Evaluation of the national health surveillance program of workers previously exposed to asbestos in Spain (2008)

Our plain-English summary of Evaluation of the national health surveillance program of workers previously exposed to asbestos in Spain (2008), by M.G. Gómez, R. Castañeda, V.G. López, et al (Gaceta Sanitaria, 2012).

The study

• Authors: M.G. Gómez, R. Castañeda, V.G. López, M.M. Vidal, V. Villanueva, M.E. Espinosa, Working Group on Occupational Health of the CISNS+ Commission on Public Health
• Journal: Gaceta Sanitaria
• Published: 2012;26(1):45-50
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: Although asbestos was banned in Spain in 2001, monitoring the health of previously-exposed workers is required. In 2002 the Ministry of Health and the autonomous regions of Spain planned a health surveillance program for workers exposed to asbestos (Programa de Vigilancia de la Salud de los Trabajadores Expuestos al Amianto [PIVISTEA]) with employers' organizations, trade unions and scientific societies. The aim of this study was to evaluate the PIVISTEA to improve its effectiveness.

Methods: A questionnaire with indicators for the year 2008 was sent to Spain's 17 autonomous regions, as well as to the autonomous cities of Ceuta and Melilla. The results were analyzed by evaluating the compliance of each program with the activities established by the PIVISTEA.

Results: In December 2008, a total of 22,158 workers from 14 autonomous regions and 306 companies were included in the program. The program had been started in 88% of the regions but surveillance activities remained scarce in 24%. Fifty-seven percent of the autonomous regions (69% of the total number of workers) provided the information requested. Seven autonomous regions provided data on the relationship between the diseases found and asbestos exposure. Only 5% of these diseases entitled affected individuals to receive compensation for occupational diseases.

Conclusions: The health surveillance of workers previously exposed to asbestos in Spain, as well as medical-legal recognition of diseases caused by exposure at work, remain in adequate. Although the trend is positive, the effectiveness of many regional programs is limited, and inter-regional inequalities among affected workers have been detected.

Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

In plain English

This study evaluated Spain's health surveillance program for workers previously exposed to asbestos (PIVISTEA), which was planned in 2002. In early 2009 the authors sent a questionnaire to Spain's 17 autonomous regions and the autonomous cities of Ceuta and Melilla. It asked for 2008 data, and the authors checked each regional program against the activities PIVISTEA sets out. In December 2008, 22,158 workers from 14 regions and 306 companies were in the program. Half were inactive (retired or unemployed) and 45.7% were active. The article reports that Ceuta and 15 regions (88%) had started the program, but four regions (24%) had carried out only a few activities. Eight regions reported coverage, meaning the share of workers examined for the first time. It ranged from 5.65% in Catalonia to 96% in Valencia, with an average of 58.6%. Only Asturias and Navarre reported the share of diseases recognized as occupational: 3.7% and 6%. The authors concluded that surveillance and medical-legal recognition were not yet adequate, with inequalities between regions. They noted that the regions supplied the data themselves and that questionnaires were not always complete.

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: Program evaluation based on a questionnaire of indicators sent to regional health authorities (descriptive analysis)
• Who was studied: Regional asbestos health surveillance programs in Spain's 17 autonomous regions and the autonomous cities of Ceuta and Melilla. Questionnaires were sent in early 2009 asking for 2008 data. By December 2008, 22,158 workers from 14 regions and 306 companies were enrolled.
• Exposure: Past occupational exposure to asbestos. Workers were grouped as exposed (removal work) or post-exposed (active or inactive). No fiber types or doses were reported.
• Main results:
  • Of the 19 regions and cities sent the questionnaire, 95% responded, with delays of between 11 days and 8 months.
  • Ceuta and 15 (88%) of the autonomous regions had started the program.
  • Four (24%) autonomous regions had implemented only a few activities.
  • In December 2008, 22,158 workers from 14 autonomous regions and 306 companies were included in the program.
  • Of the enrolled workers, half were inactive (retired and unemployed) and 45.7% were active. The rest were lost to follow-up.
  • Among the eight regions that reported process data, coverage (workers examined for the first time as a share of all workers) ranged from 5.65% in Catalonia to 96% in Valencia, with an average of 58.6%.
  • Only La Rioja and Valencia reported the delay between registration and medical examination: 150 and 120 days respectively.
  • In the regions that reported staffing, those involved were 64 health professionals from health departments, 53 from public health services (34 pneumologists and 19 radiologists), and 34 from the occupational risk prevention system.
  • Only Asturias and Navarre reported the share of diseases classified as occupational, which entitles workers to compensation: 3.7% in Asturias and 6% in Navarre.
  • Diseases the article lists as asbestos-related, diagnosed in 2008 (data from eight regions): 54 asbestosis, 159 pleural plaques, 3 pleural effusion, 21 COPD, 10 pleural mesothelioma, 3 peritoneal mesothelioma, 6 lung cancer, 1 laryngeal cancer, 6 other cancers.
  • Diseases the article lists as asbestos-related, diagnosed from 2004 to 2008 (same eight regions): 405 asbestosis, 423 pleural plaques, 7 pleural effusion, 127 COPD, 31 pleural mesothelioma, 9 peritoneal mesothelioma, 48 lung cancer, 3 laryngeal cancer, 37 other cancers.
  • The main source for the registry was the Enterprises with Asbestos Risk Registry (RERA), which supplied 61.2% of companies and 67.5% of workers.
• The authors' conclusion: The authors concluded that health surveillance of workers previously exposed to asbestos, and medical-legal recognition of diseases caused by exposure at work, were not yet adequate in Spain. In their view the trend was positive, but many regional programs had limited effectiveness, and inequalities between regions were detected.
• Limitations the authors state:
  • The validity of the data is limited because the autonomous regions supplied it themselves.
  • Some information was hard to obtain because there was no staff specifically dedicated to the program.
  • Questionnaires were not always fully completed, and collecting them took 8 months.
  • No similar published studies were found to compare the results with other countries.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Occupational Disease.

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