RESUMO
OBJECTIVE: to study determinants of occupational injuries in tunnel construction using data from the surveillance system which had been implemented in order to monitor accidents during the construction of the "high speed train tracks in the Italian Regions Emilia-Romagna and Tuscany. DESIGN: retrospective cohort study. SETTING: 16 sites for the construction of 14 tunnels of the high speed railway-tract Bologna-Firenze, in Italy. PARTICIPANTS: 1,602 workers (of 3,000 employed in the underground tunnelling), aged 18 - 67 years, operating during excavation with traditional method in 1999-2002. A total of 549 injuries occurred among 385 workers. The number of worked hours were used as time at risk. MAIN OUTCOME MEASURES: incidence rate ratios (IRR) and 95% confidence intervals for all injuries, serious injuries and first injuries were considered in separate multiple regression analyses (Poisson). RESULTS: residence, task and working phase were taken into consideration. An increased risk was found for younger workers, for carpenters (IRR "all-events" = 2.33; 95% CI=1.85-2.94; IRR" first-events" = 2.12; 95% CI 1.62-2.77) and miners (IRR "all-events" = 1.76; 95% CI 1.39-2.24; IRR"first-events" = 1.71; 95% CI 1.30-2.24) vs. machinery operators. Construction of inverted arch turns out to have an incidence rate ratio three times higher than digging out (IRR "all-events" = 2.79; 95% CI 2.27-3.43; IRR "firsts-event = 2.98; 95% CI 2.33-3.81). The probability of "serious" injuries (>30 days) is higher for miners (IRR=2.45; 95% CI 1.65-3.64) and for carpenters (IRR=2.31; 95% CI 1.53-3.49). CONCLUSION: this study pointed out to indicate some determinants (age, task and work phase) of injuries in tunneling about which little had been published previously. These results are useful for addressing preventive measures, for control and prevention activities and point to the need to explore the effect of experience and to study, through a case crossover design, transient working and individual risk factors for traumatic injury within these working sites.