title: Assessment of public health impact of work-related asthma.
abstract: BACKGROUND
  Asthma 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Assessment 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.
  
  
  CONCLUSIONS
  Public 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.
authors.affiliation: Center for Environmental and Respiratory Health Research and Respiratory Medicine Unit, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, P.O. Box 5000, 90014 Oulu, Finland. maritta.jaakkola@oulu.fi
authors.forename: Maritta S
authors.initials: MS
authors.lastname: Jaakkola
authors.forename: Jouni J K
authors.initials: JJ
authors.lastname: Jaakkola
mesh_terms: D000328:Adult; D059366:Asthma, Occupational / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D019985:Benchmarking; D001985:Bronchial Provocation Tests; D017281:Cost of Illness; D005060:Europe / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D016273:Occupational Exposure / Q000191:economics / Q000517:prevention & control* / Q000592:standards; D009786:Occupational Health Services / Q000592:standards; D011159:Population Surveillance; D015995:Prevalence; D011634:Public Health; D011785:Quality Assurance, Health Care; D012943:Social Security; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence; D014481:United States / Q000453:epidemiology; D014942:Workers' Compensation / Q000592:standards; D017132:Workplace / Q000331:legislation & jurisprudence / Q000592:standards; D014944:World Health Organization
chemical_list: D014028:Tobacco Smoke Pollution