Abstract
<title>Abstract</title> <p>Objectives Common diseases, including chronic kidney disease, asthma, and pulmonary fibrosis, may be missed or assigned an incomplete or incorrect cause in people exposed to chemicals, heat, and dust. This study developed a staged framework mapping the mechanisms by which common disease can be missed or incorrectly represented, from clinical detection through cause-of-death coding, and examined the implications for exposure-informed clinical care. Methods We conducted a framework synthesis informed by care-cascade principles. Europe PMC, web-based sources, gray literature, and major burden-estimation reports were searched for literature published from January 2000 onward. The Population, Concept, and Context approach guided eligibility. Evidence was organized across six stages: clinical detection, disease classification, etiologic attribution, reporting or compensation, death registration, and cause-of-death coding. Sources directly examining an exposure-defined population and a detection or attribution outcome were distinguished from contextual and boundary evidence. Results Approximately 6,020 records were identified, 410 titles and abstracts were reviewed, and 100 full reports were assessed. The synthesis charted 61 sources contributing 64 findings. Direct patient-level evidence was limited to one study documenting diagnostic reclassification after exposure-focused assessment, while two studies provided population-level attribution evidence within idiopathic pulmonary fibrosis. The remaining studies provided contextual or boundary evidence on exposure associations, unknown-cause categories, reporting losses, screening, mortality records, and burden estimation. No direct common-disease evidence was identified for several framework stages. Conclusion The framework distinguishes where disease may be lost or misattributed and what evidence is needed at each stage. Direct patient-level evidence remains limited, supporting further evaluation of exposure-informed approaches to disease detection, classification, and management.</p>