Under-reporting of compensable mesothelioma in Alberta

Our plain-English summary of Under-reporting of compensable mesothelioma in Alberta, by M.W. Cree, M. Lalji, B. Jiang, et al (American Journal of Industrial Medicine, 2009).

The study

• Authors: M.W. Cree, M. Lalji, B. Jiang, K.C. Carriere
• Journal: American Journal of Industrial Medicine
• Published: 2009;52(7):526-33
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: When combined with a history of occupational asbestos exposure, mesothelioma is often presumed work-related. In Canada, workers diagnosed with mesothelioma caused by occupational asbestos exposure are often eligible for compensation under provincial workers' compensation boards. Although occupational asbestos exposure causes the majority of mesothelioma, Canadian research suggests less than half of workers actually apply for compensation. Alberta's mandatory reporting requirements may produce higher filing rates but this is currently unknown. This study evaluates Alberta's mesothelioma filing and compensation rates.

Methods: Demographic information on all mesothelioma patients diagnosed between 1980 and 2004 were extracted from the Alberta Cancer Board's Cancer Registry and linked to Workers' Compensation Board of Alberta claims data.

Results: Alberta recorded a total of 568 histologically confirmed mesothelioma cases between 1980 and 2004. Forty-two percent of cases filed a claim; 83% of filed claims were accepted for compensation.

Conclusions: Patient under-reporting of compensable mesothelioma is a problem and raises larger questions regarding under-reporting of other asbestos-related cancers in Alberta. Strategies should focus on increasing filing rates where appropriate.

In plain English

This study linked Alberta Cancer Registry records of all 568 histologically confirmed mesothelioma cases diagnosed in Alberta, Canada, from 1980 to 2004 to Workers' Compensation Board of Alberta claims data. It measured filing and acceptance of compensation claims. Most cases were in males (468), and most were pleural (485). Overall, 237 patients (42%) filed a claim, 48% of males and 11% of females. Of the 237 claims, 197 (83%) were accepted, and three had no decision. Although all claimants had mesothelioma in the registry, only 42% of their claims listed mesothelioma; 37% listed asbestosis. In adjusted analysis, males were more likely to file than females (odds ratio 7.57, 95% confidence interval 3.82 to 15.02). Patients over 70 were less likely to file than those aged 50 to 70. Among male claimants, those under 50 were less likely to have claims accepted than those aged 50 to 70 (odds ratio 0.20, 95% confidence interval 0.07 to 0.63). The authors concluded that patient under-reporting of compensable mesothelioma is a problem. They noted occupational information was available for only 53% of applicants.

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: Population-based record linkage study: cancer registry cases linked to workers' compensation claims data
• Who was studied: All 568 histologically confirmed mesothelioma cases recorded in Alberta, Canada, 1980 to 2004: 468 (82%) in males, average age at diagnosis 65 years; 485 pleural, 65 peritoneal, 18 other sites
• Exposure: The study did not measure asbestos exposure. It examined workers' compensation filing and acceptance, and named no fiber types. Occupation was known for 126 applicants. Of these, 96 (77%) worked in trades, transportation or equipment operation.
• Main results:
  • 237 of the 568 mesothelioma patients filed a compensation claim, an overall filing rate of 42%
  • Filing rates were 48% for males and 11% for females
  • Of 237 claims filed, 197 (83%) were accepted and no decision had been made for three
  • Among females, only two claims were accepted
  • All claimants had mesothelioma in the registry. Their compensation board diagnoses were mesothelioma (42%), asbestosis (37%), neoplasms (8%) and other (13%).
  • Adjusted filing analysis (n = 233): males compared with females, odds ratio 7.57 (95% CI 3.82 to 15.02)
  • Adjusted filing analysis: patients over 70 compared with those aged 50 to 70, odds ratio 0.55 (95% CI 0.37 to 0.84)
  • Adjusted filing analysis: residents of the Capital (Edmonton) region compared with Southern Alberta, odds ratio 3.93 (95% CI 1.66 to 9.28)
  • Adjusted acceptance analysis, males only (n = 222): only age was significant. Claims from patients under 50 had lower odds of acceptance than claims from those aged 50 to 70 (odds ratio 0.20, 95% CI 0.07 to 0.63).
  • The filing rate increased over time, from 0 in 1981 to 64% in 1997
• The authors' conclusion: The authors concluded that patient under-reporting of compensable mesothelioma is a problem. They said it raises questions about under-reporting of other asbestos-related cancers in Alberta, and that strategies should focus on increasing filing rates where appropriate.
• Limitations the authors state:
  • Occupational information was poor. It was available for only 53% of applicants, and it referred to the job at diagnosis or filing, not necessarily the job responsible for the disease.
  • Privacy rules prevented the authors from sending registry patients to the compensation board for linking. Instead they extracted cancer-related claims and linked them to the cohort.
  • Misdiagnosis of malignant mesothelioma has likely caused some underestimation of the number of mesothelioma patients

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

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

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• Asbestos-related occupational cancers compensated under the Industrial Accident Compensation Insurance in Korea — Y.S. Ahn, S.K. Kang (2009)
• Non-Malignant Respiratory Illnesses in Association with Occupational Exposure to Asbestos and Other Insulating Materials: Findings from the Alberta Insulator Cohort — S. Moitra, A. Farshchi Tabrizi, et al. (2020)
• Lung health among plumbers and pipefitters in Edmonton, Alberta — P.A. Hessel, L.S. Melenka, et al. (1998)
• The cost of compensating asbestos victims under the Occupational Disease Compensation Act of 1983 — F.B. Siskind (1987)

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