Occupational pathologies: the National Network for Monitoring and Prevention of Occupational Diseases publishes its scientific report

4 October 2011

Since 2001, the 32 occupational disease clinics (CCPPs) in France have formed a network of medical experts called the National Network for Monitoring and Prevention of Occupational Diseases (RNV3P), coordinated by ANSES. Anonymous data from clinic visits are grouped in a common database, whose purpose is to monitor the main occupational risks, detect emerging occupational diseases, and promote their prevention in conjunction with regional actors in occupational health and prevention. In addition to ANSES, the network partners are the SFMT1, the CNAM-TS2, the MSA3, the InVS4 and the University Hospital (CHU) at Grenoble, initiator of the network.
For several years, occupational health services from the general system, the MSA, or from the civil service have also been transmitting their data to the network. These two complementary approaches allow the accumulation of increasingly precise data on occupational diseases and their development in France.

The network is publishing its scientific report today. It presents the data collected since the establishment of the RNV3P, with a focus on work-related allergies.

How many occupational health problems have been identified since the creation of the network?
Between 2001 and 2009, the “occupational disease clinics” component of the network recorded 118,852 occupational health problems. Of these, 47,768 illnesses considered by experts as possibly, probably, or certainly work-related have been diagnosed. Meanwhile, between 2003 and 2009, the "occupational health services" component of the RNV3P recorded 3622 work-related illnesses through the participation of sentinel physicians at seven occupational health services.
In total, more than 200,000 consultations have been recorded in the RNV3P database, and 15,000 new consultations are added each year.

What are the most frequently identified diseases?
Within the CCPPs, the most frequent work-related diseases mentioned are respiratory diseases (24%) and mental and behavioural disorders - psychological diseases or symptoms such as depression and anxiety - (22%), followed by dermatological diseases (17%), bone and joint diseases (16%), tumours (7.6%) and auditory diseases (5.6%).
In men, the disease families most frequently reported are tumours, ear diseases and respiratory diseases. In women, they are psychological diseases or symptoms, skin diseases, and musculoskeletal disorders (MSDs).
At the occupational health services, MSDs are the work-related diseases most frequently reported by physicians, both in men and women (64 and 60% respectively). They are followed by psychological diseases or symptoms, which account for 29% of diseases in women and 15% in men.

What are the main developments noted since the creation of the network?
Since the creation of the RNV3P, psychological diseases or symptoms seen in the network are constantly increasing in men as well as in women. The largest increase was observed in the areas of real-estate/rental and business services, public administration, financial activities, and other community and personal social services. Then there are the health and commerce sectors, as well as automotive repair; finally, the increase is less in the industrial sector.
From 2008, an increase in the MSDs observed by the network is seen in all sectors. This increase appears earlier in some sectors: real-estate/rental and business services (2005), public administration (2006), and the industry and health sectors (2007).

What emergent phenomena can the RNV3P highlight?
Methodologies relating to emergence applied in the network can detect, for example, the relationship between diseases and particular exposures or activities. This is the case for instance with lymphoma and leukaemia cases in agricultural areas, and rare neurodegenerative diseases with exposure to certain metals. These data reflect reports that lead eventually to investigations and further research in order to evaluate their relationship to work.

Are some diseases related to certain sectors in particular?
The RNV3P conducted statistical analyses to determine, in the different sectors, whether some illnesses led to more network consultations than did others.
Compared to other reasons for consultation in the same industry:

  • there are more consultations for respiratory diseases in the areas of mining, utilities and manufacturing industries;
  • there are more consultations for skin diseases in the areas of health and social work, hotels and restaurants and personal assistance services;
  • there are more consultations for respiratory diseases in the areas of mining, utilities and manufacturing industries;
  • there are more consultations for MSDs in the areas of domestic services, hotels and restaurants, public administration, construction, transport, communication, commerce, automotive repair and agriculture;
  • there are more consultations for psychological diseases or symptoms in the service sectors, especially financial activities, real estate/rentals, business services, commerce and repair;
  • there are more consultations for auditory diseases in the construction and education sectors.

How have occupational allergies changed since the creation of the network?
Occupational allergies are complex diseases, whose incidence has been increasing in recent decades, and which may have serious socio-professional consequences for the people involved.
The number of occupational asthma cases reported to the network between 2001 and 2009 is declining, especially in sectors traditionally affected by these conditions, such as rubber and plastics. This decrease concerns asthma associated with resins and glues, rubber or metal and, in terms of substances, isocyanates and aldehydes. These results, consistent with other sources of information or studies, are linked to the prevention efforts undertaken in these different sectors over the past few years. However, a statistically significant increase was observed for asthma associated with quaternary ammonium compounds and disinfectants.
There is a general increase in occupational contact dermatitis. The sectors concerned are hotels and restaurants, public administration and personal assistance services. The relevant exposures are to epoxy resins, perfumes and thiazoles. However, a significant decrease in contact dermatitis in conjunction with inorganic dust, detergents and plant-based products has also been observed.

What are the benefits of the data collected by the RNV3P?
With the data it collects, the network is able to play a watchdog role over all the diseases of interest in occupational health. It can also provide useful indicators to assess health risks in the workplace. Finally, it can target priority prevention objectives, supported by the comparison of these data with other indicators and sources of knowledge in occupational health.
The CCPPs are places which support the diagnosis of occupational diseases for occupational health physicians, but also for general practitioners and specialists, who refer more and more patients for consultations.
They also help with decisions concerning the work fitness or unfitness for employees, which are often difficult decisions to make, due to the complexity of the situations involved, these include, for example, problems related to psychosocial risks.
The link to occupational health physicians and to those responsible for prevention, facilitates the implementation of preventive actions in the workplace (workstation improvements, advice on appropriate individual or group protection, etc.).
They also participate in the identification and recognition of occupational diseases giving rise to compensation. For example, two-thirds of work-related asthma cases and one-third of allergic dermatosis cases seen in the network are considered to be occupational diseases giving rise to compensation.
Finally, they play an important role in post-occupational monitoring, especially for employees who have been exposed to carcinogens such as asbestos during their working lives.
The utilisation of the RNV3P database provides ANSES with valuable data for all its missions of expertise, risk assessment and monitoring of occupational health.

(1) French Society of Occupational Medicine
(2) National Health Insurance Fund for Salaried Workers
(3) National Health Insurance Fund for Agricultural Workers and Farmers
(4) National Institute for Public Health Surveillance