In the dissertation new solution of the actual medical problem concerning the substantiation of theoretical and methodological framework of complex hygienic assessment and risk management of occupational disease development in workers of the mining and metallurgical industry of Ukraine is theoretically generalized and scientifically substantiated on the basis of complex hygienic, epidemiological, sanitary-statistical, mathematical-statistical methods, method of expert assessments and multidimensional statistical analysis and forecasting.
It has been determined that the working conditions of the employees of basic occupations of modern metallurgical production belong to the 3 class 4 degree of harmfulness or to 4 «dangerous», so increase the level of both general and occupational morbidity. It has been found that the level of occupational pathology in the mining and metallurgical industry is 26,60±9,04 0/000 per year. The highest level of occupational pathology is observed in the employees of iron-ore mining – 70,92±8,64 0/000, 46,72 % of which are women, 59,89 % – persons of working age.
The direct causal relation between occupational morbidity and work experience is proved. It is set that the level of occupational risk belongs to the category «high» and «very high», the highest level of it is revealed in iron-ore mining industry (RR 5,45 at CI 95 % 5,29–5,60 (p <0,05)), which is associated with the highest level of harmful industrial factors.
A very high risk of occupational pathology in miners (EF from 45,1 % to 81,7 %) due to the working conditions has been revealed. In the structure of occupational diseases the hearing disorders, radiculopathy and chronic obstructive pulmonary disease (RR=60,8 at CI 95 % 33,7–109,7, RR=54,5 at CI 95 % 51,0–58,2 and RR=46,7 at CI 95 % 37,9–57,6) (p<0,05) are of the highest risk among miners, while among workers of open iron-ore extraction the vibration disease, occupational hearing disorders and pneumoconiosis (RR=13,1 at CI 95% 10,5–16,3, RR=10,0 at CI 95 % 8,1–12,3 and RR=10,0 at CI 95 % 2,5–39,7) (p<0,05) are of the highest risk due to working conditions by 55,6–98,4 %.
The method of calculation of «safe» working terms has been improved, that allows to make calculations concerning a complex of factors and to develop the «Occupational Risk Map», which consists of the following blocks – «accidents and injuries», «factors of the working environment and work process», «psychophysiological examination», «socio-psychological factors», «means of protection», «statistical occupational risk data» and to assess the level of causing harm risk and determine the priority of occupational risk management measures.
It has been revealed that the social losses (direct and indirect) from occupational morbidity among emloyees of the mining and metallurgical industry is more than UAH 17,6 million per year. Immediate implementation of modern preventive measures will save healthy years of working life and will reduce the economic losses from occupational diseases and associated pathology in employees of mining and metallurgical industry, which are at a very high level, both for enterprises and for the state as a whole.
It is proved that an objective assessment of the insurance contributions level is the key for high-quality treatment and prevention of related complications. The level of insurance contributions for the enterprises of iron ore mining corresponds to the existing ones, for the enterprises of open-cast mining it should be higher 1,7 times, and for metallurgical industry – 1,46 times.
Identifying the insurance tariffs conformity with the current situation in Ukraine based on assessing the level, structure, age and working experience of employees is the foundation for the development and implementation of principles of tariff rates differentiation depending on the classes of occupational risk, which will allow to approximate the amount of insurance contributions to the payments for the compensation of harm caused at the working place.
The results of the research have become the scientific basis for the development and implementation of the integral model for occupational pathology risk management system at each workplace with involvement in the process the main sides of social partnership - employers and employees – which will protect the health of the employee and ensure the proper occupational safety and health, will reduce the risk of work-related accidents, occupational diseases, will improve the quality of workplaces and working conditions, will reduce death rate from industrial causes, will increase the lifetime and improve the health of employees of leading enterprises of the mining and metallurgical industry of Ukraine.
