Traffic injuries and work-related health problems are among the leading causes of death worldwide.1,2 However, previous literature has pointed out that, although traffic injuries occurring during work activities represent a significant proportion of occupational fatalities in industrialized countries, research on the underlying risk factors remains limited.3 These incidents harm companies through productivity loss, legal issues, and reputational damage, while also burdening public health systems, lowering household income, and reducing overall economic participation.4 This study aims to analyse these broader social impacts, understood as externalities that, although originating in the business sphere, also affect communities and national economies.

Understanding the root causes of work-related road traffic injuries is essential for designing effective prevention strategies.5 Corporate measures can thus complement public policy efforts to reduce risk.6 These injuries intersect two domains, traffic and occupational risks, and should be classified as either “while on mission” (during work duties) or “in itinere” (commuting to or from work).

A substantial body of literature has explored various factors to explain both occupational and traffic-related injuries, although traditionally approached individually. Among other factors, the literature highlights that weather conditions are a significant factor in work-related road injuries.5,7,8 Similarly, macroeconomic indicators also influence these injuries.7,9,10 Unemployment11,12 and gross domestic product (GDP)13 are commonly used to represent economic activity and employment status.

Socioeconomic factors such as population density and education levels are also relevant.7,14 Another socioeconomic factor often linked to both types of injuries is alcohol consumption and policies aimed at limiting it.15

Legislative measures, such as the penalty point system, have been studied as playing a key role in reducing traffic-related injuries.5,16 Similarly, the literature emphasizes that enforcement and monitoring strategies are crucial for influencing traffic behavior.17

Road conditions and infrastructure investment significantly affect injury risk for all road users, including cyclists and pedestrians.18 Likewise, exposure, measured in vehicle kilometres travelled, and motorization rate are key variables.5,19

Finally, gender differences are observed in the literature, particularly in studies on work-related injuries. The relationship is not entirely clear. For example, injury rates during working hours are significantly higher among men, whereas commuting-related injury rates are higher among women.20

The study contributes to the literature by addressing both injury severities together, an approach rarely taken, thus improving the understanding of shared risk factors. It builds a robust provincial-level database, primarily using official records provided by the Spanish Ministry of Labour and Social Economy, along with other publicly available official sources. The study introduces a methodological innovation by adapting the data to estimate the social costs of work-related traffic injuries.

Sex-based disaggregation allows for the inclusion of a sex perspective, highlighting potential structural inequalities in occupational traffic risks. Spanish provinces are a suitable unit of analysis due to the availability of longitudinal data and their diverse labour policies, sectoral structures, and mobility patterns.5,7

This study analyses factors influencing the social costs of serious and slight work-related road injuries in Spanish provinces (2011–2022), disaggregated by workers’ sex, using panel data regression.

Table 5 presents the results of the models that distinguish between three types of work-related road injuries: “while on mission” (IM) during the workday, “in itinere” commuting to work (ITC), and “in itinere” returning from work (ITR). These models are further disaggregated by sex and by the two levels of severity considered: serious and slight injuries.

The models show a good level of fit: both the R2 values and the overall significance measured through the Wald test are favourable and statistically significant in all cases (the p-value is less than 0.05; see Table 5). This indicates that the explanatory variables considered jointly explain the social cost derived from injuries, whether serious or slight, per MVKT. Especially in the models of slight severity (since in these cases the R2 is greater than 0.89).

The results are notably heterogeneous, which is expected given that, although all cases are road-related, the work moments in which they occur are different and may influence the physical and mental state of the worker.

Firstly, precipitation significantly increases the costs of slight injuries in ITC for both sexes (women=2.63; men=4.18), suggesting greater vulnerability during commutes to work under adverse weather conditions. This effect is also observed in the costs of slight IM injuries for both sexes (women=2.63; men=5.19) and in serious ones for women (women=2.01). The unemployment rate is associated with a reduction in the social cost of injuries, especially in men, for whom the effect is significant in all cases except in serious ITC injuries. This negative association was expected, as unemployment reduces exposure to work-related road risks. However, exceptions were found in serious injuries among women commuting to work (women=2.84) and men returning from work (men=1.68).

Traffic volume increases the cost of injuries mainly in men, although a relevant impact is also observed in women in cases of slight injuries. Regarding replacement investment, it presents a residual and non-uniform effect, with impacts in opposite directions in ITC injuries for women-serious (women=1.93) and men-slight (men=–2.89). On the other hand, construction investment shows positive effects in several models, especially in men, although a stronger effect stands out in women in the costs of serious IM injuries (women=2.85), which could reflect that infrastructure improvements do not translate into a reduction of the cost impacting society.

Motorization rate and the proportion of high-capacity roads have mixed effects, with negative impacts on injury costs, especially in male models. However, it is important to highlight that when significant effects coincide in both sexes for the variable of road proportion, such as in slight ITC injuries (women=–2.63; men=–2.42) and serious ITR injuries (women=–1.83; men=1.82), the effect is stronger in women.

Reports of drug and alcohol use and speeding are significantly related to the social costs of injuries. For drug and alcohol-related offences, the effect is particularly notable in IM injuries cost for men, although the impact is mixed (serious=3.65; slight=–5.07). In the case of speeding offences, significant effects were observed in ITR injuries for women (serious=4.93; slight=3.77).

Finally, the annual variation in population density presents a positive significance in IM injuries costs for men (serious=1.90; slight=2.06), but diverse effects in the rest of the models, depending on the type of injury and sex.

Our study aligns with previous research regarding the effects of precipitation and unemployment rates. The results confirm that the increased danger associated with wet road surfaces outweighs the benefits of more cautious driving under adverse weather conditions.5,34,35 Additionally, higher unemployment appears to reduce travel and worker exposure.7,31,36 However, for women with severe injuries in ITC and men with severe injuries in ITR, the unemployment rate shows a positive influence, which may be attributed to stress-related effects.37

Regarding the significant link between the social cost of injuries and traffic volume, our findings are consistent with the literature30: increased exposure outweighs the reduction in speed for both sexes. However, for severe injuries in men, higher traffic volume seems to reduce the social cost, likely due to lower driving speeds.5,38

Overall, the models indicate that construction investment may unintentionally increase social costs due to higher demand and faster driving speeds. Familiarity with roads is also associated with reduced attention and increased risk-taking.39,40 In contrast, replacement investment and high-capacity roads show a negative impact, consistent with previous studies.7,23 On the other hand, motorization rates, which reflect higher levels of exposure, increase social costs in IM and ITC. 22

Variables such as control hours per kilometre, arrests for alcohol and drug consumption, and speeding arrests tend to reduce social costs, supporting previous findings17,27. This reflects improved driver behaviour due to law enforcement. However, in some cases, especially among men, social costs may increase, possibly due to the higher risk associated with substance use among drivers.28 Population density generally has a positive effect, likely due to increased infrastructure demand in certain Spanish provinces. In the case of severe injuries among men, the expected effect is observed: regions with higher population density tend to be more developed and have better public transportation systems.32 These differences between provinces had already been found in previous studies.7

These findings should guide occupational risk prevention. Public administrations and companies must adopt sex-specific policies, as risk factors and injury types differ between men and women.

For women, road safety should prioritize awareness on driving in rainy conditions, promote vehicles with active safety technologies, and address risks linked to urban density and infrastructure. Investment in road safety saves lives, reduces healthcare costs, and benefits public and private budgets. Alcohol- and drug-related arrests are especially effective in reducing female injuries. For men, policies should focus on speed control and exposure to alcohol, drugs, and dense traffic, while infrastructure investment requires careful evaluation. Unemployment management is also key, given its impact on mental health and driving behaviour.

Companies must adapt risk management to employee profiles through fleet safety, psychological support, and wellness programs. Vehicle assignment should consider technologies that mitigate sex-specific risks. Addressing links between unemployment, alcohol, and drug use calls for stronger mental health support during economic uncertainty.

A key limitation in our study is the exclusion of fatalities from the analysis due to zero-inflation in the dependent variable, which also prevents the study of individual-level (e.g., contract type, health) and organizational factors (e.g., sector, workload). Using MVKT as an exposure metric may underestimate risk in regions with high non-motorized mobility or extensive public transport, limiting representativeness in urban contexts. In addition, data from the Basque Country and Catalonia were unavailable. Nonetheless, these constraints open paths for future research, such as microdata-based approaches (structural equation modelling or machine learning) and frameworks to estimate the impact of work- and commuting-related injuries through willingness-to-pay methods.

This study highlights practical implications for policymakers and businesses: integrating the social costs of traffic injuries into corporate mobility and occupational safety strategies. These costs go beyond finances, encompassing healthcare, productivity, and quality of life, aligning decision-making with corporate social responsibility. In a context of rising regulatory and social demands, companies are expected to measure, and report risks transparently. For example, Redeia, a Spanish company listed on the Ibex-35, offers a notable example with its cost-benefit methodology in occupational health. The proposed approach provides tools to quantify externalities, support decisions, and prioritize preventive measures, advancing Sustainable Development Goals such as health, decent work, and sustainable cities. Ultimately, integrating these measures into strategic planning fosters safer, fairer, and more sustainable mobility, benefiting both workers and society.

All the data used in the empirical analysis are publicly available, except for the databases on injuries, known as ‘ACCIDENTES DE TRABAJO,’ which were provided to the authors by the Spanish Ministry of Labour.

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  [dataset] Directorate General for Traffic. (2011–2022). General Statistical Yearbook. Madrid.

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  [dataset] Directorate General for Traffic. (2011–2022). Statistical Yearbook of Accidents. Madrid.

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  [dataset] MAGRAMA. (2011–2022). Chapter 1. Territory. In MAGRAMA, Statistical Yearbook.

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  [dataset] MAGRAMA. (2011–2022). Chapter 2. Climatology and hydrology. In MAGRAMA, Statistical yearbook.

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  [dataset] Ministry of Public Works and Transport. (2011–2022). Statistical yearbook. General Directorate of Economic Planning and Budgets, General Subdirectorate of Economic Studies and Statistics. Madrid.

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  [dataset] National Statistics Institute. (n.d.). Consumer Price Index.

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  [dataset] National Statistics Institute. (n.d.). Economically Active Population Survey.

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  [dataset] National Statistics Institute. (n.d.). Official population figures from Spanish municipalities: Revision of the Municipal Register.

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  [dataset] Ministry of the Interior. (2011-2022). Traffic and road safety. Data from the Traffic Grouping of the Civil Guard (ATGC). Madrid.

David Cantarero.

The corresponding author, on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described.

All authors have contributed indistinctly to the conception, planning, data collection, analysis and interpretation, preparation and writing of the manuscript, critical review of the manuscript and final approval.

The publication of this study has been funded by the Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) in the framework of the “Convocatoria abierta de ayudas para la publicación en Gaceta Sanitaria”.

None.

The Social Research Ethics Committee of the University of the authors of the manuscript favourably approved the research project with reference number CEIS-2024-52505.