Estimating mortality from coal workers' pneumoconiosis among Medicare beneficiaries with pneumoconiosis using binary regressions for spatially sparse data

Our plain-English summary of Estimating mortality from coal workers' pneumoconiosis among Medicare beneficiaries with pneumoconiosis using binary regressions for spatially sparse data, by R. Paul, O. Adeyemi, A.A. Arif (American Journal of Industrial Medicine, 2022).

The study

• Authors: R. Paul, O. Adeyemi, A.A. Arif
• Journal: American Journal of Industrial Medicine
• Published: 2022;65(4):262-267
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Coal workers' pneumoconiosis (CWP) is an occupational lung disease due to inhalation of coal dust. We estimated mortality from CWP and other pneumoconioses among Medicare beneficiaries.

Methods: We used the 5% Medicare Limited Claims Data Set, 2011-2014, to identify patients diagnosed with ICD-9-CM 500 (CWP) through 505 (Asbestosis, Pneumoconiosis due to other silica or silicates, Pneumoconiosis due to other inorganic dust, Pneumonopathy due to inhalation of other dust, and Pneumoconiosis, unspecified) codes. We applied binary regression models with spatial random effects to determine the association between CWP and mortality. Our inferences are based on Bayesian spatial hierarchical models, and model fitting was performed using Integrated Nested Laplace Approximation (INLA) algorithm in R/RStudio software.

Results: The median age of the sample was 76 years. In a sample of 8531 Medicare beneficiaries, 2568 died. Medicare beneficiaries with CWP had 25% higher odds of death (adjusted OR: 1.25, 95% CI: 1.07, 1.46) than those with other types of pneumoconiosis. The number of comorbid conditions elevated the odds of death by 10% (adjusted OR: 1.10, 95% CI: 1.09, 1.10).

Conclusion: CWP increases the likelihood of death among Medicare beneficiaries. Healthcare professionals should make concerted efforts to monitor patients with CWP to prevent premature mortality.

© 2022 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.

In plain English

This brief report used US Medicare claims to compare deaths between people with coal workers' pneumoconiosis (CWP) and those with other pneumoconioses. It used claims from 2011 to 2014 for a random 5% of people enrolled in Medicare Fee-For-Service in the 48 contiguous states. Of 8531 beneficiaries with a pneumoconiosis diagnosis, 2568 died. Of all 8531, 1632 (19.1%) had CWP and 5932 (69.53%) had asbestosis. The authors' Bayesian logistic regression models accounted for county of residence. In the fullest model, people with CWP had higher odds of death than those with other pneumoconioses (odds ratio 1.25, 95% credible interval 1.06 to 1.46). In the unadjusted counts, people with CWP were 18.3% of those who died and 19.5% of those alive (p 0.224, not statistically significant). Each additional comorbid condition was linked to higher odds of death (fullest model: odds ratio 1.10; interval 1.09 to 1.10 in the table, 1.09 to 1.11 in the text). The authors concluded that beneficiaries with CWP had significantly elevated odds of death. They noted that Medicare data lack occupation information and covered only four years.

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: Brief report; analysis of Medicare claims data using Bayesian logistic (binary) regression models with county-level and spatial random effects
• Who was studied: 8531 Medicare beneficiaries with a pneumoconiosis diagnosis (ICD-9-CM codes 500 to 505), drawn from a random 5% of people enrolled in Medicare Fee-For-Service, 48 contiguous US states, 2011 to 2014. The median age was 76 years; 86.7% were male, 89.9% were white and 28.3% lived in rural counties.
• Exposure: Type of pneumoconiosis diagnosis: CWP (ICD-9-CM 500) compared with all other pneumoconioses (ICD-9-CM 501 to 505). Of the 8531 people, 1632 (19.1%) had CWP and 5932 (69.53%) had asbestosis, so asbestosis made up most of the comparison group. No occupation or dust exposure data were available. County-level factors (rural or urban, poverty rate, presence of active or abandoned mines) were also examined.
• Main results:
  • Of 8531 beneficiaries with pneumoconiosis, 2568 died during 2011 to 2014.
  • Beneficiaries with CWP, compared with those with other pneumoconioses: odds ratio for death 1.24 (95% credible interval 1.07 to 1.45) in Model 2 and 1.25 (95% credible interval 1.06 to 1.46) in Model 3, both including all explanatory variables.
  • In Model 1, which included one explanatory variable at a time adjusted for age, beneficiaries with CWP had an odds ratio for death of 1.18 (95% credible interval 1.04 to 1.34).
  • In the unadjusted descriptive table, people with CWP made up 1161 (19.5%) of the 5963 alive and 471 (18.3%) of the 2568 who died (p 0.224).
  • Each additional comorbid condition was associated with higher odds of death in all three models. The results text gives odds ratios of 1.09 (1.08 to 1.10), 1.09 (1.09 to 1.10) and 1.10 (1.09 to 1.11). Table 2 gives the Model 3 interval as 1.09 to 1.10.
  • Living in a rural county was associated with higher odds of death in Model 1 (odds ratio 1.14, 95% credible interval 1.03 to 1.27), but the intervals in Models 2 and 3 included 1.
  • Among those who died, the four major comorbid conditions were hypertension, COPD, atrial fibrillation and congestive heart failure.
• The authors' conclusion: The authors concluded that Medicare beneficiaries with CWP carried a substantial burden of comorbidities and had significantly elevated odds of death compared with beneficiaries with other types of pneumoconiosis.
• Limitations the authors state:
  • Medicare claims contain no occupation information, so the authors could not tell how many people got the disease from working in coal mines.
  • With only 4 years of data, the study could not account for length of exposure or the long-term progression of the disease.
  • County of residence came from Medicare enrollment records and may differ from where people lived while employed.
  • Several counties had small numbers of deaths, which can increase uncertainty in the estimates.
  • Diagnostic coding errors cannot be ruled out.

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Occupational Lung Disease, Silicate.

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