupational injuries, including accidents and work‐related
diseases, only a few studies have performed a detailed epidemiologic
analysis of all injuries in construction workers using nationwide
databases. For instance, musculoskeletal disorders were analyzed
among construction workers in Ohio, US from 2007 to 2017. This
report showed that overexertion is the major cause of work‐related
musculoskeletal disorders (WMSDs) among construction workers in
the United States. Pushing, holding, pulling, catching, and carrying
materials caused an additional 37% of WMSDs in 2015.10 Another
study published in 2010, examined the injury rate and WC payment
rate of 32,081 construction workers in Denver International Airport
by categorizing 25 types of construction work, by linking with
corresponding lost‐work‐time claims filed with Colorado's Workers'
Compensation Division. For metal/steel installation, driving/trucking,
inspection/analysis, and elevator construction, WC payment rates
that reflect both the number and severity of injuries are significantly
11
higher than expected losses. According to a CPWR study on deaths
from fatal falls in the construction industry from 1992 to 2006, fatal
injuries among Hispanic construction workers were more likely to be
caused by a fall than white, non‐Hispanic counterparts (OR = 1.48,
95% CI: 1.05–2.10) after controlling for possible confounders.12 A
recent study on the risk factors for occupational injuries among 634
frontline building construction workers in Hong Kong was conducted
in Ghana from 2016 to 2017. According to this study, monthly off
days, job/task location, work structure, trade specialization, working
13
hours, etc. were risk factors for occupational injuries.
However, previous studies analyzed the risk of occupational
injuries according to specific demographic characteristics and
occupations in the construction industry. Moreover, only a few
large‐scale studies examined occupational injuries among all con-
struction workers in a country using WC insurance data. The present
study aimed to analyze the characteristics of occupational injuries
according to fatality, sex, and classification of occupations in the
construction industry using national WC insurance data from
2009 to 2018, which includes annual data from all construction
workers in Korea.
ET AL.
2 | M A T E R I A L S AN D M E T H O D S
2.1 | Study participants and data variables
WC insurance data were collected from the Korea Workers' Compensa-
tion & Welfare Service (KCOMWEL) for all construction workers from
January 2009 to December 2018. WC insurance is a total social security
scheme to compensate workers exposed to a work‐related accident for
their resulting injury or disease on a timely and equitable basis, thereby
facilitating their rehabilitation and return to society. Employers whose
workplaces are subject to WC insurance‐mandatory coverage must pay
the premiums to the KCOMWEL in place of the government. Since July
1, 2000, Korean WC insurance has covered all workplaces with one or
more employees covered by the Industrial Accident Compensation
Insurance (IACI) Act regardless of work type (e.g., temporary workers,
contract workers, part‐timers, migrant workers). Supporting Information
Material S1 shows the demographics of the number of employees
covered by IACI in 2016 were displayed. Public officials, school teachers,
soldiers, sailors, fishermen, and so forth are not covered by IACI Act
because they are covered by other public insurance systems. Because
construction workers were covered by the IACI Act, all construction
workers, whether part‐time or full‐time, were included in the WC data.
Figure 1 shows a detailed schematic representation of the study
population under study. A total of 247,461 occupational accident claims
were collected from WC insurance data among workers working in the
construction industry as defined by the Ministry of Employment and
Labor. To focus on only occupational injury cases, we extracted 13,606
unapproved claims data and excluded data from 4,641 occupational
diseases claims, such as noise‐induced hearing loss or degenerative
musculoskeletal disease. Finally, we defined 158,947 claims of construc-
tion workers who claimed an occupational injury based on the
classification of occupations as follows: 6th Korean Standard Classifica-
tion of Occupations (6th KSCO) 771, 772, 773, 774, 792, 875, and 910,
which refer to blue‐collar construction workers.
The analyzed data might include repeat claimants. This is because the
same person can claim more than once during the 10‐year (2009–2018)
data collection period, and claimants could repeatedly claim up to twice
for the same case when they were disapproved for WC insurance. We
have handled claims with multiple diagnoses separately as individual
diseases. The full name and classification of KSCO are provided in
Supporting Information Material S2. The data contained sex, age,
employment date, Korea Standard Industry Code (KSIC), KSCO, date of
injury, type of injury, injury location, approval status, classification of
occupational accidents, occupational injury, or occupational disease,
diagnostic code, and diagnostic names. Fatal claims were defined as death
caused by occupational injury, and nonfatal claims were defined as other.
The types of occupational injuries in the KCOMWEL data consisted of
the following 16 categories: fractures, rupture/laceration, internal organ
injuries, frostbite, cuts, back pain/musculoskeletal disorders, infection/
poisoning, amputation, asphyxia/drowning, stabbing, bruising, skin
disease, burns, stabbing, abrasion, and other injuries. To estimate the
total annual number of workers in the construction industry, we used
annual construction survey data statistics published by Statistics Korea.14
JUNG ET AL.
F I G U R E 1 Flow chart depicting the
selection of the study population in Korean
construction workers
The study received approvals from the Institutional Review Board
Committee of Pusan National University Yangsan Hospital. Informed
consent was waived for this records‐based study.
2.2 | Classification of occupations
We extracted only the following seven classifications of occupations
for construction workers from the 6th KSCO: 771, 772, 773, 774,
792, 875, and 910 (Supporting Information Material S2). This
classification was recorded by the 5th KSCO from 2009 to 2013,
but the 6th KSCO was applied from 2014 to 2018.15 Data from 2009
to 2013 were extracted in five digits, but data from 2014 to 2018
were extracted in three digits; thus, we matched the 5th to the 6th
KSCO by reducing the degree of segmentation. For each of the nine
classifications of occupations of 5th KSCO, which could be matched
with multiple categories of three digits of the 6th KSCO, we
designated just one category of the 6th KSCO with a greater portion.
Supporting Information Material S3 shows 5th and 6th KSCO
matching in the nine classifications of occupations.
2.3 | Statistical analysis
Descriptive data analyses about baseline characteristics of injury claims
among study participants were performed. A Chi‐square test, Fisher's
exact test, and independent t‐test were conducted to determine
differences in characteristics between fatal and nonfatal claims or
between men and women. A p‐value of <0.05 was considered statistically
| 157
significant. The annual incidence rates of occupational injury or death by
occupational injury were determined by dividing the number of approved
injury or death claims per year by the estimated total number of
construction workers in the same year in Korea. The incidence rate ratio
(IRR) and mortality rate ratio (MRR) with 95% confidence interval of
occupational injuries were calculated using negative binomial regression
and Poisson regression models, respectively. The negative binomial is a
generalization of the Poisson model, which is particularly useful for over‐
dispersed data. The negative binomial regression and the Poisson model
were the most suitable for IRR and MRR, respectively. All statistical
analyses were conducted using IBM SPSS Statistics for Windows, version
26.0 (IBM Corp.).
3 | RESULTS
3.1 | General characteristics
We collected a total of 158,947 accepted claims of occupational
injury in construction workers from 2009 to 2018 in Korea. Among
the total claims, 155,308 (97.7%) were men and 3639 (2.3%) were
women. Of these, 3,175 (2.0%) were reported as fatal claims and
155,772 (98.0%) were reported as nonfatal claims. In fatal injury,
there were 3124 (98.4%) claims by men and 51 (1.6%) claims by
women. Among male workers, those in their 50s at the time of claim
accounted for the highest percentage of fatal injury claims at 40.0%
and nonfatal injury claims at 41.4%. In contrast, workers in their 60s
accounted for the highest percentage of fatal injury claims at 43.1%,
while their 50s accounted for the highest percentage of nonfatal
158 | JUNG
injury claims at 47.6% among female workers. By nationality, there
were 148,404 (93.4%) domestic construction workers and 10,543
(6.6%) foreign workers. Compared with domestic workers, foreign
workers were more likely to have fatal injuries (8.5%) than nonfatal
injury injuries (6.6%) (p < 0.005).
Among all occupational injuries, Construction Elementary Workers
(6th KSCO 910; 45.7%) was the most frequent classification of
occupations, followed by Construction‐Related Technical Workers (6th
KSCO 772; 39.2%). Construction‐Related Technical Workers (6th KSCO
772; 44.3%) constituted the highest proportion in fatal injuries and
Construction Elementary Workers (6th KSCO 910; 45.9%) constituted
the highest proportion in nonfatal injuries. However, there was a
difference by gender. In females, Construction Elementary Workers
(6th KSCO 910) had the highest rate of injuries, whether fatal or nonfatal.
Regarding the types of injury, fractures accounted for the highest
number at 92,042 (57.9%) cases, followed by rupture or laceration
with 29,826 (18.8%) cases in total claims. However, there was a
difference in the order according to the fatality. Fractures were in the
first place in both cases, but rupture or laceration was the second
highest for case‐type for nonfatal injuries, contrasted with internal
organ injuries for fatal injuries (Table 1).
3.2 | Injury types by classification of occupations
Among fatal occupational injuries, the top five ranking injury types among
Construction‐Related Technical Workers (6th KSCO 772) were fractures
(42.7%), internal organ injuries (17.8%), other injuries (15.5%), rupture and
laceration (12.9%), and asphyxia and drowning (4.0%). Among Construc-
tion Elementary Workers (6th KSCO 910), the top five injury types were
similar to those among Construction‐Related Technical Workers (6th
KSCO 772), slightly differently ranked, fracture came first (38.4%),
followed by other injuries (19.7%), internal organ injuries (19.5%), rupture
and laceration (10.4%), and asphyxia and drowning (4.9%). Among
nonfatal occupational injuries, fracture, rupture and laceration, contusion,
sprain, and amputation were the most frequent injury types among all
classifications of occupations. Table 2 shows the detailed frequency and
percentages; the top‐ranking 10 diagnosis codes and names are listed in
Supporting Information Material S4. Fracture of the hand and finger was
the most frequent diagnosis of the total approved occupational injuries,
accounting for 7.5%, and rib fracture was the second most common
diagnosis, accounting for 7.2% of occupational injuries. Among fatal
occupational injury, the most common diagnosis was traumatic subdural
hemorrhage and brain injury, followed by skull and rib fractures
(Supporting Information Material S4).
3.3 | Analysis of annual trends of classification of
occupations and injury types related to occupational
injuries
With respect to the annual trends of the classification of occupations,
Construction‐Related Technical Workers (6th KSCO 772) was the most
ET AL.
frequent classification until 2014, and Construction Elementary Workers
(6th KSCO 910) became the most common classification from 2014 to
2018 (Figure 2A). Among fatal occupational injuries, the highest
proportion of injuries was found among Construction‐Related Technical
Workers (6th KSCO 772), except in 2011 and 2012 when the proportion
was slightly lower than that of Construction Elementary Workers (6th
KSCO 910). In addition, the frequency of fatal occupational injuries
among Construction‐Related Technical Workers (6th KSCO 772)
increased from 2012 onwards, peaking in 2017. The frequency of fatal
claims among Construction Elementary Workers (6th KSCO 910) also
increased in 2017 and 2018 (Figure 2B). The annual trend of nonfatal
occupational injuries showed a similar pattern to that of total occupational
injuries (Figure 2C).
With respect to the annual trend of injury types, the most
common among both fatal and nonfatal injuries was fractures
(Figure 3A). Among fatal injuries, internal organ injury was the
second most frequent type since 2013 (Figure 3B). Among nonfatal
injuries, rupture and laceration were the second most frequent type
throughout the year (Figure 3C). The incidence of fractures and
ruptures and lacerations constantly increased from 2012 onwards.
3.4 | Trends in incidence and mortality of
occupational injury in Korean construction industry,
2009–2018
Incidence of all occupational injuries increased approximately 1.7
times from 700.36 per 100,000 persons in 2009 to 1,195.98 per
100,000 persons in 2018 (IRR 1.07 [95% CI: 0.86–1.33]). Deaths
caused by injury at work significantly increased annually [MRR 1.04
(95% CI: 1.03–1.05)] between 2009 and 2018. Over this 10‐year
period, deaths caused by injuries were 16.74 per 100,000 persons in
2009 and 21.91 per 100,000 persons in 2018 (Table 3).
4 | D IS CU SS IO N
We analyzed a total of 158,947 accepted claims of occupational
injuries among construction workers extracted from nationwide WC
insurance data from 2009 to 2018 in South Korea. For both fatal and
nonfatal occupational injuries, the most common age group was
50–59 years and the average age for fatal occupational injury (53.5
years) was higher than that for nonfatal occupational injury (52.5
years). But it is controversial whether the risk of occupational injury
increases with age. In a recent study of work‐related injuries among
US construction workers conducted using data from the 2004–2017
National Health Interview Survey, the odds of work‐related injury
showed significantly higher among workers who were younger
(35–54 years vs. ≥55 years: aOR = 2.2) after adjusting for major
demographic and socioeconomic factors.16 There were no significant
gender‐based differences in fatality in our study. However, female
workers might be more vulnerable than male workers. Several studies
have investigated gender inequality in the construction industry.
TABLE 1 General characteristics of accepted workers' compensation insurance claims among Korean construction workers, 2009–2018
JUNG

N (%)
ET AL.

Demographic Accepted claims (n = 158,947) Fatal (n = 3175) Nonfatal (n = 155,772)

features Total Fatal Nonfatal p value Male Female p value Male Female p‐value

Number N (%) 158,947(100.0) 3175 (2.0) 155,772 (98.0) 3124 (98.4) 51 (1.6) 152,184 (97.7) 3588 (2.3)

Age group <30 3225 (2.0) 65 (2.0) 3,160 (2.0) <0.005b 65 (2.1) 0 (0.0) 0.007c 3147 (2.1) 13 (0.4) <0.005b

30–39 12,244 (7.7) 217 (6.8) 12,027 (7.7) 216 (6.9) 1 (2.0) 11,973 (7.9) 54 (1.5)

40–49 39,234 (24.7) 728 (22.9) 38,506 (24.7) 719 (23.0) 9 (17.6) 38,013 (25.0) 493 (13.7)

50–59 65,950 (41.5) 1,263 (39.8) 64,687 (41.5) 1249 (40.0) 14 (27.5) 62,979 (41.4) 1708 (47.6)

60–69 34,474 (21.7) 782 (24.6) 33,692 (21.6) 760 (24.3) 22 (43.1) 32,565 (21.4) 1127 (31.4)

≥70 3820 (2.4) 120 (3.8) 3,700 (2.4) 115 (3.7) 5 (9.8) 3507 (2.3) 193 (5.4)
d d
Age average mean (SD) 52.5 (9.7) 53.5 (10.1) 52.5 (9.7) <0.005 53.4 (10.0) 59.2 (9.8) <0.005 52.4 (9.7) 56.9 (8.0) <0.005d

Nationality Domestic workers 148,404 (93.4) 2,905 (91.5) 145,499 (93.4) <0.005b 2860 (91.5) 45 (88.2) 0.441c 142,184 (93.4) 3315 (92.4) 0.008b

Foreign workers 10,543 (6.6) 270 (8.5) 10,273 (6.6) 264 (8.5) 6 (11.8) 10,000 (6.6) 273 (7.6)
b c
Classification of KSCO 771 4926 (3.1) 113 (3.6) 4,813 (3.1) <0.005 113 (3.6) 0 (0.0) 0.019 4776 (3.1) 37 (1.0) <0.005b
occupationsa
KSCO 772 62,323 (39.2) 1,408 (44.3) 60,915 (39.1) 1393 (44.6) 15 (29.4) 60,202 (39.6) 713 (19.9)

KSCO 773 12,378 (7.8) 211 (6.6) 12,167 (7.8) 205 (6.6) 6 (11.8) 11,304 (7.4) 863 (24.1)

KSCO 774 1672 (1.1) 37 (1.2) 1,635 (1.0) 37 (1.2) 0 (0.0) 1634 (1.1) 1 (0.0)

KSCO 792 4419 (2.8) 142 (4.5) 4,277 (2.7) 142 (4.5) 0 (0.0) 4,253 (2.8) 24 (0.7)

KSCO 875 557 (0.4) 64 (2.0) 493 (0.3) 64 (2.0) 0 (0.0) 486 (0.3) 7 (0.2)

KSCO 910 72,672 (45.7) 1,200 (37.8) 71,472 (45.9) 1170 (37.5) 30 (58.8) 69,529 (45.7) 1943 (54.2)
b c
Injury type Fracture 92,042 (57.9) 1,312 (41.3) 90,730 (58.2) <0.005 1288 (41.2) 24 (47.1) 0.460 88,132 (57.9) 2598 (72.4) <0.005b

Rupture, Laceration 29,826 (18.8) 366 (11.5) 29,460 (18.9) 361 (11.6) 5 (9.8) 29,060 (19.1) 400 (11.1)

Contusion 9165 (5.8) 122 (3.8) 9,043 (5.8) 122 (3.9) 0 (0.0) 8863 (5.8) 180 (5.0)

Sprain 7561 (4.8) 9 (0.3) 7,552 (4.8) 9 (0.3) 0 (0.0) 7408 (4.9) 144 (4.0)

Amputation 4619 (2.9) 10 (0.3) 4,609 (3.0) 10 (0.3) 0 (0.0) 4575 (3.0) 34 (0.9)

Other injuries 3958 (2.5) 541 (17.0) 3,417 (2.2) 534 (17.1) 7 (13.7) 3364 (2.2) 53 (1.5)

Cut 2810 (1.8) 10 (0.3) 2,800 (1.8) 10 (0.3) 0 (0.0) 2775 (1.8) 25 (0.7)

Back pain, MSD pain 2641 (1.7) 2 (0.1) 2,639 (1.7) 2 (0.1) 0 (0.0) 2581 (1.7) 58 (1.6)

Internal organ injury 1617 (1.0) 571 (18.0) 1,046 (0.7) 558 (17.9) 13 (25.5) 1018 (0.7) 28 (0.8)
|

Burn 1556 (1.0) 39 (1.2) 1,517 (1.0) 37 (1.2) 2 (3.9) 1483 (1.0) 34 (0.9)
159

(Continues)
160 | JUNG ET AL.

A previous study showed that female workers face several challenges

p‐value
in the traditionally male‐oriented working environment, including

Construction Structure‐Related Workers (KSCO 771), Construction‐Related Technical Workers (KSCO 772), Construction Finishing‐Related Technical Workers (KSCO 773), Civil Engineering‐Related
inadequate sanitary facilities, ergonomic hazards, and lack of access
to well‐fitting personal protective equipment (PPE). Unfitting PPE
may lead to serious injury or death. For example, oversized protective
13 (0.4)

12 (0.3)

0 (0.0)

1 (0.0)

0 (0.0)

0 (0.0)

8 (0.2)
Female

clothing presents a tripping hazard; similarly, improperly fitting gloves

Nonfatal (n = 155,772)

can expose the skin to toxic chemicals or get caught in moving parts
of machinery.17 In another study on occupational health and injuries

Technical Workers (KSCO 774), Craft and Related Trades Workers (KSCO 792), Construction Machines Operators (KSCO 875), Construction Elementary Workers (KSCO 910).
among unskilled female construction workers, the situation worsened
1258 (0.8)

1189 (0.8)

42 (0.0)

61 (0.0)

33 (0.0)

8 (0.0)

334 (0.2)
when female workers performed their tasks in unorganized sectors in
the construction industry, where the injuries included falls, slips, cuts,
Male

and medical illnesses such as weakness, urinary tract infections, and

heat stroke.18
p value

In terms of nationality, a higher proportion of foreign workers was

found among fatal injuries (8.5%) than in nonfatal injuries (6.6%). In a
study using the 2007 Labor Force Survey data by Italy's National Institute
of Statistics, the incidence of occupational injuries was significantly higher
0 (0.0)

0 (0.0)

0 (0.0)

0 (0.0)

0 (0.0)

0 (0.0)

0 (0.0)
Female

among immigrant men than among Italian men (modified OR = 1.82; 95%
CI: 1.53–2.16).19 Migrant workers were likely exposed to 3D (demanding,
Fatal (n = 3175)

dirty, and dangerous) tasks because of their lower income than domestic
workers.20 Moreover, communication difficulties due to language and
20 (0.6)

1 (0.0)

153 (4.9)

13 (0.4)

0 (0.0)

0 (0.0)

6 (0.2)

culture can explain the increasing risk of occupational injuries.21 Another

Male

study considered the lack of safety education as the explanation for

migrant workers being more vulnerable to occupational injuries.22
p value

Migrant workers who work without appropriate safety education do

not use adequate protective equipment. Moreover, they tend not to
complain about their unsafe working conditions.23 A previous study
showed that the relative risk of treatment days was significantly 2.2%
1,271 (0.8)

1,201 (0.8)

42 (0.0)

62 (0.0)

33 (0.0)

8 (0.0)

342 (0.2)

higher among migrant workers than among nonmigrant workers.24

Nonfatal

Migrant workers are more likely to fear unemployment because they

have family members to support in other countries or have dependents in
p Value was calculated using Fisher's exact test or Monte Carlo simulation, p < 0.05

Korea, but their dependents are limited in their economic activities. These
20 (0.6)

1 (0.0)

153 (4.8)

13 (0.4)

0 (0.0)

0 (0.0)

6 (0.2)
Accepted claims (n = 158,947)

factors contribute to the higher risk of occupational injury for migrant

workers.
Fatal

In the classification of occupations, Construction Elementary

Workers (6th KSCO 910) was the most common occupation among
p Value was calculated using independent sample t‐test, p < 0.05.
p Value was calculated using Pearson's chi‐square test, p < 0.05.

all occupational injuries, showing a dramatically increasing pattern

1291 (0.8)

1202 (0.8)

195 (0.1)

75 (0.0)

33 (0.0)

8 (0.0)

348 (0.2)

over the last 10 years; this pattern was also found in nonfatal
occupational injuries. In contrast, the most frequent fatal occupa-
Total

tional injuries were in Construction‐Related Technical Workers (6th

KSCO 772); the incidence of fatal occupational injuries among
Construction‐Related Technical Workers (6th KSCO 772) constantly
Infection, poisoning
Asphyxia, drowning

increased from 2012 to 2018. Construction Elementary Workers (6th

Missing values

KSCO 910) are more likely to suffer nonfatal occupational injuries as

Skin disease

they are exposed to diverse simple tasks such as digging,

Frostbite
Abrasion
Stabbing

lifting, carrying, clearing, loading, and unloading but are usually less
(Continued)

skilled at the task. Compared with Construction Elementary Workers

(6th KSCO 910), Construction‐Related Technical Workers (6th KSCO
772) perform the construction, maintenance, and repair of basic
Demographic

construction works or walls and the main parts of buildings, the

TABLE 1

exterior, and other buildings, including reinforcement worker,

features
N (%)

architectural woodworking, and so forth; accordingly, they are more

likely exposed to fatal occupational injuries such as fall‐down or
b

d
a

c
 JUNG
ET AL.

TABLE 2 Ranking of occupational injury types according to the classification of occupations among Korean construction workers, 2009–2018
Fatal Nonfatal
6th KSOC ranking 1 2 3 4 5 Ranking 1 2 3 4 5

771 Construction Injury type Fracture Internal organ Rupture, Other injuries Asphyxia, Injury type Fracture Rupture, Contusion Sprain Amputation
Structure‐Related injurya Laceration drowning Laceration
Workers
N (%) 45 (39.8) 24 (21.2) 19 (16.8) 14 (12.4) 5 (4.4) N (%) 2987 (62.1) 911 (18.9) 233 (4.8) 202 (4.2) 137 (2.8)

772 Construction‐Related Injury type Fracture Internal organ Other injuries Rupture, Asphyxia, Injury type Fracture Rupture, Contusion Sprain Amputation
Technical injurya Laceration drowning Laceration
Workers
N (%) 601 (42.7) 250 (17.8) 218 (15.5) 181 (12.9) 56 (4.0) N (%) 35,231 (57.8) 11,672 (19.2) 3494 (5.7) 3024 (5.0) 2039 (3.3)

773 Construction Injury type Fracture Internal organ Other injuries Rupture, Contusion Injury type Fracture Rupture, Sprain Contusion Amputation
Finishing‐Related injurya Laceration Laceration
Technical
N (%) 118 (55.9) 32 (15.2) 28 (13.3) 17 (8.1) 10 (4.7) N (%) 7595 (62.4) 2098 (17.2) 579 (4.8) 536 (4.4) 281 (2.3)
Workers

774 Civil Engineering‐ Injury type Other Asphyxia, Rupture, Fracture Internal organ Injury type Fracture Rupture, Contusion Sprain Amputation
Related Technical injuries drowning Laceration injury Laceration
Workers
N (%) 12 (32.4) 8 (21.6) 7 (18.9) 5 (13.5) 3 (8.1) N (%) 971 (59.4) 329 (20.1) 84 (5.1) 56 (3.4) 50 (3.1)

792 Craft and Related Injury type Fracture Other injuries Asphyxia, Internal organ Rupture, Injury type Fracture Rupture, Contusion Sprain Amputation
Trades Workers drowning injurya Laceration/ Laceration
Contusion

N (%) 56 (39.4) 24 (16.9) 17 (12.0) 16 (11.3) 10 (7.0) N (%) 2487 (58.1) 2487 (58.1) 178 (4.2) 149 (3.5) 147 (3.4)

875 Construction Injury type Fracture Internal organ Other injuries Asphyxia, Rupture, Injury type Fracture Rupture, Amputation Contusion Sprain
Machines injurya drowning Laceration Laceration
Operators
N (%) 26 (40.6) 12 (18.8) 9 (14.1) 7 (10.9) 7 (10.9) N (%) 303 (61.5) 73 (14.8) 28 (5.7) 18 (3.7) 17 (3.4)

910 Construction Injury type Fracture Other injuries Internal organ Rupture, Asphyxia, Injury type Fracture Rupture, Contusion Sprain Amputation
Elementary injurya Laceration drowning Laceration
Workers
N (%) 461 (38.4) 236 (19.7) 234 (19.5) 125 (10.4) 59 (4.9) N (%) 41,156 (57.6) 13,534 (18.9) 4500 (6.3) 3525 (4.9) 1927 (2.7)
a
Internal organ injury includes cardiovascular disease.
|
161
162 | JUNG ET AL.

FIGURE 2 Annual trends of (A) total, (B) fatal, (C) nonfatal occupational injury according to the classification of occupations, 2009–2018
JUNG ET AL. | 163

FIGURE 3 Annual trend of (A) total, (B) fatal, (C) nonfatal occupational injuries according to injury types, 2009–2018
164 | JUNG ET AL.

TABLE 3 Incidence and mortality trends due to occupational injuries in the Korean construction industry, 2009–2018

Estimated number
of construction Number of Incidence 95% Confidence Number Death per 95% Confidence
Year workers approved per 100,000 IRR interval of deaths 100,000 MRR interval

2009 1,661,000 11,633 700.36 1.07 0.86 1.33 278 16.74 1.04 1.03 1.05

2010 1,625,313 12,694 781.02 261 16.06

2011 1,574,587 12,461 791.38 293 18.61

2012 1,508,443 12,976 860.22 275 18.23

2013 1,547,486 14,745 952.84 333 21.52

2014 1,532,226 17,083 1114.91 299 19.51

2015 1,533,976 18,361 1196.95 321 20.93

2016 1,573,450 19,643 1248.40 340 21.61

2017 1,670,033 19,045 1140.40 403 24.13

2018 1,697,850 20,306 1,195.98 372 21.91

Abbreviations: IRR, incidence rate ratio; MRR, mortality rate ratio.

electric shock. A comparative study reported a higher rate of
occupational accidents along with a higher proportion of construction
manual workers.25 We represent the possibility of higher rate of
fatal occupational injuries in Construction‐Related Technical Workers
(6th KSCO 772) than the others by dividing severity of occupational
accidents. In Korea, we think that there is a little lack of awareness
of occupational injuries and social support in the construction
industry. Sometimes there is opposition from the workplace for
applying for compensation for occupational injuries. So, the
frequency of approved occupational injury might have been under-
estimated; the underestimation would be highest among Construc-
tion Elementary Workers (6th KSCO 910), because most are
temporary workers. Therefore, additional strategies for these specific
occupations are required to reduce the incidence of occupational
injuries.
We found that fracture was the most common type among fatal
and nonfatal injury cases. In this context, a case–control study of
occupational fractures among 199 construction workers reported that
the most common lesion location was the hand (31.7%), followed by
26
the foot (24.6%) and trunk (17.6%). Another study reported higher
odds of musculoskeletal disorders in the shoulders, hands, and knees
among union carpenters working for >20 years.27 Among fatal claims,
internal organ injury, asphyxia, and drowning were also important
injury types in our study. Especially, among Mining and Civil
Engineering–Related Technical Workers (6th KSCO 774), including
miners and underwater workers, asphyxia and drowning was the
second most common injury type. In the annual trends of fatal
occupational injury types, the incidence of internal organ injury has
been increasing since 2012. Internal organ injury includes traumatic
organ damage such as brain hemorrhage, splenic rupture, and electrical
shock. The increasing incidence of fatal injuries indicates a lack of
safety and health management in the workplace. Although we did not
obtain information on accident types, such as falling or electrocution,
extensive research on fatal occupational injuries indicates that falling is
the major cause of accidents in the construction industry and the
cause of motor vehicle accidents or electrocution.28 Being struck by
falling objects is another mechanism of fatal injury in the construction
industry.29 In Hong Kong, falling from heights accounted for >47% of
fatal occupational injuries in 2004.30
Furthermore, we calculated the IRR and MRR of occupational
injuries between 2009 and 2018 by applying negative binomial
regression and Poisson regression models, which revealed an IRR of
1.07 (95% CI: 0.86–1.33) and an MRR of 1.04 (95% CI: 1.03–1.05),
respectively. Although IRR did not show statistical significance,
occupational injuries increased approximately 1.7 times during the last
10 years, from 700.36 in 2009 to 1195.98 in 2018. This is contrary to
the trend of decreasing the occupational injury rate in other countries
such as the United States. In a study of occupational injury among US
construction workers with compensation‐accepted disabling claims
from 2007 to 2013, the number of workers showed a consistent
decrease from 2840 claims in 2007 to 1260 in 2013, and the rate per
100 workers also had decreased from 2.73 in 2007 to 1.70 in 2013.31
The mortality rate significantly increased by 1.04 times every year, from
16.75 in 2012 to 21.91 in 2018. In a study analyzing occupational injury
trends in major countries, including Korea, the mortality rate due to
occupational injuries in Korea was 0.361 in 2018, higher than that in
the United States (0.337), the United Kingdom (0.045), and Japan
(0.126). The higher the proportion of the construction industry among
total industry, the higher the mortality rate and occupational injury rate.
A similar proportion of the construction industry but a significantly
higher accident death rate was observed in Korea than that in the UK
and Japan.32 The increasing mortality rate in the construction industry
until recently indicates a lack of effectiveness of safety regulations
among construction workers despite improved awareness and safety
and health regulations in Korea and the necessity to establish more
detailed regulations.
A limitation of this study is that the classification of occupations
had only three digits; thus, a detailed classification of construction
JUNG ET AL.
workers could not be performed. Further, there is a possibility of
mismatched occupations between the 5th and 6th KSCO categories.
In the future, a detailed classification of jobs in construction requires
additional research. Another limitation is that the WC insurance data
were deidentified; thus, we could not determinate the proportion of
repeat claimants and multiple diseases. Nevertheless, the strength of
this study is that we used large‐scale nationwide public data of WC
insurance, including all Korean construction workers, in the past 10
years (2009–2018). Furthermore, the data were analyzed by dividing
into fatal and nonfatal occupational injuries to determine each
characteristic of occurrence according to sex, classification
of occupations, and types of injuries. In addition, the significance of
this study is that it determined the scale and characteristics of
occupational injuries by classification of occupations among Korean
construction workers. Further research on occupational injuries is
required for specific occupations in construction work.
5 | C ONC LUS I ON
This study analyzed the characteristics of occupational injuries
according to fatality, sex, and classification of occupations in the
construction industry using national WC insurance data for all
construction workers in Korea from 2009 to 2018. As only a few
studies have used public national data for all construction workers, this
study is epidemiologically important. Despite regulations and increas-
ing improvements in health and safety, the trends over the past decade
showed undiminished occupational fatal injuries, which indicates the
need for continuous intervention in safety regulations for construction
workers. This study identified the risk of industrial injuries according to
occupation characteristics and provided clues to determine the causes
of occupational injuries among specific occupations, allowing the
establishment of safety and health interventions focusing on specific
vulnerable workers groups, such as Construction‐Related Technical
Workers and Construction Elementary Workers.
A U T H O R C O N TR I B U T I O N S
The study was conceptualized by Se‐Yeong Kim. Data curation and
investigation were performed by Saemi Jung and Se‐Yeong Kim.
Funding was obtained by Se‐Yeong Kim. The original draft manuscript
was written by Saemi Jung, Se‐Yeong Kim, Yoon‐Ji Kim, and Tae‐
Kyoung Kim. Review and editing of the manuscript were by Saemi
Jung, Se‐Yeong Kim, Young‐Ki Kim, and Dongmug Kang. All authors
have read and agreed to the published version of the manuscript.
A C KN O W L E D G M E N T S
The authors would like to thank the Occupational Safety and Health
Research Institute (OSHRI) for supporting the multi‐year study of the
construction workers cohort.
CO NFL I CTS OF I NTEREST
The authors declare that there are no conflicts of interest.
| 165
D I S C L O S U R E B Y A J I M E D I TO R O F R E C O R D
John Meyer declares that he has no conflict of interest in the review
and publication decision for this article.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available in the
supplementary material of this article.
E T HI C S A P P R O V A L A N D I N F O R M E D C O NS E N T
This study was conducted according to the Declaration of Helsinki
and approved by the Institutional Review Board Committee of Pusan
National University Yangsan Hospital (IRB no. 04‐2018‐014; the date
of approval was June 18, 2018).
DISC LAIM ER
The views expressed are those of the authors and do not
necessarily represent the decisions, policies, or views of their
respective institutions. The findings and conclusions in this report
are those of the authors and do not necessarily represent the
official position of the Occupational Safety and Health Research
Institute, Korea Occupational Safety and Health Agency in the
Republic of Korea.
FU N D I NG I NF O RM AT I ON
This study was supported by Occupational Safety and Health
Research Institute, Korea Occupational Safety and Health Agency
in the Republic of Korea (grant no.: 202204166DO‐00). This study
was also supported by a 2021 research grant from Pusan National
University Yangsan Hospital. The funders were not involved in the
study design, analysis, interpretation of data, writing, or submission
of this manuscript.
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SUPP ORTING INFO RM ATION
Additional supporting information can be found online in the
Supporting Information section at the end of this article.
How to cite this article: Jung S, Kim T‐K, Kim Y‐J, Kim Y‐K,
Kang D, Kim S‐Y. Epidemiology of occupational injuries in
construction workers between 2009 and 2018 in South
Korea. Am J Ind Med. 2023;66:155‐166.
doi:10.1002/ajim.23448