1. What are the proportions of work-related diseases? A national study based on hospitalization registries Tage S. Kristensen Otto M. Poulsen Harald Hannerz Finn Tüchsen Vilhelm Borg National Institute of Occupational Health Copenhagen, Denmark 27th International Congress on Occupational Health Iguassu Falls, Brazil L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

2. Key concepts: Etiologic fraction: Preventable fraction: The proportion of a disease that would not have occurred if the risk factor had not been present. (Analytic concept) The proportion of a disease that would not have occurred if everyone had the same disease risk as a ”non-exposed” reference (occupational) group. (Descriptive concept) L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

3. Illustration of etiologic fraction EF = = 29% 40 60 2 1 0 + - RR Exposure (Causal risk factor) 40 140 The elimination of the exposure is estimated to reduce disease occurrence in the population with 29%. L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

4. Illustration of preventable fraction 20 10 20 30 45 200 100 0 SMR Occupational groups PF = =46% 185 10+10+20+45 If all occupational groups had the same disease risk as the ”non-exposed” group, the disease occurrence in the population would be 46% lower. L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

5. Study base All persons in Denmark who were 20-59 years old Jan 1, 1994. All hospitalizations during 1994-1999 in somatic hospitals. 58 occupational groups. 11 main diagnoses from the hospitalization registry. ”Teaching & research” was considered as the ”non- exposed” group. Control for age and social class. Stratified by gender. L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

6. Preventable fractions in Denmark MalesFemales Ischaemic heart disease24%(17%)31%(22%) Cancer8%(6%)3%(4%) Diseases in lungs and airways16%(9%)12%(8%) Musculoskeletal diseases21%(10%)19%(12%) Diseases in the nervous system17%(12%)12%(7%) All diseases15%(8%)11%(7%) Numbers in parentheses: Controlled for social class. L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

7. Comparisons with other estimates (Controlled for social class) Ischaemic heart diseaseM17%16% F22% Diseases in lungs & airwaysM9% 10% F8% CancerM6% 4% F Our estimateOther´s 1) Olsen & Kristensen. 2) Doll & Peto. 3) Blanc & Toren 1) 2) 3) L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

8. In conclusion The number of hospitalizations in Denmark would be reduced by 10-15% if all occupational groups had the hospitalization rates of ”teaching & research” The highest proportions were seen for ischaemic heart diseases (24-31%) and musculoskeletal diseases (19-20%). The estimates (controlled for social class) were very similar to etiologic fraction estimates from the literature calculated with different methods. The method seems to be promising when knowledge about causal risk factors is lacking. L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage

9. THE END This presentation can be found at: www.ami.dk/presentations Tage S. Kristensen Otto M. PoulsenHarald Hannerz Finn Tüchsen Vilhelm Borg L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage