Health and Safety
Executive / Commission
Statistics
Estimates of the prevalence of occupational illnesses in Great Britain – meaning the total number of people ill at any given time – may be derived from the national surveys of Self-reported Work-related Illness (SWI). From the latest survey, it was estimated that in 2006/07 29 000 people who have ever worked had "skin problems" caused or made worse by work (95% Confidence Interval: 21 000-36 000) – see Table SWIT3.
The SWI surveys rely on self diagnosis and responses given therefore depend on lay people’s perceptions of medical matters. In particular, the wording of the SWI survey questionnaire means that estimates for "skin problems" also depend on respondents recognising these as an occupational illness – rather than, for example, a condition or complaint. Furthermore, where respondents are suffering from more than one illness, prevalence estimates are based on the illness they regard as most severe. Both these factors may tend to lead to an underestimation of the prevalence of occupational skin disease by the SWI surveys.
Two data sources provide information about annual incident cases (new cases occurring each year) of occupational skin disease in Great Britain: the Department for Work and Pensions (DWP) Industrial Injuries and Disablement Benefit (IIDB) scheme and The Health and Occupation Reporting (THOR) network. Both are subject to underreporting and therefore tend to underestimate the overall incidence. However, the THOR scheme does provide useful insights about high risk occupations and particular causal agents for occupational skin disease.
In 2006, there were 3544 cases of occupational skin disease by dermatologists and occupational physicians reporting to the EPIDERM and OPRA schemes within the THOR network (Table THORS01). This suggests an incidence rate of about 125 cases per million workers per year, based on estimates of the total numbers employed from the Labour Force Survey (LFS). However, in a recent analysis of THOR data for 2002-2005, the average annual incidence rate of work related skin disease was 91.3 per million (95% Confidence Interval: 81.8-101.1 per million) as reported by dermatologists (EPIDERM), and 316.6 per million (95% Confidence Interval: 251.8-381.3 per million) as reported by occupational physicians (OPRA)2. The latter rate is higher since allowance was made for the fact that occupational physicians serve only about 12% of the workforce estimated by the LFS.
Of the skin disease cases reported within THOR in 2006, 2395 (68%) were contact dermatitis and 760 (21%) – most of the remainder – were skin cancers. The majority of the cases seen by both dermatologists occupational physicians were contact dermatitis (63% for EPIDERM and 86% for OPRA in 2006) while only EPIDERM tends to pick up cases of skin cancer (only 1 case was reported by OPRA during last three years.) This is largely due to the fact that occupational physicians see very few patients who are over the age of 65, while the reverse is true of dermatologists. Hence, skin cancers and other diseases of long latency are much less likely to be picked up by OPRA. A full description of the various occupational dermatoses reported to EPIDERM and OPRA is given in Table THORS01.
Reports to EPIDERM and OPRA include only those cases of skin disease that were serious enough to be seen by a dermatologist or occurred in workplaces where there is access to occupational physicians. Furthermore, many cases that failed to be diagnosed at all or where the link with work activity was not recognised will not be included. Thus, the true incidence of occupational skin disease is likely to be substantially higher than suggested by EPIDERM/OPRA – particularly for those conditions such as contact dermatitis where there may be substantial numbers of less serious cases.
The coverage of the IIDB scheme is much more restricted than that of THOR and typically identifies only the most severe cases of dermatitis. In 2006, there were 145 cases assessed for disablement benefit (Table IIDB03).
Diagnoses of occupational dermatitis within the THOR scheme in 2006 were split approximately evenly by sex, though a much higher proportion of skin cancers were among men, and higher proportion of contact urticaria cases were among women (Table THORS01). Contact dermatitis tends to occur at a younger age – particularly amongst female workers, however, for skin cancer the majority of the cases occur in those aged over 65 years (Table THORS02).
The majority of cases (85 per cent) of occupational skin disease in 2004-06 occurred in England, with 9 per cent in Scotland and 6 per cent in Wales (Table THORS03). For contact dermatitis the proportions were similar to these. For skin cancer, a very high percentage of cases occurred in England compared to Wales and Scotland.
Over 1500 of new diagnoses of work-related ill health were made by participating general practitioners in the first year of a new UK surveillance scheme (THOR GP). Of these, 9% were skin diseases (Table THORGP01).