Trends in occupational diseases in Finland, 1975-2013: a register study.

OBJECTIVES: The objective was to investigate trends in the incidence of recognized and suspected cases of occupational diseases in Finland from 1975 to 2013, including variations by industry - and describe and recognize factors affecting variations in incidence. DESIGN: A register study. SETTING: The data consisted of recognized and suspected cases of occupational diseases recorded in the Finnish Registry of Occupational Diseases (FROD) in 1975-2013. PARTICIPANTS: Altogether 240 000 cases of suspected and recognized ODs were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: From the annual workforce statistics and FROD data, we calculated the incidence of ODs and suspected ODs per 10 000 employees. For time trends by industrial sector, we used a 5-year moving average and a Poisson regression analysis. RESULTS: Annual average rates of ODs have varied from year to year. The total number was 25.0/10 000 employees in 1975 and 20.1/10 000 employees in 2013. Screening campaigns and legislative changes have caused temporary increases. When the financial sector was the reference (1.0), the highest incidence rates according to industrial sector were in mining and quarrying (9.87; 95% CI 8.65 to 11.30), construction (9.11; 95% CI 9.98 to 10.43), manufacturing (9.04; 95% CI 7.93 to 10.36) and agriculture (8.78; 95% CI 7.69 to 10.06). There is a distinct decreasing trend from 2005 onwards: the average annual change in incidence was, for example, -9.2% in agriculture, -10.3% in transportation and -4.7% in construction. The average annual decline was greatest in upper limb strain injuries (-11.1%). CONCLUSION: This study provides a useful overview of the status of ODs in Finland over several decades. These data are a valuable resource for determining which occupations are at an increased risk and where preventive actions should be targeted. It is important to study long-term trends in the statistics of ODs to see beyond the year-to-year fluctuations.

Use of the Finnish Information System on Occupational Exposure (FINJEM) in epidemiologic, surveillance, and other applications.

This paper reviews the use of the Finnish Information System on Occupational Exposure (Finnish job-exposure matrix, FINJEM) in different applications in Finland and other countries. We describe and discuss studies on FINJEM and studies utilizing FINJEM in regard to the validity of exposure estimates, occupational epidemiology, hazard surveillance and prevention, the assessment of health risks and the burden of disease, the assessment of exposure trends and future hazards, and the construction of job-exposure matrices (JEMs) in countries other than Finland. FINJEM can be used as an exposure assessment tool in occupational epidemiology, particularly in large register-based studies. It also provides information for hazard surveillance at the national level. It is able to identify occupations with high average exposures to chemical agents and can therefore serve the priority setting of prevention. However, it has only limited use at the workplace level due to the variability of exposure between workplaces. The national estimates of exposure and their temporal trends may contribute to the assessment of both the recent and future burden of work-related health outcomes. FINJEM has also proved to be useful in the construction of other national JEMs, for example in the Nordic Occupational Cancer study in the Nordic countries. FINJEM is a quantitative JEM, which can serve many purposes and its comprehensive documentation also makes it potentially useful in countries other than Finland.

Trends of occupational exposure to chemical agents in Finland in 1950-2020.

INTRODUCTION: The aim of this study was to quantitatively estimate the long-term trends of occupational exposure to chemical agents in Finland for surveillance, prevention, and risk assessment purposes. METHODS: We studied trends by utilizing the Finnish job-exposure matrix (FINJEM), which includes occupation-specific estimates of the prevalence P (percent of employed) and average level L (agent-specific units) of inhalation exposure to chemical agents at different time periods. We used FINJEM data to calculate national estimates of the numbers of exposed workers (N exp), and the prevalence of and level of exposure to 41 chemical agents in 1950, 1970, 1990, and 2008. We also estimated the prevalence of employees exposed to levels exceeding 50% of the Finnish occupational exposure limit (OEL) (P high) and national occupational inhalation exposure (NOIE = N exp × L). Future exposures in 2020 were estimated according to the predicted change of the occupational structure of the labor force and the observed agent-specific exposure trends in 1990-2008. We estimated dermal exposure indirectly from the statistics of occupational skin diseases in 1975-2009. RESULTS: Inhalation exposure to most chemical agents had decreased. Using 1990 as the reference (100), the median values of P for 1950, 1970, 1990, 2008, and 2020 were 91, 149, 100, 58, and 41, respectively. The corresponding values were 218, 224, 100, 30, and 14 for P high, 151, 121, 100, 78, and 66 for L, and 119, 176, 100, 38, and 20 for NOIE. The trends varied considerably according to the agent. Exposure of, for example, asbestos, benzene, and benzo(a)pyrene substantially decreased. The annual incidence of occupational skin diseases due to chemical factors decreased from 6.9 per 10 000 employed in 1975-1979 to 4.6 per 10 000 in 2000-2009, suggesting a decrease in dermal exposure. CONCLUSIONS: Inhalation exposure to most chemical agents has decreased in Finland since 1970. High exposures and the average level of exposure started to decrease already in the 1950s. The declining incidence of occupational skin diseases suggests that dermal exposure has also diminished. However, high exposures still exist and cause a substantial amount of occupational diseases and symptoms. Chemical exposures and the related disease burden are expected to continue decreasing in the future. These results cannot be generalized to other countries, particularly if the development phase of technology and the occupational structure of the labor force differ significantly from those in Finland.

Evaluation of a national register on occupational exposure to carcinogens: effectiveness in the prevention of occupational cancer, and cancer risks among the exposed workers.

OBJECTIVES: The objective of this study was to evaluate the performance and effectiveness of a register of employees exposed to carcinogens (the ASA Register) which has been in operation in Finland since 1979, and to study cancer risks among the notified workers. METHODS: The impact of ASA at workplaces was studied by questionnaires mailed to 1448 work departments, which were notified to ASA in 1996, and to 1033 departments, which departed ASA in 1991-1996. The mailing was responded by 69% of departments. The cancer incidence of 35,138 workers notified to ASA in 1979-1988 was followed up through the files of the Finnish Cancer Register for the period 1980-2003. RESULTS: Changes eliminating or substantially reducing exposure to carcinogens were reported by 73% of departments notified to ASA in 1996. The ASA notification process had directly prompted measures to reduce exposure (8% of cases) or contributed to them (24% of cases). Estimations based on responses of the workplaces suggested that the ASA registration had decreased exposure of 600 workers year(-1) (out of approximately 15,000 notified workers, which is <1% of the employed in Finland), preventing thereby an unknown number of occupational cancers. Other benefits of ASA included the saving of the treatment costs of prevented cancers, the prevention of other health outcomes of carcinogens, improved safety behaviour of exposed workers and avoidance of human suffering among cancer patients and their families. The labour safety authorities had better possibilities to direct their activities against carcinogen exposure. These benefits should be considered against the annual costs, mainly due to 7-8 person-years of work required by tasks related to ASA. The results of the cancer incidence study among notified workers were based on a relatively short follow-up (on average 19 years). The incidence of mesothelioma was significantly increased in the ASA cohort, probably due to exposure to asbestos. CONCLUSIONS: These results suggest that a national exposure register may stimulate preventive measures at workplaces. Partially based on the results of the present study the Finnish Ministry of Social Affairs and Health continues ASA registration.

Exposure to chemical carcinogens and risk of cancer among Finnish laboratory workers.

BACKGROUND: Laboratory workers have long been suspected of having increased risks of cancer due to their occupation. We evaluated occupational exposure and cancer incidence among Finnish laboratory workers. MATERIALS AND METHODS: The cohort was comprised of 4,722 laboratory workers reported to the Finnish Register of Workers Exposed to Carcinogens in 1979-1988. The standardized incidence ratios (SIR) for cancers and their 95% confidence intervals (CI) were calculated based on data of the Finnish Cancer Registry. RESULTS: The most common carcinogens, to which these workers were potentially exposed, were chromium (VI), carbon tetrachloride, cadmium, benzene, and chloroform. From this cohort, 174 persons were recorded with primary tumors in 1980-1999. The SIR for cancer of all sites combined was 0.99 (CI 0.85-1.14). None of the cancer-specific SIRs were significantly elevated. Slight excesses were found, e.g., for non-Hodgkin's lymphoma (seven observed, 4.8 expected) and leukemia (four observed, three expected). CONCLUSIONS: This study did not suggest any major cancer risks among Finnish laboratory workers but the follow-up time of the cohort was too short (on an average 15.7 years) to reveal possible cancer risks requiring a longer induction period.

Occupational respiratory hypersensitivity in dental personnel.

OBJECTIVE: The aim was to study the causes of respiratory hypersensitivity in dental personnel based on the statistics of the Finnish Register of Occupational Diseases (FROD; 1975-1998) and the patient material of the Finnish Institute of Occupational Health (FIOH; 1990-1998). METHODS: Details about the cases of respiratory hypersensitivity were compiled from the FROD. The occupational rhinitis diagnoses studied at the FIOH were based on work-related symptoms and a change in the status of the nasal mucosa during challenge testing; and the diagnosis of occupational asthma based on reactions in challenge testing, or on IgE positivity and peak flow monitoring at work and during days off. RESULTS: A total of 64 cases of occupational respiratory diseases (ORDs) was diagnosed in dental personnel during 1975 to 1998 according to the FROD; two cases in 1975 to 1989, and 62 in 1990 to 1998. Twenty-eight cases were of occupational asthma (18 caused by methacrylates), 28 occupational rhinitis (six caused by methacrylates), seven allergic alveolitis and one organic dust toxic syndrome (ODTS). The non-acrylate-material diagnosed in 1990-1998 at the FIOH comprised three cases of asthma and one of rhinitis caused by chloramine-T (sodium- N-chlorine- p-toluene sulphonamide); as well as one case of asthma, seven cases of rhinitis, and two cases of combined rhinitis and conjunctivitis caused by natural rubber latex (NRL). Furthermore, one case of occupational rhinitis caused by Nobetec containing colophony was diagnosed. The incidence rate (IR) of ORD increased from 0 in 1988 to a peak of 105.1 new cases per 100,000 working years in 1995. During the last observation year, i.e. 1998, the IR was 55 new cases per 100,000 workers. The IR in dental personnel was lower than in the whole working population in Finland up until 1992, but since then has been greater than in the whole population, peaking in 1995 when the IR of dental personnel was 2.55 times greater than in the whole population. CONCLUSION: The present study shows the increasing frequency of respiratory hypersensitivity among dental personnel. Besides methacrylates, important causes of respiratory hypersensitivity are NRL and chloramine-T.