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Background: Chemical occupational accidents remain a critical threat to worker safety in China, but existing research has often failed to capture the complex, nonlinear, multi-factor coupling mechanisms underlying accident causation. Methods: This mixed-methods study analyzed 154 Chinese chemical occupational accident cases by integrating grounded theory and fuzzy-set qualitative comparative analysis (fsQCA). Employing the three-stage coding process of grounded theory (open, axial, and selective) to identify key causal factors, the study then used fsQCA to explore the configuration paths leading to both high- and low-severity accidents. Results and discussion: Grounded theory analysis identified 55 preliminary categories, 16 main categories, and 5 overarching core categories: safety culture, safety management system, safety capability, safety behavior, and worksite condition. These categories form the basis of the proposed Latent-Active Accident Causation Model (LA-ACM), which classifies them into latent conditions and active failures. FsQCA revealed four high-severity paths, namely safety culture-driven, safety management-dominated, safety capability-deficient, and multi-triggered, and two low-severity paths, including safety behavior-induced and worksite condition-triggered. Accordingly, a two-tier risk prevention framework was proposed: the "latent condition rectification layer" targets systemic gaps, and the "active failure interception layer" addresses on-site risks. This study underscores the theoretical implications for upstream safety governance and offers practical strategies to reduce the frequency and severity of chemical occupational accidents.
Wang et al. (Mon,) studied this question.