The purpose of this study was to identify macro-socioeconomic determinants for the incidence of occupational injuries and diseases among home care workers. The study base was the total workforce of home care workers in Sweden during 1994-1998. In an ecological study design, data from three national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-socioeconomic determinants (economic resources, age structures of inhabitants and home care workers, unemployment, type of employment, size and location of municipality) for the incidence of occupational disorders among home care workers. A great variation in municipal incidence of occupational disorders was found when comparing various municipalities (10-184 occupational disorders/1000 full-time equivalent workers per year and municipality). The relation between the incidence of occupational disorders and macro-socioeconomic factors is complex. The investigated socioeconomic factors together explained 12-19 % of the differences in mean municipal occupational disorders but there were different explanations related to metropolitan regions and sparsely populated areas. The factors that had a potential to explain the differences were the age structure of inhabitants and home care workers, and unemployment. The economic resources, e.g. the gross expenses for the care of the elderly and handicapped, and the average income, or the employment conditions among the home care workers did not give any explanation for differences in occupational disorders. The group of privately employed home care workers (1-3 %) had a lower incidence of occupational disorders and were younger. The great difference in incidence of occupational disorders which appears when municipalities in Sweden are compared indicates a preventive potential. However, the relation between the incidence and macro-socioeconomic factors is complex. In order to better understand socio-environment phenomena related to occupational injuries, further studies are needed to explore the possible influence of the work system at the macro-, organisational- and micro-level.