Racial and Ethnic Disparities in Occupational Health.

Importance: Occupational health disparities affect the safety and well-being of workers across different racial and ethnic groups. Understanding these disparities is crucial for developing targeted interventions, but evidence on occupational injury rates by race and ethnicity has been scarce due to data limitations.

Objective: To determine the incidence of lost-time workplace injuries among major racial and ethnic groups in California and to assess the contributions of occupational concentration and within-occupation disparities to these differences.

Design, setting, and participants: A cross-sectional study analyzing 15 years (2005-2019) of California workers' compensation data was carried out. The study examined injury rates across 4 racial and ethnic groups: Asian/Pacific Islander (non-Hispanic), Black (non-Hispanic), Hispanic, and White (non-Hispanic). California residents employed in the private sector or state and local government, encompassing diverse industries and occupations, between 2005 and 2019 were included. Analysis was conducted between May 2024 and May 2025.

Intervention: The study analyzed existing workers' compensation data without specific interventions.

Main outcomes and measures: The primary outcome was the incidence of lost-time workplace injuries, with comparisons made between racial and ethnic groups. The analysis focused on the role of occupational concentration and within-occupation disparities in explaining injury rates.

Results: The analysis included 2.6 million lost-time injuries among California workers (mean [SD] age, 42 [11]; 63% male). The overall injury rate was 1.32 lost-time injuries per 100 full-time equivalent workers (FTE). Lost-time injury rates were higher for Black (1.74 cases per 100 FTE) and Hispanic workers (1.90 cases per 100 FTE) than for White workers (1.00 cases per 100 FTE), whereas rates were lower for Asian/Pacific Islander workers (0.63 cases per 100 FTE). Black and Hispanic workers experienced injury rates that were 74% and 90% higher, respectively, compared with White workers, whereas Asian/Pacific Islander workers had injury rates that were 37% lower. Occupational concentration accounted for 53% of the disparity between Black and White workers and 71% of the disparity between Hispanic and White workers. Notably, 56% of the excess risk of injuries for Black women was attributed to within-occupation disparities.

Conclusions and relevance: Disparities in workplace safety are a significant contributor to racial and ethnic health disparities. Addressing both occupational concentration and within-occupation disparities is essential for improving workplace safety and reducing health inequities among workers.