WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of occupational exposure to dusts and/or fibres and of the effect of occupational exposure to dusts and/or fibres on pneumoconiosis

Our plain-English summary of WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of occupational exposure to dusts and/or fibres and of the effect of occupational exposure to dusts and/or fibres on pneumoconiosis, by D. Mandrioli, V. Schlünssen, B. Ádám, et al (Environment International, 2018).

The study

• Authors: D. Mandrioli, V. Schlünssen, B. Ádám, R.A. Cohen, C. Colosio, W. Chen, A. Fischer, L. Godderis, T. Göen, I.D. Ivanov, N. Leppink, S. Mandic-Rajcevic, F. Masci, B. Nemery, F. Pega, A. Prüss-Üstün, D. Sgargi, Y. Ujita, S. van der Mierden, M. Zungu, P.T.J. Scheepers
• Journal: Environment International
• Published: 2018;119:174-185
• Cited by: 78 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years attributable to pneumoconiosis from occupational exposure to dusts and/or fibres, to inform the development of the WHO/ILO joint methodology.

Objectives: We aim to systematically review studies on occupational exposure to dusts and/or fibres (Systematic Review 1) and systematically review and meta-analyse estimates of the effect of occupational exposure to dusts and/or fibres on pneumoconiosis (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework.

Data Sources: Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science and CISDOC. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference list of previous systematic reviews and included study records; and consult additional experts.

Study Eligibility And Criteria: We will include working-age (≥15 years) study participants in the formal and informal economy in any WHO and/or ILO Member State but exclude children (<15 years) and unpaid domestic workers. Eligible risk factors will be dusts and/or fibres from: (i) asbestos; (ii) silica; and/or (iii) coal (defined as pure coal dust and/or dust from coal mining). Included outcomes will be (i) asbestosis; (ii) silicosis; (iii) coal worker pneumoconiosis; and (iv) unspecified pneumoconiosis. For Systematic Review 1, we will include quantitative prevalence studies of occupational exposure to dusts and/or fibres (i.e. no versus any exposure) stratified by country, sex, age and industrial sector or occupation. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of any occupational exposure to dusts and/or fibres on the prevalence of, incidence of or mortality due to pneumoconiosis, compared with the theoretical minimum risk exposure level of no exposure.

Study Appraisal And Synthesis Methods: At least two review authors will independently screen titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. At least two review authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2.

Prospero Registration Number: CRD42018084131.

Copyright © 2018 Elsevier Ltd. All rights reserved.

In plain English

This article is a protocol, not a study with results. It described how the authors planned two systematic reviews for the World Health Organization (WHO) and the International Labour Organization (ILO), to help estimate deaths and disability from pneumoconiosis caused by work. The first review was to gather studies on how common occupational exposure to asbestos, silica and coal dust was among workers aged 15 or older, for the years 1960 to 2018. It would use only objective measurements, not workers' self-reports. The second review was to gather trials, cohort studies and case-control studies on how such exposure affected asbestosis, silicosis, coal worker pneumoconiosis and unspecified pneumoconiosis, compared with no occupational exposure. If feasible, the authors planned to combine risk ratios in a meta-analysis. At least two reviewers were to independently screen studies, extract data and judge risk of bias. The reviews did not cover cancers or chronic obstructive pulmonary disease. They also did not cover family members exposed through dust carried home. The authors noted that no agreed methods existed for judging bias in exposure-prevalence studies. Findings were to be reported in separate articles.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Protocol for two planned systematic reviews: one of exposure-prevalence studies, and one systematic review and meta-analysis of effect studies. It reports no results.
• Who was studied: Planned eligibility: working-age workers (15 years or older) in the formal and informal economy, in any WHO and/or ILO Member State. Children under 15 and unpaid domestic workers were to be excluded.
• Exposure: Occupational exposure by inhalation to dusts and/or fibres from asbestos, silica and coal dust, each reviewed as a separate risk factor. The comparison level was no occupational exposure. Coal dust was defined as pure coal dust and/or dust from coal mining. No specific asbestos fiber types were named.
• Limitations the authors state:
  • The reviews would not capture people exposed outside the workplace, such as family members exposed through take-home dust or community members exposed to dust released from workplaces.
  • Other diseases caused by asbestos, silica and coal dust, including cancers and chronic obstructive pulmonary disease, would not be investigated.
  • The authors believed there was not enough cumulative exposure data to estimate burden of disease, so they would also prioritize a non-cumulative exposure measure.
  • Systematic Review 1 might not fit well with the Navigation Guide framework the authors used to organize the reviews.
  • No generally agreed methods existed for assessing risk of bias in studies of exposure prevalence.
  • The review covered only part of the total disease burden in the relevant WHO Global Health Estimates category.

Topics

Medical terms in this study, explained in our Lexicon: Systematic Review, Occupational Exposure, Pneumoconiosis, Silicosis, Relative Risk, Meta-Analysis.

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