Predictors of filing claims and receiving compensation in malignant mesothelioma patients

Our plain-English summary of Predictors of filing claims and receiving compensation in malignant mesothelioma patients, by A. Marinaccio, C. Gariazzo, D. Di Marzio, et al (Health Policy, 2020).

The study

• Authors: A. Marinaccio, C. Gariazzo, D. Di Marzio, S. Iavicoli, ReNaM Working Group
• Journal: Health Policy
• Published: 2020;124(9):1032-1040
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Although the predominant occupation origin of mesothelioma is well known, determinant factors involved in filing compensation are scarcely investigated. A linkage between incident mesothelioma cases collected by Italian mesothelioma register (ReNaM) and compensation claims and assignment by Italian national insurance Institute (INAIL) has been conducted for cases diagnosed in the period 2010-2015 and occupational exposure to asbestos. Logistic regression models and decision tree models have been used to identify demographic, diagnostic and anamnestic factors significant for filing and receiving compensation. We have included in the analyses 5019 mesothelioma cases, and among them, 3321 (66.2 %) were found in INAIL archives as mesothelioma cases who fil claims for compensation. The modalities of asbestos exposure, sector of working activities and job type are crucial factors. Furthermore, gender, age at diagnosis, area of residence have been found to be significant predictors of probability to fil claims. Relative risks to fil claims were obtained for the above determinants and conditions to maximize the probability to obtain compensation identified. Our findings demonstrate that there is a need to enforce policies for improving awareness of the occupational origin for mesothelioma cases. Stakeholders, occupational health and safety institutions can play an important role for improving the sensitization regarding the rights of compensation benefits, ensuring the equity and the effectiveness of insurance, welfare and public health systems.

Copyright © 2020 Elsevier B.V. All rights reserved.

In plain English

This Italian study linked national mesothelioma register (ReNaM) records with workers' compensation (INAIL) archives. It examined which patients filed compensation claims and which received compensation. It included 5019 malignant mesothelioma cases diagnosed in 2010–2015 that the register judged occupational in origin. Of these, 3321 (66.2%) filed a claim, and 2517 claimants (76%) received compensation. In adjusted models, filing was more likely among men than women (relative risk 1.44, 95% CI 1.19–1.74), patients under 65 compared with those over 74 (1.84, 1.53–2.23), and residents of the North-West (2.68, 2.15–3.33) and North-East (3.68, 2.89–4.69) compared with Southern Italy and the Isles. It was also more likely among patients with a certain rather than possible diagnosis, patients interviewed themselves rather than through relatives, blue-collar workers, and workers in sectors using asbestos directly. Among claimants, men compared with women (2.56, 1.99–3.29) and workers from direct-use sectors (5.47, 3.53–8.50, compared with asbestos present in the workplace) were more likely to receive compensation. Area of residence showed no clear role in receiving compensation. The authors concluded that compensation claims for mesothelioma remain lower than expected.

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: Record linkage study: individual-level linkage of a national mesothelioma registry with workers' compensation claim archives, analysed with adjusted logistic regression and decision tree (CHAID) models
• Who was studied: 5019 malignant mesothelioma cases (all anatomical sites, more than 95% pleural) registered by the Italian National Mesothelioma Register, diagnosed 2010–2015, with occupational asbestos exposure as assessed by the register; 4369 men and 650 women
• Exposure: Occupational asbestos exposure (fiber types not specified), classified by certainty level (certain, probable, possible), job type (blue or white collar) and economic sector: direct use of asbestos, asbestos in production processes, construction, asbestos in place in the workplace
• Main results:
  • Of the 5019 occupationally exposed cases, 3321 (66.2%) were found in INAIL archives as having filed for compensation
  • Of those who filed, 2517 (76%) received compensation
  • Filing a claim: men compared with women, adjusted RR 1.44 (95% CI 1.19–1.74)
  • Filing a claim: patients younger than 65 at diagnosis compared with those over 74, RR 1.84 (95% CI 1.53–2.23); patients aged 65–74 compared with those over 74, RR 1.55 (95% CI 1.34–1.79)
  • Filing a claim, compared with residents of Southern Italy and the Isles: North-West RR 2.68 (95% CI 2.15–3.33); North-East RR 3.68 (95% CI 2.89–4.69); Centre RR 1.89 (95% CI 1.47–2.44)
  • Filing a claim: certain (histologically confirmed) diagnosis compared with a diagnosis based only on radiological and clinical evidence, RR 3.09 (95% CI 2.32–4.11)
  • Filing a claim: exposure assessed by a direct interview with the patient compared with an interview with relatives, RR 1.69 (95% CI 1.48–1.94)
  • Filing a claim, by sector compared with asbestos in place: direct use RR 1.58 (95% CI 1.18–2.11); asbestos in production processes RR 1.48 (95% CI 1.16–1.89)
  • Filing a claim: construction sector compared with asbestos in place, RR 1.28 (95% CI 0.95–1.69), an interval that includes 1
  • Filing a claim: blue-collar compared with white-collar workers, RR 1.53 (95% CI 1.26–1.87)
  • Receiving compensation, among claimants: men compared with women, RR 2.56 (95% CI 1.99–3.29)
  • Receiving compensation, among claimants: certain diagnosis RR 2.73 (95% CI 1.70–4.40) and probable diagnosis RR 2.10 (95% CI 1.15–3.85), compared with possible diagnosis
  • Receiving compensation, among claimants, compared with asbestos in place: direct use of asbestos RR 5.47 (95% CI 3.53–8.50); asbestos in production processes RR 1.67 (95% CI 1.20–2.32)
  • Area of residence showed no role in the probability of receiving compensation
  • Decision tree for filing: the highest probability (91.8%) was for patients with a certain diagnosis, certain exposure, a direct interview, direct use of asbestos and residence in North-East Italy
  • Decision tree for filing: the lowest probability (17.9%) was for women with a not definite mesothelioma diagnosis
  • Decision tree for receiving compensation: for claimants with certain diagnosis, certain exposure, a direct interview and direct use of asbestos, the probability was 96.1%. It dropped to 61% when the sector was asbestos in place, and to 42.6% with a possible diagnosis
  • The decision tree models had an average prediction accuracy of 71%. They were better at predicting claims (86% on average) than no claims (42% on average)
• The authors' conclusion: The authors concluded that the level of compensation claims for mesothelioma is still lower than expected. In their view, sector of activity, job and the characteristics of asbestos exposure are crucial factors in the probability of filing.
• Limitations the authors state:
  • The authors cautioned that comparing their filing rate with other studies should be done carefully, because only cases with register-defined occupational exposure were included here
  • Because more than 95% of cases were pleural, the numbers were too small for separate analyses of extra-pleural sites
  • The apparent increase in filing in the more recent period needs confirmation in studies with longer observation

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Occupational Exposure, Asbestos Exposure, Relative Risk.

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