Direct cost of occupational asthma and associated factors in the private sector in central Tunisia

Background: Occupational asthma (OA) is a significant public health concern due to its high prevalence and socioeconomic burden. In Tunisia, the direct costs of OA have not been previously evaluated, despite its economic impact on both the healthcare system and workers. This study aimed to estimate the direct cost of OA in the private sector in central Tunisia and to identify the factors associated with this cost. Methods: A cross-sectional analytical study was conducted using data from the National Health Insurance Fund (CNAM) on OA cases recognised between 2015 and 2017 in the governorates of Sousse, Monastir, Mahdia, and Kairouan. Data on sociodemographic, occupational, clinical, and paraclinical characteristics were collected, alongside the direct costs related to OA. Direct costs included in-kind benefits (medical care, medicines, hospitalisation, transport) and cash benefits (temporary and permanent work indemnities) from the date of disease recognition to December 2020. Statistical analyses included univariate tests and multiple linear regression. Results: A total of 157 OA cases were analysed, predominantly female (75.8%), with a mean age of 43.41 ± 7.29 years. The textile sector accounted for 72% of cases. High-molecular-weight allergens, particularly vegetable textile dust, were the main causative agents (70.7%). The median total direct cost of OA was 4,593.525 TND [IQR: 3,408.003–6,871.725], with CNAM compensating a total of 1,029,200.1 TND for these patients. Lower forced expiratory volume in one second (FEV1) and higher rates of permanent partial disability (PPD) were independently associated with higher direct costs of OA (p < 0.001). Conclusions: This study highlights the considerable direct costs associated with occupational asthma in central Tunisia’s private sector, emphasising the burden on the healthcare system and workers. These findings underscore the need for strengthened preventive measures, early detection, and effective workplace interventions to reduce the impact of OA and guide evidence-based occupational health policies.