The Intersection Between Health Care Costs and Long Work Hours in the Transport Sector

According to the National Transportation Safety Board (NTSB) investigations conducted between 2013-2019 revealed that fatigue was a probable cause, contributing factor or finding in 12% of accidents across all modes of transportation. Even preceding this finding, rail safety has focused on fatigue and long work hours for decades due to concerns that fatigued workers may be more prone to accidents, injuries, near misses and rule violations as expressed by labor, management and government regulators. However, rail safety has improved steadily and a direct relationship between hours worked and the current state of commuter rail safety performance remains to be convincingly demonstrated. Moreover, the impetus to make changes in the existing operating rules and practices is also strongly influenced by operational realities and financial considerations. Consequently, demonstrating a link between operator fatigue, safety performance and financial considerations would be beneficial in driving decision making in commuter rail operations. The present study is designed to explore the possibility of a relationship between hours worked and the cost of worker compensation claims.

Health effects of long work hours have been well documented. For example, Yusaku (2023) found that Japanese workers engaged in overtime had a significantly higher rate of hypertensive intracerebral hemorrhage (ICH), which is a severe life-threatening disease with high mortality. Le et. al. (2022) also concluded that working more than 60 hours per week leads to higher stress, burnout and poorer health. Similarly, data from a longitudinal study in the UK found that working 55 hours/week or more was significantly related to more depressive symptoms among women, while working weekends related to more depressive symptoms for both genders. Obesity is also related to long work hours (Solovieva et al., 2013).

Research over the past 40 years has slowly but steadily consistently documented an association between long work hours and occupational injury rates. Finally, Dembe (2005), in perhaps the best study of this topic, using the data from 10,793 Americans participating in a longitudinal survey evaluating workers' work schedules and occurrence of occupational injury estimated that the relative risk of long working hours per day was associated with a 61% higher injury hazard rate compared to jobs without overtime. Moreover, working at least 12 hours per day was associated with a 37% increased hazard rate and working at least 60 hours per week was associated with a 23% increased hazard rate. The authors concluded that a strong dose-response effect was found such that the injury rate rose in direct relation the number of hours per day worked.

The National Safety Council estimates that the number of lost days in the transportation industry over the past ten years has risen from $12.15 million dollars to over $15 million dollars. (NSC, 2023) The number of persons who have lost more than 31 days due to workplace injury has also increased similarly. These are conservative estimates that do not reflect the full cost in damage to equipment, loss of function and other costs. There is no data available that shows the relationship between long work hours and the costs of occupational injuries in the transportation industry. The present study seeks to fill this gap by investigating the data from a major metropolitan area transit agency.

USDOT Priorities:

The project supports US DOT priorities by investigating factors that contribute to transportation worker safety and health. The project also contributes to US DOT priorities by investigating factors that affect public safety and operational accidents.   

San José State University
Principal Investigator: 
Patrick Sherry, PhD
PI Contact Information:

San Jose State University

Funding Source(s) and Amounts Provided (by each agency or organization): 

$40,000 (federal)

Total Project Cost: 
Agency ID or Contract Number: 
April 2024 to December 2024
Implementation of Research Outcomes: 

The outputs of this project will include a full report describing the relationship between work hours and worker health and safety. Data will be provided that demonstrates the strength of this relationship. Moreover, the report will also include policy recommendations for improving worker scheduling.

Impacts/Benefits of Implementation: 

The two main outcomes expected from this research will be policy and technology. The policy outcomes will be recommendations and guidelines that will suggest work schedules that have a positive safety benefit. The second main outcome will be the provision of algorithms that can be used to assess the risk associated with long work hours.

Project Number: 



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