Significant gaps in workplace illness health data

Data on occupational diseases in Ireland is poor, fragmented, and inconsistent, the Annual Scientific Meeting 2019 of the Irish Thoracic Society heard.

Better data is needed as occupational diseases are a heavy burden on both workers and employers, and represent an enormous cost to the economy.

Presenting at the annual gathering, Research Assistant at the University of Manchester, Dr Ana Barradas said that The Health and Occupation Research (THOR) Network is seeking more respiratory physicians to report to it, in order to improve the information collected.

Presenting on the surveillance of work-related respiratory disease in Ireland on behalf of the Health and Safety Authority (HSA) and her university, Dr Barradas said the poor data collection is due to lack of regulation.

“There is no mandatory requirement for employers to report an occupational disease or a work-related injury to the HSA unless it is liable for compensation or if it’s going to result in absence from work,” she outlined.

The HSA recognised that the Irish system suffers from unreliable data and under-reporting, and has established a number of voluntary surveillance schemes to rectify this.

The THOR Network, which was established in 2005, is financially supported and promoted by the HSA and administered by the University of Manchester. It is composed of four different reporting schemes: One for respiratory physicians; dermatologists; occupational physicians; and GPs. All occupational diseases, such as respiratory, dermatological, musculoskeletal, audiological,  infectious disease, and mental ill health are reported.

The reporting is done electronically, and while anonymous, physicians are asked to include a diagnosis, and give the patient’s gender, age, injury, and occupation. The suspected agents of the injury are also to be included.

Between 2005 and 2018, 2,557 cases were reported to the THOR Network ROI [Republic of Ireland], with 10 per cent being respiratory disease. Of these, 85 per cent were reported by chest physicians, with the remaining 15 per cent reported by occupational health physicians. The majority, 32 per cent, were asthma cases. In terms of gender, 85 per cent were male and the mean age was 57 years (19-to-87 years).

Dr Barradas said that researchers have found a difference between what the specialists and occupational health physicians report.

“Although both schemes are reporting a majority of asthma cases, the case mix is quite different,” she added. Occupational health physicians tend to report diagnoses such as rhinitis, tuberculosis, sinusitis and cough. However, respiratory specialists report more lung latency diseases, such as non-malignant pleural disease, infectious disease, and lung cancer etc.

Construction workers and those involved in the manufacture of cement, and production of food and beverages were the most frequently reported. There was quite a diverse list regarding suspected agents, she said, but the most frequently reported were cement, plaster, and masonry dust.

“For the long-term latency diseases, asbestos is the most frequently cited,” she said.

She also presented details on the average crude and adjusted incidence rates per 100,000 persons of work-related respiratory disease reported by chest physicians in Ireland. The overall crude figure was 0.7, and adjusted for participation and response it was 20.6. For asthma, the crude rate is 0.2 and the adjusted figure was 6.3. The asbestos-related crude incidence is 0.2, adjusted to 6.9.

She stressed that the THOR Network is the only source of medically attributed data on work place ill health in Ireland and asked for the gathered clinicians to consider reporting to the network.

“So apart from contributing to the prevention of occupational disease, there are a number of benefits for reporters such as continuing professional development and research opportunities,” she said.

It was questioned from the floor whether the farming sector and self-employed people were under-represented in the figures. Dr Barradas said that this was one of the things researchers tended to adjust for as not every working sector has access to occupational physicians or occupational health in general.

There was also the suggestion that doctors be provided with assistance to upload the data and Dr Barradas said the network is open to suggestions on how to improve.