Front. Public HealthFrontiers in Public HealthFront. Public Health2296-2565Frontiers Media S.A.10.3389/fpubh.2022.1035996Public HealthSystematic ReviewOccupational health risk assessment methods in China: A scoping reviewZhouLifang1XuePanqi1ZhangYixin2WeiFang1ZhouJiena3WangShasha4HuYong1LouXiaoming1*ZouHua1*1Institute of Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China2School of Medicine, Hangzhou Normal University, Hangzhou, China3Department of Public Health, Zhejiang University School of Medicine, Hangzhou, China4Shaoxing Center for Disease Control and Prevention, Shaoxing, China
Edited by: Jianlin Lou, Zhejiang Academy of Medical Sciences, China
Reviewed by: Aihong Wang, Ningbo Municipal People's Government, China; Laura Andrea Rodriguez-Villamizar, Universidad Industrial de Santander, Colombia; Fang Zhang, Shandong Academy of Occupational Health and Occupational Medicine, China
*Correspondence: Hua Zou hzou@cdc.zj.cnXiaoming Lou xmlou@cdc.zj.cn
This article was submitted to Occupational Health and Safety, a section of the journal Frontiers in Public Health
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Background
Over the decades, many assessment methods have been developed around the world and used for occupational health risk assessment (OHRA). This scoping review integrated the literature on methodological studies of OHRA in China and aimed to identifies the research hot-spots and methodological research perspectives on OHRA in China.
Methods
A scoping review of literature was undertaken to explore the research progress on OHRA methods in China. Focusing on OHRA methods, the authors systematically searched Chinese and English databases and relevant guideline websites from the date of establishment to June 30, 2022. Databases included Web of Science, PubMed, Scopus, the China National Knowledge Internet, WanFang Database. Some other websites were also searched to obtain gray literature. The extracted information included the author, year, region of first author, the target industry, risk assessment model, study type, the main results and conclusions.
Results
Finally, 145 of 9,081 studies were included in this review. There were 108 applied studies, 30 comparative studies and 7 optimization studies on OHRA in China. The OHRA methods studied included: (1) qualitative methods such as Romanian model, Australian model, International Council on Mining and Metals model, and Control of Substances Hazardous to Health Essentials; (2) quantitative methods such as the U. S. Environmental Protection Agency inhalation risk assessment model, Physiologically Based Pharmacokinetic, and Monte Carlo simulation; (3) semi-quantitative methods such as Singapore model, Fuzzy mathematical risk assessment model, Likelihood Exposure Consequence method and Occupational Hazard Risk Index assessment method; (4) comprehensive method (Chinese OHRA standard GBZ/T 298-2017). Each of the OHRA methods had its own strengths and limitations. In order to improve the applicability of OHRA methods, some of them have been optimized by researchers.
Conclusions
There is a wide range of OHRA methods studied in China, including applied, comparative, and optimization studies. Their applicability needs to be further tested through further application in different industries. Furthermore, quantitative comparative studies, optimization studies, and modeling studies are also needed.
China is the most populous country in the world with a population of 1.41 billion, of which more than 783 million are workers, and more than 200 million workers are exposed to occupational hazards (1, 2). China has carried out a series of strategies and measures to reduce the health risk of occupational hazards exposure. However, occupational health in China still faces severe conditions and challenges (3). In 2021, China's National Health Commission (NHC) reported a total of 15,407 new cases of various occupational diseases nationwide (4). Occupational pneumoconiosis, noise-related hearing loss, and occupational poisoning have become the most serious occupational diseases in China (4, 5). In China, occupational diseases come from more than 30 industries, including traditional industries such as coal mining, non-ferrous metal mining, metallurgy, machinery, construction and chemical industry, and new industries such as computer and information technology, biology and medicine (3). Occupational diseases are reported in all provinces in China, but there are differences in distribution between different regions, for example, occupational tumors are predominant in Guangdong, Shandong, Liaoning, Hubei, Beijing, and Jiangsu (6), while chronic benzene poisoning is predominant in Guangdong, Jiangsu, Shandong, Beijing, Tianjin, Fujian, Zhejiang, and Sichuan (7, 8). Like many countries, China faces the important task of occupational health risk management in order to reduce the impact of occupational hazards. Occupational health risk assessment (OHRA) is an important part of occupational health management. Understanding how much exposure to a hazard poses health risks to workers is important to appropriately eliminate, control, and reduce those risks (9). The “Law on Prevention and Control of Occupational Disease,” which approved by the Chinese National People's Congress Standing Committee in 2002 and recently modified in 2018, stipulates that occupational health risk assessment is one of the tasks of the health administrative department in China (10).
Risk assessment is a process that aims to identify what hazards exist in the workplace and evaluating the possibility of personal injury or harm caused by these hazards. The purpose of risk assessment is to determine and propose corresponding preventive and control measures (11). OHRA is a process of qualitatively or quantitatively evaluating occupational health risk levels by comprehensively and systematically identifying and analyzing risk factors and protective measures in the workplace, so as to take corresponding controls (12). The use of risk assessment methods to evaluate the effects of toxic chemicals had its primary origin in 1976 when the U.S. Environmental Protection Agency (EPA) (13) adopted a methodology introduced in the 1950s to conduct the evaluation of suspect carcinogens (14, 15). In 1983, the U.S. Nuclear Regulatory Commission (16) first proposed that the risk assessment process is divided into four stages: hazard identification, dose-response assessment, exposure assessment and risk characterization (16). Since then, the risk assessment techniques and methods for health risks caused by hazardous substances have been widely used. Subsequently, the U.S. EPA established a series of risk assessment guidelines, such as the supplemental inhalation risk assessment guidelines of the Human Health Risk Assessment Manual, to provided technical guidance for the risk assessment of airborne toxic chemicals in the workplace (13).
Meanwhile, some European countries, Australia, Singapore, and other countries and organizations established guidelines for OHRA and risk management in response to occupational hazards in the workplace. For example, the United Kingdom Health and Safety Executive initiated the Control of Substances Hazardous to Health (COSHH) essentials control banding strategy (17); Australia has established risk management methods in Australian Standards (AS/NZS) (18); Romania established the risk assessment method for occupational accidents and diseases with reference to European standards (EN292/1-19, EN 1050/96) in 1998 (19); Singapore established guidelines for the hazard assessment of occupational chemical exposures for hazardous chemicals (20).
China established a classification standard for hazardous operations in the 1980s and started health risk assessment research by introducing the USEPA models in the nuclear industry field (12). In the first decade of OHRA study, the health risk assessment technology in China is mainly based on the four-step process recommended by the USEPA, focusing on monitoring of exposure and epidemiological study (21). In 2007, the “Technical Guidelines for Pre-Assessment of Occupational Disease Hazards in Construction Projects” (GBZ/T196-2007) promulgated by the Chinese Ministry of Health proposed that the risk assessment methods should be applied to the assessment of occupational disease hazards in construction projects (22). In 2010, the Chinese Ministry of Health issued standards such as “Classification for Hazards of Occupational Exposure to Toxicant” (GBZ 230-2010) and “Classification of Occupational Hazards at workplaces” (GBZ/T 229-2010) to rank hazard levels from exposure to productive dust, chemical toxicants, heat and noise (23, 24). Due to the lack of OHRA method in China, the GBZ 230-2010 and GBZ/T 229-2010 were sometimes used as an alternative to occupational health risk assessment, although the results are often not accurate enough due to the low sensitivity of the method.
In recent years, Chinese government has paid more and more attention to occupational health risk assessment. Researchers in China have applied some international risk assessment methods for occupational health risk assessment in various industries (21). At the same time, some researchers improved and optimized the OHRA tools introduced from abroad, and established the first Chinese OHRA standard “Guidelines for Occupational Health Risk Assessment of Chemicals in the Workplace” (GBZ/T 298-2017) (25), which recommends a quantitative risk assessment method, a qualitative risk assessment method and three semi-quantitative risk assessment methods. As China's first OHRA guideline, researchers have carried out applied studies on it in different industries soon after it was released (26, 27). The application of OHRA methods in GBZ/T 298-2017 shows that it still needs further improvement and needs to be complemented by other risk assessment methods (28). There are numerous risk assessment methods internationally, and Chinese scholars have conducted a lot of research on various OHRA methods (12, 29, 30). Nevertheless, it is still not clear what kinds of OHRA methods are currently being applied for occupational health risk assessment studies in China, what types of methodology studies on OHRA tools are conducted by Chinese researchers, and how applicable these methods are in OHRA in the workplaces. To further understand the progress of research on OHRA methodology in China, an aggregation and generalization of these OHRA methodological studies needs to be carried out. Therefore, we conducted this scope review to summarize the methodological researches on OHRA methods in China to provide information for future research on OHRA and occupational health risk management in China.
MethodsStudy design
A scoping review was conducted to explore the research progress on OHRA methodology in China. The review proceeded five stages according to a scoping review method developed by Arksey and O'Malley (31), extended by Levac et al. (32), and further modified by Westphaln et al. (33). This scoping review provides an overview of the existing evidence on studies focus on OHRA methodology in China without a formal assessment of the methodological quality. The steps of the scoping review are: (1) identifying the research question; (2) identifying relevant literature; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. In order to enhance the quality of this scoping review, it was conducted and reported in accordance with the checklist of Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (34, 35).
Research questions
Specific research questions of this scoping review were:
What kinds of OHRA methods are currently involved in OHRA methodology studies in China?
What types of studies have been conducted on these OHRA methods by Chinese researchers?
What are the strengths, limitations and applicability of these OHRA methods?
Search strategy
Focusing on OHRA methods, the authors systematically searched Chinese and English databases and relevant guideline websites from the date of establishment to June 30, 2022. Databases included Web of Science, PubMed, Scopus, the China National Knowledge Internet, WanFang Database. Search terms were developed based on three main concepts of “occupational health,” “risk assessment,” and “methods,” restricted to studies conducted in China and the language of literature were in Chinese or English. We selected synonyms, Medical Subject heading (MeSH) terms, and additional keywords and altered the final search string to match the syntax requirements of each database. The detailed search strategies for the respective databases were shown in Supplementary Table 1. Retrieved articles were initially reviewed by the title and the abstract to find potentially relevant studies and exclude irrelevant ones. Reference lists of relevant articles were reviewed to identify possible additional papers. We also searched additional web-based platforms such as Google and Baidu, as well as some government websites, university homepages and other websites in June 2022 to obtain relevant gray literature.
Inclusion and exclusion criteria
Search results were screened in a reference manager by two reviewers (LZ and PX) to reduce bias and full-text screening was conducted only by the first author. Publications unrelated to the domain of this research were removed based on a review of their titles and abstracts. Unqualified records were excluded based on the exclusion criteria. The full text of article was retrieved and reviewed for more clarity if it was not satisfactorily removed based on the information available in title and abstract. Disagreements were resolved by including the articles in an in-depth analysis and discussion involved by the third reviewer (YZ).
Inclusion criteria of the study were as follows:
Studies conducted with the working population in China.
Methodological studies on OHRA methods.
Studies published in English or Chinese.
Peer-reviewed articles, gray literature (conference proceedings, thesis, government documents, and professional publications) explaining OHRA.
Exclusion criteria of the study were as follows:
Literature for which full text was not available, if the key information we need was not available from the abstract.
Letters to editors, editorials, short briefs, reviews, and study protocols.
Literature that did not describe methodological issues on OHRA such as application, comparative, optimization, or modeling.
Although the authors of the literature were Chinese, the workplaces studied were not in China.
The focus of the article was outside the scope of this review.
Data charting and analysis
Four researchers (FW, JZ, SW, and YH) were involved in data extraction and attended a training workshop focused on developing consistency across researchers by practicing the skills needed to reliable data extraction using a web-based form. To improve the accuracy of the literature information extracted, each researcher was randomly assigned to the same number of included publications, followed by an exchange review of the extracted information. Any disagreement was discussed and finalized by the four researchers to determine a unified opinion. A researcher (LZ) reviewed the extracted data for all the records included. The extracted information included year of publish, region of the institution of first author, type of study, OHRA tools involved, industries and types of hazardous if applicable, main results, strengths and limitations of OHRA methods, and main conclusions of the literature. A summary of the extracted data is available in Supplementary Table 2. The year of publication, the region of the researcher, the type of study, the type of hazard factors that each OHRA model can assess for the included literature were analyzed. The types of study included applied study, comparative study, and optimization study. Applied study is the practical application of occupational health risk assessment methods in one or more industries, with a description of the methodological characteristics. Comparative study focuses on the methodological principles, evaluation scope, strengths and limitations, and applicability of two or more OHRA methods to find the differences between the methods. Optimization study is conducted to optimize or improve one or more well-established OHRA methods and to compare the methodologies before and after the improvements.
Results
A total of 6,889 relevant non-duplicate records were identified from 9,081 records searched. After applying exclusion criteria, 253 articles were retrieved eligible for full-text screening, of which 145 records met inclusion criteria and were finally included for the review. The results of literature search by the two reviewers were generally consistent, except for disagreements on nine papers, which were resolved in discussion involved by the third reviewer. Figure 1 provides a summary of the PRISMA flowchart.
The PRISMA flowchart of this scoping review.
Characteristics of studies included in this review
Table 1 shows that this review included 145 studies focusing on OHRA methodologies in China, most of which (n = 105, 72.4%) were published in 2018 and later. There were 108 applied studies, 30 comparative studies and seven optimization studies. There were 12 OHRA methods included in this review, including four qualitative methods, four quantitative methods, three semi-quantitative methods, and a comprehensive method. The most covered OHRA methods were the “Good Practice Guidance on OHRA” developed by the International Council on Mining and Metals (ICMM model), GBZ/T 298-2017, the “Semi-quantitative Method to Assess Occupational Exposure to Harmful Chemicals” (Singaporean model), the “Supplementary Guidelines for Inhalation Risk Assessment in Part F of the US Environmental Protection Agency's Risk Assessment Guidelines” (USEPA model), and the “Occupational Hazard Risk Index Evaluation Method” (OHR Index model). As shown in Figure 2, among the included literature, research institutions in Guangdong (n = 38, 26.2%) carried out the largest number of studies on OHRA, followed by Zhejiang (n = 25, 17.2%) and Beijing (n = 23, 15.9%).
General characteristics of included studies.
Number
%
Year of publication
Before 2018
40
27.6
In or after 2018
105
72.4
Type of study
Application study
108
74.5
Comparative study
30
20.7
Optimization study
7
4.8
Classification of OHRA methods
Qualitative
4
33.3
Quantitative
3
25.0
Semi-quantitative
4
33.3
Comprehensive
1
8.3
OHRA methods*
ICMM model
33
35.2
GBZ/T 298-2017
35
33.8
Singaporean model
30
31.0
USEPA model
24
22.1
OHR index model
16
15.2
Romanian model
7
11.0
Australian model
6
7.6
COSHH model
2
4.1
LEC model
4
4.1
Fuzzy model
4
3.4
Monte Carlo simulation
4
3.4
PBPK model
2
2.1
Since a study may involve more than one OHRA method, the sum of the individual methods exceeds the total number of studies.
Region distribution of included studies based on the institutions of the first authors.
Classification of OHRA methods in China
Over the decades, Chinese researchers have introduced some international risk assessment guidelines, from which have been applied and technically innovated in OHRA and promoted nationwide. Similar to the core principles of internationally used risk assessment models, most of the OHRA methods in China are based on hazard level, exposure level and probability of occurrence, and can be classified as qualitative, quantitative and semi-quantitative.
Qualitative OHRA methods
Qualitative occupational health risk assessment methods studied in China were mainly: (1) the “Risk Assessment Method for Occupational Accidents and Diseases” (Romanian model) developed by the Ministry of Labor and Social Protection in Romania (19); (2) the “Occupational Health and Safety Risk Assessment and Management Guideline” (Australian model) formulated by University of Queensland in Australia (18); (3) the ICMM model (36); and, (4) the “Control of Substances Hazardous to Health Essentials” (COSHH model) formulated by the United Kingdom Health and Safety Executive (17).
The Romanian model assesses the most severe consequences on the human body and probability of occurrence of risk factors in the workplaces, and determines the risk levels based on the combination of severity-likelihood levels (19). The Australian model uses a risk assessment calculator consisting of several connecting lines to determine the risk levels based on the likelihood of an outcome, the frequency of exposure and the severity of the outcome (18). The ICMM model comprehensively considers factors such as possible health consequences, exposure probability and exposure time, and determines the risk levels by the quantitative assignment method or matrix method. The quantitative assignment method of the ICMM model is used in the situation where the monitoring results of occupational disease hazards in the workplace do not exist, and the matrix method is used in the situation where the monitoring results exist (36). The COSHH model identifies the hazard level of chemicals according to the hazard term or occupational exposure limits (OEL), determines the exposure level according to the dustiness or volatility and usage, and then reaches the risk level and corresponding control measures according to the hazard level and exposure level (17).
Quantitative OHRA methods
In China, the most widely studied quantitative occupational health risk assessment method was the USEPA model (13). This risk assessment model can evaluate both of the carcinogenic and non-carcinogenic risks of a variety of chemicals with reference concentration (RfC) and inhalation unit risk (IUR) in the U.S. EPA website. Some Chinese researchers applied Monte Carlo simulation to OHRA as a complement to the USEPA model, especially in parametric uncertainty studies (37). Monte Carlo simulation is usually used to deal with the uncertainties associated with risk-related problems (38). It extrapolates population metrics based on sampling results to provide a quantitative approach to assessing the probability distribution of health risks. The Physiologically Based Pharmacokinetics (PBPK model) was also studied in China (39). The principle of the PBPK model is to construct a differential equation of mass conservation of chemical substances in the body, which requires the collection of various physiological parameters, partition coefficients, metabolic parameters, and absorption parameters. PBPK model was mainly used in researches such as chemical safety evaluation, drug metabolism analysis and new drug research and development, and are also used in health risk assessment of carcinogens (40).
Semi-quantitative OHRA methods
The “Semi-quantitative Method to Assess Occupational Exposure to Harmful Chemicals” (Singaporean model) established by the Ministry of Manpower of Singapore was the most widely used and researched semi-quantitative OHRA method in China (20). Other semi-quantitative OHRA methods studied in China included the fuzzy mathematical model (Fuzzy model), likelihood exposure consequence (LEC) model, and the “Occupational Hazard Risk Index Evaluation Method” (OHR Index model) (28, 41).
Risk levels in Singaporean model are calculated based on hazard ratings (HR), which is assigned based on the carcinogenicity classifications established by the American Conference of Governmental Industrial Hygienists (ACGIH) and the International Agency for Research on Cancer (IARC), and exposure ratings (ER), which is based on the ratio of the exposure level and OEL (20). The fuzzy mathematical model establishes a mathematical model according to the fuzzy mathematical membership theory: B = A × R. B is the total evaluation score, which is divided into excellent, good, general, poor, and very poor; A is the weight distribution set; R is a fuzzy matrix, which consists of monitoring values of occupational hazards (42). The LEC model uses the product of the index values from three factors related to occupational health to evaluate the health risk of workers (which refers to Danger, D). D = L × E × C, where D is the health risk; L is the possibility of the occurrence of the hazard; E is the frequency of the worker's exposure to the hazard; C is the possible consequence of the occurrence of the hazards (43, 44). The OHR Index model was established by Lin et al. (45) on the basis of the British occupational health and safety management system and the American occupational exposure assessment management strategy. The core principle of this method is that the risk index is the comprehensive calculation result of the health effect level, the exposure ratio and the operating condition level.
Chinese OHRA standard GBZ/T 298-2017
The GBZ/T 298-2017 is a comprehensive risk assessment guideline, including a qualitative model modified according to the COSHH model, a quantitative model modified according to the USEPA model, and semi-quantitative methods modified according to the Singapore model (25). The RfC and IUR values of some chemicals are provided in the quantitative assessment model in GBZ/T 298-2017. The semi-quantitative quantitative models in GBZ/T 298-2017 are exposure limit ratio method, exposure index method and comprehensive index method. The exposure limit ratio method and exposure index method basically follow the Singapore model. The exposure level of the comprehensive index method needs to consider the factors of chemical concentration in the air, physical and chemical properties, usage, exposure time and control measures (including engineering protection, personal protective equipment, emergency rescue measures and occupational health management) (28).
Types of OHRA methodological studies in ChinaApplied studies
Applied research is mainly to apply one or more OHRA models to assess occupational health risks in one or more industries to find the applicability, strengths and limitations of the applied OHRA methods in specific industries. Researchers in China have used all of the above qualitative, quantitative and semi-quantitative OHRA methods to conduct applied studies on different types of occupational hazards in various industries, so as to explore the feasibility of applying these methods to occupational health risk assessment. For example, the results of applied research of Romanian model in precious metal smelter industry (46) and fluorescent lamp manufacturing industry (47) showed that although it is subjective and the possibility of consequences is not easy to determine, it could be used for OHRA of these industries. Huang et al. (48) applied the Singaporean model to assess the occupational health risk caused by chemicals in a dyestuff factory and found that this method is applicable and effective for OHRA.
Comparative studies
A comparative study compares the results of two or more OHRA models on occupational health risks in one or more industries. By qualitatively or quantitatively comparing the evaluation results of different methods, the differences in reliability and consistency between the methods as well as the strengths and limitations of methods can be drawn, which can provide a reference for the selection of OHRA methods (49). Xu et al. (30) compared the assessment results of six common occupational health risk assessment models (i.e., ICMM model, Singaporean model, USEPA Model, Romanian model, Australian model, and COSHH model) in leather, wooden furniture manufacturing, printing and dyeing, printing, and garment manufacturing industries. The results of this comparative study implied that the order of risk ratios (RR) between the six models was: EPA > COSHH > Singaporean > Australian > Romanian and ICMM; the USEPA model and Singaporean model had higher reliability; the USEPA model was relatively independent in methodology; the Singaporean model had the strongest correlation with other models; and combination of different methodologies could be a strategy for OHRAs. Tian et al. (29) conducted a comparative study on six types of OHRA models by expert consultation, literature summarization and key informant interviews, over-grading conversion and introduction of risk ratios to compare the consistency and correlation between the methods.
Optimization studies
The aim of an optimization study is to improve or optimize the commonly used risk assessment model, and use the optimized assessment model for occupational health risk assessment, and then evaluate the optimized model. The optimization studies carried by Luan et al. (50) and Gao et al. (51) provided ideas for the formulation of the semi-quantitative method in the GBZ/T 298-2017 in China, which considered the impact of engineering protection, personal protective equipment, emergency rescue and occupational health management on health risks compared with the Singaporean model (28). Luan et al. (50) added occupational health management and engineering control measures to improve the hazard level and exposure level evaluation of the Singaporean model and then applied the optimized model to the furniture manufacturing enterprises for occupational health assessment. The improved risk assessment model not only retained the strengths of the Singapore model, but also increased the risk assessment of physical factors. Zhang et al. (52) also built a new evaluation index based on four OHRA models to evaluate the risk of the hazards between industries.
Strengths and limitations of OHRA methods
We extracted the assessment scope, strengths and limitations of all the OHRA methods included in this scoping review. The ICMM model, OHR Index model, Romanian model, Australian model, LEC model, and Fuzzy model can be applied to assess the occupational health risk caused by chemicals, physical factors, and dust. The Singaporean model, COSHH model, the GBZ/T 298-2017, Monte Carlo simulation, and PBPK model can be used to assess health risks from chemicals and dust, while USEPA Model can only assess the health risks caused by specific chemicals. Each method has its own strengths and limitations due to different evaluation principles, as shown in Table 2.
Qualitative comparisons between OHRA models.
Model
Classification
Scope
Strengths
Limitations
ICMM model
Qualitative
Chemicals, physical factors, and dust
1. Broad scope 2. Application to various industries
1. Rely on subjective judgment 2. Has a possibility of overestimation
GBZ/T 298-2017
Comprehensive
Chemicals and dust
1. A combination of qualitative, quantitative and semi-quantitative methods 2. Suitable for different scenarios
1. Only considering exposure through inhalation 2. Cannot evaluate risks caused by physical factors
Singaporean model
Semi-quantitative
Chemicals and dust
1. Usage of exposure index method when air monitoring data are missing 2. High consistency with other methods
1. Relatively crude classification in terms of exposure index 2. Cannot evaluate risks caused by physical factors
USEPA Model
Quantitative
Chemicals
1. Quantitative assessment for the carcinogenic and non-carcinogenic risks 2. Scientific values of RfC and IUR based on epidemiological or toxicological data
1. Limited to chemicals with IUR and RfC values 2. No consideration for personal protective equipment 3. Difficult to differentiate multiple risk level
OHR Index model
Semi-quantitative
Chemicals, physical factors, and dust
Broad scope and easy to conduct
Rely on subjective judgment to get working condition grades
Romanian model
Qualitative
Chemicals, physical factors, and dust
1. Broad scope 2. Calculation of total risk level
1. Rely on subjective judgment 2. Difficult to judge the probability of a consequence occurring
Australian model
Qualitative
Chemicals, physical factors, and dust
1. Broad scope and easy to conduct 2. Appropriate for middle- and small-sized businesses
1. Rely on subjective judgment 2. Requirement of professional knowledge
COSHH model
Qualitative
Chemicals and dust
1. Simple and easy to conduct 2. Focus on middle- and small-sized businesses 3. To provide control measures
1. Overestimation of risk levels 2. Occurrence of bias when judging liquid volatility
LEC model
Semi-quantitative
Chemicals, physical factors, and dust
Broad scope and easy to conduct
Rely on subjective judgment
Fuzzy model
Semi-quantitative
Chemicals, physical factors, and dust
1. Has a wide range of application 2. Highly consistent with the evaluation results of the Singaporean model
Risk assessment of health risk is increasingly important to efficiently prevent and manage occupational diseases in the workplace. This scope review aimed to summarize the methodological studies on occupational health risk assessment methods in China. By searching major international and Chinese databases and relevant websites, we extracted 145 of the 9,081 searched papers that met the inclusion and exclusion criteria for this scoping review. Research on OHRA methodologies in China has increased significantly over the past 5 years, with most of the included studies published in 2018 and later. The regional distribution of first authors indicated that research institutions in Guangdong, Zhejiang and Beijing showed the highest interest in OHRA methodological research. The number of industrial enterprises and the level of economic development in these three regions are relatively developed within China (1).
The OHRA methods studied in the included literature were the ICMM model, GBZ/T 298-2017, the Singaporean model, the USEPA model, the OHR Index model, the Romanian model, the Australian model, the COSHH model, the LEC model, the Fuzzy model, the Monte Carlo simulation, and the PBPK model, ranked according to the number of studies. Researches on some of these methods has also been employed in other countries. American researchers have studied the USEPA model in the assessment of health risks of asbestos exposure and analyzed the strengths and limitations of the assess procedure (53). Golbabaei et al. (49) applied the Singaporean model to assess health risks of exposure to gases released by welding processes in natural gas transmission pipelines industry in Iran. In the U.S., Clewell et al. (54) described the process of the PBPK model development and highlighted issues related to the specification of model structure and parameters, model evaluation, and consideration of uncertainty in environmental and occupational risk assessment. Monte Carlo simulation was carried out to assess health risk of occupational exposure to heavy metals in a steel casting unit of a steelmaking plant in Iran (55).
OHRA methodological studies in China were mainly focused on applied studies, followed by comparative studies. The applied studies found that OHRA methods developed by different countries or international organizations had different principles and methodological characteristics (48, 56–63). Likewise, Mumtaz et al. (64) applied the PBPK model in some selected examples of environmental and occupational exposure assessments of chemicals and their mixtures to discuss the applicability of PBPK model in the U.S. The strengths, limitations and applicability of OHRA methods could be observed not only by carrying out applied studies, but also by conducting comparative studies (28–30, 65–67). Similar to the Chinese researchers, scholars in South Korea have also conducted a comparative study on a qualitative risk assessment method improved based on the COSHH model and a quantitative assessment improved based on USEPA model to evaluate health risks caused by 36 kinds of hazardous substances requiring management (68). In Iran, the results of a comparison study on health risk assessment on occupational exposure to styrene in a petrochemical industry using the USEPA model and the Singaporean model implied that the estimated health risk of exposure to styrene was higher in the EPA model than in the Singaporean model (69). Only a few studies included in this review were methodological optimization studies (45, 50–52, 70–72), which were conducted to improve the OHRA methods and provide insights for establishing OHRA methods suitable for the workplace in China. Optimization studies on OHRA methods have also been attempted in other countries. Ji et al. (73) in New Zealand revised the conventional risk assessment methods into a comprehensive risk assessment method with consideration of both safety accidents and chronic health issues, providing a way to include long-term health outcomes in OHRA.
The studied OHRA methods were divided into quantitative, semi-quantitative and qualitative methods, as well as a comprehensive method (i.e., the first OHRA guideline GBZ/T 298-2017 in China) that included a quantitative model, a qualitative model and three semi-quantitative models. Through this scoping review, we identified that various international and Chinese occupational health risk assessment methods have their own strengths, limitations and application scopes. The ICMM model, the OHR Index model, the Romanian model, the Australian model, the LEC model, and the Fuzzy model have the broadest range of assessments scope. These methods can be used to assess occupational health risks caused by nearly all kinds of hazards in various industries, though some of them may relatively rely on subjective judgment (42, 56, 63, 70, 74–76). Although the Singaporean model, the COSHH model, and the qualitative and semi-quantitative assessment models in GBZ/T 298-2017 cannot assess health risks caused by physical factors, they are simple and easy to operate, and are especially suitable for rapid assessment (26, 75, 77–79). The USEPA Model, the Monte Carlo simulation, and the PBPK model are objective methods, although the calculation processes are relatively complex, and the application scopes are limited (37, 39, 65, 80, 81).
Thus, there may not be a single model for a comprehensive risk assessment for all workplaces in all industries. Before applying them to OHRA in workplace, it is necessary to comprehensively consider the characteristics and evaluation principles of the methods and then choose a suitable OHRA method or combine multiple OHRA methods according to the characteristics of the workplaces (82, 83). Applicability of methodology is one of the most important issues that occupational health workers need to think deeply about. The Chinese occupational health risk evaluation standard GBZ/T 298-2017 has just been developed for 5 years and needs further improvement (27, 78, 84). Liang et al. (85) compared the results of four methods including GBZ/T 298-2017 to evaluate the risk of chemicals in the electrical appliance manufacturing industry. The result revealed that the quantitative method of GBZ/T 298-2017 may overestimate the health risk of chemicals. Tian et al. (78) carried out OHRA in battery manufacturing industries and indicated that the GBZ/T 298-2017 had several limitations, such as just considers exposure through inhalation route, cannot assess occupational health risks from physical factors, and the hazard classification of dust and chemical toxicants in semi-quantitative methods needs to be further refined. Therefore, it is necessary to strengthen the research on occupational health risk assessment methodology, and to establish and promote scientific, reasonable and operational occupational health risk assessment methods in line with China's national conditions in the future.
Using the established process outlined by Arksey and O'Malley (31) for conducting a scoping review, and reporting the results consistent with the PRISMA-ScR checklist, enhances the rigor and transparency of our review design, and trustworthiness of the results. We also anticipate that this review will provide insights for researchers focusing on OHRA methodological research. Probable limitations of this study must also be considered. Consistent with the limitations of the scope review, we did not systematically assess the methodological quality of the included studies in our review; however, this is a potential avenue for future systematic reviews and meta-analyses. Additionally, given the conceptual ambiguity regarding implementation outcome terminology (e.g., the multiple ways in which researchers define and discuss 'Applicable'), some literature that include OHRA methodological study may be excluded.
Conclusion
The results of this scoping review indicated that occupational health risk assessment methodological research in China has been very popular in recent years. The most common OHRA methodological studies in China were applied studies, with some comparative studies and limited optimization studies. There are several types of OHRA methods studied, including qualitative, quantitative and semi-quantitative methods, as well as a comprehensive guideline proposed in China. Since each method has its strengths and limitations, the application of OHRA methods in occupational health risk assessment requires comprehensive consideration. At the same time, researches on the application of OHRA methods in more industries, quantitative comparative studies, optimization studies, and modeling studies of OHRA methods are essential to explore OHRA methods more suitable for workplaces in China.
Data availability statement
The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding authors.
Author contributions
LZ and HZ designed this scoping review, search strategy, searched databases, and conducted data analysis and interpretation. LZ, PX, and YZ conducted the article screening process. FW, JZ, SW, and YH were involved in full-text reviewing of articles during the final stage of literature screening and extract information from literature. LZ and XL drafted the manuscript. All authors reviewed and approved it, contributed to the article, and approved the submitted version.
Funding
This research was funded by the Zhejiang Provincial Key Research and Development Project (Grant Number: 2015C03039); the Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health Talents, Zhejiang Province, China; and the Health Commission of Zhejiang Province (2019KY057).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2022.1035996/full#supplementary-material
ReferencesNational Bureau of Statistics N. China Statistical Yearbook 2020. (2021). Available online at: http://www.stats.gov.cn/tjsj/ndsj/2021/indexch.htm (accessed July 12, 2022).LiJYinPWangHZengXZhangXWangL. The disease burden attributable to 18 occupational risks in China: an analysis for the global burden of disease study 2017. Environ Health. (2020) 19:21. 10.1186/s12940-020-00577-y32075644WangBWuCKangLHuangLPanW. What are the new challenges, goals, and tasks of occupational health in China's thirteenth five-year plan (13th fyp) period?J Occup Health. (2018) 60:208–28. 10.1539/joh.2017-0275-RA29563366NHC. 2021 Statistical Bulletin on the Development of Health and Wellness. (2022). Available online at: http://www.nhc.gov.cn/guihuaxxs/s3586s/202207/51b55216c2154332a660157abf28b09d.shtml (accessed July 13, 2022).DingQSchenkLHanssonSO. Occupational diseases in the people's republic of China between 2000 and 2010. Am J Ind Med. (2013) 56:1423–32. 10.1002/ajim.2224523970481LiXWangDLiuAHuWSunX. Epidemiological characteristics of occupational cancers reported - China, 2006-2020. China CDC Wkly. (2022) 4:370–3. 10.46234/ccdcw2022.08635547634ZhouJHanLZhaoJChengXHouFJiaQ. Characteristics in the distribution of chronic benzene poisoning associated industries - 6 plads, China, 2005-2019. China CDC Wkly. (2020) 2:891–6. 10.46234/ccdcw2020.24334594794WangXZhouJHanLChengXShaoHJiaQ. The distribution and concentration monitoring of benzene industries - six plads, China, 2020. China CDC Wkly. (2021) 3:897–900. 10.46234/ccdcw2021.22034745687NIOSH. Occupational Risk Assessment. (2017). Available online at: https://www.cdc.gov/niosh/topics/riskassessment/default.html (accessed August 25, 2022).NPC. Law on Prevention and Control of Occupational Disease. (2018). Available online at: http://www.npc.gov.cn/npc/c30834/201901/aeaec9d8f33343119be1a4df98b9097e.shtml (accessed July 01, 2022).HerberRFMDuffusJHChristensenJMOlsenEParkMV. Risk assessment for occupational exposure to chemicals. a review of current methodology (IUPAC technical report). Pure Appl Chem. (2001) 73:993–1031. 10.1351/pac200173060993ZhouLTianFZouHYuanWHaoMZhangM. Research progress in occupational health risk assessment methods in China. Biomed Environ Sci. (2017) 30:616–22. 10.3967/bes2017.08228807103USEPA. Risk Assessment Guidance for Superfund Volume I: Human Health Evaluation Manual (Part F, Supplemental Guidance for Inhalation Risk Assessment, Epa-540-R-070-002oswer 9285. 7-82 January 2009).Washington, DC: USEPA (2009).AndersonEL. Scientific trends in risk assessment research. Toxicol Ind Health. (1989) 5:777–90.2683223RodricksJV. When risk assessment came to Washington: a look back. Dose Response. (2019) 17:1559325818824934. 10.1177/155932581882493430783394National Research Council N. Risk Assessment in the Federal Government: Managing the Process. Washington, DC: National Academies Press (US) (1983).Health Safety Executive H. Coshh Essentials-Easy Steps to Control Chemicals. (1999). Available online at: https://www.hse.gov.uk/pubns/guidance/coshh-technical-basis.pdf (accessed July 01, 2022).University of Queensland A. Occupational Health and Safety Risk Assessment and Management Guideline. (2011). Available online at: http://www.mtpinnacle.com/pdfs/RiskAssessment_Queensland.pdf (accessed July 01, 2022).Pece DES, Dascalescu EA. Risk Assessment Method for Occupational Accidents Diseases Bucharest: Ministry of Labor Social Protection (Romania). (1998). Available online at: http://www.protectiamuncii.ro/pdfs/risk_assessment_method.pdf (accessed July 02, 2022).Ministry of Manpower (Singapore) M. A Semi-Quantitative Method to Assess Occupational Exposure to Harmful Chemicals Singapore: Ministry of Manpower Occupational Safety and Health Division. (2014). Available online at: http://li.eversafe.com.sg/HTIM/6.%20A%20Semiquantitative%20Method%20to%20Assess%20Occupational%20Exposure%20to%20Harmful%20Chemical.pdf (accessed July 01, 2022).LiMHuangDLiuaM. Review of recent researches on occupational health assessment in China. Procedia Eng. (2012) 43:464–71. 10.1016/j.proeng.2012.08.080NHC. Technical Guidelines for Pre-Assessment of Occupational Disease Hazards in Construction Projects (Gbz/T196-2007). Beijing: People's Medical Publishing House (2008).NHC. Classification for Hazards of Occupational Exposure to Toxicant (Gbz 230-2010).Beijing: People's Medical Publishing House (2010).NHC. Classification of Occupational Hazards at Workplaces (Gbz/T 229-2010).Beijing: People's Medical Publishing House (2010).NHC. Guidelines for Occupational Health Risk Assessment of Chemicals in the Workplace (Gbz/T 298-2017). Beijing: People's Medical Publishing House (2017).SuSLiangZZhangSXuHChenJZhaoZ. Application of multiple occupational health risk assessment models in occupation health risk prediction of trichloroethylene in the electroplating and electronics industries. Int J Occup Saf Ergon. (2022) 1−7. 10.1080/10803548.2021.2022956. [Epub ahead of print].34983310WangTSSongBSunQHLinYXSunYSunP. Occupational health risk assessment of benzene, toluene, and xylene in Shanghai. Biomed Environ Sci. (2021) 34:290–8. 10.3967/bes2021.03833894808ZhouLZhangM. Research progress on occupational health risk assessment methodology. J Environ Occup Med. (2020) 37:125–30. 10.13213/j.cnki.jeom.2020.19509TianFZhangMZhouLLouHWangAHaoM. Qualitative and quantitative differences between common occupational health risk assessment models in typical industries. J Occup Health. (2018) 60:337–47. 10.1539/joh.2018-0039-OA29877200XuQYuFLiFZhouHZhengKZhangM. Quantitative differences between common occupational health risk assessment models. J Occup Health. (2020) 62:e12164. 10.1002/1348-9585.1216432949432ArkseyHO'MalleyL. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. (2005) 8:19–32. 10.1080/1364557032000119616LevacDColquhounHO'BrienKK. Scoping studies: advancing the methodology. Implement Sci. (2010) 5:69. 10.1186/1748-5908-5-6920854677WestphalnKKRegoecziWMasotyaMVazquez-WestphalnBLounsburyKMcDavidL. From arksey and o'malley and beyond: customizations to enhance a team-based, mixed approach to scoping review methodology. MethodsX. (2021) 8:101375. 10.1016/j.mex.2021.10137534430271TriccoACLillieEZarinWO'BrienKKColquhounHLevacD. Prisma extension for scoping reviews (prisma-scr): checklist and explanation. Ann Intern Med. (2018) 169:467–73. 10.7326/M18-085030178033PetersMDJMarnieCTriccoACPollockDMunnZAlexanderL. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement. (2021) 19:3–10. 10.1097/XEB.000000000000027733570328International Council on Mining and Metals I. Good Practice Guidance on Occupational Health Risk Assessment. United Kingdom: International Council on Mining and Metals (ICMM) (2009).HuangDLiuMZhangJWangYeditors. Research on risk assessment based on monte carlo simulation and dose-response multistage model. In: 2010 3rd International Conference on Biomedical Engineering and Informatics (BMEI 2010) vols 1-7.Yantai (2010). 10.1109/BMEI.2010.5639276TongRChengMMaXYangYLiuYLiJ. Quantitative health risk assessment of inhalation exposure to automobile foundry dust. Environ Geochem Health. (2019) 41:2179–93. 10.1007/s10653-019-00277-830874937YeSPengXHuDZhaoXYuRa. Health risk of shenzhen gas station workers exposed to Mtbe: a primary study based on Pbpk model. J Environ Health. (2014) 31:1076–9. 10.16241/j.cnki.1001-5914.2014.12.008ThompsonCMSonawaneBBartonHADeWoskinRSLipscombJCSchlosserP. Approaches for applications of physiologically based pharmacokinetic models in risk assessment. J Toxicol Environ Health B Crit Rev. (2008) 11:519–47. 10.1080/1093740070172433718584453WangZLiT. Occupational Health Risk Assessment and Practice. Beijing: China Environment Press (2016).15212200CaoS. Application of two occupational health risk assessment models in an automobile-component manufactory in Fengxian district of Shanghai. Occup Health. (2018) 34:2740–4. 10.13329/j.cnki.zyyjk.2018.0730TangXZouYLuL. Application of Lec method in occupation health risk assessment of toner production enterprise. Chin J Public Health Manag. (2016) 32:652–4. 10.19568/j.cnki.23-1318.2016.05.024LiangZFuFLiLJinYLinHCengQ. Comparison of multiple risk assessment methods for occutaptional health risk assessment for aluminum dust post. China Occup Med. (2018) 45:766–9. 10.11763/j.issn.2095-2619.2018.06.022LinSWangZTangWWangMLanYWangP. Preliminary study on the evaluation method of occupational hazard risk index. Chin J Ind Hyg Occup Dis. (2006) (12):769–71. Available online at: http://www.cnki.com.cn/Article/CJFDTotal-ZHLD200612028.htmYuXHanLXieKHeLZhangM. Romanian Method for Risk Assessment of Occupational Accidents and Diseases Application Effect in a Precious Metal Smelter. Preventive Medicine. (2016) 28(02):186–8+91. 10.19485/j.cnki.issn1007-0931.2016.02.027LiMWangSJiangGZhangM. A study on the application of Romania risk assessment method of occupational accidents and diseases in a certain fluorescent lamp manufacture enterprise. Prev Med. (2017) 29:146–9+54. 10.19485/j.cnki.issn1007-0931.2017.02.011HuangDZhangJLiuMIeeeeditors. Application of a health risk classification method to assessing occupational hazard in China. In: 2009 3rd International Conference on Bioinformatics and Biomedical Engineering, vols 1-11.China (2009). 10.1109/ICBBE.2009.5162381GolbabaeiFHassaniHGhahriAArefianSKhademMHosseiniM. Risk assessment of exposure to gases released by welding processes in iranian natural gas transmission pipelines industry. Int J Occup Hyg. (2012) 4:6–9. Available online at: https://ijoh.tums.ac.ir/index.php/ijoh/article/view/42LuanYZhangMZouHQuanZ. A study on application of semi-quantitative risk assessment models in furniture industry. Prev Med. (2017) 29:770–6. 10.19485/j.cnki.issn1007-0931.2017.08.004GaoH. A Study on Application and Modification of Three Occupational Health Risk Assessment Models [master's thesis].Xinjiang: Shihezi University (2016).ZhangLSunPSunDZhouYHanLZhangH. Occupational health risk assessment of the benzene exposure industries: a comprehensive scoring method through 4 health risk assessment models. Environ Sci Pollut Res. (2022). 10.1007/s11356-022-21275-x. [Epub ahead of print].35780272MoolgavkarSHAndersonELChangETLauECTurnhamPHoelDG. A review and critique of US Epa's risk assessments for asbestos. Crit Rev Toxicol. (2014) 44:499–522. 10.3109/10408444.2014.90242324806876ClewellRAClewell HJ3rd. Development and specification of physiologically based pharmacokinetic models for Use in risk assessment. Regul Toxicol Pharmacol. (2008) 50:129–43. 10.1016/j.yrtph.2007.10.01218077066DehghaniFOmidiFFallahzadehRAPourhassanB. Health risk assessment of occupational exposure to heavy metals in a steel casting unit of a steelmaking plant using monte-carlo simulation technique. Toxicol Ind Health. (2021) 37:431–40. 10.1177/0748233721101959334096392ZhuZShiY-KQinG-PBianP-Y. Research on the occupational hazards risk assessment in coal mine based on the hazard theory. Proc Eng. (2011) 26:2157–64. 10.1016/j.proeng.2011.11.2420XueMYangYRuanJXuZ. Assessment of noise and heavy metals (Cr, Cu, Cd, Pb) in the ambience of the production line for recycling waste printed circuit boards. Environ Sci Technol. (2012) 46:494–9. 10.1021/es202513b22126443ZhouLZhangMYuanWZouH. A study on application of inhalation risk assessment model of usepa in occupational health risk assessment. Prev Med. (2014) 26(02) 109–13+27. 10.19485/j.cnki.issn1007-0931.2014.02.001ZhouPGuoJZhouXZhangWLiuLLiuY. Pm25, Pm10 and health risk assessment of heavy metals in a typical printed circuit noards manufacturing workshop. J Environ Sci. (2014) 26:2018–26. 10.1016/j.jes.2014.08.00325288545YanYPengLChengNBaiHMuL. Health risk assessment of toxic vocs species for the coal fire well drillers. Environ Sci Pollut Res. (2015) 22:15132–44. 10.1007/s11356-015-4729-726004562LiuTZhangPMaLZhangCZhuJZhangM. Occupational semi-quantitative risk assessment in a crane manufacturing enterprise. Prev Med. (2017) 29:347–50+54. 10.19485/j.cnki.issn1007-0931.2017.04.006SuMSunRZhangXWangSZhangPYuanZ. Assessment of the inhalation risks associated with working in printing rooms: a study on the staff of eight printing rooms in Beijing, China. Environ Sci Pollut Res. (2018) 25:17137–43. 10.1007/s11356-018-1802-z29644615WangXHuWZhangSKangNWangHDongY. Occupational dust hazards and risk assessment of coal-fired thermal power plants of different capacities - China, 2017-2019. China CDC Wkly. (2021) 3:901–5. 10.46234/ccdcw2021.22134745688MumtazMFisherJBlountBRuizP. Application of physiologically based pharmacokinetic models in chemical risk assessment. J Toxicol. (2012) 2012:904603. 10.1155/2012/90460322523493YuanWLengPZhouLZouHZhangM. Comparative study on occupational risk assessment using two freign models. J Environ Occup Med. (2015) 32:51–5. 10.13213/j.cnki.jeom2015.14292BianHKangNDongYQiuLHuW. Comparative study of three semi-quantitative risk assessment methods in risk classification of silica dusts exposed posts. Chin J Indus Med. (2019) 32:167–71. 10.13631/j.cnki.zggyyx.2019.03.002ZhouZSuSCengY. Comparative study on common occupational health risk assessment methods in a paint manufacture. Chin J Public Health Eng. (2021) 20:719–23+26. 10.19937/j.issn.1671-4199.2021.05.005MoonHIHanSWShinSByeonSH. Comparison of the qualitative and the quantitative risk assessment of hazardous substances requiring management under the occupational safety and health act in South Korea. Int J Environ Res Public Health. (2021) 18:1354. 10.3390/ijerph1803135433540897MoshiranVAKarimiAGolbabaeiFYarandiMSSajedianAAKoozekonanAG. Quantitative and semiquantitative health risk assessment of occupational exposure to styrene in a petrochemical industry. Saf Health Work. (2021) 12:396–402. 10.1016/j.shaw.2021.01.00934527402LiuK. Occupational Health Risk Assessment of Silicosis Caused by Silica Dust Exposure in Non-Ferrous Metal Mines [master's thesis].Beijing: Chinese Center for Disease Control and Prevention (2021).XiaoZZhouDLiWChangLWangN. Occupational chemical hazard risk assessment of benzene and its analogies in storage tank areas of petrochemical enterprises based on risk matrix method. J Environ Occup Med. (2021) 38:1140–4. 10.13213/j.cnki.jeom.2021.21078ZhangSWangRTaoLZhangPZouWWeiH. Application of improved comprehensive index method in risk assessment of frp yacht manufacturing enterprises. Chin J Indus Hyg Occup Dis. (2021) 39:151–4. 10.3760/cma.j.cn121094-20200221-0007033691375JiZPonsDPearseJ. A methodology for harmonizing safety and health scales in occupational risk assessment. Int J Environ Res Public Health. (2021) 18:4849. 10.3390/ijerph1809484934062816LiXA. Study on Application of Five Risk Assessment Methods for Occupational Health [master's thesis].Zhejiang: Zhejiang University (2014).BianGWangALiXZhangMZhangZA. Comparative study on the application of different methods of occupation health risk assessment in small furniture manufacturing industry. Prev Med. (2017) 29:1003–8. 10.19485/j.cnki.issn1007-0931.2017.10.008XuQCaoYWangPRenHYuanWLiF. Comparison of five occupational health risk assessment models applied to silica dust hazard in small open pits. Prev Med. (2021) 33:873–6+83. 10.19485/j.cnki.issn2096-5087.2021.09.003HeJYinQLiaoCSuS. Comparison of different semi-quantitative risk assessment methods applied in ammonia and hydrazine posts of power plants. Chin J Indus Med. (2022) 35:268–70. 10.13631/j.cnki.zggyyx.2022.03.026TianYLiuKWuLLihuaWDaiZFengJ. Comparison of the application of three occupational health risk assessment models in battery manufacturers. Prev Med. (2018) 30:1248–51. 10.19485/j.cnki.issn2096-5087.2018.12.015GuMXuXZhangMLiY. A comparative study on application of three methods of occupational health risk assessment for alumina dust exposure workstations. J Environ Occup Med. (2021) 38:64–9. 10.13213/j.cnki.jeom.2021.20317ZhangJCaiYLiFWuZ. Comparison of occupational health risk assessment of an electronic enterprise based on epa method and occupational disease work classification method. J Saf Environ. (2018) 18:1692–8. 10.13637/j.issn.1009-6094.2018.05.008GuoQLiMHuangDZhangQ. Risk assessment method and application of occupational hazards in operation exposed to aromatic mixture based pbpk model. Chin J Indus Med. (2022) 35:200–4. 10.13631/j.cnki.zggyyx.2022.03.002ZhaoXCengQLiuJNiYWangXGuQ. Application of five methods in the occupational health risk assessment of workers exposed to welding fumes. Chin J Indus Hyg Occup Dis. (2021) 39:375–8. 10.3760/cma.j.cn121094-20200630-0036834074087DongYBianHWangXHuW. Application of common occupational health risk assessment methods in vinyl chloride manufacturing factories. J Environ Occup Med. (2020) 37:797–803. 10.13213/j.cnki.jeom.2020.19870WangAPengboLXiaohaiLGuochuanMGuozhangX. Occupational health risk assessment of low concentrations benzene toluene and xylenes. Chin J Indus Hyg Occup Dis. (2019) 37:627–32. 10.3760/cma.j.issn.1001-9391.2019.08.01831495123LiangZCengQDengYLiLYuJZhongX. Comparison of four methods for assessing the risk of chemical hazards in the electrical appliance manufacturing industry. Prev Med. (2020) 32:310–4. 10.19485/j.cnki.issn2096-5087.2020.03.025