The aim of this study was to investigate the work-related risks and pathways that precede head injuries, which is essential for promoting industry-specific safety. We found considerable variation in the circumstances across industries, with the highest injury incidences being in construction. In our material, the most commonly affected area was the eyes. In addition, clearly more head injuries were caused by violence in human health and social work activities than in the other sectors.

The main strength of the current study was its extensive data on 32,898 work-related injuries, based on a national system of statutory insurance and reporting, in which the percentage of non-reported injuries is low. However, the setting is also a limitation of the study, particularly in terms of the accuracy of information recorded by the employer.

Comparison of occupational accident data is difficult due to the different data collection and recording practises in different countries. ESAW was launched to harmonise this data (EU 2013), but the coding reliability of ESAW variables varies, and some variables are difficult to understand and code without training (Jacinto et al. 2016). The ESAW ‘age’, ‘sex’ and ‘nationality’ variables have shown good coding reliability, whereas the variables concerning accidents, such as ‘deviation’, have shown ‘low to moderate’ reliability (Molinero-Ruiz et al. 2015). To improve the reliability in our setting, we combined all the ESAW variables (variables 11–19) and combined the injuries to different areas of the head into one variable (‘head injury’), as the employer, who is responsible for the accident report, is not usually educated in health care.

National differences in the accuracy of recording work-related injuries, and underreporting of these are a recognised challenge (Eurofound 2017; Jacinto and Aspinwall 2004). The level of reporting is higher in countries with insurance-based systems. In contrast, the reporting level can be as low as 30% (Jacinto and Aspinwall 2004) in countries with non-insurance-based systems. Detailed data on work-related injuries are available in the Nordic countries, including Finland (Jacinto and Aspinwall 2004), where worker’s compensation insurance, is in a primary position compared to other social security benefits, with significant financial compensation for the victim. In Finland, less than 10% of the employees are not covered, reasons being related to amount of salaries paid by employer, and in some cases neglect. Consequently, the current material is likely to reflect the overall national situation.

Some of the employees in our data were 14 years old, because of work during school holidays and short internships at workplaces as part of the school year. The oldest age group of the cases were 70–79 years, as some retired people still worked. Comparison of exact age and gender distribution with all Finnish employees is not possible due to national insurance practises and the European Union General Data Protection Regulation (GDPR).

The work-related injury densities and risk profiles of the different industries varied greatly in the current results. Construction had a consistently high density of injuries; whereas at the other end of the scale was information and communications, which had consistently low injury density. Mining also had a high injury density, but the size of the industry was small, with wide variation in injury density. The ESAW subcategory counts stood out in the three main industry sectors (human health and social work activities, construction, and manufacturing) from the others. We selected these sectors for further analyses, which revealed differences in a wide range of subclasses of the ESAW variables (specific physical activity, deviation of norm, and modes of injury).

Previous studies (Haslam et al. 2005; Jaafar et al. 2018; Ren et al. 2008) have presented different models to explain the pathways related to injuries at work; many of these being developed specifically for the construction industry in which the incidence of non-fatal injuries has been high (EU 2020). Several consecutive errors are usually behind an accident and the failure of safety factors (Ren et al. 2008). Moreover, both distal (e.g. organisation, society) and proximal (e.g. site condition, individual characteristics) factors are important when exploring the causes of work-related injuries (Khosravi et al. 2014).

Previous studies have shown that about half of eye traumas (34–54%) are work related (Cai and Zhang 2015; Sahraravand et al. 2017). In our study, the most common area of the head that was affected was the eyes (49.6%). Both in construction (70.4%) and manufacturing (66.2%), eye injuries were the leading form of head injury. Of these eye injuries, 83% occurred among men, which is similar to the results of a previous study by Martin-Prieto et al. (2020). Thus, attention to safety and eye protection is still required.

In general, the risk of work-related accidents in the construction industry is high (EU 2020). Consistent with a previous systematic review (Chang et al. 2015), we observed the highest incidence of head injuries to be in construction. Falls are the main cause of TBI in the construction industry (Brolin et al. 2021; Colantonio et al. 2009; Kim et al. 2006). In our material, which was not restricted to TBI, falls did not emerge in the context of the injuries, as the eyes were the most commonly affected area. In construction and manufacturing, current head injuries occurred due to the typical stages of the work in question, such as ‘working with hand-held tools’.

The circumstances behind the work-related head injuries in the human health and social work activities sector were different to those in all the other sectors. When examining the ‘deviation’ and ‘mode of injury’, behind the head injuries in the human health and social work activities, ‘shock, fright, violence, aggression, threat, presence’ and ‘bite, kick, etc.’ showed almost a ninefold higher risk of head injury compared to other industry sectors, suggesting violence being a major factor behind the head injuries in this industry. In addition, ‘Contact with hazardous substances—through the nose, mouth via inhalation’ showed an almost 14-fold risk of head injuries, which further emphasises the differences between industry sectors.

Workplace violence has received increasing attention in recent years. The European Working Conditions Survey (EWCS) (Eurofound 2017) revealed that 2% of workers in 35 European countries were exposed to workplace physical violence in the last 12 months, and health and social work employees reported the highest percentage (7%) (Eurofound 2013). Some TBI has been indicated in health care and social assistance (Shafi et al. 2019), and our study contributed by showing a clear excess of head injuries in the human health and social work sector. The threat of violence may be more common in occupations in which the work involves a great deal of external client contact, as is the case in health care (Eurofound 2013). The construction industry involves less interaction with people outside the organisation and the sites, which may contribute to its lower incidence of violence. A systematic review and meta-analysis by Liu et al. (2019) showed that workplace violence is high in the health care sector, especially among nurses and physicians. In our study, we did not separate employees by profession. A study by Torre et al. (2022) highlighted the difficulty to assess the prevalence of violence experienced by health care workers due to under-reportment or un-reportment of the violence. However, when investigating the more serious consequences of workplace violence, such as head injury, we can assume that most of the occupational accidents resulting from violence are reported. A previous study using a sample from an occupational injury database of the same Finnish insurance company as that in our study showed reoccurrence of violence-related accidents for every other subject (Pietilä et al. 2018). Therefore, analysing accidents can be important for preventing the probability of incidents.