Beyond the numbers: rethinking evidence in pooled analyses of hand-arm vibration syndrome.

Hand-arm vibration syndrome (HAVS) continues to weigh heavily on workers’ health, yet how we study it often limits what we learn. Bovenzi et al. make an important contribution by pooling Italian datasets, but the heavy reliance on cross-sectional designs restricts causal insight. Inconsistent exposure metrics, varied outcome definitions, and limited adjustment for confounders risk blurring the true picture of vibration-related harm. The continued use of the ISO 5349-1 standard, despite questions about its accuracy, further complicates interpretation. Perhaps most concerning is the underrepresentation of women, leaving gender differences in susceptibility largely unexplored. To move the field forward, HAVS research needs more than bigger datasets—it needs standardized definitions, better exposure models, stronger adjustment for confounders, and, crucially, prospective cohort studies. Only then can we deliver evidence that truly shapes occupational health policy and prevention.