Levi Miriam, Ariani Filippo, Baldasseroni Alberto
Centro regionale infortuni malattie professionali e da lavoro CeRIMP, Regione Toscana, Firenze.
Epidemiol Prev. 2011 Sep-Dec;35(5-6):307-14.
To introduce the concept of DALYs (Disability Adjusted Life Years), in order to calculate the burden of occupational injuries and to compare the disability weights methodology applied by the National Institute for Insurance against Accidents at Work (INAIL) to occupational injuries, with respect to the methodology adopted by the World Health Organization in the Global Burden of Disease Study (GBD), in order to facilitate, on a regional-national basis, the future application of estimates of Burden of Disease due to this phenomenon, based on data available from the NHS.
In the first part of the present study, a comparison between the theoretical GBD methodology, based on Disability Weights, and the INAIL methodology based on Gradi di inabilità (Degree of Disability) (GI) described in the table of impairments is made, using data on occupational injuries occurred in Tuscany from 2001 to 2008. Given the different criteria adopted by WHO and INAIL for the classification of injuries sequelae, in the second part, two equations described in the literature have been applied in order to correct systematic biases.
In the INAIL dataset, all types of injuries, though often small in scale, have cases with permanent consequences, some of them serious.This contrasts with the assumptions of the WHO, that, apart from the cases of amputation, reduces the possibility of lifelong disabilities to a few very serious categories. In the case of femur and skull fractures, the proportion of lifelong cases is considered by WHO similar to the proportion that in the INAIL dataset is achieved after narrowing the threshold of permanent damage to cases with GI ≥ 33. In the case of amputations and spinal cord injuries, for which the WHO assumes a priori that all cases have lifelong consequences, on the contrary, the greater similarity between the assumptions and the empirically observable reality is obtained after extending the threshold of permanent damage to all cases with even minimal sequelae.The comparison between the WHO DW and INAIL GI, possible only in relation to injuries resulting in permanent damage, shows that in case of injuries of greater severity, INAIL GI are generally lower than the WHO DW. In the case of less serious injuries, INAIL gives instead higher values. The length of temporary disabilities recorded by INAIL is systematically higher than that estimated by WHO.
These initial comparisons between the WHO methodology and the cases evaluation performed by INAIL show that the Italian system, based on the gathering of all relevant aspects related to each case, has the potential to utilize and synthesize a greater amount of information.However, wide limits of uncertainty still remain and further empirical findings are needed in order to compare the two systems in terms of precise determination of the DW, the length of disabilities and variations of mortality related to injuries.
介绍伤残调整生命年（DALYs）的概念，以计算职业伤害负担，并将意大利国家工伤事故保险协会（INAIL）应用于职业伤害的残疾权重方法与世界卫生组织在《全球疾病负担研究》（GBD）中采用的方法进行比较，以便在区域 - 国家层面上，基于英国国家医疗服务体系（NHS）提供的数据，促进未来对这一现象所致疾病负担估计值的应用。
在本研究的第一部分，利用2001年至2008年托斯卡纳地区发生的职业伤害数据，对基于残疾权重的理论GBD方法与基于损伤表中描述的伤残程度（GI）的INAIL方法进行比较。鉴于世界卫生组织（WHO）和INAIL在损伤后遗症分类上采用了不同标准，在第二部分，应用了文献中描述的两个方程来纠正系统偏差。
在INAIL数据集中，所有类型的伤害，尽管规模通常较小，但都有产生永久性后果的案例，其中一些后果严重。这与WHO的假设形成对比，WHO认为除截肢案例外，终身残疾的可能性仅限于少数非常严重的类别。在股骨和颅骨骨折的案例中，WHO认为终身案例的比例与INAIL数据集中将永久性损伤阈值缩小到GI≥33的案例所达到的比例相似。在截肢和脊髓损伤的案例中，WHO事先假定所有案例都有终身后果，相反，在将永久性损伤阈值扩展到所有即使有最小后遗症的案例后，假设与实际可观察到的现实之间的相似性更大。WHO的残疾权重（DW）与INAIL的GI之间的比较，仅适用于导致永久性损伤的伤害，结果表明，在更严重伤害的情况下，INAIL的GI通常低于WHO的DW。在不太严重伤害的情况下，INAIL给出的值则更高。INAIL记录的临时残疾时长系统性地高于WHO估计的时长。
WHO方法与INAIL进行的案例评估之间的这些初步比较表明，基于收集每个案例所有相关方面信息的意大利系统有潜力利用和综合更多信息。然而，不确定性的广泛限制仍然存在，需要进一步的实证研究结果，以便在DW的精确确定、残疾时长以及与伤害相关的死亡率变化方面比较这两个系统。
