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Occupational Medicine 53:201-208 (2003)
Copyright © 2003 Society of Occupational Medicine

Investigating and analysing workplace clusters of diseases: a Health & Safety Executive perspective

D. M. McElvenny1, A. H. Mounstephen2, J. T. Hodgson1, J. Osman1, R. C. Elliott3 and N. R. Williams4

1Epidemiology and Medical Statistics Unit, Health & Safety Executive, Bootle, Merseyside L20 3QZ, UK.
2Occupational Health and Safety Advisory Service, Fife Primary Care NHS Trust, Fife KY11 2BJ, UK.
3Medical Unit, Health & Safety Executive, Bootle, Merseyside L20 3QZ, UK.
4Employment Medical Advisory Service, Health & Safety Executive, Birmingham B16 8HS, UK.

Correspondence to: Damien McElvenny, Epidemiology and Medical Statistics Unit, Health & Safety Executive, Magdalen House, Stanley Precinct, Bootle, Merseyside L20 3QZ, UK. e-mail: damien.mcelvenny{at}hse.gsi.gov.uk

Abstract

Background Clusters of disease arising in workplaces cause concern among the management of the company, the workers affected and their families and friends. Chance is the most likely explanation for their occurrence, although a number of real workplace hazards have been identified through their observation and investigation. Employers have a duty to investigate such occurrences in order to assess whether some unknown or unidentified hazard is at work and to take the appropriate action. Several papers have been published over the last 15 years or so that set out a method for investigating workplace clusters of disease.

Aims This paper presents the steps in the approach taken by the Health & Safety Executive in Great Britain.

Method An initial step identifies the relevant stakeholders at the outset, in order to maintain a realistic expectation of what the investigation can hope to achieve and to open a dialogue. The main steps in the assessment are: (1) identifying cases; (2) determining the other parameters of the investigation; (3) statistically assessing the cluster; (4) examining potential exposures and assessing their biological plausibility; and (5) determining the overall significance of the cluster. The approach is illustrated throughout by examples.

Keywords      Cluster; examples; Great Britain; investigation; method; workplace


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