Comparative Effectiveness of Occupational Health Control Strategies in Mitigating Chronic Disease Among Oil Drilling Workers
Abstract
The hierarchy of controls framework prioritizes engineering solutions over administrative measures and personal protective equipment, yet oil drilling operations typically invert this approach. This mixed-methods comparative effectiveness study evaluated 400 workers across 15 drilling sites implementing different control strategies over 18 months. Engineering-dominant sites demonstrated 61% lower chronic respiratory disease incidence (HR=0.39, 95% CI: 0.23-0.66) and 56% lower musculoskeletal disorders (HR=0.44. 95% CI: 0.28-0.69) compared to PPE-reliant sites. Cost-effectiveness analysis revealed engineering controls achieved N19,840,000 ($12,400) per Quality-Adjusted Life Year (QALY) gained versus N82,880,000 ($51,800) for administrative controls and N109,120,000 ($68,200) for PPE programmes. However, engineering control effectiveness degraded 47% over 18 months without adequate maintenance, while administrative compliance declined from 78% to 34%. Qualitative analysis identified six implementation barriers: capital investment resistance (87% of sites), production-safety conflicts (73%), maintenance system inadequacy (93%), management turnover disrupting continuity (67%), worker skepticism from past failures (73%), and chronic disease invisibility preventing urgency (93%). Findings demonstrate engineering controls' superior effectiveness and cost-efficiency while revealing that implementation sustainability determines real-world impact. Meaningful chronic disease prevention requires regulatory mandates prioritizing engineering solutions, adequate maintenance systems, organizational accountability for health outcomes, and long-term monitoring capturing delayed disease manifestations.
Keywords
hierarchy of controls
engineering controls
chronic occupational disease
comparative effectiveness
cost-utility analysis
implementation sustainability
References
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