Standards for recognition and approval rate of occupational cerebro-cardiovascular diseases in Korea

Abstract

Background: Although working hours have decreased in Korea, they are still high compared to that of other countries. In Korea, cardiovascular and cerebrovascular diseases (CCVDs) related to overwork in Korea continually occur, and the social burden from overwork is estimated to be high. This study investigated the amendment of regulations affecting the approval rate of occupational CCVDs.

Methods: The change in approval rate of occupational CCVDs and related regulations were investigated using the Act and public notice on the standards for recognition of occupational CCVDs and the yearbooks of the Ministry of Employment and Labor. The CCVD mortality was estimated using data on the number of deaths according to the cause of death, the number of employed people, and resident registration population aged 15-64 years. The cumulative mortality of CCVDs was estimated using the Kaplan-Meier method.

Results: Since the establishment of the standards for recognition in Korea in 1982, the scope of occupational diseases has been expanded to include intracerebral hemorrhage, subarachnoid hemorrhage, cerebral infarction, myocardial infarction, and aortic dissection. In 2013, the concept of working hours was introduced in chronic overwork. The approval rate of occupational CCVDs was 44.7% in 2006, which decreased to 12.9% in 2011. After the improvement of related regulations, the approval rate increased to 41.3% in 2018. From 2000 to 2017, the CCVD mortality of both the unemployed and employed tended to decrease, and their cumulative CCVD mortalities were 549.3 and 319.7 per 100,000 people, respectively.

Conclusions: CCVDs are recognized as occupational diseases in Korea. The amendments to the standards for recognition, the introduction of the Occupational Disease Adjudication Committee, the principle of presumption, and the reduction of working hours have changed the approval rate of occupational CCVDs. A strategic approach is needed to further reduce the incidence of CCVDs.

Keywords: Approval rate; Cardiovascular diseases; Cerebrovascular diseases; Occupational diseases; Standards for recognition.

Fig. 1. Numbers of applications and approvals of CCVDs as occupational diseases per year and their approval rate as well as numbers of workers covered by the Industrial Accident Compensation Insurance (2000–2020).

^aIn July 2008, the standards for recognition of CCVDs were tightened (removing the provision that recognized cerebral hemorrhage as an occupational disease in the course of work) and the Occupational Disease Review Commission system was introduced; ^bIn July 2013, the standards for recognition of CCVDs were relaxed (working hours added); ^cIn September 2017, the principle of estimation was applied; and ^dIn January 2018, the standards for recognition of CCVDs were relaxed (eliminating the duty for health status considerations of short-term overwork workers, subdividing standard time for chronic overwork, and taking into account weighting factors of workload and night shifts). CCVD: cardiovascular and cerebrovascular disease.

Fig. 2. Numbers of deaths, mortality rates, and cumulative mortality rates per year (2000–2017) of the unemployed and employed. (A) Cardiovascular and cerebrovascular diseases, (B) cardiovascular disease, and (C) cerebrovascular disease.