Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P)

Our plain-English summary of Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P), by V. Bonneterre, L. Faisandier, D. Bicout, et al (Occupational and Environmental Medicine, 2010).

The study

• Authors: V. Bonneterre, L. Faisandier, D. Bicout, C. Bernardet, J. Piollat, J. Ameille, C. de Clavière, M. Aptel, G. Lasfargues, R. de Gaudemaris, RNV3P
• Journal: Occupational and Environmental Medicine
• Published: 2010;67(3):178-86
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The French national occupational disease surveillance and prevention network (RNV3P) includes the 30 occupational disease consultation centres in university hospitals to which patients are referred for potentially work-related diseases, and an occupational health service. The aim of this work is to demonstrate the contribution of RNV3P to national health surveillance.

Methods: Data from consultations are recorded in standardised occupational health reports and coded using international or national classifications. Programmed health surveillance is carried out through annual follow-up of annual referrals to experts for pre-selected disease-exposure associations, as well as incidence estimations for the well characterised working population followed by the occupational health service. Hypotheses on new emerging diseases are generated using statistical methods employed in pharmacosurveillance and by modelling as an exposome to analyse multiple exposures.

Results: 58,777 occupational health reports were collected and analysed from 2001 to 2007. Referrals to the 30 university hospital centres increased significantly for asbestos-related diseases, mood disorders and adjustment disorders related to psychological and organisational demands, and for elbow and shoulder disorders related to manual handling. Referrals significantly decreased for asthma and for rhinitis related to exposure to organic dusts (vegetable or animal) or chemicals, except for cosmetics and cleaning products. Estimation of incidences by the occupational health services showed different patterns in different sectors of activity. The methods for detecting emerging diseases are presented and illustrated using the example of systemic sclerosis, identifying new exposures and new sectors of activity to be investigated.

Conclusion: The RNV3P collects data from two complementary samples: 30 university hospital centres (workers or former workers) and an occupational health service (current workers). This dual approach is useful for surveillance and for hypothesis generation on new emerging disease-exposure associations.

In plain English

This methodology paper described how France's occupational disease surveillance network (RNV3P) works. It drew on 58,777 reports from 2001 to 2007 at occupational disease centres in France's 30 university hospitals, plus 907 reports from 2004 to 2007 from a Grenoble-area occupational health service. Among 40,819 work-related reports from 2002 to 2007, the authors followed 20 preselected disease–exposure pairs yearly. Referrals for respiratory tract cancer linked to "asbestos and other inorganic substances" rose from 229 in 2002 to 549 in 2007. The authors attributed the 2006–2007 lung cancer rise mainly to a clinical research program in five centres. Mesothelioma referrals linked to the same category went from 63 to 94 (trend p value 0.06). Pleural plaque referrals linked to it were 865 in 2002 and 804 in 2007, peaking at 1109 in 2004. Asthma and rhinitis referrals linked to organic dusts, and to chemicals other than cleaning products and cosmetics, fell significantly. The authors stated that the population these hospital patients come from is not characterised enough for conventional epidemiological indicators. They concluded the approach is useful for surveillance and hypothesis generation.

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: Methodology paper describing a national surveillance network and analysing its database of occupational health reports (trend analysis of referrals, incidence estimates, and statistical signal detection)
• Who was studied: Patients referred to occupational disease consultation centres at France's 30 university hospitals: 58,777 reports from 1 January 2001 to 31 December 2007. The trend analysis used 40,819 work-related reports from 2002 to 2007. Separately, eight sentinel physicians in a Grenoble-area occupational health service followed 10,725 to 12,781 employees from 2004 to 2007 and collected 907 reports.
• Exposure: Many occupational exposures in 20 preselected disease–exposure pairs. The asbestos-related category is "Asbestos and other inorganic substances", linked to respiratory tract cancers, mesothelioma and pleural plaque. No fiber types are specified.
• Main results:
  • Primary malignant neoplasms of the respiratory tract (C34–C39) attributed to asbestos and other inorganic substances, 30 university hospital centres: 229 (2002), 289 (2003), 289 (2004), 299 (2005), 453 (2006), 549 (2007). Trend p value printed as 0.00.
  • Mesothelioma (C45) attributed to asbestos and other inorganic substances, 30 university hospital centres: 63 (2002), 68, 87, 76, 99, 94 (2007). Trend p value 0.06.
  • Pleural plaque (J92) attributed to asbestos and other inorganic substances, 30 university hospital centres: 865 (2002), 801, 1109, 1004, 985, 804 (2007). Trend p value printed as 0.00.
  • In the authors' text, the main significant increase in referrals was for adjustment disorders attributed to mental exposures and organisational stress (about 2.3% per year). Next came primary lung cancer attributed to asbestos, then shoulder and elbow musculoskeletal disorders related to manual handling.
  • Referrals for asthma and rhinitis showed a significant annual decrease when linked to organic dusts (vegetable or animal) or to chemical products other than cleaning products and cosmetics.
  • In the Grenoble occupational health service, the incidence of mental and behavioural disorders rose to 6.8 per 1000 employees in 2007. The text gives the 2004 starting figure as 2.5 per 1000, while Table 4 shows 2.7.
• The authors' conclusion: The authors concluded that combining data from the 30 university hospital centres (workers or former workers) with an occupational health service (current workers) is useful for surveillance and for generating hypotheses about new emerging disease–exposure associations.
• Limitations the authors state:
  • The population the hospital-centre patients come from is not characterised well enough to allow conventional epidemiological indicators.
  • The increase in lung cancer referrals in 2006 and 2007 was mainly due to a clinical research program run by five centres, which changed recruitment.
  • Physicians refer only patients with specific occupational exposures, not all patients with a given disease.
  • Greater social concern about some diseases may explain part of the observed trends.
  • Catchment areas are mainly urban, and agricultural workers are under-represented.
  • Exhaustive collection of reports is a recurring problem for any declaration system.
  • Signals from the automated detection methods are hypotheses only and need expert investigation.

Topics

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

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