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.

Implementation and Cost Analysis of a Novel Silicosis Case-Finding Program For Mine Workers in Rural Rwanda.

Little is known about the burden of silicosis in Africa, despite extensive mining and construction operations in the region putting numerous people at risk. The implementation experience and costs of case-finding for occupational lung disease in resource-limited settings are also currently unknown. We describe the first-ever silicosis case-finding project in rural Rwanda using chest X-ray, symptom questionnaires, and spirometry. This was coupled with routine noncommunicable disease case-finding for diabetes and hypertension. We performed an ingredient-based analysis of the costs of all case-finding activities. In 2022, over 25 days, 1,032 mine workers were included in the program, of which 1,014 (98.3%) completed silicosis case-finding activities. The total cost of the program was estimated to be US$38,656, representing a cost of US$37.49 per person. We conclude that conducting large-scale occupational lung disease case-finding is clinically and economically feasible in resource-limited settings and can be effectively integrated with routine noncommunicable disease case-finding.

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.

A century of miners' compensation in South Africa.

The year 2011 marked the centenary of compensation legislation for miners' lung disease in South Africa. This commentary aims to demonstrate that the current compensation system does not serve its intended beneficiaries, particularly the large population of former gold miners affected by high rates of silicosis and tuberculosis. The system has a complex legislative history, reflecting contending political, and economic forces, and characterized by racial discrimination. The financial basis of the system is currently in crisis owing to historical underfunding and failure to take into account the mounting burden of disease among black former miners. The real value of compensation awards fell sharply between 1973 and 1993, only partly recovering in recent years. Barriers to claiming benefits, particularly by black former miners who know little about the process, have been extensively documented. Integration of miners' compensation into general workers' compensation has been mooted since the 1980s but has stalled, owing to the high cost of closing the gap between the mostly inferior financial benefits under the mining legislation and those available under workers' compensation legislation. A recent constitutional court decision has opened the way for unprecedented civil litigation against the gold mining industry for silicosis, adding to the pressure for reform. A number of changes are called for: harmonization of financial benefits with retention of certain of the special arrangements for miner claims, a regional cross-border system of medical examination points for former miners, education of miners about the system, and some degree of privatization of claims processing.

The Utility of Length of Mining Service and Latency in Predicting Silicosis among Claimants to a Compensation Trust.

In the wake of a large burden of silicosis and tuberculosis among ex-miners from the South African gold mining industry, several programmes have been engaged in examining and compensating those at risk of these diseases. Availability of a database from one such programme, the Q(h)ubeka Trust, provided an opportunity to examine the accuracy of length of service in predicting compensable silicosis, and the concordance between self-reported employment and that officially recorded. Compensable silicosis was determined by expert panels, with ILO profusion ≥1/0 as the threshold for compensability. Age, officially recorded and self-reported years of service, and years since first and last service of 3146 claimants for compensable silicosis were analysed. Self-reported and recorded service were moderately correlated (R = 0.66, 95% confidence interval 0.64−0.68), with a Bland−Altman plot showing no systematic bias. There was reasonably high agreement with 75% of the differences being less than two years. Logistic regression and receiver operating characteristic curve analysis were used to test prediction of compensable silicosis. There was little predictive difference between length of service on its own and a model adjusting for length of service, age, and years since last exposure. Predictive accuracy was moderate, with significant potential misclassification. Twenty percent of claimants with compensable silicosis had a length of service <10 years; in almost all these claims, the interval between last exposure and the claim was 10 years or more. In conclusion, self-reported service length in the absence of an official service record could be accepted in claims with compatible clinical findings. Length of service offers, at best, moderate predictive capability for silicosis. Relatively short service compensable silicosis, when combined with at least 10 years since last exposure, was not uncommon.

The social costs of uranium mining in the US Colorado Plateau cohort, 1960-2005.

OBJECTIVES: Long-term social costs associated with underground uranium mining are largely unknown. This study estimated health costs of Native American and white (Hispanic and non-Hispanic origin) uranium miners in the US Public Health Service Colorado Plateau cohort study. METHODS: Elevated uranium miner person-years of life lost (PYLL) were calculated from the most recent study of the Colorado Plateau cohort over 1960-2005. Nine causes of death categories were included. Costs to society of miner PYLL were monetized using the value of a statistical life-year approach. RESULTS: Costs over 1960-2005 totaled $2 billion USD [95% CI: $1.8, $2.2], or $2.9 million per elevated miner death. This corresponds to $43.1 million [95%: $38.7, $48.7] in annual costs. Lung cancer was the most costly cause of death at $1.4 billion [95%: $1.3, $1.5]. Absolute health costs were largest for white miners, but Native Americans had larger costs per elevated death. Annual excess mortality over 1960-2005 averaged 366.4 per 100,000 miners; 404.6 (white) and 201.5 per 100,000 (Native American). CONCLUSIONS: This research advances our understanding of uranium extraction legacy impacts, particularly among indigenous populations.

Sleights of Hand: South Africa's Gold Mines and Occupational Disease.

South Africa's gold mines were the first to compensate silicosis and tuberculosis as occupational diseases. They were also the first mines to introduce a state-sanctioned regime of medical surveillance. Despite those innovations, the major mining houses are currently facing class actions by former miners with occupational lung disease. The obvious reason for this medical and legislative failure is to be found in the economic fabric of South Africa's gold industry. In this article, I will argue that it is also found in the system of mine medicine, which was designed to hide rather than reveal the actual disease rates.

The Energy Employees Occupational Illness Compensation Program Act: new legislation to compensate affected employees.

Nurses make a bureaucracy work on behalf of clients. Occupational health nurses who are already versed in basic concepts applicable to EEOICPA--confidence intervals, occupational histories, exposure assessment, and dose response--can play constructive, caring roles in assisting claimants in securing benefits under this landmark program. Occupational health nurses know that chronically ill employees have a finite number of hours a week to make phone calls, visit providers, and advocate on their own behalf. Thoughtful referrals to occupational health providers who are both experienced and supportive can come from an occupational health nurse or a family physician. Involvement of university-based programs in projects to empower organizations representing EEOICP claimants would be a welcome development.

Silicosis and workers' compensation in New Jersey.

The employer is expected to maintain responsibility for health care expenses and lost income that result from occupational injury and illness through the workers' compensation insurance system. However, financial support for individuals with occupational illnesses, especially those with long latency, is often from sources other than workers' compensation. Silicosis, a well defined, chronic, occupational lung disease, can be viewed as a sentinel for the inadequacy of the public policy to compensate workers for chronic occupational lung disease. Three hundred twenty-nine patients with confirmed silicosis were identified by the silicosis surveillance program in the New Jersey Department of Health using source data from 1979 through 1992. One hundred seventy-seven of these individuals provided information on the status of any compensation claims against their employer. Only 31% of these patients stated that a claim had been filed; 84% of those whose claims were settled were awarded payments. Severity of radiologic findings was not associated with the likelihood of filing a claim or with being awarded a payment; whereas, smoking was associated with these outcomes. The implications of these findings for the health care system are discussed.

Mortality of workers compensated for silicosis during the period 1959-1963 in the Veneto region of Italy.

After reports appeared from other countries indicating an excess risk of lung cancer among silicotics, a cohort of workers compensated for silicosis during the period 1959-1963 in the Veneto region of Italy was constructed and followed for mortality through 1984. The results of the study showed a large mortality excess for infectious diseases (180 observed versus 9.5 expected), due to silicotuberculosis, and for diseases of the respiratory system (270 observed versus 33.5 expected) due to silicosis. An elevated standardized mortality ratio of 239 (70 observed versus 29.3 expected) from lung cancer was also detected. An increasing pattern was observed with time since first exposure, while the relationship with employment category and duration of exposure was less clear-cut. The lung cancer excess was also strongly associated with cigarette smoking, there being a dose-response relationship with daily cigarette consumption. The study confirms the results from other epidemiologic studies on silicotics which show this pathological condition to be associated with increased lung cancer mortality.

Policy development for compensating workers exposed to crystalline silica in Ontario, Canada.

The Ontario Workers' Compensation Board develops policy for diseases by considering scientific information within legal, political, and social contexts. The purpose of this paper is to describe the process used to develop a policy for lung cancer among gold miners and to examine the extent to which this process assists the development of similar guidelines for workers with silica dust exposure. The scientific and policy questions are similar, both requiring consultation with stakeholders. To improve the development process for the gold miner policy, consultation for silica and lung cancer needs to be more inclusive. The resulting procedures would also need to be precise enough to assist adjudicators to make decisions without limiting their ability to decide each claim on the merits of the case. The major challenge is to ensure that the final policy is scientifically and legally supportable and acceptable to both workers and employers.

[Silicosis or chronical obstructive bronchitis/emphysema as compensatory occupational disease]. / Silikose oder chronische obstruktive Bronchitis/Emphysem als entschädigungspflichtige Berufskrankheit?

We report on a 73-year-old man, who developed chronical bronchitis after 15 years of working as a coal miner. About 3 decades later a manifest COPD, and additionally a silicosis, were diagnosed. The silicosis was rated as an accepted case for the hazard insurance, but not as a reason for pension. The reasoning for the declining of pension for the applicant is refuted by the literature which defines occupational diseases and is generally accepted by the legislation. In this case the insurance argued that in low- to medium-grade spread of silicosis functional deficits of the lung and/or the cardio-vascular system are not to be expected. Thus the recognition and recompensation of a BK 4101 (grinders' disease, silicosis) was proposed, in contrast to the social court which demanded an expert's opinion on causality.

The cost effectiveness of occupational health interventions: prevention of silicosis.

BACKGROUND: The failure to recognize occupational health as an economic phenomenon limits the effectiveness of interventions ostensibly designed to prevent disease and injury. Hence, consideration of economic efficiency is essential in the evaluations of interventions to reduce hazardous working conditions. In this paper, we present an analysis of the cost effectiveness of alternative means of preventing silicosis. METHODS: To evaluate the cost effectiveness of specific interventions for the prevention of occupationally induced silicosis, we have used the simulation models based on the generalized cost-effectiveness analysis (GCEA) developed by the WHO-CHOICE initiative for two representative subregions namely AMROA (Canada, United States of America), and WPROB1 (China, Korea, Mongolia). RESULTS: In both of the two subregions, engineering controls are the most cost effective with ratios varying from 105.89 dollars per healthy year or disability adjusted life year saved in AMROA to approximately 109 dollars in WPROB1. In the two subregions, the incremental cost-effectiveness ratio of engineering controls (EC) looks most attractive. Although dust masks (DM) look attractive in terms of cost, the total efficacy is extremely limited. CONCLUSIONS: To the extent that this analysis can be generalized across other subregions, it suggests that engineering control programs would be cost effective in both developed and developing countries for reducing silica exposure to save lives. Note that this analysis understates health benefits since only silicosis and not all silica-related diseases are considered.

[Silicosis in Switzerland. The jurist's viewpoint: compensation for silicotic patients by the National Fund]. / La silicose en Suisse. Le point de vue du juriste: l'indemnisation du silicotique par la Caisse nationale.

Occupational diseases are defined in the light of present and forthcoming legislation. Administrative processing and the conditions for indemnity are described. The problems surrounding the level of disability pensions for silicotics and the determination of annual income are central to the discussion. International conventions and judicial procedures are briefly reviewed.

Compensation for occupational lung disease in non-mining industry.

The course from claim submission (by the National Centre for Occupational health (NCOH)) to compensation (by the Workmen's Compensation Commissioner (WCC)) in 56 cases of occupational disease (OD) was traced. Success rates were determined and the procedural factors which affect claim outcomes isolated. Of note are the 22% of claims which remained unresolved 3 years after submission. The long latent period of ODs causes difficulty in obtaining the employer's corroborating documentation; this was found to be a major factor in the non-resolution of claims. Active intervention by the NCOH resulted in claim resolution for an additional 9%. These findings support the proposal that the WCC establish a network of access points for workers where assistance from trained staff is available. It is further recommended that the WCC accept substitutes for the employer's documentary proof in cases where this is unobtainable.