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  1. Hans Kromhout1,
  2. Martie van Tongeren2,
  3. Cheryl E Peters3,4,
  4. Amy L Hall5
  1. 1 Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  2. 2 Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
  3. 3 Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
  4. 4 Community Health Sciences and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  5. 5 Veterans Affairs, Government of Canada, Charlottetown, Prince Edward Island, Canada
  1. Correspondence to Professor Hans Kromhout, Institute for Risk Assessment Sciences, Utrecht University, Utrecht 3508 TD, The Netherlands; h.kromhout{at}

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We are writing with respect to three recently published papers1–3 that address the global burden of disease due to occupational exposures. This work by the Global Burden of Disease (GBD) 2016 Occupational Risk Factors Collaborators presents what appear to be precise estimates of the global burden of death and disease due to occupational exposure, for example, 2.8% of deaths and 3.2% of disability-adjusted life years (DALYs) from all causes.1 For cancer, the estimates are 3.9% of all cancer deaths and 3.4% of all cancer DALYs.3 For chronic respiratory disease, the authors report only population attributable fractions (based on DALYs) of 17% for chronic obstructive pulmonary disease and 10% for asthma.2 In the accompanying commentary by Loomis some limitations of these estimates have been outlined (eg, considering only a limited number of established carcinogens).4 In addition to these limitations, we wish to consider some inherent issues with the occupational exposure estimates used in the development of these global burden of occupational disease estimates.

The GBD 2016 Collaborators broadly acknowledge the limitations of estimating prevalence of occupational exposures on a global scale, explaining their assumptions with However, currently the necessary data are not available. We agree that limited exposure data availability, particularly in low-and middle-income countries, is a concern for various global initiatives focussed on surveillance, hazard and risk assessment and disease burden estimation. However, there are presently a number of opportunities to improve exposure estimation through the use of existing data sources and methods. We contend that more effort should be applied to leverage existing occupational exposure data that has been collected through decades of occupational hygiene, exposure science and epidemiological …

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