This study provides information on all occupational burn injuries in Finland in 2011–2015.
According to our knowledge, such comprehensive data on one country has not previously been published.
Our data consisted of two sources which were rather different. The FWCC is a non-medical register that contains literally all the occupational burn cases of a given year. Reporting of any occupational accident is mandatory and based on Finnish legislation. Further employer gains financial benefits by reporting occupational accidents (Tilastokeskus Työtapaturmat 2015). From the NBC, we collected the reports on occupational burn patients who met the EMSB referral criteria for specialized burn care. The NBC admitted during the study period only 26 patients. These cases represented approximately 2/3 of the severe cases in the country that needed tertiary-level burn care. Some other injuries may have been hospitalized in another smaller national burn center till 2015, but still the number of the most severe occupational burn injuries is low.
In Finland, the working-age population was 3,480,000 in 2015 and the unemployment rate was 9.4% (men 9.9%, women 8.8%) (Tilastokeskus 2015; Tilastokeskus 2016). There were a total of 127,000 accidents at work in the same year (62.5% of men), including both accidents at work and commuting accidents. Total number of wage earners in 2015 was 2,090,000 and they had 36,020 accidents at the work place (men 65.2%) that caused absence from work four days or more (Työllisyys ja työttömyys 2015). Absence from work for more than 30 days (average 11 days) was defined as a serious accident and 19.1% of accidents fulfilled this description. The trend is similar for entrepreneurs, but serious accidents were more common among farmers.
Older people had longer absence from work in the same statistics. Burn injuries were rare: 2,0 percent of cases were reported as burn, corrode or frost bite injuries. Based on injury mechanisms heat, electricity or dangerous substances caused 2,7 percent of injuries (Official Statistics Finland 2017).
Several earlier studies have shown that men are at the highest risk of both occupational accidents and burn injuries (Mian et al. 2011; Reichard et al. 2015; Hansen 2019; Hanvold et al. 2019; Tanttula et al. 2018). Our data showed different results: The gender distribution in the FWCC register was almost even (men 54%) but men dominated (25/26 cases) in the NBC data. Based on this result, women tend to have occupational burn injuries almost as often as men, but their injuries are minor. Similarly, men dominated the group in the FWCC, with compensation of over EUR 1000, which supports the result that men sustained more severe occupational burn injuries. Patients also had non-identical professional profiles: The NBC patients mainly worked in industrial professions, electrical injuries being the most common. In the FWCC, the men had similar professions, but the women mainly worked in the service sector, in kitchen and bakery work.
In Finland, women work outside the home almost as often as men, but professions are still segregated. Men dominate in construction work, transportation and logistics, for example, whereas women more often work in the social and service sectors (Terveyden 2022). Risk profiles are very different but one can also speculate whether women have more careful working habits and follow safety regulations more precisely. Another explanation might be that our data covered work-related injuries comprehensively, even minor ones, which earlier studies may have not recognized.
The NBC patients were older than those in the FWCC register. Further, in the NBC, older patients had more severe injuries: In the 51–60- and the 61–70-year age groups, the mean TBSA was 37% vs 22% in the entire NBC data. The mean age in the NBC was 43 years, but those with a TBSA of 40% or over had a mean age of 53 years.
Notably, the NBC data did not contain any 31–40-year-olds, whereas in the FWCC register this age groups was well represented: males 23% and females 20%. We do not know the reason for this. It may be merely a statistical item due to the small number of cases, but other factors may also be at play. This is a group that already has good professional skills but is not overconfident and perhaps follows safety regulations better than older people.
Many earlier studies have shown different results: A US study by Guerin et al. (2020) showed that younger employees suffered more work-related injuries than employees over 24 years of age. The study did not include burn injuries as a separate group but gives nevertheless the overall picture of age and occupational injuries (Guerin et al. 2020). Limitation of this paper is that it includes only employees under 44 years.
Rommel et al. (2016) had similar results in Germany: Older men had less work-related injuries than younger ones (Rommel et al. 2016). In our study, the number of patients in the NBC data was low, but the trend was obvious. Those with major injuries had high-risk professions (industrial, transportation, etc.). The accidents were sudden (transport accidents, falling into hot water, explosions) but in principle, avoidable events. We did not study the working conditions or events prior to the accident. Experienced employee might also be tempted to perform repeated tasks routinely, and some safety habits may become neglected over time. In addition, safety regulations are very strict in Finland and young people may not be allowed to carry out dangerous work before proper training, which may not be the case in many other countries.
Earlier, Finnish studies have shown that TBSA accurately predicts return to work (Palmu et al. 2015; Tanttula et al. 1997). In our study, TBSA was only available in the NBC medical reports and correlated with length of absence from work.
Almost all the patients NBC returned to work: Only one patient retired, and five patients had to change professions but returned to work life. A Danish study by Rikhardsson and Impgaard (2004) showed that the average cost of occupational accident per employee is EUR 4200, 60% of which is due to absence from work, emphasizing that return to work life is also an important goal from the financial point of view (Rikhardsson and Impgaard 2004).
Finnish legislation on occupational injuries is strong, and the employer is responsible for compensation. In the case of retirement due to occupational accidents, compensation is 85% of the employee’s former salary until the employee is 65 years old. Costs are covered by insurance, but to the employer the loss of competent worker is expensive: In the short run, the employer must hire a new employee, who probably lacks the required know-how. Work capacity is lower because of the training period, and in the long run, the prices of insurance may rise due to severe injuries. On the individual level, retirement at a young age is devastating, and highly expensive for society. One important goal of specialized burn care of working-aged people is to guarantee the ability to return to work life. According to the NBC data, this was well achieved.
Eurostat is the statistical office of the European Union, responsible for publishing high-quality, Europe-wide statistics. According to their data, in 2018 the incidence of occupational accidents in Europe was 1659/100,000. In Finland, the corresponding figure was clearly higher, at 1887/100,000. It is notable that even in Eurostat’s own analysis reporting mistakes are recognized (Eurostat 2022). In Finland, everyone has a unique social security number and general attitudes toward registers are positive. Based on Finnish legislation, actors in social and health care are registered and must report patient/client information (Finlex 2015 ; Harala 2010). Reporting is based on compensation claims which insurance companies have received. Due to this reporting is separate from employer, who might like to hide occupational accidents. Further, insurance companies are separate from employers and have no reason not to report accidents compensated by them. In a highly educated and organized country with strict safety rules, the number of reported occupational injuries is very close to the true number. It can be postulated that the same does not apply to all the European countries and their statistics, which should be taken into consideration when comparing the figures.
Safety at work has improved substantially over recent decades in Finland, and the number of fatal occupational accidents has declined. The expected retirement age has risen in all age groups (Statistics Finland 2022; Oksa et al. 2019).
Both data sources have limitations: The FWCC register is not a medical register and does not include ICD-10 diagnoses; the data are thus not directly comparable with medical data.
The NBC occupational burn patient data from 2011 to 2015 were collected based on ICD-10 Y96 codes. The data search yielded only 51 cases, of whom only five were women. Of these, 26 patients met the EMSB criteria (one woman). During the same time period, the NBC had approximately 20 patients per year with burn injuries with TBSA of 20% or higher and who needed intensive care. Further statistical analysis of genders or age groups is not possible due to the small number of cases. On the other hand, having such a small number of occupational burn patients in a tertiary-level burn is a desirable outcome.
The FWCC register includes practically all the occupational burn injuries in the entire country during the study period. Unfortunately, the register does not contain information on the length of hospital stay, the number of outpatient visits, etc. These variables form the total cost of burn injury together with many other factors (physio- and occupational therapy, mental care, special clothing, traveling costs, etc.). Furthermore, the FWCC register does not include TBSA. Due to this, the severity of the burn injury is evaluated indirectly, based on the total sum of compensation.
One limitation of our study is that we are unable to provide denominator data concerning Finnish population. Due to this, we cannot compare directly burn cases with the total number of men or women working with certain profession.
