Author ORCID Identifier

https://orcid.org/0000-0002-9034-2949

Semester

Spring

Date of Graduation

2025

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Gordon Smith

Committee Co-Chair

Karen Innes

Committee Member

Karen Innes

Committee Member

Sijin Wen

Committee Member

Desta Fekedulegn

Committee Member

Heidi Stallings

Abstract

ABSTRACT

An Epidemiological Study of Finger, Hand, and Wrist Injuries in the Department of Air Force and US workers

Melody Gwilliam

Background and Objectives: Fingers, hands, and wrists (FHW) are the leading injured body parts in work-related injuries in the United States (U.S.) and in the U.S. Department of the Air Force (DAF). There has been limited research on risk factors for FHW injuries. Workers across all industries are at risk for these injuries. The objectives of these studies are to 1) describe and compare FHW injuries among enlisted, officer, and civilian U.S. Department of the Air Force (DAF) personnel to those in the U.S. workforce, 2) examine epidemiologic characteristics and outcomes of FHW injuries by severity in the DAF workers and provide prevention recommendations, and 3) analyze national estimates and rates of work-related FHW ED-treated injuries by industry, source of injury, diagnosis, demographics, and severity.

Methods: Study 1. All work-related, noncombat FHW injuries (≥1 lost workday) and demographics among DAF personnel and U.S. workforce (2008–2018) were included using Air Force Safety Automated System (AFSAS) and the US Survey of Occupational Injuries and Illnesses (SOII). The AFSAS data captures both DAF military and civilian employees’-work related injury events, reported by local safety professionals. The SOII data is based on employer reported injuries and illnesses. The DAF FHW injury rates were age adjusted to the US employed population and compared by sex, source, event, and nature of the injuries. Study 2. This study evaluated general characteristics, injury details, and injury severity among all DAF personnel with work-related, noncombat FHW injuries between 2008 to 2018 using the Air Force Safety Automated System (AFSAS). Injury rates were calculated, patterns of injury severity were determined, and at-risk populations were identified within the DAF. Study 3. The National Electronic Injury Surveillance System - Occupational Supplement (NEISS-Work), a national estimate of emergency department (ED) injuries, was used to analyze FHW injuries between 2015 and 2022. National estimates and rates per 10,000 full-time equivalent (FTE) workers were calculated using employment labor force estimates (denominator) from the Current Population Survey.

Results: Study 1. Finger, hand, and wrist injuries were significantly lower among the DAF (3.30 per 10,000 workers) compared to all US workers (15.71 per 10,000 workers) by estimates and among females. In both populations, FHW injuries from falls were higher and increased with age group among females. Males had higher overall FHW injuries from contact with objects and equipment. Study 2. Nearly a quarter of injuries in the DAF during 2008 to 2018 were from FHW related injuries, with an overall injury rate of 27.9 per 10,000 workers. The highest rates of FHW injuries in the DAF were non-severe (24.6 per 10,000 workers), among males (29 per 10,000 workers), those 30 and younger (38.9 per 10,000 workers), and enlisted workers (31.8 per 10,000 workers). Among the severe FHW injuries, the majority occurred among those who were male (3.5 per 10,000 workers), 30 and younger (4.5 per 10,000 worker), 60 and older (3.7 per 10,000 worker), and enlisted (3.8 per 10,000 worker). There were significantly increasing odds of older age groups (40-49: aOR 1.32, 50-59: aOR: 1.45, 60 and older years: aOR 2.01) of having a severe injury compared to workers aged 30 and younger after adjusting for demographic factors (sex, age, occupational group, and DAF group). Male had significantly higher likelihood (uOR: 1.22) of severe FHW injury compared to females on crude analysis but after adjusting for sex, age, occupational group, and DAF group there was no significant difference (aOR: 0.96). Open wounds accounted for more than half of all FHW injuries, however fractures accounted for the largest percentage (37%)of severe injuries. Among all and severe FHW injuries, aircraft maintenance workers had the highest number of injuries and metal workers had the highest rates of injuries. After adjusting for demographic factors, the highest likelihood of severe injury appears significantly elevated in equipment, facilities, and services workers, while the lowest likelihood to have a severe injury was among medical sciences when compared to maintenance workers. Severe FHW injuries were significantly more likely to be related to vehicles, chemical/toxic substances, vehicles, and heat compared to aircrafts and tools/machinery after adjusting for all demographic factors. There was a significant decrease among FHW injuries in the DAF from 2011 to 2018. Study 3. There were approximately five million FHW ED-treated injuries between 2015 and 2022 and 2% were severe. More than half of the injuries were to fingers (58%). Approximately two-thirds (67%) of work-related ED-treated FHW injuries were among males, however females had higher odds of severe ED-treated work-related FHW injuries than male when adjusting for industry. The rate of injury decreased with the increasing age; however, there was a higher likelihood of severe ED-treated work-related FHW injuries among older age groups after adjusting for industry. Lacerations accounted for more than a third (36%) of these FHW injuries. Health care and social assistance workers experienced the highest number of FHW injuries (814,100 injuries), however, accommodation and food service workers had the highest rate of injury (81 per 10,000 FTE). The leading source of injury and diagnosis, respectively, for severe ED-treated FHW injuries were machinery-related (31%) and fractures (27%). Construction (24%) and manufacturing (23%) workers each experienced nearly a quarter of the severe FHW injuries. However, the leading industries for severe FHW injury rates were agriculture, forestry, fishing, and hunting (35.3 per 100,000 FTE workers) and construction (23.4 per 100,000 FTE workers).

Conclusions: Examining three separate work-related datasets provides a valuable way to improve understanding of FHW injuries and adds strength to the common findings in the datasets. The findings address the dearth of information on these common work-related injuries and the largely descriptive nature of previous studies compared to the more analytic methods used in this study. Future research should examine tailored prevention strategies for high-risk groups, including males, females (with an emphasis on severe injuries by industry/occupation), younger and older workers, and workers in high-risk industries and occupations such as aircraft maintenance, metalworking, construction, and manufacturing. Linkage of acute injury reports to other databases on longer-term medical outcomes such as time off work or permanent disability would also provide valuable information to better target specific causes of the more disabling injuries. There is a need for industry specific surveillance and targeted interventions for high-risk occupations, including examining severe injuries investigation text records using machine learning to gain more detailed information regarding specific circumstances and causes of injuries. There is also a need to review and update training programs, implement engineering modifications, updating operating procedures, and policies to improve worker safety. Also, there is a need to evaluate successful injury prevention programs to share this information across industries for prevention efforts to better understanding of common risk factors and sharing of effective prevention strategies. Investigations of injury prevention programs and examination of workplace safety climates can also benefit future intervention efforts.

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Available for download on Tuesday, December 23, 2025

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