How to improve the assessment of the impact of occupational diseases at a national level? the Netherlands as an example

Objective: To explore the impact of occupational diseases (ODs) through estimations of population attributable fractions (PAFs) in a national context. Methods: PAFs were calculated for eight prevalent ODs using existing data on the prevalence of exposure to risk factors at work and the strength of their association with diseases based on systematic reviews. Six systematic reviews with meta-analyses and two overview papers were selected. All addressed the relationship between occupational exposure to work-related risk factors for these eight prevalent ODs. Prevalence figures for exposure to work-related risk factors were retrieved from the Dutch National Working Conditions Survey (NWCS) based on self-reports by approximately 40 000 workers. The specific risk factors retrieved from the reviews were matched with the available and dichotomised self-reported exposure items from the NWCS by two authors. Results: The eight frequently reported ODs among the Dutch working population revealed PAFs varying between 3% and 25%. Lateral epicondylitis and distress/burnout had the highest attributable fractions, with percentages of 25% and 18%, respectively. For knee osteoarthritis (13%), shoulder soft tissue disorders (10%) and non-specific low back pain (10%) approximately 1 in 10 cases were attributable to work. PAFs for irritant contact dermatitis, noise-induced hearing loss and chronic obstructive pulmonary disease were 15%, 6% and 3%, respectively. Conclusion: Data from systematic reviews and self-reported data on exposure provide opportunities to estimate the impact of ODs. For the Netherlands, they revealed substantial and varying attributions of work for prevalent diseases.