Measurement of trends in incidence of work-related skin and respiratory diseases, UK 1996-2005.
OBJECTIVE
The ability to measure temporal trends in disease incidence is important, but valid methods are needed. This study investigates UK trends during 1996-2005 in work-related skin and respiratory diseases including non-malignant pleural disease, asthma, mesothelioma and pneumoconiosis and the potential for bias when using surveillance systems for this purpose.


METHODS
The volunteer reporters in three surveillance schemes were specialist physicians for skin diseases, specialist physicians for respiratory diseases and occupational physicians, respectively, who provided monthly reports of new cases of disease which they considered work related. Poisson regression models were used to investigate variation by calendar year (trend), season and reporter characteristics. Separately, temporal patterns in the probabilities of non-response and zero reports were investigated. Annual changes in disease incidences were compared between reporter groups.


RESULTS
There was little evidence of change in incidences of non-malignant pleural disease, mesothelioma, skin neoplasia and urticaria, but falls were seen for contact dermatitis and pneumoconiosis. Although the directions of change were similar across reporter groups, the magnitude of annual change in incidence was often inconsistent: for occupational asthma, it was -1.9% (95% CI -5.2 to 1.4) and -12.1% (95% CI-19.5 to -4.1) using respiratory and occupational physician reports, respectively. Response rates were high (approximately 85%), but non-response increased slightly with membership time, as did the probability of a zero return in some groups. Adjustment of results for presumed reporting fatigue led to an upward correction in some calendar trends.


CONCLUSIONS
As some estimated changes in incidence based on volunteer reporting may be biased by reporting fatigue, apparent downward trends need to be interpreted cautiously. Differences in the population bases of the surveillance schemes and UK health service capacity constraints may also explain the differences in trends found here.
McNamee
R
R
Health Methodology Research Group, School of Community-based Medicine, University Place (1st Floor), University of Manchester, Oxford Road, Manchester M13 9PL, UK. mcnamee@manchester.ac.uk
Carder
M
M
Chen
Y
Y
Agius
R
R
D001249:Asthma / Q000453:epidemiology; D009783:Dermatitis, Occupational / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008654:Mesothelioma / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology*; D010995:Pleural Diseases / Q000453:epidemiology; D011009:Pneumoconiosis / Q000453:epidemiology; D012120:Respiration Disorders / Q000453:epidemiology*; D012871:Skin Diseases / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology