The Prognosis Following Certification With Asbestosis In The United Kingdom

Our plain-English summary of The Prognosis Following Certification With Asbestosis In The United Kingdom, by G. Berry (1980).

The study

• Author: G. Berry
• Published: Biological Effects Of Mineral Fibres (J.C. Wagner, Editor), Lyon: Iarc Scientific Publications, Volume 30, Pp. 603-608 (1980)
• Type of article: Conference paper
• Our copy: from Johns-Manville's own medical library, J-M no. 002172. The article is still under copyright, so we describe it here rather than post it.

In plain English

This study followed up men first awarded compensation for asbestosis by the London, Cardiff and Swansea Pneumoconiosis Medical Panels in the UK between 1952 and 1976. Women, men certified at death, and men diagnosed with lung cancer or mesothelioma at first certification were excluded, leaving 665 men. Of these, 283 had died, at an average age of 62. 36% of the deaths were due to lung cancer, 25 (9%) to mesothelioma and 57 (20%) primarily to asbestosis. Compared with England and Wales death rates, the all-causes death rate was 2.6 times that expected and the lung cancer rate 8.5 times. The excess was higher for the London men than for the Cardiff men. The author noted that regional differences in lung cancer rates might explain part of this. Risks were greater at higher benefit percentages. Men awarded only 10 or 20% still had lung cancer death rates nine times (London) and three times (Cardiff) those expected, and remained at risk of death from mesothelioma and asbestosis. Excess deaths appeared in the first year after certification, and men surviving 10 years were still at risk afterwards.

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: Follow-up (retrospective cohort) study of compensation records and autopsy findings. Observed deaths were compared with deaths expected from England and Wales death rates using the subject-years at risk method.
• Who was studied: 665 men first awarded benefit for asbestosis during 1952-1976 at the London, Cardiff and Swansea Pneumoconiosis Medical Panels, UK. The panels had 481, 274 and 24 cases in total, but 39 files could not be located. The 23 women were excluded, as were men certified at death and men diagnosed with lung cancer or mesothelioma when first certified. Age at certification ranged from 28 to 85 years, with a mean of 55.
• Exposure: Occupational exposure to asbestos. Some men worked with insulating materials (for example lagging or spraying); the percentage is illegible in the scan. The rest made asbestos products or used or came into contact with asbestos products at work. Fiber types are not specified.
• Main results:
  • Of the 665 men, 283 had died; the average age at death was 62.
  • Lung cancer caused 36% of the deaths among all study men.
  • 25 deaths (9%) were due to mesothelioma.
  • 57 deaths (20%) were due primarily to asbestosis.
  • Compared with England and Wales death rates, the death rate for all causes among all study men was 2.6 times that expected.
  • The lung cancer death rate among all study men was 8.5 times that expected.
  • The all-causes death rate was three times that expected for the London men and about twice that expected for the Cardiff men. The lung cancer rate for the Cardiff men was six times that expected; the London figure is illegible in the scan.
  • The mesothelioma death rate was 7 per 1000 subject-years for the London men and 4 per 1000 for the Cardiff men. This difference was not statistically significant.
  • Asbestosis deaths occurred at a similar rate, 13 per 1000 subject-years, at both panels.
  • Excess deaths appeared in the first year after certification. In that year the London men had 33 deaths (10 lung cancer, 5 mesothelioma, 6 asbestosis), and the Cardiff men had 18 deaths (7 lung cancer, 3 mesothelioma, 1 asbestosis).
  • The percentage benefit awarded at first certification had the largest influence: the higher the compensation, the greater the excess lung cancer rate and the risk of dying of mesothelioma or asbestosis. Men awarded only 10 or 20% still had lung cancer death rates nine times (London) and three times (Cardiff) those expected, and were also at risk of death from mesothelioma and asbestosis.
  • Relative to expectation, men certified when younger than 55 had higher excess total and lung cancer death rates than older men. In absolute terms, older men had the larger risk because expected death rates are higher at older ages. Other factors had small effects.
  • Men who survived for 10 years after certification were still at risk after this time.
• The authors' conclusion: The author concluded that mortality was related to the rate of compensation awarded but was still high from lung cancer, mesothelioma and asbestosis for men awarded the lowest rates. The excess was apparent in the first year after certification and still operating after 10 years in survivors.
• Limitations the authors state:
  • Part of the difference in excess lung cancer mortality between the London and Cardiff panels may be explained by regional differences in lung cancer death rates.

Topics

Medical terms in this study, explained in our Lexicon: Prognosis, Pneumoconiosis, Lung Cancer, Mesothelioma.

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