Musculoskeletal disorder burden among construction and other physically demanding occupations: A comparative secondary analysis of national surveillance data

Abstract

Musculoskeletal disorders (MSDs) constitute the largest category of occupational injury by days away from work across U.S. industries. This study examined MSD injury trends, ergonomic hazard exposure, and ergonomics program access gaps across construction, manufacturing, transportation and warehousing, and agriculture using nationally representative federal surveillance data. Five publicly available federal datasets were analyzed: the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses and Census of Fatal Occupational Injuries (2018-2022), the NIOSH National Health Interview Survey Occupational Health Supplement (2010 and 2015), the OSHA Injury Tracking Application (2017-2022), and CPWR Center for Construction Research and Training data bulletins (2019-2023). Construction workers sustained MSD-related days-away-from-work rates 45% above the all-industry average, with rates still rising while overall injury rates declined. Heavy lifting (adjusted OR = 2.31), awkward posture (OR = 2.14), and absence of an ergonomics program (OR = 1.94) were the strongest predictors of MSD symptoms. Only 18.4% of construction workers reported access to a workplace ergonomics program, the lowest of any sector analyzed. These findings indicate that MSD burden in physically demanding occupations is structurally preventable, and that mandatory ergonomics program requirements represent the highest-return policy intervention available across these sectors.