To review the literature on the burden of occupational disease and injury and to provide a comprehensive characterization of the burden. The scientific and governmental literature from 1990 to the present was searched and evaluated. Thirty-eight studies illustrative of the burden of occupational disease were reviewed for findings, methodology, strengths, and limitations. Recent U.S. estimates of occupational mortality and morbidity include approximately 55,000 deaths (eighth leading cause) and 3.8 million disabling injuries per year, respectively. Comprehensive estimates of U.S. costs related to these burdens range between $128 billion and $155 billion per year. Despite these significant indicators, occupational morbidity, mortality, and risks are not well characterized in comparative burden assessments. The magnitude of occupational disease and injury burden is significant but underestimated. There is a need for an integrated approach to address these underestimates.