Table of preferred sources for Ill Health

Preferred data sources for different categories of work related ill health
Acronym key LFS - Labour Force Survey THOR - The Health and Occupation Reporting network SWORD - Surveillance of Work-related and Occupational Respiratory Disease specialist surveillance scheme EPIDERM - Skin specialist surveillance scheme IIDB - Industrial Disablement Benefit DC - Death certificates AF - Attributable Fraction - This is the proportion of the total number of cases of the disease that are caused by occupational exposure. The AF is either measured directly from a bespoke study or estimated by combining and comparing relevant epidemiological studies from around the world.
Nature of harm *	Preferred data source	Reason for preference
1. Common conditions arising in a wide range of occupational settings
Stress	LFS	The Labour force survey provides our preferred estimate of the scale of occupationally related stress in Great Britain. Our current research suggests that there is high correlation between self-reported and medically diagnosed stress in respect of attribution to work. The question has been asked in the LFS annually for the last decade and hence the LFS is the best source for trend information. THOR –GP is the source which can best capture likely causes of work related mental ill health by asking patients about the events leading to the diagnoses of the condition at the general practitioner level to indicate probable/likely cause.
Musculoskeletal disorders	LFS	The labour force survey is the preferred data source for estimating the scale of work related musculoskeletal disorders in Great Britain. Musculoskeletal disorders are ubiquitous in the working population, can occur as chronic or acute conditions and are often episodic in nature and severity. Our current research suggests that there is high correlation between self-reported and medically diagnosed musculoskeletal disorders in respect of attribution to work. The question relating to work related musculoskeletal disorders has been asked in the LFS annually for the last decade and hence the LFS is the best source for trend information. THOR-GP is the best source for understanding likely cause of work-related musculoskeletal disorders by identifying the attributable task or movement and anatomical site related to the condition.
2. Common conditions arising in a limited range of occupational settings
Asthma	THOR-GP	GPs are best placed to capture most new cases of asthma that occur, rather than only those serious enough to be referred to consultants. It is unlikely that participating GPs are substantially less accurate than consultants in attributing occupational causation, and therefore THOR-GP is our preferred source. SWORD provides the largest numbers of actual reported cases of occupational asthma and, though restricted to cases referred to consultants, therefore provides the best basis for more detailed analyses.
Chronic Obstructive Pulmonary Disorder (COPD)	AF	A/F estimates are preferred since they do not rely on the correct occupational attribution of individual cases, which is particularly difficult for COPD since smoking is the predominant cause. The epidemiological data on which A/F estimates of the overall scale are based provide information about the contribution of different exposures, occupations and industries.
Cancer	AF	Due to the long latency and multifactorial nature of cancer development, there are considerable uncertainties and variation in the assessment of work attribution on individual cases. The data generated using AF do not require the assessment of work attribution in individual cases and has the advantage over other sources of data, where the numbers of occupational cancer cases were counted based on self-assessment or assessment by physicians for disease surveillance or compensation purposes.
Deafness	AF	The preferred source indicating the prevalence of work-related deafness in the working population of Great Britain comes from the extensive study carried out in 1997/98 by the Medical Research Council which estimated that 509'000 individuals suffer from deafness as a result of exposure to noise at work. This was calculated by an attributable fraction method which does not rely on individual exposures which are difficult to ascertain and is a better measure of the scale of the problem in the workforce of GB. This data is currently being updated to reflect the current prevalence rate and will report in 2013. From the IIDB we get numbers of new claims assessed for work-related deafness but these remain small with case numbers in the hundreds. The Labour Force survey estimates around 20'000 individuals become aware of deafness onset each year which they attribute to their work.
Skin disorders/dermatitis	THOR-GP	Occupational skin disease can vary widely in severity from, for example, skin cancers and serious cases of dermatitis, to minor skin irritation, which may not be recognised as an adverse health outcome by the individual. THOR-GP captures those cases which are of enough concern to have triggered a visit to a GP and be subsequently diagnosed and attributed to work, but is not restricted to including only those cases serious enough to be referred to a dermatologist. EPIDERM provides by far the largest numbers of actual reported cases of skin disease and, though restricted to more severe cases, provides the best basis for more detailed analyses.
3. Specific or rare conditions arising in a limited range of occupational settings
Asbestosis	IIBD	This is a serious lung disease with well established arrangements for state compensation and as such IIDB provides the best indication of the scale.
Asbestos-related lung cancer	AF	AF estimates are preferred since they do not rely on the correct occupational attribution of individual cases, which is particularly difficult for asbestos-related lung cancer since smoking is the predominant cause. Temporal trends and the past sources of risk are likely to mirror those of mesothelioma to some extent, for which detailed information is available from DCs and epidemiological studies.
Diffuse pleural thickening	IIDB	This is a serious lung disease with well established arrangements for state compensation and as such IIDB provides the best indication of the scale.
Hand-arm vibration syndrome	AF	The preferred source to estimate the scale of HAV's in the GB working population is derived from the MRC attributable fraction study carried out in 1997/98 which estimated that 288'000 individuals suffered HAV'S as a result of occupational exposure. This method does not rely on measurement of individual exposure and is a better measure of the scale of HAV in the workforce of GB. This data is currently being updated to reflect the current prevalence of HAV's in Great Britain and will report in 2013. The IIDB continues to publish the number of new claimant cases annually and these numbers remain small.
Mesothelioma	DC	Most mesothelioma deaths in GB can be readily identified via the death certificate. Since the disease is rapidly fatal following diagnosis, mortality approximates to incidence. National mesothelioma mortality statistics have been collected on a consistent basis since 1968 so is the best source of information on trends. The British mesothelioma case-control study (Peto et al. 2009, RR696) provides the best indication of the past sources of mesothelioma risk in GB.
Pneumoconiosis and silicosis	IIDB	This is a serious lung disease with well established arrangements for state compensation and as such IIDB provides the best indication of the scale.
Other respiratory disease	SWORD	The specialist reporting scheme includes non-fatal cases and those who have not claimed for IIDB.
Infections	IIDB	Numbers of individuals assessed for occupational infections which are eligible for Industrial Injury and Disablement Benefit

* There are a number of conditions for which a proportion of cases are likely to be caused or made worse by work but for which HSE does not currently have a preferred data source, including cardiovascular, neurological and reproductive disease. HSE continues to monitor the epidemiological evidence about the causes of such diseases and will produce statistical estimates in future where it is feasible to do so with reasonable precision.