Epidemiological surveillance
Mortality rates compared to the French population and risk of cancer-related death in the cohort
Mortality compared to the French population
Over the 2005–2016 period, 700 deaths were recorded (8%), and the number of observed deaths was lower than the expected number, with 640 deaths versus 880 among men (SMR=0.73) and 60 deaths versus 77 among women (SMR=0.78).
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Observed and expected deaths – standardized mortality ratios and 95% confidence intervals by age and period of death among retired male and female artisans (N=8,583) |
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Men
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Women
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Observed population |
Expected numbers* |
SMR1 |
95% CI |
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Observed numbers |
Expected numbers* |
SMR1 |
95% CI |
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Overall |
640 |
880 |
0.73 |
0.67–0.79 |
S |
60 |
77 |
0.78 |
0.59–1.00 |
NS |
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Age |
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55–64 years |
220 |
310 |
0.71 |
0.62–0.81 |
S |
15 |
15 |
0.98 |
0.55–1.62 |
NS |
|
65–74 years |
365 |
510 |
0.72 |
0.64–0.79 |
S |
26 |
45 |
0.58 |
0.38–0.84 |
S |
|
75–84 years |
43 |
47 |
0.92 |
0.67–1.24 |
NS |
5 |
8 |
0.60 |
0.20–1.40 |
NS |
|
85–94 years |
12 |
13 |
0.96 |
0.50–1.68 |
NS |
14 |
8 |
1.70 |
0.93–2.86 |
NS |
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Period |
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2005–2008 |
52 |
78 |
0.67 |
0.50–0.88 |
S |
5 |
7 |
0.72 |
0.23–1.68 |
NS |
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2009–2012 |
272 |
366 |
0.74 |
0.66–0.84 |
S |
29 |
31 |
0.93 |
0.62–1.34 |
NS |
|
2013–2016 |
316 |
329 |
0.96 |
0.86–1.07 |
NS |
26 |
30 |
0.87 |
0.57–1.27 |
NS |
This overall undermortality does not mean that excess mortality for a given cause is impossible, but at this time it has not been identified, as the cohort follow-up is still too recent. Furthermore, this lack of historical perspective in the follow-up does not allow for a detailed description of mortality by subgroup (by occupation or sector of activity, for example) due to the small number of deaths observed. It can already be noted that retired craftsmen do not die in the short term from a single major cause, compared to the general French population. The “healthy worker effect” could partly explain this, as could the fact that artisans who continue working until retirement age are in relatively good health; furthermore, it is known that survey respondents are potentially in better health than non-respondents.
Extending the follow-up period and updating mortality data in 2018 will allow us to update this study with newly observed deaths and refine the analyses if the new data allow it.
Cancer Mortality
The most common cancer-related deaths potentially linked to asbestos and silica are described in the table, for both men and women.
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Number of retired men and women in the skilled trades who died of cancer* before October 31, 2016 (N=8,583) |
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|---|---|---|
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Malignant tumors |
Men
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Women
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Colon, Rectum, and Anus C18 to C21 |
29 |
1 |
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Trachea-Bronchi-Lung C33 and C34 |
83 |
4 |
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Larynx C32 |
3 |
0 |
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Pleura C384 Mesothelioma C45 |
3 |
0 |
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Breast C50 |
1 |
7 |
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Ovary C56 |
- |
2 |
Risk of death from cancer among exposed and unexposed individuals
Modeling to study the link between cancer incidence and past occupational exposure was performed using a Cox model when the number of cancer deaths from a given site exceeded 10. It did not reveal an increased risk of cancer-related death among those exposed to asbestos or silica compared to unexposed individuals. Extended follow-up and updated mortality data will allow for more refined analyses over time.
Morbidity: Risk of Cancer Development Associated with Occupational Exposure
A total of 7,544 participants agreed to take part in the morbidity study.
With the aim of describing and identifying new cases of diseases linked to asbestos or silica and quantifying the associations and risks of developing these diseases—including cancers—based on past occupational exposures, sectors, and occupations, the monitoring of disease incidence is conducted using annual data extracts from the CNAM and the SNIIRAM databases.
Cancers identified by site and year of incidence among retired male and female craftsmen between 2011 and 2017
| Locations* | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | Total |
|---|---|---|---|---|---|---|---|---|
| Colon, rectum, and anus C18 to C21 | 18 | 21 | 12 | 9 | 19 | 22 | 19 | 120 |
| Rectosigmoid colon C18 and C19 | 15 | 15 | 11 | 7 | 18 | 18 | 14 | 98 |
| Rectum-anus C20 and C21 | 6 | 9 | 5 | 3 | 6 | 6 | 9 | 44 |
| Trachea and lungs C33 and C34 | 6 | 13 | 25 | 14 | 17 | 20 | 10 | 105 |
| Larynx C32 | 2 | 1 | 2 | 1 | 1 | 2 | 0 | 9 |
| Pleura C384 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 3 |
| Mesothelioma C45 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 |
| C50 cup | 4 | 10 | 5 | 5 | 6 | 6 | 3 | 39 |
| Ovary C56 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
*A retiree may be classified in one or more locations.
ESPrI is involved in the Tumor Group of the REDSIAM network.
No increased risk of cancer was found among exposed men compared to unexposed men, for either asbestos or silica exposure.
As the cohort ages and annual updates on cancer cases identified through Sniiram are incorporated, the statistical power of this analysis will increase, allowing for a more detailed examination of the link between occupational exposure and other cancer sites.
Claims to the Asbestos Victims Compensation Fund
Since 2002, retirees have filed 89 claims with the FIVA, including 3 filed by beneficiaries since their inclusion.
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Description of applications submitted by artisans to Fiva prior to 2016 (N=89) |
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|---|---|
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Average age at the time of application (years) |
64.5 |
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Perception of having been exposed to asbestos in the |
45% |
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Fiva claims for: |
63% |
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Most common trades |
42% |
The perception of having been regularly exposed to asbestos versus occasionally exposed or not exposed at all during one’s career, and having consulted a pulmonologist versus a general practitioner during the initial medical evaluation, are factors that increase the likelihood of seeking treatment, regardless of the retiree’s age, gender, industry, or occupation, particularly if the retiree has developed a condition potentially linked to asbestos.
