Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois.
Ann Am Thorac Soc. 2021 Oct;18(10):1634-1641. doi: 10.1513/AnnalsATS.202010-1350OC.
The U.S. Department of Labor administers the Federal Black Lung Program (FBLP), an administrative system charged with managing claims by coal miners for workers' compensation for totally disabling coal mine dust lung disease. Specific case reports have raised concern that financial conflicts of interest (COIs) may systematically bias physicians when they are classifying chest X-rays (CXRs) for the absence, presence, and severity of pneumoconiosis. To evaluate the direction and magnitude of association between financial COIs of physicians participating in the FBLP and international standards for the classification of radiographs of pneumoconiosis. An epidemiologic assessment of black lung claims filed to the FBLP from 2000 to 2013 was conducted to determine physician classifications of radiographs. FBLP court decisions from 2002 to 2019 ( = 7,656) were used to evaluate financial COIs of each physician. The main outcome measures used were classifications of radiographs for the absence of pneumoconiosis (small opacity classifications of 0/0 or 0/1), simple pneumoconiosis (small opacity classifications of 1/0 through 3/+), and progressive massive fibrosis (PMF) (large opacities with classifications of A, B, or C). Of 63,780 radiograph classifications made by 264 physicians, 31.4% were read positive for simple pneumoconiosis and 3.6% were read as having PMF. There were 52 physicians who classified CXRs as having no evidence of pneumoconiosis in 99%+ of their readings and 18 physicians who classified CXRs as positive for simple pneumoconiosis in 99%+ of their readings. The adjusted odds of a negative classification of pneumoconiosis was 1.46 (95% confidence interval [CI], 1.44-1.47) per 10% increase in the proportion of court records demonstrating that a physician was hired by the employer. Per 10% increase in court records indicating a physician was hired by the miner/claimant, the adjusted odds ratio for classifying simple pneumoconiosis was 1.51 (95% CI, 1.49-1.52), and the adjusted odds ratio for finding PMF was 1.28 (95% CI, 1.26-1.30). There was a strong association between source of payment and radiograph classification, suggesting the importance of eliminating financial COIs in what should be an objective determination of eligibility for Black Lung Workers' compensation benefits.
美国劳工部管理着联邦黑肺计划（FBLP），这是一个管理系统，负责管理煤矿工人因完全致残的煤矿尘肺病而获得工人赔偿的索赔。具体的案例报告引起了人们的关注，即财务利益冲突（COI）可能会在医生对 X 射线（CXR）进行分类时，系统地影响他们对尘肺病的有无、存在和严重程度的判断。为了评估参与 FBLP 的医生的财务 COI 与尘肺病 X 射线分类国际标准之间的方向和幅度的关联。对 2000 年至 2013 年向 FBLP 提交的黑肺病索赔进行了流行病学评估，以确定医生对 X 射线的分类。使用了 2002 年至 2019 年的 FBLP 法院判决（=7656）来评估每位医生的财务 COI。主要的测量结果是对 X 射线的分类，用于判断是否存在尘肺病（小混浊度分类为 0/0 或 0/1）、单纯性尘肺病（小混浊度分类为 1/0 至 3/+)和进行性大块纤维化（PMF）（大混浊度，分类为 A、B 或 C）。在 264 名医生进行的 63780 次 X 射线分类中，31.4%的分类结果为单纯性尘肺病阳性，3.6%的分类结果为 PMF。有 52 名医生在其 99%+的阅读中分类 CXR 为无尘肺病证据，有 18 名医生在其 99%+的阅读中分类 CXR 为单纯性尘肺病阳性。每增加 10%的记录表明医生受雇于雇主，无尘肺病分类的调整后比值比为 1.46（95%置信区间[CI]，1.44-1.47）。每增加 10%的记录表明医生受雇于矿工/索赔人，将单纯性尘肺病分类的调整后比值比为 1.51（95%CI，1.49-1.52），而发现 PMF 的调整后比值比为 1.28（95%CI，1.26-1.30）。支付来源与 X 射线分类之间存在很强的关联，这表明在确定是否有资格获得黑肺工人赔偿福利时，消除财务 COI 至关重要。
