Costs of asbestosis and silicosis hospitalization in Italy (2001-2018) : Costs of asbestosis and silicosis hospitalization.

BACKGROUND: Asbestosis and silicosis are preventable fibrotic forms of pneumoconiosis. Decades ago, the World Health Organization began prevention campaigns for eliminating these diseases worldwide. PURPOSE: To establish Italian hospitalization costs of asbestosis and silicosis in relation to national adopted prevention policies. METHODS: This is a retrospective population-based study of Italian hospitalizations treating asbestosis or silicosis in the period 2001-2018. We have extracted data from the National Hospital Discharge Registry and merged with national standard charges of hospitalizations through diagnosis-related group coding. We expressed costs in 2018 euros and evaluated data time-trends by linear normal and logistic regression models. RESULTS: During 2001-2018, hospitalization costs per year were 3,787,540 € for asbestosis and 10,103,215 € for silicosis. There were significant annual reductions in frequency (- 41 and - 266 hospitalizations per year for asbestosis and silicosis, respectively), length of stay (- 148 and - 2781 days per year for asbestosis and silicosis, respectively) and cost (- 43,881 and - 959,516 € per year for asbestosis and silicosis, respectively) of diseases. Length and cost of hospital stay per admission significantly increased over time for asbestosis (+ 0.2 days and + 100 €, respectively, per year). CONCLUSION: Overall hospitalizations costs were higher for silicosis than asbestosis. Over time hospitals treated fewer cases with greater severity. The decreased 2001-2018 consumption of hospital resources by patients with asbestosis or silicosis is associated with the occupational health policies instituted from the 1990s to reduce exposures to asbestos and silica. Extending existing epidemiological surveillance systems to pneumoconioses would help to control the social costs of work-related diseases.

Call for a global ban policy on and scientific management of asbestos to eliminate asbestos-related diseases.

Asbestos is a primary cause of cancer worldwide. Global estimates indicate workplace exposure of 125 million people and about 255,000 deaths each year. Of the approximately 300 million metric tonnes of asbestos ever produced worldwide, most will become waste and disposed of in landfills. The recycling and transforming asbestos fibre into a non-harmful product offer a sustainable solution, but a global commitment remains elusive. Urgent action is needed. Sixty-seven countries have banned the use of asbestos-containing material, however, repeated calls to stop the use of asbestos globally have gone unheeded. We call for more stringent uniform global legislation and policies, backed up by funds to induce action along with research and education required to eliminate use of asbestos. Only by doing this, will we prevent deaths due to asbestos and help protect the environment.

[Financial compensation for asbestosis patients]. / Financiële compensatie voor patiënten met asbestose.

Asbestosis in the Netherlands is a rare work-related form of pulmonary fibrosis caused by long-term, intensive exposure to asbestos. It can have a great impact on patients' quality of life and life expectancy even 20-30 years after initial exposure. The Dutch Institute of Asbestos Victims (IAS) mediates between the victims and their employers or former employers about payment of compensation. Liability procedures against a previous employer are long and stressful. Since 1 April 2014 it has, therefore, been possible to receive financial aid from the state. The IAS and the Netherlands Asbestosis Panel determine who is eligible for this. In this article we look in detail at the conditions for, and the process of, application for this financial aid. Since the introduction of this arrangement, more than 250 asbestosis victims have applied for aid; so far, 65 applicants have met the required conditions.

Eligibility for low-dose computerized tomography screening among asbestos-exposed individuals.

OBJECTIVES: The study aimed to incorporate an estimate of risk for asbestos exposure in the Canadian Cancer Risk Management Lung Cancer (CRMM-LC) microsimulation model. METHODS: In CRMM-LC, a 3-year probability of developing lung cancer can be derived from different risk profiles. An asbestos-exposed cohort was simulated and different scenarios of low-dose computerized tomography (LDCT) screening were simulated. RESULTS: As annual LDCT screening among non-asbestos-exposed individuals is less cost-effective than biennial screening, all the scenarios modeled for an asbestos-exposed cohort were biennial. For individuals with a two-fold risk of asbestos-induced lung cancer to be eligible for biennial LDCT screening, a smoking history of ≥15 pack-years would be necessary. For non-smokers with asbestos exposure resulting in a relative risk (RR) for lung cancer, it is not cost-effective to screen those with a RR of 5, but it is cost-effective to screen those with a RR of 10 (the heavily exposed). CONCLUSION: Asbestos-exposed individuals with an estimated two-fold or more risk of lung cancer from asbestos-exposure are eligible for LDCT screening at all ages from 55-74 years if they have a cigarette smoking history of ≥15 pack-years. Asbestos-exposed individuals who are lifelong non-smokers are eligible for LDCT screening at all ages from 55-74 years if they have accumulated a degree of asbestos exposure resulting in an estimated risk of lung cancer of ≥10.

Workers' compensation for occupational respiratory diseases.

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.

Workers' Compensation for Occupational Respiratory Diseases

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.

Descriptive review of asbestosis and silicosis hospitalization trends in North Carolina, 2002-2011.

BACKGROUND: Asbestosis and silicosis are debilitating pulmonary conditions resulting from inhalation of asbestos fibers or silica dust. PURPOSE: We provide a descriptive analysis of asbestosis and silicosis hospitalizations in North Carolina to assess trends over a 10-year period. METHODS: Events were defined as inpatient hospital discharges during the period 2002-2011 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 501 or 502. Using statewide discharge data for 2002-2011, we calculated asbestosis and silicosis hospitalization rates in North Carolina (by demographics, hospital length of stay, cost, and payment type) and compared them with national rates. RESULTS: In North Carolina, average annual age-standardized hospitalization rates for asbestosis and silicosis were 71.2 hospitalizations per 1 million residents and 6.2 hospitalizations per 1 million residents, respectively. Rates for asbestosis and silicosis decreased significantly (less than .01 for both conditions) between 2002 and 2011, by 46% and 67%, respectively. Men had significantly higher rates than women (less than .01), more than half of hospitalizations were among persons aged 65-84 years, and Medicare was the predominant payment source. The highest silicosis rates by county were clustered in Western North Carolina; no geographic patterns were observed for asbestosis. The estimated average annual cost statewide for these hospitalizations was $10,170,417 for asbestosis and $886,143 for silicosis. LIMITATIONS: ICD-9-CM misclassification and duplicate hospitalization records may have biased the observed rates of asbestosis and silicosis. CONCLUSIONS: Decreases in hospitalization rates in North Carolina may be due to misdiagnosis, underreporting, or the declining use of asbestos in industries. Obtaining complete exposure histories at diagnosis is useful for continued public health surveillance.

Compensation for environmental asbestos-related diseases in South Africa: a neglected issue.

BACKGROUND: Environmentally acquired asbestos-related diseases (ARDs) are of concern globally. In South Africa, there is widespread contamination of the environment due to historical asbestos mining operations that were poorly regulated. Although the law makes provision for the compensation of occupationally acquired ARDs, compensation for environmentally acquired ARDs is only available through the Asbestos Relief Trust (ART) and Kgalagadi Relief Trust, both of which are administered by the ART. This study assessed ARDs and compensation outcomes of environmental claims submitted to the Trusts. METHODS: The personal details, medical diagnoses, and exposure information of all environmental claims considered by the Trusts from their inception in 2003 to April 2010 were used to calculate the numbers and proportions of ARDs and compensation awards. RESULTS: There were 146 environmental claimants of whom 35 (23.9%) had fibrotic pleural disease, 1 (0.7%) had lung cancer, and 77 (52.7%) had malignant mesothelioma. 53 (36.3%) claimants were compensated: 20 with fibrotic pleural disease and 33 with mesothelioma. Of the 93 (63.7%) claimants who were not compensated, 33 had no ARDs, 18 had fibrotic pleural disease, 1 had lung cancer, and 44 had mesothelioma. In addition to having ARDs, those that were compensated had qualifying domestic (33; 62.2%) or neighbourhood (20; 37.8%) exposures to asbestos. Most of the claimants who were not compensated had ARDs but their exposures did not meet the Trusts' exposure criteria. CONCLUSIONS: This study demonstrates the environmental impact of asbestos mining on the burden of ARDs. Mesothelioma was the most common disease diagnosed, but most cases were not compensated. This highlights that there is little redress for individuals with environmentally acquired ARDs in South Africa. To stop this ARD epidemic, there is a need for the rehabilitation of abandoned asbestos mines and the environment. These issues may not be unique to South Africa as many countries continue to mine and use asbestos.

[Compensation for occupational diseases after tomodensitometry screening for benign pleuro-pulmonary disease in a multiregional post-occupational medical surveillance program of asbestos-exposed retired workers]. / Déclaration et reconnaissance en maladie professionnelle après dépistage tomodensitométrique de maladies pleuropulmonaires bénignes dans le programme multirégional de surveillance postprofessionnelle de personnes exposées à l'amiante.

BACKGROUND: Underreporting of occupational diseases related to asbestos exposure remains a matter of concern in France. The aim of this study was to evaluate the number of claims for compensation for asbestos-related non-malignant pulmonary or pleural occupational disease in subjects having undergone a chest CT-scan in a multiregional screening programme. METHODS: Among the 5444 voluntary retired asbestos-exposed subjects recruited in four regions between 2003 and 2005 who had undergone a chest CT-scan, the number of claims for compensation for an asbestos-related pulmonary or pleural benign disease was analysed in 2006 and 2010. RESULTS: Following CT-scan screening, 17.2% of participants were acknowledged as presenting with an asbestos-related non-malignant occupational disease, essentially pleural plaques, by the French National Health Insurance fund. Underreporting decreased as duration of follow-up after CT-scan increased. Nevertheless, 4 years after CT-scan, underreporting was still as high as 36% for subjects identified as presenting with pleural plaques. Mean duration between the date of CT-scan and the date of recognition as occupational disease was 7.4 months, shorter in cases where screening was coordinated by specialized centres. CONCLUSION: A plan of action for an easier claiming process for compensation of asbestos-related diseases is desired. This could probably be obtained through improved sensitization of physicians engaged in the follow-up of asbestos-exposed subjects, and by standardization of the interpretation and reporting of asbestos-related abnormalities observed on chest CT-scans.

[What are the non-medical individual and collective objectives?]. / Quels sont les objectifs non médicaux individuels et collectifs ?

INDIVIDUAL NON-MEDICAL OBJECTIVES ARE: Information to patients concerning their past exposure to asbestos and their right to compensation; equity demands that every person potentially eligible should be fully informed. Social recognition. Facilitation of compensation by informing the patient and his physician of the mechanisms. COLLECTIVE NON-MEDICAL OBJECTIVES ARE: Social visibility, contributing to the prevention of occupational cancer. Better balance of the Social Security budget since it is the employers who bear the cost of compensation of occupational diseases. Improved epidemiological understanding of the circumstances of exposure and the most commonly concerned occupations and industries. Evaluation of the mechanisms of management of occupational diseases. PSYCHOLOGICAL IMPACT: It is of the same magnitude as any screening procedure; it should be acceptable and avoid long-term negative psychological effects; it may be useful to implement specific support for the few patients with psychological problems.

Asbestos-related occupational cancers compensated under the Industrial Accident Compensation Insurance in Korea.

Compensation for asbestos-related cancers occurring in occupationally-exposed workers is a global issue; this is also an issue in Korea. To provide basic information regarding compensation for workers exposed to asbestos, 60 cases of asbestos-related occupational lung cancer and mesothelioma that were compensated during 15 yr; from 1993 (the year the first case was compensated) to 2007 by the Korea Labor Welfare Corporation (KLWC) are described. The characteristics of the cases were analyzed using the KLWC electronic data and the epidemiologic investigation data conducted by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety and Health Agency (KOSHA). The KLWC approved compensation for 41 cases of lung cancer and 19 cases of mesothelioma. Males accounted for 91.7% (55 cases) of the approved cases. The most common age group was 50-59 yr (45.0%). The mean duration of asbestos exposure for lung cancer and mesothelioma cases was 19.2 and 16.0 yr, respectively. The mean latency period for lung cancer and mesothelioma cases was 22.1 and 22.6 yr, respectively. The major industries associated with mesothelioma cases were shipbuilding and maintenance (4 cases) and manufacture of asbestos textiles (3 cases). The major industries associated with lung cancer cases were shipbuilding and maintenance (7 cases), construction (6 cases), and manufacture of basic metals (4 cases). The statistics pertaining to asbestos-related occupational cancers in Korea differ from other developed countries in that more cases of mesothelioma were compensated than lung cancer cases. Also, the mean latency period for disease onset was shorter than reported by existing epidemiologic studies; this discrepancy may be related to the short history of occupational asbestos use in Korea. Considering the current Korean use of asbestos, the number of compensated cases in Korea is expected to increase in the future but not as much as developed countries.

Compensation of asbestos victims in France.

The alarming development of pathologies linked to asbestos led to the creation in France of two funds to indemnify the victims of asbestos-related illnesses: the FCAATA (Fund for asbestos workers who take early retirement), which compensates for their reduced life expectancy, and the FIVA (Indemnification fund for asbestos victims) which ensures full compensation for harm suffered by asbestos victims.

Asbestos-related disease in South Africa: the social production of an invisible epidemic.

South Africa was the third largest exporter of asbestos in the world for more than a century. As a consequence of particularly exploitative social conditions, former workers and residents of mining regions suffered--and continue to suffer--from a serious yet still largely undocumented burden of asbestos-related disease. This epidemic has been invisible both internationally and inside South Africa. We examined the work environment, labor policies, and occupational-health framework of the asbestos industry in South Africa during the 20th century. In a changing local context where the majority of workers were increasingly disenfranchised, unorganized, excluded from skilled work, and predominantly rural, mining operations of the asbestos industry not only exposed workers to high levels of asbestos but also contaminated the environment extensively.