January 8, 2002
Increasing Prevalence of Occupational
Lung Disease Justifies Greater Prevention Efforts
Dollar Costs of Job-Related COPD and Asthma Reach Into Billions
- The rising costs and incidence of occupational COPD and asthma warrant
preventive intervention, says a study reported in the journal CHEST, the
peer-reviewed journal of the American College of Chest Physicians (ACCP).
Looking at both direct and indirect costs, the study found that $6.6 billion
was spent on obstructive lung diseases in 1996, and likely increased in more
"These costs are significant, especially since the lion's share is borne by
diseased workers and their families, by all workers through lower wages, and
by taxpayers," said study author J. Paul Leigh, PhD, professor of health
economics in the Department of Epidemiology and Preventive Medicine, School
of Medicine, University of California at Davis. "Given the increasing
prevalence of COPD and asthma as well as inflation, the costs would be
roughly $8.5 billion in 2001. Clearly this is a significant price tag that
Reviewing data from national surveys and applying a population attributable
risk (PAR) of 15 percent for both asthma and COPD, the study team found
costs of $5 billion for COPD (56% were direct costs; 44% were indirect) and
$1.6 billion for asthma (74% were direct; 26% were indirect). Direct costs
included medical and administrative expenses and indirect costs included
lost wages, lost fringe benefits and lost home production. In terms of human
deaths, the study estimated 15,032 occupational COPD deaths and 805
occupational asthma deaths in 1996, assuming a 15 percent PAR.
"These numbers should not be taken lightly," said ACCP President Sidney S.
Braman, MD, FCCP. "The incidence of occupational obstructive lung disease is
significant and represents an important burden on the health care system and
a drain on the economy. As chest physicians, we are seeing a rise in
incidence that without intervention will only continue."
Obstructive lung diseases, including asthma and COPD, represent the
fourth-leading cause of death in the United States. From 1980 to 1994, the
obstructive lung disease death rate in women nearly doubled, due, in part,
to increased smoking and the rapid increase of women in the workforce.
Occupationally related asthma and COPD far exceeds death rates for coal
workers' pneumoconiosis, asbestosis and mesothelioma.
"COPD and asthma incidence can be reduced or prevented by cutting down on
dust and particulate matter in the workplace air," said Leigh. "One way to
reduce the pollution might be to tax the industries that generate poor air
and use those funds to pay Medicare directly. That approach provides an
incentive for industry to clean up their air while lessening the financial
burden on Medicare, and thus the taxpaying public."
In an effort to raise awareness of COPD and encourage people to seek early
diagnosis and treatment, the White House recently proclaimed November
National COPD Awareness Month. In the coming months, partner organizations
will be conducting screening programs, workshops and other special events to
help people recognize the risk factors and symptoms of COPD.