Introduction Surveillance is useful for identifying occupations and industries at high risk of disease. However, less is known about workers’ risks from exposure to specific occupational hazards.

Objectives Apply a job-exposure matrix to occupational disease risk estimates to enhance surveillance efforts.

Methods The Occupational Disease Surveillance System (ODSS) uses Cox proportional hazards models to derive health risks for 30+ health outcomes. The Canadian job-exposure matrix (CANJEM) is a general population JEM that provides exposure data on over 250 hazards by occupation and industry. Exposure data for prevalence, intensity (non-exposed, low, medium, high), and duration of exposure (proportion of workweek exposed) were extracted. Hazard ratios (HRs) for silicosis and lung cancer from the ODSS were linked to silica exposure metrics from CANJEM by occupation (4-digit Canadian Classification and Dictionary of Occupations) and industry (3-digit 1970 Standard Industrial Classification).

Results There were 163 occupations and 141 industries exposed to silica according to CANJEM. Among occupations with >5 cases and ≥50% prevalence, the mean HRs were 18.33 (range: 16.5–19.7) and 1.25 (0.77–1.87) for silicosis and lung cancer respectively. Similar results were seen with occupations with ≥ medium intensity, and ≥25% duration of exposure. Occupations with both ≥50% prevalence and ≥ medium intensity had mean HRs 18.33 (16.5–19.7) and 1.44 (1.16–1.87) for silicosis and lung cancer respectively. Industry results had similar distributions for lung cancer HRs, and lower mean HRs for silicosis (at ≥50% prevalence HR: 8.57, range: 1.48–19.3).

Conclusion Using silica, we demonstrated that incorporating exposure information can help to identify and quantify workers’ exposure risk. Incorporating multiple exposure metrics improved detection of high-risk groups although is less sensitive. Understanding the role of exposure on health risk may allow prevention strategies to be implemented more pragmatically.