Population-based asbestosis surveillance in British Columbia

Objectives: To investigate the use of multiple health data sources for population-based asbestosis surveillance in British Columbia, Canada. Methods: Provincial health insurance registration records, workers' compensation records, hospitalisation records, and outpatient medical service records were linked using individual-specific study identifiers. The study population was restricted to individuals >= 15 years of age living in the province during 1992-2004. Results: 1170 new asbestosis cases were identified from 1992 to 2004 for an overall incidence rate of 2.82 (men: 5.48, women: 0.23) per 100 000 population; 96% of cases were male and average (SD) age was 69 (10) years. Although the annual number of new cases increased by 30% during the surveillance period (beta=2.36, p=0.019), the observed increase in annual incidence rates was not significant (beta=0.02, p=0.398). Workers' compensation, hospitalisation and outpatient databases identified 23%, 48% and 50% of the total new cases, respectively. Of the new cases, 82% were identified through single data sources, 10% were only recorded in the workers' compensation records, and 36% only in each of the hospitalisation and outpatient records. 84% of hospitalisation cases and 83% of outpatient cases were not included in the workers' compensation records. The three data sources showed different temporal trends in the annual number of new cases and annual incidence rates. Conclusions: Single data sources were not sufficient to identify all new cases, thus leading to serious under-estimations of the true burden of asbestosis. Integrating multiple health data sources could provide a more complete picture in population-based surveillance of asbestosis and other occupational diseases.