OCCUPATIONAL SKIN DISEASES - RELIABILITY AND UTILITY OF THE DATA IN THE VARIOUS REGISTERS - THE COURSE FROM NOTIFICATION TO COMPENSATION AND THE COSTS - A CASE-STUDY FROM DENMARK

Occupational diseases affect many people and may have serious social a nd economic consequences. In 1984, the National Labour Inspection Serv ice established the Register of Occupational Diseases (ROD). The purpo se of the central register was to provide information about injury-cau sing factors and risk groups, etc., changes in risk factors (ongoing m onitoring and warning system), and to document the effects of preventi ve activies. However, we are dealing with several uncertain factors (i .e., whether the number of notified cases is too high or too low), and although the ROD contains a lot of information, it basically represen ts only notified (suspected) cases, until otherwise proven. Therefore, the utility and reliability of the data in the ROD may be questionabl e. The National Board of Industrial Injuries and the insurance compani es represent recognized and compensated (genuine) cases, but their reg isters in general contain little information on variables. Thus, it is difficult to obtain exact information of occupational diseases (i.e., the real frequency and causes). What is known, is the number of cases that are notified, recognized and compensated, and the costs. Clearly , the higher the frequency of recognition, the more representative the data in the ROD of the recognized (genuine) cases. Therefore, the cou rse from notification to recognition, and from recognition to compensa tion was calculated, and, for each step, the importance of skin diseas es was considered. Only in the case of skin diseases, was the frequenc y of recognition high (2/3), and the data in the ROD were considered i n more detail, and, where possible, compared with recognized and compe nsated cases. The various registers concurrently showed that nearly al l occupational skin diseases were eczematous in nature (98%), most cas es belonged to the younger age group (2/3), women (2/3) predominated o ver men, and the dominant type of occupational eczema was irritant (2/ 3). It has not been possible to get further information about exposure sources, occupations and trades from the other registers. However, co nsidering the high frequency of recognition for skin diseases (eczemas ), it is likely that the information in the ROD is also to some extent representative of the recognized (genuine) cases. As regards the impo rtance of various disease categories, skin diseases (eczemas) ranked I st (numerically) among both recognized and compensated cases, and were the most expensive. Therefore preventive activities are mandatory, an d because of the high frequency of recognition, the data in the ROD ma y provide a basis for establishment of the most relevant preventive ac tivities. For other disease categories, the frequency of recognition w as low, and the utility and reliability of the data in ROD is in quest ionable. Therefore, in general, an improvement in the notification sys tem is desirable, but a system that takes into account the many uncert ain factors is extremely difficult to set up. Linking of the registers is in progress, and this will be useful during everyday situations. ( C) Munksgaard, 1998.