Abstract
BackgroundAsthma is among the most common chronic diseases in working-aged populations and occupational exposures are important causal agents. Our aims were to evaluate the best methods to assess occurrence, public health impact, and burden to society related to occupational or work-related asthma and to achieve comparable estimates for different populations.MethodsWe addressed three central questions: 1: What is the best method to assess the occurrence of occupational asthma? We evaluated: 1) assessment of the occurrence of occupational asthma per se, and 2) assessment of adult-onset asthma and the population attributable fractions due to specific occupational exposures. 2: What are the best methods to assess public health impact and burden to society related to occupational or work-related asthma? We evaluated methods based on assessment of excess burden of disease due to specific occupational exposures. 3: How to achieve comparable estimates for different populations? We evaluated comparability of estimates of occurrence and burden attributable to occupational asthma based on different methods.ResultsAssessment of the occurrence of occupational asthma per se can be used in countries with good coverage of the identification system for occupational asthma, i.e. countries with well-functioning occupational health services. Assessment based on adult-onset asthma and population attributable fractions due to specific occupational exposures is a good approach to estimate the occurrence of occupational asthma at the population level. For assessment of public health impact from work-related asthma we recommend assessing excess burden of disease due to specific occupational exposures, including excess incidence of asthma complemented by an assessment of disability from it. International comparability of estimates can be best achieved by methods based on population attributable fractions.ConclusionsPublic health impact assessment for occupational asthma is central in prevention and health policy planning and could be improved by purposeful development of methods for assessing health benefits from preventive actions. Registry-based methods are suitable for evaluating time-trends of occurrence at a given population but for international comparisons they face serious limitations. Assessment of excess burden of disease due to specific occupational exposure is a useful measure, when there is valid information on population exposure and attributable fractions.
Highlights
Asthma is among the most common chronic diseases in working-aged populations and occupational exposures are important causal agents
Question 1: What is the best method to assess the occurrence of occupational asthma? Theoretically, two epidemiologic approaches can be used to assess the occurrence of occupational asthma in a given population: 1. Assessment of the occurrence of occupational asthma per se
Assessment of the occurrence of occupational asthma per se For assessing the occurrence of occupational asthma in a given population per se one needs an estimate of the numerator representing the cases of occupational asthma and the denominator representing the population at risk which produces the cases, expressed in person-time
Summary
Asthma is among the most common chronic diseases in working-aged populations and occupational exposures are important causal agents. In developing countries the workforces probably have even more extensive occupational reduced workability and increased health care costs. It is practically always accompanied by economic losses to the individual worker as well as to the society [8]. Despite being the most common occupational lung disease worldwide, with pneumoconioses common in the developing countries, there is little data on international comparisons of occurrence of occupational asthma or its public health impact. This is partly explained by difficulties in the methods used for assessing these. There is a need to develop the methodology for assessing the impact of work-related asthma to provide a comprehensive picture for the purposes of planning preventive actions and health policy
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