SWORD '97: surveillance of work-related and occupational respiratory disease in the UK

Our plain-English summary of SWORD '97: surveillance of work-related and occupational respiratory disease in the UK, by D.J. Ross, H.L. Keynes, J.C. McDonald (Occupational Medicine, 1998).

The study

• Authors: D.J. Ross, H.L. Keynes, J.C. McDonald
• Journal: Occupational Medicine
• Published: 1998;48(8):481-5
• Type of article: Review
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

SWORD is one of seven clinically based reporting schemes which together now provide almost comprehensive coverage of occupational diseases across the UK. Although SWORD is now in its tenth year, participation rates remain high. Of an estimated 3,903 new cases seen this year, 1,031 (26%) were of occupational asthma, 978 (25%) of mesothelioma, 794 (20%) of non-malignant pleural disease, 336 (9%) of pneumoconiosis and 233 (6%) of inhalation accidents. Incidence rates of occupational asthma were generally highest among workers in the manufacture of wood products, textiles and food (particularly grain products and crustaceans) and additionally, in the production of precious and non-ferrous metals, rubber goods, detergents and perfumes, and in mining. Health care workers were noted to have a surprisingly high incidence of inhalation accidents. Occupational asthma attributed to latex has increased dramatically; the highest rates are among laboratory technicians, shoe workers and health care workers.

In plain English

This was SWORD's 1997 annual report. In this UK scheme, chest and occupational physicians reported new cases of work-related respiratory disease. It did not study asbestos exposure specifically. By 16 March 1998 it had received 1,153 reports of cases first diagnosed in 1997, an estimated 3,903 new cases after scaling up. Of these, an estimated 1,031 were occupational asthma, 978 mesothelioma, 794 non-malignant (benign) pleural disease, 336 pneumoconiosis and 233 inhalation accidents. Both mesothelioma and benign pleural disease reports rose considerably from 1996. The mesothelioma estimate was close to the latest count of 1,235 mesothelioma deaths, which included non-pleural cases. Of benign pleural cases classified by core chest physicians, 73% were mainly plaques, 26% mainly diffuse disease and 1% unspecified. Mineral dust diseases made up over half of new cases. Industry rates covered only short-latency diseases. Asthma rates were generally highest in wood, textile and food manufacture, especially grain and crustaceans. Sixty-four asthma cases were attributed to latex. The authors found it disturbing that asthma due to most agents showed little sign of decrease, while latex cases clearly rose after 1993.

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 (case-reporting) scheme for occupational respiratory disease
• Who was studied: Cases first diagnosed in 1997 and reported by participating UK chest physicians (nearly 430) and, through the parallel OPRA scheme, occupational physicians (over 600). There were 1,153 reports received by 16 March 1998.
• Exposure: Work-related respiratory exposures of all kinds. Asbestos fiber types are not reported. Mesothelioma and benign pleural disease are reported as disease categories, and some case reports described patients with asbestos-related disease.
• Main results:
  • Applying the sampling fraction to the 1,153 reports gave an estimated 3,903 new cases in 1997.
  • Of the estimated 3,903 new cases: 1,031 (26%) occupational asthma, 978 (25%) mesothelioma, 794 (20%) non-malignant pleural disease, 336 (9%) pneumoconiosis and 233 (6%) inhalation accidents.
  • Reports of both mesothelioma and benign pleural disease were considerably increased compared with the previous year. Table 1 gives 1996 estimated totals of 496 for mesothelioma and 556 for benign pleural disease.
  • The estimated 978 mesothelioma cases was close to the most recent total of 1,235 mesothelioma deaths, a figure that includes non-pleural cases.
  • Mineral dust diseases together accounted for over half of new work-related illnesses seen by specialist physicians.
  • Benign pleural disease cases were subdivided by the core group of chest physicians, in the same way as asthma cases. Of these, 73% were mainly plaques, 26% mainly diffuse disease, and 1% were unspecified.
  • Food production workers handling grain had a very high annual occupational asthma rate of 2,815 per million workers, and those handling fish had a rate of 1,516 per million workers. The grain figure is flagged in Table 2 as resting on a denominator under 10,000.
  • Of 1,031 occupational asthma cases, 64 were attributed to latex. For 1994 to 1997, nursing staff had the most latex asthma cases (50, rate 15.2 per million per year), but laboratory technicians had a higher rate (76.5 per million per year).
  • Health care workers had an inhalation accident rate of 65 per million per year.
• The authors' conclusion: The authors called it disturbing that occupational asthma incidence due to most agents showed little sign of decrease, with a clear increase since 1993 in cases attributed to latex.
• Limitations the authors state:
  • Industry rates were not calculated for long-latency diseases (including malignancy, pneumoconiosis and other asbestos-related diseases) because current workforce denominators might be misleading.
  • Labour Force Survey denominators below 10,000 might not be reliable.
  • Coverage is near-complete only at the level of specialist physicians.
  • The high asthma rate in coal miners was based on only two sampled cases.
  • Latex asthma rates for some groups, such as dental staff and hospital cleaners, are probably underestimated because the denominators are too broad.

Topics

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

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 '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)
• Non-response bias in a surveillance program for asbestos-related lung cancer — L. Knoll, M.K. Felten, et al. (2011)

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