Inequities in occupational diseases recognition in France

Our plain-English summary of Inequities in occupational diseases recognition in France, by J.F. Gehanno, S. Letalon, A. Gislard, et al (Revue D'épidémiologie et de Santé Publique, 2019).

The study

• Authors: J.F. Gehanno, S. Letalon, A. Gislard, L. Rollin
• Journal: Revue D'épidémiologie et de Santé Publique
• Published: 2019;67(4):247-252
• Read it: PubMed · Publisher

Abstract

Background: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases.

Methods: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD.

Results: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases.

Conclusion: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.

Copyright © 2019. Published by Elsevier Masson SAS.

In plain English

This French study tested whether the 18 regional committees deciding complex occupational disease claims reach the same decisions on identical cases. Three occupational physicians wrote 28 short case descriptions typical of real claims. In March 2017 these went to all 18 committees, asking whether each case would be recognised as an occupational disease. All committees took part. Acceptance rates ranged from 18% in Auvergne to 70% in Britany. Of 504 committee assessments, 434 produced a decision; in 70 (13.9%) committees said they lacked enough information. Among committees giving a decision, there was unanimous agreement on only 7 of the 28 cases. For 3 cases, half of the committees giving a decision accepted and half refused. Two of these were asbestos cases: pleural plaques in an electrician exposed 2 years instead of the required 5, and lung cancer in a non-smoking bricklayer exposed 6 years instead of 10. Disagreement was highest for musculoskeletal and asbestos-related cases. The authors concluded that the regional system does not ensure consistent decisions, and they called for harmonisation. They noted the case descriptions were brief and there was no gold standard for the correct decision.

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: survey of regional compensation committees using standardized case vignettes
• Who was studied: all 18 French regional occupational disease recognition committees (CRRMP): 16 in metropolitan France plus La Martinique and La Reunion; vignettes sent March 2017, answers due May 2017
• Exposure: 28 vignettes covering exposures including asbestos (5 cases: pleural plaque, pleural mesothelioma, three lung cancers; fiber type not specified), noise, manual handling, whole-body vibrations, pesticides and PAH. Each vignette fell outside the official tables on one criterion (job, exposure duration, latent period) or involved a disease not in the tables
• Main results:
  • Acceptance rates varied across committees, from 18% (Auvergne) to 70% (Britany)
  • Of the 504 committee assessments of cases (28 cases by 18 committees), a decision was taken in 434 (86.1%)
  • In the other 70 assessments (13.9%), committees considered there was not enough information to decide
  • Among committees that gave a decision, there was unanimous agreement on 7 of the 28 cases
  • For 3 cases (cases 1, 3 and 7), half of the committees giving a decision accepted and half refused (concordance index 0). For case 3, 8 committees gave no answer; for cases 7 and 19, 6 committees gave no answer
  • For asbestos-related cases, discrepancies were highest. Case 1 (pleural plaque, electrician, 2 years of exposure instead of 5) and case 3 (lung cancer, non-smoking bricklayer, 6 years instead of 10) each had a 50% acceptance rate and a concordance index of 0
  • Other asbestos cases: pleural mesothelioma (latent period 46 years instead of 40) and lung cancer after changing cylinder heads and exhaust pipes (7 years instead of 10) were each accepted at 100%. Lung cancer in a truck mechanic (3 years instead of 10) was accepted at 69%, with a concordance index of 0.38
  • For the 5 work-related upper limb disorder cases, the mean concordance index was 0.5
• The authors' conclusion: The authors concluded that a regional system relying on different people does not ensure homogeneity in recognition and compensation, and that harmonisation is urgently needed
• Limitations the authors state:
  • The case descriptions in the vignettes were short, and in 70 situations committees declined to answer for lack of information
  • Decisions could not be compared with a gold standard of whether each case was truly work-related

Topics

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

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