Work disability among sugarcane agroindustry workers in Brazil: an ecological study (2012–2021)Abstract
Objective To analyze the social security work-related temporary disability benefits granted to workers in the Brazilian sugarcane agroindustry, comparing groups engaged in manual and mechanized activities.
Methods This ecological study used secondary data on formal employment and social security benefits from 2012 to 2021. Annual and cumulative incidence rates over the study period were calculated, stratified according to manual and mechanized activity groups, as well as relative risks (RR) between groups.
Results A total of 102,974 benefits were granted, with 76.4% occurring among workers engaged in manual activities and 23.6% among those in mechanized activities, corresponding to cumulative incidence rates of 32.5 and 26.9 per 1,000 workers, respectively. The RR was 1.21, indicating higher risk among workers performing manual activities. For work-related benefits, the RR was 1.69. Musculoskeletal disorders (MSD) were more frequent among workers in manual activities (26.3%) than among those in mechanized activities (20.7%). The main cause for granting accident-related benefits in the first group was dorsalgia (16.7%), whereas wrist and hand fractures predominated in the second group (12.3%).
Conclusion There was a reduction in benefits over the study period. The frequency of MSD was higher among workers performing manual activities, whereas traumatic injuries were more frequent among those engaged in mechanized activities. Investments in training, safety, regulatory enforcement, and improvements in working conditions are needed in the sugarcane sector.
Keywords
Automation; Rural Workers; Sugarcane; Social Security; Occupational Health
Resumo
Objetivo Analisar os benefícios por incapacidade temporária concedidos a trabalhadores da agroindústria canavieira brasileira, comparando os grupos que realizam atividades manuais e mecanizadas.
Métodos Estudo ecológico com dados secundários sobre vínculos formais de trabalho e benefícios previdenciários, no período 2012-2021. Calcularam-se taxas de incidência acumuladas e anuais para o período, estratificadas segundo os grupos de atividades manuais e mecanizadas, e riscos relativos (RR) entre os grupos.
Resultados Foram concedidos 102.974 benefícios, sendo 76,4% no grupo de atividades manuais e 23,6% de mecanizadas, com taxas de incidência acumuladas de 32,5 e 26,9 por 1.000 trabalhadores, respectivamente. O RR foi de 1,21, indicando maior risco no grupo das atividades manuais. Para benefícios acidentários, o RR foi de 1,69. Distúrbios musculoesqueléticos (DME) foram mais frequentes no grupo das atividades manuais (26,3%) do que no das mecanizadas (20,7%). A principal causa de benefícios acidentários no primeiro grupo foi dorsalgia (16,7%) e, no segundo, fraturas de punho/mão (12,3%).
Conclusão Houve redução dos afastamentos no período. A frequência de DME foi maior no grupo das atividades manuais e a ocorrência de traumas acidentais foi maior no das mecanizadas. São necessários investimentos em capacitação, segurança, fiscalização e melhorias nas condições de trabalho no setor sucroalcooleiro.
Palavras-chave
Mecanização; Trabalhadores Rurais; Cana-de-Açúcar; Previdência Social; Saúde do Trabalhador
Introduction
Brazil is one of the leading producers of sugarcane and its derivatives. In 2022, 38% of the world’s planted area for this crop was located within the country’s borders1. The country is the largest producer and exporter of sugar, its main derivative product, in the international market. In terms of production, during the 2020/21 harvest, Brazil produced 23% of the world’s sugar and accounted for 50% of the sugar sold globally during the same period2.
Brazil’s leading role in the global sugar market stems from the crop’s long history in the country. With nearly 500 years of cultivation, sugarcane fields and their manufacturing processes have undergone numerous transformations. More recently, particularly since 2007, Brazilian sugarcane fields have experienced a new wave of change with the intensification of agricultural mechanization, mainly during the harvesting and planting phases3-4.
The harvest mechanisation has grown exponentially in recent years. In 2007/2008, only 24.4% of the harvest was done by machine, and ten years later, and in subsequent periods, this percentage exceeded 90%5. The mechanization of work processes in Brazilian sugarcane fields has had a direct impact on the workforce, as one of the main effects of incorporating mechanical technologies was the reduction of manual work jobs.
In light of these developments, it is evident that the composition of the sugarcane workforce has changed due to the increased proportion of workers operating machinery. To understand these changes, it is important to note that the ratio of workers engaged in manual versus mechanized activities was approximately 92% manual to 8% mechanized in 2008. In 2018, this ratio shifted to approximately 71% and 29%, respectively6.
The transformations in the sugarcane sector are not limited to structural changes or productive restructuring. As noted in the bibliometric study by Lima, Coelho, and Araújo7, health and safety issues are among the main topics addressed in research on labor in sugarcane fields. The category of labor within the sugarcane sector demands particular attention: first, due to its historical roots linked to slavery in Brazil8 and, second, because of the direct relationship between sugarcane labor and labor overexploitation9.
Given the nature of their production model and the factors inherent to the work process and environment, sugarcane workers face numerous occupational hazards. Among the most common risks are exposure to non-ionizing radiation, chemical agents, the lack of biomechanical and organizational ergonomics, and the risk of accidents10-11. The negative health repercussions affect various systems and organs of the human body, such as the respiratory, circulatory, renal, and musculoskeletal systems10-11. Another effect resulting from this combination is work-related physical exhaustion, which ultimately renders the worker temporarily or permanently unable to work10-11.
Workers may be entitled to a Social Security benefit when afflicted by illnesses that renders them unable to work. If the condition results from a work-related accident or illness, the social security benefit will be classified as accident-related12. The legal criterion for classifying the benefit as work-related — the relationship between the incapacitating illness or condition and working conditions — is determined by applying the social security technical nexus, which can be of three types: a) illness equivalent to a work-related or individual accident; b) occupational or work-related; and c) epidemiological13-15.
Given the socioeconomic importance of the labor market in the sugarcane agroindustry and the associated occupational risks, it is essential to understand the impacts of working conditions on workers’ health in a sector that has undergone recent productive restructuring, with the incorporation of mechanical technologies as the main driver of change. However, there remains a gap in the literature regarding the incidence of occupational diseases and the granting of temporary social security benefits in the sector. Thus, this study aims to analyze the social security work-related temporary disability benefits granted to workers in the Brazilian sugarcane agroindustry, comparing groups engaged in manual and mechanized activities.
Methods
Design
This is an ecological study conducted using secondary data on social security benefits and the formal labor market for sugarcane workers in Brazil.
The time frame adopted spans the years 2012 to 2021. This period was chosen, first, because it follows 2007 — a time of intensified mechanization of sugarcane production processes — and second, because data is available for this period.
Data Sources
Data on social security benefits was accessed via the Smartlab16 platform (https://smartlabbr.org/), which is the database that compiles information related to decent work in Brazil. It is a collaboration between the Public Labor Prosecution Office (MPT) and the International Labour Organization (ILO).
Data on the formal workforce was extracted from the RAIS (Annual Report of Social Information) database, administered by the Brazilian Ministry of Labor and Employment, available for public access at <bi.mte.gov.br/bgcaged/login.php>.
Data extraction
To extract data, adjustments were necessary, considering the seasonality and vertical integration of the areas that make up this sector’s production complex. The sugarcane agro-industrial production complex consists of three major areas: agricultural, industrial, and administrative. The agricultural sector, which is the focus of this study, may have a direct or indirect relationship with the complex; that is, the industries themselves may own plantations or rely on third parties, known as “sugarcane suppliers.” Given this reality, the recommendations of Lima and Carvalho6 were followed to extract information regarding the group of workers who perform work processes in the agricultural sector of the sugar and ethanol industry, who will be referred to here as “sugarcane workers.” The economic activities (National Classification of Economic Activities – CNAE) and occupations (Brazilian Classification of Occupations – CBO) recommended by these authors were used. These adjustments were made due to the particularities that characterize this economic activity in Brazil and are also intended to minimize selection bias.
Data on the formal labor force were extracted from the RAIS database on March 15, 2023. Adjustments aimed at reducing information asymmetries regarding the labor market in relation to the seasonality of the harvest were also made. For the Central-South labor market, we chose to consider all workers employed in these occupations during the calendar year, as the harvest in this region takes place between March and October of the same year. For the North-Northeast region, where the harvest spans two calendar years, we chose to use only data on workers active in December of the year under analysis, as the harvest is at its “peak” of production at that time.
On April 22, 2023, data were extracted on the absences that justified the granting of the sickness benefit (currently temporary disability benefit) and its subcategories — code B31, for non-work-related illness or condition, and code B91, for work-related illness or condition (work-related injury); and the cause of the incapacity, according to the 10th International Statistical Classification of Diseases and Related Health Problems (ICD-10). The data was retrieved again on March 12, 2026, to verify the information.
Data compilation, organization, and analysis
The data was obtained from the Digital Observatory for Occupational Safety and Health (SmartLab) website, under the “Occupational Safety and Health” section, “Sick Leave Profile – INSS” tab. The data was extracted using the “Sick Leave by International Classification of Diseases (ICD-10) – Code” feature. Data on benefits was extracted annually for each year from 2012 to 2021, ensuring the construction of consistent time series. Benefits were extracted separately according to benefit type (B31 and B91) and subsequently aggregated to calculate the total number of absences.
The economic activities corresponding to the following CNAE categories were selected: sugarcane cultivation, refined cane sugar manufacturing, raw sugar manufacturing, and alcohol manufacturing.
In light of the changes that sugarcane plantations have undergone in recent years, shifts in the composition of the workforce have been observed, and the workforce, which was once predominantly manual, has ultimately lost its prominence. Thus, the workforce investigated here was divided into two groups:
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Workers engaged in manual work — responsible for performing manual tasks at various stages of the sugarcane production process, including soil preparation, planting, crop management, and harvesting. This group includes the occupations of “sugarcane field workers,” “agricultural laborers,” and “general agricultural workers”;
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Workers performing mechanized activities — consisting of agricultural machinery operators, including “harvester operators,” “agricultural tractor drivers,” and “agricultural product processing machinery operators.” These occupations are responsible for operating mechanized equipment in sugarcane fields.
The data was compiled by exporting aggregated tables from the SmartLab platform and subsequently organizing them in spreadsheets (Microsoft Excel®). Structured databases were created containing the annual number of benefits by type (B31 and B91), as well as the number of workers in each occupational group.
To ensure data consistency, internal verification procedures were performed, including: (i) checking the completeness of the time series for the period from 2012 to 2021; (ii) comparing aggregate totals with subtotals by occupational category and type of benefit; and (iii) cross-checking the tables by more than one researcher.
Data analysis
The annual incidence rate of benefit grants was calculated for each year and occupational group (total number of workers enrolled in social security, total number of sugarcane workers, mechanized activities group, and manual activities group) as the ratio of the number of benefits granted in the year to the number of workers registered in the same year, multiplied by 1,000.
Similarly, the cumulative incidence rate for the period was calculated by occupational group as the ratio of the total benefits granted from 2012 to 2021 to the total number of workers registered during the same period, multiplied by 1,000.
The relative risk (RR) expresses the strength of the association between the type of work process and the occurrence of the outcome, indicating how many times the event is more (or less) likely in one group compared to the other. RR values greater than 1.0 suggest greater likelihood of occurrence in the exposed group (manual work), while values less than 1.0 indicate protection compared to the reference group (mechanized work).
The RR was calculated based on the ratio of the cumulative incidence rates over the period, between the manual and mechanized work groups. The 95% confidence interval (95% CI) for the RR was calculated using the approximate method based on the log-normal distribution, using the standard error of the natural logarithm of the RR and applying the exponential function to the lower and upper limits.
Results
During the period, an average of 2,214,715 benefits per year were granted in Brazil, for an average of 69,913,514 workers in the labor force. Among workers in the sugarcane sector, 102,974 temporary disability benefits were granted, with 76.4% going to workers in manual labor and 23.6% to workers in mechanized operations. These figures correspond to cumulative incidence rates for the period of 32.5 per 1,000 workers in the manual labor group and 26.9 per 1,000 in the mechanized labor group.
Graph 1 shows the trend in the annual incidence rate of new non-work-related benefits (B31) for all workers covered by social security in Brazil, for all sugarcane workers, and for the groups studied, according to whether they perform manual or mechanized work. During the study period, a reduction in the cumulative incidence rate of benefits for workers in the sector can be observed, with a higher rate among workers performing manual tasks (60.1%) than among workers in mechanized positions (16.4%).
Annual incidence rate of social security benefits for temporary disability (non-work-related – B31) (per 1,000 people in the labor force). Brazil, 2012–2021
Regarding work-related benefits (Graph 2), the annual incidence rate was lower for all workers covered by social security than for the subset of workers in the sugarcane sector in every year of the analysis. Regarding the work process, 15.2% of all claims in manual occupations were B91, while in mechanized occupations they were 11.4%, with this proportion being lower in all years. Furthermore, a sustained decline in claims over time can be observed, with a sharp drop in the first year of the COVID-19 pandemic, followed by a resumption of growth. During the period, there was a total reduction of 75.4% in the subset of sugarcane workers, with a greater decline among those in manual positions (77.9%) than among those in mechanized activities (56.3%).
Annual incidence rate of social security benefits for temporary disability (work-related - B91) (per 1,000 people in the labor force). Brazil, 2012–2021
Graph 3 presents the relative risks (RR), along with their respective 95% confidence intervals (95% CI), for the incidence of temporary disability benefits among workers in manual activities compared with those in mechanized activities. The RR for the period was 1.21 (95% CI 1.19; 1.22). The annual relative risks showed negligible variations throughout the series.
Relative risks (RR), with corresponding 95% confidence intervals, for the incidence of temporary disability benefits among sugarcane sector workers engaged in manual activities (exposure group) compared to workers engaged in mechanized activities (reference group), by type of benefit. Brazil, 2012–2021
In the analysis stratified by type of benefit, the RR for the period was 1.14 (95% CI 1.13; 1.16) for non-accident-related benefits (B31) and 1.69 (95% CI 1.62; 1.76) for work-related benefits (B91).
Regarding the cause of disability, traumatic injuries due to external causes were the main reason for benefit claims overall (31.6%) and in both groups of workers. However, musculoskeletal disorders, which were the second most frequent cause, accounted for a higher proportion in manual occupations (26.3%) than in mechanized occupations (20.7%). This difference is even more pronounced when considering only benefits under category B91, for which musculoskeletal disorders accounted for 40.1% in the manual activities group and only 22.7% in the mechanized activities group (Table 1).
Among the work-related benefits granted (B91), the leading cause was dorsalgia (M54; 16.7%) in the manual activities group, while among workers in mechanized activities, it was fracture at wrist and hand level (S62; 12.3%). It is noted that three of the five leading causes of disability in the manual activities group were musculoskeletal disorders, whereas in the mechanized activities group, only one was. Table 2 presents the ten leading causes for the granting of B91 benefits to workers, according to the manual and mechanized activities groups.
Discussion
This study revealed striking differences in the profile of temporary disability benefit grants among workers involved in the production process in the sugarcane sector, particularly between those performing manual tasks and those assigned to mechanized processes. The higher annual incidence rate of benefits among manual workers points to specific vulnerabilities within this group.
Between 2012 and 2021, a significant reduction in annual benefit grant rates was observed, especially among workers in manual activities. This trend may reflect changes in the production model, such as the advancement of mechanization and the strengthening of preventive measures, but also possible changes in eligibility criteria and barriers to accessing the benefit. Nevertheless, the data reveals that workers in manual occupations remain more susceptible to sick leave (both in absolute and proportional terms), which reinforces the need for specific public policies aimed at protecting this segment.
The literature highlights that, although mechanization has contributed to reducing exposure to unhealthy conditions, distinct occupational risks remain present in both harvesting models. Researchers such as Scopinho et al.17, Silva et al.10, and Lima et al.18 draw attention to the specificities of manual and mechanized work processes in sugarcane fields and their distinct impacts on workers’ health and safety.
In fact, the technological transition has profoundly altered the composition of the workforce in the sector: between 2008 and 2018, there was a 58% reduction in the total number of workers in sugarcane fields, with a 67% decrease among those engaged in manual activities and a 51% increase among mechanized workers6. This restructuring contributed to an overall reduction in disability benefit claims, especially among mechanized workers. However, workers in manual activities remain more exposed to work-related health issues, highlighting persistent inequality in the sector.
The relative risk during the period indicated that the incidence of temporary disability leave was 21% higher among workers in the manual activities group. When analyzing the types of benefits, a relatively higher magnitude was observed in work-related benefits (B91), suggesting an intensification of inequalities associated with manual labor.
The causes of disability also reveal distinct patterns among the occupational groups analyzed. Traumatic injuries were the leading cause of sick leave among both manual and mechanized workers. However, musculoskeletal disorders were the most common among workers engaged in manual labor, accounting for 26.3% of total benefits and 40.1% of accident benefits (B91), compared to 20.7% and 22.7% among workers performing mechanized activities, respectively.
In the study by Ceccato et al.19, which analyzed sick leave due to occupational diseases during a sugarcane harvest among 400 rural workers, musculoskeletal disorders were the leading cause of absences, especially toward the end of the harvest. These findings reinforce the literature on the impact of intense and repetitive physical labor on musculoskeletal disorders among sugarcane cutters, indicating that, even with a reduction in the number of benefits, the burden of morbidity remains strongly associated with unfavorable ergonomic conditions.
Work-related benefits (B91) deserve special attention, as their incidence in the sugarcane sector was consistently higher than the national average throughout the entire period analyzed. The proportion of these benefits (B91) relative to the total benefits granted was higher among manual workers (15.2%) than among those in mechanized activities (11.4%). The reduction observed throughout the historical series was more pronounced during the Covid-19 pandemic period, followed by a resumption of growth, suggesting not only the impact of health dynamics but also potential barriers to reporting.
According to social security legislation, the technical nexus (individual, occupational, or epidemiological) is the instrument that establishes the relationship between the disease and work12-13. The individual technical nexus is based on specific conditions of the work environment, supported by elements of clinical-occupational history and documents such as the Work Accident Report (CAT), and is commonly applied in cases of work-related trauma14-15.
The Social Security Epidemiological Nexus (NTEP) is applicable when the International Classification of Diseases (ICD-10) code for the disabling condition relates to the company’s CNAE code, in accordance with List C of Annex II of Decree No. 3,048/9914-15,20. In the case of CNAE 0113 (sugarcane cultivation), there is an association with several groups of ICD-10 codes, including M40-M54 (dorsopathies), M60-M79 (soft tissue disorders), and S60-S69 (injuries to the wrist and hand), corroborating the relevance of ergonomic conditions and exposure to traumatic risks in this sector13.
The intensive use of machetes at a fast work pace significantly increases the risk of accidents, particularly lacerations and contusions. The main body parts affected in workplace accidents are the hands and fingers18. Despite the mandatory use of personal protective equipment (PPE), this equipment is often inadequate, nonexistent, or provided without proper training. When available, PPE is often damaged, which increases the risk of accidents or exacerbates the health effects on workers. Melo21, in analyzing hand injuries among sugarcane cutters, identified this structural weakness in protective equipment.
Additionally, the survey by Lima et al.18 shows that workers in mechanized activities are more exposed to more serious accidents, with fatality rates higher than those observed in manual activities. This reality reinforces the need for intensified oversight by public agencies10.
Although less frequent than in manual work, accidents in mechanized work tend to be more severe, involving falls, collisions, burns, and crush injuries during activities that go beyond machine operation18. Many workers in mechanized activities, given the versatility required, are responsible for transporting and maintaining the machinery, thereby increasing the risk of accidents9,22. During the night shift, risks increase due to drowsiness, low visibility, and fog10-11. Outside the harvest season, workers often take on additional tasks such as planting and maintenance, increasing their workload and exposure to occupational risks different from their usual routine10-11.
Additionally, an analysis of the specific causes of B91 benefits shows that three of the five leading causes among workers performing manual activities are musculoskeletal disorders, notably back pain (M54), which accounts for 16.7% of claims. Among mechanization workers, however, wrist and hand fractures (S62) predominate, suggesting a more accidental and sporadic pattern related to specific events, as opposed to the chronic overload evident in manual occupations.
Manual sugarcane cutting requires intense physical exertion, as cutters perform thousands of spinal flexions and rotations during their work9, which, combined with a productivity-based pay policy, imposes exhausting work rhythms and reduced breaks, exacerbating health problems23. Messias et al.24 report that, for most of the time during experiments simulating the motion of cutting sugarcane, the angles of shoulder flexion and abduction remained above the limits considered safe, indicating a high risk of injury to this joint. In addition, cutting workers are responsible for loading and stacking the sugarcane to facilitate transport by machinery. The combination of these activities increases physical strain, as many workers repeatedly carry approximately 15 kg of cut sugarcane in their arms over distances of 1.5 to 3 meters throughout the workday9,25. The overexploitation of the body results in severe musculoskeletal disorders, leading to a process of chronic physical wear and tear—a reality highlighted by Cruz9, who states that the bodies of the cutters are transformed into veritable “bagasse”.
Although mechanization has reduced manual work positions, the remaining workers face even more intense workdays. Competition with machines imposes new productivity standards that directly influence workers’ health and contribute to an increase in occupational diseases26. Literature reviews on the impacts of production processes in the sugarcane sector identify recurring risk factors, such as a fast pace of work, insufficient breaks, repetitive movements, exposure to heat, pesticides, attacks by venomous animals, and poor housing conditions10,11,27,28.
Mechanization has altered the dynamics of field work but has not eliminated occupational risks, highlighting the need for continuous improvement of working conditions and intensified oversight. The reality faced by agricultural machinery operators is marked by physical and mental overload, long working hours, environmental exposure, and accidents, some with fatal outcomes. The pace imposed by the machines is monitored by computerized systems that increase the pressure for productivity29. Shifts can last 12 to 24 hours, without regular breaks, requiring high concentration and causing chronic fatigue. Many cabins lack adequate ventilation, forcing operators to open windows and exposing themselves to dust, noise, pesticides, and sugarcane fragments. Additionally, there are reports of accidents caused by animals in sugarcane fields. According to Lima et al.18, 17% of accidents involving machine operators were attributed to venomous animals. Constant vibration, combined with repetitive movements, contributes to the development of musculoskeletal disorders and fatigue17,30.
Regulatory Standard No. 3131, issued by the Ministry of Labor and Employment, establishes fundamental guidelines for occupational safety and health in rural work, including sugarcane harvesting. According to Gomes and Walter30, this regulation served as one of the main references for the notifications issued by enforcement agents in the sugar and ethanol sector between 2000 and 2019. Its application is essential for minimizing occupational risks and improving working conditions. NR-31 mandates the use of safety devices on machinery and equipment, in addition to providing for adequate ergonomic conditions, such as adjustable seats and regular breaks, with the aim of preventing muscle strain31.
The standard also imposes limits on exhausting work shifts and requires mandatory breaks during continuous physical exertion, promoting workers’ physical recovery31. To mitigate health risks, it requires the provision of appropriate PPE and regulates the use and handling of pesticides. It also establishes measures to reduce exposure to heat, dust, and noise, including the requirement for adequate ventilation in agricultural machinery cabins. Finally, the standard mandates mandatory training on safety and first aid, which is essential for the prevention of accidents and occupational diseases31. However, its effectiveness depends on rigorous enforcement and companies’ commitment to its implementation.
The findings of this study indicate a decline in the granting of temporary disability benefits among sugarcane workers over the period under investigation. However, they also revealed the specific characteristics that distinguish the two occupational groups — manual and mechanized — both in terms of the nature of the injuries and the frequency and severity of the absences. The fluctuations in benefit grants observed in 2020–2021 should be interpreted in light of the impact of the COVID-19 pandemic. The overall reduction in demand for health services and changes in the administrative operations of the National Social Security Institute (INSS), including the suspension of in-person medical examinations, likely affected manual and mechanized workers in a similar manner, which explains the parallel pattern of decline in B31 and B91 rates. Thus, the reduction observed during the period is more consistent with a systemic, health-related, and administrative effect, rather than with actual changes in the incidence of work-related conditions.
The differences between B31 and B91 benefits stem not only from occupational exposure but also from the particularities of the social security medical examination process and the recognition of the causal link. Studies indicate that establishing a link between work and illness depends on multiple factors beyond direct exposure. Silva-Junior, Almeida, and Morrone14 show that, although the NTEP has expanded the recognition of work-related conditions, its application requires integrating epidemiological evidence with individual analyses, which leads to variations in case classification. Subsequently, Silva-Junior et al.15 demonstrated that the conversion from B31 to B91 remains limited, even when there is compatible epidemiological evidence, highlighting the influence of expert interpretation and the practices of INSS agencies. Thus, part of the difference between B31 and B91 may reflect expert heterogeneity, difficulties in providing documentary evidence, and administrative variations in the recognition of the causal link.
This study has important limitations that must be considered. The analysis is restricted to data from the formal labor market, which compromises a full understanding of the reality of workers in the sector, especially given the persistence of informality and even clandestine labor relations in rural areas. Furthermore, access to social security benefits is sometimes limited by bureaucratic and institutional barriers. As Reis32 points out, many sugarcane workers face a veritable “ordeal” to secure the recognition and granting of their social security rights.
From a methodological standpoint, this study has limitations inherent to the ecological design, based on aggregated data, which prevents the inference of causal relationships at the individual level. The analysis was conducted using secondary data from the formal labor market and the INSS’s administrative records on the granting of disability benefits, which may introduce biases related to underreporting, inconsistencies in the records, or variations in eligibility criteria over time. Furthermore, the absence of individual-level data precludes the control of potential confounding factors, such as pre-existing health conditions, sociodemographic characteristics, or occupational history.
Conclusion
This study found that, although there was a decline in the number of temporary disability benefits granted to sugarcane workers over the period analyzed, significant disparities persist between workers in manual and mechanized activities. Manual occupations showed a higher frequency of musculoskeletal disorders, related to intense, repetitive, and poorly paid physical labor, while workers in mechanized activities were more susceptible to serious injuries, highlighting distinct risk patterns depending on the nature of the activity. The higher incidence rate of work-related benefits in the manual labor group, which exceeds the national average, reinforces the link between working conditions and health problems among these workers.
Transforming this scenario requires an integrated approach that combines effective enforcement actions, the strengthening of public health and occupational safety policies, and the valorization of rural work. It is necessary to expand the scope of NR-31, ensuring its full implementation through regular audits, holding companies accountable, and promoting real improvements in working conditions. Furthermore, it is essential to address informality in the countryside, expand access to social security rights, and promote prevention programs based on the specific realities of the sugarcane sector. Investments in safe mechanization, technical training, ergonomics, and innovation in production models can reduce the burden of illness and ensure greater dignity for the workers who form the backbone of the sugarcane production chain and make the country the world’s largest producer.
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Data availability:
Data on the formal workforce were extracted from the RAIS (Annual Social Information Report) database, available for public access at <https://bi.mte.gov.br/bgcaged/login.php >. Data extraction took place on March 15, 2023. Information related to social security benefits was accessed on the SmartLab platform (https://smartlabbr.org/), with data extracted on April 22, 2023, and updated on March 12, 2026.
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Statement on the use of Artificial Intelligence:
During the preparation of this article, the ChatGPT (OpenAI) artificial intelligence tool, a version based on the GPT-4 model available in 2025, was used to assist with language review, textual organization, and the improvement of clarity and fluency in scientific writing. The authors declare that they reviewed and validated all content generated with the aid of the artificial intelligence tool.
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Presentation at a scientific event:
The authors report that the study was presented at the 8th Congresso Paulista de Medicina do Trabalho (São Paulo Congress of Occupational Medicine), in the city of São Paulo, SP, in 2024; and at the 30th International Conference on Occupational Epidemiology, in the city of Utrecht, Netherlands, in 2025.
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Funding:
The authors declare that the study was not subsidized.
Edited by
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Responsible editor:
Leila Posenato Garcia https://orcid.org/0000-0003-1146-2641 Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho - FUNDACENTRO
Data on the formal workforce were extracted from the RAIS (Annual Social Information Report) database, available for public access at <https://bi.mte.gov.br/bgcaged/login.php >. Data extraction took place on March 15, 2023. Information related to social security benefits was accessed on the SmartLab platform (https://smartlabbr.org/), with data extracted on April 22, 2023, and updated on March 12, 2026.
Notes: Relative risk (RR) values greater than 1 indicate a higher risk of work absence among workers in manual activities compared to workers in mechanized tasks (reference group). The vertical dashed line at RR = 1 represents no difference in risk between the groups. The points represent the RRs for the period, and the horizontal bars represent the respective 95% confidence intervals (95% CI). Benefit type: B31 - non-work-related temporary disability benefit; B91 - work-related temporary disability benefit.