Effect of HIV on work-related injury rates in South African gold miners.
OBJECTIVE
Work-related injuries have severe, well-documented economic and social impacts, and injury is a leading cause of death in working adults. As adults of working age are one of the groups most affected by the HIV epidemic, the interaction between work-related injuries and HIV is important. The objective was to calculate the effect of HIV on the rate and severity of work-related injuries by duration of infection.


METHODS
A large, retrospective seroincident cohort of South African gold miners was studied. Data routinely collected by the mines, and assurance company injury data were analysed. HIV-positive and negative miners were compared, allowing the calculation of injury rates and rate ratios. Severity of injuries was measured by the number of days away from work, percentage of permanent disability, and fatalities.


RESULTS
Results were available for 1661 HIV-positive and 6166 HIV-negative miners over 10 years. HIV infection increased the rate of work-related injuries overall (adjusted rate ratio, 1.3; 95% confidence interval, 1.1-1.4), but had less effect on severe injuries. Injury rates in HIV-positive men prior to the first positive test were similar to those in HIV-negative men. The injury rate rose soon after the first HIV positive test. After seroconversion there was only weak evidence of an increase in injury rates by duration of infection.


CONCLUSIONS
This is the first study to demonstrate an increase in injury rates in HIV-positive individuals. The increase may reflect direct effects of HIV infection as well as behaviour change once HIV is diagnosed.
Murray
Jill
J
National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa. jill.murray@nioh.nhls.ac.za
Sonnenberg
Pam
P
Nelson
Gill
G
Shearer
Stuart
S
Bester
Andre
A
Begley
Arthur
A
Glynn
Judith R
JR
D000328:Adult; D006046:Gold; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology; D015528:HIV Seroprevalence; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008906:Mining; D009784:Occupational Diseases / Q000150:complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology*
D006046:Gold