Review synthesizes differences between men, women in injury risks and outcomes

IWH systematic review finds differences in the same occupations, likely due to differences in job tasks

Published: May 20, 2022

If you’re a man working in a janitorial job, you may be at higher risk than a female coworker of getting hurt due to falling from a height or being struck by an object. If you’re a woman in health care, you may be at greater risk than a male colleague of getting injured from doing repetitive tasks.

These are a few examples of the differences in injury/illness risks faced by men and women in the same occupations, according to a new systematic review by an Institute for Work & Health (IWH) team led by IWH Associate Scientist Dr. Aviroop Biswas.

Sifting through published studies from 2009 to 2019 that met a standard of quality, the review found several occupations where injury/illness risks differ between men and women. The differences include:

  • higher risks for men in janitorial work, forestry, emergency response and manufacturing; and
  • higher risks for women in aluminium production and health care.

The review also found some differences in injury/illness risks for men and women based on exposures (i.e. hazards or work conditions) across occupations. These include:

  • higher risks for men due to physical demands, noise, some forms of repetitive work and chemical and biological exposures;
  • higher risks for women due to repetitive work tasks, some physical demands, cleaning agents, metalworking fluids and motor exhaust; and
  • no differences between men and women in risks from psychosocial hazards, including bullying, job strain, low organizational support and work stress.

The findings above came from 33 studies, 11 studies of which looked at differences within occupations. A paper on the review has been accepted for publication by the American Journal of Industrial Medicine (doi:10.1002/ajim.23364).

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The reasons for these differences are difficult to disentangle, says Biswas. Noting that most industries in countries like Canada are still predominantly segregated along sex or gender lines, Biswas says the differences in injury/illness risks are likely due to men and women doing different job tasks.

Sex/gender differences in OHS

The findings point to a need for more research on differences in work injury risks due to sex and gender, says Biswas.

Sex differences refer to the biological and physiological attributes that shape differences between men and women and their health responses. Due to differences in the average size and shape of men and women, tool design, working surface height and equipment dimensions may make very different demands on the bodies of men and women, he explains. Similarly, hormonal differences among men and women may mean their bodies have differing biological responses to chemical substances.

Gender differences refer to the social constructs that differentiate men from women, or boys from girls, in their roles, behaviours, expressions and identities. Gender differences in the type of work people do can result in men being more exposed to harmful ultraviolet rays from outdoor work, or in women being at greater risk of contact dermatitis from jobs that involve wet work, such as cleaning and hairdressing.

Beyond job content, there are gender differences in workplace culture, adds Biswas. Men are concentrated toward the top of the job hierarchy, which translates into more autonomy and control at work. These work factors have been associated with a lowered risk for chronic disease and better self-rated health, he notes. Women, on the other hand, are more often in jobs with less control and more stress at work. They also shoulder more of the responsibilities outside of work, such as caregiving responsibilities, he adds.

Despite these understandings, many occupational studies continue to ignore sex and gender. Or they use single sex samples and assume that findings can be generalized to both men and women, says Biswas.

How the review was conducted

Using IWH’s systematic review methodology, the team engaged with stakeholders from the start of the project to solicit their input on the review questions and search strategies.

The researchers searched eight electronic databases for studies that examined occupational exposures or work-related injury or disability outcomes in a working population. To be included, studies had to either compare the occupational injury/illness risks between men and women or present separate results so that the review team could itself make the comparison.

The team included studies in any language, but limited the search window to 2009-2019. Studies that were randomized controlled trials, case-control studies or cohort studies were included. Cross-sectional (“moment in time”) studies were excluded because a cause-effect relationship over time could not be inferred with this study design.

With 14,000 search results, the researchers decided to split the review into two separate parts. The first was a scoping review of studies on exposures, which focused only on the breadth of evidence, not on quality. It was published in November 2021, in the journal Current Environmental Health Reports (doi:10.1007/s40572-021-00330-8). The second part was the systematic review of studies on outcomes, including work-related injury, work-related disability, work-related illness and sickness absence. The team assessed study methods for quality and synthesized only those that were of medium to high quality.

Why sex/gender differences matter

Biswas acknowledges that most of the studies on psychosocial hazards—for example, low job control or high work stress—indicated no difference in outcomes for men and women (although no difference can mean both are at greater risk). However, he is more reluctant to draw any conclusions from the studies on physical hazards that indicated no sex/gender differences. The absence of studies looking at an occupation doesn’t mean that there’s no risk, he says. It probably speaks more to the lack of emphasis on looking at sex/gender differences in certain occupations.

Recognizing sex/gender differences is important because failure to do so can result in hazards and risks being overlooked. Looking across occupations, we’ve long perceived men’s work as more hazardous. As a result, we run the risk of neglecting the less obvious hazards faced by women in the occupations in which they’re the majority, says Biswas.

Within same occupations, not seeing how the same job may pose different risks for men and women can mask the greater risk that one or the other may face. For example, in a male-centric occupation, we may not pick up the greater risks women face because of the low number of female workers who get hurt. That’s where research that puts a spotlight on these differences can be helpful, he adds.