Establishment survey data for the United States as a whole and workers' compensation data for the State of California were used to document long-term trends in occupational injury and acute illness rates. After declining throughout the first half of the century, national rates of disabling injuries in manufacturing, construction, and the trade sector have risen sharply in recent decades. Injury rates in mining show no strong trend either up or down since 1960. Increases over recent years have been especially pronounced for strains and sprains, cuts, lacerations and punctures, bone fractures, and acute illnesses. Injury rates in the manufacturing sector are strongly influenced by general economic conditions--rising sharply with business upsurges and declining during recessions. Increases in the rate of unemployment, which decrease worker and labor union bargaining power, are associated with increases in injury rates within manufacturing.