Estimating Burden of Work on Health ILO & WHO Methods

Estimating Burden of Work on Health

ILO & WHO Methods For Discussion

13 Oct 2014

27-Oct-14 Visiting Expert Week – Tim Driscoll

1

Work-related Burden of Disease

• Wellbeing of workers are diminished

due to work

– Fall sick diseases and conditions

– Get injured major and minor

– Die

• Quantified by number of persons

and persons-time

Visiting Expert Week – Tim Driscoll 2 27-Oct-14

What Outcomes

are we estimating

?

Who are we

including?

How do we calculate ‘Burden’?

• Mortality

– No. of persons died from work-related causes

– No. of years of lives lost , YLL

• Morbidity

– No. of persons who got sick or injured from work-related causes

– No. of healthy years of lives lost, Disability Adjusted Life Years,

DALYs

Therefore, total no. of healthy years of lives lost provides a numerical value

to the “burden” of a risk factor (i.e.: work or specific occupation

exposure) to populations.


Not so straight forward as information is usually missing or under-reported, especially for diseases, and from developing countries


Results of Fatalities from Work

ILO’s Estimate

2.3 million deaths

Fatal Injuries

Fatalities due to Illnesses

WHO’s Estimate

850,000 deaths

Fatalities due to: 1. Workplace carcinogens 2. Airborne particulates 3. Ergo stressors of the back 4. Noise 5. Hazards for injuries

2.5%

53.0%

5.7%

28.0%

6.0%

0.8% 1.0%

2.4%

Communicable Diseases

Malignant neoplasms

Neuropsychiatric conditions

Circulatory diseases

Respiratory diseases

Digestive diseases

Genitourinary diseases

Accidents & violence

Circulatory

Diseases

Cancers

In EU28, cardiovascular and circulatory diseases accounts for 28%

and cancers at 53%. They were the top illnesses responsible for 4/5

of deaths from work-related diseases. Occupational injuries and

infectious diseases together amount accounts for less than 5%.

% Work-related Deaths caused by Illness in EU28

8% (2.5%)

46% (53%)

6 % (6%)

32% (28%)

0.3% (5.7%) 0.3% (0.8%)

4% (1%) 4% (2.4%)

Communicable diseases Cancers

Respiratory Diseases Circulatory diseases

Mental Disorders Digestive systems diseases

Genitourinary system Accidents and violence

Deaths attributed to work, Singapore (Resid.) 834, EU: 192,000 (new!)

Work-related Annual Deaths – EU-27

Sources: WSH Institute Singapore 2014, Hämäläinen P, Takala J, Saarela KL; TUT,

ILO, WHO, EU-OSHA, WSH Institute Singapore, JOEH May 2014, ref. data:

MOH/MOM and WHO A region

Work-related Annual Deaths – Singapore and EU distribution of fatal injuries

and illnesses, EU in brackets

10 leading causes of Deaths in East Asia

Murray et al. Lancet 2012,

http://www.healthmetricsandevaluation.org/gbd/visualizations/regional


10 leading causes of Deaths in East Asia

Murray et al. Lancet 2012,


WORK-related


27-Oct-14 Visiting Expert Week – Tim Driscoll 13

846 DALYs re occ. cancer

2,757 DALYs re

occ. injuries

3,979 DALYs re occ.

low back pain

No

disability Sickness

absence Retirement on

health grounds

chronic disease

Premature

death

Basic associations

Psychosocial

factors

Kivimäki 2013 Source:


Cancer, AFmortality= 8.4%

DALYs in 2010 by age, Singapore

AF= Attributable

Fraction, re work

Communicable AF=4.8%

GBD= Global Burden

of Disease

DALY= Disability

Adjusted Life Years

Mental health,

AF= 6.5 %...30+ %

Musculoskeletal, AF= 37%

CVD, stress

AF= 6.5%–25.2 %

AFmortality =16.9%

Work –relatedness of common

diseases

A Leading Institute for WSH Knowledge and Innovations

17

3.7% (6.4%m /1.0% f)

Driscoll/Lancet 2014 26

WorkWork--relatedness of common diseasesrelatedness of common diseases

Overall work-relatedness of mortality, ILO: 6.7%

GDP loss, Australian method 5.9%

Global Burden of disease and injury in Europe, WHO 5.0%

Work –relatedness of common

diseases

A Leading Institute for WSH Knowledge and Innovations

18

SG: 3.2% ; AUS: new 4.8 % prev.

3.7%

Selected data from various sources,

refs included



Year & Type/Area Singaporea Finland Germanyb Spainb U.K.b EU15b EU28 EU28/ILOadj. ILO/Worldd WHO/GBD

Rate, 2011 excl.

traffic@work

2.3

0.75

0.94

2.16

0.74

1.39

2.0

2.15

15.9h

15.0h

N*, 2011 excl.

traffic@work

61

26

194

N*, 2010-11 incl.

traffic@work

80

28

507

365

~700

2,910

4,103

4,692

352,800h

481,429

Table 1. Fatal injuries at work (occupational accidents) including and excluding those

related to traffic in selected countries and regions, absolute numbers (N*)

and fatal injury rate (N*/100,000), 2011

[a] Singapore WSH Statistics, WSH Institute [b] EUROSTAT numbers referred by the Health and Safety Executive, U.K. web page: http://www.hse.gov.uk/statistics/pdf/fatalinjuries.pdf (accessed 11.9.2014) [c] EUROSTAT Fatal Accidents at Work by Economic Activity 18 July 2014, includes road traffic at work, web page http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Health_and_safety_at_work_statistics (accessed 11.9.2014) [d] See end note references 2 and 3 referring to Global Estimates 2012 and 2014, adjusted: includes all employed and road traffic at work etc. [e] Institute of Health Metrics, GBD Cause Patterns, Occupational Risks, Rate, Both sexes, Global, web page: http://vizhub.healthdata.org/gbd-cause-patterns/ (accessed 11.9.2014) [f] Statistics Finland, Official Statistics of Finland (OSF): Occupational accident statistics [e-publication]. ISSN=1797-9544. 2011. Helsinki: Statistics Finland [referred: 11.9.2014]. Access method: http://www.stat.fi/til/ttap/2011/ttap_2011_2013-11-27_tie_001_en.html and http://www.stat.fi/til/ttap/2011/ttap_2011_2013-11-27_tau_001_fi.html [g] The Royal Society for the Prevention of Accidents: “Around one third of fatal and serious road crashes involve someone who was at work.“ In 2012: 1754 road fatalities altogether, of which 1/3 is more than 500, web page: http://www.rospa.com/faqs/detail.aspx?faq=296 (accessed 11.9.2014) [h] For WHO Global Burden of illness and injuries the denominator is the whole Labour Force, whether formally employed or not. In particular, the method does not limit to those employed only which is the case for the ILO estimates. Thus self-employed and the informal sector are included.

http://www.hse.gov.uk/statistics/pdf/fatalinjuries.pdf

http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Health_and_safety_at_work_statistics

http://vizhub.healthdata.org/gbd-cause-patterns/





http://www.stat.fi/til/ttap/2011/ttap_2011_2013-11-27_tie_001_en.html





http://www.stat.fi/til/ttap/2011/ttap_2011_2013-11-27_tau_001_fi.html





http://www.rospa.com/faqs/detail.aspx?faq=296

Year & type/area Singapore (this

paper)

Finland United

States

Spain U.K. New

Zealand

Chile EU28

ILO adj.

ILO World WHO/

GBD World

N*, all fatal injuries and

illnesses, national est.

1 439

1 810 i

49 000

16 100

13 000

700-1000

-

n/a

n/a

n/a

N*, all fatal injuries and

illnesses, ILO Estimate of

2014

2 400

2 075

119 500

17 935

24 400

1 812

3 695

192 200

1 979 000

n/a

Employment and labour

force, ILO mill.

1.85

3. 09n

2.45 139.06 18.46 28.94 2.18 7.35 218.05 2 221.63

3 200.51

Illness rate,N*/100 000

-ILO Estimate

-National Estimate

77.7

42.8

73.9

82.2 i

85.9

35.2

97.2

87.2

84.3

n/a

83.1

32.1-45.9

43.1

88.1

89.1

n/a

N*, all fatal injuries

national 2010-14m

55+14

82i

6 200j

338

172

~100

261

n/a

n/a

n/a

N*, all fatal injuries ILO

Est. 2010-14m

55

43

4 690

342

172

118

529

4,692

352 800

n/a

N*, all fatal injuries GBD

IHME Estimate

61

58

4 798

1133

377

402

929

14 148

n/a

481 429

Injury rate N*/100 000

-ILO Estimate, 2010

-National Estimate

-GBD/IHME Estim.q

1.78

2.23

1.97

1.76

4.1i

2.37

3.37

4.46

3.45

1.85

1.83k

6.13

0.59

0.59

1.30

5.41

4.59

18.44

7.2

9.0q

11.7

2.15

n/a

6.49

15.88

n/a

n/a

n/a

n/a

15.04

N*, fatal occup. cancers,

natl./

International

388+194 38

839 154

19 000 j 5 928

9 500 1 002

8 010 6 750

237-425 139

1244

102 500 22 673

666 000 118 097

118 097 q

N* occ.cancer caused by

asbestos

60-100

208 i

10 000

n/a

4 500

n/a

360-620t

open

open

107 000 -

112 000

Work-related illnesses and injuries in past studies, fatal numbers N* and fatal rates N*/ 100 000 employed

UK:

DALY’s

Germany:

DALY’s

DALYs in men in 2010 by age, High-income Asia-Pacific

Musculoskeletal

Mental health

Cancer

CVD

Transport injuries

Injuries

Musculoskeletal

Mental/behavioural

disorders

Cancer

CVD

Injuries

Musculoskeletal

Mental/behavioural

disorders

Cancer

CVD


Occupational cancer Occupational injuries

Death rates

http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-cause-patterns







The Lancet, 2013

UK: 6,750

est. 8010

USA: 5,928

est. 19,000-35,000

Singapore: 38

est. 383

Finl: 154

est. 839



375,105

YLLs re

occ. cancer

498,604

YLLs re

occ. injuries

Years of Lost Life, N=deaths, L = lost years

For cancer (UK): L = 19.8 years

For injuries(UK): L = 45.3 years

Years Lived with Disability

Disability Adjusted Life Years

Deaths and Lost Years through GBD/WHO and/or ILO

YLLs, U.K. selected causes by

WHO and GBD Estimation Method:

Prof. Tim Driscoll


• 26 risk factors to overall GDB

• Only 5 Selected occupational risks;

1. Workplace carcinogens

2. Airborne particulates

3. Hazards for injuries

4. Ergonomic stressors for back pain

5. Noise

Extra:

• Contaminated sharps injuries (healthcare workers)

• Included low-high exposures limits by geographical regions

What exposures were included?


Due to inadequate data, WHO’s comparative risk assessment model excluded other occupational risks

ILO Estimation Method



Who were included in the ILO estimates?

Labour Force by Country Total employed Total employed by Main Sectors

Agriculture

Industry

Services

Farming,

Fishing,

Forestry

Mining,

Manufacturing,

Energy,

Construction


Who were included in the ILO estimates?

Labour Force by Country Total employed Total employed by Main Sectors

• ILOSTAT

• CIA World Fact Book

• ILOSTAT

• US Dept of Interior

(for American Samoa)

• Nauru Bureau of Stats

• % labour force by sector

of occupation (CIA)

• % employed by sector of

economic activity

(ILOSTAT)

AFRO AMRO

EURO

EMRO

SEARO

WPRO

HIGH


Data Sources and Estimates of Fatal Injuries

ILOSTAT

EUROSTAT

For all countries

For all 28 EU countries

Year 2010: • As much as possible, will use most reliable and

accessible data

• Country sources are used for Finland & US

• If there are discrepancies btw ILOSTAT &

EUROSTAT, will adopt larger reported fig

Missing Fatal Injury Data

• Select rep country for each region and apply their rate of fatal injuries Main sectors

to missing country’s total employed Main Sector

Region Representative Countries

High Australia, Canada, France, Italy, Norway, Singapore, Switzerland

AFRO Algeria, Ghana, Togo, Tunisia, Zimbabwe

AMRO Argentina, Belize, Costa Rica, Dominican Republic, Mexico

EMRO Bahrain, Turkey

EURO Croatia, Czech Republic, Estonia, Latvia, Lithuania, Poland, Romania, Turkey

SEARO, WPRO China, Republic of Korea, Kyrgyzstan, Malaysia, Myanmar, Philippines, Thailand


Data Sources and Estimates of Non - Fatal Injuries

ILOSTAT

EUROSTAT

For all countries

For all 28 EU countries

Year 2010: • As much as possible, will use most reliable and

accessible data

• Country sources are used for Finland & US

• If there are discrepancies btw ILOSTAT &

EUROSTAT, will adopt larger reported fig

To address Under reporting of non-fatal injuries & Missing Data

• Estimate from prop of fatal to non-fatal injuries & lower/upper limits of

estimates from reference countries

• Apply limits to derived (or most reliable) fatal injuries by country to est total

non-fatal injuries by country

Lower Limit Upper Limit

EU 15 exclude Greece = 0.13%

Finland, France, Germany = 0.10%


Data Sources and Estimates of Occupational Mortality by Diseases

WHO GHE All Cause Mortality by WHO regions by age, gender

Year 2011:

Nurminen &

Karjalainen, 2001 Attributable Fractions by Disease groups

Inclusion-Exclusion of Age and Diseases • Excluded Diseases/Conditions that are not occupational or work-related

• Excluded Diseases/Conditions that are not in Nurminen paper

• Circulatory diseases included only IHD, stroke, cardiomyopathy, myocarditis, endocarditis

• Applied age cut-offs on mortality figures for specific disease groups

• Adjusted AFs for communicable diseases (regional difference)

Regional mortality tables

by Disease groups,

Gender, Age groups

X AFs =

Region Est. Fatal occupational diseases by

Disease groups, Gender, Age

groups

Estimating Burden of Work on Health ILO & WHO Methods

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