Asbestos Disease Report: Disease Data Limitations Continued

Read the report from the CDC regarding the lung diseases associated with exposure to asbestos and other carcinogens. This section continues the discussion of the disease data limitations noted in the final report.

Byssinosis and asthma lack the characteristic fibrosis and associated radiographic appearance commonly observed in mineral dust pneumoconioses. In addition, advanced stages of asthma and byssinosis may be difficult to distinguish from other chronic obstructive pulmonary diseases, including those due solely to cigarette smoking. For both these reasons, under-diagnosis may be more likely for byssinosis and work-related asthma than for the radiographically apparent pneumoconioses.

Categorization of lung diseases for which mortality data are presented in this report is limited by the ICD coding system used for the NCHS multiple cause of death data. Also, ICD-8, ICD-9, and ICD-10 disease rubrics differ somewhat for all types of pneumoconioses. However, the effect of ICD changes is not substantial for most of the diseases under consideration (e.g., there is no indication of any changes in the yearly trend in national silicosis mortality related to changes in the rubrics for the ICD code related to silicosis).

Prior to ICD-10, there was no discrete ICD code for malignant mesothelioma, a disease strongly associated with exposure to asbestos. ICD-10 coding of national death data in the United States began with 1999 deaths; thus, only one year of malignant mesothelioma data is presented in this report. Past reports in this Work-Related Lung Disease Surveillance Report series have presented data on mortality associated with “malignant neoplasm of the pleura,” but that former ICD category lacked specificity and sensitivity for malignant mesothelioma.

A general assumption of work-relatedness for pneumoconiosis deaths is reasonable for surveillance purposes. However, a very small proportion of pneumoconiosis decedents may have developed their disease as a result of non-occupational (e.g., avocational) exposure to pneumoconiotic agents.

Courtesy of the CDC.

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