Social Burden and Economic Cost Estimation of Fatal Injuries in Workers Affiliated to Social Security in Ecuador: a Shared Challenge in Public and Occupational Health

Introduction

Work-related injuries represent a significant social burden due to premature exit from the labor market as a result of disability and death. This burden is especially notable when deaths occur at a younger age [1]. Additionally, the loss of labor force result in a considerable economic impact, representing between 4% and 6% of the Gross Domestic Product (GDP) in most countries [2].

In the field of occupational health, various epidemiological indicators are used to analyze work-related fatal injuries [3]. While most of these indicators focus on the relative frequency of deaths from different causes in relation to the exposed working population over a given period, a recently noted alternative is the use of working years of potential life lost (WYPLLs) [4,5]. For example, if the age limit of 65 years (retirement) is taken as a reference, WYPLLs is obtained by subtracting the age at the time of death from this limit. Thus, if a worker dies at the age of 20, they would lose 45 years of potential labor market contribution (Example 1). Similarly, if a worker dies at 42, the loss would be 23 years (Example 2), and in the case of a worker who dies at 64, the lost contribution would be 1 year (Example 3). In total, the sum of WYPLLs for these three cases would be 69 years. However, as observed, the burden is greater for deaths occurring at younger ages (Example 1). Quantifying WYPLLs provides a much broader perspective in terms of relevance for societal sustainability and economic development. On the one hand, it represents the loss of human capital in terms of years of working life due to a specific cause of death, reflecting the time a worker would have contributed to society had they not died before reaching life expectancy or retirement age. On the other hand, WYPLLs translate into monetary costs that negatively impact national productivity and GDP growth by reducing the years in which workers could have contributed to a country's economy [6].

Most studies have focused on estimating WYPLLs associated with various work-related causes [7,8]. However, few investigations have analyzed a breakdown by the place of occurrence. According to estimates from the International Labour Organization, there are 350,000 workplace deaths and 158,000 deaths during work-related road commutes each year [9]. Work-related road commutes have become a major unresolved occupational road safety issue, particularly affecting low- and middle-income countries [10]. A disaggregated analysis by place of occurrence, distinguishing between deaths occurring in the workplace and those during work-related road commutes, would enable the design of more targeted interventions to reduce the social burden of premature deaths and, consequently, their economic impact [8,11].

In the Republic of Ecuador, the minimum age for formal employment is 18 years. However, under exceptional circumstances, employment is permitted from the age of 15, provided specific requirements are met and the necessary authorization is obtained. Retirement is possible at the age of 65, contingent upon meeting the minimum required contributions. Regardless of age, occupational injuries, both fatal and non-fatal, are acknowledged by the social security system for compensation purposes. This includes accidents occurring while commuting to and from work, on secondments, as well as travelling for work-related purposes. As in other countries across Latin America, road accidents are among the leading causes of death in the working-age population [12]. It is plausible that the number of work-related commuting fatalities may surpass those occurring directly in the workplace due to increased exposure to road hazards, with significant differences likely across gender and age groups [13]. Despite the decreasing trend in the number of occupational accidents in the country, to our knowledge, there is no research quantifying WYPLLs by place of death in the working population affiliated with the social security system.

In this context, the objective of this study was to estimate the social burden and assess the economic impact of deaths by place of occurrence among workers covered by social security using administrative records available in the Republic of Ecuador. Specifically, the aim is to quantify WYPLLs and economic losses (ELs), as well as to estimate their impact on GDP. Based on the demographic distribution of workers affiliated with the social security system in the country (Supplement, S1), we hypothesize that there are significant differences in the location of occurrence by sex, with deaths occurring at the workplace representing the greatest economic burden and impact.

Methodology

Design and data

This study adopts a retrospective quantitative approach based on the analysis of secondary data. Since the administrative records of occupational accidents were not publicly accessible, the Observatorio Ecuatoriano de Seguridad y Salud en el Trabajo at the Universidad Espíritu Santo formally requested these records from the General Occupational Risk Insurance of the Ecuadorian Social Security Institute (IESS) and obtained them electronically. This source of information has been used in previous studies on other occupational health issues in the country [14,15]. The nationally provided microdata included detailed information on the age and sex of the victims, as well as the place of death, covering the period from January 1, 2014, to December 24, 2020. Ethics committee approval was not required, as the records were anonymous. This study has formal authorization to use data from the General Occupational Risk Insurance for research purposes (No. IESS-DSGRT-2020-0151-OF).

Variables

Age threshold

In the absence of a consensus on the age limit for estimating WYPLLs [16], 64 years of age was established as the threshold for active working life, working capacity, and the standard retirement age [6]. Recent research on the mortality of working-age populations in Latin American countries used this age limit [17]. For the analysis, age was grouped into ten-year categories (15-24, 25-34, 35-44, and 45-64). Workers aged 65 years and older constituted 1.9% of the total fatalities, even though they made up 4.8% of the employed population, averaging 156,906 affiliated workers throughout the study period (Supplement, S2).

Categorization of place (death)

As variables resulting from work accidents, fatal injuries in the workplace (WFi) versus fatal injuries in commuting accidents (CFi) were considered, as established in the legal regulations in the country. This disaggregated analysis, according to the place of occurrence, allows us to more precisely identify the social burden that deaths represent. Workplace accidents are linked to occupation-specific activities and working conditions, whereas accidents during work-related commutes are influenced by external factors such as traffic, road infrastructure, and journey duration [11,18]. Given the limitations of the available information, the explanatory variables analyzed focused on sociodemographic characteristics, specifically sex and age. Despite these restrictions, these variables are suitable for comparing the social and economic burdens of WFi and CFi.

Indicators

The following outlines the indicators utilized to estimation the social burden in terms of WYPLLs and the economic impact expressed as a percentage of GDP. The calculation of WYPLLs is based on the classical approach proposed by Romeder & McWhinnie (1977) [7], adapted to assess workforce losses due to premature mortality. It involves summing the number of deaths in each age group, multiplied by the years remaining until the reference age:

\[ \textbf{WYPLLs} = \sum d_i \times (R - W) + \sum d_i \times (R - i) \]

where:

• d_i represents the number of deaths at agei,

• R is the upper limit of working age, set at 64 years (retirement age), and

• W is the lower limit of working age, set at 15 years.

To identify the population groups with the highest social burden, WYPLLs rates were calculated using the following formula:

\[ \textbf{WYPLLs rate} = \left( \frac{\sum \text{WYPLLs}}{N} \right) \times 100{,}000 \]

where:

• N represents the total study population within the 15-64 years age group (Supplement, S1).

Subsequently, the analysis aimed to determine the economic impact (ELs) that the country would forgo in terms of GDP (%) due to YWPLLs. This assessment considered two key elements: the average annual salary of workers affiliated with social security (Supplement, S3) and the annual GDP per capita in US dollars (Supplement, S4). The following formula provides a simplified estimate of the impact on GDP:

\[ \% \textbf{GDP} = \left( \frac{\text{ELs}}{\text{GDP}} \right) \times 100 \]

where:

• ELs are calculated by multiplying WYPLLs by the average annual salary of socially insured workers aged 15-64 years. The annual salary serves as a measure to evaluate the purchasing power and income levels of workers, as well as to estimate the economic impact of productivity loss due to premature deaths resulting from work-related accidents [19].

• The annual GDP represents the market value of the final goods and services produced over a specific period, expressed in millions of USD. The loss of contribution from deceased individuals adversely affects consumption and investment, ultimately hindering economic growth.

By quantifying these losses, policymakers can better understand the long-term consequences of work-related fatalities and design targeted interventions to mitigate their impact.

Analysis

In addition to the previous estimates [9,10], the statistical analysis included trend analysis through the calculation of the slope value (S) to describe temporal changes (both downward and upward) and the statistical significance at the 95% level (p < 0.05). For data processing and statistical analysis, we used Microsoft Excel for Mac (version 16.78).

Results

The results of this study are presented in two sections. The first section focuses on estimating the social burden broken down by sex. This analysis highlights gender disparities in WYPLLs. The second section quantifies the economic impact of this social burden. This approach provides a comprehensive view of the socioeconomic cost of premature mortality.

Social burden

In total, the WYPLLs amounted to 40,409 between 2014 and 2020, of which 52.5% were attributed to CFi. Men accounted for 93% of the total WYPLLs. The temporal evolution of the study period is shown in Figure 1. Between 2014 and 2019, the WYPLLs exhibited a significant downward trend, with a more pronounced decrease in WFi (slope = -434.8; p = 0.004) compared to CFi (slope = -245.9; p = 0.003). In 2020, a notable reduction was observed compared to the previous year. Starting in 2016, the number of WYPLLs due to CFi exceeded that of WFi and remained high for the remainder of the period.

Figure 1. Temporal evolution of WYPLLs by place of occurrence among workers affiliated with the social security system, Republic of Ecuador: 2014-2020.

The age group of 25-34 years showed the highest number of WYPLLs for both locations of occurrence, with 9,971 in CFi and 8,418 in WFi (Figure 2.1). However, the highest WYPLL rates were concentrated in the 15 to 24 age group (Figure 2.2).

Figure 2. Distribution of WYPLLs (2.1) and rate (2.2) by place of occurrence and age groups among workers affiliated with the social security system, Republic of Ecuador: 2014-2020.

Below are the estimated calculations of WYPLLs based on the place of death and stratified by age groups for both men and women separately. Among men (Table 1), there were general trends towards a decrease in WYPLLs, from 3,334 to 1,888 Cfi and from 4,615 to 1,844 CFi for WFi between 2014 and 2019. However, these reductions were not significant for certain age groups in men. The decrease in WYPLLs was not significant for the 45-64 age group for Cfi (p = 0.141) and for the 25-34 and 35-44 age groups for WFi (p = 0.184 and p = 0.055, respectively). In 2020, compared with 2019, the lowest reductions in WYPLLs were in the 45-64 age group for workplace deaths and in the 15-24 and 25-34 age groups during CFi. As for women (Table 2), WYPLLs for CFi showed a general trend of decrease, except for the age group 45-64, where there was a slight increase, but no significant change. WFi among women accounted for only 0.7% of WYPLLs, with a total of 12 deceased.

Table 1. Trends in WYPLLs of men by place of occurrence and age groups workers affiliated with the social security system by place of death and age groups, Republic of Ecuador: 2014-2020.

Table 2. Trends in WYPLLs of women by place of occurrence and age groups workers affiliated with the social security system by place of death and age groups, Republic of Ecuador: 2014-2020.

Economic impact

The ELs associated with premature deaths among workers affiliated with the social security system amounted to 323.7 million USD during the study period, representing an average reduction of -0.045% in the national GDP due to all WYPLLs. The ELs for CFi totaled 170.3 million USD (-0.024% of GDP), while WFi accounted for 153.4 million USD (-0.022% of GDP).

As shown in Figure 3, the ELs exhibited a downward trend between 2014 and 2019, with a more significant continuous decline for WFi (slope = -3.2; p = 0.002) compared to CFi (slope = -2.6; p = 0.016). However, starting in 2016, the ELs and associated GDP percentage for premature deaths from CFi surpassed and remained above those for WFi.

Figure 3. Temporal evolution of ELs and %GDP by place of occurrence, Republic of Ecuador: 2014-2020.

Discussion

The objective of this study was to estimate the social burden and analyze the economic impact of premature mortality among workers affiliated with social security in Ecuador, differentiating by sex and place of occurrence. The findings highlight a significant burden in terms of working years of potential life lost (WYPLLs) and economic losses (ELs), with men accounting for the largest proportion of WYPLLs and a decreasing trend observed between 2014 and 2019. Additionally, a reduction in ELs associated with these deaths was noted, although significant differences were found depending on the place of occurrence.

Our results are consistent with those of other studies reporting on the social burden of work-related premature mortality and the economic impact on national GDP. A study conducted in a state in Brazil estimated a total of 64,791.5 WYPLLs for the 2,137 deaths caused by work-related injuries between 2000 and 2019 [20]. In Colombia, a total of 229,573 WYPLLs were quantified for the 7,968 deaths recorded due to work-related accidents between 2009 and 2021, representing an approximate economic loss of 2,236.34 million USD, equivalent to 0.112% of GDP in 2009 and 0.011% in 2021 [21]. A study conducted in Hungary revealed that among nearly 4.8 million people aged 30 to 64 in the workforce, the costs associated with the loss of working years due to premature death amounted to approximately 7.119 billion USD, representing 7.21% of the country's GDP [22].

The analysis reveals differentiated patterns in the place of occurrence based on sex and age groups. Men bear the greatest social burden of premature deaths, particularly those occurring in the workplace. This suggests greater occupational risk exposure compared to women, a phenomenon widely documented in the literature [2]. This pattern is primarily attributed to their higher presence in high-risk economic sectors such as construction, manufacturing, and transportation. In contrast, female mortality was higher during commuting than in the workplace. In many cases, their reliance on public transportation increases their exposure to additional road hazards, such as pedestrian accidents while traveling to work, reflecting greater vulnerability as road users [13].

Young workers showed the highest number of WYPLLs, which reinforces the indications of the International Labour Organization [3], empowering young people to act to protect themselves and their peers at work should be at the heart of strategies to improve the safety and health of these workers. On the other hand, the decrease in WYPLLs was not significant for the older workers, which may be an effect of higher levels of experience and the phenomena of the aging of the working population [23].

The economic costs associated with illness, disability, and premature death continue to play a pivotal role in health sector resource allocation decisions. This decline in productivity highlights the substantial social and economic costs tied to premature mortality. The reduction in the economic impact of this burden is linked to fewer WYPLLs and a corresponding decrease in GDP percentage, as noted in the ILO's World Employment and Social Outlook [3] report. The significant economic repercussions of premature workforce mortality underscore the urgent need for comprehensive occupational health and safety measures, emphasizing the value of preventive strategies and robust labor policies to alleviate this burden and potentially save billions in healthcare costs and productivity losses.

Despite the relevant findings obtained in this study, it is important to acknowledge certain limitations that may influence the interpretation of the results. The study relies on administrative records, restricting the analysis to the variables available in official databases. Incorporating additional variables would allow for a more detailed analysis. Moreover, in this context, the actual number of fatalities may be significantly higher than reported in official records. Additionally, the study is limited to workers affiliated with social security, excluding a considerable portion of the Ecuadorian workforce, particularly those employed in the informal sector. This exclusion may affect the validity of the estimates regarding working years lost and the associated economic losses [12,15]. Future research could incorporate complementary data sources, such as statistical death records, to provide a more comprehensive understanding of the issue of fatal occupational accidents in the country.

Conclusions

The metrics used reveal the economic impact of WYPLL in percentage terms of GDP, allowing us to assess the magnitude of the effect of premature mortality on the country's economy. The differences observed according to place of occurrence by sex and age suggest the need for a new approach to public policies. Regarding future projects, it is essential to continue strengthening the improvement of safe and healthy work environments, and priority must be given to implementing more effective prevention programs to reduce deaths associated with work-related travel, which reflect road insecurity in Ecuador.

References

1. Tompa E, Mofidi A, van den Heuvel S, van Bree T, Michaelsen F, Jung Y, et al. Economic burden of work injuries and diseases: a framework and application in five European Union countries. BMC Public Health [Internet]. 2021;21(1):49. doi: https://doi.org/10.1186/s12889-020-10050-7

2. Takala J, Hämäläinen P, Sauni R, Nygård CH, Gagliardi D, Neupane S. Global-, regional- and country-level estimates of the work-related burden of diseases and accidents in 2019. Scand J Work Environ Health [Internet]. 2024;50(2):73-82. doi: https://doi.org/10.5271/sjweh.4132

3. Vision Zero Fund. Collective action for safer and healthier supply chains. Thematic brief n° 1. 2021 [Internet]. Geneva: International Labour Organization (ILO); 2021 Sep 1 [cited 2024 Oct 22]. 7 p. Available from: Available from: https://vzf.ilo.org/insights/collective-action-for-safer-and-healthier-supply-chains/

4. Shiri R, Hiilamo A, Lallukka T. Indicators and determinants of the years of working life lost: a narrative review. Scand J Public Health [Internet]. 2021;49(6):666-74. doi: https://doi.org/10.1177/1403494821993669

5. Rubo M, Czuppon P. How should we speak about years of life lost (YLL) values? Eur J Epidemiol [Internet]. 2023;38(3):345-7. doi: https://doi.org/10.1007/s10654-023-00966-w

6. Rumisha SF, George J, Bwana VM, Mboera LEG. Years of potential life lost and productivity costs due to premature mortality from six priority diseases in Tanzania, 2006-2015. PloS one [Internet]. 2020;15(6):e0234300. doi: https://doi.org/10.1371/journal.pone.0234300

7. Hartikainen E, Solovieva S, Viikari-Juntura E, Leinonen T. Working life expectancy and working years lost among users of part- and full-time sickness absence in Finland. Scand J Work Environ Health [Internet]. 2023;49(1):23-32. doi: https://doi.org/10.5271/sjweh.4054

8. Lilley R, Davie G, Horsburgh S, McNoe B, Driscoll T. Societal burden of work on injury deaths in New Zealand, 2005-14: An observational study. SSM Popul Health [Internet]. 2023;21:101353. doi: https://doi.org/10.1016/j.ssmph.2023.101353

9. Rusli Bin N. Rising trend of work-related commuting accidents, deaths, injuries and disabilities in developing countries: a case study of Malaysia. Ind Health [Internet]. 2014;52(4):275-7. doi: https://doi.org/10.2486/indhealth.52-275

10. Cunha AA, Corona RA, Silva DG, Fecury AA, Dias CAGM, Araújo MHM. Trend in the incidence of commuting accidents among workers in Brazil between 2009 and 2016. Rev Bras Med Trab [Internet]. 2019;17(4):490-8. doi: https://doi.org/10.5327/Z1679443520190439

11. Charbotel B, Martin JL, Chiron M. Work-related versus non-work-related road accidents, developments in the last decade in France. Accident Analysis & Prevention [Internet]. 2010;42(2):604-11. doi: https://doi.org/10.1016/j.aap.2009.10.006

12. Gómez-García AR, Martínez-Jimbo D. Letalidad por desplazamientos domicilio-trabajo-domicilio en el Ecuador, 2014-2019 y 2020. Rev Asoc Esp Espec Med Trab [Internet]. 2022;31(2):189-97. Available from: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S3020-11602022000200006

13. Xu Y, Chen M, Yang R, Wumaierjiang M, Huang S. Global, regional, and national burden of road injuries from 1990 to 2019. Int J Environ Res Public Health [Internet]. 2022;19(24):1-20. doi: https://doi.org/10.3390/ijerph192416479

14. Gómez-García AR, Córdova Falconí KP, Merino-Salazar P, García-Arroyo J. Fatal work accidents in Ecuador from 2014 to 2020: How the age of the deceased worker relates to the accidents' temporal and geographical characteristics. Arch Environ Occup Health [Internet]. 2023;78(5):305-11. doi: https://doi.org/10.1080/19338244.2023.2196051

15. Gómez-García AR, Vega Chica ML, García-Arroyo JA. Relationship between the territorial distribution of labor inspectors and work accident injuries: clustering Ecuadorian provinces into four management scenarios. Saf Sci [Internet]. 2023;158:105956. doi: https://doi.org/10.1016/j.ssci.2022.105956

16. Inoue Y, Nomura S, Nishiura C, Hori A, Yamamoto K, Nakagawa T, et al. Loss of working life years due to mortality, sickness absence, or ill-health retirement: a comprehensive approach to estimating disease burden in the workplace. J Epidemiol [Internet]. 2021;31(7):403-9. doi: https://doi.org/10.2188/jea.JE20190332

17. Benavides FG, Vives A, Zimmerman M, Silva-Peñaherrera M. Exceso de mortalidad en población en edad de trabajar en nueve países de Latinoamérica, año 2020. Rev Panam Salud Publica [Internet]. 2022;46:e75. doi: https://doi.org/10.26633/RPSP.2022.75

18. Fort E, Connesson N, Brière J, Ndiaye A, Gadegbeku B, Charbotel B. Work-related Road traffic accidents: emergence of new modes of personal journey - analysis based on data from a register of road traffic accidents in France. Inj Prev [Internet]. 2024; ip-2023-045102. doi: https://doi.org/10.1136/ip-2023-045102

19. Oliva-Moreno J, Peña-Longobardo LM. Labour productivity loss caused by premature deaths associated with breast cancer: results from Spain over a 10-year period. Breast Cancer Res Treat [Internet]. 2018;172(3):571-6. https://doi.org/10.1007/s10549-018-4963-z

20. Dreger Nery FS, Magalhães de Souza I, de Araújo EM, Fernandes de Oliveira N, Dreger Nery MG. Tendência temporal dos anos potenciais de vida perdidos por acidentes de trabalho fatais segundo raça/cor da pele na Bahia, 2000-2019. Rev Bras Saúde Ocup [Internet]. 2022;47:1-10. doi: https://doi.org/10.1590/2317-6369/18719pt2022v47e1

21. Toloza-Pérez YG, Mesa-Sierra J, Malagón-Rojas J, Niño-Barrero YF. Impacto de la implementación del Sistema de Gestión de Seguridad y Salud en el Trabajo sobre la mortalidad y años de vida potencialmente perdidos por accidentalidad laboral y ocupacional en Colombia, 2009-2021. Rev Fac Nac Salud Pública [Internet]. 2024;42:e352686. doi: https://doi.org/10.17533/udea.rfnsp.e352686

22. Joó T, Fadgyas-Freyler P, Vitrai J, Kollányi Z. [The social cost of ill health among the working-age population in 2019 in Hungary]. Orv Hetil [Internet]. 2024;165(3):110-20. doi: https://doi.org/10.1556/650.2024.32955

23. Quinby L, Wettstein G. Are older workers capable of working longer? Center for Retirement Research [Internet]. 2021;21(12). doi: Available from: https://crr.bc.edu/wp-content/uploads/2021/07/IB_21-12.pdf

Supplements

According to the Statistical Employment Register of Social Security (REESS), in the Republic of Ecuador, the Services sector accounts for 52.4% of workers affiliated with the social security system, followed by commerce with 18.3%, and manufacturing with 13.3%. Large companies (with more than 200 workers) employed 44.8% of the active workforce, while medium-sized companies represented 16.2%. Between 2014 and 2020, the number of affiliated workers decreased by an average of 38,467 annually, dropping from 3.29 million to 3.06 million. Workers aged 15-34 years remain predominant. However, since 2016, there has been a significant increase in the number of workers over 35, especially in the 45-64 age group. In terms of sex distribution, 57.4% were men and 42.6% were women.

S1. Average number of workers affiliated to the social security system by sex and age groups (2014-2020).

Of the 123,121 work-related injuries recorded by social security between 2014 and 2020, 99.1% occurred among workers aged 15-64 years. Of these injuries, 1.3% resulted in death, with 783 cases occurring during work-related commutes and 749 occurring in the workplace. Men recorded the highest number of deaths in both settings, with the age group of 25-34 years being the most affected. A chi-square test p-value of 0.520 indicated that there was no statistically significant evidence. This suggests that there are no significant differences in the distribution of accidents between work-related commutes and the workplace based on sex and age group.

S2. Cumulative number of deaths by place of occurrence, sex, and age groups (2014-2020).

The distribution of the average annual salary in US dollars (USD) reveals gender disparities. While women earn more than men in the 15-34 age group, men surpass women starting at age 35, with the largest difference occurring in the 65 and older age group, where men earn an average of 9,023 USD, compared to 6,424 USD for women. Student’s t-test revealed significant differences in means for the age groups 25-34 (p = 0.020), 45-64, and 65 years and older (p < 0.0001), with no significant differences observed in the 15-24 (p = 0.431) and 35-44 (p = 0.608) age groups.

S3. Average annual salary in USD (2014-2020).

According to estimates from the Economic Commission for Latin America and the Caribbean, Ecuador's GDP declined between 2014 and 2015, indicating an economic contraction. Beginning in 2017, the country began to show signs of recovery. However, in 2020, the economy faced a significant drop in GDP, declining by 10.9% compared with 2019, primarily owing to the impacts of the COVID-19 pandemic.

S4. Annual GDP of Ecuador in millions of USD (2014-2020).