4.1. Findings
Our study of 22 thoroughbred horse farms and the injury incidents reported by workers to managers on these farms reveals three main findings: (1) it describes the nature of injuries that occur on thoroughbred farms, (2) it reports on the relative frequency of horse-related injuries compared to non-horse related injuries, and (3) it provides information about the demographic composition of farmworkers and injured farmworkers who reported injuries. Although our research design collected more detailed information about worker demographics and events leading up to the injury than is included national injury surveillance systems—including information about ethnicity—it was still limited by the fact that workers must have reported an injury to a manager, supervisor, or other farm representative in order to have been included in our analysis. Thus, we are careful to note that these injuries may not reflect the full spectrum of every injury experienced on these farms. Yet, these findings are important because scant literature exists on injuries to workers on horse farms. As such, this is one of the first studies to describe patterns of injuries associated with handling horses known for their strength, quick responses, and high-strung temperaments. It is also one of the first studies to offer details about a previously understudied and vulnerable workforce in the equine sector of the agricultural industry.
Our first finding relates to the diagnosis and distribution of injuries reported on thoroughbred farms. Nearly a third of the injuries fell into the most common category, “general injuries”, a term that was ascribed to injuries without a specific diagnosis. Because these injuries did not include a diagnosis they may be less severe than injuries that were documented by a health care provider (e.g., “employee was holding a foal’s back leg while brushing and foal kicked employee in forehead”). If one adopts this interpretation, these findings indicate that minor injuries may be relatively common on horse farms, especially among individuals working directly with horses. This may explain the discrepancy with findings from a Japanese study of thoroughbred worker injuries obtained from hospital records which showed a preponderance of contusions, fractures, and abrasion/laceration as the most dominant injuries sustained [
11]. Because hospitalization was required for inclusion in that study, minor injuries would not have been included. However, it is also possible that these injuries simply may not have been described in sufficient detail in the injury logs, which argues for making the case to farm representatives to include more detail in injury reporting to enable researchers a better ability to determine causation and make helpful recommendations to improve farm and worker outcomes.
After “general injuries”, the most common injury diagnosis was musculoskeletal sprains, strains, and tears. The prevalence of these injuries reveals the strenuous nature of the work, which is often comprised of bending, twisting, and throwing while mucking or sweeping stalls. These tasks, and the particularly high postural load inherent in stable work, have been documented by Swedish riding instructors and stable hands [
13,
14], among whom mucking (removal of manure) and handling straw or hay were responsible for the greatest work load.
Taken together, upper limbs and extremities were most frequently injured at the farms in our sample, followed by ankles, feet, and toes. The frequency of upper limb and extremity injuries is consistent with musculoskeletal discomfort in riding instructors in Sweden [
13] and a NIOSH review of injuries documented in the thoroughbred and standard-bred industries in the USA [
5]. Both upper and lower limb and extremity injuries are consistent with hospitalization records of thoroughbred workers in Japan [
11] and “sports related injury riding” patients in the U.K. [
34]. This finding lends support to the idea that the nature of injuries sustained by horse workers may be different than those experienced by those riding for sport or pleasure, in which head injuries have historically been more prevalent [
4,
35]. It also supports the argument that severe injury prevalence among riders is shifting from the head to upper and lower extremities [
34], perhaps due to the increased use of helmets among riders. Moss
et al.’s [
34] recommendation to develop and promote protective gear for the upper and lower extremities, particularly the wrist, may prove fruitful for horse farmworkers.
Despite the higher frequency of injuries in the upper and lower limbs in general, in our sample, head and chest injuries were more frequently experienced by workers performing horse-related tasks compared to tasks not directly involving a horse. Given the potentially critical nature of injuries to the head or chest, strategies to prevent these injuries by protecting these areas remain important.
Our second finding focuses on the mechanism of injuries and the relationships that horse-related tasks and non-horse related tasks have with injuries on these farms. General injuries, contusions, and injuries to the head and chest more often happened when working with horses, while non-horse related tasks were more often associated with injuries to the back and spine, knee, and neck as well as musculoskeletal sprains, strains and tears; irritation; and stings. These findings show that while the horse accounts for the greatest threat, there are many facets of working on a horse farm that carry risk of injury.
Kicks were the most common mechanism of injury among our sample, consistent with injuries incurred by Japanese thoroughbred workers [
11]. When combined with being struck by, trampled, bitten, jerked, or falling from the animal, horses themselves accounted for half of all injuries. This is not surprising, the horse is a frequently unpredictable animal whose well developed fight or flight instinct may cause it to react to even small changes in the environment [
29,
36]. In fact, several researchers have concluded that increased exposure to horses was more influential than experience regarding one’s risk of injury [
3,
35]. Our finding that the animal provides the greatest source of injuries on the farm is consistent with a review of workers’ compensation claims related to livestock operations in Colorado [
8]; however, the proportion of injuries attributed to the horse in our sample (50.0%) was even higher than the 31% attributed to livestock handling in that study.
It should be noted that nearly half of all injuries on the farm involved mechanisms and tasks that don’t directly involve the animal, such as mucking stalls; performing farm maintenance or landscaping with machinery, equipment, or tools; or lifting heavy loads. This is an important distinction to make on horse farms due to the wide variety of tasks to which workers may be exposed. Depending on the size and organization of the farm, these tasks could be delegated to different worker groups (e.g., grooms vs. maintenance) or to the same worker (e.g., general farm hand).
Our third finding pertains to the demographic information this study provides relative to employees’ injury experiences on horse farms. Similar to farms in other agricultural sectors [
37,
38,
39], farms in this study’s sample heavily depend on Latino workers, who held half of all farmworker positions in the sample. The injuries reported, however, were not equally divided between Latinos and non-Latinos. There are several possible reasons for this. First, the information on worker injuries is inclusive of all workers on the farms—frontline workers as well as supervisors and managers. Reports from farm representatives indicate that managers and supervisors on thoroughbred horse farms are more likely to be non-Latino, and because of their leadership role on the farm may be more likely than frontline workers to report an injury when it occurred. Second, Latino workers may have underreported injuries to their supervisor. Research conducted with vulnerable worker groups, like immigrant farmworkers who may fear retribution or termination if injured, indicates that they may be reluctant to report injuries to supervisors [
29,
40]. A study of injuries among Latino farm workers, from the worker perspective, revealed that one out four had been injured in the last year [
24]. Such findings expose limitations in surveillance mechanisms that rely on workers reporting injuries to a manager for them to be counted [
41]. Consequently, a worker may be a more reliable source of information about employee health than a farm representative, and that information is not available in this analysis.
In light of these limitations, we found no differences in the specific diagnoses or distribution of the injuries reported by ethnicity. This suggests the type and location of the injuries may be similar for all workers, regardless of ethnicity. In contrast, differences in the specific mechanism of the injuries were found between Latino and non-Latino workers. Latinos were more likely to report being struck by or trampled by a horse than non-Latinos, while non-Latino workers were more likely to report injuries involving insects or plants. This former finding may be attributed to an increased prevalence of Latino workers in jobs directly related to working with horses or indicative of Latinos not receiving adequate training that may reduce trampling or struck-by incidents. It’s also possible that Latinos may be more likely to report more severe events (e.g., trampled by a horse), than seemingly “minor” events (e.g., insect or plant-related incident). Future research is needed to better understand the nuances surrounding injuries experienced by Latino and non-Latino farmworkers, and to better understand what factors may contribute to differences between the two worker populations.
4.2. Limitations
This exploratory study is part of a larger effort to delineate the inherent hazards, injuries, and work organization factors on horse farms, which are chief employers of a non-English speaking workforce. Its mixed-methods research design, which incorporates both qualitative and quantitative data collection in addition to formal and informal injury logs, helps to address inherent difficulties in standard injury surveillance programs, including the lack of contextual information about events leading to injuries, limited demographic information about workers, and the omission of small employers from reporting requirements.
However, it is also limited by its design in the following ways. First, we cannot presume that our small, nonrandom sample is representative of all horse farms, as participating farms may have been more motivated to participate because they have strong health and safety programs in place. Also, although 32 farms participated in the survey, only 22 were included in the final analysis due to their providing information about recent injuries or illnesses. Some farms did not provide data because they reported that no injuries were experienced in the past five years. Other farms did not keep records or declined to share this information. As such, the injury information garnered from farm records and conversations may be inherently biased. Further, despite our attempt to mimic the size distribution of the industry, which is predominantly composed of small farms, the reality is that small farms are often run by a single or small staff of manager/owners who do not have much time to spare. Although we contacted a greater number of small farms, a greater percentage of medium and larger farms consented.
Another limitation is that exposure of different worker groups is not assessed in this analysis, though we learned that the positions and schedules vary according to responsibility. Animals need care and feeding every day of the week, every month of the year. Consequently, the workers in charge of caring for horses work long weeks, with a six-day workweek being an industry standard for grooms. This schedule is intense, with little time away from work to recover, and significant exposure to the animals. Evidence from a small study of horse and crop workers suggests that increased work hours increases the odds of work-related injury [
24]. Further information about the work environment at the farm and the experiences of the workers should be gathered in order to assess the relationship between work schedules, exposure, and injury risk.
It should be noted that the injuries reported in this study do not necessarily reflect all injuries that occurred on the farms in the sample over a five-year period. Some farms in our sample provided information about injuries that occurred in the past five years; other farms only included injuries that had occurred in the past year, or verbally described recent injuries experienced. Consequently, these injuries are illustrative of the types of injuries that may occur on farms and the demographic profile of the workers they impact.
Through the mixed-methods research design, and the collection and triangulation of multiple types of data, an effort was made to minimize the limitations associated with national surveillance mechanisms. Despite these efforts, standardized injury logs were a primary source of data for many of the injuries in the analysis and are limited in similar ways, including: (1) the reliance on a manager’s awareness of an injury for it to have been recorded, (2) the absence of demographic data such as age or ethnicity on many standardized injury logs. Collecting data from multiple sources enabled many of these limitations to be overcome; however, missing data remained in many of these fields, which should be considered when interpreting the analysis. Even with these limitations, because so little is known about the work tasks, hazards and injuries experienced by horse workers, this descriptive information is important for determining priorities for future research.
