Prevalence of Asbestos-Related Disease Among Workers in Sri Lanka

Our plain-English summary of Prevalence of Asbestos-Related Disease Among Workers in Sri Lanka, by B.A. Wickramatillake, M.A. Fernando, A.L. Frank (Annals of Global Health, 2019).

The study

• Authors: B.A. Wickramatillake, M.A. Fernando, A.L. Frank
• Journal: Annals of Global Health
• Published: 2019;85(1)
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestos products are manufactured and used in Sri Lanka in the construction and automobile industries.

Objective: To determine radiologically if exposure to asbestos caused lung disease among workers handling asbestos products, and to generate data in Sri Lanka where no such data exist due to poor reporting and a poor surveillance system.

Methods: Following ethics approval and written consent plain chest X-rays and exposure data were obtained in 230 workers in asbestos manufacturing, building construction, building demolition, tsunami debris cleanup, and other trades. The assumption was that all exposed workers were exposed to chrysotile. Participants were from provinces with asbestos factories, and where tsunami cleanup had occurred.

Findings And Conclusions: Radiological findings of the 230 participants showed lung fibrosis in 7% (16 cases), and other non-asbestos-related lung conditions. Of the 16 fibrosis cases, none were in manufacturing workers, one in a construction worker, six in tsunami workers, six in demolition workers, and three cases in others. Globally, Sri Lanka has one of the highest consumptions of chrysotile asbestos per capita. This first known study documenting asbestos disease in Sri Lanka is clearly a limited, self-selected group of workers studied with obvious limitations. The prevalence of asbestos-related lung disease among tsunami and demolition worker indicates that a risk exists for asbestos material already in use in Sri Lanka. Hence a significant concern is the safety of asbestos demolition workers and cleanup workers exposed to asbestos debris from major natural disasters such as hurricanes, tornados, typhoons, and tsunamis.

© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

In plain English

This descriptive study screened 230 self-selected workers who had worked with asbestos in five of Sri Lanka's nine provinces. It used plain chest X-rays and questionnaires on age, sex, smoking, work and exposure history. Participants came from asbestos manufacturing plants, building construction, building demolition, cleanup of debris from the 2004 tsunami, and other trades such as brake-pad work and dockyards. No workplace measurements were taken. The authors stated that most, if not all, of the asbestos would have been chrysotile. Two radiologists read the X-rays independently using the 1980 International Labour Organization classification. Of the 230 workers, 16 (7%) showed lung fibrosis consistent with prior asbestos exposure: 1 of 149 construction workers, 6 of 8 tsunami debris workers, 6 of 12 demolition workers and 3 workers in other industries. None were manufacturing workers. Thirteen of the 16 had been exposed at work for more than 10 years. The authors concluded that the findings in tsunami and demolition workers indicate a risk from asbestos already in use in Sri Lanka. They described their group as limited and self-selected.

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: Descriptive study: one-time chest X-ray screening of self-selected asbestos-exposed workers, with questionnaires
• Who was studied: 230 workers (207 males with mean age 39.7 years, and 23 females with mean age 46.5 years) from five of Sri Lanka's nine provinces: Western, North Western, Central, Eastern and Southern. Groups were asbestos manufacturing workers, building construction workers, building demolition workers (including tsunami debris clearing workers), and past and present workers in other asbestos-related occupations. 47% of males were active or ex-smokers; no females smoked. The dates of the study are not given.
• Exposure: Work exposure to asbestos products in manufacturing, building construction, demolition, 2004 tsunami debris cleanup, and other trades (decorative molding, vehicle brake pads, dockyards). No workplace measurements or fiber-type assessment were made; the authors assumed the asbestos was mostly, if not all, chrysotile.
• Main results:
  • 16 of the 230 participants (7%) showed lung fibrosis consistent with prior asbestos exposure.
  • Fibrosis was found in 1 of 149 construction workers, 6 of 8 tsunami debris clearing workers, 6 of 12 demolition workers, and 3 workers in other industries. These add up to all 16 cases, so none were among manufacturing workers, as the article's own abstract also states.
  • 13 of the 16 people with fibrosis had been exposed to asbestos at work for more than 10 years. Of the 16, 4 were smokers and 1 was female.
  • 27 participants had chest X-ray findings other than lung fibrosis: 15 cardiomegaly (enlarged heart), 5 lung nodules, 2 bronchiectasis, and 5 other conditions such as emphysema.
• The authors' conclusion: The authors concluded that the asbestos-related lung disease found among tsunami and demolition workers indicates that a risk exists from asbestos material already in use in Sri Lanka. They raised concern for demolition workers and for cleanup workers exposed to asbestos debris after major natural disasters.
• Limitations the authors state:
  • The authors described the participants as a limited, self-selected group of workers and said the study has obvious limitations.
  • No workplace measurements were taken and fiber type was not assessed.
  • Tsunami debris workers may not yet show X-ray changes because little time had passed since their exposure.
  • North and North Central provinces were left out for logistics and security reasons; UVA and Sabaragamuwa provinces were left out because they had little construction and demolition work.

Topics

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Chrysotile, Fibrosis.

Related studies

• Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2016 — G.H. West, R.K. Sokas, et al. (2019)
• The prevalence of pleural plaques and/or pulmonary changes among construction workers in Okayama, Japan — T. Kishimoto, K. Morinaga, et al. (2000)
• Prevalence of asbestos related lung disease among employees in non-asbestos industries — I. Young, S. West, et al. (1981)
• Asbestos-related disease among sheet-metal workers. Preliminary results of the National Sheet Metal Worker Asbestos Disease Screening Program — L.S. Welch, D. Michaels, et al. (1991)
• Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships — G. Mastrangelo, M.N. Ballarin, et al. (2009)
• Radiographic Changes in Colombian Asbestos Factory Workers — A.L. Frank, G. Villamizar, et al. (2020)

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