Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Via Stefano Gradi, 55, 00143 Rome, Italy.
Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Via Stefano Gradi, 55, 00143 Rome, Italy.
Health Policy. 2020 Sep;124(9):1032-1040. doi: 10.1016/j.healthpol.2020.06.005. Epub 2020 Jun 10.
Although the predominant occupation origin of mesothelioma is well known, determinant factors involved in filing compensation are scarcely investigated. A linkage between incident mesothelioma cases collected by Italian mesothelioma register (ReNaM) and compensation claims and assignment by Italian national insurance Institute (INAIL) has been conducted for cases diagnosed in the period 2010-2015 and occupational exposure to asbestos. Logistic regression models and decision tree models have been used to identify demographic, diagnostic and anamnestic factors significant for filing and receiving compensation. We have included in the analyses 5019 mesothelioma cases, and among them, 3321 (66.2 %) were found in INAIL archives as mesothelioma cases who fil claims for compensation. The modalities of asbestos exposure, sector of working activities and job type are crucial factors. Furthermore, gender, age at diagnosis, area of residence have been found to be significant predictors of probability to fil claims. Relative risks to fil claims were obtained for the above determinants and conditions to maximize the probability to obtain compensation identified. Our findings demonstrate that there is a need to enforce policies for improving awareness of the occupational origin for mesothelioma cases. Stakeholders, occupational health and safety institutions can play an important role for improving the sensitization regarding the rights of compensation benefits, ensuring the equity and the effectiveness of insurance, welfare and public health systems.
尽管间皮瘤的主要职业来源众所周知，但与申请赔偿有关的决定因素却很少被调查。意大利间皮瘤登记处（ReNaM）收集的间皮瘤病例与意大利国家保险研究所（INAIL）的赔偿申请和分配之间存在关联，研究对象为 2010-2015 年间诊断出的病例和职业性石棉暴露。使用逻辑回归模型和决策树模型来确定与申请和获得赔偿相关的人口统计学、诊断和病史因素。我们在分析中纳入了 5019 例间皮瘤病例，其中 3321 例（66.2%）在 INAIL 档案中被发现为申请赔偿的间皮瘤病例。石棉暴露的方式、工作活动领域和工作类型是关键因素。此外，性别、诊断时的年龄和居住地区也是申请赔偿的重要预测因素。对于上述决定因素和条件，我们得出了申请赔偿的相对风险，以最大限度地提高获得赔偿的概率。我们的研究结果表明，需要加强政策，提高对间皮瘤职业来源的认识。利益相关者、职业健康和安全机构可以在提高对赔偿权益的认识方面发挥重要作用，确保保险、福利和公共卫生系统的公平性和有效性。
