Asbestos-related findings in chest radiographs of the male population of the county of Telemark, Norway--a cross-sectional study

Our plain-English summary of Asbestos-related findings in chest radiographs of the male population of the county of Telemark, Norway--a cross-sectional study, by B. Hilt, J.T. Lien, P.G. Lund-Larsen, et al (Scandinavian Journal of Work, Environment & Health, 1986).

The study

• Authors: B. Hilt, J.T. Lien, P.G. Lund-Larsen, K. Lund, S. Langärd
• Journal: Scandinavian Journal of Work, Environment & Health
• Published: 1986;12(6):567-73
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000400).

Abstract

In order to investigate the prevalence of asbestos-related diseases, a cross-sectional population study was conducted among 28,216 men aged 40 years in nine municipalities of the county of Telemark, Norway. In a primary radiographic screening 10 X 10-cm chest radiographs were taken of 21,483 persons. In two independent readings of the radiographs, pleural changes were observed in 6.9 and 8.5% of the study subjects. Radiographic findings in the primary screening led to 1,431 subjects being selected for a reexamination. On the basis of occupational histories and 40 X 40-cm chest radiographs, it was concluded that 470 of these subjects (2.2% of the screened population) had radiographic changes consistent with an asbestos-related disorder. Among these, 86 had lung fibrosis (82 in combination with pleural plaques) and 384 had pleural plaques only. There were marked differences in the occurrence of asbestos-related disorders between the seven urban and two rural communities studied, and agreement was observed between the occurrence of such disorders and the degree and duration of the reported asbestos exposure. The study presents evidence that asbestos-related disorders may be more prevalent in the general male population than has been recognized earlier.

In plain English

This cross-sectional study examined chest X-rays of men aged 40 and over in nine municipalities of Telemark county, Norway, seven industrial and two rural. Of 28,216 eligible men, 21,483 (76.1%) attended a screening with small chest radiographs. Two independent radiologists reported pleural changes in 6.9% and 8.5% of the men. Based on these findings, 1,431 men were selected for reexamination with larger radiographs and a detailed occupational history. The authors concluded that 470 men (2.2% of those screened) had changes consistent with an asbestos-related disorder. Of these, 86 had lung fibrosis (82 also with pleural plaques) and 384 had pleural plaques only. The highest rates were in Tinn (5.4%) and Porsgrunn (3.6%). The authors reported marked urban-rural differences and agreement with the reported degree and duration of exposure. Among 1,367 reexamined men, selected because of screening X-ray findings, age-adjusted lung fibrosis rates were 8.0% in current smokers and 2.8% in never smokers. The authors concluded that asbestos-related disorders may be more common in the general male population than previously recognized. They regarded the 470 cases as a minimum number.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional population study: a primary chest X-ray screening of the general male population, followed by reexamination of a selected group
• Who was studied: Men aged 40 years and over in nine municipalities of the county of Telemark, Norway. Of 28,216 eligible men, 26,715 lived in seven industrial communities and 1,501 in two rural communities. 21,483 (76.1%) attended the primary screening.
• Exposure: Occupational asbestos exposure as reported in interviews at the reexamination. It was graded as uncertain, light, moderate or heavy (heavy included, for example, industrial insulators), and by start and duration. 852 reexamined men reported exposure. The article did not name fiber types.
• Main results:
  • In the primary screening of 21,483 men, the two independent readers reported pleural changes in 6.9% and 8.5% of the men.
  • 1,431 men were selected for reexamination on the basis of their screening radiographs.
  • 470 men (2.2% of the screened population) were judged to have radiographic changes consistent with an asbestos-related disorder.
  • Of the 470, 86 had lung fibrosis (82 of them together with pleural plaques) and 384 had pleural plaques only.
  • The two municipalities with the highest rates of asbestos-related disorders were Tinn (5.4%) and Porsgrunn (3.6%). The authors reported a marked difference between urban and rural communities.
  • The authors observed agreement between the occurrence of asbestos-related disorders and the reported degree and duration of asbestos exposure.
  • Among 1,367 men who attended the reexamination, all of whom had been selected because of findings on their screening radiographs, the age-adjusted prevalence of lung fibrosis was 8.0% in all current smokers and 2.8% in never smokers. There were no marked differences in pleural plaques between smoking categories.
  • The mean time from first exposure to diagnosis was 39.6 years for men with lung fibrosis and 37.3 years for men with pleural plaques only.
• The authors' conclusion: The authors concluded that occupational asbestos exposure and asbestos-related diseases may be more prevalent in the general population than had been recognized so far.
• Limitations the authors state:
  • The authors described the sensitivity of the method as rather low. Together with losses from the study's restrictions and from non-attenders, this meant the 470 cases should be regarded as a minimum number.
  • No analysis of the men who did not attend the screening was carried out.
  • All exposed men had been selected because of abnormal screening radiographs. The proportions with disease in each exposure category are therefore probably higher than would be expected in an unselected group.
  • Only men with confirmed exposure could be diagnosed with asbestos-related disorders, so there was no zero-exposure comparison level in the exposure analyses.
  • The authors considered it probable that, because of ill health, more asbestos-exposed heavy smokers than unexposed never smokers had left the study base before the investigation.
  • The results cannot be applied generally to other counties in Norway.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Fibrosis, Pleural Plaques, Asbestos Exposure.

Related studies

• Chest radiographs in subjects with asbestos-related abnormalities: comparison between ILO categorizations and clinical reading — B. Hilt, A. Borgerson, et al. (1992)
• Lung function and respiratory symptoms in subjects with asbestos-related disorders: a cross-sectional study — B. Hilt, J.T. Lien, et al. (1987)
• Modelling prevalence and incidence of fibrosis and pleural plaques in asbestos-exposed populations for screening and follow-up: a cross-sectional study — C. Paris, A. Martin, et al. (2008)
• Asbestos-related radiographic changes by ILO classification of 10 x 10 cm chest X-rays in a screening of the general population — B. Hilt, G. Hillerdal, et al. (1995)
• Asbestos-related disease in railroad workers. A cross-sectional study — L.C. Oliver, E.A. Eisen, et al. (1985)
• Malignant pleural mesothelioma patients' experience by gender: findings from a cross-sectional UK-national questionnaire — M. Senek, S. Robertson, et al. (2022)

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