Asbestos-related occupational cancers compensated under the Spanish National Insurance System, 1978-2011

Our plain-English summary of Asbestos-related occupational cancers compensated under the Spanish National Insurance System, 1978-2011, by M. García-Gómez, A. Menéndez-Navarro, R.C. López (International Journal of Occupational and Environmental Health, 2015).

The study

• Authors: M. García-Gómez, A. Menéndez-Navarro, R.C. López
• Journal: International Journal of Occupational and Environmental Health
• Published: 2015;21(1):31-9
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: In 1978, asbestos-related occupational cancers were added to the Spanish list of occupational diseases. However, there are no full accounts of compensated cases since their inclusion.

Objective: To analyze the cases of asbestos-related cancer recognized as occupational in Spain between 1978 and 2011.

Methods: Cases were obtained from the Spanish Employment Ministry. Specific incidence rates by year, economic activity, and occupation were obtained. We compared mortality rates of mesothelioma and bronchus and lung cancer mortality in Spain and the European Union.

Results: Between 1978 and 2011, 164 asbestos-related occupational cancers were recognized in Spain, with a mean annual rate of 0·08 per 10(5) employees (0·13 in males, 0·002 in females). Under-recognition rates were an estimated 93·6% (males) and 99·7% (females) for pleural mesothelioma and 98·8% (males) and 100% (females) for bronchus and lung cancer. In Europe for the year 2000, asbestos-related occupational cancer rates ranged from 0·04 per 10(5) employees in Spain to 7·32 per 10(5) employees in Norway.

Conclusions: These findings provide evidence of gross under-recognition of asbestos-related occupational cancers in Spain. Future work should investigate cases treated in the National Healthcare System to better establish the impact of asbestos on health in Spain.

In plain English

This study analyzed official records of asbestos-related cancers that Spain's National Insurance System recognized as occupational diseases from 1978 to 2011, using data from the Spanish Ministry of Employment. These cancers joined Spain's occupational disease list in 1978, but the first case was recorded in 1997. In all, 164 cases were recognized, 162 in men and two in women. More than half were recognized in 2010 and 2011. Mesothelioma was the most common type (99 cases, 65.6% of the 151 cases recorded from 2002 to 2011). From 1997 to 2011, four sectors accounted for 74.4% of cases: transport-material manufacturing, non-metallic mineral products, metallurgy and the manufacture of metallic products, and construction. The authors compared these cases with national deaths for 2007 to 2011, using assumptions about the share caused by work. They estimated 1038 to 1102 work-related pleural mesothelioma deaths, against 50 recognized cases. For lung cancer, they estimated 4076 work-related deaths, against 47 recognized cases. The authors concluded that these cancers are grossly under-declared and under-recognized in Spain. They noted that only accepted cases are published and that disease coding systems often disagreed.

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: Descriptive analysis of national records of compensated occupational disease cases, compared with national mortality data and with European recognition figures
• Who was studied: All asbestos-related cancers recognized as occupational diseases by the Spanish National Insurance System, 1978 to 2011 (164 cases), from Spanish Ministry of Employment statistics. Rates per 100,000 employees were calculated for 1997 to 2011.
• Exposure: Occupational asbestos exposure, recorded through recognized occupational disease cases. No fiber types or doses were reported for the cases. Cases were concentrated in railway material manufacture, shipbuilding and repair, fibrocement manufacturing, metallurgy and the manufacture of metallic products, and construction.
• Main results:
  • 164 asbestos-related cancers were recognized as occupational diseases between 1978 and 2011. The first case was recorded in 1997.
  • The rate per 100,000 social security-affiliated employees rose from 0.01 in 1997 to 0.43 in 2011. The mean rate for 1997 to 2011 was 0.08 overall, 0.13 in males and 0.002 in females.
  • 162 recognized cases were in males and two in females.
  • Of 151 cases recorded in 2002 to 2011, mesothelioma was the most common type (99 cases, 65.6%).
  • Of the 70 mesotheliomas recognized in 2007 to 2011, 50 (71.4%) were pleural. No laryngeal cancer cases were recorded.
  • Four sectors accounted for 74.4% of compensated cases, 1997 to 2011 (rates per 100,000 workers): manufacture of transport materials (1.05), non-metallic minerals (1.32), metallurgy and the manufacture of metallic products (1.34), and construction (0.09).
  • About half of cases (51.85%) were among craft and related trades workers.
  • In 2007 to 2011, 1297 people aged 40 and over died of pleural mesothelioma in Spain. Assuming 80 to 85% were due to occupational exposure, the authors estimated 1038 to 1102 work-related deaths (740 to 786 in males, 298 to 316 in females).
  • Over the same period, only 50 pleural mesotheliomas were recognized as occupational diseases (49 in males, 1 in females).
  • The authors estimated that 93.4 to 93.8% of occupational pleural mesothelioma cases in males were under-recognized.
  • In females, only 0.33% of pleural mesothelioma deaths were attributed to occupational asbestos exposure and recorded as occupational cancers.
  • Assuming 4% of the 101,906 bronchus and lung cancer deaths in 2007 to 2011 were due to occupational asbestos exposure, an estimated 4076 deaths were work-related. Only 47 cases were recognized as occupational, none among females.
  • Estimated under-recognition of asbestos-attributable bronchus and lung cancer was 98.8% (98.6% in males, 100% in females).
  • Asbestos-related cancers made up 76% of all occupational cancers recognized in Spain between 1997 and 2011.
  • Using year-2000 Eurogip figures, recognized cases of asbestos-related cancers per 100,000 insured workers were 183-fold higher in Norway than in Spain, and 133-fold higher in Denmark. Recognized cases were 124-fold higher in France and 41-fold higher in Italy.
• The authors' conclusion: The authors concluded that the number of recorded asbestos-related cancers indicates gross under-declaration and under-recognition of these diseases in Spain. In their view, occupational disease data do not reflect the true burden of asbestos-related disease.
• Limitations the authors state:
  • Data from earlier periods were difficult to gather, and the quality of information was limited. Sources changed many times, and data were not initially broken down by occupation, activity, age or gender.
  • The Social Security system publishes only accepted cases, not the number of claims made.
  • Agreement between occupational disease codes and ICD diagnostic codes was 81% in 2001 to 2006 but only 47% in 2007 to 2011.
  • The records contain errors in how disease severity was evaluated.
  • Some cases will be missing from the records. For example, workers retired or out of work at diagnosis do not generate an occupational disease report from insurance companies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Occupational Disease, Incidence, Mesothelioma, Bronchus, Lung Cancer, Pleural Mesothelioma.

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