Costs of asbestosis and silicosis hospitalization in Italy (2001-2018) : Costs of asbestosis and silicosis hospitalization

Our plain-English summary of Costs of asbestosis and silicosis hospitalization in Italy (2001-2018) : Costs of asbestosis and silicosis hospitalization, by P. Ferrante (International Archives of Occupational and Environmental Health, 2021).

The study

• Author: P. Ferrante
• Journal: International Archives of Occupational and Environmental Health
• Published: 2021;94(4):763-771
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Asbestosis and silicosis are preventable fibrotic forms of pneumoconiosis. Decades ago, the World Health Organization began prevention campaigns for eliminating these diseases worldwide.

Purpose: To establish Italian hospitalization costs of asbestosis and silicosis in relation to national adopted prevention policies.

Methods: This is a retrospective population-based study of Italian hospitalizations treating asbestosis or silicosis in the period 2001-2018. We have extracted data from the National Hospital Discharge Registry and merged with national standard charges of hospitalizations through diagnosis-related group coding. We expressed costs in 2018 euros and evaluated data time-trends by linear normal and logistic regression models.

Results: During 2001-2018, hospitalization costs per year were 3,787,540 € for asbestosis and 10,103,215 € for silicosis. There were significant annual reductions in frequency (- 41 and - 266 hospitalizations per year for asbestosis and silicosis, respectively), length of stay (- 148 and - 2781 days per year for asbestosis and silicosis, respectively) and cost (- 43,881 and - 959,516 € per year for asbestosis and silicosis, respectively) of diseases. Length and cost of hospital stay per admission significantly increased over time for asbestosis (+ 0.2 days and + 100 €, respectively, per year).

Conclusion: Overall hospitalizations costs were higher for silicosis than asbestosis. Over time hospitals treated fewer cases with greater severity. The decreased 2001-2018 consumption of hospital resources by patients with asbestosis or silicosis is associated with the occupational health policies instituted from the 1990s to reduce exposures to asbestos and silica. Extending existing epidemiological surveillance systems to pneumoconioses would help to control the social costs of work-related diseases.

In plain English

This retrospective study used Italy's National Hospital Discharge Registry to estimate the costs of hospital admissions that listed asbestosis or silicosis as a primary or contributing diagnosis from 2001 to 2018. The author linked the records to national standard hospital charges and expressed costs in 2018 euros. There were 69,763 such admissions, with an estimated total cost of 248,689,213 euros. Admissions with asbestosis cost an estimated 3,787,540 euros per year and those with silicosis 10,103,215 euros per year. Over the period, yearly admissions, hospital days and total cost fell significantly for both diseases. On average there were 41 fewer asbestosis admissions and 266 fewer silicosis admissions each year. For asbestosis, length of stay and cost per admission rose each year, by 0.2 days and 100 euros. For both diseases, patients' mean age and the odds of urgent admission and of in-hospital death increased. The author concluded that hospitals treated fewer cases of greater severity, and that the decline is associated with Italian occupational health policies from the 1990s. The author noted that the data cannot establish that the policies caused these changes, and cannot count individual patients.

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: Retrospective population-based study of national hospital discharge records, with costs estimated from national standard hospital charges (by diagnosis-related group) and time trends assessed by regression
• Who was studied: Hospital discharge records in Italy, 2001 to 2018, with a primary or contributing diagnosis of asbestosis (ICD-9-CM 501) or silicosis (ICD-9-CM 502). There were 69,763 admissions in total: 19,531 with asbestosis, 50,635 with silicosis, and 403 with both.
• Exposure: No individual exposure data were analyzed. Hospitalization trends for asbestosis and silicosis were examined in relation to Italian laws on asbestos and silica, including the 1992 national asbestos ban, the 1999 prohibition of silica sand for dry-sandblasting on ships, and the 2008 Consolidated Safety Act.
• Main results:
  • Across both diseases, 2001 to 2018: an estimated total cost of 248,689,213 euros (2018 euros), from 69,763 admissions.
  • Asbestosis: 19,531 records, or 1,085 per year on average.
  • Asbestosis: estimated annual cost of 3,787,540 euros, of which 947,268 euros was attributed to asbestosis itself.
  • Silicosis: 50,635 records, or 2,813 per year on average.
  • Silicosis: estimated annual cost of 10,103,215 euros, of which 2,269,486 euros was attributed to silicosis itself.
  • Annual reductions in admissions: on average 41 per year for asbestosis and 266 per year for silicosis.
  • Annual reductions in hospital days: 148 per year for asbestosis and 2,781 per year for silicosis. Annual reductions in cost: 43,881 euros per year for asbestosis and 959,516 euros per year for silicosis.
  • Asbestosis: hospital stay per admission rose by 0.2 days per year.
  • Asbestosis: cost per admission rose by 100 euros per year.
  • Asbestosis: each year, mean age at discharge rose by about 7 months. The odds of urgent admission rose (OR = 1.11 per year), as did the odds of dying (OR = 1.05 per year).
  • Silicosis: each year, mean age at discharge rose by 5 months. The odds of urgent admission rose (OR = 1.10 per year), as did the odds of dying (OR = 1.04 per year).
  • Silicosis: hospital stay per admission, cost per admission and surgery were steady over time.
• The authors' conclusion: The author concluded that overall hospitalization costs were higher for silicosis than for asbestosis, and that over time hospitals treated fewer cases with greater severity. The author also concluded that the decreased use of hospital resources from 2001 to 2018 is associated with occupational health policies introduced from the 1990s to reduce asbestos and silica exposure. The author suggested that extending existing epidemiological surveillance systems to pneumoconioses would help control the social costs of these diseases.
• Limitations the authors state:
  • The data do not establish a causal relationship between the hospitalization trends and the health policy changes.
  • The records have no patient identifier, so the true number of individual patients cannot be determined. The author states this does not affect the cost estimates.

Topics

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

Medical terms in this study, explained in our Lexicon: Silicosis, Pneumoconiosis.

Related studies

• Mechanisms in the pathogenesis of asbestosis and silicosis — B.T. Mossman, A. Churg (1998)
• Asbestosis and silicosis — G.R. Wagner (1997)
• Current concepts about the pathogenesis of silicosis and asbestosis — R.D. deShazo (1982)
• Serum oncoproteins and growth factors in asbestosis and silicosis patients — P.W. Brandt-Rauf, S. Smith, et al. (1992)
• Cancer incidence and mortality among Finnish asbestos sprayers and in asbestosis and silicosis patients — P. Oksa, E. Pukkala, et al. (1997)
• Serum concentrations of Krebs von den Lungen-6, surfactant protein D, and matrix metalloproteinase-2 as diagnostic biomarkers in patients with asbestosis and silicosis: a case-control study — C. Xue, N. Wu, et al. (2017)

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