Thor Trends 12

Time trends in the incidence of work-related illhealth in the UK, 1996-2011: estimation from THOR surveillance data
Carder M, McNamee R, Hussey L, Turner S, Agius R

Centre for Occupational and Environmental Health, Health Sciences Group, School of Community Based Medicine, Faculty of Medical and Human Sciences, the University of Manchester
http://www.medicine.manchester.ac.uk/oeh/research/thor/ September 2012
EXECUTIVE SUMMARY
BACKGROUND: This report describes the latest analyses of case reports collected by The Health and Occupation Research (THOR) network to investigate the trend in the physician reported incidence of work-related illness (WRI) over time. Case reports of WRI from the three THOR schemes currently supported by HSE were analysed: skin disease reported to EPIDERM by dermatologists (1996-2011), respiratory disease reported to SWORD by chest physicians (1999-2011), and (any) WRI reported to THORGP by general practitioners (2006-2011).
METHOD: The methodology employed remained unchanged from that described previously. The statistical software package STATA was used to fit longitudinal, negative binomial (i.e. over-dispersed) Poisson models with random effects. The dependent variable was the number of actual cases, including zeros, per reporter per month. Variables were also included to represent season, reporter type (core or sample), and first month/s as a new reporter. Changes in the population base were accounted for by including an offset variable representing the UK working population for each year. Change in incidence was measured in two different ways related to the treatment of calendar time in the model: a non-parametric approach containing separate indicators for different years (2011 as the reference year) and a parametric approach with continuous time variable measured on a scale of years.
RESULTS: Case reports of skin disease to EPIDERM were predominantly contact dermatitis (CD) (81%) with smaller proportions of neoplasia (12%) and other skin diagnoses. Overall the addition of a further year of data (2011) had little impact on the annual average change in incidence of work-related skin disease which remained similar to those previously reported i.e. indicating a small but significant yearly reduction in incidence. The updated results were -3.4% (95% CIs:-3.9, -2.8) for all skin diagnoses, -3.3% (95% CIs:-3.9,-2.6) for CD, -5.6% (95% CIs:-7.5, -3.6) for contact urticaria and -2.6% (95% CIs:-4.1, -1.0) for neoplasia. Relative rates by year, however, suggested a larger 2
decrease between 2010 and 2011 compared to changes between other years but this may be related to a change in reporting options. Previously reported upon variations between type of CD (allergic, irritant, and mixed) and between reporter type (core and sample) were still observed. An overall (but not statistically significant) decrease in the incidence of GP reported skin disease (10% of the total case reports to THOR-GP were skin) was also observed at -5.3% (95% CIs: -13.2, 2.3) for the period 2006-2011.
The majority of the case reports by chest physicians to SWORD were the (primarily) asbestos related diseases; benign pleural plaques (44%), and mesothelioma (20%), as well as pneumoconiosis (8%), with a further 20% being asthma. An overall, statistically significant, decrease in incidence was observed for asthma of -7.7% (95% CIs: -9.2, -6.2) per year. A significant downward trend was also observed for mesothelioma (annual average decrease of -2.8% (95% CIs:-4.4,-1.1)) with relatively flat trends observed for benign pleural plaques (annual average decrease of -0.7% (95% CIs:-2.0, 0.6)) and pneumoconiosis (annual average decrease of -0.3% (95% CIs: -2.9, 2.3))
Case reports to THOR-GP were predominantly musculoskeletal disorders (MSDs) (53%) or mental ill-health (32%), with overall trends for these two groups remaining relatively unchanged from those reported for the period 2006-2010. An annual average decrease in incidence was observed for all musculoskeletal groups collectively at -15.4% (95% CIs: -18.6, -12.0) for total MSDs, -15.2% (-19.5%, -10.7%) for upper limb disorders, -19.2% (95% CIs: -24.1, -14.1) for spine back disorders, and a non-significant -8.7% (95% CIs: -17.4, 0.9) for lower limb disorders. The relative rates by year suggested a continued decrease between 2010 and 2011. Similarly, an overall decrease in incidence was observed for GP reported mental ill-health at -9.2% (95% CIs: -13.5, -4.7) for total mental ill-health, -7.7% (95% CIs:-14.2, -0.6) for anxiety and depression and -10.7% (95% CIs: -15.9, -5.2) for other work stress.
DISCUSSION: Overall, the addition of the 2011 data has shown consistency 3
with previous observations regarding the annual average estimated change in incidence of the categories of work-related illness investigated here. For dermatologists and chest physicians, the reported incidence was observed either to be falling (contact dermatitis, contact urticaria, neoplasia, asthma, mesothelioma) or to remain relatively unchanged over time (benign pleural plaques, pneumoconiosis). In addition to simply observing these trends, recent THOR work has begun to investigate to what extent the observed changes are the result of changes in legislation, regulatory activity and market forces, relating to specific substances such as latex, chromium and glutaraldehyde. The application of the MLM methodology to investigate interventions such as these, has proved to be a useful tool and further work is anticipated in this area.
The estimated annual change in incidence based on data from GPs also remained relatively unchanged with the addition of the 2011 data, with a decrease in incidence over time observed for all the disease groups investigated. However, the impact of the changes in sampling methodology, resulting from the cessation of funding to GPs for participation, on the estimates of trend is yet to be fully understood.
It is also possible that the trends in GPs as well as in specialists have been influenced by reporter fatigue. A large body of work has been carried out to date investigating this issue within THOR with some evidence of fatigue present for some (but not all) physician groups and types (core or sample) as suggested by an increase in nil returns, non-response and excess zeros over time. The implications of these findings are under review.
CONCLUSION: Annual reports describing the trend in incidence of workrelated illness, as reported by medical physicians to THOR, have been provided to HSE since 2006. To date, this has generated a large and invaluable body of work not only providing annual updates of the trends but also describing ongoing developments in the methodology, including investigations of the important issue of reporter fatigue. Some of the observed trends have remained relatively unchanged with the addition of each 4
successive year of data and are in accordance with those expected as a result of Government initiatives (for example, the decline in incidence of asthma, contact dermatitis and contact urticaria), with further work by this group investigating these trends in relation to specific sectors or agents. For others, in particular the asbestos related diseases, the observed trends have shown a greater degree of variation and may, at least in part, reflect a change in management and referral patterns rather than a true trend. Ongoing work, including benchmarking with other data sources will help clarify these issues further. Since 2009, the annual trends reports have also analysed data reported by GPs. However, these GP data should be interpreted with caution until issues such as the impact of reporting activity and reporter fatigue are better understood. Work continues to improve the THOR trends methodology to enable these and other partially resolved issues to be investigated further.
CONTENTS Page number 10 10 13 13 13 13 14 14 15 17 37 51 56 60 67
1 2 3 3.1 3.1.1 3.1.2 3.1.3 3.2 3.2.1 3.2.2 3.2.3 3.2.4 3.2.5 4 5
BACKGROUND METHOD RESULTS OVERVIEW OF SCHEMES EPIDERM SWORD THOR-GP TIME TRENDS BY DISEASE CATEGORY TOTAL WORK-RELATED ILLNESS WORK-RELATED SKIN DISEASE WORK-RELATED RESPIRATORY DISEASE WORK-RELATED MUSCULOSKELETAL DISORDERS WORK-RELATED MENTAL ILL-HEALTH DISCUSSION CONCLUSION
LIST OF TABLES Page number 11 12 16 16 19 20 23 25 27 29 31 33 35 38 39 41 43 45 47 49 51 52 53 54 7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Data period for trends analyses Categories of illness included in the analyses Average annual percentage change in risk in total workrelated ill-health Relative rates by year, with 95% comparison intervals, total work-related ill-health (2011 estimate =1) Average annual percentage change in reported incidence in work-related skin disease Relative rates by year, with 95% comparison intervals, total skin disease (2011 estimate =1) Relative rates by year, with 95% comparison intervals, all contact dermatitis (2011 estimate =1) Relative rates by year, with 95% comparison intervals, allergic contact dermatitis (2011 estimate =1) Relative rates by year, with 95% comparison intervals, irritant contact dermatitis (2011 estimate =1) Relative rates by year, with 95% comparison intervals, mixed contact dermatitis (2011 estimate =1) Relative rates by year, with 95% comparison intervals, contact urticaria (2011 estimate =1) Relative rates by year, with 95% comparison intervals, neoplasia (2011 estimate =1) Relative rates by year, with 95% comparison intervals, other skin* (2011 estimate =1) Average annual percentage change in reported incidence in work-related respiratory disease Relative rates by year, with 95% comparison intervals, total respiratory disease (2011 estimate =1) Relative rates by year, with 95% comparison intervals, asthma (2011 estimate =1) Relative rates by year, with 95% comparison intervals, mesothelioma (2011 estimate =1) Relative rates by year, with 95% comparison intervals (2011 estimate =1), benign pleural plaques Relative rates by year, with 95% comparison intervals, pneumoconiosis (2011 estimate =1) Relative rates by year, with 95% comparison intervals, other* respiratory disease (2011 estimate =1) Average annual percentage change in reported incidence in work-related musculoskeletal disorders Relative rates by year, with 95% comparison intervals, total musculoskeletal disorders (2011 estimate = 1) Relative rates by year, with 95% comparison intervals, upper limb disorders (2011 estimate = 1) Relative rates by year, with 95% comparison intervals, spine/back disorders (2011 estimate = 1)
25 Relative rates by year, with 95% comparison lower limb disorders (2011 estimate = 1) 26 Average annual percentage change in incidence in work-related mental ill-health 27 Relative rates by year, with 95% comparison total mental ill-health (2011 estimate = 1) 28 Relative rates by year, with 95% comparison anxiety and depression (2011 estimate = 1) 29 Relative rates by year, with 95% comparison other work stress (2011 estimate = 1)
intervals, reported intervals, intervals, intervals,
55 56 57 58 59
LIST OF FIGURES Page number 16 21 24 26 28 30 32 34 36
1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total work-related ill-health Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total skin disease Relative rates by year (2011 estimate = 1), with 95% comparison intervals, all contact dermatitis Relative rates by year (2011 estimate = 1), with 95% comparison intervals, allergic contact dermatitis Relative rates by year (2011 estimate = 1), with 95% comparison intervals, irritant contact dermatitis Relative rates by year (2011 estimate = 1), with 95% comparison intervals, mixed contact dermatitis Relative rates by year (2011 estimate = 1), with 95% comparison intervals, contact urticaria Relative rates by year (2011 estimate = 1), with 95% comparison intervals, neoplasia Relative rates by year (2011 estimate = 1), with 95% comparison intervals, other (than contact dermatitis) skin Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total respiratory disease Relative rates by year (2011 estimate = 1), with 95% comparison intervals, asthma Relative rates by year (2011 estimate = 1), with 95% comparison intervals, mesothelioma Relative rates by year (2011 estimate = 1), with 95% comparison intervals, benign pleural plaques Relative rates by year (2011 estimate = 1), with 95% comparison intervals, pneumoconiosis Relative rates by year (2011 estimate = 1), with 95% comparison intervals, other respiratory disease Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total musculoskeletal disorders
40 42 44 46 48 50 52 8
17 Relative rates by year (2011 estimate = 1), comparison intervals, upper limb disorders 18 Relative rates by year (2011 estimate = 1), comparison intervals, upper limb disorders 19 Relative rates by year (2011 estimate = 1), comparison intervals, lower limb disorders 20 Relative rates by year (2011 estimate = 1), comparison intervals, total mental ill-health 21 Relative rates by year (2011 estimate = 1), comparison intervals, anxiety and depression 22 Relative rates by year (2011 estimate = 1), comparison intervals, other work stress
with 95% with 95% with 95% with 95% with 95% with 95%
53 54 55 57 58 59
LIST OF APPENDICES A Descriptive analyses Page number 71
1.
BACKGROUND
This report describes the latest analyses of case reports collected by The Health and Occupation Research (THOR) network1 to investigate the trend in incidence of work-related illness (WRI) over time. This report should not be viewed as a stand-alone report but should be viewed in conjunction with previous reports submitted to the Health and Safety Executive (HSE) which provide much fuller detail regarding the THOR network, the rationale behind the study and advances in the methodology over time2-8. For the present study, data from the three THOR schemes currently supported by HSE were analysed: case reports of work-related skin disease reported to EPIDERM by dermatologists (1996-2011), case reports of work-related respiratory disease reported to SWORD by chest physicians (1999-2011), and case reports of (any) WRI reported to THOR-GP by general practitioners (2006-2011).
2.
METHOD
The methodology employed in this study has been described in full in previous reports2-8 and only a brief summary is provided here. The data period and diagnostic groups analysed are shown in Tables 1 and 2. Analyses were based on all reporters in each scheme combined, and separately (where appropriate) for core (i.e. physicians reporting every month) or sample (i.e. physicians reporting for one randomly selected month per year) reporting groups. A brief history of the individual schemes, including any significant changes to the proportion of core to sample reporters over time, was provided in the trends report submitted to HSE in 20112. The only substantial change in 2011 was for THOR-GP, which moved from 80% sample reporting in 2010 to 100% sample reporting in 2011. For the present report, analyses of THOR-GP data were based on all reporters (i.e. core and sample combined) only, with no separate analysis by reporter type (core only or sample only). Core only analyses were not carried out because core reporting stopped in December 2010, with core only trends for the period 2006-2010 reported on in the trends report submitted in 20112. Sample only analyses were not carried out because prior to 2010 only a small proportion (4%) of GPs reported on a sample basis; 10
of the 201 sample reporters actively reporting during the study period (i.e. either returning cases or declaring I have nothing to report this month), the majority (63%) only have data for two years, with a further 30% having data for one year only.
The STATA software command xtnbreg was used to fit longitudinal, negative binomial (i.e. over-dispersed) Poisson models with random effects. The dependent variable was the number of actual cases, including zeros, per reporter per month. Variables were also included to represent season, reporter type (core or sample), and first month/s as a new reporter. Changes in the population base were accounted for by including an offset variable representing the UK working population, obtained from the Labour Force Survey, for each year9. Further information regarding these variables and the rationale for including them is provided in previous reports2-8. Change in incidence was estimated in two different ways related to the treatment of calendar time in the model: a non-parametric approach containing separate indicators for different years (2011 as the reference year) and a parametric approach with continuous time variable measured on a scale of years.
Table 1
Data period for trends analyses

Data period for trends study 1996-2011 1999-2011 2006-2011
Scheme start date EPIDERM 1993 SWORD 1989 THOR-GP June 2005
11
Table 2
Categories of illness included in the analyses

Clinical specialist THOR-GP Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
All WRI Total skin Contact dermatitis (CD) Allergic CD Irritant CD Mixed CD Neoplasia Contact urticaria Other skina Total respiratory Asthma Mesothelioma Benign pleural disease Pneumoconiosis Other respiratory diseaseb Total musculoskeletal Upper limb disordersc Spine/back disordersd Lower limb disorderse Total mental ill-health Anxiety and depression Other work stress
a b
Other than contact dermatitis Other than asthma, mesothelioma, benign pleural disease or pneumoconiosis c Hand/wrist/arm, shoulder and elbow d Neck/thoracic spine, lumbar spine/trunk e Hip/knee, ankle/foot
12
3.
RESULTS
3.1
OVERVIEW OF SCHEMES
An overview of the reporting activity of the physicians participating in EPIDERM, SWORD, and THOR-GP is provided in Appendix A and briefly described below.
3.1.1 EPIDERM
A total of 415 dermatologists have been enrolled in EPIDERM during the study period with 93% actively participating at least once (i.e. either returning cases or declaring I have nothing to report this month). 2011 saw a small decrease in the overall number of physicians in EPIDERM (from 181 in 2010 to 175 in 2011) and a decrease in the average number of active reporters per month (26 per month in 2010 to 21 per month in 2011). However, the average cases per active reporter remained little changed between the two years (2.4 in 2010 and 2.2 in 2011). Reporters to EPIDERM are predominantly sample (86% in 2011) but core reporters report more cases per active reporter per month (3.7) compared to sample (0.9). Case reports to EPIDERM continue to be predominantly contact dermatitis (81% of total cases) with smaller proportions of neoplasia (12%) and other skin diagnoses.
3.1.2 SWORD
Active participation in SWORD during the study period was similar to EPIDERM with 94% of the 798 chest physicians enrolled during this period actively reporting at least once. Although the total number of reporters in SWORD fell slightly between 2010 and 2011 (474 to 460) the average number of active reporters per month was similar (37 in 2010 and 35 in 2011) and the average number of cases per active reporter actually slightly increased (1 in 2010 to 1.2 in 2011). Similar to EPIDERM, the smaller group of chest physicians reporting as core reported more cases per active reporter per month than chest physicians reporting as sample. The majority of the actual diagnoses (44%) reported to SWORD during the study period were benign 13
pleural plaques. Of the remaining cases 20% were mesothelioma, 19% asthma, 8% pneumoconiosis, and 12% other respiratory disease.
3.1.3 THOR-GP
THOR-GP differs to EPIDERM and SWORD in that at the start of the study period (2006) all GPs reported to THOR-GP on a core basis whilst at the end of the study period (2011) reporting was exclusively sample, with the majority of the switch from core to sample occurring in 2010. Active participation during this period was lower than observed for SWORD and EPIDERM (76% of the 699 GPs ever enrolled). In contrast to the clinical specialists, GPs participating as sample physicians reported on average more cases per active reporter per month than GPs participating as core reporters. Thus, although the switch to 100% sample meant that there was a substantial decrease in the average number of active reporters per month between 2010 and 2011 (47 to 15), the average number of cases per active reporter month actually increased between 2010 and 2011 (0.9 to 1.4). Musculoskeletal and mental ill-health case reports comprised the majority (52% and 32%, respectively) of the cases reported to THOR-GP with smaller proportions of skin (10%), respiratory (2%) and other diagnoses (4%). 3.2 TIME TRENDS BY DISEASE CATEGORY
This report continues with the approach first adopted in the trends report submitted to HSE in September 20103, in that the statistical uncertainty (confidence intervals) in the graphs illustrating time trends are presented in such a way as to allow the reader to assess the significance of the difference between any two years. This approach suggested by the HSE liaison officer when steering the research follows the method described by Firth and de Menezes10 which assigns a confidence (or comparison) interval to the reference category (2011 in the present analyses) and reduces the width of the confidence (comparison) intervals of non-reference categories in such a way that all pairwise comparisons between years can validly be made using these adjusted confidence intervals.
14
3.2.1 TOTAL WORK-RELATED ILLNESS
The average annual percentage change in risk of total WRI, as reported to THOR-GP is shown in Table 3 whilst the relative rates by year are shown in Table 4 and Figure 1. For the period 2006-2011, the average annual decrease in incidence was -12.5% (95% CIs: -15, -10). This remains little changed from the last reported estimate (for the period 2006-2010) which was very similar at -12.3% (95% CIs: -14.8, -9.7). The graphs showing relative rates by year for THOR-GP suggest the slight rise in incidence observed in 2010 has been followed by a fall in 2011. However, it should be noted that the confidence intervals are wider in 2010 and (especially) 2011, (reflecting the move to a greater proportion of sample reporters) and overlap earlier years.
15
Table 3
Average annual percentage change in risk in total workrelated illness

ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) THOR-GP -12.5 (-15, -10)
Reporters All
Year (continuous) 2006-2011
Table 4
Relative rates by year, with 95% comparison intervals, total work-related ill-health (2011 estimate =1)
Relative rates (95% comparison interval) THOR-GP
Reporter Group All
Year 2006 2007 2008 2009 2010 2011
1.74 (1.61, 1.88) 1.39 (1.30, 1.48) 1.30 (1.20, 1.40) 1.06 (0.98, 1.14) 1.23 (1.09, 1.38) 1.00 (0.83, 1.20)
Figure 1
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total work-related ill-health
THORGP, all reporters

2 1.8 1.6
Relative rate
1.4 1.2 1 0.8 0.6 0.4 0.2 0 2006 2007 2008 2009 2010 2011
Year
16
3.2.2 WORK-RELATED SKIN DISEASE
The average annual percentage change in risk of work-related skin disease, as reported by dermatologists and GPs is shown in Table 5 whilst the relative rates by year are shown in Tables 6 to 13 and Figures 2 to 9.
For both dermatologists and GPs, the addition of a further year of data (2011) had little impact on the annual average change in incidence of work-related skin disease which remained at -3.4% (95% CIs: -3.9, -2.8) for dermatologists and increased slightly from -5.3% (2006-2010) to -5.7% (95% CI: -13.2, 2.3) for GPs (2006-2011). Analyses restricted to case reports from dermatologists during 2006-2011 (thus enabling a direct comparison with GP case reports) suggested a steeper decrease in incidence for GPs compared to dermatologists. Although the annual average change in incidence remained little changed after the addition of 2011 data, the graphs showing relative rates by year suggest a large decrease in incidence for dermatologists between 2010 and 2011 compared to changes in previous years. Analyses based on reporter type (i.e. core only or sample only) suggest that this decrease occurred amongst the core reporters rather than the sample reporters. The graph showing relative rates by year for THOR-GP suggests the slight increase observed for 2010 has been followed by a further increase in 2011. However, trends based on GP data should be viewed with caution as results are based on relatively few cases (confidence intervals are overlapping for all years).
The predicted trend for contact dermatitis (CD) was very similar to that observed for total work-related skin disease. For dermatologists, in addition to all contact dermatitis combined, further analyses by type of CD were carried out. As reported previously, a steeper decrease in the incidence of allergic CD was observed (-5.4% (95% CIs: -6.3, -4.6)) compared to irritant CD (-1.2 (95% CIs: -2.1, -0.3)) or mixed CD (-2.2% (95% CIs: -3.5, -0.8)). Restricting the analyses to cases reported by core reporters had little effect on the observed trend for these CD sub-categories. For sample only analyses however, the percentage decrease in allergic CD and irritant CD were very similar (2-3%).
17
The annual average change in incidence of both urticaria and neoplasia (investigated for dermatologists only) also remained little changed by the addition of the 2011 data with the previously observed variation between reporter type (decrease in incidence observed for core reporters and increase for sample reporters) still apparent. Of interest, the large fall in incidence between 2010 and 2011 observed for CD was similarly observed for neoplasia, with the drop again appearing to be largely driven by a decrease in case reports from core reporters. However, it should be noted that the confidence intervals for 2011 are very wide and overlap previous years, making it difficult to draw any firm conclusions.
For the purpose of this study, the group other skin referred to all non CD cases (and therefore included all of the groups already discussed, other then CD). As expected from the individual group analyses, an overall downward trend was predicted for this group. Some variation between core and sample reporters was observed for EPIDERM, but this was probably largely driven by the (already discussed) core and sample differences for neoplasia.
18
Table 5
Average annual percentage change in reported incidence in work-related skin disease
a) All reporters
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) EPIDERM THOR-GP -3.4 (-3.9, -2.8) -2.0 (-4.3, 0.4) -3.3 (-3.9, -2.6) -5.4 (-6.3, -4.6) -1.2 (-2.1,-0.3) -2.2 (-3.5,-0.8) -5.6 (-7.5, -3.6) -2.6 (-4.1, -1.0) -3.2 (-4.3, -2.0) / -5.7 (-13.2, 2.3) / / / / / / /
Total skin Contact dermatitis (CD) Allergic CD Irritant CD Mixed CD Urticaria Neoplasia Other* skin
Year (continuous) 1996-2011 2006-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011
b) Core reporters
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) EPIDERM -3.6 (-4.2, -3.0) -3.3 (-4.0, -2.7) -6.0 (-6.9, -5.0) -1.1 (-2.0, -0.1) -2.3 (-3.7, -0.9) -6.2 (-8.2, -4.2) -4.6 (-6.2, -3.0) -4.5 (-5.7, -3.3)
Total skin Contact dermatitis (CD) Allergic CD Irritant CD Mixed CD Urticaria Neoplasia Other* skin
Year (continuous) 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011
c) Sample reporters
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) EPIDERM -1.3 (-3.1, 0.5) -2.7 (-4.6, -0.6) -1.8 (-4.5, 1.0) -2.5 (-5.3, 0.5) -0.3 (-4.7, 4.3) 1.2 (-6.4, 9.5) 6.7 (2.8, 10.6) 3.9 (0.8, 7.1)
Total skin Contact dermatitis (CD) Allergic CD Irritant CD Mixed CD Urticaria Neoplasia Other* skin *Other than contact dermatitis
Year (continuous) 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011 1996-2011
19
Table 6
Relative rates by year, with 95% comparison intervals, total skin disease (2011 estimate =1)
Relative rates (95% comparison interval) EPIDERM THOR-GP
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
1.71 (1.58, 1.86) 1.82 (1.69, 1.96) 1.67 (1.54, 1.80) 1.71 (1.59, 1.85) 1.57 (1.45, 1.71) 1.45 (1.34, 1.56) 1.41 (1.30, 1.52) 1.41 (1.31, 1.52) 1.30 (1.20, 1.40) 1.32 (1.22, 1.43) 1.16 (1.07, 1.26) 1.22 (1.12, 1.32) 1.13 (1.03, 1.24) 1.30 (1.19, 1.42) 1.22 (1.11, 1.35) 1.00 (0.89, 1.13) 1.80 (1.65, 1.96) 1.92 (1.78, 2.07) 1.75 (1.62, 1.89) 1.79 (1.65, 1.93) 1.68 (1.54, 1.82) 1.51 (1.39, 1.64) 1.44 (1.33, 1.56) 1.49 (1.38, 1.61) 1.34 (1.23, 1.45) 1.36 (1.25, 1.48) 1.17 (1.07, 1.27) 1.26 (1.16, 1.38) 1.19 (1.08, 1.30) 1.34 (1.23, 1.47) 1.26 (1.13, 1.39) 1.00 (0.88, 1.14) 1.00 (0.73, 1.37) 1.22 (0.93, 1.61) 1.14 (0.89, 1.46) 1.23 (0.98, 1.53) 0.99 (0.78, 1.26) 1.09 (0.87, 1.37) 1.26 (0.99, 1.61) 0.90 (0.68, 1.18) 1.05 (0.82, 1.35) 1.05 (0.82, 1.34) 1.21 (0.96, 1.51) 0.93 (0.72, 1.20) 0.78 (0.57, 1.07) 1.04 (0.78, 1.39) 1.00 (0.74, 1.35) 1.00 (0.73, 1.38)
/ / / / / / / / / / 0.98 (0.79, 1.23) 0.91 (0.74, 1.11) 0.93 (0.76, 1.14) 0.76 (0.60, 0.96) 0.81 (0.58, 1.12) 1.00 (0.58, 1.73) / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
Core
Sample
Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model
20
Figure 2
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total skin disease
a) EPIDERM
EPIDERM, all reporters

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
EPIDERM, core reporters

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
EPIDERM, sample reporters

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
21
b) THOR-GP
THORGP, all reporters

2 1.8 1.6
Relative rate
1.4 1.2 1 0.8 0.6 0.4 0.2 0 2006 2007 2008 2009 2010 2011
Year
22
Table 7
Relative rates by year, with 95% comparison intervals, all contact dermatitis (2011 estimate =1)
Relative rates (95% comparison interval) EPIDERM
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
1.64 (1.50, 1.80) 1.76 (1.62, 1.90) 1.64 (1.51, 1.78) 1.67 (1.54, 1.81) 1.48 (1.36, 1.62) 1.35 (1.24, 1.47) 1.41 (1.30, 1.53) 1.38 (1.26, 1.50) 1.25 (1.15, 1.36) 1.25 (1.14, 1.37) 1.10 (1.00, 1.20) 1.15 (1.05, 1.26) 1.10 (1.00, 1.22) 1.29 (1.17, 1.41) 1.23 (1.11, 1.36) 1.00 (0.88, 1.13) 1.69 (1.53, 1.86) 1.83 (1.68, 1.99) 1.71 (1.57, 1.86) 1.70 (1.56, 1.85) 1.55 (1.41, 1.70) 1.41 (1.29, 1.55) 1.43 (1.31, 1.56) 1.44 (1.32, 1.57) 1.29 (1.19, 1.41) 1.28 (1.16, 1.40) 1.12 (1.01, 1.23) 1.19 (1.08, 1.32) 1.15 (1.04, 1.28) 1.33 (1.20, 1.46) 1.26 (1.14, 1.41) 1.00 (0.88, 1.14) 1.14 (0.81, 1.59) 1.21 (0.89, 1.63) 1.17 (0.88, 1.56) 1.40 (1.11, 1.78) 1.04 (0.80, 1.36) 0.95 (0.72, 1.24) 1.32 (1.01, 1.73) 0.88 (0.65, 1.21) 0.90 (0.66, 1.22) 1.05 (0.80, 1.39) 1.00 (0.76, 1.31) 0.78 (0.58, 1.06) 0.71 (0.50, 1.02) 0.91 (0.65, 1.27) 0.93 (0.66, 1.31) 1.00 (0.70, 1.44)
Core
Sample
Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model
23
Figure 3
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, all contact dermatitis
a) EPIDERM

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
24
Table 8
Relative rates by year, with 95% comparison intervals, allergic contact dermatitis (2011 estimate =1)
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2.39 (2.09, 2.73) 2.77 (2.48, 3.10) 2.29 (2.03, 2.58) 2.27 (2.01, 2.55) 2.26 (2.00, 2.55) 1.84 (1.61, 2.09) 2.12 (1.89, 2.39) 2.06 (1.83, 2.32) 1.63 (1.44, 1.85) 1.65 (1.45, 1.89) 1.55 (1.35, 1.77) 1.35 (1.16, 1.56) 1.35 (1.16, 1.58) 1.33 (1.14, 1.56) 1.34 (1.14, 1.58) 1.00 (0.82, 1.22) 2.64 (2.30, 3.04) 3.07 (2.73, 3.45) 2.59 (2.30, 2.93) 2.51 (2.21, 2.84) 2.53 (2.23, 2.87) 2.11 (1.85, 2.41) 2.25 (1.99, 2.54) 2.26 (1.99, 2.55) 1.79 (1.57, 2.03) 1.73 (1.50, 1.99) 1.63 (1.41, 1.88) 1.42 (1.21, 1.66) 1.44 (1.23, 1.70) 1.44 (1.22, 1.69) 1.39 (1.17, 1.66) 1.00 (0.80, 1.24)
Core
Sample
1996 1.17 (0.74, 1.83) 1997 1.34 (0.91, 1.96) 1998 0.91 (0.59, 1.38) 1999 1.08 (0.74, 1.57) 2000 1.00 (0.70, 1.44) 2001 0.64 (0.42, 0.99) 2002 1.48 (1.05, 2.09) 2003 1.07 (0.72, 1.58) 2004 0.82 (0.53, 1.28) 2005 1.18 (0.82, 1.69) 2006 1.06 (0.73, 1.54) 2007 0.88 (0.58, 1.33) 2008 0.80 (0.50, 1.27) 2009 0.72 (0.43, 1.21) 2010 0.93 (0.57, 1.50) 2011 1.00 (0.61, 1.64) Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model
25
Figure 4
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, allergic contact dermatitis

4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
26
Table 9
Relative rates by year, with 95% comparison intervals, irritant contact dermatitis (2011 estimate =1)
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
1.27 (1.12, 1.44) 1.18 (1.05, 1.33) 1.23 (1.10, 1.38) 1.29 (1.15, 1.45) 1.05 (0.92, 1.20) 1.01 (0.89, 1.14) 1.05 (0.93, 1.19) 1.01 (0.89, 1.14) 0.90 (0.80, 1.02) 1.03 (0.90, 1.17) 0.94 (0.83, 1.07) 1.06 (0.94, 1.20) 0.98 (0.86, 1.12) 1.12 (0.98, 1.27) 1.17 (1.03, 1.34) 1.00 (0.86, 1.17) 1.29 (1.13, 1.48) 1.21 (1.07, 1.37) 1.22 (1.08, 1.38) 1.29 (1.14, 1.46) 1.06 (0.93, 1.22) 0.99 (0.86, 1.13) 1.04 (0.91, 1.18) 1.01 (0.89, 1.15) 0.90 (0.79, 1.03) 1.02 (0.90, 1.17) 0.95 (0.83, 1.08) 1.10 (0.97, 1.24) 1.01 (0.88, 1.16) 1.15 (1.01, 1.31) 1.21 (1.05, 1.38) 1.00 (0.85, 1.18)
Core
Sample
27
Figure 5
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, irritant contact dermatitis

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
28
Table 10
Relative rates by year, with 95% comparison intervals, mixed contact dermatitis (2011 estimate =1)
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
1.28 (1.04, 1.58) 1.41 (1.18, 1.69) 1.29 (1.07, 1.56) 1.28 (1.06, 1.55) 1.10 (0.89, 1.35) 1.00 (0.82, 1.24) 1.24 (1.04, 1.49) 1.28 (1.07, 1.53) 1.28 (1.08, 1.51) 1.06 (0.87, 1.29) 0.84 (0.68, 1.05) 0.99 (0.81, 1.21) 0.91 (0.73, 1.12) 1.22 (0.99, 1.49) 0.97 (0.77, 1.22) 1.00 (0.78, 1.28) 1.39 (1.11, 1.73) 1.53 (1.27, 1.84) 1.42 (1.16, 1.73) 1.38 (1.13, 1.68) 1.22 (0.99, 1.50) 1.18 (0.95, 1.45) 1.35 (1.12, 1.63) 1.45 (1.22, 1.74) 1.39 (1.17, 1.65) 1.16 (0.95, 1.42) 0.91 (0.73, 1.13) 1.13 (0.91, 1.40) 0.99 (0.79, 1.24) 1.39 (1.13, 1.70) 0.99 (0.77, 1.27) 1.00 (0.76, 1.31)
Core
Sample
29
Figure 6
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, mixed contact dermatitis

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
30
Table 11
Relative rates by year, with 95% comparison intervals, contact urticaria (2011 estimate =1)
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2.36 (1.66, 3.36) 3.33 (2.58, 4.30) 2.65 (1.98, 3.55) 2.59 (1.91, 3.51) 3.59 (2.80, 4.60) 2.28 (1.70, 3.06) 2.64 (2.02, 3.45) 2.82 (2.18, 3.67) 2.14 (1.60, 2.86) 3.05 (2.33, 3.99) 1.89 (1.35, 2.63) 1.84 (1.29, 2.61) 1.16 (0.75, 1.80) 1.15 (0.74, 1.79) 1.60 (1.08, 2.39) 1.00 (0.59, 1.68) 2.65 (1.85, 3.80) 3.82 (2.96, 4.94) 3.00 (2.24, 4.03) 2.87 (2.10, 3.92) 4.20 (3.27, 5.38) 2.59 (1.92, 3.49) 2.98 (2.28, 3.91) 3.26 (2.52, 4.22) 2.36 (1.76, 3.16) 3.46 (2.64, 4.53) 1.89 (1.32, 2.69) 2.02 (1.41, 2.89) 1.19 (0.75, 1.89) 1.18 (0.74, 1.86) 1.70 (1.13, 2.57) 1.00 (0.58, 1.73)
Core
Sample
31
Figure 7
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, contact urticaria

6 5
Relative rate
4 3 2 1 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year

6 5
Relative rate
4 3 2 1 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year

6 5
Relative rate
4 3 2 1 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
32
Table 12
Relative rates by year, with 95% comparison intervals, neoplasia (2011 estimate =1)
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
1.67 (1.35, 2.06) 1.58 (1.29, 1.94) 1.24 (1.00, 1.55) 1.32 (1.06, 1.64) 1.46 (1.20, 1.79) 1.52 (1.28, 1.80) 1.21 (0.99, 1.47) 1.27 (1.05, 1.54) 1.17 (0.96, 1.43) 1.10 (0.90, 1.34) 1.07 (0.88, 1.30) 1.25 (1.02, 1.54) 1.07 (0.83, 1.38) 1.33 (1.05, 1.67) 1.07 (0.78, 1.45) 1.00 (0.57, 1.74) 4.08 (3.28, 5.08) 3.78 (3.07, 4.66) 2.87 (2.28, 3.61) 3.29 (2.63, 4.11) 3.49 (2.83, 4.31) 3.37 (2.80, 4.05) 2.60 (2.13, 3.19) 2.79 (2.31, 3.36) 2.45 (2.01, 3.00) 2.48 (2.03, 3.04) 2.04 (1.64, 2.53) 2.54 (2.03, 3.19) 2.30 (1.78, 2.99) 2.50 (1.94, 3.23) 1.86 (1.30, 2.67) 1.00 (0.30, 3.31)
Core
Sample
33
Figure 8
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, neoplasia

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
34
Table 13
Relative rates by year, with 95% comparison intervals, other skin* (2011 estimate =1)
Reporter Group All
Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2.19 (1.84, 2.60) 2.22 (1.90, 2.59) 1.95 (1.66, 2.30) 1.98 (1.68, 2.34) 2.17 (1.86, 2.53) 1.96 (1.69, 2.28) 1.55 (1.32, 1.83) 1.69 (1.45, 1.98) 1.59 (1.35, 1.86) 1.87 (1.61, 2.17) 1.66 (1.43, 1.93) 1.78 (1.51, 2.09) 1.28 (1.04, 1.58) 1.52 (1.25, 1.84) 1.43 (1.15, 1.79) 1.00 (0.71, 1.41) 3.40 (2.86, 4.03) 3.31 (2.82, 3.88) 2.85 (2.40, 3.38) 3.11 (2.63, 3.69) 3.39 (2.89, 3.97) 2.85 (2.44, 3.33) 2.18 (1.84, 2.58) 2.44 (2.08, 2.87) 2.16 (1.83, 2.55) 2.73 (2.34, 3.18) 2.06 (1.75, 2.44) 2.42 (2.04, 2.87) 1.76 (1.41, 2.20) 1.98 (1.61, 2.42) 1.85 (1.45, 2.36) 1.00 (0.63, 1.58)
Core
Sample
1996 0.56 (0.30, 1.06) 1997 0.97 (0.60, 1.55) 1998 0.80 (0.52, 1.22) 1999 0.57 (0.36, 0.91) 2000 0.62 (0.40, 0.97) 2001 0.95 (0.64, 1.41) 2002 0.86 (0.54, 1.36) 2003 0.69 (0.43, 1.11) 2004 1.04 (0.70, 1.54) 2005 0.71 (0.45, 1.13) 2006 1.57 (1.13, 2.20) 2007 1.14 (0.77, 1.70) 2008 0.80 (0.48, 1.35) 2009 1.27 (0.81, 2.00) 2010 1.06 (0.64, 1.73) 2011 1.00 (0.60, 1.67) Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model *Other than contact dermatitis
35
Figure 9
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, other (than contact dermatitis) skin

4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

4 3.5 3 2.5 2 1.5 1 0.5 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
36
3.2.3 WORK-RELATED RESPIRATORY DISEASE
The average annual percentage change in risk of work-related respiratory disease, as reported by chest physicians to SWORD is shown in Table 14 whilst the relative rates by year are shown in Tables 15 to 20 and Figures 10 to 15. For total respiratory disease, the graphs showing relative rates by year suggest a slight increase in incidence between 2010 and 2011 (although confidence intervals are overlapping for the two years) with the overall average annual percentage decrease in incidence reducing slightly from -3.6% reported upon last year for the period 1999-2010 to -3.3% (95% CIs: -4.2,-2.4) for the period 1999-2011, with little variation between core and sample reporters.
As observed previously, the annual average decrease in the incidence of asthma was greater than that observed for total respiratory disease at -7.7% (95% CIs: -9.2, -6.2) with a sharper decline observed for sample compared to core reporters. Similarly, the addition of the 2011 case reports had little impact on the overall observed trends for the other respiratory diagnoses investigated with a smaller (than asthma), but still significant downward trend in the incidence of mesothelioma (annual average decrease of -2.8% (95% CIs: -4.4,-1.1), and relatively flat trends for benign pleural plaques,
pneumoconiosis and other respiratory disease (which includes rhinitis, allergic alveolitis, lung cancer, inhalation accidents and other respiratory diagnoses not already specified) over the study period.
37
Table 14
Average annual percentage change in reported incidence in work-related respiratory disease
a) All reporters
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) SWORD -3.3 (-4.2, -2.4) -7.7 (-9.2, -6.2) -2.8 (-4.4, -1.1) -0.7 (-2.0, 0.6) -0.3 (-2.9, 2.3) 0.5 (-1.5, 2.6)
Total respiratory Asthma Mesothelioma Benign pleural plaques Pneumoconiosis Other* respiratory disease
Year (continuous) 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011
b) Core reporters
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) SWORD -3.7 (-4.7, -2.6) -7.4 (-9.0, -5.7) -1.6 (-4.0, 0.8) -1.7 (-3.2, -0.1) 0.7 (-2.4, 3.9) 0.3 (-2.1, 2.8)
Year (continuous) 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011
c) Sample reporters
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) SWORD -2.5 (-4.1, -0.9) -9.1 (-12.7, -5.3) -4.0 (-6.3, -1.6) 1.8 (-0.8, 4.5) -3.2 (-7.8, 1.7) 1.1 (-2.8, 5.2)
Year (continuous) 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011
38
Table 15
Relative rates by year, with 95% comparison intervals, total respiratory disease (2011 estimate =1)
Relative rates (95% comparison interval) SWORD
Reporter Group All
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
1.35 (1.23, 1.47) 1.30 (1.19, 1.41) 1.28 (1.17, 1.39) 1.31 (1.20, 1.43) 1.30 (1.20, 1.42) 1.22 (1.12, 1.33) 1.16 (1.06, 1.27) 1.07 (0.98, 1.18) 0.94 (0.85, 1.05) 1.01 (0.91, 1.13) 0.96 (0.86, 1.07) 0.92 (0.82, 1.04) 1.00 (0.89, 1.12) 1.35 (1.22, 1.50) 1.34 (1.21, 1.48) 1.37 (1.25, 1.51) 1.44 (1.30, 1.59) 1.47 (1.34, 1.61) 1.36 (1.24, 1.50) 1.22 (1.10, 1.34) 1.10 (0.99, 1.22) 0.92 (0.81, 1.05) 1.00 (0.88, 1.14) 0.94 (0.82, 1.09) 0.95 (0.83, 1.10) 1.00 (0.87, 1.15)
Core
Sample
1999 1.40 (1.19, 1.65) 2000 1.24 (1.05, 1.47) 2001 1.07 (0.89, 1.29) 2002 1.03 (0.85, 1.24) 2003 0.89 (0.73, 1.09) 2004 0.87 (0.71, 1.06) 2005 1.08 (0.90, 1.28) 2006 1.05 (0.88, 1.26) 2007 0.99 (0.82, 1.19) 2008 1.01 (0.84, 1.22) 2009 0.98 (0.80, 1.19) 2010 0.84 (0.68, 1.05) 2011 1.00 (0.81, 1.23) Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model
39
Figure 10
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total respiratory disease
SWORD, all reporters

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
SWORD, core reporters

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
SWORD, sample reporters

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
40
Table 16
Relative rates by year, with 95% comparison intervals, asthma (2011 estimate =1)
Reporter Group All
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2.56 (2.21, 2.98) 1.92 (1.64, 2.26) 2.04 (1.74, 2.38) 2.10 (1.78, 2.48) 2.06 (1.74, 2.43) 1.92 (1.61, 2.29) 1.72 (1.43, 2.07) 1.63 (1.37, 1.94) 1.13 (0.91, 1.40) 1.21 (0.98, 1.49) 0.93 (0.73, 1.18) 0.95 (0.75, 1.22) 1.00 (0.78, 1.28) 2.34 (1.97, 2.77) 1.74 (1.45, 2.09) 2.02 (1.71, 2.39) 2.09 (1.75, 2.50) 2.09 (1.75, 2.50) 1.97 (1.64, 2.38) 1.69 (1.38, 2.07) 1.51 (1.25, 1.84) 1.08 (0.85, 1.36) 1.13 (0.90, 1.43) 0.89 (0.68, 1.16) 0.90 (0.69, 1.18) 1.00 (0.77, 1.31)
Core
Sample
41
Figure 11
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, asthma

5 4
Relative rate
3 2 1 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year

5 4
Relative rate
3 2 1 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year

5 4
Relative rate
3 2 1 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
42
Table 17
Relative rates by year, with 95% comparison intervals, mesothelioma (2011 estimate =1)
Reporter Group All
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
1.40 (1.19, 1.65) 1.41 (1.21, 1.65) 1.40 (1.20, 1.64) 1.39 (1.18, 1.63) 1.34 (1.14, 1.57) 1.18 (1.01, 1.39) 1.04 (0.87, 1.24) 1.04 (0.87, 1.25) 1.32 (1.09, 1.61) 1.30 (1.06, 1.59) 1.16 (0.93, 1.45) 1.08 (0.86, 1.36) 1.00 (0.78, 1.28) 1.15 (0.92, 1.43) 1.28 (1.05, 1.56) 1.26 (1.03, 1.53) 1.28 (1.05, 1.56) 1.27 (1.05, 1.55) 1.16 (0.96, 1.41) 0.96 (0.77, 1.19) 1.02 (0.81, 1.29) 1.15 (0.87, 1.52) 1.47 (1.12, 1.94) 1.22 (0.91, 1.63) 1.03 (0.75, 1.41) 1.00 (0.72, 1.39)
Core
Sample
43
Figure 12
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, mesothelioma

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
44
Table 18
Relative rates by year, with 95% comparison intervals (2011 estimate =1), benign pleural plaques
Reporter Group All
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
0.92 (0.80, 1.06) 1.10 (0.98, 1.25) 1.07 (0.94, 1.21) 1.09 (0.95, 1.24) 1.14 (1.02, 1.29) 1.03 (0.92, 1.16) 1.09 (0.98, 1.22) 0.95 (0.84, 1.08) 0.88 (0.76, 1.02) 0.94 (0.81, 1.10) 0.89 (0.75, 1.05) 1.01 (0.86, 1.18) 1.00 (0.85, 1.18) 0.98 (0.84, 1.14) 1.21 (1.05, 1.39) 1.23 (1.08, 1.40) 1.24 (1.08, 1.43) 1.30 (1.14, 1.48) 1.15 (1.01, 1.31) 1.14 (1.01, 1.29) 0.92 (0.80, 1.06) 0.89 (0.75, 1.06) 0.89 (0.74, 1.07) 0.88 (0.72, 1.08) 1.06 (0.88, 1.29) 1.00 (0.82, 1.22)
Core
Sample
45
Figure 13
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, benign pleural plaques

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
46
Table 19
Relative rates by year, with 95% comparison intervals, pneumoconiosis (2011 estimate =1)
Reporter Group All
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 0.84 (0.66, 1.06) 0.79 (0.62, 1.00) 0.74 (0.58, 0.94) 0.65 (0.50, 0.85) 0.70 (0.54, 0.89) 0.56 (0.42, 0.74) 0.68 (0.54, 0.87) 0.77 (0.60, 0.98) 0.53 (0.38, 0.74) 0.69 (0.50, 0.95) 0.84 (0.62, 1.15) 0.67 (0.48, 0.95) 1.00 (0.75, 1.33) 0.74 (0.56, 0.98) 0.78 (0.61, 1.02) 0.67 (0.51, 0.89) 0.70 (0.52, 0.94) 0.74 (0.57, 0.96) 0.64 (0.48, 0.85) 0.69 (0.52, 0.91) 0.80 (0.62, 1.05) 0.47 (0.31, 0.71) 0.68 (0.47, 0.98) 0.89 (0.63, 1.27) 0.75 (0.51, 1.11) 1.00 (0.71, 1.41)
Core
Sample
47
Figure 14
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, pneumoconiosis

2.5 2
Relative rate
1.5 1 0.5 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year

2.5 2
Relative rate
1.5 1 0.5 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year

2.5 2
Relative rate
1.5 1 0.5 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
48
Table 20
Relative rates by year, with 95% comparison intervals, other* respiratory disease (2011 estimate =1)
Reporter Group All
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
0.92 (0.72, 1.18) 0.90 (0.71, 1.14) 0.93 (0.73, 1.17) 1.02 (0.80, 1.29) 0.97 (0.77, 1.22) 1.12 (0.92, 1.38) 0.81 (0.64, 1.03) 1.07 (0.87, 1.32) 0.77 (0.60, 1.00) 1.07 (0.84, 1.36) 1.22 (0.98, 1.52) 0.81 (0.61, 1.07) 1.00 (0.78, 1.29) 1.14 (0.86, 1.51) 1.01 (0.76, 1.34) 1.04 (0.78, 1.38) 1.29 (0.98, 1.70) 1.24 (0.96, 1.59) 1.42 (1.14, 1.78) 0.98 (0.75, 1.28) 1.40 (1.11, 1.76) 0.93 (0.69, 1.26) 1.35 (1.03, 1.77) 1.42 (1.09, 1.85) 1.08 (0.79, 1.46) 1.00 (0.72, 1.39)
Core
Sample
1999 0.53 (0.32, 0.88) 2000 0.68 (0.43, 1.06) 2001 0.72 (0.47, 1.13) 2002 0.52 (0.31, 0.87) 2003 0.52 (0.31, 0.88) 2004 0.62 (0.39, 0.98) 2005 0.52 (0.32, 0.87) 2006 0.50 (0.30, 0.83) 2007 0.49 (0.29, 0.81) 2008 0.59 (0.36, 0.96) 2009 0.82 (0.54, 1.25) 2010 0.36 (0.19, 0.69) 2011 1.00 (0.65, 1.53) Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model *Other than those specified above
49
Figure 15
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, other respiratory disease

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Relative rate
Year
50
3.2.4 WORK-RELATED MUSCULOSKELETAL DISORDERS The average annual percentage change in reported incidence of work-related musculoskeletal disorders (MSDs), as reported by GPs (THOR-GP) is shown in Table 21 whilst the relative rates by year are shown in Tables 22 to 25 and Figures 16 to 19. Data from GPs suggested a downward trend in the incidence of total work-related MSDs in the order of -15.4% (95% CIs: -18.6, -12.0) per year. For comparison, the annual average decrease based on data for 2006-2010 was -15.2% (95% CIs: -18.5, -11.6). The pattern for upper limb disorders was very similar to that observed for total MSDs, whilst for spine/back disorders generally a steeper annual decrease was observed. A downward trend in the incidence of lower limb disorders was also observed (although this was not statistically significant). The graphs showing relative rates by year show a sharp drop in incidence for THOR-GP between 2006 and 2007 with rates continuing to fall thereafter.
Table 21
Average annual percentage change in reported incidence in work-related musculoskeletal disorders
Reporter group All
Year (continuous) Total musculoskeletal Upper limb Spine/back Lower limb 2006-2011 2006-2011 2006-2011 2006-2011
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) THOR-GP -15.4 (-18.6, -12.0) -15.2 (-19.5, -10.7) -19.2 (-24.1, -14.1) -8.7 (-17.4, 0.9)
51
Table 22
Relative rates by year, with 95% comparison intervals, total musculoskeletal disorders (2011 estimate = 1)
Relative rates (95% comparison interval) Reporter Group THOR-GP All 2006 2.51 (2.27, 2.78) 2007 1.85 (1.69, 2.03) 2008 1.74 (1.57, 1.92) 2009 1.47 (1.33, 1.63) 2010 1.27 (1.07, 1.52) 2011 1.00 (0.77, 1.31) Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model
Figure 16
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total musculoskeletal disorders
THOR-GP, all reporters

4 3.5
Relative rate
3 2.5 2 1.5 1 0.5 0 2006 2007 2008 2009 2010 2011
Year
52
Table 23
Relative rates by year, with 95% comparison intervals, upper limb disorders (2011 estimate = 1)
Figure 17
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, upper limb disorders

4 3.5
Relative rate
3 2.5 2 1.5 1 0.5 0 2006 2007 2008 2009 2010 2011
Year
53
Table 24
Relative rates by year, with 95% comparison intervals, spine/back disorders (2011 estimate = 1)
Figure 18
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, spine/back disorders

4 3.5
Relative rate
3 2.5 2 1.5 1 0.5 0 2006 2007 2008 2009 2010 2011
Year
54
Table 25
Relative rates by year, with 95% comparison intervals, lower limb disorders (2011 estimate = 1)
Relative rates comparison interval) THOR-GP (95%
Reporter Group All
2006 1.64 (1.22, 2.21) 2007 1.10 (0.83, 1.44) 2008 1.27 (0.97, 1.66) 2009 1.16 (0.88, 1.54) 2010 0.99 (0.69, 1.43) 2011 1.00 (0.48, 2.10) Models adjusted for reporter type (where appropriate), season and harvesting Population offset included in the model
Figure 19
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, lower limb disorders

4 3.5
Relative rate
3 2.5 2 1.5 1 0.5 0 2006 2007 2008 2009 2010 2011
Year
55
3.2.5 WORK-RELATED MENTAL ILL-HEALTH The average annual percentage change in reported incidence of work-related mental ill-health, as reported by GPs (THOR-GP) is shown in Table 26 whilst the relative rates by year are shown in Tables 27 to 29 and Figures 20 to 22. Overall an average annual decrease in the incidence of total mental ill-health was observed of -9.2% (95% CIs: -13.5, -4.7). This compared to a decrease of -8.8% (95% CIs: -13.1, -4.1) observed previously (2006-2010). However, the graphs showing relative rates by year suggest the previously observed increase in incidence in 2010 has been followed by a decrease in incidence in 2011 (although it must be noted that the confidence intervals for the 2010 and 2011 estimates overlap the other years). A similar pattern was seen for
anxiety and depression, and other work stress.
Table 26
Average annual percentage change in reported incidence in work-related mental ill-health
Reporter group All
Year (continuous) Total mental ill-health Anxiety and depression Other work stress 2006-2011 2006-2011 2006-2011
ESTIMATED % CHANGE (95% CONFIDENCE INTERVAL) THOR-GP -9.2 (-13.5, -4.7) -7.7 (-14.2, -0.6) -10.7 (-15.9, -5.2)
56
Table 27
Relative rates by year, with 95% comparison intervals, total mental ill-health (2011 estimate = 1)
Reporter Group All
Figure 20 Relative rates by year (2011 estimate = 1), with 95% comparison intervals, total mental ill-health

2 1.8 1.6
Relative rate
1.4 1.2 1 0.8 0.6 0.4 0.2 0 2006 2007 2008 2009 2010 2011
Year
57
Table 28
Relative rates by year, with 95% comparison intervals, anxiety and depression (2011 estimate = 1)
Reporter Group All
Figure 21
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, anxiety and depression

2 1.8 1.6
Relative rate
1.4 1.2 1 0.8 0.6 0.4 0.2 0 2006 2007 2008 2009 2010 2011
Year
58
Table 29
Relative rates by year, with 95% comparison intervals, other work stress (2011 estimate = 1)
Reporter Group All
Figure 22
Relative rates by year (2011 estimate = 1), with 95% comparison intervals, other work stress

2 1.8 1.6
Relative rate
1.4 1.2 1 0.8 0.6 0.4 0.2 0 2006 2007 2008 2009 2010 2011
Year
59
DISCUSSION
This is the latest report describing temporal trends in incidence of WRI as reported by physicians to the THOR surveillance network. For the current report, data from NHS hospital based specialist consultants reporting to EPIDERM (skin) and SWORD (respiratory), and from GPs reporting to THORGP (all WRI) were used to estimate trends for the period 1996-2011 (EPIDERM), 1999-2011 (SWORD) and 2006-2011 (THOR-GP). HSE funding for data collection for the other main extant THOR scheme, OPRA (occupational physicians), ceased at the end of 2010, with trends for that period (2006-2010) reported upon previously2.
There have been no changes to the methodology reported on here in respect of trends calculations since the 2011 trends report was submitted and changes made at that point and earlier are discussed in full in previous reports2-7. However, one important issue that was discussed in the 2011 report that warrants further comment here was the substantial change to the THOR-GP sampling methodology, which moved from >90% core (reporting on a monthly basis) prior to 2010 to 78% sample (reporting one randomly chosen month per year) in 2010. By way of background it should be restated that when THOR-GP was launched in 2005 it started generating reports at a far higher level than specified in the contract (so as to pump prime the database). The data collection in 2010 was as per the original contract. Moreover, since HSE funding was limited, the participating GPs were then no longer paid an honorarium for these reports. Therefore, for the present round of analyses, a further shift occurred with 100% of the GPs reporting in 2011 reporting on a sample basis. Initial investigations of case reporting in THOR-GP suggested that physicians reporting as sample in 2010 and 2011 reported, on average, three times as many cases (in any one month) than when reporting as core reporters in 2009. Work is currently underway to investigate this rate difference between core and sample. We had previously reported the same phenomenon with OPRA11 but with a much smaller magnitude. One hypothesis that has been put forward is that some of the cases reported by GPs might not be truly incident. It is likely that a patient will make more frequent visits to the GP than to other physicians, possibly for further sickness 60
certification. Therefore a GP may report a case in their reporting month that they first saw in clinic with the same problem in a previous month (i.e. harvesting). This would produce an overestimate in rates as such a case is prevalent, rather than incident. This is more likely to happen for those only reporting one month a year (sample) compared to continuous (core) reporters. However, further work is required to understand this issue fully. As discussed previously2 the approach adopted in the MLM analyses was to treat a physician as a new reporter if they changed from core to sample (or vice versa). GPs reporting for the first time as sample reporters in 2010 would therefore only have two data points and those reporting as sample for the first time in 2011 would only have one data point and would therefore (in theory) contribute less to the overall trend. Analyses reported upon previously for the period 2006-2010 did appear to confirm this with estimates from the THORGP MLM in which sample data were excluded being very similar to those in which all data were included. Core reporting stopped at the end of 2010 so this exercise was not repeated in the current round of analyses. It would also be informative to investigate trends based on sample data only but at present numbers are too small to yield any meaningful results (63% of sample reporters have two data points, with a further 30% having one data point only). In view of the small numbers and until the issue of change in time sampling pattern is more fully understood, the THOR-GP trend estimates need to be interpreted with caution.
THOR trends methodology has progressively addressed relevant artefacts (e.g. changing denominators). The main residual issue which has been much discussed within the trends project is the issue of reporter fatigue. Initial investigations primarily focussed on determining whether the proportion of responses that are zero returns (i.e. declaring I have nothing to report) or the proportion of non-response had increased over time (both of which could be an indication of reporter fatigue)12,
13
. In brief, for the specialist schemes,
results suggested some evidence that the proportion of both non-response and zero returns increased with membership time, whilst for THOR-GP, the proportion of zero returns but not non-response increased with membership time. Following this it was recognised that further work in this area was 61
required, and as such, additional HSE funding was secured to address this and other issues relating to THOR trends and incidence. This comprised 6 work packages, 2 of which related to specifically to the issue of fatigue14-16. The first of these built on the earlier work investigating changes in the probability of a zero-return or non-response over time. The other work package relevant to this issue investigated whether there was evidence of fatigue manifesting as an excess of zeros in the THOR data and if so, how this could best be modelled. The results suggested evidence of zero-inflation in some schemes/reporter groups (in EPIDERM both core and sample reporters and in OPRA sample reporters only) but not others (THOR-GP, SWORD, and OPRA core reporters). However, an excess of zeros would only impact on the trends analysis if there was further evidence that the percentage of false zeros changed over time and such evidence was found for EPIDERM sample reporters only.
As in previous reports, the estimates presented here have not been adjusted for the potential effects of fatigue. The latest body of work regarding this issue has only fairly recently been completed, with the findings and their implications for future analyses still under discussion within the THOR team and in the THOR steering group. However, it is planned that the 2013 trends report will provide further updates regarding this issue.
An abridged commentary by category of illness is provided in the following sections.
SKIN (EPIDERM and THOR-GP): The primary source of THOR data of workrelated skin disease is reports from dermatologists to EPIDERM, with trends in incidence for this group first described in a report submitted to HSE in 20057. Overall, the addition of each successive year of data has not greatly affected the estimated average annual change in incidence of total workrelated skin disease which has remained at around a 3% decrease per year. However, the plots showing relative rates have suggested some variation in incidence between years. Most notable in the current round of analyses was the relatively large drop in incidence between 2010 and 2011 compared to changes between other years. This may reflect (at least in part) changes in 62
reporting methods between the two years and has therefore to be treated very cautiously. Prior to 2011, dermatologists could submit their case reports to EPIDERM using either the traditional paper based report card (which would be sent to them in the post prior to their reporting month) or electronically via a web form. For 2011 however, it was decided not to send the report card in the post as usual but to instead email the physicians an electronic version of the card which they could then complete and return (with the option to report via a web form also still available). This was both an attempt to increase the proportion of physicians reporting electronically (with the obvious benefits of reducing transcription errors etc) and of reducing the costs incurred through the printing and postage of the traditional report cards (HSE funding for 2011 EPIDERM data collection had not been secured at the time). However, response rates for 2011 were notably lower than in previous years, particularly for core reporters, and feedback from the physicians suggested that they found the traditional report cards much more practical for their day to day practice. In view of this, the cards were reinstated for reporting in 2012.
The trend in incidence observed for dermatologist reported contact dermatitis (CD) was very similar to that observed for skin overall, unsurprising given that case reports of CD comprise the majority of the skin reports. The larger decrease in incidence observed for allergic CD compared to irritant CD has been discussed in previous reports2,3 with the suggestion that it may reflect steps such as the reduction in use of powdered latex gloves following Government interventions (introduced between 1996 and 1998) aiming to reduce exposure to latex. This theory is further corroborated by the observed change in the incidence of (dermatologist reported) contact urticaria (CU) (which would also be expected to decrease if the latex interventions were successful) which shows a decline over a similar period. Indeed, as the quality and quantity of the data increases, it has been possible for THOR to apply the trends methodology to investigate the impact of Government (or other) interventions aiming to reduce the incidence of WRI attributed to specific agents such as latex and chromium17, 18.
The other main sub-group of skin diagnoses reported by dermatologists to EPIDERM was neoplasia, for which a smaller (compared to CD and CU), but 63
still statistically significant, annual decrease in incidence was observed. However, there was a large drop in the number of case reports of neoplasia (particularly from core physicians) in 2011 compared to previous years, reflected in the results by the wide confidence intervals around the 2011 estimate. This drop in 2011 may partly reflect the overall decline in response rates arising from the cessation of the paper based report card. However, different trends have been observed between reporter type (core and sample) previously2, with core data suggesting a decrease in incidence and sample data suggesting an increase in incidence. This may be because core EPIDERM reporters main area of expertise has historically been and probably still is in occupational contact dermatitis, so skin neoplasia referrals may be triaged to other (sample) reporters.
A decrease in the incidence of GP reported work-related skin disease was also observed which, although not statistically significant, was larger than that seen for dermatologists over the same time period. However, skin reports comprise a relatively small proportion of the total cases reported to THOR-GP, and this coupled with the (as yet unknown) impact on the trend estimate of the previously discussed changes in sampling frequency (i.e. the move from predominantly core to predominantly sample), means it is important to be cautious when interpreting the trend estimates for THOR-GP.
RESPIRATORY (SWORD): Trends in incidence based on data from respiratory physicians have also been described since the initial report submitted to HSE in 20067. Compared to dermatologists however, the addition of each successive year of data appears to have had more of an impact on the annual average estimated change in incidence of total work-related respiratory disease from an initial decrease of around 1% per year (based on data for the period 1999-2004) to a decrease of around 3% observed in the current round of analyses. The greater variability (compared to skin) may reflect differences in case mix (and changes in case mix over time) between the two groups of reporters. Whilst case reports to EPIDERM are predominantly CD and neoplasia (and have been throughout the study period), case reports to SWORD encompass a wider diagnostic range with the proportion of the total cases attributed to each diagnosis exhibiting some 64
variation throughout the study period. Therefore, for respiratory disease (as reported by chest physicians), it is probably more informative to look at changes in incidence for the individual respiratory sub-groups.
Regarding asthma, the average annual percentage change in reported incidence has remained at about a 7% decrease per year with much of this decrease appearing to have been driven by a fall in incidence in earlier years, with a relatively flat trend apparent since 2007. As observed for skin disease, this decrease in incidence may, in part, reflect the introduction of Government (and other) initiatives targeting this disease category. Recent work has begun to investigate the impact of changes in legislation, regulatory activity and market forces on the incidence of workplace asthma in the UK19.
In addition to asthma, changes in the incidence of the (primarily) asbestos related diseases, namely, mesothelioma, benign pleural plaques and pneumoconiosis were also (separately) investigated. For all three groups, an overall decrease in incidence was observed (but this was only statistically significant for mesothelioma). The reported decline in the incidence of mesothelioma has been discussed previously as the results are contrary to what is expected from other evidence (including epidemiological studies from Peto et al and the mesothelioma death registers) which suggests the incidence is rising with a possible peak expected in 201620,
21
. It has been
suggested (after consultation with key SWORD reporters) that the observed decrease reflects changes in referral patterns/case mix rather than a true decrease in incidence with a possible shift in referral patterns since a proportion of these cases are now being referred to oncologists rather than exclusively to chest physicians as used to be the case. Similarly, the relatively flat trend observed for benign pleural plaques probably reflects the fact that individuals presenting with this disease (in England and Wales) are no longer financially compensated22 and therefore, referrals to chest physicians are less common. It was suggested (by members of the SWORD Advisory Committee) that it would be interesting to examine whether a different trend was apparent if analyses were restricted to data for Scotland (where compensation is still available). Although data are not yet sufficient in numbers to apply the MLM methodology, analysis of the crude trend (i.e. actual case reports per year) did 65
appear to suggest an increase in case reports over time, and this is something that could be investigated further in the future. Similarly, it has been postulated that it could be interesting to investigate pneumoconiosis trends separately by agent. However, analysis of the crude data suggested the majority of the cases were attributed to asbestos with relatively few attributed to other agents (mainly silica and coal) and therefore there may not be enough statistical power to make such a comparison. Further benchmarking of the THOR asbestos data with national registers is planned to help investigate these issues further.
MUSCULOSKELETAL AND MENTAL-ILL-HEALTH (THOR-GP)
In the absence of HSE funded data from occupational physicians for 2011, case reports to THOR-GP comprise the only THOR source of data on both work-related musculoskeletal disorders (MSDs) and mental ill-health. Until the end of 2009, these two diagnostic groups were also reported by rheumatologists (MOSS) and psychiatrists (SOSMI) but these schemes have not continued due to lack of funding. However, a comparison of these data with data from GPs suggested that, although proving of great value in building up a better picture of the burden and relationship between MSDs and mental ill-health in primary and secondary care, reports from rheumatologists and psychiatrists only captured the tip of the iceberg (or surveillance pyramid) and were subject to certain biases such as severity and referral patterns23. It was concluded that data from GPs are likely to give a truer reflection of the overall patterns and incidence of work-related MSDs and mental ill-health in the UK as GPs are the first port of call when an individual is feeling unwell. GPs participating in THOR-GP are, in particular, best placed to provide this information as they have been trained to have a better understanding of the relationship between work and heath than other GPs.
GP data suggested a decline in the incidence of both MSDs and mental illhealth over the study period, with a larger annual decrease observed for the former compared to the latter. A similar pattern was observed for each of the 66
MSD and mental ill-health sub-groups analysed. The addition of the 2011 data had very little impact on the annual average estimated change, further supporting the theory that (at present) the data from sample reporters (the majority of whom had only one or two data points) has little impact on the overall trend.
It is not yet clear whether this large downward trend in GP reported incidence is a true change in incidence or whether it is due to other factors, for example, reporter fatigue. It has been postulated previously that sample reporters are perhaps less prone to reporter fatigue (as they only have to report for one month a year). It is therefore valuable to continue to monitor the GP trends now that reporting is 100% sample. One hypothesis that has been discussed previously regarding the decrease in incidence of MSDs and back pain in particular, is that the decrease may reflect a change in how patients present their symptoms. The combination of mental ill-health being perceived as less of a stigma and the policy of active treatment for MSDs may mean that cases previously presenting as MSDs might now be more likely to present as psychological. Analysis of occupational physician reported data within the healthcare sector did provide some evidence of such an effect24. However, if this also holds true for GP reports, THOR has not yet observed the accompanying expected increase in GP reported incidence for mental illhealth.
CONCLUSION
Trends in incidence of work-related illness, as reported by medical physicians to THOR, have been described on an annual basis since the submission of the first report to HSE in 2006. Subsequent reports have not only updated these trends but have also described ongoing methodological developments, including investigations of the important issue of reporter fatigue. Thus, to date, a large body of work has been generated which has proved a useful resource in terms of both measuring and interpreting trends in (medically reported) work-related illness in the UK. Some of the observed trends have remained relatively unchanged with the addition of each successive year of data and are in accordance with those expected as a result of Government 67
initiatives (for example, the decline in incidence of asthma, contact dermatitis and contact urticaria), with further work by this group investigating these trends in relation to specific sectors or agents. For others, in particular the asbestos related diseases, the observed trends have shown a greater degree of variation and may, at least in part, reflect a change in management and referral patterns rather than a true trend. Ongoing work, including benchmarking with other data sources will help clarify these issues further. Since 2009, the annual trends reports have also analysed data reported by GPs. However, these data should be interpreted with caution until issues such as the impact of reporting activity and reporter fatigue are better understood, with continued efforts undertaken to improve the THOR trends methodology to enable these and other partially resolved issues to be investigated further.
ACKNOWLEDGMENTS
THOR is partially funded by the Health and Safety Executive and has also received funding from other sources. We are grateful to the physicians who report to THOR for their continuing support. The authors would also particularly like to thank John Hodgson (HSE) for his advice to enable the revised presentation of the statistical uncertainty (confidence intervals) in the graphs illustrating time trends.
REFERENCES
1 The THOR website. Available at: http://www.medicine.manchester.ac.uk/oeh/thor
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McNamee R, Carder M, Chen Y, Agius R. Time trends in the incidence of work-related disease in the UK, 1996-2006: estimation from ODIN/THOR surveillance data. Report to HSE submitted September 2007. McNamee R, Carder M, Chen Y, Agius R. Time trends in the incidence of work-related disease in the UK, 1996-2004: estimation from ODIN/THOR surveillance data. Available at http://www.hse.gov.uk/statistics/pdf/trendsinthor.pdf. Last accessed September 2012. McNamee R, Carder M, Chen Y and Agius R. Assessment of changes in the incidence of work-related disease over time using ODIN and THOR surveillance data. Report to HSE submitted 2005 Office for National Statistics. Labour Force Survey 1996-2011: The Stationery Office, 2012. Firth D and De Menezes RX. Quasi-variances. Biometrika (2004); 91 (1): 6580. McNamee R, Chen Y, Hussey L, Agius R. Randomised Controlled Trial comparing time-sampled versus continuous time reporting for measuring incidence. Epidemiology, 2010; 21(3): 376-378 McNamee R. Fatigue discussion. Document sent to HSE via email 12th March 2007. McNamee R. Surveillance and reporter fatigue. Report sent to HSE via email 8th May 2007 Holland F and McNamee R. Work package 1: Modelling of zeros and nonresponse with membership time. Report sent to HSE via email January 2012 Holland F and McNamee R. Work package 2: Analysis of zero-inflated count data for EPIDERM, OPRA, THOR-GP and SWORD. Report sent to HSE via email July 2011 Holland F, McNamee R and Hodgson J. Summary of statistical work packages applied to THOR surveillance data. Report sent to HSE via email 19th March 2012 Turner S, McNamee R, Wilkinson SM, Agius R, Carder M, Stocks J. Evaluating interventions aimed at reducing occupational exposure to latex and rubber glove allergens. Occupational and Environmental Medicine, in press. Stocks SJ, McNamee R, Turner S et al. Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK? Occup Environ Med 2012;69:150-152. SJ Stocks, R McNamee, M Carder, S Turner, RM Agius. The impact of changes in legislation, regulatory activity and market forces on the incidence of workplace respiratory disease in the UK from 1996 to 2010. In preparation.
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Peto J, Hodgson J, Matthews F, Jones J (1995). Continuing increase in mesothelioma mortality in Britain. The Lancet 1995; 345:535-539. Health and Safety Executive. Deaths from asbestos-related and other occupational lung diseases. Table MESO01: Death certificates mentioning mesothelioma, 1968-2008. Available at: http://www.hse.gov.uk/statistics/tables/index.htm [accessed September 2012]. Pleural plaques litigation, House of Lords judgement. Available at: http://www.publications.parliament.uk/pa/ld200607/ldjudgmt/jd071017/johns1.htm [accessed September 2012]. Hussey L, Carder M, Money A, Turner S and Agius R. THOR-GP, MOSS and SOSMI: A comparison of work-related musculoskeletal and mental ill-health reported to THOR by general practitioners, rheumatologists and psychiatrists. Internal report to HSE, submitted by email November 2012 Carder M, McNamee R, Turner S, Hodgson J, Holland F, and Agius RM. Time trends in the incidence of work-related mental ill-health and musculoskeletal disorders in the UK. Occupational and Environmental Medicine. In press
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22
23
24
70
APPENDIX A Table A1
DESCRIPTIVE ANALYSES
Reporting activity of reporters in EPIDERM, 1996-2011 CORE SAMPLE 47 368 46 90% 17% 0 338 76% 63% 108
Total reporters ever in 1996-2011 Total active* reporters in 1996-2011 Response rate** % of returns that are blank Number of reporters who responded at least once but never returned a case Number of reporters who have never responded * Active reporter is someone who returns a card **Response rate = cards returned/cards sent out
30
Figure A1
250
Number of reporters in EPIDERM by year and reporter type
Core reporters Sample reporters
Number of reporters
200
150
100
50
0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
71
Figure A2
45 40
Number of active reporters per month EPIDERM
no of active reporters
35 30 25 20 15 10 5 0
months
Figure A3 Cases per active reporter per month EPIDERM a) Total cases
actual cases per active reporters
months
72
b) Contact dermatitis
months
c) Contact urticaria (note scale change)
1.0
0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0
months
73
d) Neoplasia
1
0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
e) Other skin (other than contact dermatitis)

1
0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
74
Table A2
Cases reported per month by disease category and type of reporter, EPIDERM, 1996-2011
All Reporters Statistic Total active reporters ever in 1996-2011 Mean no. of active* reporters per month 415 32.0 17071 88.91 2.76 13838 72.1 2.25 5137 26.76 0.83 6147 32.02 1.01 2138 11.14 0.35 3304 17.21 0.53 Min Max SD 47 20.97 15141 78.86 3.73 12516 65.19 3.09 4541 23.65 1.11 5667 29.52 1.41 1971 10.27 0.49 2688 14.00 0.65 Core reporters Min Max SD 368 11.03 1947 10.14 0.93 1340 6.98 0.64 596 3.10 0.28 480 2.50 0.23 167 0.87 0.08 614 3.20 0.29 Sample reporters Min Max SD
16.0
42.0
4.9
13.00
26.00
2.93
3.00
20.00
3.07
Disease group All cases
Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month
29 1.12
152 6.08
25.61 0.67
23.00 1.57
150.00 7.89
24.04 0.95
0.00 0.00
33.00 4.67
6.53 0.59
Contact dermatitis (CD)
26 0.97
124 4.96
21.26 0.57
23.00 1.35
122.00 6.42
20.02 0.80
0.00 0.00
23.00 3.00
4.74475 0.43
Allergic CD
4 0.21
58 1.68
10.64 0.29
3.00 0.23
54.00 2.44
9.74 0.40
0.00 0.00
12.00 2.00
2.77 0.27
Irritant CD
13 0.41
58 2.32
9.42 0.29
10.00 0.61
58.00 3.05
9.22 0.41
0.00 0.00
12.00 1.00
2.21 0.20
Mixed CD
2 0.07
27 0.92
5.03 0.15
1.00 0.05
25.00 1.21
4.86 0.21
0.00 0.00
5.00 0.63
1.12 0.11
Other* cases
1 0.05
36 1.12
7.40 0.21
0.00 0.00
28.00 1.50
6.32 0.28
0.00 0.00
15.00 1.67
3.39 0.32
75
All Reporters Statistic Min Max SD
Core reporters Min Max SD
Sample reporters Min Max SD
Contact urticaria
Total cases Mean cases per month Mean cases per active reporter per month
809 4.21 0.13 2086 10.86 0.33
0 0.00
15 0.42
2.90 0.08
764 3.98 0.19 1635 8.52 0.39
0.00 0.00
14.00 0.78
2.84 0.13
45 0.23 0.02 451 2.35 0.21
0.00 0.00
3.00 0.33
0.53 0.05
Neoplasia
Total cases Mean cases per month Mean cases per active reporter per month *other than contact dermatitis
0 0.00
28 0.80
5.69 0.16
0.00 0.00
20.00 1.05
4.53 0.21
0.00 0.00
15.00 1.38
3.03 0.27
76
Table A3
Reporting activity of reporters in SWORD, 1999-2011 CORE SAMPLE 43 755 40 86% 29% 710 76% 72%
Total reporters ever in 1999-2011 Total active* reporters in 1999-2011 Response rate** % of returns that are zero returns (i.e. no cases to report) Number of reporters who responded at least once but never returned a case Number of reporters who have never responded * Active reporter is someone who returns a card **Response rate = cards returned/cards sent out
241
45
Figure A4
600 500
Number of reporters in SWORD by year and reporter type
core reporters sample reporters
Number of reporters
400 300 200 100 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year
77
Figure A5
70
Number of active reporters per month SWORD
No. of active reporters
60 50 40 30 20 10 0
Month
Figure A6 Cases per active reporter per month SWORD a) Total cases
2.8 2.6 2.4 2.2 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
Cases per active reporters
Month
78
b) Non-malignant pleural disease

2.8 2.6 2.4 2.2 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
Month
c) Asthma (note scale change)

1
0.8
0.6
0.4
0.2
Month
79
d) Mesothelioma
1
0.8
0.6
0.4
0.2
Month
e) Pneumoconiosis
1
0.8
0.6
0.4
0.2
Month
80
f) Other respiratory
1
0.8
0.6
0.4
0.2
Month
81
Table A4
Cases reported per month by disease category and type of reporter, SWORD, 1999-2011
Statistic Total active reporters ever in 1999-2011 Mean no. of active* reporters per month 750 45.87 11013 70.60 1.51 2107 13.51 0.29 2190 14.04 0.30 4793 30.72 0.66 853 5.47 0.12 All Reporters Min Max SD 40 17.12 8811 56.48 3.20 1870 11.99 0.69 1476 9.46 0.53 3969 25.44 1.43 697 4.47 0.26 Core reporters Min Max SD Sample reporters Min Max SD 710 28.75 2202 14.12 0.49 237 1.52 0.05 714 4.58 0.16 824 5.28 0.18 156 1.00 0.03
27.00
59.00
6.64
10.00
23.00
3.41
16.00
38.00
4.18
Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month
19.00 0.57
133.00 2.71
24.89 0.41
11.00 0.92
112.00 5.83
23.54 0.97
3.00 0.09
35.00 1.03
6.34 0.20
Asthma
3.00 0.07
42.00 0.76
6.87 0.13
2.00 0.16
42.00 2.33
6.24 0.31
0.00 0.00
9.00 0.28
1.55 0.05
Mesothelioma
2.00 0.06
36.00 0.70
6.78 0.13
0.00 0.00
27.00 1.69
5.83 0.29
0.00 0.00
11.00 0.39
2.64 0.09
Non malignant pleural plaques
5.00 0.14
60.00 1.25
12.28 0.22
3.00 0.25
59.00 2.84
12.18 0.53
0.00 0.00
17.00 0.63
3.48 0.12
Pneumoconiosis
0.00 0.00
16.00 0.31
2.85 0.06
0.00 0.00
13.00 0.73
2.48 0.13
0.00 0.00
5.00 0.15
1.15 0.04
Other cases*
Total cases 1278 1000 278 Mean cases per month 8.19 1.00 20.00 3.89 6.41 1.00 20.00 3.48 1.78 0.00 13.00 1.88 Mean cases per active reporter per month 0.18 0.02 0.41 0.08 0.38 0.05 1.11 0.20 0.06 0.00 0.45 0.07 *Other than those specified above i.e SWORD categories: inhalation accidents, allergic alveolitis, bronchitis/emphysema, infectious disease, lung cancer and other (the latter includes rhinitis). NOTE: A case may have more than one diagnosis
82
Table A5
Reporting activity of reporters in THOR-GP, 2006-2011
Total reporters ever in 2006-2011 Total active* reporters in 2006-2011 Response rate** % of returns that are zero returns (i.e. no cases to report) Number of reporters who responded at least once but never returned a case Number of reporters who have never responded * Active reporter is someone who returns a card **Response rate = cards returned/cards sent out
CORE SAMPLE 442 257 332 58% 60% 202 74% 32%
46
46
110
55
Figure A7
400 350
Number of reporters in THOR-GP by year and reporter type

Core reporters Sample reporters
Number of reporters
300 250 200 150 100 50 0 2006 2007 2008 2009 2010 2011
Year
83
Figure A8
200 180 160
Number of active reporters per month THOR-GP
no of active reporters
140 120 100 80 60 40 20 0
months
Figure A9 Cases per active reporter per month THOR-GP a) Total cases
2 1.8
Actual cases per active reporter
1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
months
84
b) Total skin
1 0.9
Cases per active reporter
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
c) Contact dermatitis
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
85
d) Total musculoskeletal
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
e) Upper limb
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
86
f) Spine/back
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
g) Lower limb
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
87
h) Total mental ill-health
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
i) Anxiety and depression
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
88
j) Other work stress
1 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
months
89
Table A6
Cases reported per month by disease category and type of reporter, THOR-GP, 2006-2011
All Reporters Statistic Total active reporters ever in 2006-2010 Mean no. of active* reporters per month 534 118.65 5695 79.10 0.80 565 7.85 0.08 437 6.07 0.06 2991 41.54 0.40 1420 19.72 0.18 1128 15.67 0.16 Min 12 Max 187 SD 64.57 332 136.23 5115 85.25 0.62 508 8.47 0.06 400 6.67 0.05 2713 45.22 0.32 1304 21.73 0.15 1007 16.78 0.11 Core reporters Min 31 Max 185 SD 53.33 202 6.15 580 9.67 1.73 57 0.95 0.20 37 0.62 0.11 278 4.63 0.86 116 1.93 0.37 121 2.02 0.35 Sample reporters Min 0 Max 18 SD
6.41
Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month
12 0.35
190 1.79
42.41 0.34
11 0.33
190 1.44
42.39 0.20
0 0
34 7
10.30 1.53
All skin
0 0.00
25 0.36
5.02 0.07
0 0
25 0.17
5.06 0.03
0 0
5 2
1.36 0.36
Contact dermatitis
0 0.00
21 0.33
4.22 0.05
0 0
21 0.14
4.25 0.03
0 0
4 1
0.96 0.22
All musculoskeletal
3 0.20
106 1.07
24.46 0.17
5 0.15
106 0.77
24.53 0.12
0 0
17 5
5.12 0.95
Upper limb
1 0.07
52 0.44
12.13 0.07
1 0.03
52 0.44
11.87 0.07
0 0
8 2
2.16 0.43
Spine/back
1 0.04
49 0.71
10.15 0.10
0 0
49 0.29
10.67 0.05
0 0
10 2
2.72 0.41
90
All Reporters Statistic

Lower limb
d
Core reporters Max 14 0.23 SD 3.45 0.04 356 5.93 0.04 1604 26.73 0.20 700 11.67 0.09 1051 17.52 0.13 Min 0 0 Max 14 0.14 SD 3.52 0.02
Sample reporters Min 41 0.68 0.14 218 3.63 0.54 90 1.50 0.17 145 2.42 0.37 0 0 Max 4 2 SD
Min 397 5.51 0.06 1822 25.31 0.27 790 10.97 0.12 1196 16.61 0.18 0 0.00
Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month Total cases Mean cases per month Mean cases per active reporter per month
1.02 0.33
All mental ill-health
3 0.08
56 0.94
12.78 0.15
3 0.08
56 0.44
13.03 0.07
0 0
16 3
4.37 0.51
Anxiety/depression
0 0.00
26 0.35
6.26 0.07
1 0.02
26 0.21
6.33 0.04
0 0
9 2
2.19 0.27
Other work stress
1 0.05
38 0.76
8.89 0.12
0 0
38 0.29
9.26 0.05
0 0
13 1
2.93 0.32
a b
Trends in respiratory disease not analysed separately as <250 cases Upper limb = hand/wrist/arm, elbow and shoulder c Spine/back = neck/thoracic spine and lumbar spine/trunk d Lower limb = ankle/knee/foot NOTE: A case may have more than one diagnosis
91
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Thor Trends 12

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Time trends in the incidence of work-related illhealth in the UK, 1996-2011: estimation from THOR surveillance data

Carder M, McNamee R, Hussey L, Turner S, Agius R

http://www.medicine.manchester.ac.uk/oeh/research/thor/ September 2012

CONTENTS Page number 10 10 13 13 13 13 14 14 15 17 37 51 56 60 67

LIST OF TABLES Page number 11 12 16 16 19 20 23 25 27 29 31 33 35 38 39 41 43 45 47 49 51 52 53 54 7

intervals, reported intervals, intervals, intervals,

LIST OF FIGURES Page number 16 21 24 26 28 30 32 34 36

LIST OF APPENDICES A Descriptive analyses Page number 71

Data period for trends analyses

Categories of illness included in the analyses

3.2.1 TOTAL WORK-RELATED ILLNESS

Average annual percentage change in risk in total workrelated illness

Year (continuous) 2006-2011

Reporter Group All

Year 2006 2007 2008 2009 2010 2011

THORGP, all reporters

3.2.2 WORK-RELATED SKIN DISEASE

Average annual percentage change in reported incidence in work-related skin disease

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

THORGP, all reporters

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

Reporter Group All

EPIDERM, all reporters

EPIDERM, core reporters

EPIDERM, sample reporters

3.2.3 WORK-RELATED RESPIRATORY DISEASE

Average annual percentage change in reported incidence in work-related respiratory disease

Year (continuous) 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011

Year (continuous) 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011

Year (continuous) 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011 1999-2011

Reporter Group All

SWORD, all reporters

SWORD, core reporters

SWORD, sample reporters

Reporter Group All

SWORD, all reporters

SWORD, core reporters

SWORD, sample reporters