Health conditions and occupational injuries in formal and informal employment: evidence from a national population-based survey in Chile

Background Informal employment represents a substantial share of the labor force in many middle-income countries and is often associated with weaker occupational safety regulation and limited access to occupational health protections. Although growing evidence suggests that health conditions are associated with occupational injuries, little is known about whether these associations differ between formal and informal employment contexts. This question is particularly relevant in settings where informal employment remains widespread. Methods This study used nationally representative data from the CASEN 2024 survey in Chile. After applying the predefined inclusion criteria and survey expansion weights, the analytical sample represented approximately 8.52 million workers. Survey-weighted logistic regression models accounting for the complex sampling design were used to examine the associations between health conditions, functional limitations, and occupational injuries occurring during the previous three months. Fully adjusted models included demographic, socioeconomic, occupational, and employment-related covariates. Interaction terms were used to assess whether these associations differed between formal and informal workers. Results Overall, 0.75% of workers reported an occupational injury during the three months preceding the survey. Diabetes (AOR = 1.71, 95% CI: 1.16–2.52) and other unspecified health conditions (AOR = 1.88, 95% CI: 1.36–2.59) were significantly associated with higher odds of occupational injury. Among functional limitations, physical or mobility difficulties (AOR = 1.80, 95% CI: 1.26–2.57) and hearing difficulties (AOR = 1.76, 95% CI: 1.09–2.85) were also significantly associated with occupational injury. No statistically significant interactions were observed between health conditions or functional limitations and employment status. Informal workers reported a lower prevalence of occupational injuries, and the sensitivity analysis restricted to injuries requiring medical attention yielded findings generally consistent with the primary analyses. Conclusions Health conditions and functional limitations were associated with higher odds of occupational injuries among Chilean workers. These associations were broadly similar among formal and informal workers, suggesting that health-related vulnerabilities are associated with occupational injury risk across employment contexts. The lower prevalence of reported occupational injuries among informal workers may reflect differences in reporting practices and work interruption behaviors. The main findings remained generally consistent when the analysis was restricted to occupational injuries requiring medical attention. Strengthening occupational health surveillance and prevention strategies that account for workers’ health status across both formal and informal employment contexts may contribute to improving worker safety and reducing occupational injury risk.