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BackgroundOlder workers experience higher rates of fatal occupational injury than younger workers worldwide. In North Carolina, the population of older workers more than doubled between 2000 and 2017. In 2008, the Great Recession changed occupational patterns among all age groups. We examined annual rates and distribution of fatal occupational injuries experienced by older workers, comparing the pre-recession period (2000–2007) to the post-recession period (2009–2017).MethodsDetailed information on all fatal occupational injuries during the period between 1 January 2000 and 31 December 2017 were abstracted from the records of the North Carolina Office of the Chief Medical Examiner and the office of vital records. The decennial Census and American Community Survey were used to estimate the population at risk and derive annual rates of fatal occupational injury.ResultsDuring the study period, 537 occupational fatalities occurred among workers 55+ years of age. The rate of fatal occupational injury among older workers declined 2.8% per year, with a 7.7% yearly decline in the pre-recession period compared with a 1.4% increase per year in the post-recession period. Workers 65+ years of age experienced rate increases in both periods. The highest rates of unintentional fatal occupational injury (injuries that were not purposefully inflicted) were observed in forestry, fishing hunting and trapping, and wood building manufacturing. Intentional fatal occupational injury rates (homicide, suicide) were highest in transportation, gas/service stations and grocery/food stores.ConclusionsOlder workers have persistently high rates of fatal occupational injury in North Carolina before and after the Great Recession.

BackgroundRespiratory exposure to silica is associated with the risk of death due to malignant and non-malignant disease. 2.3 million U.S. workers are exposed to silica. Occupational exposure limits for silica are derived from a number of lines of evidence, including observational studies. Observational studies may be subject to healthy worker survivor bias, which could result in underestimates of silica’s impact on worker mortality and, in turn, bias risk estimates for occupational exposure limits.MethodsUsing data on 65 999 workers pooled across multiple industries, we estimate the impacts of several hypothetical occupational exposure limits on silica exposure on lung cancer and all-cause mortality. We use the parametric g-formula, which can account for healthy worker survivor bias.ResultsAssuming we could eliminate occupational exposure, we estimate that there would be 20.7 fewer deaths per 1000 workers in our pooled study by age 80 (95% confidence interval: 14.5, 26.8), including 3.91 fewer deaths due to lung cancer (95% CI: 1.53, 6.30). Less restrictive interventions demonstrated smaller, but still substantial risk reductions.ConclusionsOur results suggest that occupational exposure limits for silica can be further strengthened to reduce silica-associated mortality and illustrate how current risk analysis for occupational limits can be improved.