ORIGINAL ARTICLE
Asymmetric impact of the 2012 Occupational Health and Safety Law on occupational injury and disease reporting in Türkiye: An interrupted time series analysis with emphasis on emerging female occupational disease patterns
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1
Department of Pulmonary Diseases, Faculty of Medicine, Ege University, İzmir, Türkiye
2
Department of Pulmonary Diseases, Faculty of Medicine, Ağrı İbrahim Çeçen University, Ağrı, Türkiye
Submission date: 2026-05-19
Online publication date: 2026-10-01
Corresponding author
Funda Ekimci Deniz
Department of Family Medicine, Faculty of Medicine, Aydın Adnan Menderes University, Aydın Adnan Menderes Üniversitesi, Tıp Fakültesi Dekanlığı, Merkez Kampüs, 09100 Efeler – Aydın, Türkiye
KEYWORDS
ABSTRACT
Objective(s):
This study aimed to characterize 18-year trends in occupational injury (OI) and recognized occupational disease (OD) in Türkiye’s compensation-based surveillance, with emphasis on emerging female disease patterns and on the impact of the 2012 Occupational Health and Safety (OHS) Law.
Methods:
We extracted nationwide annual data (2007–2024) from Social Security Institution Statistical Yearbooks. We computed rates per 100 000 insured, the OI/OD ratio, and sex-stratified International Classification of Diseases, 10th Revision (ICD-10) sub-code distributions. Segmented regression with two intervention points used Newey–West heteroscedasticity- and autocorrelation-consistent (HAC) standard errors.
Results:
The proportion of recognized OD among women rose from 0.9% (2007) to 25.5% (2024) but with marked asymmetry: respiratory OD remained 96% male while nervous-system OD shifted from 24% female (2018) to 75% female (2024), driven by ICD-10 G62.2 toxic polyneuropathy (26 of 40 female cases in 2024). Female musculoskeletal OD rose from 20% to 34% with dominant upper-extremity repetitive-motion sub-codes; no female silicosis was recorded 2018–2024. Annual OI rose 9.1-fold (80 602 to 733 646); recognized OD declined (1208 to 888). The 2012 OHS Law produced an OI level change of +584 per 100 000 (P<0.001) but no statistically significant OD level change (P=0.32); the OI/OD ratio rose from 67 to 826.
Conclusion(s):
The convergence of women’s share of OD toward 25% masks marked diagnostic asymmetries: women are visible primarily through feminized service-sector and chemical-exposure categories and scarcely in pneumoconioses. Reform priorities include diagnosis-stage notification, active screening of female workers in mixed-exposure environments, and gender-sensitive occupational history-taking.
REFERENCES (37)
1.
Coggon D, Palmer KT, Walker-Bone K. Occupational health surveillance: a 21st-century perspective. Occup Med (Lond) 2019;69(8-9):527–30.
2.
Driscoll T, Nelson DI, Steenland K, Leigh J, Concha-Barrientos M, Fingerhut M et al. The global burden of disease due to occupational carcinogens. Am J Ind Med 2005 Dec;48(6):419–31.
https://doi.org/10.1002/ajim.2....
3.
Lenderink AF, Zoer I, van der Molen HF, Spreeuwers D, Frings-Dresen MH, van Dijk FJ. Review on the validity of self-report to assess work-related diseases. Int Arch Occup Environ Health 2012 Apr;85(3):229–51.
https://doi.org/10.1007/s00420....
4.
Spreeuwers D, de Boer AG, Verbeek JH, van Dijk FJ. Evaluation of occupational disease surveillance in six EU countries. Occup Med (Lond) 2010 Oct;60(7):509–16.
https://doi.org/10.1093/occmed....
5.
Cavariani F, Di Pietro A, Miceli M, Forastiere F, Biggeri A, Scavalli P et al. Incidence of silicosis among ceramic workers in central Italy. Scand J Work Environ Health 1995;21 Suppl 2:58–62.
6.
Kerget B, Araz O, Yilmazel Ucar E, Karaman A, Calik M, Alper F et al. Female workers’ silicosis diagnosis delayed due to gender bias. Occup Med (Lond) 2019 May;69(3):219–22.
https://doi.org/10.1093/occmed....
7.
Messing K, Punnett L, Bond M, Alexanderson K, Pyle J, Zahm S et al. Be the fairest of them all: challenges and recommendations for the treatment of gender in occupational health research. Am J Ind Med 2003 Jun;43(6):618–29.
https://doi.org/10.1002/ajim.1....
8.
Campos-Serna J, Ronda-Pérez E, Artazcoz L, Moen BE, Benavides FG. Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review. Int J Equity Health 2013 Aug;12:57.
https://doi.org/10.1186/1475-9....
10.
Camp PG, Dimich-Ward H, Kennedy SM. Women and occupational lung disease: sex differences and gender influences on research and disease outcomes. Clin Chest Med 2004 Jun;25(2):269–79.
https://doi.org/10.1016/j.ccm.....
11.
Messing K, Mager Stellman J. Sex, gender and women’s occupational health: the importance of considering mechanism. Environ Res 2006 Jun;101(2):149–62.
https://doi.org/10.1016/j.envr....
12.
Criado Perez C. Invisible women: exposing data bias in a world designed for men. London: Chatto and Windus; 2019.
13.
Türkiye Cumhuriyeti. İş Sağlığı ve Güvenliği Kanunu, Kanun No. 6331 [Republic of Türkiye. Occupational Health and Safety Law, No. 6331]. Resmî Gazete. 2012;28339. Turkish.
14.
Türkiye Cumhuriyeti. Sosyal Sigortalar ve Genel Sağlık Sigortası Kanunu, Kanun No. 5510 [Republic of Türkiye. Social Insurance and Universal Health Insurance Law, No. 5510]. Resmî Gazete. 2006;26200. Turkish.
15.
Türkiye Cumhuriyeti. Sosyal Sigorta Sağlık İşlemleri Tüzüğü [Republic of Türkiye. Social Insurance Health Procedures Regulation]. Resmî Gazete. 2008;26920. Turkish.
16.
Akgun M, Araz O, Akkurt I, Eroglu A, Alper F, Saglam L et al. An epidemic of silicosis among former denim sandblasters. Eur Respir J 2008 Nov;32(5):1295–303.
https://doi.org/10.1183/090319....
17.
Akgun M, Araz O, Ucar EY, Karaman A, Alper F, Gorguner M et al. Silicosis appears inevitable among former denim sandblasters: a 4-year follow-up study. Chest 2015 Sep;148(3):647–54.
https://doi.org/10.1378/chest.....
18.
Hua JT, Zell-Baran L, Go LH, Kramer MR, Van Bree JB, Chambers D et al. Demographic, exposure and clinical characteristics in a multinational registry of engineered stone workers with silicosis. Occup Environ Med 2022 Aug;79(9):586–93.
https://doi.org/10.1136/oemed-....
19.
Hoy RF, Tomic D, Gwini S, Dimitriadis C, Abramson M, Collie A et al. The rapid rise of silicosis in Victoria, Australia associated with artificial stone countertop industry work. Am J Ind Med 2025 Apr;68(4):358–67.
https://doi.org/10.1002/ajim.2....
20.
Sosyal Güvenlik Kurumu. SGK İstatistik Yıllıkları 2007–2024 [Social Security Institution. SGK Statistical Yearbooks 2007–2024]. Ankara: SGK; 2008–2025. Turkish. Available from:
https://www.sgk.gov.tr/Istatis....
21.
Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335–351.
22.
Lopez Bernal J, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–355.
23.
Turner SL, Karahalios A, Forbes AB, Taljaard M, Grimshaw JM, McKenzie JE. Comparison of six statistical methods for interrupted time series studies: empirical evaluation of 190 published series. BMC Med Res Methodol 2021 Jun;21(1):134.
https://doi.org/10.1186/s12874....
24.
Newey WK, West KD. A simple, positive semi-definite, heteroskedasticity and autocorrelation consistent covariance matrix. Econometrica 1987;55(3):703–8.
https://doi.org/10.2307/191361....
25.
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I et al.; RECORD Working Committee. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 2015 Oct;12(10):e1001885.
https://doi.org/10.1371/journa....
26.
Dumas O, Varraso R, Boggs KM, Quinot C, Zock JP, Henneberger PK et al. Association of occupational exposure to disinfectants with incidence of chronic obstructive pulmonary disease among US female nurses. JAMA Netw Open 2019 Oct;2(10):e1913563.
https://doi.org/10.1001/jamane....
27.
Razmjou H, Lincoln S, Macritchie I, Richards RR, Medeiros D, Elmaraghy A. Sex and gender disparity in pathology, disability, referral pattern, and wait time for surgery in workers with shoulder injury. BMC Musculoskelet Disord. 2016 Sep 21;17(1):401.
https://doi.org/10.1186/s12891....
28.
Ichihara G, Li W, Shibata E, Ding X, Wang H, Liang Y et al. Neurologic abnormalities in workers of a 1-bromopropane factory. Environ Health Perspect 2004 Sep;112(13):1319–25.
https://doi.org/10.1289/ehp.69....
29.
Atun R, Aydin S, Chakraborty S, Sumer S, Aran M, Gurol I, et al. Universal health coverage in Turkey: enhancement of equity. Lancet. 2013;382(9886):65-99.
https://doi.org/10.1016/S0140-....
30.
Karjalainen A, Niederlaender E. Occupational diseases in Europe in 2001. Statistics in focus, theme 3-15/2004. Luxembourg: Eurostat; 2004.
31.
Spieler EA, Burton JF Jr. The lack of correspondence between work-related disability and receipt of workers’ compensation benefits. Am J Ind Med 2012 Jun;55(6):487–505.
https://doi.org/10.1002/ajim.2....
32.
León-Jiménez A, Hidalgo-Molina A, Conde-Sánchez MÁ, Pérez-Alonso A, Morales-Morales JM, García-Gámez EM et al. Artificial stone silicosis: rapid progression following exposure cessation. Chest 2020 Sep;158(3):1060–8.
https://doi.org/10.1016/j.ches....
33.
Marinaccio A, Boccuni F, Rondinone BM, Brusco A, D’Amario S, Iavicoli S. Occupational factors in the COVID-19 pandemic in Italy: compensation claims applications support establishing an occupational surveillance system. Occup Environ Med 2020 Dec;77(12):818–21.
https://doi.org/10.1136/oemed-....
34.
34. Lee DW, Kim I, Hwang J, Choi S, Jang TW, Chung I, et al. Occupational disease monitoring by the Korea Occupational Disease Surveillance Center: a narrative review. Ewha Med J. 2025;48(1):e9.
https://doi.org/10.12771/emj.2....
35.
Azaroff LS, Levenstein C, Wegman DH. Occupational injury and illness surveillance: conceptual filters explain underreporting. Am J Public Health 2002 Sep;92(9):1421–9.
https://doi.org/10.2105/AJPH.9....
36.
Türkiye İstatistik Kurumu. İşgücü istatistikleri: kayıt dışı istihdam, 2023 [Turkish Statistical Institute. Labour force statistics: informal employment, 2023]. Ankara: TÜİK; 2024. Turkish.
37.
Türkiye İstatistik Kurumu. İşgücü İstatistikleri, 2023 [Turkish Statistical Institute. Labour Force Statistics, 2023]. Ankara: TÜİK; 2024. Turkish.