The psychosocial work environment among educators during the COVID-19 pandemic.

BACKGROUND: The education sector has been heavily impacted by COVID-19. While the impact on school-aged children has received much attention, less attention has focused on the experiences of educators. AIMS: To compare various dimensions of the psychosocial work environment and health outcomes between educators engaged in online learning to those engaged in in-person learning in the Canadian province of Ontario. METHODS: Responses from 5438 educators engaged in either online or in-person learning were collected between 23 November and 21 December 2020; three months after the start of the 2020/21 academic year in September 2020. Psychosocial outcomes included quantitative demands, work pace, predictability, role conflicts, and social support from supervisors and co-workers; assessed using an abbreviated version of the Copenhagen Psychosocial Questionnaire. Secondary outcomes included burnout and sleep troubles. Ordinary Least-Squares regression models examined adjusted mean differences in the levels of outcomes for respondents in in-person versus online learning, after adjustment for a variety of covariates. RESULTS: Compared to respondents engaged in in-person learning, respondents engaged in online learning reported less predictability, higher role conflicts and less support from supervisors and co-workers. Statistically significant differences in work pace, burnout and sleep troubles were also observed across learning modes, although these differences did not exceed previously suggested thresholds for minimum important differences. CONCLUSIONS: Important differences in the psychosocial work environment were observed between respondents engaged in in-person learning versus online learning. Addressing these differences is required, given the potential continued importance of online learning within the context of the COVID-19 pandemic and beyond.

The demographic and contextual correlates of work-related repetitive strain injuries among Canadian men and women.

BACKGROUND: The study sought to identify gender differences in work-related repetitive strain injuries (RSI), as well as examine the degree to which non-work factors such as family roles interact with gender to modify RSI risk. Another aim is to examine whether there are potential provincial differences in work-related RSI risk. METHODS: The 2003/2005 Canadian Community Health Survey included over 89,000 respondents who reported working in the past 12 months. Separate multi-level models for men and women were used to identify the correlates of work-related RSIs. RESULTS: Women reported sustaining more work-related RSIs than men. Also, having one or more children in the household was associated with lower work-related RSI risk for females. Both men and women in British Columbia reported higher work-related RSI rates than in Ontario. CONCLUSIONS: Gender contributes to RSI risk in multiple and diverse ways based on labor market segregation, non-work exposures, and possibly biological vulnerability, which suggests more tailored interventions. Also, the provincial differences indicate that monitoring and surveillance of work injury across jurisdictions can assist in province-wide prevention and occupational health and safety evaluation.

The psychosocial work environment and incident diabetes in Ontario, Canada.

BACKGROUND: Relatively few longitudinal studies have explored the relationship between psychosocial work conditions and diabetes incidence. Given the increasing global burden of diabetes this is an important area for public health research. AIMS: To examine the relationships between dimensions of the psychosocial work environment on the subsequent incidence of diabetes among men and women in Ontario, Canada over a 9 year period. METHODS: We used data from Ontario respondents (35 to 60 years of age) to the 2000-01 Canadian Community Health Survey linked to the Ontario Health Insurance Plan database for physician services and the Canadian Institute for Health Information Discharge Abstract Database for hospital admissions. Our sample of actively employed labour market participants with no previous diagnoses for diabetes was followed for a 9 year period to ascertain incident diabetes. RESULTS: There were 7443 participants. Low levels of job control were associated with an increased risk of diabetes among women, but not among men. Counter to our hypotheses high levels of social support were also associated with increased diabetes risk among women, but not among men. No relationship was found between any psychosocial work measure and risk of diabetes among men. CONCLUSIONS: Given the increasing prevalence of diabetes worldwide, job control could potentially be an import ant modifiable risk factor to reduce the incidence of diabetes among female, but not among male, workers. More research is needed to understand the pathways through which low social support may protect against the development of diabetes.

Disability management outcomes in the Ontario long-term care sector.

INTRODUCTION: Optimal disability management practices supporting early and safe return-to-work involve the workplace adoption of formal policies and procedures to ensure the quality of disability management outcomes. In the Canadian province of Ontario, there are approximately 60,000 health care workers in 600 licensed facilities providing long-term residential care to approximately 75,000 elderly residents. Workers in this sector are exposed to high biomechanical demands arising from care-giving tasks and have a substantial risk of work-related disability. Over the period 2000-2006, many long-term care facilities in Ontario adopted disability management practices that encourage modified work arrangements. The objective of this study was to describe differences in modified work arrangements and disability outcomes in long-term care facilities in Ontario. METHODS: Measures of disability episode outcomes are described for a representative sample of 32 Ontario long-term care facilities for two consecutive years 2005 and 2006. Data were obtained from a questionnaire survey of facilities, a survey of a representative sample of caregivers and administrative records from the provincial workers' compensation agency. RESULTS: A total of 28,747 days of disability attributed to work-related conditions were experienced by 3,271 full-time equivalent staff in 2005 (28,034 days in 2006). Average total disability days were 922 per 100 full-time equivalent staff in 2005 and 889 per 100 full-time equivalent staff in 2006. Disability compensation expenditures, measured as wage replacement benefits received by disabled workers, were estimated to be $72,332 per 100 full-time equivalent staff in 2005 and $64,619 per 100 full-time equivalent staff in 2006. On average, approximately 60% of all disability days were managed by modified duty arrangements and the proportion of total disability days managed by modified duty arrangements for each facility was correlated between the two observation years. CONCLUSIONS: Across facilities, there was no evidence that modified duty arrangements were associated with lower disability compensation expenditures and there was mixed evidence that modified duty was associated with a lower burden of disability. In this setting, disability days managed by modified duty arrangements were not accurately documented in worker's compensation claim records.

Comparing the risk of work-related injuries between immigrants to Canada and Canadian-born labour market participants.

OBJECTIVES: To examine the burden of work-related injuries among immigrants to Canada compared to Canadian-born labour force participants. METHODS: Using data from the 2003 and 2005 Canadian Community Health Surveys (n = 99,115), two nationally representative population samples, we examined the risk of self-reported, activity limiting work-related injuries among immigrants with varying time periods since arrival in Canada. Models were adjusted for hours of work in the last 12 months as well as various demographic and work-related variables. RESULTS: Immigrant men in their first 5 years in Canada reported lower rates of activity limiting injuries compared to Canadian-born respondents. Surprisingly, the percentage of injuries that required medical attention was much higher among recent immigrants compared to Canadian-born respondents, resulting in an increased risk of activity limiting injuries requiring medical attention among immigrant men compared to Canadian-born labour force participants. No excess risk was found among female immigrants compared to Canadian-born female labour market participants. CONCLUSIONS: Immigrant men in their first 5 years in Canada are at increased risk of work-related injuries that require medical attention. A similar risk is not present among immigrant women. Further, given differences in the number of activity limiting injuries requiring medical attention across immigrant groups, we believe this excess risk among immigrant men may be underestimated in the current data source. Future research should attempt to fully capture the barriers faced by immigrants in obtaining safe employment, the number of injuries that are sustained by immigrants while working, and the consequences of these injuries.

Differential risk of employment in more physically demanding jobs among a recent cohort of immigrants to Canada.

OBJECTIVE: To examine the proportion of a recent cohort of immigrants to Canada who were working in jobs that were more physically demanding than those in which they worked before migration to Canada. DESIGN: Longitudinal cohort of immigrants to Canada with occupational position measured before and 2 and 4 years after arrival in Canada. SUBJECTS: Respondents to Statistics Canada's Longitudinal Survey of Immigrants to Canada (LSIC). The LSIC surveyed a representative sample of immigrants, aged 15 and older, who arrived in Canada between November 2000 and December 2001. For the purpose of this study, the sample was restricted to respondents who had worked before immigrating and were working when re-interviewed 2 (n = 4331) or 4 (n = 4238) years after arrival in Canada. MAIN OUTCOME: Employment in an occupation with higher physical demands than that employed in before arrival in Canada. RESULTS: Respondents with less proficiency at speaking English and family class or refugee applicants were the most likely to be employed in occupations with higher physical demands both 2 and 4 years after arrival in Canada. CONCLUSIONS: Employment in a more physically demanding occupation may pose particular risks of workplace injury. In this sample of immigrants to Canada, respondents with poorer English skills and refugees (factors that may increase this risk) were more likely to be employed in more physically demanding occupations. Greater attention to the prevention of workplace injuries among particular groups of new immigrants to Canada is required.

Examining the relationships between job control and health status: a path analysis approach.

OBJECTIVE: To examine the pathways through which job control affects health status; to examine if the effects of job control on health status are attenuated by including other measures associated with lower socioeconomic status, and to examine if the relationship between job control and health status is consistent across socioeconomic status groups. DESIGN: A prospective observational cohort study over eight years (1994-2002). PARTICIPANTS: 4886 Respondents aged 25-60 years, who were non-self-employed labour force participants, working more than 20 hours per week, without physical or mental limitations restricting the type or amount of work they could do at baseline. After longitudinal attrition, the remaining study sample was 3411 (87% of the original study sample who did not die or become pregnant during the survey period). MAIN RESULTS: Low job control in 1994 was associated with worse than expected self-rated health in 2002, both directly and indirectly via a lower physical activity level in 1996. Adjustment for other factors associated with low socioeconomic status did not attenuate these relationships to a large extent. No differences were found in the effects of job control on physical activity or health status between socioeconomic groups (high and low education and high and low household income). CONCLUSIONS: The inclusion of other factors associated with lower socioeconomic status did not attenuate the direct and indirect effects of job control on health status. The finding that low job control is associated with lower physical activity levels deserves further investigation, given the increasing concern about rising levels of obesity in the developed world.

Age-social stratification designs had a negligible impact on income-mortality associations.

OBJECTIVES: Age-social stratification has been used to offset socioeconomic status (SES) misclassification due to cohort effects. This study was to evaluate whether age-income stratification designs generate comparable income-mortality associations as those whose income rankings are based on absolute thresholds. STUDY DESIGN AND SETTING: Using self-reported income as our SES variable, and mortality as our outcome measure, the impact of age-social stratification was examined in two distinct cohorts: one with acute myocardial infarction (AMI) (n=3,138), and the second free of cardiovascular disease (n=15,115). Age-adjusted income-mortality associations were compared between age-social stratification techniques, which used "age-relative" income thresholds and "absolute" income thresholds whose ranks were independent of patient age. RESULTS: In both cohorts, crude mortality inversely correlated with age and income. Techniques using "age-relative" income thresholds yielded similar adjusted odds ratio for mortality as did those that used "absolute" income threshold methods (differences in adjusted odds ratios [+/-95% confidence interval (CI)] between "absolute" and "age-relative" classifications for highest vs. lowest income tertiles: -0.05 [-0.24, 0.12] among patients with AMI and 0.05 [-0.03, 0.13] among patients without cardiovascular disease). CONCLUSION: More complex designs incorporating age-social stratification techniques generate similar income-mortality associations as more simplified approaches, which classified SES using absolute income thresholds.

Time allocation between work and recreation and the associated injury risks among young people.

PROBLEM: The purpose of this study was to examine the relationship between overall risk of injury and time use patterns between work and active recreation among adolescents and young adults. METHODS: Using a representative sample of 9,795 Canadians aged 15-24 years, a multivariate logistic regression on the likelihood of any medically attended injury was conducted, including sociodemographic, individual, and time factors. RESULTS: Young people who engaged in a combination of high work and high activity hours were twice as likely to sustain a medically attended injury compared to those who worked low hours, but did not participate in any recreational activity. Those respondents who were not in school had a 43% increase in injury risk compared to full-time students. SUMMARY: Our findings suggest that injury risk was not a simple function of fatigue and cumulative exposure time. Our findings suggest the importance of considering time use and the associated injury risk tradeoffs. IMPACT ON INDUSTRY: Relevant to state and federal work safety policy makers, our findings suggest the importance of understanding where youth might otherwise spend their time if constraint were placed on their employment opportunities, and the associated injury risk tradeoffs must be taken into consideration.

Differential antibody responses to gliadin-derived indigestible peptides in patients with schizophrenia.

Gluten consumption has previously been implicated in the development of schizophrenia while an immunological link between gluten and schizophrenia was established by the detection of circulating antibodies against gliadin, a major component of wheat gluten. Several studies have reported an increase in circulating antibodies against native gliadin molecules that are unlikely to survive degradation in the digestive system. In this study, therefore, we measured plasma immunoglobulin G (IgG) and IgA antibodies against indigestible gliadin-derived peptide antigens using an in-house enzyme-linked immunosorbent assay (ELISA) among 169 patients with schizophrenia and 236 control subjects. We also examined the plasma levels of IgG and IgA antibodies against the mixture of native gliadins using commercially available ELISA kits. The results showed that patients with schizophrenia had the increased levels of plasma IgG against the γ-gliadin-derived fragment, namely AAQ6C, but decreased levels of plasma IgG against the α- and γ3-gliadin-derived antigens, as compared with control subjects. This study also demonstrated a uniform decrease in plasma IgA antibodies against gliadin-derived antigens. There was no significant difference in the levels of plasma antibodies against native gliadins between the patient group and the control group. Of eight gliadin-derived antigens tested, four showed a sensitivity of >20% against the specificity of ⩾95% for detection of their corresponding antibodies in plasma. These four tests may thus have a potential to serve as biomarkers for the identification of schizophrenia subgroups that may need an alternative therapy or precision treatment. Further investigation with clinical trials should be carried out to explore this possibility.

Healthcare use before and after a workplace injury in British Columbia, Canada.

OBJECTIVES: There is growing evidence that occupational injuries influence workers' emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers' Compensation Board (WCB). METHODS: The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non-injured = NI). RESULTS: LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics. CONCLUSIONS: Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.

Impact of diabetes on employment and income in Manitoba, Canada.

OBJECTIVE: To compare employment and income of working-age (18-64 years) people with and without diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective population-based cohort study based in Manitoba, Canada, consisting of 25,554 individuals without diabetes and 608 with diabetes, of whom 242 had a complication of the disease. Adjusted odds ratios (ORs) of employment and income variables were determined. RESULTS: Diabetic individuals with complications were twice as likely not to be in the labor force (OR 2.07 [95% CI 1.49-2.87]) than nondiabetic individuals. This difference was not evident for diabetic individuals without complications (OR 1.20 [0.93-1.56]). Diabetic individuals without complications had incomes similar to those of nondiabetic individuals. The total income of diabetic individuals with complications was 72% of the income of nondiabetic individuals. When the analysis was limited to only those in the labor force, diabetic workers with complications still had only 85% the employment income of nondiabetic people. Diabetic individuals with complications received 58% more social support income. In a separate analysis of aboriginal individuals, complicated diabetes was not associated with an increased likelihood of not working or a decrease in employment income. CONCLUSIONS: In general, complications of diabetes and the absence of the disease affect the ability to earn income in Manitoba, Canada. This effect was not identified in the aboriginal population of the province.

Continuity of pediatric ambulatory care in a universally insured population.

OBJECTIVE: To describe the prevalence of continuity of care over a 5-year period in a complete cohort of urban children universally insured for medical care provided under fee-for-service reimbursement. METHOD: All children enrolled in the study were born to women living in metropolitan Winnipeg between July 1, 1987 and December 31, 1988 (N = 12,590). All ambulatory physician services for this group were enumerated from computerized administrative databases for the period from birth through 60 months. Continuity of care, defined as the proportion of total care provided by the most frequently seen physician or physician practice over time, was calculated for each child. Descriptive analyses include an examination of maternal and household characteristics associated with children receiving 80% or more of total ambulatory care from a single provider source. RESULTS: From birth to 24 months, 51% of children received at least 80% of ambulatory visits from a single provider practice. This proportion of the children declined to 28% at 25 through 60 months. Children living in low-income neighborhoods had poorer continuity profiles. Other household factors associated with poor continuity included young maternal age, single maternal marital status, residential mobility, and inadequate maternal use of prenatal medical care. Households affiliated with pediatric practices had better continuity profiles than households affiliated with general medical practices. CONCLUSION: Despite universal medical insurance, barriers to a longitudinally continuous relationship with a primary care provider remain in this setting. Although this study has emphasized the description of those barriers associated with household characteristics, there is evidence that factors related to the organization and delivery of medical care are also relevant.

Comparison of survey and physician claims data for detecting hypertension.

Using linked data from the Manitoba (Canada) Heart Health Survey (MHHS) and physician service claims files we assessed the degree to which self-reported hypertension and clinically measured hypetension agreed with physician claims hypertension, and examined the likely sources of disagreement. The overall agreement between survey and claims data for hypertension detection was moderate to high: 82% (kappa = 0.56) for self-reported and physician claims hypertension, and 85% (kappa = 0.60) for clinically measured and physician claims hypertension. In the comparison between self-report and physician claims, those who were classified as obese, diabetic, or a homemaker were significantly more likely to have a hypertension measure not confirmed by the other. Disagreement between clinically measured and physician claims was also more common among the obese and homemakers, as well as those on medication for heart diseases, elevated cholesterol levels (LDL), and 35 years of age and older. The high overall level of agreement among these three measures suggest that each may be used with confidence as an indication of hypertension; however, the agreement appears lower among individuals presenting a more complicated clinical profile.

Factors associated with nursing-home entry for elders in Manitoba, Canada.

BACKGROUND: As the population ages, a greater demand for long-term care services and, in particular, nursing homes is expected. Policy analysts continue to search for alternative, less costly forms of care for the elderly and have attempted to develop programs to delay or prevent nursing-home entry. Health care administrators require information for planning the future demand for nursing-home services. This study assesses the relative importance of predisposing, enabling, and need characteristics in predicting and understanding nursing-home entry. METHODS: Proportional hazard models, incorporating changes in needs over time, are used to estimate the hazard of nursing-home entry over a 5-year period, using health and sociodemographic characteristics of a representative sample of elderly residents from Manitoba, Canada. RESULTS: After age, need factors have the greatest impact on nursing-home entry. Specific medical conditions have at least as great a contribution as functional limitations. The presence of a spouse significantly reduces the hazard of entry for males only. CONCLUSIONS: The results suggest that the greatest gains in preventing or delaying nursing-home entry can be achieved through intervention programs targeted at specific medical conditions such as Alzheimer's disease, musculoskeletal disorders, and stroke.

Socioeconomic status, drug insurance benefits, and new prescriptions for inhaled corticosteroids in schoolchildren with asthma.

BACKGROUND: Low-income children with asthma are less likely to receive inhaled corticosteroid prescriptions that can prevent asthma morbidity. OBJECTIVE: To determine whether the receipt of inhaled corticosteroids in children with asthma is related to household socioeconomic status and type of drug insurance. DESIGN: Using population-based prescription and health care data from Manitoba, a cohort study of the determinants of receiving new prescriptions for inhaled corticosteroids was conducted in children treated with asthma drugs. PARTICIPANTS: School-aged children (n = 12 481) receiving asthma prescriptions from January 1995 to March 1996 but no inhaled corticosteroid prescriptions in the initial 6-month period. MAIN OUTCOME MEASURES: Household socioeconomic and drug insurance predictors of the probability of receiving a new inhaled corticosteroid prescription from July 1995 to March 1998, following adjustment for disease and health care utilization factors. RESULTS: In comparison with higher-income children insured through a provincial cost-sharing drug plan, the adjusted likelihood ratio for a new inhaled corticosteroid prescription was 0.88 (95% confidence interval, 0.80-0.97) in low-income children insured through the same drug plan and 0.82 (95% confidence interval, 0.76-0.88) in children receiving prescriptions at no charge through provincial income assistance or First Nations benefits programs (Winnipeg, Manitoba). CONCLUSION: Independent of asthma severity, type of drug insurance, or health care utilization patterns, low-income children with asthma are significantly less likely to receive inhaled corticosteroid prescriptions.

Gender differences in socioeconomic inequality in mortality.

OBJECTIVES: There is uncertainty about whether position in a socioeconomic hierarchy confers different mortality risks on men and women. The objective of this study was to conduct a systematic review of gender differences in socioeconomic inequality in risk of death. METHODS: This research systematically reviewed observational cohort studies describing all cause or cause specific mortality for populations aged 25-64 in developed countries. For inclusion in the review, mortality had to be reported stratified by gender and by one or more measures of socioeconomic status. For all eligible studies, five absolute and six relative measures of the socioeconomic inequality in mortality were computed for male and female populations separately. RESULTS: A total of 136 published papers were reviewed for eligibility, with 58 studies deemed eligible for inclusion. Of these eligible studies, 20 papers published data that permitted the computation of both absolute and relative measures of inequality. Absolute measures of socioeconomic mortality inequality for men and women generally agreed, with about 90% of studies indicating that male mortality was more unequal than female mortality across socioeconomic groups. In contrast, the pattern of relative inequality results across the 20 studies suggested that male and female socioeconomic inequality in mortality was equivalent. CONCLUSIONS: Inferences about gender differences in socioeconomic inequality in mortality are sensitive to the choice of inequality measure. Wider understanding of this methodological issue would improve the clarity of the reporting and synthesis of evidence on the magnitude of health inequalities in populations.

A regional comparison of socioeconomic and health indices in a Canadian province.

In most jurisdictions, information on socioeconomic attributes of geographic areas is readily available. As well, limited measures of health, such as mortality rates or indicators derived from health service use, are also routinely collected for geographically defined populations. In this paper we present a methodology for selecting and combining measures of area socioeconomic characteristics to produce a composite index which is relevant for health-related research. The performance of this composite index in this setting was consistent with deprivation indices developed in the United Kingdom, and showed strong associations with measures of population health status and health service utilization.

Age-specific education and income gradients in morbidity and mortality in a Canadian province.

While important age-related trends in the use of health care services over the past two decades in Canada have been well described, a comprehensive description of socioeconomic gradients in morbidity and mortality across age cohorts for a representative population has not been accomplished to date in Canada. The objective of this study was to describe age-specific socioeconomic differentials in mortality and morbidity for a representative sample of a single Canadian province. The study sample was formed from the linkage of individual respondent records in the 1986 census to vital statistics records and comprehensive records of health care utilization for a 5% sample of residents of the province of Manitoba. Using two measures of socioeconomic status derived from census responses, attained education and household income, individuals were stratified into age-specific quartile ranks. Based on diagnostic information contained on health care utilization records, the proportion of the sample in treatment during a 12-month observation period was calculated for 15 broadly defined categories of morbidity and tested for differences across socioeconomic quartiles. Mortality was inversely associated with both income and education quartile rank. In the analysis of morbidity, no association between socioeconomic status and treatment prevalence was observed in the majority, no association between socioeconomic status and treatment prevalence was observed in the majority of the 122 age- and disorder-specific strata tested. Of the observed associations, however, negative relationships were dominant, indicating a higher treatment prevalence among individuals of lower attained education or lower household income. Across the age course, negative relationships were most frequently present among young and middle aged adults, those aged 30-64, and were more consistently found for income than for education. The general findings of this study of a representative Canadian population support observations from other developed country settings that socioeconomic differences in relative rates of mortality and morbidity over the life course are greatest in the adult years.

Examining the associations between physical work demands and work injury rates between men and women in Ontario, 1990-2000.

AIMS: To describe the decline in injury rates between 1990 and 2000 within occupations stratified across three levels of physical demands and gender, adjusting for industry, in Canada's largest province. METHODS: Records of injury compensation claims were obtained from the Ontario Workplace Safety & Insurance Board. The population likely to be insured by the Ontario Workplace Safety & Insurance Board was estimated from Statistics Canada's Labour Force Survey. Injury rates were calculated by three broad levels of physical demands, separately for men and women. RESULTS: Injury rates decreased across each grouping of lower physical demands at work for both men and women, with the largest absolute differences in manual occupational groups (high physical demands). Occupations classified as manual (high physical demands) and mixed (moderate physical demands) showed larger differences in injury rates between genders than did non-manual (low physical demands), although the directions of these differences were not always consistent across different natures of injury classification. CONCLUSIONS: The absolute reduction in injury rates in Ontario between 1990 and 2000 was dominated by the reduction in injury rates for men and women in manual and mixed occupations. However, not all types of injury have declined to the same extent. A large proportion of differences in injury rates between men and women can be attributed to the differential labour force participation across occupations and industries, as well as the differential tasks within occupational groups.