Chronic Pulmonary Diseases of self-employed in the craft, trade and services sector.

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) Eumass 14-16 June 2012, Padova, Italy 1

2. Occupational factors Hairdressers [Blainey, 1986 ; Leino, 1997] Bakers [Houba, 1998] Tailor, seamstress [Wang,2005; LeVan, 2006] are exposed to occupational Chronic Pulmonary Diseases Car repairers [Bener, 1998] Dental prosthetists [Hu,2006] Woodworkers [Carosso, 1987] Taxi drivers [Bener, 1998] 2

3. 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. • It is entitled to a public mission in managing the social security for more than 4 million people. • 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). CNAMTS MSA RSI 3

4. Goal  - to identify in the RSI populationthe high-risk jobs with regard to CPD, Relevance  - exposure to occupational risk factors account for 15 to 20% of the etiologies of CPD Operational goal - to prioritize the preventive measures by targeting the high-risk jobs.

5. Design  - cross sectional study - across the working population - in 2010. - using the health care reimbursement data base of the RSI The RSI’s data center receives the teletransmission from the recipients or providers of care.

6. Geographical area With an overall population of 4.9 million people, Provence-Alpes- Côte d'Azur is located in Southeastern France. It comprises 6 departments Variable continue : Moyenne (écart type); Variable nominale : Pourcentage 6

7. High rurality High level of unemployment Departments with different socio demographic characteristics

8. Targeted population  Includes 153 334 subjects insured by the RSI • Craftmen, shopkeepers, self-employed people and small business owners in crafts, trades and services • Currently active persons • Formerly active persons if now retired or disabled Males or females aged between 30 to 90 8

9. How to asses the risk of CPD by measuring an Health Indicator Chronic Pulmonary Disease Reimbursements records Billing repositoryclassification system Health Indicator (based on reimbursement data) 9

10. Respiratory consultations • prescription medications delivery approved only for a pneumology indication • Procedure coding • Pharmaceutical coding Work loss wage compensation benefits for pulmonary disease (temporary or permanent disability) • diagnosis coding (ICD) Domiciliary Oxygen Therapy (DOT) • Device Classification • casemix-based hospital financing system (T2A & PMSI) Hospital Admission with a principal diagnosis of respiratory failure Long Term Affection n° 14: Severe chronic respiratory failure • 30 Long Term Affections entitling to exemption of copayment (ALD30)  Potential indicators of Chronic Pulmonary Disease Reimbursements records Billing repositories classification systems

11. Respiratory consultations • prescription medications delivery approved only for a pneumology indication • Procedure coding • Pharmaceutical coding Work loss wage compensation benefits for pulmonary disease (temporary or permanent disability) • diagnosis coding (ICD) Domiciliary Oxygen Therapy (DOT) • Device Classification • casemix-based hospital financing system (T2A & PMSI) Hospital Admission with a principal diagnosis of respiratory failure Long Term Affection n° 14: Severe chronic respiratory failure • 30 Long Term Affections entitling to exemption of copayment (ALD30) Indicators that have been chosen in our study Insurance reimbursements Repositories and classification systems

12. The risk of CPD is higher for male worker than female • Advices: • Implementing preventive action targeted at male workers • Avoiding that tobacco consumption habits and men’s specific working conditions spread to women. 12

13. The 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. 13

14. Workers living in rural areas are at higher risk of CPD • Advices: • Chronic pulmonary diseases prevention initiatives should include rural areas. • Medical nursing homes could take a substantial part in the process. 14

15. Workers living in a high unemployment area have a higher risk of CPD • Advices: • CPD prevention initiatives should emphasize on high unemployment areas. • Unemployment reduction is needed. 15

16. Occupations at increased risk of CPD • bakers: allergy to flour , • tobacconists: passive smoking , • dental prosthetists: microparticles of grinding, • metal workers: vapors of welding and grinding, • shoemakers: glues. (to be followed) 16

17. Occupations at increased risk of CPD (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. 17

18. What do the results of our research suggest? • With regard to our findings, preventives actions should be 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: • Shoemakers • Dressmakers, seamstresses • Driving instructors 18

19. What does the RSI intend to do ? • 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. 19

20. Bottom line

21. Baker Eumass Juin-2012 21

22. Tobacconist Eumass Juin-2012 22

23. Dental prosthetists Eumass Juin-2012 23

24. Metal worker Eumass Juin-2012 24

25. are 4 risky jobs with regard to Chronic Pulmomary Disease in the RSI working population Eumass Juin-2012 25

26. Thank you for your attention Contact: philippe.ha-vinh@provencealpes.rsi.fr 26