\[Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018.\]

Our plain-English summary of [Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018.], by A. Esteban Porcar, M. García Gómez, L. Santana Yllobre, et al (Revista Española de Salud Pública, 2023).

The study

• Authors: A. Esteban Porcar, M. García Gómez, L. Santana Yllobre, F. Gómez Pajares, V. Esteban Buedo, R. Usó Talamantes
• Journal: Revista Española de Salud Pública
• Published: 2023;97
• Language: Spanish
• Read it: PubMed · Free full text

Abstract

Objective: Pleural mesothelioma is a neoplasm almost exclusively attributed to occupational exposure to asbestos and is legally considered an occupational disease. Nevertheless, only a few cases achieve that official recognition. The objective of this work was to describe and analyse this issue, and to identify the major obstacles to its recognition.

Methods: A descriptive and retrospective epidemiological study of data was carried out, including figures and some characteristics, of all patients with pleural mesothelioma registered in the official health and labor registries of the Valencian Community from 2012 to 2018, using frequencies, proportions, and incidence rates.

Results: There were large differences between the two sets of data collected in the different registries, especially regarding the number of cases. During the seven years of data examined, 590 pleural mesotheliomas were diagnosed in the Valencian public health system. Of these, the number of cases that were related to occupational exposure was at least 437. Despite the legal duty of doctors to report such cases, only 31 were reported as suspected occupational disease (7.09%), of which only 13 were ultimately officially recognized as such. It was estimated that the annual economic overcost to the public system of unrecognised patients with this occupational disease by was 2,2270,520 euros.

Conclusions: Only a small proportion of occupational mesotheliomas are officially recognized as such. This has important health care and economic repercussions for the individuals involved as well as for the public health system.

In plain English

This descriptive, retrospective study compared three official registries in the Valencian Community, Spain, covering pleural mesothelioma diagnosed from 2012 to 2018 in people aged 25 or older. The public health system recorded 590 cases (444 men, 146 women). The study did not measure anyone's asbestos exposure. Instead, the authors applied the lowest published shares of cases attributable to work (90% in men, 25% in women) and estimated that at least 437 cases were work-related. Doctors reported 31 of these as suspected occupational disease, which was 7.09% of the work-attributable cases. All 31 reports came from the public health system and none from occupational risk prevention services. Overall, 406 work-attributable cases were never reported. Reports rose in 2017 and 2018. In the labor registry, 13 pleural mesotheliomas were officially recognized as occupational disease, all in men. The remaining 424 work-attributable cases were treated in the public system at an estimated cost of 2,270,520 euros. The authors concluded that only a small fraction of mesotheliomas obtain recognition as occupational disease. They noted that adequate denominators for exposure and exposed workers were unavailable. As a result, specific rates were not calculated, which limited interpretation of the differences.

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: Descriptive, retrospective epidemiological study comparing official health and labor registries
• Who was studied: All cases with the diagnostic codes the authors assigned to pleural mesothelioma (ICD-9 163.0, 163.1, 163.8, 163.9; ICD-10 C38.4), in people aged 25 or older, diagnosed January 2012 to December 2018 in the Valencian Community, Spain. Cases came from three registries: SIA (outpatient clinical records), SISVEL (reports of suspected occupational disease) and CEPROSS (officially recognized occupational diseases). The public health system recorded 590 cases: 444 men and 146 women.
• Exposure: The study did not measure occupational asbestos exposure. It estimated work-attributable cases by applying the lowest attributable fraction described in the literature: 90% in men and 25% in women. No fiber types were specified.
• Main results:
  • Of the 590 diagnosed cases, at least 437 were estimated to be attributable to work (398 men, 39 women).
  • Doctors reported 31 cases to SISVEL as suspected occupational disease, 7.09% of the 437 work-attributable cases (27 men, 4 women).
  • Over the whole period, 406 work-attributable cases were not reported as suspected occupational disease.
  • All reports came from the public health system; none came from occupational risk prevention services (SPRL).
  • Of the cases reported to SISVEL, 54.84% were referred to the corresponding mutual insurer or the INSS. The article states that 25.85% were not referred because no relation to asbestos exposure was found.
  • Reports of suspected occupational disease rose in 2017 and 2018 (9 and 10 cases, compared with 1 to 3 per year earlier), tripling compared with earlier years.
  • In CEPROSS, 23 occupational cancers caused by carcinogenic agents (Group 6) were recognized in the Valencian Community from 2012 to 2018. Of these, 13 (56.52%) were pleural mesothelioma.
  • No pleural mesothelioma in a woman was recognized as an occupational disease; all recognized cases were in men.
  • Of the 23 recognized occupational cancers, 9 (39.13%) took between one and five years from diagnosis to recognition, 8 (34.78%) took more than five years, and 6 (26.09%) took less than one year.
  • The 424 work-attributable cases not recognized as occupational disease were diagnosed and treated in the public health system. Using an estimated annual cost per case of 5,355 euros, the authors estimated a total cost of 2,270,520 euros.
• The authors' conclusion: The authors concluded that only a very small proportion of pleural mesotheliomas obtain recognition as occupational disease. They stated that this has major care and economic consequences for the people affected and for the public health system.
• Limitations the authors state:
  • Adequate denominators, for exposure or for exposed workers, were not available. As a result, specific rates were not calculated, which limits interpretation of the differences, described only with absolute numbers and percentages.
  • Few studies analyze this problem, which made comparison difficult.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleura, Pleural Mesothelioma, Neoplasm, Occupational Exposure, Occupational Disease, Incidence, Mesothelioma.

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