Aggregate Exposure and Cumulative Risk Assessment—Integrating Occupational and Non-occupational Risk Factors

Abstract

Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and nonchemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.

Toward an Expanded Focus for Occupational Safety and Health: A Commentary

“…The necessary changes involve how we conduct OSH research, train future OSH professionals, develop risk assessment and management strategies, and design interventions to maximize worker health and well-being [25,26] Thinking about the working-life continuum implies addressing the cumulative nature of risks. Cumulative risk assessment and exposomic science are growing fields that acknowledge the accretion of risks over time [66][67][68]. This includes the accumulation of all types of risks: chemical, physical, biological, and psychosocial [68].…”

“…Cumulative risk assessment and exposomic science are growing fields that acknowledge the accretion of risks over time [66][67][68]. This includes the accumulation of all types of risks: chemical, physical, biological, and psychosocial [68]. How this assessment will be used in the changing OSH environment is a critical, unanswered question.…”

Food Supplements for Weight Loss: Risk Assessment of Selected Impurities

“…According to the EPA, if available data is scarce the Hazard Index (HI) to assess cumulative risk is recommended for use for element impurities present in the mixture, assuming the cumulative effect of dose [36]. The calculation of HI does not require the knowledge of action mode of the elements present in the sample and does not consider the interactions between them, it only requires that elements have the same target organ [37,38]. HI determination is based on various elemental constituents of the mixture, for each route of exposure of interest, taking into account a single specific toxic effect or toxicity to a target organ [36].…”

Current intelligence bulletin 69: NIOSH practices in occupational risk assessment.

“…Research into risk assessment methods for nonchemical stressors and cumulative risks is ongoing [Lentz et al 2015;Lewis et al 2011]. For example, NIOSH has developed methods similar to chemical risk assessment to assess some non-chemical hazards, such as ionizing radiation and noise [NIOSH 1987;NIOSH 1998].…”