Alcohol Consumption and Incidence of Workers’ Compensation Claims: A 5-Year Prospective Study of Urban Transit Operators David R. Ragland, Niklas Krause, Birgit A. Greiner, Barbara L. Holman, June M. Fisher, and Carol B. Cunradi Background: Numerous studies have linked alcohol impairment on the job to occupational injury. Few studies have looked at the association of nonwork drinking and occupational injury. Methods: This study examines first workers’ compensation claims after a baseline assessment of alcohol consumption and other occupational variables in 1836 transit operators participating in a medical exami- nation for driver’s license renewal. A proportional hazard model was used for the analysis. Results: Individuals with higher alcohol consumption were more likely to be male, have more years of driving, and have a higher job-stress score. When these variables were controlled for, individuals with higher alcohol consumption were more likely to have a workers’ compensation claim over the follow-up period. Individuals reporting a consumption of 10 to 14 drinks per week had a hazard of 1.30 (p = 0.03), and those reporting 15 or more drinks per week had a hazard of 1.27 (p = 0.05) compared with individuals reporting no drinks consumed per week. Conclusions: This study indicates that drinking off the job is associated with workers’ compensation injury claims. Because it is presumed that most drinking was done outside work, due to high public scrutiny of city transit operators, these results suggest that experience in life outside of work may influence work outcomes. Research should be conducted to identify the mechanisms (e.g., drinking before work, hangover, fatigue) of such effects. Key Words: Accidents, Occupational, Alcohol Consumption, Injury, Workers’ Compensation Claims. A FAIRLY LARGE NUMBER of studies have reported an immediate link between alcohol consumption and occupational injury. For example, numerous case series report alcohol involvement of 5 to 20% (Alleyne et al., 1991; Baker et al., 1982; Crandall et al., 1997; Fullerton et al., 1995; Harrison et al., 1993; Hollo et al., 1993; Lewis and Cooper, 1989) for on-the-job injury or mortality. There is less information about the relationship between general drinking patterns and occupational injury and mor- tality. In an anonymous telephone survey of randomly se- lected employed adults, Hingson et al. (1985) found that an average daily intake of five or more drinks was associated with a relative risk of 2.0 for job-based accidental injuries. In a study of industrial workers, Webb et al. (1994) found a significant relationship between problem drinking and work injuries but not between high alcohol consumption and work injuries. In analyses from the 1988 National Health Interview Survey, Dawson (1994) found that the odds of occupational injury during the year preceding the interview increased with the frequency of heavy drinking; the odds ratio for daily heavy drinking and occupational injury was 1.74. These findings suggest that patterns of alcohol consump- tion may influence work-related injury and mortality. How- ever, there have been very few studies in which occupa- tional injuries have been monitored prospectively after a baseline assessment of alcohol consumption. Pollack et al. (1998) found that a diagnosis of substance abuse among construction laborers was associated with an increased risk of work-related injuries, as recorded in workers’ compen- sation records. This study is similar in design and reports that alcohol consumption measured in a baseline survey conducted in 1983– 85 was linked to subsequent workers’ compensation injury claims until the end of 1988. METHODS The data reported in this article are part of a study of health and safety in transit operators employed by the San Francisco Municipal Railway (Muni). The data were derived from three different sources: (1) a cross- From the School of Public Health (DRR, NK, BAG), University of California, Berkeley; the Trauma Foundation (BLH), San Francisco General Hospital and University of California; School of Medicine (JMF), University of California, San Francisco; and Prevention Research Center, Berkeley, California. Received for publication January 6, 1999; accepted June 5, 2002. Funded in part by Grant AA8949 from the NIAAA (Worksite-Related Alcohol Behavior in Urban Transit Drivers) and in part by a grant from the Alcohol Beverage Medical Research Foundation. Reprint requests: David R. Ragland, PhD, MPH, School of Public Health, 140 Warren Hall #7360, University of California, Berkeley, CA 94720-7360; Fax: 510-643-9922; E-mail: davidr@uclink4.berkeley.edu. Copyright © 2002 by the Research Society on Alcoholism. DOI: 10.1097/01.ALC.0000029600.12047.D6 0145-6008/02/2609-1388$03.00/0 ALCOHOLISM:CLINICAL AND EXPERIMENTAL RESEARCH Vol. 26, No. 9 September 2002 1388 Alcohol Clin Exp Res, Vol 26, No 9, 2002: pp 1388–1394