Global reporting and underreporting of occupational diseases: A systematic review

Background: Disease reporting is often unreliable and faces many challenges, making it difficult to estimate the true burden of occupational diseases, defined as any disease that is caused by work activities or environment. This study aimed to assess the global reporting and underreporting rate of occupational diseases, and to identify the factors affecting the underreporting of occupational diseases. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, this study searched Medline (PubMed), CINAHL, EMBASE, Scopus, Web of Science, WHO Institutional Repository for Information Sharing (IRIS) database, Dimensions, and Google Scholar in September 2024. Search terms related to reporting and underreporting of occupational diseases or illnesses were used. The selected records were screened, and data extracted using the Covidence software tool. Screening and quality assessment were conducted by two independent researchers and finalized by a third researcher. The quality of the evidence was assessed with the Mixed Methods Appraisal Tool. This study is registered on PROSPERO, number CRD42023417814. Results: A total of 127 studies from 29 countries were identified, all coming from high-income and upper-middle-income countries. The incidence rate of occupational disease varied widely, ranging between 1.71 to 1,387 per 100,000 employees yearly. The highest number of annual cases was reported in the agricultural sector (ranging from 33 to 6,431), followed by the health sector (146–5,508), and then the construction sector (264). Two studies evaluated rates of underreporting, which varied from 50% to 95%. The main factor contributing to underreporting was employee concerns about job security. Conclusions: The results reveal a significant gap in the reporting of occupational diseases among high-income and low-middle-income countries. Variations in reporting mechanisms across countries were also identified. Our findings highlight the need to establish a national system for reporting occupational diseases that engages employers, employees, and healthcare providers.