Association Between Financial Conflicts of Interest and International Labor Office Classifications for Black Lung Disease

Details

• Personal Author:
  Almberg KS ; Cohen RA ; De S ; Friedman LS
• Description:
  Rationale: 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. Objectives: 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. Methods: 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 (n = 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). Results: 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). Conclusions: 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. [Description provided by NIOSH]
• Subjects:
  Coal Coal Mining Epidemiology Lung Lung Diseases Mining Occupational Health Radiography Respiratory System Respiratory Tract Diseases Safety

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• Keywords:
  Author Keywords: Pneumoconiosis Bioethics Black Lung Black Lung Disease Chest X-rays Coal Workers Pneumoconiosis Conflict Of Interest Cost Analyses Medical Screening Miners Mining Industry Surveillance Workers' Compensation Workers Compensation

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• ISSN:
  2329-6933
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Illinois ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  18
• Issue:
  10
• NIOSHTIC Number:
  nn:20067544
• Citation:
  Ann Am Thorac Soc 2021 Oct; 18(10):1634-1641
• Contact Point Address:
  Lee S. Friedman, Ph.D., Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, Chicago, IL 60612
• Email:
  lfried1@uic.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  University of Illinois at Chicago
• Peer Reviewed:
  True
• Start Date:
  20150701
• Source Full Name:
  Annals of the American Thoracic Society
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c161639161d9fac7d6b59a8416dcda4a3dc29e5ff7646a409589ed490e78d231c0b6117a3b438d8a6a8d645e4264fa43c9a5cfe2282204da58d8ccb3275e4d29
• Download URL:
  https://stacks.cdc.gov/view/cdc/231490/cdc_231490_DS1.pdf
• File Type:
  [PDF - 619.35 KB ]