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Incidence and Cost of Non-Fatal Farm Youth Injury, United States, 2001-
2006
Eduard Zaloshnja, Ph.D.*
Pacific Institute for Research and Evaluation
Ted R. Miller, Ph.D.
Pacific Institute for Research and Evaluation
Barbara Lee, R.N. Ph.D.
National Farm Medicine Center
Marshfield Clinic Research Foundation
*Corresponding Author
Eduard Zaloshnja, PhD
Research Scientist
Pacific Institute for Research and Evaluation
11720 Beltsville Dr. Suite 900
Beltsville, MD 20705
Phone: 301-755-2734
Fax: 301-755-2799
E-mail: zaloshnja@pire.org
Running footer: Incidence and Cost of Non-Fatal Farm Youth Injury
Abstract
Objective: Estimate the annual incidence and cost of non-fatal farm youth injury in the
United States for the period 2001-2006.
Methods: We used 2001-2006 Childhood Agricultural Injury Survey data to estimate the
annual incidence of farm youth non-fatal injury. To estimate the costs for injuries suffered by
youth working/living on the farm, we multiplied the number of injuries times published unit
costs by body part, nature of injury, and age group.
Results: The annual number of non-fatal injuries to youth (ages 0-19) on farms in 2001-
2006 was 26,570. The annual cost of non-fatal farm youth injuries was $1 billion (in 2005
dollars), with 26% of costs related to working on the farm and 47% on beef cattle farms. Around
9.3% of the cost was medical costs, 37.2% work and household productivity loss, and 53.5%
quality of life loss.
Keywords: farm youth, injury incidence, injury costs
Introduction
Injury is a common and costly childhood affliction, accounting for approximately 15% of
medical spending among those aged 1-19 years.1 Indeed, for children and adolescents 5-19 years
of age, injury rivals the common cold in frequency.1 Injuries, however, are much more likely
than colds to have lasting effects. In 2000, almost 160,000 were permanently disabled as a result
of an injury.2
Agricultural production – farming – consistently ranks among the industries with the
highest rates of work-related injuries in the United States. It also ranks in the highest echelon in
injury cost per worker.3 Family farming is unique in employing large numbers of largely unpaid
children and adolescents, often looking on their work as doing chores. Family farming is the
primary industry where the workplace typically is integrated with the home. Youth, children and
adolescents, who commonly work on farms, are exposed to agricultural production hazards.
Although the Fair Labor Standards Act of 1938 (FLSA) and its amendments set standards for
child labor in agriculture, it only covers employees whose work involves production of
agricultural goods which are part of interstate commerce. In addition, FLSA regulations do not
apply to youth working for their parents or guardians on the family’s farm or to visiting youth.
Household youth account for over 60% of all youth work injuries on farms and visitors for
another 15%.4 Youth who work on farms are often not protected by workplace safety and health
regulations from the Occupational Safety and Health Administration (OSHA) because they
frequently work for small farming operations that are not inspected by OSHA, or because OSHA
regulations do not apply to farm household members and visitors. Moreover, small family farms
are exempt from the Workers’ Compensation system in most states and thus do not have access
to the system’s loss prevention/safety programs. Finally, youth on farms have virtually no
protection against injuries from non-work activities that expose them to the same hazards as
work activities. For example, a child playing in the field and a child working in the field face the
same risks of pesticide poisoning, heat stress, and being run over by farm vehicles.
In 2006 an estimated 1.1 million youth lived on farms, 307,000 additional youth worked
as hired farm laborers, and 29.3 million youth visited a farm.5 During that year, youth less than
20 years of age suffered an estimated 22,900 farm-related injuries. Over 50% (11,700) of these
injuries were to youth living on the farm.4 Approximately 60% of the household youth injuries
were to males. Youth between the ages of 10 and 15 years experienced the highest number of
farm-related injuries (over 10,000, or around 44%). The most common types of injuries were
fractures (27%) and cuts (21%). The body parts most commonly injured were the arm (19%), leg
(16%), and hand, wrist, and finger (14%).
Farm injury rates have fluctuated over time. Hendricks and Hendricks6 compared
childhood agricultural injury rates of 1998, 2001, 2004 and 2006. They found that the injury rate
for household youth declined from 13.9/1,000 in 1998 to 9.8/1,000 in 2006. Over four study
periods, the number and rate of all injuries declined for male youth; however, the rate and
number of injuries increased for female youth in 2001 then declined in the two following
periods. Rivara7 reported a rate of 17.2 injuries per 1,000 child farm residents in 1991-1993,
10.7% higher than in 1979-1983. Tractors accounted for 20.9% of all injuries, followed by
horses (8.4%), all terrain vehicles and minibikes (8.0%), and farm wagons (7.7%).
Gerberich et al.8 estimated that in the five-state region of Minnesota, Wisconsin, North
Dakota, South Dakota, and Nebraska, farm household youth injury rates for farming and non-
farming sources, respectively, were 16.8 and 69.8 per 1,000 persons in 1990. Animals (40%)
were the primary sources of injuries related to farming operations; sports/recreation sources
(61%) were associated primarily with non-farming related injuries. Of the farming and non-
farming injury cases, 83% and 90%, respectively, required some type of health care; moreover,
17% and 24%, respectively, were restricted from regular activities for one month or more.
Statistically significant increased injury rate ratios were observed for operating a tractor, working
with dairy cattle, and being male.
Quantifying the costs associated with child agricultural injuries is important. Cost
estimates reduce different outcomes or injuries— an arm mangled by a rotating shaft, a foot
crushed by a cow, a rattlesnake snakebite while mending fence—to a common metric.1 This
makes cost data a useful element in gauging the relative size of various problems, assessing
risks, setting research priorities, and selecting interventions that most efficiently reduce the
burden of injury. For example, injury costs by diagnosis can inform a decision between spending
the safety budget to repair hayloft ladders (estimated to prevent 7 broken legs and 23 broken
arms) or to retrofit old tractors with rollover protection structures (ROPS) (estimated to prevent 2
traumatic brain injuries). On a broader scale, comparably measured costs of injury and illness
can provide insight into the relative magnitude of these problems, and may inform resource
allocation. Finally, cost data can be used for advocacy purposes, by conveying risk reductions in
a way that captures the attention of policy makers, insurers, the media, and the public. While
both risk reduction and cost savings are important, communicating the benefit in monetary terms
may provide useful insights for agribusiness leaders and policy makers concerned with cost
control.
Only one study has explored the cost of agricultural injury in depth. Leigh et al.9
estimated that in 1992, agricultural occupational injuries cost an estimated $4.57 billion. Direct
medical and administrative costs were estimated at $1.66 billion and indirect costs of lost work at
$2.93 billion. A separate estimate for child agricultural injuries was not provided.
This study probes both incidence and costs of non-fatal farm youth injuries. It analyses
them from different perspectives: relation to farm and gender, relation to farm and age, type of
farm and work status, type of farm and age, injury source and age, and injury event and age.
Fatality data are excluded because they lack information about relation to farm, farm type,
source, and event.
Methods
Injury Incidence
We used three waves of Childhood Agricultural Injury Survey (CAIS) data (public use
files for 2001, 2004, and 2006) to estimate the annual incidence of farm youth injury. We
extracted cases from CAIS files where youth under age 20 were injured on the farm. CAIS
collects data on nonfatal childhood injuries on farms that occurred during a calendar year from a
random sample of farms across the U.S. 10 The CAIS is conducted using a Computer Assisted
Telephone Interview (CATI) survey instrument. Randomly selected farming operations across
the U.S. are contacted by eight calling centers during February and March of the following year.
The CAIS is conducted in these winter months to increase the response rate of the survey. The
average response rate for the three waves was 71%. All agricultural production operations,
excluding large swine confinement operations, are included in the study population. For the
survey, a farm is defined as any operation of $1,000 or more of gross agricultural production
within a calendar year, and includes both crop and livestock operations. An injury is defined as
any condition that results in 4 hours or more of restricted activity (e.g., person cannot perform
work or other normal duties, misses work, misses school), or a condition that requires
professional medical treatment.
In the survey, a youth is defined as any person under the age of 20 years. Household
youth are defined as all youth who reside on the farm. Hired farm workers are defined as youth
who are hired directly by the farm operator (excluding contract laborers) to work on the farm,
but are not household members. Visitors are defined as all other youth who are on the farm, but
are not household members or hired workers. An agricultural work-related injury is defined as
any medically treated or restricted activity injury that occurred while performing work on the
farm associated with the farm business, including chores. Non-work injuries are defined as
injuries occurring on the farm that are not due to farm work. The survey excludes injuries to
contractors working for the farm operation, or injuries that occur to youth off the farm property.
All information provided in the survey is self-reported by the farm operator, spouse, or the
injured youth if they are 16 years of age or older so responses to items such as age and the cause
of the injury event are subject to the interpretation of the respondent. While the total number of
childhood agricultural lost-time injuries is requested for the calendar year, descriptive
information is only requested for the four most recent injury events.
CAIS is based on a stratified random sample of 50,000 farm operations drawn to provide
estimates for the study population. The strata for the sampling design are the four Bureau of the
Census geographic regions.11 An equal sample allocation of 12,500 farms is selected in each
region. A farm is considered to be a valid member of the sample regardless of whether youth
were on the farm in the year covered by the survey. Our analysis was conducted in SAS 9.2
(http://support.sas.com/documentation/index.html) using its survey procedures that account for
sample stratification.
Injury Costs
Medical costs: To estimate the medical costs for injuries suffered by youth
working/living on the farm, we multiplied the number of injuries times published unit medical
costs2, 12, 13 by hospitalization status, body part, nature of injury, and age group (0-4, 5-14, 15-
19). That work estimated incidence-based costs, which represent the present value of the lifetime
costs that may result from injuries that occur during a single year. Like this article, it converted
all costs (and quality-adjusted life year, QALY) losses in future years to present value using the
3% discount rate prescribed by the Panel on Cost-Effectiveness in Health and Medicine.14 We
inflated the costs to 2005 dollars using the Consumer Price Index – Medical Care.
Finkelstein et al.13 and Miller et al.2 estimated medical costs separately for hospitalized
and non-hospitalized cases. They derived estimates of direct costs for hospitalized injuries from
the 2000 Healthcare Cost and Utilization Project–Nationwide Inpatient Sample (HCUP-NIS)
data supplemented by Medstat’s MarketScan® database for non-facility fees, the Uniform Data
System for Medical Rehabilitation (UDSMR), the Medical Expenditure Panel Survey (MEPS)
and hospital cost-to-charge ratios provided by the Agency for Healthcare Research and Quality
(AHRQ). For non-hospitalized injuries, they used the 1999 MEPS data to quantify direct medical
costs. MEPS participants with injury-related expenditures but without an inpatient admission
were divided into three categories by primary treatment location: 1 - any emergency department
utilization; 2 - any outpatient but no office-based or emergency department utilization; and 3 -
any office-based utilization but no emergency department utilization. For each diagnosis
grouping (classified using the Barell Injury Diagnosis Matrix,
http://www.cdc.gov/nchs/data/ice/final_matrix_post_ice.pdf ), by primary treatment location,
they calculated mean 18-month medical costs by summing costs across all treatment locations of
the same type (including prescription drug costs) and dividing by the number of individuals who
received treatment in that primary location type.
Even pooling three years of CAIS data, the number of non-hospitalized injuries is too
small for each treatment location to yield stable/reliable distributions by diagnosis grouping,
especially in breakdown tables (e.g., by farm type or for common sources like tractors or
animals). Therefore, the costing of non-hospitalized injuries began by combining costs by
diagnosis grouping into averages across treatment settings based on the overall unintentional
childhood injury hospitalization rate for the specific diagnosis grouping (from the data base
underlying Miller et al.2 and Finkelstein et al.13). We also modified maps we already have
developed that map International Classification of Diseases, 9th Edition, Clinical Modification
diagnosis codes to American National Standards Institute Z16.2 occupational injury codes,
collapsing them into the CAIS body part and nature of injury codes (CAIS map available from
the authors). Using the maps, we collapsed our existing unintentional injury costs by age group
and detailed ICD9-CM diagnosis into costs by CAIS diagnosis category, weighting the costs
with national unintentional injury incidence data by detailed diagnosis and age group. For
example, if the CAIS category were hand/finger fracture and ICD9-CM included separate codes
for hand fracture and for finger fracture, the CAIS cost would equal
(Cost(hand) * # hand + Cost(finger) * # finger) / (# hand + # finger)
where all the values in the equation are for the relevant age group.
The methods described here for merging the medical cost estimates onto the CAIS data
were used for the other cost categories as well.
Short-term Work Loss: The CAIS provides information about the length of time that
normal activities are restricted as a result of injury. The time intervals, however, are too broad to
be very useful: up to one day, one week, two weeks, one month, three months, and more than
three months. Moreover, work days lost by injured youth are not recorded. CAIS only records
how many hours per week the injured youth typically worked on the farm at the time of injury
(and only if the injury was work-related). Except in the summer, farm youth typically work part-
time. Given this lack of detail in CAIS, we estimated indirectly the number of work days lost by
youth due to injury. For that, we used the mean work days lost per unintentional injury by body
part and nature of injury for employed injury victims from Finkelstein et al.13 collapsed into
CAIS categories. The percentage of a 40-hour week worked reported in the survey was used as a
multiplier to factor down the injured youth’s wage work loss. For example, if an injured
adolescent worked a maximum of 20 hour per week rather than 40 hours and the average U.S.
worker lost four days for the same injury, the work loss for the adolescent will be two days. For
youth injured on the farm while doing chores or conducting recreational activities and who were
reported as working on the farm at any time during the calendar year, we assumed the same farm
work pattern as for their counterparts who were injured while working. To estimate the value of
short term work loss by the youth, we assumed that the farm operator will hire somebody else to
do the work missed by the injured youth. Losses in household productivity were not factored
down as they tend to be daily responsibilities; the days lost and cost per day by age group and
gender came from Miller et al.2 Following Miller et al.2 , we included parental work loss due to
youth injury. Work and household productivity losses were inflated to 2005 dollars using the
Employment Cost Index (ECI), total compensation for total private employment.
Long-term Work Loss: The CAIS provides information on whether the injury resulted in
permanent disability but its sample is too thin to capture small disability probabilities accurately.
It also does not indicate the degree of disability. Miller et al.,15 Leigh et al.,3 and Finkelstein et
al.13 developed data by body part and nature of injury derived from a national sample of
Workers’ Compensation data on the probability the person is totally disabled and the mean
percentage of work-related disability for people who are partially permanently disabled.
Finkelstein et al.13 provided some independent validation of these estimates. Given the modest
disability information in CAIS, we used these percentages to estimate the life-time work loss for
permanently disabled youth independently of their future occupation. To compute work loss due
to permanent disability, we considered permanent total disability and permanent partial disability
separately. For permanent total disability, we multiplied the present value of age and sex specific
lifetime earnings and household production reported in Haddix et al.16 times the probability of
permanent disability for each type of injury. For permanent partial disability, we multiplied the
estimate for a permanent total disability times an additional factor from Leigh et al.3 identifying
the percentage of disability. We then summed the results to compute the net long-term work loss
associated with permanent disability.
Quality-Adjusted Life Years Lost: The medical and work loss costs associated with child
and adolescent injuries do not fully capture the burden of these injuries. Injuries also reduce the
quality of life of children and families. Losing a child unnecessarily to injury can cause a lifetime
of mental anguish. Children and youth who are permanently disabled by injury may experience
lifelong pain, or suffer permanent loss of motor or cognitive functioning. Both monetary costs
and quality of life measures should be considered when allocating resources, and both should be
incorporated into cost-effectiveness analyses that weigh “net costs” against quality of life
improvements.14 To capture these less quantifiable consequences of child and adolescent injuries,
we report quality of life losses, valued in non-monetary terms as QALYs.
Estimating QALYs is one way to value the good health lost to an individual who suffers a
health problem, is disabled, or dies prematurely. A QALY is a measure based on individuals’
preferences for states of health that assigns a value of “1” to a year of perfect health and “0” to
death.14 QALY losses are affected by the duration and severity of a health problem. To estimate
QALY losses, years of potential life lost to a fatal injury are added to the number of years spent
with an injury-related disability times a “weighting factor” that represents the severity of the
disability.15
We used the present value of the QALYs lost per case by body part and nature of injury
from Miller et al.2,15 to estimate QALY loss for youth injured on farms. Miller et al.2,15 based
QALY loss estimates on physician ratings of the functional losses resulting from injury by
diagnosis. Its estimates are routinely used in regulatory analysis by the U.S. Department of
Transportation. We provide two sets of quality of life loss estimates, one in QALYs and the
second in monetized QALYs. The dollar value per QALY comes from Miller et al.2, inflated to
2005 dollars using the ECI.
Results
Table 1 provides estimates of annual incidence and costs of injury to farm youth by
relation to farm, age group, and detailed cost categories. The annual number of non-fatal farm
youth injuries in 2001-2006 was 26,570. Age groups 10-14 and 15-19 were more prone to non-
fatal injury than younger children – their shares of injuries were 36% and 32.4%, respectively
(95% confidence intervals: 25.4%-46.6% and 23.8%-41%). They were followed by the 5-9 age
group with 23% (95% confidence interval: 18.8%-27.2%) and the 0-4 age group with 9% (95%
confidence interval: 5.2%-12.8). As expected, among household youth working and hired youth,
the 15-19 age group had the highest share of injuries. Among household youth not working and
farm visitors, the 10-14 age group had the highest share of injuries.
Non-fatal farm youth injuries annually cost $1 billion (in 2005 dollars), or $466 million
excluding QALY loss. Around 9.3% of the total cost was comprised of medical costs, 37.2% of
work and household productivity loss, and 53.5% of QALY loss. Household youth not working
had the highest share of injury costs (54%; 95% confidence interval: 48.2%-59.4%). The overall
mean cost was $ 37,744 per case, or $17,526 excluding QALY loss. Importantly, mean costs per
injured youth did not differ significantly between any of the groups of youth listed in Table 1 (p-
values ranged from 0.12 to 0.86).
(Insert Table 1 here)
Table 2 indicates that 45.1% occurred to household youth not working (95% confidence
interval: 39.6%-50.6%). Hired youth had the smallest share of injuries (5.2%; 95% confidence
interval: 1.7%-8.7%). Males experienced more injuries than females. Overall, 58% of injuries
occurred to males (95% confidence interval: 54.5%-61.5%). Again mean costs per injury did not
differ significantly among groups (p-values ranged from 0.14 to 0.91).
(Insert Table 2 here)
Table 3 shows that beef cattle farms (31% of all U.S. farms) accounted for 48% of all
child agricultural injury costs including 62% of work-related costs and 42% of non-work costs.
Hog farms, however, had the highest rate of youth injuries at work (14.3 per thousand farms –
95% confidence interval: 11.3-17.3) and sheep, goat, wool and mohair farms had the highest rate
of not-at-work injuries (45.4 per thousand farms; 95% confidence interval: 38.5-52.3). The rate
of at-work injury in hog farms is not statistically different from rates in dairy and
sheep/goat/wool/mohair farms (p-values: 0.38 and 0.93, respectively). Similarly, the rate of not-
at-work injury in sheep, goat, wool, and mohair farms is not statistically different from rates in
hog and poultry/egg farms (p-values: 0.06 and 0.09, respectively). Overall, the rate is 2.4 times
higher for not-at-work than for at-work injuries (p-value: 0.001). Not-at-work injury costs
represented 71.4% of the total cost of farm youth injury (95% confidence interval: 65.3%-
77.5%). At the 95% confidence level, only mean costs per injury for youth working on tobacco
and cotton farms were significantly different from other groups (p-value: 0.048).
(Insert Table 3 here)
Table 4 shows that youth 15-19 years old on beef cattle farms had the most injuries
(2,542). They were followed by youth 10-14 and 5-9 years old on beef cattle farms (2,425 and
2,182, respectively). However, 10-14 year olds on sheep, goat, wool and mohair farms had the
highest injury rate (28.6 per thousand farms). Their rate is statistically different at the 95%
confidence level from all other age group and farm type combinations (p-values ranged from
0.001 to 0.047). The beef cattle/15-19 age group combination had by far the highest annual cost
($241 million), of which $30 million was comprised of medical costs.
(Insert Table 4 here)
Table 5 indicates that structures and surfaces were by far the most common source of
injury to farm youth in the age groups 0-4, 5-9, and 10-14 year old (999, 2,601, and 3,373
injuries annually, respectively). For the 15-19 age group, persons, plants, animals, and minerals
were the main source of injury (2,431 annually) followed by structures and surfaces (1,960
injuries annually). The incidence difference between the two sources for this age group is not
statistically significant (p-value: 0.06). Injuries to 15-19 year olds caused by persons, plants,
animals, and minerals had the highest share of the total cost among all the source/age group
combinations (20%), followed by injuries caused by structures and surfaces (9.5%). Mean costs
per injury do not differ significantly by source/age group or by injury event/age group (p-values
ranged from 0.11 to 0.93).
(Insert Table 5 here)
Table 6 indicates that falls were the most common type of injury event in the age groups
0-4, 5-9, and 10-14 years old (1,278, 3,090, and 3,165 injuries annually, respectively). For the
15-19 age group, contacts with objects or equipment were by far the most common injury event
(3,122 annually). Assault/violent acts to this age group had the highest share of the total cost
among all the event/age group combinations (16.5%), followed by falls of 10-14 year olds
(12.3%).
(Insert Table 6 here)
Discussion
Non-fatal farm youth injuries cost society at least $1 billion annually during the period
2001-2006 including $463 million in tangible costs and $537 million in quality of life loss. These
cost estimates are conservative. We did not include possible parental household productivity loss
due to youth injury. If included, the tangible costs would be $470 million. Losses in household
work/chores were estimated based on the days lost and cost per day by age group and gender for
all children. Since farm children do more chores than most children, we underestimate these
losses. Depending on the agricultural cycle, injury to a youth also may cost the family farm
operator more than just the hours spent to take the injured to the emergency department or
visiting him/her in hospital. The operator’s presence on the farm at that time may be critical for
crop yield, so some injuries cause collateral economic damage. Since CAIS excludes young
contract laborers, to the extent they are injured, we have underestimated the burden of farm
youth injuries. For lack of data, this estimate omits police and fire department costs, but we
suspect those costs are minimal. Also the costs estimated in this study are costs of medically
attended injury, not costs of injury incidents, because data on the costs of associated property
damage are not available. This article excluded fatalities because data were not available to break
them down into many of the categories tabulated.
The one-year recall period of the CAIS survey creates recall bias - minor injuries may be
under-reported. For example, only 11% of injuries are reported in CAIS as non-medically
treated. To the extent that non-medically treated injury is under-reported, the overall mean cost
of injury is overestimated. This study shares the limitations of the unit costs we used. Notable
among those are the assumption that permanent disability rates are the same for children and
adults with comparable injuries and reliance on aging data on the pattern of medical costs
beyond 30 months post-injury. Because the unit costs used as input to the process do not have
confidence intervals, our estimates of mean cost variance for different categories were based on
the injury severity variance of each category (e.g., the injury severity variance in dairy farms).
Youth farm injuries are comparable to other occupational injuries, which makes them
much more serious than the average youth injury. Their medical care costs average $3,500 which
is quite close to the $3,641 average for all days-away-from-work (DAFW) agricultural injuries
and the $3,696 average for all DAFW occupational injuries.18 That average is higher than the
$2,728 average for occupational injuries of teenagers19 and much higher than the $1,388 average
for all medically-attended nonfatal unintentional childhood injuries.2
For several reasons, work injuries accounted for just 29% of the youth injury incidence
and costs on farms. Some farmers, recognizing farm work is hazardous, do not let their children
work on the farm. Even a child who works on the farm may only work a few hours a week
resulting in more hours of exposure to home than farm injury risks. Also, 29% of the injuries are
to visiting children and only 12% of their injuries are work-related. Finally, 12% of all injuries
and 24% of related costs come from assaults; these rarely are associated with youth agricultural
work.
The past two decades have brought an influx of federal and private funds into the
prevention of childhood agricultural injuries. With funding from the National Institute for
Occupational Safety and Health (NIOSH), guidelines were established for children working on
family farms,20 for youth employed on non-family farms,21 for creating safe play areas on farms22
and for agritourism farms catering to child visitors.23 Research and programmatic activities have
primarily addressed youth-based educational programs and many of these educational
interventions reference the guideline documents. A 2004 systematic review of intervention
effectiveness 24 reported a dearth of methodologically rigorous evaluation research and no clear
indicators of prevention effectiveness. Subsequent to the 2004 review, Gadomski et al.25 reported
that farms on which tasks for children ages 7 – 19 years were consistent with North American
Guidelines for Children’s Agricultural Tasks (NAGCAT) experienced only half the number of
injuries compared to a control group. Yet, the same study noted that for many of the injuries, no
applicable guidelines existed. Regardless of the task assigned to a youth, if the working
conditions are inherently unsafe for adults, the risk of injury or death is equal or greater for the
child.
When the farm is also the home for children younger than seven years, safety
professionals encourage a complete separation from the adult work setting. Off-site child care is
the ideal. In contrast to their urban counterparts, farm parents are less likely to use child care
services for a variety of reasons, including cost. Child care services for a pre-schooler may range
from $5,000 - $10,000 annually. The absence of affordable, high quality, off-farm child care
programs is a major challenge in protecting young, non-working children on farms. When off-
site child care is not an option, the creation and use of a supervised, safe play area on the farm is
recommended.22
Conclusion
Although the number and rate of childhood agricultural injuries has declined over the
past decade, the economic impact of these events continues to extol major costs for the families
of injury victims and the health care system. The average cost of medical treatment for a
childhood agricultural injury is almost $4,000. While farm families often have limited financial
resources, this study suggests that adopting safe practices associated with working and non-
working children on farms yields economic benefits.
Acknowledgement
This study was funded by NIOSH grant U54 OH009568.
References
Table 1. Annual incidence and costs of non-fatal farm youth injury in 2001-2006 by relation to farm and age group, ages 0-19 (2005 dollars)
Relation to farm
and age
Annual
incidence
Medica
l cost*
Short
term
child
work
loss*
Short
term
parental
work
loss*
Short term
child
household
productivit
y loss*
Long
term
work
loss*
Long term
household
productivit
y loss*
Monetize
d QALY
loss*
Total
costs
net of
QALY
loss*
Total
cost*
Total
QAL
Ys
lost
Mean
cost
net of
QALY
loss
Mean
cost
Household youth
working 5,486 34.0 1.78 4.33 1.04 77.7 18.5 118.2 137.3 255.4 939 25,022 46,566
05-09 609 1.1 0.10 0.44 0.00 4.0 1.0 2.8 6.7 9.5 21 10,925 15,566
10-14 2,054 4.7 0.52 1.68 0.31 15.0 3.6 18.7 25.8 44.5 146 12,564 21,680
15-19 2,823 28.2 1.16 2.22 0.73 58.6 13.9 96.6 104.8 201.4 772 37,126 71,358
Household youth
not working 12,047 39.2 3.90 15.09 1.21 127.7 30.2 323.5 217.4 540.9 2,631 18,046 44,901
00-04 1,574 6.5 0.00 2.69 0.00 20.9 5.1 57.7 35.3 92.9 470 22,397 59,028
05-09 3,405 8.9 0.65 3.73 0.00 36.2 8.6 64.1 58.0 122.1 513 17,037 35,875
10-14 4,715 16.9 2.02 6.05 0.83 45.8 10.8 108.6 82.4 191.0 880 17,485 40,510
15-19 2,353 7.0 1.24 2.62 0.38 24.8 5.7 93.2 41.7 134.9 768 17,717 57,308
Visitor 7,650 17.5 0.00 8.16 0.88 59.5 15.0 90.0 101.1 191.1 711 13,214 24,976
00-04 851 2.0 0.00 0.48 0.00 4.7 1.1 4.1 8.2 12.4 31 9,685 14,523
05-09 1,969 3.6 0.00 1.67 0.00 13.6 3.3 22.8 22.2 45.0 182 11,276 22,873
10-14 2,653 6.7 0.00 3.73 0.55 25.8 6.7 36.9 43.5 80.4 290 16,390 30,293
15-19 2,177 5.2 0.00 2.28 0.33 15.5 3.9 26.2 27.2 53.3 208 12,475 24,485
Hired youth 1,387 2.3 0.45 0.87 0.10 5.0 1.2 5.5 9.9 15.4 42 7,164 11,128
10-14 132 0.4 0.05 0.14 0.02 0.9 0.2 2.1 1.7 3.9 17 13,234 29,488
15-19 1,255 1.9 0.40 0.73 0.08 4.1 1.0 3.4 8.2 11.5 25 6,525 9,195
All 00-04 2,425 8.4 0.00 3.16 0.00 25.6 6.3 61.8 43.5 105.3 501 17,937 43,414
All 05-09 5,983 13.7 0.75 5.85 0.00 53.8 12.8 89.8 86.9 176.7 715 14,518 29,528
All 10-14 9,554 28.6 2.59 11.60 1.71 87.6 21.3 166.3 153.5 319.8 1,333 16,065 33,473
All 15-19 8,609 42.2 2.80 7.85 1.51 102.9 24.5 219.3 181.8 401.2 1,773 21,124 46,599
All youth 26,570 93.0 6.13 28.46 3.23 270.0 64.9 537.2 465.7
1,002
.9 4,322 17,526 37,744
* In millions
Table 2. Annual incidence and costs of non-fatal farm youth injury in 2001-2006 by relation to farm and gender,
ages 0-19 (2005 dollars)
Relation to farm and
gender
Annual
incidenc
e
Medical
cost*
Short term
work &
household
productivit
y loss*
Long term
work &
household
productivit
y loss*
Monetize
d QALY
loss*
Total
cost*
Total
QALYs
lost
Household youth working 5,486 34.0 7.2 96.1 118.2 255.4 939
Males 3,215 6.6 3.9 19.9 21.1 51.6 165
Females 2,270 27.4 3.3 76.2 97.1 203.9 774
Household youth not
working 12,047 39.2 20.2 158.0 323.5 540.9 2,631
Males 6,682 22.6 11.1 84.9 192.8 311.4 1,574
Females 5,365 16.6 9.1 73.1 130.7 229.6 1,057
Visitors 7,650 17.5 9.0 74.6 90.0 191.1 711
Males 4,384 9.1 4.5 37.5 38.1 89.3 297
Females 3,266 8.4 4.5 37.1 51.9 101.8 414
Hired youth 1,387 2.3 1.4 6.2 5.5 15.4 42
Males 1,109 2.1 1.1 5.7 5.0 13.9 39
Females 279 0.3 0.3 0.5 0.5 1.5 3
All males 15,390 40.4 20.6 148.0 257.1 466.1 2,075
All females 11,181 52.6 17.2 186.9 280.1 536.8 2,248
All youth 26,570 93.0 37.8 334.9 537.2 1,002.9 4,322
* In millions
Table 3. Annual incidence and costs of non-fatal farm youth injury in 2001-2006 by work status and type of farm,
ages 0-19 (2005 dollars)
Work status and type of farm
Annual
incidenc
e
Rate/100
0
Farms**
Medical
cost*
Work &
household
productivit
y loss*
Monetize
d QALY
loss*
Total
cost*
Total
QAL
Ys
lost
Total
cost
per
farm**
All farms, injured while working 7,795 3.6 38.0 117.6 131.2 286.8 1,041 132
Grain and oilseed 922 2.7 3.6 24.6 13.4 41.6 99 121
Tobacco and cotton 125 3.5 0.1 0.1 0.1 0.3 1 9
Vegetable and melon 262 7.0 0.3 0.7 0.8 1.7 6 46
Fruit, tree nut and berry 158 1.6 0.2 0.5 0.3 1.1 2 11
Nursery, greenhouse and
floriculture 166 2.8 0.5 2.2 1.3 4.0 10 68
Other crop 814 1.8 2.4 6.7 5.3 14.4 41 32
Beef cattle 2,154 3.1 25.4 63.2 89.7 178.4 722 253
Dairy 725 11.2 1.6 8.5 4.4 14.5 32 223
Hog 457 14.3 0.7 2.0 1.8 4.5 14 141
Sheep, goat, wool and mohair 796 14.2 1.3 2.7 3.4 7.4 27 133
Equine 814 4.6 1.2 4.4 7.5 13.1 61 75
Poultry and egg 245 4.5 0.3 0.9 1.8 3.0 15 55
Other animal 158 2.6 0.2 1.0 1.4 2.7 12 43
All farms, injury while not
working 18,776 8.7 55.0 255.1 406.0 716.1 3,281 330
Grain and oilseed 1,899 5.5 5.1 28.4 23.5 57.0 182 166
Tobacco and cotton 180 5.1 0.3 1.1 0.5 1.9 4 54
Vegetable and melon 300 8.0 0.3 1.4 1.3 3.0 10 79
Fruit, tree nut and berry 548 5.7 0.8 4.9 11.7 17.4 96 180
Nursery, greenhouse and
floriculture 163 2.7 0.3 1.2 1.0 2.5 8 41
Other crop 1,347 3.0 5.7 21.8 40.5 68.0 330 153
Beef cattle 5,882 8.4 23.0 102.9 175.0 300.9 1,419 428
Dairy 876 13.5 1.6 7.3 9.2 18.1 74 279
Hog 569 17.7 2.9 16.4 21.0 40.3 168 1,256
Sheep, goat, wool and mohair 2,522 45.4 4.4 20.5 39.8 64.7 324 1,165
Equine 2,648 15.1 4.8 29.0 48.4 82.2 392 468
Poultry and egg 1,185 21.8 4.2 14.2 25.5 43.9 207 807
Other animal 656 10.7 1.6 6.2 8.5 16.2 68 264
All Injuries 26,570 12.3 93.0 372.7 537.2
1,002.
9 4,322 463
*In millions; **The number of farms is an average from the 2002 and 2007 U.S. Census of Agriculture
http://www.agcensus.usda.gov/Publications/2002/Volume_1,_Chapter_1_US/st99_1_050_050.pdf
http://www.agcensus.usda.gov/Publications/2007/Full_Report/Volume_1,_Chapter_1_US/st99_1_062_062.pdf
Table 4. Annual incidence and costs of non-fatal farm youth injury in 2001-2006 by age group and type of farm,
ages 0-19 (2005 dollars)
Type of farm
Annual
incidenc
e
Rate/100
0
Farms**
Medica
l cost*
Total
cost*
Annual
incidenc
e
Rate/100
0
Farms**
Medica
l cost*
Total
cost*
Age 00-04 Age 05-09
Total for the age group 2,425 1.1 8,438
105,27
5 5,983 2.8 13,667
176,67
1
Grains and oilseeds 334 1.0 977 4,575 696 2.0 1,511 18,860
Tobacco and cotton 91 2.6 59 317 19 0.5 37 456
Vegetables and melons 75 2.0 62 529 37 1.0 13 115
Fruit, tree nuts and berries 136 1.4 414 8,659 96 1.0 161 1,220
Nursery, greenhouse and
floriculture 28 0.5 53 865 24 0.4 164 1,148
Other crops 55 0.1 50 195 530 1.2 454 3,026
Beef cattle 888 1.3 3,567 41,866 2,182 3.1 5,750 89,530
Dairy 138 2.1 254 7,723 304 4.7 625 6,849
Hogs 220 6.9 2,002 24,711 116 3.6 332 5,737
Sheep, goats, wool and mohair 261 4.7 170 2,256 636 11.4 1,857 17,872
Equine 117 0.7 763 13,231 827 4.7 2,311 28,142
Poultry and eggs 22 0.4 39 289 302 5.6 215 1,484
Other animals 59 1.0 29 60 216 3.5 237 2,233
Age 10-14 Age 15-19
Total for the age group 9,554 4.4 28,639
319,78
8 8,609 4.0 42,235
401,15
4
Grains and oilseeds 825 2.4 2,648 32,496 966 2.8 3,603 42,688
Tobacco and cotton 148 4.2 302 1,299 49 1.4 45 190
Vegetables and melons 171 4.6 184 2,107 279 7.4 312 1,960
Fruit, tree nuts and berries 167 1.7 203 7,446 308 3.2 251 1,183
Nursery, greenhouse and
floriculture 15 0.3 195 1,589 261 4.4 426 2,903
Other crops 968 2.2 5,357 61,469 607 1.4 2,282 17,735
Beef cattle 2,425 3.4 9,326
107,02
52,542 3.6 29,802
240,82
2
Dairy 612 9.4 1,101 8,839 547 8.4 1,237 9,195
Hogs 324 10.1 585 8,014 366 11.4 726 6,384
Sheep, goats, wool and mohair 1,591 28.6 2,093 19,945 829 14.9 1,545 32,039
Equine 1,320 7.5 1,749 20,870 1,198 6.8 1,147 33,011
Poultry and eggs 602 11.1 3,479 32,388 504 9.3 743 12,752
Other animals 387 6.3 1,417 16,302 152 2.5 116 293
* In thousands; **The number of farms is an average from the 2002 and 2007 U.S. Census of Agriculture
http://www.agcensus.usda.gov/Publications/2002/Volume_1,_Chapter_1_US/st99_1_050_050.pdf
http://www.agcensus.usda.gov/Publications/2007/Full_Report/Volume_1,_Chapter_1_US/st99_1_062_062.pdf
Table 5. Annual incidence and costs of non-fatal farm youth injury in 2001-2006 by age group and source of
injury, ages 0-19 (2005 dollars)
Source of injury Annual
incidenc
e
Medical
cost*
Total
cost*
Annual
incidenc
e
Medical
cost*
Total
cost*
Age 00-04 Age 05-09
Total for the age group 2,425 8,438 105,275 5,983 13,667 176,671
Chemicals and Chemical Products 87 455 2,720 00 0
Containers 106 1,331 19,762 119 1,023 22,237
Furniture and Fixtures 91 254 1,448 199 499 9,859
Machinery 35 130 6,339 224 321 2,249
Parts and Materials 109 197 1,252 245 322 4,282
Persons, Plants, Animals, and Minerals 258 441 3,490 1,059 2,241 24,537
Structures and Surfaces 999 1,741 27,174 2,601 3,642 58,199
Tools, Instruments, and Equipment 152 1,630 24,168 436 1,601 16,329
Vehicles 358 1,355 12,295 804 3,472 34,737
Other Sources 231 904 6,627 295 546 4,243
Age 10-14 Age 15-19
Total for the age group 9,554 28,639 319,788 8,609 42,235 401,154
Chemicals and Chemical Products 43 77 284 63 100 812
Containers 114 98 1,914 85 113 1,264
Furniture and Fixtures 143 563 7,733 72 57 174
Machinery 216 412 2,526 613 968 6,464
Parts and Materials 434 337 2,316 713 861 3,412
Persons, Plants, Animals, and Minerals 2,239 6,875 78,025 2,431 27,449 202,808
Structures and Surfaces 3,373 7,085 95,302 1,960 4,704 95,740
Tools, Instruments, and Equipment 787 1,541 20,049 646 566 2,407
Vehicles 1,849 11,029 101,422 1,272 5,407 56,295
Other Sources 355 623 10,218 753 2,008 31,777
* In thousands
Table 6. Annual incidence and costs of non-fatal farm youth injury in 2001-2006 by age group and event, ages
0-19 (2005 dollars)
Injury event
Annual
incidence
Medical
cost*
Total
cost*
Annual
incidenc
e
Medical
cost*
Total
cost*
Age 00-04 Age 05-09
Total for the age group 2,425 8,438
105,27
5 5,983 13,667
176,67
1
Contact With Objects and Equipment 562 1,325 19,005 1,221 2,205 14,086
Falls 1,278 4,741 67,962 3,090 5,814
104,26
0
Bodily Reaction and Exertion 5 56 384 4 3 7
Exposure to Harmful Substances or
Environments 161 1,227 7,980 35 14 58
Transportation Incidents 241 920 7,971 676 3,309 33,717
Fires and Explosions 0 0 0 73 130 465
Assaults and Violent Acts 137 133 1,264 739 1,723 15,873
Other Events or Exposures 41 36 710 146 469 8,204
Age 10-14 Age 15-19
Total for the age group 9,554 28,639
319,78
8 8,609 42,235
401,15
4
Contact With Objects and Equipment 2,279 3,027 21,897 3,122 5,166 54,357
Falls 3,165 8,688
123,68
4 1,936 5,039
103,46
3
Bodily Reaction and Exertion 352 447 3,904 567 2,113 14,694
Exposure to Harmful Substances or
Environments 356 391 1,103 341 903 4,774
Transportation Incidents 1,709 10,900
100,85
3 1,209 5,333 55,018
Fires and Explosions 19 33 125 65 220 1,643
Assaults and Violent Acts 1,252 4,586 57,857 998 23,070
165,46
1
Other Events or Exposures 423 567 10,365 370 391 1,744
* In thousands
