Background Work-related risk factors are important determinants of health, but existing surveillance systems commonly fail to capture occupational information.

Objectives A novel surveillance program was established for the detection of work-related diseases in Ontario, Canada’s largest province, through the linkage of several existing administrative databases. The Occupational Disease Surveillance System (ODSS) was used to detect work-related risks of cancers, and other chronic diseases and to identify at-risk groups of workers for targeted prevention.

Methods The ODSS identifies workers and their occupations and industries in compensation records for time-loss claims (1983-2014) and links these records through deterministic and probabilistic methods to health data captured in the Ontario Cancer Registry to monitor cancer risks and hospital discharge and out-patient billing data to identify chronic disease risks.

Results ODSS captured data for approximately 2.5 million workers (Ontario’s labour force in 2015 was 7.4M). A pilot project detected many excess risks among occupation groups and cancers consistent with established risk factors, including elevated risks of lung cancer in mining workers (HR 1.42, 95% CI: 1.27–1.59), mesothelioma in construction workers (HR 1.78, 95% CI: 1.26–2.53) and breast cancer among teachers (HR 1.57, 95% CI: 1.37–1.81). The ODSS cohort, derived from workers’ compensation claims records over represents workers with a higher risk profile and has the ability to identify and monitor work-related health outcomes within very specific occupational groups. This system was useful in determining that the more than 3-fold excess mesothelioma risk observed among educational services workers was driven by an excess risk among custodial staff, as opposed to teachers or administrators.

Piloted in Ontario, this model can be extended to other jurisdictions. Linkage of workers compensation data to other health records can be a valuable strategic resource for large-scale occupational chronic disease surveillance.