Chronic Pulmonary Diseases of self-employed in the craft, trade and services sector. Doctor Philippe Ha-Vinh Expert physician advisor in health studies diffusion at the French national retirement and health insurance fund for self-employed people in craft, trade and services, - PowerPoint PPT Presentation
1 Eumass 14-16 June 2012, Padova, Italy 1 Chronic Pulmonary Diseases of self- employed in the craft, trade and services sector. Doctor Philippe Ha-Vinh Expert physician advisor in health studies diffusion at the French national retirement and health insurance fund for self-employed people in craft, trade and services, A public statutory Health Care Insurance Fund Régime Social des Indépendants (RSI) France Palazzo Moroni Room Anziani Session: 15- Work related diseases and injuries II Time for presentation: 15 mn (10+5 discussion)
Transcript
1Eumass 14-16 June 2012, Padova, Italy
1
Chronic Pulmonary Diseases of self-employed in the craft,
trade and services sector.Doctor Philippe Ha-Vinh
Expert physician advisor in health studies diffusion at the French national retirement and health insurance fund
for self-employed people in craft, trade and services,A public statutory Health Care Insurance Fund
Régime Social des Indépendants (RSI)France
Palazzo Moroni Room Anziani
Session: 15- Work related diseases and injuries II
Time for presentation: 15 mn (10+5 discussion)
22
Occupational factors
are exposed to occupational Chronic Pulmonary Diseases
Woodworkers [Carosso, 1987]
Bakers [Houba, 1998]
Car repairers [Bener, 1998]
Taxi drivers [Bener, 1998]
Hairdressers [Blainey, 1986 ; Leino, 1997]
Dental prosthetists [Hu,2006]
Tailor, seamstress [Wang,2005; LeVan, 2006]
33
The RSIWho is insured to the RSI ?
• The RSI was born in 2006 from the merging of three social insurance funds. It is the mandatory health care and retirement fund for the self employed in crafts, trades and services.
RSI
• It is entitled to a public mission in managing the social security for more than 4 million people.
MSACNAMTS
• It is one of the three main statutory social security schemes in France, the two others being the salaried scheme (CNAMTS) and the agricultural scheme (MSA).
4
Relevance - exposure to occupational risk factors account for 15 to 20% of the etiologies of CPD
Goal
- to identify in the RSI population the high-risk jobs with regard to CPD,
Operational goal - to prioritize the preventive measures by targeting the high-risk jobs.
5
- in 2010.
- across the working population
Design - cross sectional study
- using the health care reimbursement data base of the RSI
The RSI’s data centerreceives the teletransmission from the recipients or providers of care.
Work loss wage compensation benefits for pulmonary disease (temporary or permanent
disability)
•diagnosis coding (ICD)
Repositories and classification systems Insurance reimbursements
Indicators that have been chosen in our study
1212
The risk of CPD is higher for male worker than femaleThe risk of CPD is higher for male worker than femaleChronic Pulmonary Disease Relative Risk
male
female (Réf)
0
0,5
1
1,5
2
IC 95% Adjusted OR
Advices:• Implementing preventive action targeted at male workers• Avoiding that tobacco consumption habits and men’s specific working conditions
spread to women.
1313
Chronic Pulmonary Disease Relative Risk
30-45 (Réf)
46-55 56-65
86-90
66-75 76-85
-10
0
10
20
30
40
50
60
70
80
IC 95% Adjusted OR
The risk of CPD increase with ageThe risk of CPD increase with age
Advices:• Acting early on any occupational exposure without waiting for the occurrence of the
clinical symptoms (Preventive actions should begin at the stage of apprenticeship).• Post professional surveillance of the retired at risk.
1414
Workers living in rural areas are at higher risk of CPDWorkers living in rural areas are at higher risk of CPDChronic Pulmonary Disease Relative Risk
Lowrurality (Réf)
Medium rurality
High rurality
0,000
0,500
1,000
1,500
2,000
2,500
IC 95% OR
Advices:• Chronic pulmonary diseases prevention initiatives should include rural areas.• Medical nursing homes could take a substantial part in the process.
1515
Workers living in a high unemployment area have a higher risk of CPDWorkers living in a high unemployment area have a higher risk of CPDChronic Pulmonary Disease Relative Risk
High unemployment
Medium unemployment
Low unemployment
(Réf)
0,000
0,200
0,400
0,600
0,800
1,000
1,200
1,400
1,600
1,800
2,000
IC 95% OR
Advices:• CPD prevention initiatives should emphasize on high unemployment areas.• Unemployment reduction is needed.
1616
Occupations at increased risk of CPD Occupations at increased risk of CPD Chronic Pulmonary Disease Relative Risk
Dental prostetistBaker Tobacconist Metal worker Shoemaker0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
5
IC 95% Adjusted OR
(to be (to be followed)followed)
• bakers: allergy to flour ,• tobacconists: passive smoking ,• dental prosthetists: microparticles of grinding, • metal workers: vapors of welding and grinding,• shoemakers: glues.
1717
Chronic Pulmonary Disease Relative Risk
stalls stand and markets
Transport bricklayer dressmaker driving school
Restaurants Real estateand finance
(Ref)0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
IC 95% Adjusted OR
Occupations at increased risk of CPD Occupations at increased risk of CPD (followed)(followed)
• vocational drivers: exhaust gases, • Bricklayers: mineral dust and vapors of pesticide treatment of buildings,• non sedentary storekeepers on stalls and markets: cold,• dressmakers, tailors, seamstresses: dust from cotton, • driving school instructors: exhaust gases,• restaurant owners: passive smoking and cooking fumes.
1818
What do the results of our research suggest?What do the results of our research suggest?
With regard to our findings, preventives actions should be With regard to our findings, preventives actions should be implemented concerning the following professionals:implemented concerning the following professionals:
•Baker
•Tobacconists
•Dental prosthetists
•Metal workers
•Vocational drivers
•Bricklayers
•Stalls stands and market
•Restaurants owners
More powerful epidemiological studies should be implemented for:More powerful epidemiological studies should be implemented for:•Shoemakers
•Dressmakers, seamstresses
•Driving instructors
1919
The RSI sets up actions called "RSI prevention pro", a new prevention program
addressing the professional risks based on:
The reimbursement of a primary care practitioner consultation completely dedicated to occupational risk prevention,
Providing simple and practical recommendations adapted to the self-employed and small business owners.
What does the RSI intend to do ?What does the RSI intend to do ?
20
Bottom line
21Eumass Juin-2012 21
Baker
22Eumass Juin-2012 22
Tobacconist
23Eumass Juin-2012 23
Dental prosthetists
24Eumass Juin-2012 24
Metal worker
25Eumass Juin-2012 25
are 4 risky jobs with regard to Chronic Pulmomary Disease in the RSI working population
