Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project

Our plain-English summary of Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project, by S.K. Meredith, J.C. McDonald (Occupational Medicine, 1994).

The study

• Authors: S.K. Meredith, J.C. McDonald
• Journal: Occupational Medicine
• Published: 1994;44(4):183-9
• Cited by: 73 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The objective of this project is the creation of a reliable and cost-effective national system of surveillance for work-related respiratory disease as a basis for control and simple epidemiological research. With the voluntary participation of almost 800 chest and occupational physicians from throughout the UK, newly diagnosed cases of respiratory illness thought to be due to occupational factors have been reported regularly since January 1989. Since January 1992, reports from chest physicians have been submitted monthly by a core group with special interest in occupational lung disease (n = 32) and rotating random samples of the remainder. Between 1989 and 1991, 5576 new cases were reported, of which half were diseases of long latency mainly due to asbestos, 28% were occupational asthma, and the rest were divided between inhalation accidents (10%) and a variety of other acute diseases (14%). Disease incidence rates, with denominators from the Labour Force Survey, showed a very high risk of asthma among paint sprayers, chemical and food processors, laboratory staff, plastics and metal treatment workers, and in welding and electronic assembly. Some of the same groups also experienced high rates of inhalation accidents and bronchitis. The risk of diseases of long latency, using denominators from the 1961 census, was highest in shipyard and dock workers, miners and construction workers. The SWORD scheme has provided estimates of disease incidence not previously available, has encouraged awareness of occupational factors among chest physicians, has assisted those responsible for prevention and control, and has demonstrated the feasibility of this approach to surveillance.

In plain English

This article reported on SWORD, a voluntary UK scheme, begun in January 1989, in which chest and occupational physicians reported new cases of respiratory disease they thought were work-related. In 1989-1991, 776 physicians took part, and 5541 cases were analysed after exclusions. Half were diseases of long latency (mesothelioma, pneumoconiosis, lung cancer or benign pleural disease), 28% were occupational asthma and 10% were illness from inhalation accidents. Asbestos was the suspected cause of 2257 (78%) of the 2877 long-latency cases and of nearly all malignant and non-malignant pleural disease. Among men, long-latency disease rates were highest in three groups: shipyard and dock workers (mainly mesothelioma and non-malignant pleural disease), miners and quarrymen (pneumoconiosis), and construction workers (all three diseases). The authors concluded that the scheme provided incidence estimates not previously available and showed this approach was feasible. They noted that the rates underestimate true incidence, that no standard diagnostic criteria were imposed, and that physicians might tend to attribute pleural disease to asbestos.

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: Report of a national voluntary surveillance scheme in which specialist physicians reported newly diagnosed work-related respiratory disease cases (descriptive analysis of reported cases with incidence rates)
• Who was studied: Cases reported by 776 UK physicians (391 occupational, 385 thoracic) in 1989-1991. Of 6194 cases reported, 5541 were analysed after excluding duplicates, cases exposed abroad or not work-related, and two special groups. Reporting continued through 1992 with a sampling scheme.
• Exposure: Suspected occupational causes as recorded by the reporting physician. For long-latency diseases this was mainly asbestos; silica and coal were the leading other agents for pneumoconiosis and radon for lung cancer. Acute diseases were linked to many chemical, organic and metal agents. No asbestos fiber types were specified.
• Main results:
  • Of the 5541 cases in 1989-1991, half were diseases of long latency, 28% occupational asthma and 10% inhalation accidents. The seven other diagnostic groups made up the remaining 14%.
  • Asbestos was the suspected cause of 2257 (78%) of the 2877 long-latency disease cases and of nearly all malignant and non-malignant pleural disease.
  • Asbestos was not positively identified in only 89 (10%) of malignant pleural disease cases and 36 (4%) of non-malignant pleural disease cases.
  • 440 (49%) of pneumoconiosis cases and 40 (30%) of lung cancers were attributed to agents other than asbestos. For pneumoconiosis the most common were silica (197 cases, 22%) and coal (178 cases, 20%).
  • Among men, the highest reported long-latency disease rates were in three groups: shipyard and dock workers (mainly mesothelioma and non-malignant pleural disease), miners and quarrymen (pneumoconiosis), and construction workers (all three diseases).
  • Regionally, the highest long-latency disease rates, mainly due to asbestos, were in the North of England and Scotland.
  • For acute disease, the highest annual incidence rates were in paint sprayers (almost all asthma) and chemical processors.
  • After the 1992 change to a core group plus rotating random samples of chest physicians, their average monthly return rate rose from 63% to 77%.
• The authors' conclusion: The authors concluded that SWORD had provided disease incidence estimates not previously available, encouraged awareness of occupational factors among chest physicians, assisted those responsible for prevention and control, and shown that this approach to surveillance is feasible.
• Limitations the authors state:
  • The rates underestimate true incidence, because some patients are seen only by general practitioners or other specialists and because participating physicians under-report cases.
  • No standard diagnostic criteria were imposed, so questions remain about diagnostic accuracy and cause.
  • Physicians may tend to attribute illness to recognized agents, such as asbestos in pleural disease.
  • Occupational lung cancer is probably under-diagnosed and is certainly under-reported.
  • Cases from Northern Ireland were excluded from the long-latency incidence analysis because suitable denominators were not readily available.
  • Few cases of bronchitis, inhalation accident and non-malignant pleural disease were reported at first, probably because these categories were not listed separately on the report card until 1990.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, Latency, 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 '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)
• 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)
• Chest physician-reported, work-related, long-latency respiratory disease in Great Britain — M. Carder, A. Darnton, et al. (2017)

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