Part 1 - Workplace Safety and Health Institute

Estimating Burden of Work on Health
ILO & WHO Methods
1
For Discussion
13 Oct 2014
27-Oct-14
Visiting Expert Week – Tim Driscoll
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
27-Oct-14
Visiting Expert Week – Tim Driscoll
2
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 underreported, especially for diseases, and from developing countries
27-Oct-14
Visiting Expert Week – Tim Driscoll
3
Results of Fatalities from Work
ILO’s Estimate
2.3 million deaths
WHO’s Estimate
850,000 deaths
Fatal Injuries
Fatalities due to:
1. Workplace carcinogens
2. Airborne particulates
3. Ergo stressors of the back
4. Noise
5. Hazards for injuries
Fatalities due to
Illnesses
27-Oct-14
Visiting Expert Week – Tim Driscoll
6
% Work-related Deaths caused by Illness in EU28
2.4%
0.8%
1.0%
Communicable Diseases
2.5%
Malignant neoplasms
6.0%
Neuropsychiatric
conditions
Circulatory diseases
28.0%
53.0%
Circulatory
Diseases
Cancers
Respiratory diseases
Digestive diseases
5.7%
Genitourinary diseases
Accidents & violence
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 Annual Deaths – EU-27
Work-related Annual Deaths –
Singapore and EU distribution of fatal injuries
and illnesses, EU in brackets
Deaths attributed to work, Singapore (Resid.) 834, EU: 192,000 (new!)
4% (1%)
0.3% (0.8%)
0.3% (5.7%)
4% (2.4%)
8% (2.5%)
32% (28%)
46% (53%)
6 % (6%)
Communicable diseases
Respiratory Diseases
Mental Disorders
Genitourinary system
Cancers
Circulatory diseases
Digestive systems diseases
Accidents and violence
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
10 leading causes of Deaths in East Asia
http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
Murray et al. Lancet 2012,
10 leading causes of Deaths in East Asia
WORK-related
http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
Murray et al. Lancet 2012,
3,979 DALYs re occ.
low back pain
2,757 DALYs re
occ. injuries
846 DALYs re occ. cancer
27-Oct-14
Visiting Expert Week – Tim Driscoll
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Basic associations
No
disability
Sickness
absence
Retirement on
health grounds
chronic disease
Premature
death
Psychosocial
factors
Source: Kivimäki 2013
DALYs in 2010 by age, Singapore
Musculoskeletal, AF= 37%
Mental health,
AF= 6.5 %...30+ %
CVD, stress
AF= 6.5%–25.2 %
AFmortality =16.9%
Cancer, AFmortality= 8.4%
AF= Attributable
Fraction, re work
GBD= Global Burden
of Disease
Communicable AF=4.8%
27-Oct-14
Visiting Expert Week – Tim Driscoll
DALY= Disability
16
Adjusted Life Years
Work –relatedness of common
diseases
3.7% (6.4%m /1.0% f)
26
17
A Leading Institute for WSH Knowledge and Innovations
Driscoll/Lancet 2014
Work –relatedness
of common
Work-relatedness of common diseases
diseases
3.7%
Overall work-relatedness of mortality, ILO:
6.7%
GDP loss, Australian method SG: 3.2% ; AUS: new 4.8 % prev. 5.9%
Global Burden of disease and injury in Europe, WHO
5.0%
18
A Leading Institute for WSH Knowledge and Innovations
27-Oct-14
Visiting Expert Week – Tim Driscoll
19
Selected data from various sources,
refs included
27-Oct-14
Visiting Expert Week – Tim Driscoll
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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
Year & Type/Area
Singaporea Finland Germanyb
Rate, 2011 excl.
traffic@work
2.3
0.75
N*, 2011 excl.
traffic@work
61
26
N*, 2010-11 incl.
traffic@work
80
28
0.94
Spainb
U.K.b
EU15b
EU28
EU28/ILOadj.
ILO/Worldd
WHO/GBD
2.16
0.74
1.39
2.0
2.15
15.9h
15.0h
2,910
4,103
4,692
352,800h
481,429
194
507
365
~700
[a]
Singapore WSH Statistics, WSH Institute
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.
[b]
27-Oct-14
Visiting Expert Week – Tim Driscoll
21
Work-related illnesses and injuries in past studies, fatal numbers N* and fatal rates N*/ 100 000 employed
Year & type/area
Singapore (this
paper)
Finland
United
States
Spain
U.K.
New
Zealand
Chile
EU28
ILO adj.
ILO World
WHO/
GBD World
1 439
1 810 i
49 000
16 100
13 000
700-1000
-
n/a
n/a
n/a
2 400
2 075
119 500
17 935
24 400
1 812
3 695
192 200
1 979 000
n/a
1.85
3. 09n
2.45
139.06
18.46
28.94
2.18
7.35
218.05
2 221.63
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
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
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
388+194
839
19 000 j
9 500
8 010
237-425
1244
102 500
666 000
118 097 q
38
154
5 928
1 002
6 750
139
22 673
118 097
60-100
208 i
10 000
n/a
4 500
n/a
open
open
N*, all fatal injuries and
illnesses, national est.
N*, all fatal injuries and
illnesses, ILO Estimate of
2014
Employment and labour
force, ILO mill.
Illness rate,N*/100 000
-ILO Estimate
-National Estimate
N*, all fatal injuries
national 2010-14m
Injury rate N*/100 000
-ILO Estimate, 2010
-National Estimate
-GBD/IHME Estim.q
N*, fatal occup. cancers,
natl./
International
N* occ.cancer caused by
asbestos
3 200.51
360-620t
107 000 112 000
UK:
DALY’s
Germany:
DALY’s
DALYs in men in 2010 by age, High-income Asia-Pacific
Injuries
Death rates
Injuries injuries
Transport
Musculoskeletal
Musculoskeletal
Musculoskeletal
Mental/behavioural
Mental/behavioural
disorders
disorders
Mental health
Occupational injuries
CVD
CVD
CVD
Cancer
Occupational cancer
Cancer
Cancer
http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-cause-patterns
The Lancet, 2013
USA: 5,928
est. 19,000-35,000
Finl: 154
est. 839
UK: 6,750
est. 8010
http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
Singapore: 38
est. 383
http://vizhub.healthdata.org/gbd-cause-patterns/
Deaths and Lost Years through GBD/WHO and/or ILO
YLLs, U.K. selected causes by
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
498,604
YLLs re
occ. injuries
375,105
YLLs re
occ. cancer
WHO and GBD Estimation Method:
Prof. Tim Driscoll
27-Oct-14
Visiting Expert Week – Tim Driscoll
30
What exposures were included?
• 26 risk factors to overall GDB
• Only 5 Selected occupational risks;
1.
2.
3.
4.
5.
Workplace carcinogens
Airborne particulates
Hazards for injuries
Ergonomic stressors for back pain
Noise
Due to inadequate data,
WHO’s comparative risk
assessment model
excluded other
occupational risks
Extra:
• Contaminated sharps injuries (healthcare workers)
• Included low-high exposures limits by geographical regions
27-Oct-14
Visiting Expert Week – Tim Driscoll
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ILO Estimation Method
27-Oct-14
Visiting Expert Week – Tim Driscoll
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Who were included in the ILO estimates?
Labour Force by Country
Total employed
Total employed by Main Sectors
Agriculture
Industry
Services
27-Oct-14
Visiting Expert Week – Tim Driscoll
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Farming,
Fishing,
Forestry
Mining,
Manufacturing,
Energy,
Construction
Who were included in the ILO estimates?
EURO
HIGH
EMRO
WPRO
AMRO
Labour Force by Country
• ILOSTAT
• CIA World Fact Book
27-Oct-14
AFRO
SEARO
Total employed
Total employed by Main Sectors
• ILOSTAT
• US Dept of Interior
(for American Samoa)
• Nauru Bureau of Stats
Visiting Expert Week – Tim Driscoll
• % labour force by sector
of occupation (CIA)
• % employed by sector of
economic activity
(ILOSTAT)
34
Data Sources and Estimates of Fatal Injuries
Year 2010:
ILOSTAT
For all countries
EUROSTAT
For all 28 EU countries
• 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
to missing country’s total employed Main Sector
Main sectors
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
27-Oct-14
Visiting Expert Week – Tim Driscoll
35
Data Sources and Estimates of Non - Fatal Injuries
Year 2010:
ILOSTAT
For all countries
EUROSTAT
For all 28 EU countries
• 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%
27-Oct-14
Visiting Expert Week – Tim Driscoll
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Data Sources and Estimates of Occupational Mortality by Diseases
Year 2011:
WHO GHE
All Cause Mortality by WHO regions by age, gender
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
27-Oct-14
X AFs =
Region Est. Fatal
occupational
diseases by
Disease groups,
Gender, Age
groups
Visiting Expert Week – Tim Driscoll
37

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