Malignant asbestos-related disease in a population exposed to asbestos.

OBJECTIVES: The first asbestos fiber cement plant in Spain operated in Cerdanyola, in the Barcelona metropolitan area, between 1907 and 1997. We describe clinical and epidemiological characteristics of patients diagnosed with the malignant asbestos-related disease (ARD) in the area of the plant between 2007 and 2016. METHODS: A prospective, descriptive study was undertaken in the 12 municipalities of the county of Barcelona most proximate to the plant. We describe malignant ARD cases by time of diagnosis, source of exposure, periods of exposure and latency, and distribution by sex. Cumulative incidence and age-standardized incidence rates (ASIR) are calculated. RESULTS: Of 477 patients diagnosed with ARD between 2007 and 2016, 128 (26%) presented with asbestos-associated malignancy. Pleural mesothelioma was noted in 105 patients (82.0%) with a linear trend Z-score of -0.2 (NS) in men and 2.7 (P < .01) in women. The highest ASIRs for malignant ARD (6.1/100 000 residents/year; 95% confidence interval [CI], 2.2-13.3) and pleural mesothelioma (4.8/100 000 residents/year; 95% CI, 1.5-11.6) occurred in municipalities closest to the focal point of contamination. The origin of malignant ARD was nonoccupational in 32.2% of men and 81.6% of women (P < .001). CONCLUSIONS: More than 20 years after the closure of the fiber cement plant, the grave consequences of exposure to asbestos remain. The detection of cases of pleural mesothelioma in men seems to have plateaued whereas in women an ascending trend continues, which principally has its origin in nonoccupational exposures.

Risk factors associated with asbestos-related diseases: a community-based case-control study.

BACKGROUND: Asbestos is a first level carcinogen. However, few epidemiological studies analyse the risk and protective factors associated with asbestos-related diseases and follow up these conditions in the general population. Pleural mesothelioma, caused by inhalation of asbestos fibres at work, at home or in the environment, is the most representative asbestos-related disease.The objectives of this study are to analyse the risk and protective factors associated with asbestos-related diseases and to investigate the incidence of new clinical manifestations in patients already diagnosed with some form of ARD. METHODS/DESIGN: We have designed a matched case-control study with follow up of both cohorts from a population of a health district of the Barcelona province that has been exposed to asbestos for a period of 90 years. DISCUSSION: A better understanding of asbestos-related diseases should improve i) the clinical and epidemiological follow up of patients with this condition; ii) the design of new treatment strategies; iii) and the development of preventive activities. At the end of the study, the two cohorts created in this study (affected cases and healthy controls) will constitute the basis for future research.

[Duration of work absence attributable to non work-related diseases by health regions in catalonia]. / Duración de los episodios de incapacidad temporal por contingencia común según regiones sanitarias en Catalunya.

BACKGROUND: This study analyze the duration of episodes of work absence due to non work-related diseases in Catalonia by health regions, assuming a homogeneous distribution of durations between health regions. METHODS: A retrospective cohort study of 811.790 episodes in 2005 and followed to episode closure through July 2007 provided by the Institut Català d'Avaluacions Mèdiques, describing their median duration (MD) in days for each of the seven health regions of Catalonia. The probability of returning to work was plotted according to Wang_Chang survival curves and median durations were then compared using the Barcelona health region as the referent group. Results were extended through stratification by sex. RESULTS: The Camp de Tarragona health region had the shortest MD (5 days), while the episodes in the Alt Pirineu i Aran region had the longest (MD, 13 days). The Barcelona health region had a MD of 7 days as was the case for Cataluña Central. MD in Girona was 8 days, and in Lleida and Terres de l'Ebre it was 9 days. This latter region also had the highest median duration 13 days. CONCLUSIONS: The are significant differences in the duration of work absence between the health regions of Catalonia. These differences persisted after adjusting for age, management of episodes and social security system status, in both men and women.

[Sick leave due to tobacco use in workers aged 35-64. Catalonia, 2007-2016]. / La incapacidad temporal atribuible al consumo de tabaco en trabajadores de 35-64 años. Cataluña, 2007-2016.

OBJECTIVE: Few recent studies have researched into the size and trends of the impact of tobacco use on productivity losses. The objective of this work was to describe the percentage of episodes and non work-related sick leave days with a duration over 5 days due to tobacco use in Catalonia in the period 2007-2016 in relation to the total sick-leave episodes and sick leave days in patients aged 35-64. METHODS: Descriptive study of 3,627,107 episodes and 237,219,230 days in sick-leave by any cause, except those work-related, in workers aged 35-64. Population etiological fractions were used. The annual percentage of number of episodes and sick-leave days due to tobacco use in relation with total episodes and sick-leave days was calculated and a trend test was performed. RESULTS: The percentage of sick-leave episodes and days due to tobacco use was higher in men (3.9%; 5.5% respectively) than in women (2.3%; 1.5% respectively). The trend for sick-leave due to tobacco use was positive, with a maximum OR in 2013. For the number of sick-leave episodes due to tobacco use, the corrected Z was 25.3 in men (p<0.001) and 49.4 in women (p<0.001). For sick-leave days due to tobacco use, the corrected Z was 36.9 in men (p<0.001) and 250.4 in women (p< 0.001). CONCLUSIONS: About 3% of sick-leave episodes with a duration over than 5 days are due to tobacco use, with a positive trend in both sexes. It is necessary to continue reinforcing the tobacco prevention and control policies in order to improve such trends for years to come.

OBJETIVO: Pocos estudios recientes han investigado en nuestro medio la magnitud y las tendencias del impacto del consumo de tabaco en la pérdida de productividad. El objetivo de este trabajo fue describir la proporción de episodios y de días en incapacidad temporal no profesional de duración superior a 5 días y atribuible al consumo de tabaco en Cataluña en el período 2007-2016, respecto del total de incapacidad temporal en trabajadores de 35-64 años. METODOS: Estudio descriptivo de 3.627.107 episodios y 237.219.230 días de incapacidad temporal por todas las causas, excepto las de origen profesional, en trabajadores de 35-64 años. Se aplicaron las fracciones etiológicas poblacionales. Se calculó la proporción anual de episodios y de días en incapacidad temporal atribuible (ITA) respecto de la incapacidad temporal (IT) por todas las causas y se realizó un test de tendencia. RESULTADOS: El porcentaje de episodios y de días en ITA por consumo de tabaco fue superior en hombres (3,9%; 5,5% respectivamente) que en mujeres (2,3%; 1,5% respectivamente). La tendencia de la ITA fue ascendente, con un OR máximo en 2013. Para los episodios de ITA, la Z corregida fue 25,3 en hombres (p<0,001) y 49,4 en mujeres (p<0,001). Para los días en ITA, la Z corregida fue 36,9 en hombres (p<0,001) y 250,4 en mujeres (p<0,001). CONCLUSIONES: Alrededor de un 3% de los episodios de IT de 5 días o más son atribuibles al tabaco, con una tendencia ascendente en ambos sexos. Es necesario continuar reforzando las políticas de prevención y control del tabaquismo para mejorar esta tendencia.

Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis.

BACKGROUND: The mortality from all malignant and nonmalignant asbestos-related diseases remains unknown. The authors assessed the incidence and risk factors for all asbestos-related deaths. METHODS: The sample included 544 patients from an asbestos-exposed community in the area of Barcelona (Spain), between Jan 1, 1970, and Dec 31, 2006. Competing risk regression through a subdistribution hazard analysis was used to estimate risk factors for the outcomes. RESULTS: Asbestos-related deaths were observed in 167 (30.7%) patients and 57.5% of these deaths were caused by some type of mesothelioma. The incidence rate after diagnosis was 3,600 per 100,000 person-years. In 7.5% of patients death was non-asbestos-related, while pleural and peritoneal mesothelioma were identified in 87 (16.0%) and 18 (3.3%) patients, respectively. CONCLUSIONS: Age, sex, household exposure, cumulative nonmalignant asbestos-related disease, and single malignant pathology were identified as risk factors for asbestos-related death. These findings suggest the need to develop a preventive approach to the community and to improve the clinical follow-up process of these patients.

[Estimating non work-related sickness leave absences related to a previous occupational injury in Catalonia (Spain)]. / Estimación de episodios de incapacidad temporal por contingencia común relacionados con un accidente de trabajo previo en Cataluña / Estimació d'episodis d'incapacitat temporal per contingències comunes relacionats amb un accident de treball previ a Catalunya.

OBJECTIVES: To estimate the frequency of non-work sickness absence (ITcc) related to previous occupational injuries with (ATB) or without (ATSB) sick leave. METHODS: Prospective longitudinal study. Workers with ATB or ATSB notified to the Occupational Accident Registry of Catalonia were selected in the last term of 2009. They were followed-up for six months after returning to work (ATB) or after the accident (ATSB), by sex and occupation. Official labor and health authority registries were used as information sources. An "injury-associated ITcc" was defined when the sick leave occurred in the following six months and within the same diagnosis group. The absolute and relative frequency were calculated according to time elapsed and its duration (cumulated days, measures of central trend and dispersion), by diagnosis group or affected body area, as compared to all of Catalonia. RESULTS: 2,9%of ATB (n=627) had an injury-associated ITcc, with differences by diagnosis, sex and occupation; this was also the case for 2,1% of ATSB (n=496).With the same diagnosis, duration of ITcc was longer among those who had an associated injury, and with respect to all of Catalonia. CONCLUSIONS: Some of the under-reporting of occupational pathology corresponds to episodes initially recognized as being work-related. Duration of sickness absence depends not only on diagnosis and clinical course, but also on criteria established by the entities managing the case. This could imply that more complicated injuries are referred to the national health system, resulting in personal, legal, healthcare and economic cost consequences for all involved stakeholders.

La incapacidad temporal atribuible al consumo de tabaco en trabajadores de 35-64 años. Cataluña, 2007-2016 / Sick leave due to tobacco use in workers aged 35-64. Catalonia, 2007-2016

Fundamentos: Pocos estudios recientes han investigado en nuestro medio la magnitud y las tendencias del impacto del consumo de tabaco en la pérdida de productividad. El objetivo de este trabajo fue describir la proporción de episodios y de días en incapacidad temporal no profesional de duración superior a 5 días y atribuible al consumo de tabaco en Cataluña en el período 2007-2016, respecto del total de incapacidad temporal en trabajadores de 35-64 años. Métodos: Estudio descriptivo de 3.627.107 episodios y 237.219.230 días de incapacidad temporal por todas las causas, excepto las de origen profesional, en trabajadores de 35-64 años. Se aplicaron las fracciones etiológicas poblacionales. Se calculó la proporción anual de episodios y de días en incapacidad temporal atribuible (ITA) respecto de la incapacidad temporal (IT) por todas las causas y se realizó un test de tendencia. Resultados: El porcentaje de episodios y de días en ITA por consumo de tabaco fue superior en hombres (3,9%; 5,5% respectivamente) que en mujeres (2,3%; 1,5% respectivamente). La tendencia de la ITA fue ascendente, con un OR máximo en 2013. Para los episodios de ITA, la Z corregida fue 25,3 en hombres (p<0,001) y 49,4 en mujeres (p<0,001). Para los días en ITA, la Z corregida fue 36,9 en hombres (p<0,001) y 250,4 en mujeres (p<0,001). Conclusiones: Alrededor de un 3% de los episodios de IT de 5 días o más son atribuibles al tabaco, con una tendencia ascendente en ambos sexos. Es necesario continuar reforzando las políticas de prevención y control del tabaquismo para mejorar esta tendencia

Background: Few recent studies have researched into the size and trends of the impact of tobacco use on productivity losses. The objective of this work was to describe the percentage of episodes and non work-related sick leave days with a duration over 5 days due to tobacco use in Catalonia in the period 2007-2016 in relation to the total sick-leave episodes and sick leave days in patients aged 35-64. Methods: Descriptive study of 3,627,107 episodes and 237,219,230 days in sick-leave by any cause, except those work-related, in workers aged 35-64. Population etiological fractions were used. The annual percentage of number of episodes and sick-leave days due to tobacco use in relation with total episodes and sick-leave days was calculated and a trend test was performed. Results: The percentage of sick-leave episodes and days due to tobacco use was higher in men (3.9%; 5.5% respectively) than in women (2.3%; 1.5% respectively). The trend for sick-leave due to tobacco use was positive, with a maximum OR in 2013. For the number of sick-leave episodes due to tobacco use, the corrected Z was 25.3 in men (p < 0.001) and 49.4 in women (p < 0.001). For sick-leave days due to tobacco use, the corrected Z was 36.9 in men (p < 0.001) and 250.4 in women (p < 0.001). Conclusions: About 3% of sick-leave episodes with a duration over than 5 days are due to tobacco use, with a positive trend in both sexes. It is necessary to continue reinforcing the tobacco prevention and control policies in order to improve such trends for years to come

Estimación de episodios de incapacidad temporal por contingencia común relacionados con un accidente de trabajo previo en Cataluña / Estimating non work-related sickness leave absences related to a previous occupational injury in Catalonia (Spain)

Objetivo: Estimar la frecuencia de incapacidades temporales por contingencia común (ITcc) relacionadas con accidentes de trabajo (AT) previos con (ATB) o sin baja (ATSB). Métodos: Estudio longitudinal prospectivo. Se seleccionaron los trabajadores con ATB o ATSB notificados en Catalunya el último trimestre de 2009. Se hizo seguimiento durante seis meses posteriores al alta (ATB) o accidente (ATSB) según sexo y ocupación. Las fuentes de información fueron los registros oficiales de la autoridad laboral y sanitaria. Se definió 'ITcc compatible con AT' si la incapacidad temporal se producía en los seis meses siguientes por el mismo grupo diagnóstico. Se calculó la frecuencia absoluta y relativa de ITcc según tiempo transcurrido y su duración (días acumulados, medidas de tendencia central y dispersión) según grupo diagnostico o área del cuerpo afectada comparándola con la del conjunto de Catalunya. Resultados: Un 2,9% de los ATB (n=627) presentó una ITcc compatible con AT con diferencias según diagnóstico, sexo y ocupación, siendo el mismo caso para el 2,1% de los ATSB (n=496). A igual diagnóstico, la duración de los ATB fue superior entre los que tuvieron después una ITcc compatible con ellos y la duración de éstas ITcc, superior al conjunto de Catalunya. Conclusiones: Parte de la infradeclaración de patología laboral corresponde a episodios reconocidos como laborales en un primer momento. La duración de la incapacidad no dependería únicamente del diagnóstico y curso clínico sino también de criterios de gestión de las Mutuas que podrían determinar que las lesiones más complicadas fueran derivadas a la asistencia pública con consecuencias personales, legales, sanitarias y económicas para todos los implicados (AU)

Objectives: To estimate the frequency of non-work sickness absence (ITcc) related to previous occupational injuries with (ATB) or without (ATSB) sick leave. Methods: Prospective longitudinal study. Workers with ATB or ATSB notified to the Occupational Accident Registry of Catalonia were selected in the last term of 2009. They were followed-up for six months after returning to work (ATB) or after the accident (ATSB), by sex and occupation. Official labor and health authority registries were used as information sources. An 'injury-associated ITcc' was defined when the sick leave occurred in the following six months and within the same diagnosis group. The absolute and relative frequency were calculated according to time elapsed and its duration (cumulated days, measures of central trend and dispersion), by diagnosis group or affected body area, as compared to all of Catalonia. Results: 2,9% of ATB (n=627) had an injury-associated ITcc, with differences by diagnosis, sex and occupation; this was also the case for 2,1% of ATSB (n=496). With the same diagnosis, duration of ITcc was longer among those who had an associated injury, and with respect to all of Catalonia. Conclusions: Some of the under-reporting of occupational pathology corresponds to episodes initially recognized as being work-related. Duration of sickness absence depends not only on diagnosis and clinical course, but also on criteria established by the entities managing the case. This could imply that more complicated injuries are referred to the national health system, resulting in personal, legal, healthcare and economic cost consequences for all involved stakeholders (AU)

Duración de los episodios de incapacidad temporal por contingencia común según regiones sanitarias en Catalunya / Duration of work absence attributable to non work-related diseases by health regions in Catalonia

Fundamentos: En este estudio se analizó la duración de los episodiosde incapacidad temporal por contingencia común en Cataluñasegún regiones sanitarias. Partiendo de la hipótesis de una distribuciónhomogénea de las duraciones entre las regiones sanitarias.Métodos: Estudio de cohorte retrospectiva de 811.790 episodiosobtenidos del Institut Català d’Avaluacions Mèdiques iniciados elaño 2005 y seguidos hasta su finalización, cómo máximo julio de2007, donde se describió la mediana de la duración en días de los episodiospara cada una de las siete regiones sanitarias de Cataluña. Laprobabilidad de volver al trabajo se representó según las curvas desupervivencia de Wang_Chang y se comparó la duración mediana(DM) tomando como referencia la Región Sanitaria Barcelona,estratificando por sexo.Resultados: La región de Camp de Tarragona registra la menorduración de 5 días. Por contra, los episodios ocurridos en el Alt Pirineui Aran presentaron una mayor duración de 13 días. Para la regiónde Barcelona la duración fue 7 días, al igual que para Cataluña Central.En Girona fue de 8 días, y en Lleida y Terres de l’Ebre de 9 días.Conclusiones: Existen diferencias significativas en las duracionesde los episodios entre las regiones sanitarias de Cataluña, que semantienen después de ajustar por la edad, la gestión del episodio y elrégimen de Seguridad Social, tanto para hombres como para mujeres(AU)

Background: This study analyze the duration of episodes ofwork absence due to non work-related diseases in Catalonia byhealth regions, assuming a homogeneous distribution of durationsbetween health regions.Methods: A retrospective cohort study of 811.790 episodes in2005 and followed to episode closure through July 2007 provided bythe Institut Català d’Avaluacions Mèdiques, describing their medianduration (MD) in days for each of the seven health regions of Catalonia.The probability of returning to work was plotted according toWang_Chang survival curves and median durations were then comparedusing the Barcelona health region as the referent group.Results were extended through stratification by sex.Results: The Camp de Tarragona health region had the shortestMD (5 days), while the episodes in the Alt Pirineu i Aran region hadthe longest (MD, 13 days). The Barcelona health region had a MD of7 days as was the case for Cataluña Central. MD in Girona was 8days, and in Lleida and Terres de l’Ebre it was 9 days. This latterregion also had the highest median duration 13 days.Conclusions: The are significant differences in the duration ofwork absence between the health regions of Catalonia. These differencespersisted after adjusting for age, management of episodes andsocial security system status, in both men and women(AU)