Chest physician-reported, work-related, long-latency respiratory disease in Great Britain

Our plain-English summary of Chest physician-reported, work-related, long-latency respiratory disease in Great Britain, by M. Carder, A. Darnton, M. Gittins, et al (The European Respiratory Journal, 2017).

The study

• Authors: M. Carder, A. Darnton, M. Gittins, S.J. Stocks, D. Ross, C.M. Barber, R.M. Agius
• Journal: The European Respiratory Journal
• Published: 2017;50(6)
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Much of the current burden of long-latency respiratory disease (LLRD) in Great Britain is attributed to historical asbestos exposure. However, continuing exposure to other agents, notably silica, also contributes to disease burden. The aim of this study was to investigate the incidence of work-related LLRD reported by chest physicians in Great Britain, including variations by age, gender, occupation and suspected agent.LLRD incidence and incidence rate ratios by occupation were estimated (1996-2014). Mesothelioma cases by occupation were compared with proportional mortality ratios.Cases were predominantly in men (95%) and 92% of all cases were attributed to asbestos. Annual average incidence rates (males) per 100 000 were: benign pleural disease, 7.1 (95% CI 6.0-8.2); mesothelioma, 5.4 (4.8-6.0); pneumoconiosis, 1.9 (1.7-2.2); lung cancer, 0.8 (0.6-1.0); chronic obstructive pulmonary disease (COPD), 0.3 (0.2-0.4). Occupations with a particularly high incidence of LLRD were miners and quarrymen (COPD), plumbers and gas fitters (asbestosis), and shipyard and dock workers (all other categories). There was a clear concordance between cases of SWORD mesothelioma and proportional mortality ratios by occupation.Occupationally caused LLRD continues to contribute to a significant disease burden. Many cases are attributable to past exposure to agents such as asbestos and silica, but the potential for occupational exposures persists.

Copyright ©ERS 2017.

In plain English

This study used SWORD, a scheme in which chest physicians in Great Britain voluntarily report new cases they judge caused or made worse by work. The authors analysed long-latency respiratory diseases reported from 1996 to 2014, including non-malignant pleural disease, mesothelioma, asbestosis and other pneumoconiosis, lung cancer and COPD. Most cases were in men (95% of estimated cases), and physicians reported asbestos as the cause in 92% of actual cases. Among men, the average yearly rate per 100000 adults was 7.1 (95% CI 6.0–8.2) for non-malignant pleural disease and 5.4 (4.8–6.0) for mesothelioma, with lower rates for other diseases. Compared with all other occupations, rate ratios were highest in shipyard and dock workers for most diseases, plumbers and gas fitters for asbestosis, and miners and quarrymen for COPD. Among women, textile workers had high rate ratios for pleural disease, mesothelioma and asbestosis. In men, the occupational spread of reported mesothelioma cases broadly matched national mesothelioma death records. The authors concluded that disease from past asbestos, silica and coal exposure continues. They noted that true incidence is probably underestimated.

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: Analysis of voluntary physician-reported surveillance data (SWORD). The authors estimated incidence rates and incidence rate ratios by occupation, and compared mesothelioma cases with national proportional mortality ratios.
• Who was studied: Newly diagnosed cases of work-related long-latency respiratory disease reported by chest physicians in Great Britain to SWORD, 1996–2014. Physicians reported either for one randomly selected month per year or for all 12 months.
• Exposure: Occupational exposures recorded by the reporting physicians. These were mainly asbestos (fiber type not specified in the reports), and also silica and silicates, coal and other agents. Occupations were coded from the reports.
• Main results:
  • Cases were mostly in men (95% of estimated cases), with a mean age of 69 years.
  • Annual average incidence rates per 100000 for men were: benign pleural disease 7.1 (95% CI 6.0–8.2); mesothelioma 5.4 (4.8–6.0); pneumoconiosis 1.9 (1.7–2.2); lung cancer 0.8 (0.6–1.0); COPD 0.3 (0.2–0.4). The denominator was the total adult population, both working and non-working.
  • Asbestos was reported as the causal agent in 92% of actual cases, including 99% of non-malignant pleural disease cases and 94% of mesothelioma cases. For pneumoconiosis, 10% of cases were attributed to silica and silicates and 8% to coal. Coal was the agent reported most often for COPD (41% of cases).
  • Among men, the highest incidence rate ratios (compared with all other occupations) were in miners and quarrymen for COPD, plumbers and gas fitters for asbestosis, and shipyard and dock workers for all other categories. For all long-latency diseases combined, incidence in shipyard and dock workers was more than 10 times the average.
  • COPD incidence among male miners and quarrymen was 66 times the average for all occupations.
  • Silicosis incidence rate ratios were 30.2 (95% CI 21.8–41.8) for miners and quarrymen, 10.9 (5.6–21.6) for glass and ceramics makers, and 10.7 (7.7–14.6) for construction workers.
  • Female textile workers had incidence rate ratios of 10.8 (7.4–15.8) for non-malignant pleural disease, 6.8 (4.5–10.2) for mesothelioma and 37.2 (14.8–93.2) for asbestosis.
  • In men, the distribution of SWORD mesothelioma cases by occupation correlated with national mesothelioma deaths (Spearman's rank correlation coefficient 0.58, significant at the 0.01 level). There were exceptions, such as pipe fitters, who made up a much lower share of SWORD cases than their proportional mortality ratio would suggest.
• The authors' conclusion: The authors concluded that the study shows continuing incidence of long-latency respiratory disease in Great Britain arising from historical exposure to agents such as asbestos, silica and coal. They added that identifying occupations still at risk can inform prevention.
• Limitations the authors state:
  • The adjustment for non-participating and non-responding physicians might overestimate rates, but the authors judged that true incidence is probably still underestimated.
  • Difficulty attributing cases to work, especially COPD and lung cancer, may cause under-reporting.
  • Some reported information may be wrong. For example, 241 mesothelioma or non-malignant pleural disease cases were not attributed to asbestos, which the authors consider likely misattribution.
  • The authors described their method as crude: it assumed a fixed lag period between exposure and disease and used a single-year (1971) census denominator, which may under- or overestimate incidence rate ratios.
  • Smoking and other risk factors may affect the attribution of individual lung cancer cases.

Topics

Medical terms in this study, explained in our Lexicon: Latency, Asbestos Exposure, Incidence, Mesothelioma, Proportional mortality, Pneumoconiosis, Lung Cancer, COPD.

Related studies

• Medically reported work-related ill-health in the UK agricultural sector — S.J. Stocks, S. Turner, et al. (2010)
• The incidence of medically reported work-related ill health in the UK construction industry — S.J. Stocks, R. McNamee, et al. (2010)
• Exercise training to improve exercise capacity and quality of life in people with non-malignant dust-related respiratory diseases — M.T. Dale, Z.J. McKeough, et al. (2015)
• Occupational and work-related respiratory disease attributed to cleaning products — M. Carder, M.J. Seed, et al. (2019)
• Relation of occupational exposure to respiratory symptoms and asthma in a general population sample: self-reported versus interview-based exposure data — P.S. Bakke, R. Hanoa, et al. (2001)
• Longitudinal pattern of reported respiratory symptoms and accelerated ventilatory loss in asbestos-exposed workers — C.A. Brodkin, S. Barnhart, et al. (1996)

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