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DURHAM, N.C. – Despite changes made at a chicken processing plant in eastern North Carolina since being cited by state inspectors in 1989, employees there continue to suffer from a host of musculoskeletal injuries of the hands, arms and neck.

Duke University Medical Center occupational medicine researchers who conducted the latest study believe that the pace and pressures of the work need to be reduced to protect workers from injury. However, they added, a number of economic, social and political factors could complicate these efforts.

The researchers studied the Perdue Farms chicken plant in Lewiston, N.C., whose approximately 2,500 workers process more than 400,000 chickens a day. It is located in an economically depressed area where there are few opportunities for employment.

In the current study of 291 women, almost all of whom were African-American, the researchers found high rates of pain and disorders in their wrists, shoulders and forearms, particularly, as well as increasing risk with increasing exposure, according to Hester Lipscomb, Ph.D., associate professor of occupational and environmental medicine at Duke University and senior author of the study appearing in the latest issue of the American Journal of Industrial Medicine.

Levels of work exposure were based on the time the women worked in the industry as well as the department in which they worked. Women in the study came from a variety of jobs in the plant, ranging from those performing lower-risk work such as inspection to those doing high-risk activities such as gutting, deboning and cutting up chickens.

In 2000, women from the community around the plant approached Duke researchers because of continued concerns about the health of the poultry workers.

"The women reported that their upper extremity problems were often dismissed as being the result of obesity or child care responsibilities or mental health problems," Lipscomb said. "However, while the levels of obesity and depression are of concern to us, our analysis found that these factors do not explain the high incidence of musculoskeletal problems separate from their work exposures and physical pathology."

The Duke team trained five women from the community to recruit and interview the workers after hours and weekends about their working conditions and physical symptoms. Trained nurses performed the medical exams and all the data collected was analyzed by Duke researchers. A total of 987 interviews and physical exams were performed -- 291 at baseline and 696 at follow-up.

Currently, no federal health and safety agencies regulate line speeds of poultry plants. However, the U.S. Department of Agriculture (USDA) sets maximal line speeds to ensure food safety, without regard for worker safety.

"Since the USDA began setting line speeds in 1968, the pace has increased from less than 20 birds a minute to the current maximum of 91 birds a minute," Lipscomb said. "Reducing the health exposures for these women in the current political climate could be difficult, considering the occupational health and safety guidelines are based on voluntary compliance."

Lipscomb also found that women who were worried about losing their job during the first encounter with the study team were more likely to be identified as having a new musculoskeletal disorder at a follow-up visit.

"We hypothesize that women with high job insecurity may continue to work despite symptoms and without seeking treatment, which may lead to more serious disorders later," Lipscomb said. "The plant we examined is in a poor rural area with an African-American majority population. The average pay is eight dollars an hour, and even at that low rate, these are considered some of the better paying jobs in the area."

Earlier published work from this study identified that the poultry workers had significantly more musculoskeletal symptoms than women in other low-wage jobs in the same geographic area as well as more depressive symptoms.

Other authors of the current report include Kristen Kucera, Carol Epling and John Dement. The study was supported by the National Institute of Environmental Health Sciences and the National Institute of Arthritis, Musculoskeletal and Skin Diseases.