Productivity Losses From Nonfatal Injuries in the U.S.

Abstract

Introduction:

Information on productivity losses due to nonfatal injuries is limited. This study estimated annual productivity losses attributable to nonfatal injuries among U.S. adults aged ≥18 years in 2023.

Methods:

Productivity losses attributable to nonfatal injuries were estimated using the human capital approach. Various data sources, including the 2021 and 2023 National Health Interview Surveys and published literature, were used to estimate the cost of absenteeism, presenteeism, inability to work, and household productivity loss attributable to these injuries. All costs were estimated for 2023, and all analyses were conducted in 2025.

Results:

In 2023, the total annual cost of productivity losses attributable to nonfatal injuries among U.S. adults was $25.15 billion (prediction interval=$10.29–$43.95 billion). Of this amount, absenteeism accounted for $8.95 billion (prediction interval=$4.92–$14.21 billion), representing 36% of the total; presenteeism contributed $6.33 billion (prediction interval=$2.74–$11.10 billion) or 25%; inability to work resulted in costs of $9.67 billion (prediction interval=$2.54–$18.32 billion) or 38%; and household productivity loss totaled $0.20 billion (prediction interval=$0.10–$0.32 billion), which is nearly 1% of the overall cost.

Conclusions:

The annual cost of productivity losses from nonfatal injuries among U.S. adults is substantial as of 2023. Public health strategies that reduce nonfatal injuries can create cost-savings for the U.S. economy by avoiding preventable work and personal time losses.

INTRODUCTION

Morbidity-related productivity losses are a significant part of the overall economic cost of nonfatal injuries—including those from falls, sports/exercises, motor vehicle crashes/collisions, and household activities—but to date, there is limited direct and comprehensive measurement of these losses. Existing estimates of productivity losses due to nonfatal injuries are outdated, tend to focus on absenteeism or disability, and address only injuries treated in hospital emergency departments.^1,2 This study estimates the total population and per affected person annual productivity losses from these injuries in terms of absenteeism, presenteeism, inability to work, and household productivity loss. Absenteeism occurs when employees miss a workday owing to illness/injury; presenteeism arises from reduced productivity at work; inability to work results from disability; and household productivity loss stems from the inability to perform household production.^3-5

METHODS

Data from the 2021 and 2023 National Health Interview Survey (NHIS) were combined and analyzed for sample adults who responded to the injury question.^6,7 The NHIS is an annual household survey collecting nationally representative data on the health, behavior, and demographic characteristics of the noninstitutionalized U.S. population.^6,7 The injury question^6,7 (… the past 3 months, did you have an accident or an injury where any part of your body was hurt?) was included in a NHIS rotating core module, beginning in 2020.

All types of nonfatal injuries were included, covering those caused by falls, sports/exercises, and motor vehicle crashes/collisions as well as those occurring while doing household activities.^6,7 Productivity losses included days lost due to absenteeism, presenteeism, inability to work, and inability to perform household production.^3-5 Absenteeism was measured using the number of missed workdays due to illness/injury; presenteeism was assessed on the basis of the number of days worked while physically ill, applying productivity loss while working physically ill from literature; inability to work was measured using disability status; and household productivity loss was evaluated on the basis of overnight hospitalization. To estimate the cost of productivity losses, these estimated days lost were multiplied by standard market or nonmarket economic values^8,9 (Appendix Tables 1 and 2, available online).

This study used the human capital approach,¹⁰ and all costs were estimated by age group (18–24, 25–44, 45–64, 65–74, and ≥75 years) and sex. A regression-based approach used Stata (StataNow, version 18.5) to account for survey weights and individuals’ sociodemographic characteristics, health- and behavior-related variables, and year-specific effects. This approach estimated days lost due to absenteeism, inability to work, and inability to perform household production.^3,4 To estimate presenteeism days loss, a literature-based estimate of 24.15% average productivity loss during presenteeism days^11,12 was applied to the model-based presenteeism days. These resulting days losses were multiplied by the corresponding 2023 market or nonmarket economic values (Appendix Table 2, available online).^8,9 Because the work arrangements section was not included in the 2023 NHIS, presenteeism estimates reflect 2021 NHIS data.

Absenteeism and presenteeism days were estimated for employed adults, using a standard negative binomial model, on the basis of model specification tests and Akaike and Bayesian information criteria (Appendix Table 2, available online). These costs were calculated by multiplying absenteeism and presenteeism days lost by daily market economic values and by the prevalence population (Appendix Table 3, available online). The number of adults with an inability to work and hospitalized overnight or longer were estimated for all adults using a logistic model (Appendix Table 2, available online). Multiplying the number of adults with an inability to work by the annual market economic value gives the inability to work cost. Multiplying the number of adults who were hospitalized for nonfatal injuries by the number of hospitalized days from the Healthcare Cost and Utilization Project¹³ and the daily nonmarket economic value gives the cost of household productivity loss. This study used publicly available data; it did not constitute human research and does not require IRB review or exemption (45 CFR §46).

RESULTS

In 2023, the estimated cost of morbidity-related productivity losses attributable to injuries among U.S. adults was $25.15 billion (95% prediction interval [PI]=$10.29–$43.95 billion) (Table 1). Of this total, males accounted for $14.93 billion (95% PI=$6.04–$26.18 billion), and females accounted for $10.22 billion (95% PI=$4.25–$17.78 billion). The absenteeism cost totaled $8.95 billion (95% PI=$4.92–$14.21 billion), whereas presenteeism cost accounted for $6.33 billion (95% PI=$2.74–$11.10 billion). The inability to work resulted in costs of $9.67 billion (95% PI=$2.53–$18.32 billion), and household productivity loss amounted to $0.20 billion (95% PI=$0.10–$0.32 billion).

Table 1.

Annual Productivity Losses From Nonfatal Injuries, U.S., 2023

Cost component	Male	Female	Total
Absenteeisma	5.25 (2.90–8.29)	3.70 (2.02–5.92)	8.95 (4.92–14.21)
Presenteeismb	3.68 (1.57–6.46)	2.66 (1.17–4.64)	6.33 (2.74–11.10)
Inability to workc	5.93 (1.53–11.31)	3.73 (1.00–7.01)	9.67 (2.53–18.32)
Household productivity lossd	0.07 (0.03–0.11)	0.13 (0.07–0.20)	0.20 (0.10–0.32)
Total coste	14.93 (6.04–26.18)	10.22 (4.25–17.78)	25.15 (10.29–43.95)

Notes: All costs were estimated in 2023 U.S. dollars (in billion). Each cost component was calculated as the sum of each cost component over all age groups. Values in parentheses are 95% prediction intervals, calculated on the basis of the 95% CIs of model-based estimates. Note that these prediction intervals do not account for variation in other estimates, including the number of adults or economic value.

^aAbsenteeism cost attributable to injuries was calculated by multiplying the age group– and sex-specific total absenteeism days lost attributable to injuries for those who were employed, by the age group– and sex-specific market economic value from Grosse et al.,⁹ which was inflation adjusted to $2023.

^bPresenteeism cost attributable to injuries was calculated by multiplying the age group– and sex-specific total presenteeism days lost attributable to injuries for those who were employed, by the age group– and sex-specific market economic value from Grosse et al.,⁹ which was inflation adjusted to $2023.

^cThe cost of inability to work attributable to injuries was calculated by multiplying the age group– and sex-specific total number of adults who had an inability to work attributable to injuries, by the age group– and sex-specific market economic value from Grosse et al.,⁹ which was inflation adjusted to $2023.

^dCost of household productivity loss attributable to injuries was calculated by multiplying the age group– and sex-specific total days of hospital stay overnight or longer, attributable to injuries, by the age group– and sex-specific nonmarket economic value from Grosse et al.,⁹ which was inflation adjusted to $2023.

^eTotal cost was calculated as the sum of the cost of absenteeism, presenteeism, inability to work, and household productivity loss. Total cost prediction intervals were calculated by summing the corresponding lower and upper bounds of the sex-specific intervals.

The estimated cost of morbidity-related productivity losses per injured adult was $1,025 (95% PI=$478–$1,595) in 2023 (Table 2). For males, this cost was $1,224 (95% PI=$567–$1,902), and for females, it was $829 (95% PI=$391–$1,288). The cost of absenteeism was $365 (95% PI=$229–$516) per injured adult, whereas the cost of presenteeism was $258 (95% PI= $127–$403) per injured adult. The cost of inability to work was $394 (95% PI=$118–$665) per injured adult, and the cost of household productivity loss was <$10 per injured adult.

Table 2.

Annual Productivity Losses From Nonfatal Injuries, Per-Injured Adult, U.S., 2023

Cost component	Male	Female	Total
Absenteeisma	430 (273–602)	300 (185–429)	365 (229–516)
Presenteeismb	301 (148–470)	215 (108–336)	258 (127–403)
Inability to workc	486 (144–822)	303 (92–508)	394 (118–665)
Household productivity lossd	6 (3–8)	10 (6–15)	8 (5–11)
Total per adult coste	1,224 (567–1,902)	829 (391–1,288)	1,025 (478–1,595)

Notes: All costs were estimated per adult aged ≥18 years who had injuries, in 2023 U.S. dollars. Each cost component was calculated as the sum of each cost component over all age groups. Values in parentheses are 95% prediction intervals, calculated on the basis of the 95% CIs of model-based estimates. Note that these prediction intervals do not account for variation in other estimates, including the number of adults or economic value.

^aPer-person absenteeism cost attributable to injuries was calculated by dividing the total absenteeism cost attributable to injuries by the number of adults aged ≥18 years who had injuries in 2023.

^bPer-person presenteeism cost attributable to injuries was calculated by dividing the total presenteeism cost attributable to injuries by the number of adults aged ≥18 years who had injuries in 2023.

^cPer-person cost of inability to work attributable to injuries was calculated by dividing the total cost of inability to work attributable to injuries by the number of adults aged ≥18 years who had injuries in 2023.

^dPer-person cost of household productivity loss attributable to injuries was calculated by dividing the total cost of household productivity loss attributable to injuries by the number of adults aged ≥18 years who had injuries in 2023.

^eTotal per adult cost was calculated as the sum of the per adult cost of absenteeism, presenteeism, inability to work, and household productivity loss. Total cost prediction intervals were calculated by summing the corresponding lower and upper bounds of the sex-specific intervals.

The loss of productive time due to absenteeism, presenteeism, and inability to work was greater for females (Appendix Table 4, available online), whereas the associated economic costs were higher for males (Appendix Table 5, available online). The loss of productive time and economic costs varied across age groups in each cost component (Appendix Tables 4-7, available online).

DISCUSSION

Annual productivity losses due to nonfatal injuries among U.S. adults exceed $25 billion in 2023, and failing to account for these losses substantially underestimates the economic burden of nonfatal injuries. Consistent with previous studies on cigarette smoking⁴ and diabetes,⁵ inability to work had the largest share (38%), followed by absenteeism (36%), presenteeism (25%), and household productivity loss (1%). The higher economic costs for males resulting from absenteeism, presenteeism, and inability to work—despite their lower loss of productivity time—can be attributed to higher market economic values for males than for females.

The estimated cost of absenteeism and inability to work per adult presented in this paper, on the basis of self-reported injuries, are modestly lower than previous estimates, which addressed only hospital-treated (most severe) injuries.¹ Because these cost estimates depend on the prevalence of nonfatal injuries and the amount of lost productive time, implementing prevention efforts and strategies to reduce injury rates and minimize the loss of productive time can lower these costs.

Limitations

NHIS data on injury incidence and productivity losses are subject to respondents’ recall bias. Injury prevalence was based on those reported in the past 3 months, leading to a potential underestimation of productivity losses. The human capital approach applied in this study is based on observed average wages by sex, which is a higher monetary valuation of time than the alternative friction cost method of valuing lost productivity.⁸ Number of days lost due to presenteeism^11,12 and injury-related hospitalization days¹³ were based on separate data sources, because the required information was not collected in the survey. This study assumed respondents’ reported disability as the primary reason for not working in the past week, which may have overestimated the inability to work cost. Household productivity loss estimates included overnight hospitalization only, which might have underestimated household productivity loss.

CONCLUSIONS

The estimated cost of productivity losses from nonfatal injuries is substantial, and this estimate can be combined with those resulting from premature deaths and injury- related medical costs to calculate the total economic cost of these injuries. Quantifying the cost burden of injuries is essential to identify cost-effective prevention strategies.

Supplementary Material

Supplemental materials associated with this article can be found in the online version at https://doi.org/10.1016/j.amepre.2025.108056.