Estimation of under-reporting of work-related musculoskeletal diseases (MSDs) in France: comparison between data from compensated occupational diseases system and data from epidemiological surveillance system of non-compensated work-related diseases (WRD)

Objectives In industrial countries, studies suggest under-reporting of occupational diseases, particularly for MSDs. In France, the financial compensation of occupational disease relies on “tables”, based on presumption of causality, which define the necessary and sufficient conditions. WRD are all the non-compensated diseases from occupational origin. They were registered via an epidemiological surveillance system, based on a network of volunteer occupational physicians, in 7 regions in 2007. The aim of this study was to evaluate under-reporting of 3 localisations of MSDs: shoulder, hand-wrist-fingers (including carpal tunnel syndrome) and rachis by comparing data from these two systems. Methods Agriculture, education, health and administration were excluded because they were insured by another special compensation system. For each localisation, an indicator of under-reporting (I1) was defined as following: frequency of non-compensated MSDs corresponding to a compensation system table / frequency of compensated MSDs. I1 was analysed by gender, age, business activity sectors and region. Results I1 was equal to 4 for shoulder, 7 for hand-wrist-fingers and 6 for rachis, with variations according to gender and age. I1 was lower in the manufacturing industries for hand-wrist-fingers. According to region, I1 varied from 8 to 14 for hand-wrist-fingers, from 1 to 9 for shoulder and 0 to 15 for rachis. Conclusions The indicator quantification is crude because external factors not only diagnosis had to be considered from reporting to compensation. However, this study for the first time provided an estimation of under-reporting of 3 localisations of MSDs in France. A similar work about under-compensation is in progress.