The healthy worker survivor effect (HWSE) arises in occupational epidemiology when less healthy workers leave work, resulting in a survivor population of healthier, more heavily exposed workers. Ignoring this selection process can lead to underestimation of lifetime risk in cohort studies. Bridging the gap between policy-makers, who develop occupational health standards, and the academic literature on HWSE would increase the accuracy of risk assessment for workplace health hazards and improve worker protection. In its Final Silica Rule (2024), the US Mine Safety and Health Administration (MSHA) lowered the permissible exposure limit (PEL) for silica based on a quantitative risk assessment. MSHA explicitly acknowledged that their excess risk estimates are likely to be underestimated due to the HWSE but stopped short of adjusting the risk estimates at the PEL.1 Although the current literature on health effects of silica provides a concrete, actionable estimate of HWSE-adjusted risk for lung...]]>