[Epidemiology of risks in the workplace]

Epidemiologic studies of occupationally exposed subjects allow to detect diseases caused by the work environment and to identify hazardous exposures. They provide the basis for preventive measures and workers compensation. Occupational epidemiology traditionally emphasized the study of work related cancer. Long latency periods for the development of most cancers and limited information about the exposure history of the study subjects are problems for all study types. The specific advantages and limitations of different study designs are discussed. Research strategies in occupational epidemiology are demonstrated using as an example two studies from the American tire and rubber industry. The specific contributions of a historical cohort study and a nested case-control study, concerning the association between lymphosarcoma and exposure to solvents, are discussed. Experiences and first results from a historical cohort study in the German rubber industry are reported. Future research in occupational epidemiology should concentrate more on the study of work related morbidity such as musculoskeletal disorders, hearing loss, accidents and the influence of the work environment on the mental and physical well being. Modern research methods such as prospective cohort studies or workforce monitoring should be used more often. Prospective cohort studies provide quantitatively and qualitatively more precise information about exposures and potential confounders, e.g. cigarette smoking or alcohol consumption, than traditional study methods. The promising perspectives of biological markers warrant further research. The situation of occupational epidemiology in Germany can only be improved if all concerned parties and institutions realize the importance of occupational epidemiology. Laws concerning data confidentiality which seriously hamper epidemiologic research must be modified.