Prevalence of Occupational Lung Disease Justifies Greater Prevention Efforts

The rising costs - estimated at over $8 billion in 2001 - and incidence of occupational lung diseases warrant preventive intervention, say researchers in a new study.

The rising costs and incidence of occupational chronic obstructive pulmonary disease (COPD) and asthma warrant preventive intervention, says a study reported in the journal CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP).

Looking at both direct and indirect costs, the study found that $6.6 billion was spent on obstructive lung diseases in 1996, and likely increased in subsequent years.

"These costs are significant, especially since the lion's share is borne by diseased workers and their families, by all workers through lower wages, and by taxpayers," said study author J. Paul Leigh, PhD, professor of health economics in the Department of Epidemiology and Preventive Medicine, School of Medicine, University of California at Davis.

Given the increasing prevalence of COPD and asthma as well as inflation, the cost of occupational lung diseases was probably around $8.5 billion in 2001, said Leigh, adding "Clearly this is a significant price tag that deserves attention."

Reviewing data from national surveys and applying a population attributable risk (PAR) of 15 percent for both asthma and COPD, the study team found costs of $5 billion for COPD (56 percent were direct costs; 44 percent were indirect) and $1.6 billion for asthma (74 percent were direct; 26 percent were indirect). Direct costs included medical and administrative expenses and indirect costs included lost wages, lost fringe benefits and lost home production. In terms of human deaths, the study estimated 15,032 occupational COPD deaths and 805 occupational asthma deaths in 1996, assuming a 15 percent PAR.

"These numbers should not be taken lightly," said ACCP President Sidney S. Braman, MD, FCCP. "The incidence of occupational obstructive lung disease is significant and represents an important burden on the health care system and a drain on the economy. As chest physicians, we are seeing a rise in incidence that without intervention will only continue."

Obstructive lung diseases, including asthma and COPD, represent the fourth-leading cause of death in the United States. From 1980 to 1994, the obstructive lung disease death rate in women nearly doubled, due in part to increased smoking and the rapid increase of women in the workforce.

Occupational-related asthma and COPD far exceeds death rates for coal workers' pneumoconiosis, asbestosis and mesothelioma.

"COPD and asthma incidence can be reduced or prevented by cutting down on dust and particulate matter in the workplace air," said Leigh. "One way to reduce the pollution might be to tax the industries that generate poor air and use those funds to pay Medicare directly. That approach provides an incentive for industry to clean up their air while lessening the financial burden on Medicare, and thus the taxpaying public."

In an effort to raise awareness of COPD and encourage people to seek early diagnosis and treatment, the White House recently proclaimed November National COPD Awareness Month. In the coming months, partner organizations will be conducting screening programs, workshops and other special events to help people recognize the risk factors and symptoms of COPD.

CHEST is a peer-reviewed journal published by the American College of Chest Physicians (ACCP). It is available online each month at

edited by Sandy Smith ([email protected])

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