Respiratory Diseases with High Occupational Fraction in Italy: Results from the Italian Hospital Discharge Registry (2010-2021)

Our plain-English summary of Respiratory Diseases with High Occupational Fraction in Italy: Results from the Italian Hospital Discharge Registry (2010-2021), by P. Ferrante (Healthcare, 2024).

The study

• Author: P. Ferrante
• Journal: Healthcare
• Published: 2024;12(24)
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Occupational respiratory diseases represent a major public health concern worldwide. This study analyses the hospitalization costs and characteristics of four major occupational respiratory diseases: malignant mesothelioma (MM), sinonasal cancer (SNC), pneumoconiosis (PN), and hypersensitivity pneumonitis (HP). The findings are situated within the context of Italy's population trends and healthcare system, offering insights into the economic and clinical burden of these diseases.

Study Design: This retrospective, population-based study examines Italian hospitalizations for MM, SNC, PN, and HP during the period 2010-2021. The primary outcomes were the number of hospitalizations, length of stay, and associated cost. Costs were derived from charges linked to diagnosis-related groups (version 24) and major diagnostic category coding systems.

Results: Though the Italian population is rapidly aging, the annual number and rate of hospitalizations declined by 35% over the study period. SNC hospitalizations aligned with the overall trend, PN and MM experienced faster declines, whereas HP admissions remained steady. MM emerged as the most resource-intensive (EUR 25 million yearly, with 86% attributable to occupation), followed by PN (EUR 10 million, entirely occupational), SNC (EUR 5 million, with EUR 650,000 occupational), and HP (EUR 2 million, with EUR 370,000 occupational). All studied diseases had an average length of stay exceeding the national one. The SNC admissions were the shortest (6.5 days) and least expensive (EUR 3647). In contrast, MM, PN, and HP had a mean length of stay exceeding 10 days, with admission costs averaging EUR 4700 for MM and EUR 4000 for PN and HP. The median age was the highest for PN (78 years) and MM (71 years), while SNC and HP patients had a median age of approximately 65 years.

Conclusions: Consistent with their anticipated benefits, Italian workplace health regulations over the last three decades, including the 1992 asbestos ban and D.lgs. 81/2008, are associated with significant reductions in the hospitalization burden and an increased median age at discharge for MM and PN. In contrast, fewer conclusions can be drawn for SNC and HP due to their lower occupational fractions (10-20%). This finding suggests adding an occupational exposure flag in hospital records for acknowledged occupational diseases to enhance surveillance. Finally, this study provides the first estimate of the occupational fraction of hospitalization costs for the studied diseases in Italy.

In plain English

This study used Italy's national hospital discharge records from 2010 to 2021 to count hospital stays and estimate their costs for four occupational respiratory diseases: malignant mesothelioma, pneumoconiosis, sinonasal cancer and hypersensitivity pneumonitis. No one's exposure was measured. The work-related share was estimated by applying attributable fractions taken from earlier studies. There were on average 5252 mesothelioma admissions a year, costing EUR 24,807,495. Of these, 4548 admissions and EUR 21,483,292 were attributed to occupational exposure. Yearly mesothelioma admissions fell from 6329 to 3908. Mesothelioma patients had a median age of 71.0 years, and 71.1% were male. Pneumoconiosis averaged 2392 admissions a year, all counted as work-related, and fell from 3963 to 994. The author concluded that these declines were associated with past workplace measures, including the 1992 asbestos ban, and were consistent with those measures' expected benefits, though other factors may also have played a role. The author noted that the coding system had no specific code for mesothelioma, so mesothelioma counts had to be estimated. Costs may also be overestimated.

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: Retrospective analysis of national hospital discharge data, estimating hospitalization numbers, length of stay and costs
• Who was studied: All hospitalization episodes in Italy from 2010 to 2021 with a primary or secondary diagnosis of hypersensitivity pneumonitis, pneumoconiosis, malignant mesothelioma or sinonasal cancer, from aggregated Ministry of Health registry data
• Exposure: No individual exposure was measured. The share of each disease due to occupational exposure was estimated using attributable fractions from other sources. The methods state 86.6% for mesothelioma, 18.1% for sinonasal cancer, 100% for pneumoconiosis and 11.8% for hypersensitivity pneumonitis; the tables show different labels (see text problems).
• Main results:
  • All four diseases combined: on average 9625 hospitalizations per year, 93,650 hospital days (9.7 per admission), and a mean annual cost of EUR 41.6 million
  • Malignant mesothelioma: on average 5252 admissions per year (87.6 per million residents), 52,772 hospital days and EUR 24,807,495 per year
  • Malignant mesothelioma: annual admissions fell from 6329 to 3908, and rates fell from 106.0 to 66.0 per million, over 2010 to 2021
  • Malignant mesothelioma: the part attributed to occupational exposure was 4548 admissions, 45,701 hospital days and EUR 21,483,292 per year on average
  • Malignant mesothelioma: cost per admission EUR 4723 and per day EUR 470
  • Malignant mesothelioma patients: 71.1% male, median age 71.0 years, 30.4% surgical hospitalizations
  • Pneumoconiosis: on average 2392 admissions per year (39.9 per million), 24,388 hospital days and EUR 9,333,045 per year
  • Pneumoconiosis: annual admissions fell from 3963 to 994, and rates fell from 66.4 to 16.8 per million
  • Pneumoconiosis: all admissions were counted as attributable to occupational exposure
  • Pneumoconiosis patients: 94.5% male, median age 77.9 years
  • Sinonasal cancer: on average 1508 admissions per year (25.1 per million)
  • Sinonasal cancer: the part attributed to occupational exposure was 178 admissions, 1360 hospital days and EUR 649,307 per year on average
  • Hypersensitivity pneumonitis: on average 473 admissions per year (7.9 per million)
  • Hypersensitivity pneumonitis: admissions and costs stayed stable until COVID-19
  • Hypersensitivity pneumonitis: on average 90 admissions per year were attributed to occupational exposure
• The authors' conclusion: The author concluded that past work-related interventions, including the 1992 asbestos ban, were associated with significant declines in the hospital burden and the highest median age at discharge for mesothelioma and pneumoconiosis during 2010 to 2021. The author judged this consistent with the expected benefits of policies to reduce occupational exposure, while noting that other factors may also have played a role.
• Limitations the authors state:
  • The ICD-9-CM coding system has no specific code for mesothelioma, so the share of mesothelioma among tumours by site had to be estimated using mortality data
  • Every patient with any of the studied diagnoses was included, so disease-specific costs may be overestimated

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pneumoconiosis, Pneumonitis, Occupational Exposure, Occupational Disease.

Related studies

• Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities — T. Tamura, N. Suganuma, et al. (2015)
• Non-occupational exposure to asbestos and malignant mesothelioma in the Italian National Registry of Mesotheliomas — D. Mirabelli, D. Cavone, et al. (2010)
• Attributable Fraction of Cancer Related to Occupational Exposure in Italy — G. Collatuzzo, F. Turati, et al. (2023)
• Estimation of Occupational Exposure to Asbestos in Italy by the Linkage of Mesothelioma Registry (ReNaM) and National Insurance Archives. Methodology and Results — C. Airoldi, D. Ferrante, et al. (2020)
• Hospital records as a data source for occupational disease surveillance: a feasibility study — J. Balmes, D. Rempel, et al. (1992)
• Hospital records: an underutilized source of information regarding occupational diseases and exposures — G.M. Liss, R.A. Kusiak, et al. (1997)

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