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Spanje: onderrapportage van asbestziekten

23-05-2006 00:00

Onderzoeken in de Spaanse deelstaten Catalonië en Navarra hebben aangetoond dat asbestziekten, zoals mesothelioom, er veel vaker voorkomen dan de officiële cijfers aangeven: in Catalonië vier keer zoveel, in Navarra drie keer zo veel. Bronnen: Artieda, L., Beloqui, A. & Lezaun, M. (2005). Cohort of asbestos exposed workers. Navarre (Spain) 1999-2004. Orriols, R. et al. (2006). Reported occupational respiratory diseases in Catalonia. Occupational and Environmental Medicine, n-63 (4), pp. 255-260. Artieda L, Beloqui A, Lezaun M. (2005). Cohort of asbestos exposed workers. Navarre (Spain) 1999-2004] An Sist Sanit Navarra Sep-Dec.28(3):335-44.
Artieda L, Beloqui A, Lezaun M. (2005). Cohort of asbestos exposed workers. Navarre (Spain) 1999-2004] An Sist Sanit Navarra Sep-Dec.28(3):335-44.


BACKGROUND: The identification of a population cohort of workers exposed to asbestos is important because it facilitates health surveillance, allowing us to fulfil the ethical obligation of recognizing the occupational origin of the illness and contributing to the development of scientific research. The goal of this study is to identify the asbestos exposed workers in Navarre and the success of the health surveillance offer. METHODS: The register of asbestos exposed workers was created in 1999. It includes companies and workers from the national register, the records of the regional institution of occupational health and the data of the occupational health services and the inspectorate of sick leave. The health programme deals with occupational and post-occupational workers. RESULTS: The cohort consists of 2,294 workers, from 33 companies, 40% of whom are active, half work manufacturing motor vehicles, 91% are exposed to chrysotile, 25% exposed to high concentrations (0.20 fibers /cm3 or more for chrysotile or 0.10 fibers /cm3 for others). The 1970s and 1990s were when most workers began to be exposed. Workers who began in the 1940s and 1950s have longer exposure times. Medical surveillance is accepted by 72%, with higher acceptance among those who are active. CONCLUSIONS: The follow-up has allowed us to recognize three times as many cases of pathology for asbestos, in comparison with those declared spontaneously in the eleven years prior to the program, which reflects its importance. The level of acceptance of the surveillance is adapted, given the methodology of the programme.

Orriols R, Costa R, Albanell M, Alberti C, Castejon J, Monso E, Panades R, Rubira N, Zock JP. (2006). Reported occupational respiratory diseases in Catalonia. Occupational and Environmental Medicine,63(4), pp 255-60.

A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system.

METHODS: In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia.

RESULTS: Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. CONCLUSIONS: The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.