Development of a Scoring Method as Predictive Analytics for the Risk of Sudden Death in the Workplace Using Employees’ Fit-to-Work Status, Workload, and Extreme Work Environments: A Case Study of PT XYZ
DOI:
https://doi.org/10.55324/ijoms.v5i11.1318Keywords:
sudden death, predictive analytics, fit to work, workload, operational riskAbstract
Sudden death due to illness in the workplace remains a critical occupational health challenge, particularly in high-risk industries where workers are exposed to complex operational conditions. The increasing occurrence of illness-related fatality incidents highlights the need for predictive approaches that integrate occupational health and operational risk management. This study aimed to develop a predictive analytics model for assessing sudden death risk among workers at PT XYZ by examining the effects of Fit-to-Work (FTW) status, workload, and extreme work environments, as well as developing an early warning scoring system. The study employed a quantitative approach using a case-control design based on secondary data from Medical Check-Up (MCU) records and workplace sudden death investigation reports. A total of 581 worker records were analyzed, consisting of 65 illness-related fatality cases and 516 control samples, using chi-square analysis and binary logistic regression. The results showed that shift work significantly increased sudden death risk (adjusted odds ratio [AOR] = 18.06; p < 0.001), while outdoor work environments also contributed significantly (AOR = 2.60; p = 0.004). FTW status showed a protective tendency but was not statistically significant. The developed Illness Fatality Risk Score (SRIF) demonstrated good predictive performance, with an area under the curve (AUC) value of 0.840. In conclusion, workload characteristics and environmental exposure were important predictors of workplace sudden death risk, and SRIF could serve as a practical early warning tool to support proactive occupational health risk management.
References
Affinito, G., Arpaia, P., Barone-Adesi, F., Fontana, L., Palladino, R., & Triassi, M. (2021). A cardiovascular risk score for use in occupational medicine. Journal of Clinical Medicine, 10(13), 2789. https://doi.org/10.3390/jcm10132789
Cheng, M., He, H., Wang, D., Xu, L., Wang, B., Ho, K. M., & Chen, W. (2019). Shift work and ischaemic heart disease: Meta-analysis and dose-response relationship. Occupational Medicine, 69(3), 182-188. https://doi.org/10.1093/occmed/kqz020
Chugh, S. S., Reinier, K., Uy-Evanado, A., Chugh, H. S., Elashoff, D., Young, C., Salvucci, A., & Jui, J. (2022). Prediction of sudden cardiac death manifesting with documented ventricular fibrillation or pulseless ventricular tachycardia. JACC: Clinical Electrophysiology, 8(4), 411-423. https://doi.org/10.1016/j.jacep.2022.02.004
Cillekens, B., Huysmans, M. A., Holtermann, A., van Mechelen, W., Straker, L., Krause, N., van der Beek, A. J., & Coenen, P. (2022). Physical activity at work may not be health enhancing: A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655,892 participants. Scandinavian Journal of Work, Environment & Health, 48(2), 86-98. https://doi.org/10.5271/sjweh.3993
Cillekens, B., Lang, M., van Mechelen, W., Verhagen, E., Huysmans, M. A., Holtermann, A., van der Beek, A. J., & Coenen, P. (2020). How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies. British Journal of Sports Medicine, 54(24), 1474-1481. https://doi.org/10.1136/bjsports-2020-102587
Coenen, P., Huysmans, M. A., Holtermann, A., Krause, N., van Mechelen, W., Straker, L. M., & van der Beek, A. J. (2018). Do highly physically active workers die early? A systematic review with meta-analysis of data from 193,696 participants. British Journal of Sports Medicine, 52(20), 1320-1326. https://doi.org/10.1136/bjsports-2017-098540
Cohn, J. B., & Wardlaw, M. I. (2016). Financing constraints and workplace safety. The Journal of Finance, 71(5), 2017-2058. https://doi.org/10.1111/jofi.12430
Culp, K., & Tonelli, S. (2019). Heat-related illness in Midwestern Hispanic farmworkers: A descriptive analysis of hydration status and reported symptoms. Occupational Health & Safety, 67(4), 168-178. https://doi.org/10.1177/2165079918813380
Dai, Y., Tong, X., & Wang, L. (2022). Workplace safety accident, employee treatment, and firm value: Evidence from China. Economic Modelling, 115, 105960. https://doi.org/10.1016/j.econmod.2022.105960
Deo, R., Norby, F. L., Katz, R., Sotoodehnia, N., Adabag, S., DeFilippi, C. R., Kestenbaum, B., Chen, L. Y., Heckbert, S. R., Folsom, A. R., Kronmal, R. A., Konety, S., Patton, K. K., Siscovick, D., Shlipak, M. G., & Alonso, A. (2016). Development and validation of a sudden cardiac death prediction model for the general population. Circulation, 134(11), 806-816. https://doi.org/10.1161/CIRCULATIONAHA.116.023042
Fadel, M., Li, J., Sembajwe, G., Gagliardi, D., Pico, F., Ozguler, A., Evanoff, B. A., Baer, M., Tsutsumi, A., Iavicoli, S., Leclerc, A., Roquelaure, Y., Siegrist, J., & Descatha, A. (2020). Cumulative exposure to long working hours and occurrence of ischemic heart disease: Evidence from the CONSTANCES cohort at inception. Journal of the American Heart Association, 9(12), e015753. https://doi.org/10.1161/JAHA.119.015753
Fatima, S. H., Rothmore, P., Giles, L. C., Varghese, B. M., & B. P. (2021). Extreme heat and occupational injuries in different climate zones: A systematic review and meta-analysis of epidemiological evidence. Environment International, 148, 106384. https://doi.org/10.1016/j.envint.2021.106384
Flouris, A. D., Dinas, P. C., Ioannou, L. G., Nybo, L., Havenith, G., Kenny, G. P., & Kjellstrom, T. (2018). Workers' health and productivity under occupational heat strain: A systematic review and meta-analysis. The Lancet Planetary Health, 2(12), e521-e531. https://doi.org/10.1016/S2542-5196(18)30237-7
Gamboa Madeira, S., Fernandes, C., Paiva, T., Santos Moreira, C., & Caldeira, D. (2021). The impact of different types of shift work on blood pressure and hypertension: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(13), 6738. https://doi.org/10.3390/ijerph18136738
Gu, F., Han, J., Laden, F., Pan, A., Caporaso, N. E., Stampfer, M. J., Kawachi, I., Rexrode, K. M., Willett, W. C., Hankinson, S. E., Speizer, F. E., & Schernhammer, E. S. (2015). Total and cause-specific mortality of U.S. nurses working rotating night shifts. American Journal of Preventive Medicine, 48(3), 241-252. https://doi.org/10.1016/j.amepre.2014.10.018
Ho, F. K., Celis-Morales, C., Gray, S. R., Demou, E., Mackay, D., Welsh, P., Katikireddi, S. V., Sattar, N., & Pell, J. P. (2022). Association and pathways between shift work and cardiovascular disease: A prospective cohort study of 238,661 participants from UK Biobank. International Journal of Epidemiology, 51(2), 579-590. https://doi.org/10.1093/ije/dyab144
Holmstrom, L., Chugh, H., Nakamura, K., Bhanji, Z., Seifer, M., Uy-Evanado, A., Reinier, K., Ouyang, D., & Chugh, S. S. (2024). An ECG-based artificial intelligence model for assessment of sudden cardiac death risk. Communications Medicine, 4, 17. https://doi.org/10.1038/s43856-024-00451-9
Ioannou, L. G., Foster, J., Morris, N. B., Piil, J. F., Havenith, G., Mekjavic, I. B., Kenny, G. P., Nybo, L., & Flouris, A. D. (2022). Occupational heat strain in outdoor workers: A comprehensive review and meta-analysis. Temperature, 9(1), 67-102. https://doi.org/10.1080/23328940.2022.2030634
Karimova, L. K., Muldasheva, N. A., Bakirov, A. B., Gimaeva, Z. F., & Mavrina, L. N. (2020). Risk of a sudden death at a workplace caused by non-occupational diseases in Bashkortostan. Health Risk Analysis, (2), 55-62. https://doi.org/10.21668/health.risk/2020.2.06.eng
Kecklund, G., & Axelsson, J. (2016). Health consequences of shift work and insufficient sleep. BMJ, 355, i5210. https://doi.org/10.1136/bmj.i5210
Kervezee, L., Kosmadopoulos, A., & Boivin, D. B. (2020). Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances. European Journal of Neuroscience, 51(1), 396-412. https://doi.org/10.1111/ejn.14216
Ketels, M., Cillekens, B., Clays, E., Huysmans, M. A., De Bacquer, D., Holtermann, A., Troiano, R. P., Mork, P. J., Krokstad, S., Völzke, H., Dörr, M., Bahls, M., Ittermann, T., Clausen, J., Jensen, M. T., Kauhanen, J., Voutilainen, A., Wanner, M., Bopp, M., ... Coenen, P. (2025). Exploring the 'fit for work' principle: The association between occupational physical activity, cardiorespiratory fitness, and mortality-a meta-analysis of male worker data. Scandinavian Journal of Work, Environment & Health, 51(3), 159-169. https://doi.org/10.5271/sjweh.4218
Kolk, M. Z. H., Ruipérez-Campillo, S., Wilde, A. A. M., Knops, R. E., Narayan, S. M., & Tjong, F. V. Y. (2025). Prediction of sudden cardiac death using artificial intelligence: Current status and future directions. Heart Rhythm, 22(3), 756-766. https://doi.org/10.1016/j.hrthm.2024.09.003
Koo, J. E., & Ki, E. S. (2020). Corporate social responsibility and employee safety: Evidence from Korea. Sustainability, 12(7), 2649. https://doi.org/10.3390/su12072649
Lee, J., Lee, Y. H., Choi, W.-J., Ham, S., Kang, S.-K., Yoon, J.-H., Yoon, M. J., Kang, M.-Y., & Lee, W. (2022). Heat exposure and workers' health: A systematic review. Reviews on Environmental Health, 37(1), 45-59. https://doi.org/10.1515/reveh-2020-0158
Li, J., Pega, F., Ujita, Y., Brisson, C., Clays, E., Descatha, A., Ferrario, M. M., Godderis, L., Iavicoli, S., Landsbergis, P. A., Metzendorf, M.-I., Morgan, R. L., Pachito, D. V., Pikhart, H., Richter, B., Roncaioli, M., Rugulies, R., Schnall, P. L., Sembajwe, G., ... Siegrist, J. (2020). The effect of exposure to long working hours on ischaemic heart disease: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environment International, 142, 105739. https://doi.org/10.1016/j.envint.2020.105739
Liu, J., Varghese, B. M., Hansen, A., Zhang, Y., Driscoll, T., Morgan, G., Dear, K., Gourley, M., Capon, A., & Bi, P. (2022). Heat exposure and cardiovascular health outcomes: A systematic review and meta-analysis. The Lancet Planetary Health, 6(6), e484-e495. https://doi.org/10.1016/S2542-5196(22)00117-6
McCarthy, R. B., Shofer, F. S., & Green-McKenzie, J. (2019). Outcomes of a heat stress awareness program on heat-related illness in municipal outdoor workers. Journal of Occupational and Environmental Medicine, 61(9), 724-728. https://doi.org/10.1097/JOM.0000000000001639
Morris, C. E., Gonzales, R. G., Hodgson, M. J., & Tustin, A. W. (2019). Actual and simulated weather data to evaluate wet bulb globe temperature and heat index as alerts for occupational heat-related illness. Journal of Occupational and Environmental Hygiene, 16(1), 54-65. https://doi.org/10.1080/15459624.2018.1532574
Nowrouzi-Kia, B., Chattu, V. K., Sunil, T. S., Carnide, N., Thomson, H., Premji, R., Sathananthan, A., Choi, C., & Mencia-Ledo, J. (2026). Heat exposure and health outcomes in construction workers: A systematic review and meta-analysis. Environmental Health Insights, 20, 11786302261426720. https://doi.org/10.1177/11786302261426720
Ouyang, Z., Wei, J., & Zhao, D. (2017). Stock market's reaction to self-disclosure of work safety accidents: An empirical study in China. Quality & Quantity, 51(4), 1611-1626. https://doi.org/10.1007/s11135-016-0355-9
Palladino, R., Caporale, O., Nardone, A., Fiorentino, D., Torre, I., & Triassi, M. (2016). Use of Framingham Risk Score as a clinical tool for the assessment of fitness for work: Results from a cohort study. Journal of Occupational and Environmental Medicine, 58(8), 805-809. https://doi.org/10.1097/JOM.0000000000000795
Pega, F., Náfrádi, B., Momen, N. C., Ujita, Y., Streicher, K. N., Prüss-Üstün, A. M., Descatha, A., Driscoll, T., Fischer, F. M., Godderis, L., Kiiver, H. M., Li, J., Magnusson Hanson, L. L., Rugulies, R., Sørensen, K., Woodruff, T. J., & Technical Advisory Group. (2021). Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environment International, 154, 106595. https://doi.org/10.1016/j.envint.2021.106595
Perry, J., Brody, J. A., Fong, C., Sunshine, J. E., O'Reilly-Shah, V. N., Sayre, M. R., Rea, T. D., Simon, N., Shojaie, A., Sotoodehnia, N., & Chatterjee, N. A. (2024). Predicting out-of-hospital cardiac arrest in the general population using electronic health records. Circulation, 150(2), 102-110. https://doi.org/10.1161/CIRCULATIONAHA.124.069105
Saiki, M., Tsutsumi, A., & Li, J. (2026). Long working hours and risk of ischemic heart disease among Japanese workers: The Jichi Medical School Cohort Study. Journal of Preventive Medicine and Public Health, 59(2), 211-218. https://doi.org/10.3961/jpmph.25.577
Sullivan, L. M., Massaro, J. M., & D'Agostino, R. B., Sr. (2004). Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Statistics in Medicine, 23(10), 1631-1660. https://doi.org/10.1002/sim.1742
Torquati, L., Mielke, G. I., Brown, W. J., & Kolbe-Alexander, T. (2018). Shift work and the risk of cardiovascular disease: A systematic review and meta-analysis including dose-response relationship. Scandinavian Journal of Work, Environment & Health, 44(3), 229-238. https://doi.org/10.5271/sjweh.3700
Tustin, A., Sayeed, Y., Berenji, M., Fagan, K., McCarthy, R. B., Green-McKenzie, J., McNicholas, J., Onigbogi, C. B., Perkison, W. B., Butler, J. W., & Acoem Working Group on Occupational Heat-Related Illness. (2021). Prevention of occupational heat-related illnesses. Journal of Occupational and Environmental Medicine, 63(10), e737-e744. https://doi.org/10.1097/JOM.0000000000002351
Vega-Arroyo, A. J., Mitchell, D. C., Castro, J. R., Armitage, T. L., Tancredi, D. J., Bennett, D. H., & Schenker, M. B. (2019). Impacts of weather, work rate, hydration, and clothing in heat-related illness in California farmworkers. American Journal of Industrial Medicine, 62(12), 1038-1046. https://doi.org/10.1002/ajim.22973
Vestergaard, J. M., Dalbøge, A., Bonde, J. P. E., Garde, A. H., Hansen, J., Hansen, A. M., Larsen, A. D., Härmä, M., Costello, S., Böttcher, M., & Kolstad, H. A. (2023). Night shift work characteristics and risk of incident coronary heart disease among health care workers: National cohort study. International Journal of Epidemiology, 52(6), 1853-1861. https://doi.org/10.1093/ije/dyad126
Vetter, C., Devore, E. E., Wegrzyn, L. R., Massa, J., Speizer, F. E., Kawachi, I., Rosner, B., Stampfer, M. J., & Schernhammer, E. S. (2016). Association between rotating night shift work and risk of coronary heart disease among women. JAMA, 315(16), 1726-1734. https://doi.org/10.1001/jama.2016.4454
Vyas, M. V., Garg, A. X., Iansavichus, A. V., Costella, J., Donner, A., Laugsand, L. E., Janszky, I., Mrkobrada, M., Parraga, G., & Hackam, D. G. (2012). Shift work and vascular events: Systematic review and meta-analysis. BMJ, 345, e4800. https://doi.org/10.1136/bmj.e4800
Wang, D., Ruan, W., Chen, Z., Peng, Y., & Li, W. (2018). Shift work and risk of cardiovascular disease morbidity and mortality: A dose-response meta-analysis of cohort studies. European Journal of Preventive Cardiology, 25(12), 1293-1302. https://doi.org/10.1177/2047487318783892
Weng, S. F., Reps, J., Kai, J., Garibaldi, J. M., & Qureshi, N. (2017). Can machine-learning improve cardiovascular risk prediction using routine clinical data? PLOS ONE, 12(4), e0174944. https://doi.org/10.1371/journal.pone.0174944
Xi, J., Ma, W., Tao, Y., Zhang, X., Liu, L., & Wang, H. (2025). Association between night shift work and cardiovascular disease: A systematic review and dose-response meta-analysis. Frontiers in Public Health, 13, 1668848. https://doi.org/10.3389/fpubh.2025.1668848
Xiang, J., B., P., Pisaniello, D., & Hansen, A. (2014b). The impact of heatwaves on workers' health and safety in Adelaide, South Australia. Environmental Research, 133, 90-95. https://doi.org/10.1016/j.envres.2014.04.042
Xiang, J., Bi, P., Pisaniello, D., Hansen, A., & Sullivan, T. (2014a). Association between high temperature and work-related injuries in Adelaide, South Australia, 2001-2010. Occupational and Environmental Medicine, 71(4), 246-252. https://doi.org/10.1136/oemed-2013-101584
Youssfi, Y., Chocron, R., Laurenceau, T., Beganton, F., Empana, J.-P., Rea, T., Chopin, N., Bougouin, W., & Jouven, X. (2026). Machine learning-based prediction of sudden cardiac death in the general population using electronic health record data. European Journal of Preventive Cardiology. Advance online publication. https://doi.org/10.1093/eurjpc/zwag087
Zhou, K., Cai, C., He, Y., & Chen, Z. (2022). Potential prognostic biomarkers of sudden cardiac death discovered by machine learning. Computers in Biology and Medicine, 150, 106154. https://doi.org/10.1016/j.compbiomed.2022.106154
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Christiandi Agus Fagihari Ardianto, Suhari Pranyoto, Nanda R Nurdianto
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
