SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK

Our plain-English summary of SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK, by B.A. Sallie, D.J. Ross, S.K. Meredith, et al (Occupational Medicine, 1994).

The study

• Authors: B.A. Sallie, D.J. Ross, S.K. Meredith, J.C. McDonald
• Journal: Occupational Medicine
• Published: 1994;44(4):177-82
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Some 3500 new cases of occupational respiratory disease are estimated to have been seen annually by SWORD participants in 1992 and 1993 with little important difference between the two years. As the number of new cases recognized and reported by chest physicians is close to complete, the estimated incidence is essentially correct. The pattern of disease which clearly emerges shows that at least half is attributable to asbestos exposure, despite the fact that lung cancer from this cause may be under-reported. Benign pleural disease comprises a large proportion of the cases, the long-term implications of which are unknown. Almost 40% of the cases reported are of occupational asthma or inhalation accidents, both due to a very large number of different agents and affecting many and varied occupations. These cases are preventable providing their occupational aetiology is recognized and appropriate measures of control are intensified.

In plain English

This was the 1993 report of SWORD, a UK scheme in which chest and occupational physicians voluntarily reported respiratory disease they attributed to work. By the end of January 1994, SWORD had received 1443 cases first identified in 1993. Using its sampling method, the authors estimated 3269 cases for 1993 (standard error 155), against 3635 (standard error 164) for 1992. Diseases of long latency made up 52% of reported cases, asthma 27% and inhalation accidents 12%. Of the long-latency diseases, 93% were attributed to asbestos. In the occupational breakdown of long-latency disease, engineers and metalworkers made up at least 25% of each category. Twenty-five mesothelioma, 16 benign pleural disease and one pneumoconiosis case from domestic asbestos exposure were excluded from that breakdown. One reported case was a dentist who prepared fillings when some filling materials were said to contain crocidolite. The dentist died of pleural mesothelioma, with a high crocidolite lung burden at autopsy. The authors concluded that at least half the disease was attributable to asbestos and that asbestos lung cancer may be under-reported. They noted that voluntary reporting allows errors and bias.

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: National voluntary surveillance scheme (annual summary report of physician-reported cases, with estimated totals from a sampling system)
• Who was studied: New cases of work-related respiratory disease reported in 1993 by UK chest physicians and occupational physicians. Reporters were a core group of 32 chest physicians, about 300 chest physicians sampled in 12 monthly groups, 69 occupational physicians reporting monthly and 301 reporting less often.
• Exposure: Many workplace exposures. Asbestos (fiber type not specified for the series as a whole) was the agent behind most long-latency disease. Other exposures included silica, coal, metal or welding fumes, ionizing radiation and many asthma-causing agents. Crocidolite is named in one case report.
• Main results:
  • 1443 cases first identified in 1993 had been received by the end of January 1994.
  • Estimated total of new cases for 1993 using the sampling fraction: 3269 (standard error 155). The 1992 estimate was 3635 (standard error 164).
  • Diseases of long latency accounted for 52% of 1993 cases.
  • Asthma accounted for 27% of 1993 cases, inhalation accidents for 12% and the six other diagnostic groups for 8%.
  • 93% of all long-latency diseases were attributed to asbestos.
  • In the analysis of long-latency disease by occupation (Figure 3), engineers and metalworkers were the most affected group, at least 25% of cases in each disease category. The exception was pneumoconiosis, where construction workers made up 31%.
  • 25 mesothelioma cases, 16 benign pleural disease cases and one pneumoconiosis case were reported as resulting from domestic asbestos exposure. They were not included in the analysis of long-latency disease by occupation.
  • One case report described a dentist who had prepared fillings during a period when some dental filling materials were said to contain crocidolite. The dentist died of pleural mesothelioma, and a high lung burden of crocidolite was found at autopsy.
  • Occupational asthma continued to account for about 1000 new cases annually.
• The authors' conclusion: The authors concluded that at least half of the reported disease is attributable to asbestos exposure, and that lung cancer from asbestos may be under-reported. They added that asbestos-related diseases may increase in incidence for some years.
• Limitations the authors state:
  • Not everyone with occupational lung disease sees a doctor, and only some are seen by the consultant physicians who report to SWORD.
  • Errors in diagnosis and attribution are inevitable. Reporting may be affected by memory, enthusiasm and time pressures.
  • The scheme carries a potential for bias and distortion of the true picture of disease incidence.
  • Reports for 1993 were still arriving when the article was written.
  • Lung cancer resulting from asbestos exposure is probably under-reported.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Lung Cancer.

Related studies

• SWORD '97: surveillance of work-related and occupational respiratory disease in the UK — D.J. Ross, H.L. Keynes, et al. (1998)
• SWORD '94: surveillance of work-related and occupational respiratory disease in the UK — D.J. Ross, B.A. Sallie, et al. (1995)
• Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project — S.K. Meredith, J.C. McDonald (1994)
• Occupational and work-related respiratory disease attributed to cleaning products — M. Carder, M.J. Seed, et al. (2019)
• Work-related respiratory health conditions among construction workers: a systematic narrative review — E.F. Boadu, S.R. Okeke, et al. (2023)
• Trends in suspected and recognized occupational respiratory diseases in Germany between 1970 and 2005 — V. van Kampen, R. Merget, et al. (2008)

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