Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales

Our plain-English summary of Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales, by K. Hannaford-Turner, D. Elder, M.R. Sim, et al (Occupational Medicine, 2010).

The study

• Authors: K. Hannaford-Turner, D. Elder, M.R. Sim, M.J. Abramson, A.R. Johnson, D.H. Yates
• Journal: Occupational Medicine
• Published: 2010;60(5):376-82
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The Surveillance of Australian workplace Based Respiratory Events (SABRE) New South Wales (NSW) scheme is a voluntary notification scheme established to determine the incidence of occupational lung diseases in NSW Australia.

Aims: Data presented in this paper summarize the last 7 years of reporting to SABRE (June 2001 to December 2008).

Methods: Every 2 months, participating occupational physicians, respiratory physicians and general practitioners (accredited by the NSW WorkCover Authority) reported new cases of occupational lung disease seen in their practices. Data collected include gender, age, causal agent and the occupations and industries believed responsible. Estimated incidence was calculated for each disease.

Results: Three thousand six hundred and fifty-four cases were notified to the scheme, consisting of 3856 diagnoses. Most of the cases were males (76%). Pleural plaques [1218 (28%)] were the most frequently reported condition, followed by mesothelioma [919 (24%)]. Silicosis [90 (2%)] and occupational asthma [OA; 89 (2%)] were the most frequently reported non-asbestos-related diseases. Estimated rates for mesothelioma, diffuse pleural thickening (DPT) and OA were 83, 83 and 5 cases per million employed males per year, respectively. Trades such as carpenters and electricians associated with the building industry, electricity supply and asbestos product manufacture were the most common occupations and industries reported.

Conclusions: Asbestos-related diseases are the most frequently reported conditions to SABRE NSW. The very low incidence of OA for NSW most likely reflects under-diagnosis as well as under-reporting. Occupational lung disease is still occurring in NSW despite current preventative strategies. The SABRE scheme currently provides the only available information in this area.

In plain English

This paper reported 7.5 years (June 2001 to December 2008) of SABRE NSW, a voluntary scheme in New South Wales, Australia. Respiratory physicians, occupational physicians and general practitioners reported new cases of work-related lung disease every two months. Of 464 doctors invited, 157 took part (response rate 34%). They notified 3654 patients with 3856 diagnoses. Of cases with gender recorded, 95% were men, and mean age at diagnosis was 70. Asbestos-related disorders made up 3584 (93%) of diagnoses, including pleural plaques (1218), mesothelioma (919), diffuse pleural thickening (839) and asbestosis (366). Of 207 lung cancers, 196 were reported as asbestos-related. Estimated rates were 83 cases per million employed males per year for mesothelioma, 83 for diffuse pleural thickening and 5 for occupational asthma. Reported asbestos-exposed jobs included carpenters, electricians and plumbers. The authors concluded that asbestos-related diseases were the most frequently reported conditions. They also concluded that the very low occupational asthma rate most likely reflected under-diagnosis as well as under-reporting. They noted their low response rate as a limitation.

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: Voluntary physician-based surveillance (notification) scheme for occupational lung disease; descriptive summary of notifications with estimated incidence rates
• Who was studied: Patients with occupational lung disease notified by 157 participating doctors (66 respiratory physicians, 66 occupational physicians, 25 GPs; 34% of 464 invited) in New South Wales, Australia, June 2001 to December 2008. Notifications covered 3654 patient cases with 3856 diagnoses. Of cases with gender recorded, 3352 (95%) were male. Mean age at diagnosis was 70 (SD 11) years.
• Exposure: Occupational exposures as reported by doctors, mainly asbestos (fiber type not specified in the study data), plus silica and occupational asthma agents. The most frequently reported asbestos-exposed occupations were carpenters, maintenance fitters and turners, electricians, plumbers, pipe laggers, waterside workers and construction workers. The associated industries were the building industry, asbestos product manufacture, electricity supply and shipbuilding.
• Main results:
  • Asbestos-related disorders accounted for 3584 (93%) of the 3856 diagnoses notified. These included pleural plaques, diffuse pleural thickening, asbestosis and mesothelioma.
  • Table 1 gives the counts by diagnosis (all diagnoses): pleural plaques 1218 (32%), mesothelioma 919 (24%), diffuse pleural thickening 839 (22%), asbestosis 366 (10%), lung cancer 207 (5%), silicosis 90 (2%), occupational asthma 89 (2%).
  • Estimated average annual incidence was 83 per million employed males for mesothelioma, 83 for diffuse pleural thickening and 5 for occupational asthma. Table 1 also gives 110 for pleural plaques, 36 for asbestosis, 20 for lung cancer and 9 for silicosis.
  • Of the 207 lung cancers notified, 196 (95%) were reported as asbestos-related.
  • Among women, the commonest notification was mesothelioma: 78 cases, or 9% of total mesothelioma cases.
  • Of the 89 occupational asthma cases, 42 were asthma due to sensitization, 40 were RADS (asthma due to irritation) and 7 were unspecified.
  • Doctors rated their diagnosis as 'highly likely' for 3379 (94%) cases.
• The authors' conclusion: The authors concluded that asbestos-related diseases were the most frequently reported conditions to SABRE NSW. They concluded that the very low incidence of occupational asthma most likely reflected under-diagnosis as well as under-reporting. They also concluded that occupational lung disease was still occurring in NSW despite current preventive strategies.
• Limitations the authors state:
  • The response rate among invited doctors (34%) was low.
  • Under-reporting resulting from the low response rate affects the validity of the estimated incidence rates. The authors considered under-reporting of occupational asthma likely to be real.
  • Under-reporting probably occurred more in regional than in metropolitan areas, since most cases were reported from Sydney.
  • High public awareness of asbestos hazards, media interest and the inquiry into James Hardie were likely to have affected diagnosis and reporting patterns.
  • A significant proportion of the denominator population had likely been exposed to asbestos.
  • Reporting and diagnostic biases in NSW are hard to separate from true differences in incidence, so comparisons of incidence rates between schemes should be made with caution.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, Pleural Plaques, Mesothelioma, Silicosis, Diffuse Pleural Thickening.

Related studies

• Surveillance of Australian workplace Based Respiratory Events (SABRE): notifications for the first 3.5 years and validation of occupational asthma cases — D. Elder, M. Abramson, et al. (2004)
• Patterns in the incidence, mortality and survival of malignant pleural and peritoneal mesothelioma, New South Wales, 1972-2009 — M.J. Soeberg, N. Creighton, et al. (2016)
• Asbestos exposure during home renovation in New South Wales — E.K. Park, D.H. Yates, et al. (2013)
• Occupational exposure to asbestos in New South Wales, Australia (1970-1989): development of an asbestos task exposure matrix — R.A. Hyland, D.H. Yates, et al. (2010)
• Projected mesothelioma incidence in men in New South Wales — M. Clements, G. Berry, et al. (2007)
• Industrial hygiene and occupational health studies in Australian (New South Wales) shipyards — A. Bell (1976)

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