Mesothelioma incidence surveillance systems and claims for workers' compensation. Epidemiological evidence and prospects for an integrated framework

Our plain-English summary of Mesothelioma incidence surveillance systems and claims for workers' compensation. Epidemiological evidence and prospects for an integrated framework, by A. Marinaccio, A. Scarselli, E. Merler, et al (BMC Public Health, 2012).

The study

• Authors: A. Marinaccio, A. Scarselli, E. Merler, S. Iavicoli
• Journal: BMC Public Health
• Published: 2012;12:314
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large proportion of workers are protected from occupational diseases by public insurance and an epidemiological surveillance system for incident mesothelioma cases.

Methods: We set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers' compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables.

Results: We extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and the elderly. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos.

Conclusions: Our data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed.

In plain English

This Italian study linked the national mesothelioma register (ReNaM) with records of the national workers' compensation authority (INAIL) to see how many people with work-related mesothelioma had claimed compensation. The authors took 3,270 cases diagnosed in 2000 to 2004, from regions covering 77.7% of Italy's population, whose asbestos exposure at work was classed as definite, probable or possible. Of these, 1,625 (49.7%) had filed a claim, and 91.2% (1,482) of those claims were compensated. After adjustment, the odds of not claiming were higher for women than men (odds ratio 1.734, 95% CI 1.347 to 2.231), for residents of the South and Islands than the North-East (5.011, 95% CI 3.701 to 6.785), and for construction workers than people who used asbestos directly (1.857, 95% CI 1.423 to 2.423). Claim rates were 70.2% in port handling and 62.6% in shipbuilding and repair, but 26.7% in education and 8.6% in agriculture. The authors called for notification systems so that everyone newly diagnosed seeks compensation. They noted large gaps between regions in how the register works.

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: Record-linkage study matching cases in the Italian national mesothelioma register (ReNaM) with workers' compensation claims held by INAIL, analysed with logistic regression
• Who was studied: 3,270 malignant mesothelioma cases (pleural, peritoneal or pericardial) with occupational asbestos exposure, diagnosed 2000 to 2004 in 13 Italian regions covering 77.7% of the population (2,836 men, 434 women), matched against INAIL mesothelioma claims registered 2000 to 2007
• Exposure: Occupational asbestos exposure assessed by questionnaire and classed as definite, probable or possible. Cases were grouped into direct use of asbestos, indirect use for insulation and auxiliary tools, the construction sector, and atypical exposures. No fiber types are reported.
• Main results:
  • Of 3,270 cases, 1,625 (49.7%) had filed a compensation claim with INAIL, and 91.2% (1,482) of these claims were compensated.
  • Women claimed less often than men: 144 of 434 women (33.18%) versus 1,481 of 2,836 men (52.22%). The adjusted odds of not claiming, which the authors call relative risk, was 1.734 (95% CI 1.347 to 2.231) for women versus men. For age 75 and over, 37.06% claimed and the odds ratio of not claiming was 3.124 compared with under 45.
  • Only 25.66% of cases in the South and Islands claimed, versus 62.43% in the North-East. The adjusted odds ratio of not claiming was 5.011 (95% CI 3.701 to 6.785) for the South and Islands and 1.753 (1.441 to 2.134) for the North-West, both compared with the North-East.
  • Construction workers had a higher adjusted odds of not seeking compensation than people who used asbestos directly at work. The text gives this as 1.9 (95% CI 1.4 to 2.4), and Table 2 gives 1.857 (95% CI 1.423 to 2.423). Only 44.4% of construction-sector cases claimed.
  • Claim proportions by sector were 73% for railway rolling stock maintenance and repair, 70.2% for port handling, 62.6% for shipbuilding and repair, and 61.9% for the asbestos-cement industry.
  • The lowest claim proportions were in health and social services (32.3%), education (26.7%) and agriculture (8.6%).
  • The proportion of cases filing claims rose from 43.5% for those diagnosed in 2000 to 54.2% for those diagnosed in 2004.
  • Claim proportions did not differ significantly between pleural cases (49.84%, 1,544 of 3,098) and peritoneal cases (48.15%, 78 of 162). Pericardial cases were too few to draw conclusions.
• The authors' conclusion: The authors concluded that a substantial number of people who deserve compensation do not seek it. They said regulatory and public health agencies need effective notification systems to ensure that all people newly diagnosed with mesothelioma seek compensation.
• Limitations the authors state:
  • The register has not developed uniformly across Italy, and regions differ in how they assess asbestos exposure. Large gaps remain between regions despite national guidelines.
  • The study looked only at incident cases, not incidence rates. The reference populations of the register and the insurance system are not the same.

Topics

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

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

Related studies

• Surveillance of mesothelioma and workers' compensation in British Columbia, Canada — T.L. Kirkham, M.W. Koehoorn, et al. (2011)
• Compensation of pleural mesothelioma in France: data from the French National Mesothelioma Surveillance Programme — S. Chamming's, B. Clin, et al. (2013)
• Asbestos, asbestos-related diseases, and compensation claims in The Netherlands — P. Swuste, A. Burdorf, et al. (2004)
• Epidemiological surveillance of mesothelioma mortality in Italy — L. Fazzo, G. Minelli, et al. (2018)
• Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues — A. Marinaccio, A. Binazzi, et al. (2015)
• Italian National Register of Occupational Cancers: data system and findings — A. Scarselli, S. Massari, et al. (2010)

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