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International Journal of
Environmental Research
and Public Health
Article
Prohibition on Changing Workplaces and Fatal
Occupational Injuries among Chinese Migrant
Workers in South Korea
Ju-Yeun Lee 1and Sung-il Cho 1,2,*
1The Department of Public Health Science, Graduate School of Public Health, Seoul National University,
Seoul 08826, Korea
2Institute of Health and Environment, Seoul National University, Seoul 08826, Korea
*Correspondence: persontime@hotmail.com
Received: 21 August 2019; Accepted: 9 September 2019; Published: 10 September 2019
Abstract:
We assessed the risk of fatal occupational injuries among migrant workers with two different
types of employment permits in South Korea. This observational study used national data from
January 2007 to September 2018 and analyzed 42,089 cases of occupationally injured migrant workers
of Chinese nationality. Fatality rates were analyzed according to year, sex, age, occupation, industry,
and type of employment permit. Chinese workers were permitted to work for one employer and
prohibited from changing employers, whereas Korean-Chinese workers were permitted to change
their employer. The adjusted fatality rate of occupational injuries of Chinese migrant workers was
significantly higher (1.80-fold, 95% confidence interval 1.31–2.46) than that of Korean-Chinese migrant
workers. The prohibition on changing workplaces; male sex; age
≥
45 years; machine operator;
construction industry; and agriculture, livestock, and fisheries industry were risk factors for fatal
occupational injuries. The results imply a need for revision of the migrant-worker employment
permit systems and implementation of occupational safety and health policies for all workers to
promote health equity.
Keywords:
migrant worker; risk factor; workplace change; occupational injury; fatality; occupational
safety and health
1. Introduction
Worldwide, 2.3 million workers die annually due to occupational injuries and diseases [
1
].
Migrant workers have greater adverse occupational exposure and worse working conditions than
native workers, resulting in adverse health outcomes such as fatal occupational injuries [
2
]. In 2013,
the number of migrant workers reached 150.3 million globally [
3
], and labor migration between
countries and continents is now a permanent feature of the global economy [4].
Although the occupational safety and health (OSH) of migrant workers is a global issue, only a
few studies have investigated the related risk factors. While not specialized for migrant workers’
OSH, a conceptual model for integrated approaches to protection and promotion of worker health [
5
]
helps understand risk factors in workplaces. The model shows that workplace policies, programs,
and practices may concurrently affect the conditions of work through many pathways, e.g., the physical
work environment, job tasks and demands. Conditions of work are affected by policies that determine
health and safety outcomes. Policies are also emphasized in the “conceptual framework of OSH
vulnerability” and there are strong associations among OSH vulnerability, policy, and the prevalence of
workplace injury [
6
]. According to the framework, OSH vulnerability results from exposure to hazards
in the workplace and inadequate mitigation resources. Migrant workers are generally included in
Int. J. Environ. Res. Public Health 2019,16, 3333; doi:10.3390/ijerph16183333 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2019,16, 3333 2 of 14
this “vulnerable” category and in South Korea they are no exception to this. In addition, there is an
unusual policy-prohibition on migrant workers changing workplaces in South Korea. Migrant workers
experience higher levels of policy and procedure vulnerability [
7
] although policies protecting migrants’
rights may result in lower injury rates [
8
]. In this regard, it is necessary to find out whether the policy of
prohibition on changing workplaces affects the OSH of migrant workers, however, no related research
has been conducted so far.
South Korea is one of the major destination countries for migrant workers in Asia. Two kinds of
permits are available under the Employment Permit System (EPS), a dependent employment permit
and a work permit, although the latter are not common in South Korea. Migrant workers in other
major destination countries usually work with a work permit. The policy of prohibiting a change of
workplace is a distinguishing factor of working conditions for migrant workers who hold a dependent
employment permit. Such migrant workers may not work for another employer unless the current
employer breaks the law or the business closes [
9
]. The prohibition may make fatal occupational
injuries more frequent because migrant workers are forced to either accept dangerous workplaces or
change jobs without permission to avoid the danger. One survey in South Korea showed that poor
working conditions are the main reason that migrant workers want to move to other workplaces [
10
].
The EPS instituted a government-to-government labor recruitment program to reduce the cost of
migration, the majority of which is funded by debt [
11
], a major cause of overwork among migrant
workers [
12
]. Despite the reduction in the cost of migration, the EPS has not enhanced the OSH of
migrant workers. The rate of occupational injuries and disease among migrant workers increased from
0.96% in 2007 (when the EPS was initiated) to 1.08% in 2014, while the rate among native workers
decreased from 0.71% to 0.51% during the same period [13,14].
The two migrant-worker employment permit systems can be evaluated by comparing groups of
migrant workers of Chinese nationality with similar migration histories. The work permit system only
applies to workers of Korean descent and Korean Chinese people account for 95.7% of all workers of
Korean descent [
15
]. In September 2018, about 41.1% (n=215,665) of documented migrant workers
were of Chinese nationality [
13
]. Korean-Chinese and Chinese migrant workers share a language and
culture because they are of the same nationality. Korean-Chinese people are the descendants of those
who migrated to China after the 19th century due to famine, natural disasters, and the conquest of
Korea by Japan, but did not return when the Communist Party of China came to power in 1949 and
severed diplomatic relations with South Korea [
16
]. In the late 1980s, when South Korea was in the
midst of rapid economic development, Korean-Chinese migrants entered the country to visit relatives
and began to sell Chinese goods. In the early 1990s, the South Korean government began to allow
the entry of migrant workers of other nationalities. Migrant workers can be hired only by small and
medium-sized companies that are unable to recruit suitable native workers.
Korean-Chinese and Chinese migrant workers may also differ in terms of their ability to change
jobs, Korean language proficiency, and whether they have relatives in South Korea. These factors
may impact the fatality rate of occupational injury (FROI). Also, previous studies cite a lack of labor
rights, restricted access to family and other support systems [4], and the xenophobic political climate
of the host country [
2
] as risk factors for adverse occupational exposure and working conditions for
migrant workers.
In this study, we determined whether the FROI differed due to prohibition on changing workplaces
between Korean-Chinese and Chinese migrant workers. In addition, we identified the risk factors for
fatal occupational injuries among Chinese migrant workers in South Korea. This is the first study of
the effects of the prohibition on changing workplaces on the FROI of migrant workers.
Int. J. Environ. Res. Public Health 2019,16, 3333 3 of 14
2. Materials and Methods
2.1. Data
We used data from the Korea Workers Compensation and Welfare Services (KCOMWEL).
The KCOMWEL is a national agency that manages all claims for compensation due to occupational
injuries and diseases. Raw de-identified data were obtained from the KCOMWEL website through
an information request system [
17
]. The data title is “Status of Occupational Injuries and Diseases of
Migrant Workers”. The data are comprised of migrant workers’ claims for compensation from January
2007 to September 2018. The study was approved by the institutional review board (IRB) of Seoul
National University.
The annual data comprised work-related injuries and diseases with fatal and non-fatal outcomes,
causes and sites of injuries, demographic variables (e.g., sex, age, and nationality), and employment
variables (e.g., occupation and industry). According to the KCOMWEL definitions, occupational injuries
were defined as those that occurred while workers were engaged in work-related activities,
including commuting (after 2018), that required >4 days of medical treatment. From 2007 to
2018, there were a total of 71,593 occupational injury or disease compensation claims, of which 42,089
were filed by migrant workers of Chinese nationality. The exclusion criteria were as conservative as
possible to ensure generation of reliable results. Selection of the study population is shown in Figure 1.
Int. J. Environ. Res. Public Health 2019, 16, x 3 of 14
The data are comprised of migrant workers’ claims for compensation from January 2007 to September 2018.
The study was approved by the institutional review board (IRB) of Seoul National University.
The annual data comprised work-related injuries and diseases with fatal and non-fatal outcomes,
causes and sites of injuries, demographic variables (e.g., sex, age, and nationality), and employment
variables (e.g., occupation and industry). According to the KCOMWEL definitions, occupational injuries
were defined as those that occurred while workers were engaged in work-related activities, including
commuting (after 2018), that required >4 days of medical treatment. From 2007 to 2018, there were a total of
71,593 occupational injury or disease compensation claims, of which 42,089 were filed by migrant workers
of Chinese nationality. The exclusion criteria were as conservative as possible to ensure generation of
reliable results. Selection of the study population is shown in Figure 1.
Figure 1. Selection of the study population.
The study population comprised migrant workers of Chinese nationality whose workers’
compensation claims due to occupational injuries were approved. We defined migrant workers as persons
of non-Korean nationality working under the EPS irrespective of their legal status. The Ministry of
Employment and Labor of South Korea has, as of September 2018, issued memoranda of understanding on
migrant workers with the governments of China, Vietnam, Sri Lanka, Uzbekistan, Indonesia, Thailand, the
Philippines, Nepal, Mongolia, Pakistan, Bangladesh, Cambodia, Myanmar, Kyrgyzstan, East Timor, and
Laos [18]. The population of South Korea includes 2.3 million immigrants (>4%), of whom 525,000 are
documented workers under the EPS. These workers originate from China (41.1%, 215,665 workers),
Cambodia (7.5%, 39,122), Vietnam (7.3%, 38,075), and Nepal (6.5%, 33,906) at the end of September 2018
Figure 1. Selection of the study population.
Int. J. Environ. Res. Public Health 2019,16, 3333 4 of 14
The study population comprised migrant workers of Chinese nationality whose workers’
compensation claims due to occupational injuries were approved. We defined migrant workers
as persons of non-Korean nationality working under the EPS irrespective of their legal status.
The Ministry of Employment and Labor of South Korea has, as of September 2018, issued memoranda
of understanding on migrant workers with the governments of China, Vietnam, Sri Lanka, Uzbekistan,
Indonesia, Thailand, the Philippines, Nepal, Mongolia, Pakistan, Bangladesh, Cambodia, Myanmar,
Kyrgyzstan, East Timor, and Laos [
18
]. The population of South Korea includes 2.3 million immigrants
(>4%), of whom 525,000 are documented workers under the EPS. These workers originate from China
(41.1%, 215,665 workers), Cambodia (7.5%, 39,122), Vietnam (7.3%, 38,075), and Nepal (6.5%, 33,906) at
the end of September 2018 [
13
]. As of the second half of 2018, 522,595 migrant workers were employed
by companies that were members of the Korea Workers Compensation Insurance, which covers 67,138
workplaces [19].
2.2. Measures
This observational study evaluated risk factors for fatal occupational injuries by comparing
the FROIs of two groups of migrant workers of Chinese nationality. The FROI is defined as the
proportion of occupational deaths among migrant workers as a result of occupational injuries. We used
FROI as the outcome variable because the death count was the most reliable measure due to the
high rates of under-reporting, particularly by migrant workers in South Korea. According to the
OSH Research Institute of South Korea, over 70% of migrant workers who suffered an occupational
injury failed to file claims for workers’ compensation [
20
]. A poor organizational safety climate,
including management values, safety communication, safety training, and safety systems, leads to a
high rate of under-reporting [
21
]. We thus assumed that the incidence of occupational injuries among
migrant workers in South Korea had been underestimated. The difference in legal status, language,
and culture, along with the high rate of under-reporting migrant workers makes it difficult to directly
compare FROIs of migrant and native workers. The FROI of Korean-Chinese migrant workers was
used as the reference. The workers were 15–104 years of age. Four subjects aged over 90 years old
were considered outliers and removed from the analysis. The remaining workers aged from 15 to 81
years were categorized into quintiles.
Korean-Chinese migrant workers have the right to employment of their choice under the
working-visit system of the EPS. To assess the effect of the prohibition on changing workplaces,
we compared the FROIs of Korean-Chinese and Chinese migrant workers with adjustment for year, sex,
age, occupation, industry, and site of injury. Since the start of the EPS, there have been two revisions to
the law regarding the prohibition on migrant workers changing workplaces, one on
9 October 2009
and the other on 1 February 2012. Migrant workers with a dependent employment permit may apply
for a workplace change only for special reasons. The 2009 revision slightly expanded the “special
reasons,” and the 2012 revision clarified these reasons by providing examples; the restriction on
changing workplaces remained in place. We divided the study period into three parts by the years in
which revisions were issued to also assess the longitudinal effect of the related policies.
The employment of migrants is tightly controlled by the EPS with regard to both the annual
numbers and the types of positions. The occupations classified by the seventh Korea Classification
of Occupational Standards were divided into the four employment categories in which migrant
workers were most frequently employed: manager and service workers; agriculture, livestock,
and fisheries workers; machine operators; and elementary workers. Managers and service workers
were grouped together due to the low fatality rates [
22
] in these categories. Considering that only
non-professional migrant labor is permissible by the EPS, we interpreted “manager” as indicating a
worker who has worked a little longer than other workers in their field, or an independent business
owner. “Machine operator” included craft and related trades workers, equipment or machine
operators, and assembly workers (e.g., food processing, wood and furniture, dyeing and molding,
and metal-casting workers).
Int. J. Environ. Res. Public Health 2019,16, 3333 5 of 14
Nine industries were classified into five categories in which migrant workers could be employed:
manufacturing, construction, service, agriculture, livestock, and fisheries. However, because there were
few claims for workers’ compensation from the agriculture, livestock, and fisheries industries, we treated
these as a single unit-agriculture, livestock, and fisheries (ALF). Furthermore, the transportation and
delivery industries were classified as other, and the sales, food, and accommodation sectors were
pooled as the service industry, in which Korean-Chinese workers account for 93.3% of the migrant
workers [
23
]. The site of injury leading to death was classified according to the International Statistical
Classification of Diseases and Related Health Problems, 10th revision (ICD-10), as head and neck,
extremity, trunk, and whole body (including multiple-site injuries).
2.3. Statistical Analysis
The data from 42,089 migrant workers of Chinese nationality were analyzed in three stages.
First, a chi-squared test was used to determine whether the FROI differed significantly according to
the characteristics of the study population. Second, differences in the FROIs of each covariate were
compared between the Korean-Chinese and Chinese migrant workers. Third, we identified risk factors
for fatal occupational injuries using three logistic regression models with adjustment for covariates.
R software (version 1.0.153) (useR, St. Louis, USA) was used to conduct all statistical analyses.
3. Results
3.1. FROI by Characteristics
The FROIs of the study population are listed in Table 1. FROIs did not differ significantly between
the Korean-Chinese and Chinese migrant workers according to their characteristics. Male workers had
a higher mean FROI (1.89%) than female workers (0.48%). The FROIs decreased annually and increased
with worker age. The FROI of machine operators was the highest (2.34%), followed by those of ALF
workers (1.74%) and elementary workers (1.36%). The industry with the highest fatality rate was
construction (2.74%), followed by ALF (2.23%). The service and other industries had similar fatality
rates, but the former had a lower FROI. The most frequent causes of mortality were whole-body injuries
(25.95%) and head and neck (7.36%) injuries. The most frequent cause of a claim for compensation
was injury to the extremities. The whole-body injuries included falls from a height, systemic burns,
poisoning, multiple injuries, suffocation, and drowning.
There were differences in the causes of death due to occupational injuries according to the group
and industry variables (Table 2). Collision (including falling from a height, being struck by a flying
object, and being pinned under a collapsed structure) was the most common cause of mortality due to
occupational injury for all occupations and industries. The deaths of machine operators had various
causes, among which collision was the most frequent; the rates of other causes of mortality were
similar. Cuts were the second most frequent cause of death among machine operators and elementary
workers, and involved hypovolemic shock caused by stabbing or amputation. More than half of
the deaths of workers in the construction industry were due to collision. Suffocation caused by fire,
explosion, poison, or drowning was the second most frequent cause of occupational mortality in the
service industry. The rate of suffocation was higher among Chinese workers (20.27%) than among
Korean-Chinese migrant workers (11.36%). Although rolling/jamming was not always fatal, it was the
major cause of permanent disability of migrant workers. In some cases, the cause of mortality was not
identified; these cases were classified as “other”.
Int. J. Environ. Res. Public Health 2019,16, 3333 6 of 14
Table 1. FROI aaccording to subjects’ characteristics (chi-squared test) (n=42,089).
Variables Total
FROI a
n%n%p-Value #
42,089 100.00 686 1.63
Group 0.97
Korean-Chinese 32,987 78.37 538 1.63
Chinese 9102 21.63 148 1.63
Year <0.01
2007–2009 7515 17.86 174 2.32
2010–2011 14,765 35.08 250 1.69
2012–2018 19,809 47.06 262 1.32
Sex <0.01
Female 7875 18.71 38 0.48
Male 34,214 81.29 648 1.89
Age <0.01
15–28 2130 5.06 16 0.75
29–36 5134 12.20 62 1.21
37–44 8307 19.74 110 1.32
45–53 13,737 32.64 234 1.70
54–81 12,781 30.37 264 2.07
Occupation <0.01
Manager & Service worker 9248 21.97 84 0.91
ALF bworker 516 1.23 9 1.74
Machine operator 15,665 37.22 367 2.34
Elementary worker 16,660 39.58 226 1.36
Industry <0.01
Manufacturing 16,845 40.02 186 1.10
Construction 13,873 32.96 380 2.74
ALF b1166 2.77 26 2.23
Service 6772 16.09 45 0.66
Others 3433 8.16 49 1.43
Site of Injury <0.01
Head & Neck 4703 11.17 346 7.36
Extremity 31,542 74.94 30 0.10
Trunk 5031 11.95 99 1.97
Whole body 813 1.93 211 25.95
Fatality Rate of Occupational Injury
Agriculture, Livestock and Fisheries
Note:
#
All p-values were from chi-squared tests.
a
Fatality Rate of Occupational Injury,
b
Agriculture,
Livestock and Fisheries.
3.2. FROIs of Korean-Chinese and Chinese Migrant Workers
The FROIs of Chinese migrant workers according to their characteristics were equal to or greater
than those of the Korean-Chinese migrant workers (Table 3). The average age of the Korean-Chinese
migrant workers was 48.2 years (median 49 years), compared to an average age of 43.79 years (median
44 years) for the Chinese migrant workers. The FROI of Chinese migrant workers working in ALF
(2.55%) was higher than that of Korean-Chinese migrant workers doing the same work, and higher
than that of Chinese migrant workers doing other jobs.
Int. J. Environ. Res. Public Health 2019,16, 3333 7 of 14
Table 2.
Mechanisms of deaths due to occupational injuries according to subjects’ characteristics
(n=686).
Variables
Collision Cuts Suffocation Rolling/Jamming Others Total p-Value #
n%n%n%n%n%n%
Group 0.04
Korean-Chinese
278 51.77 101 18.81
61
11.36
33 6.15 65
11.92 538 78.43
Chinese 75
50.68
23
15.54
30
20.27
9 6.08 11 7.43
148 21.57
Occupation 0.06
Manager & Service worker
44
52.38
11
13.10
19
22.62
3 3.57 7 8.33 84
12.24
ALF aworker 4
44.44
1
11.12
4
44.44
0 0.00 0 0.00 9
1.31
Machine operator
184 50.14
66
17.98
50
13.62
25 6.81 42
11.44 367 53.50
Elementary worker
121 53.54
46
20.35
18
7.96
14 6.19 27
11.96 226 32.94
Industry <0.01
Manufacturing 71
38.17
40
21.51
25
13.44
29
15.59
21
11.29 186 27.11
Construction
222 58.42
67
17.63
39
10.26
6 1.58 46
12.11 380 55.39
ALF a13
50.00
4
15.38
7
26.93
2 7.69 0 0.00 26
3.79
Service 17
37.78
6
13.33
13
28.89
1 2.22 8
17.78
45
6.56
Others 30
61.22
7
14.29
7
14.29
4 8.16 1 2.04 49
7.14
aAgriculture, Livestock and Fisheries. #All p-values were from chi-squared or Fisher exact tests.
Table 3. FROI aof Korean-Chinese and Chinese migrant workers (n=42,089).
Variables
Korean-Chinese (n=32,987) Chinese (n=9102)
p-Value #
nDeath FROI a(%) nDeath FROI a(%)
Sex 0.08
Female 6114 26 0.43 1761 12 0.68
Male 26,873 512 1.91 7341 136 1.85
Year <0.01
2007–2009 5109 105 2.06 2406 69 2.87
2010–2011 12,205 221 1.81 2560 29 1.13
2012–2018 15,673 212 1.35 4136 50 1.20
Age <0.01
15–28 873 1 0.11 1257 15 1.19
29–36 3653 39 1.07 1481 23 1.55
37–44 6282 78 1.24 2025 32 1.58
45–53 11,552 192 1.66 2185 42 1.92
54–81 10,627 228 2.15 2154 36 1.67
Occupation <0.01
Manager & Service worker 7415 68 0.92 1833 16 0.87
ALF bworker 359 5 1.39 157 4 2.55
Machine operator 12,531 288 2.30 3134 79 2.52
Elementary Worker 12,682 177 1.40 3978 49 1.23
Category of Business <0.01
Manufacturing 12,533 143 1.14 4312 43 1.00
Construction 11,413 298 2.61 2460 82 3.33
ALF b931 21 2.26 235 5 2.13
Service 5334 35 0.66 1438 10 0.70
Others 2776 41 1.48 657 8 1.22
Injury Site <0.01
Head & Neck 3720 282 7.58 983 64 6.51
Extremity 24,493 24 0.10 7049 6 0.09
Trunk 4148 79 1.90 883 20 2.27
Whole body 626 153 24.44 187 58 31.02
a
Fatality Rate of Occupational Injury,
b
Agriculture, Livestock and Fisheries,
#
all p-values were from chi-squared test.
The differences in FROI between the two groups according to year allowed us to gauge the effect of
the two revisions to the law regarding the prohibition on changing workplaces. Unlike Korean-Chinese
migrant workers, the FROI of Chinese migrant workers did not show a decreasing tendency over
time. The FROI of Chinese migrant workers decreased after 2009, when the first revision occurred,
but increased after 2012, when the second revision took place. Based on the different trends in the FROI
Int. J. Environ. Res. Public Health 2019,16, 3333 8 of 14
between the two groups, we evaluated the interaction effects between group and year, controlling for
other variables (sex, age, occupation, and industry) (Figure 2). The interaction plot showed the odds
ratios for fatalities in the two groups according to year. The odds ratios were calculated by multiplying
the odds ratios from Model 3 (Table 4).
Table 4.
Odds ratios for fatality rate of occupational injuries between Korean-Chinese and Chinese
migrant workers by models.
Variables Model 1 Model 2 Model 3
OR a95% CI bOR a95% CI bOR a95% CI b
Group
Korean-Chinese 1.00 - 1.00 - 1.00 -
Chinese 1.22 1.01–1.47 * 1.18 0.97–1.42 1.80 1.31–2.46 ***
Year
2007–2009 1.00 - 1.00 -
2010–2011 0.70 0.57–0.86 *** 0.85 0.67–1.09
2012–2018 0.48 0.39–0.58 *** 0.57 0.45–0.72 ***
Group:Year
Chinese * (2007–2009) 1.00 -
Chinese * (2010–2011) 0.45 0.27–0.74 **
Chinese * (2012–2018) 0.58 0.37–0.90 *
Sex
Female 1.00 - 1.00 - 1.00 -
Male 2.86 1.96–4.01 *** 2.80 1.95–4.00 *** 2.81 1.96–4.02 ***
Age
15–28 1.00 - 1.00 - 1.00 -
29–36 1.49 0.87–2.63 1.49 0.85–2.59 1.46 0.84–2.54
37–44 1.52 0.90–2.61 1.46 0.86–2.50 1.45 0.85–2.47
45–53 2.06 1.20–3.40 ** 2.03 1.21–3.41 ** 2.01 1.19–3.37 **
54–81 2.47 1.42–3.99 ** 2.54 1.51–4.26 *** 2.53 1.50–4.24 ***
Occupation
Manager & Service worker 1.00 - 1.00 - 1.00 -
ALF cworker 0.75 0.34–1.65 0.78 0.35–1.73 0.79 0.36–1.75
Machine operator 1.38 1.00–1.88 * 1.35 0.99–1.85 1.37 1.00–1.87
Elementary worker 0.79 0.56–1.09 0.78 0.56–1.08 0.79 0.56–1.10
Industry
Service 1.00 - 1.00 - 1.00 -
Manufacturing 1.10 0.71–1.70 1.06 0.69–1.64 1.06 0.68–1.63
Construction 2.40 1.56–3.68 *** 2.48 1.62–3.80 *** 2.46 1.61–3.76 ***
ALF c2.13 1.21–3.77 ** 1.96 1.10–3.50 * 1.92 1.08–3.44 *
Others 1.34 0.84–2.14 1.26 0.78–2.02 1.24 0.77–2.00
Note: Estimates were obtained by logistic regression with logit as a binomial link function. Model 1 was adjusted
for sex, age, occupation, and industry. Model 2 added year to Model 1 for confounding factors. Model 3 showed
interactions between group and year variables.
a
OR: Odds Ratio,
b
CI: Confidence Interval,
c
Agriculture,
Livestock and Fisheries, * p<0.05, ** p<0.01, *** p<0.001.
Int. J. Environ. Res. Public Health 2019,16, 3333 9 of 14
Int. J. Environ. Res. Public Health 2019, 16, x 8 of 14
Figure 2. Group and year interaction odds ratio plot.
3.3. Factors Associated with Fatal Occupational Injuries
The FROI of Chinese migrant workers was significantly higher (1.80-fold, 95% CI 1.31–2.46 in
Model 3; 1.22-fold, 95% CI 1.01–1.47 in Model 1) than that of Korean-Chinese migrant workers (Table
4) after controlling for the confounding effects of sex, age, occupation, and industry in Model 1 and
for those of year and the group–year interaction in Model 3. Model 2 was controlled for year as well
as for the variables in Model 1, but it did not yield a significant difference in the fatality rates of the
two groups. We used the stepwise method to identify the best-fitting model and checked the
goodness of fit using the Hosmer-Lemeshow test.
Table 4. Odds ratios for fatality rate of occupational injuries between Korean-Chinese and Chinese
migrant workers by models.
Var i ab le s
Model 1 Model 2 Model 3
OR a 95% CI
b OR
a 95% CI
b OR
a 95% CI
b
Grou
p
Korean-Chinese 1.00 - 1.00 - 1.00 -
Chinese 1.22 1.01–1.47 * 1.18 0.97–1.42 1.80 1.31–2.46 ***
Year
2007-2009 1.00 - 1.00 -
2010-2011 0.70 0.57–0.86 *** 0.85 0.67–1.09
2012-2018 0.48 0.39–0.58 *** 0.57 0.45–0.72 ***
Grou
p
:Year
Chinese *
(
2007–2009
)
1.00 -
Chinese *
(
2010–2011
)
0.45 0.27–0.74 **
Chinese *
(
2012–2018
)
0.58 0.37–0.90 *
Sex
Female 1.00 - 1.00 - 1.00 -
Male 2.86 1.96–4.01 *** 2.80 1.95–4.00 *** 2.81 1.96–4.02 ***
A
g
e
15–28 1.00 - 1.00 - 1.00 -
29–36 1.49 0.87–2.63 1.49 0.85–2.59 1.46 0.84–2.54
37–44 1.52 0.90–2.61 1.46 0.86–2.50 1.45 0.85–2.47
45–53 2.06 1.20–3.40 ** 2.03 1.21–3.41 ** 2.01 1.19–3.37 **
54–81 2.47 1.42–3.99 ** 2.54 1.51–4.26 *** 2.53 1.50–4.24 ***
Occu
p
ation
Mana
g
er & Service worker 1.00 - 1.00 - 1.00 -
ALF c worker 0.75 0.34–1.65 0.78 0.35–1.73 0.79 0.36–1.75
Machine o
p
erator 1.38 1.00–1.88 * 1.35 0.99–1.85 1.37 1.00–1.87
Elementar
y
worker 0.79 0.56–1.09 0.78 0.56–1.08 0.79 0.56–1.10
Industr
y
Figure 2. Group and year interaction odds ratio plot.
3.3. Factors Associated with Fatal Occupational Injuries
The FROI of Chinese migrant workers was significantly higher (1.80-fold, 95% CI 1.31–2.46 in
Model 3; 1.22-fold, 95% CI 1.01–1.47 in Model 1) than that of Korean-Chinese migrant workers (Table 4)
after controlling for the confounding effects of sex, age, occupation, and industry in Model 1 and for
those of year and the group–year interaction in Model 3. Model 2 was controlled for year as well as
for the variables in Model 1, but it did not yield a significant difference in the fatality rates of the two
groups. We used the stepwise method to identify the best-fitting model and checked the goodness of
fit using the Hosmer-Lemeshow test.
The FROI did not differ according to age until subjects were in their mid-40s. Compared to
subjects 15–28 years of age, the FROIs of those aged 45–53 years and 54–81 years were more than
two-fold higher. Thus, age
≥
45 years was a risk factor for fatal occupational injury. Machine operators
had a significantly higher (1.38-fold, 95% CI 1.00–1.88, Model 1) FROI than managers and service
workers. The ORs of the construction and ALF industries were significantly higher using the service
sector as the reference industry. Therefore, machine operating and the construction and ALF industries
were associated with fatal occupational injuries among migrant workers.
4. Discussions
We evaluated factors associated with fatal occupational injuries among migrant workers in
South Korea using data from 42,089 Chinese migrant workers from January 2007 to September
2018. The results showed that the prohibition on changing workplaces; male sex; age
≥
45 years;
machine operator; and the construction and agriculture, livestock, and fishery industries were risk
factors for occupational injuries among migrant workers.
A high FROI may indicate the occurrence of occupational injuries of greater severity.
Whole-body injuries were overwhelmingly fatal (Table 1). Chinese migrant workers had a higher
rate of whole-body injuries and higher FROIs for the injury sites (Table 3). Alternatively, a high
FROI may indicate limited access to medical services. Because the data used do not indicate legal
status, identifying differences in access to medical services between the two groups was difficult.
Changing workplaces without permission changes the worker’s legal status and results in forced
deportation. Therefore, Chinese migrant workers are more likely to become undocumented migrants
than Korean-Chinese migrant workers. With a high rate of under-reporting of occupational accidents,
many migrant workers are treated under national health insurance. Undocumented migrants are
Int. J. Environ. Res. Public Health 2019,16, 3333 10 of 14
not eligible for health insurance, so their access to healthcare is restricted, encouraging delay or
abandonment of treatment.
The FROI of Chinese migrant workers after controlling for the potential confounding effects of
covariates was 1.80-fold higher in Model 3 and 1.22-fold higher in Model 1 than that of Korean-Chinese
workers. The difference in FROIs between the two groups was tied to our second research question,
namely, identifying the risk factors of occupational fatal injury. The following parameters need to
be considered when comparing the two groups: (1) Korean language proficiency, (2) the presence of
family and relatives in South Korea, and (3) the prohibition on changing workplaces.
First, the language barrier is not an important issue in South Korea because all migrant workers,
including Korean-Chinese migrant workers from EPS countries, are required to score well on the
official Employment Permit System Test of Proficiency in Korean before beginning employment.
Although Korean-Chinese workers have better proficiency in the Korean language than do Chinese
migrant workers, Chinese migrant workers achieve higher scores than EPS workers from other
regions [
24
], which prevents any conclusion on the impact of fluency in the Korean language on the
incidence of fatal occupational injuries. Moreover, prior studies on language barriers as a risk factor
for occupational injury have reported inconsistent results [
25
,
26
]. Several studies from the US and
Gulf Cooperation Council countries found that a language barrier was a risk factor [
2
,
27
]. In contrast,
a study in Lebanon showed that 80% of fatally injured non-Lebanese workers spoke Arabic, the native
language of that country [
26
]. A study in South Korea suggested that lack of communication, but not
language proficiency, was a risk factor as 80% of migrant workers were Korean-Chinese and were
bilingual [
28
]. The risk related to a language barrier varies depending on the recruiting system for
migrant workers in the host country. A lack of communication, e.g., no or inaccurate work instructions,
rather than Korean language proficiency is more likely to be associated with fatal occupational injuries
in South Korea.
Second, the right to family reunification for migrant workers in South Korea is restricted. Until 2007,
Korean-Chinese migrants could obtain a labor visa only if they were invited by relatives residing in
South Korea; since then, they can be granted a visa without an invitation. However, such visas do not
allow migrant workers to bring their families with them. It is important to note that access to family
support is not only a basic human right but also an important protective factor from occupational
injury [
4
]. The Korean-Chinese migrant workers were not in a better position than the Chinese workers
in this regard.
Therefore, the prohibition on changing workplaces, rather than language proficiency and
access to family, likely explains the disparity in the incidence of fatal occupational injuries between
Korean-Chinese and Chinese migrant workers. Additionally, the interaction effect between group and
year (Figure 2) supports this conclusion because only the policy changed during the duration of this
study. The EPS, which deprives workers of a free choice of employment had a greater deleterious
impact on the fatality rate of occupational injuries to migrant workers than did the work permit
system. South Korea has adopted a no-settlement principle for migrant workers, which includes a
prohibition on changing workplaces. This could jeopardize the rights of migrant workers and impact
their occupational health [
2
]. Limiting the freedom to leave employment means that workers are
thoroughly subordinate to their employers. Prohibition on changing workplaces may also be used as a
proxy for employers to force migrant workers to do dangerous work. Migrant workers who leave
their jobs without permission are subject to deportation or become undocumented. This situation
results in increased risk and severity of occupational injuries and hampers access to medical services.
The prohibition on changing workplaces has been criticized, and its abolition has been recommended
by the UN Committee on the Elimination of Racial Discrimination (CERD) [
29
], the committee of
experts of the International Labor Organization (ILO) [
30
], and the UN General Assembly Human
Rights Council [
31
] for promoting forced labor and human trafficking. Despite this international
criticism, the provision remains in place.
Int. J. Environ. Res. Public Health 2019,16, 3333 11 of 14
The prohibition on changing workplaces has a negative impact on the health of migrant workers,
and its maintenance lacks a scientific basis. According to the precedent statement and the International
Organization for Migration (IOM) report, the provision exists for economic reasons. The EPS was
instituted to address manpower shortages at small and medium-sized enterprises, and the South
Korean government accepted employers’ claims that they would suffer from wage hikes [
10
]. However,
on average, Korean-Chinese migrant workers change workplaces 1.27 times during their stay in South
Korea according to the 2015 policy report of the IOM Immigration Policy Research Institute, a UN
migration agency established based on a special relationship with the South Korean government.
Migrant workers tend to change workplaces to overcome complex issues such as the labor environment,
labor intensity, or human relations, rather than to obtain an increased wage, unless there is a prohibition
in place [
10
]. Financial status is not a major consideration when migrant workers decide to change
workplaces. Therefore, abolition of the provision may not disrupt the labor supply or lead to continuous
wage increases.
Expanding the scope of the law regarding changing workplaces could affect the FROI of migrant
workers (Figure 2). Permission to change workplaces was limited by the law to cancellation or
termination of a work contract, temporary or complete closure of a business, cancellation or restriction
of employment permits, and injury of workers; all are related to employers. The possibility of changing
workplaces was increased slightly by the addition of “violation of working conditions, unfair treatment”
to the law at the end of 2009; indeed, this resulted in a rapid decrease in the FROI of Chinese migrant
workers compared to that of Korean-Chinese migrant workers. In contrast, the revision in early 2012
only clarified the scope of the law, but the subsequent increase in the FROI of Chinese migrant workers
suggests that expanding the possibility of changing workplaces was of limited utility in terms of
reducing the fatality rate of workers.
Injured male migrant workers were more likely to die than were injured female migrant workers.
However, in South Korea, only workers who meet the criteria of the Labor Standards Law can claim
workers’ compensation under the Korea Workers’ Compensation Insurance Act. It is thus possible
that some female migrant workers were unable to claim workers’ compensation because they were
not legally defined as workers. In the case of domestic workers who perform domestic duties such
as cleaning, cooking, and looking after children or elderly people [
9
], the overwhelming majority
were female and 92.8% were classified as self-employed; i.e., not legal workers [
32
]. Being male
is reportedly a risk factor for migrant workers, but there are marked disparities in mental-health
outcomes, cancer rates, occupational injuries, and reproductive-health outcomes between male and
female workers [
2
]. Females comprise only 8.8% of non-professional migrant workers in South Korea,
but 40.4% of all migrant workers of Korean descent [
13
]. The different employment patterns of female
and male migrant workers may mean that they face different occupational hazards.
Age
≥
45 years was a risk factor for fatal occupational injuries among migrant workers, as reported
previously [
4
,
25
]. In contrast, older native workers in the US had a low injury rate. This was attributed
to the healthy worker effect whereby older workers retire from high-risk jobs or move to less demanding
jobs [
33
,
34
]. However, no such effect was identified for older migrant workers who may need to remain
in high-risk occupations [25,35].
Machine operation was the highest-risk occupation, and construction and ALF were the most
physically demanding industries. Only machine operators had a significantly high risk of occupational
injury, compared to managers and service workers. Construction and ALF were risk factors for fatal
occupational injuries, consistent with previous reports [
36
,
37
]. The ALF industry had a high FROI but
few (n=26) fatalities, suggesting that ALF workers could not claim workers’ compensation unless
they were severely injured.
This study has several limitations. First, persons not defined as workers according to South Korean
law are omitted from the workers’ compensation claims data; thus, further studies that include such
workers are needed. Second, the occupational categories may have been inaccurate. The colleagues or
agents who reported deaths may have misclassified the occupation of the deceased [
38
]. Despite these
Int. J. Environ. Res. Public Health 2019,16, 3333 12 of 14
limitations, we used FROI as the dependent variable because data on workers’ compensation for fatal
occupational injuries provide reliable information about occupational deaths [
39
,
40
], and because
mortality data are the most reliable measure when under-reporting rates are high.
A longitudinal follow-up study of the health of migrant workers is needed to ascertain whether
the prohibition on changing workplaces affects not only occupational injuries but also occupational
diseases. Because this was basically an observational cross-sectional study, we could not control for
missing or unmeasured factors, and were unable to establish causality. The importance of this study
lies in its comparison of recruitment systems and it being the first investigation of the effect of the
prohibition on migrant workers changing workplaces on fatal occupational injuries.
5. Conclusions
We compared two groups of migrant workers of Chinese nationality with different types of
employment permits under the EPS. Of the two types of permits, it was found that the FROI for the
group with the dependent employment permit, which prohibits changing workplaces was significantly
higher. The status of occupational injuries and diseases of migrant workers’ data revealed the
prohibition on changing workplaces to be a risk factor for fatal occupational injury. Additionally,
male sex; age
≥
45 years; machine operator; construction; and the agriculture, livestock, and fishery
industries were associated with fatal occupational injuries among migrant workers in South Korea.
Policies to improve the recruiting system and to strengthen workplace safety measures for better OSH
of migrant workers are the responsibility of the global community as well as local governments and
businesses. Ultimately, preventing occupational injuries to migrant workers in high-risk occupations
will improve the health of all workers.
Author Contributions:
Conceptualization, J.-Y.L. and S.C.; Formal Analysis, J.-Y.L.; Methodology, S.C.;
Supervision, S.C.; Writing–Original Draft, J.-Y.L.; Writing–Review & Editing, S.C.
Funding:
This research did not receive any specific grant from funding agencies in the public, commercial,
or not-for-profit sectors.
Conflicts of Interest: The authors declare no conflict of interest.
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