SWORD '94: surveillance of work-related and occupational respiratory disease in the UK

Our plain-English summary of SWORD '94: surveillance of work-related and occupational respiratory disease in the UK, by D.J. Ross, B.A. Sallie, J.C. McDonald (Occupational Medicine, 1995).

The study

• Authors: D.J. Ross, B.A. Sallie, J.C. McDonald
• Journal: Occupational Medicine
• Published: 1995;45(4):175-8
• Cited by: 48 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Chest and occupational physicians participating in SWORD are estimated to have seen some 3300 cases of work-related respiratory disease in 1994, similar to the totals for 1992-1993. Occupational asthma was the single most frequent diagnosis (941 cases), but asbestos exposure was considered the cause in 1529 cases of diseases of long latency. Large-scale follow-up studies showed (i) that most patients with occupational asthma failed to recover and that half had left their employer, and (ii) that many patients had long-term respiratory illness including asthma following inhalation accidents. Over the six years of the scheme there have been slight changes in attributed agents for occupational asthma and in the frequency of various diagnoses; for example, there has been a gradual reduction in reports of pneumoconiosis. A decline with birth cohort in the proportion of mesotheliomas in men employed in shipyards is shown, with some evidence of a compensatory trend in construction trades.

In plain English

This article was a yearly report from SWORD, a UK scheme in which chest physicians and occupational physicians reported new cases of work-related respiratory disease. By the end of February 1995 the scheme had received 1452 cases first identified in 1994. Using its sampling method, it estimated 3267 cases in total. Diseases of long latency made up 45% of reports, followed by asthma (31%) and inhalation accidents (14%). Asbestos was the attributed cause in 92% of reports of long-latency diseases (1529 cases). Its share was lower for pneumoconiosis (74% of 132 cases) and lung cancer (65% of 26 cases). Over the life of the scheme, the proportion of pneumoconiosis fell from 14% to 10%, and reports of benign pleural disease came to outnumber those of mesothelioma. Among men with mesothelioma, the share who had worked in shipyards fell with year of birth from 1930 onwards, while the share who had worked in construction rose. The authors linked this probably to the post-war decline of shipbuilding and perhaps to post-war growth in construction. They noted that occupational histories were brief and that mesothelioma patterns reflect exposures 20-40 years earlier.

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: Annual report of a national voluntary surveillance scheme in which specialist physicians report new cases of occupational respiratory disease
• Who was studied: Cases of work-related respiratory disease first identified in 1994 and reported by chest physicians and occupational physicians in the UK: 1452 reported cases, an estimated 3267 in total
• Exposure: Workplace exposures attributed by reporting physicians, mainly past asbestos exposure for long-latency diseases; also silica, coal, welding fumes, talc and other dusts for pneumoconiosis, and agents such as isocyanates for asthma
• Main results:
  • Among all 1994 reports, diseases of long latency made up 45%, asthma 31% and inhalation accidents 14%
  • Asbestos was the attributed cause in 92% of reports of long-latency diseases (1529 cases)
  • Asbestos accounted for lower proportions of the 132 pneumoconiosis cases (74%) and the 26 lung cancer cases (65%)
  • Since SWORD began, the proportion of reports that were pneumoconiosis declined gradually from 14% to 10%
  • Reports of benign pleural disease now outnumbered reports of mesothelioma
  • Among men with mesothelioma reported in 1989-1994, the proportion who had worked in shipyards fell with year of birth from 1930 onwards, and the proportion who had worked in construction increased (shown in a figure; no numbers given in the text)
  • In a follow-up of occupational asthma diagnosed in 1989-1992, 50 (14%) of 358 cases reported by chest physicians had recovered from asthma, compared with 55 (45%) of 121 cases reported by occupational physicians
• The authors' conclusion: The authors concluded that analysis of mesothelioma reports showed a change in attributed occupation with year of birth: shipyards had declined in importance, and there was some evidence that the proportion of cases due to construction work was higher in younger age groups
• Limitations the authors state:
  • The scheme only covers cases seen by specialists in occupational and respiratory medicine
  • Misclassification of occupation cannot be ruled out because the occupational histories supplied were brief
  • Mesothelioma patterns reflect exposures 20-40 years earlier, so they do not show current exposure levels
  • Lung cancer is probably the most under-reported long-latency disease

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Latency, Pneumoconiosis, Mesothelioma.

Related studies

• SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK — B.A. Sallie, D.J. Ross, et al. (1994)
• SWORD '97: surveillance of work-related and occupational respiratory disease in the UK — D.J. Ross, H.L. Keynes, et al. (1998)
• 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)
• 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)
• Chest physician-reported, work-related, long-latency respiratory disease in Great Britain — M. Carder, A. Darnton, et al. (2017)

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