Nikolaeva, I.

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Varna Medical University Press: Journals

PRELIMINARY DATA CONCERNING PRIMARY D I S A B I L I T Y ASSESSMENT IN W O R K E R S FROM T H E CHEMICAL, GLASS AND T E X T I L E INDUSTRY, AND MACHINE-BUILDING IN T H E VARNA DISTRICT I . Nikolaeva Disability is an important problem of social medicine. As one of the pos-sible outcomes of morbid conditions, it is taken to be an indicator of the health state of the population, and of the quality of health cares. Along with that, it is closely linked to economics owing to premature loss of working ability, on the one hand, and to the substantial funds alloted to the programs for as-sistance of disabled persons, on the other. The level and dynamics of the three aspects of invalidity — medical, social and legal — define the changes taking place in the social and politi-cal life of our society, and accordingly, in its public health system. The great significance of the issue, and lack of clarity in terms of its va-riable aspects in our district, led us to undertake a comprehensive research along this line. It is part of an extensive study on disability caused by illness or infirmity among workers from the basic industries in the district — che-mical, machine-building, textile and glass production. Method Primary disability for 1977 is evaluated in the following plants and fac-tories: "Parvi Mai" , "Hristo Botev", shipbuilding plant " G . Dimitrov", " E l -prom", "Cherno More", "St. I . Peev", PVC plant, new plant for soda, and plant for mineral fertilizers. The primary disability notion is made up of the number of subjects with primary invalidization, recognized during the year under review. The data concerning primary disablement were obtained from the di-sability filing records in the Varna district, and more particularly, from re-port card No 18 of the Labour Expert Medical Examination Commission ( T E L K ) — "Expert examination decision". In processing the data about pri-mary disability, both extensive and intensive indicators were calculated, as well as average values and correlation indices. To eliminate differences in age-sex structure, the direct standardization method was made use of. The incidence of primary disability amounts to 1.62 per cent or 16.19%0. According to Y . Magarill's scale (1969) for the assessment of disability indi-cators, it falls within the low incidence limits (below 6 per cent — low, 6 to 9 per cent — medium, 9 to 11 per cent — high, and above 11 per cent — very high). In the various industries the level of this indicator is variable (Table 1). The impression is that heavy industries have low incidence of disability (che-Preliminary data concerning primary disability assessment. 125 »H- j Incidence of Primary Disability by Sex and Industrial Branch T a b l e 1 Industrial branch Men Sex Women Total Textile Machine-building Shipbuilding inclusive Glass Chemical Total 25.44 19.21 20.23 11.72 11.96 16,34 23.54 9.91 19.75 17.02 17.43 15.97 24.13 15.86 20.19 14.15 13.68 16.19 mistry and machine-building), as compared to textile industry, where the indicator in question reaches the highest value. Analyzed by sex the difference in incidence is insignificant, being how-ever higher among men, as compared to women (Table 1). The latter dif-ference is not recorded in all four industries. Also, it can be seen from the table that in machine-building and textile industry men really display a higher incidence of disability, -reaching twice as high a level in machine-building. In chemical and glass industries women show higher incidence of primary disability. The present research confirms the dependence of primary disabi-lity on the length of work, already proved by a number of authors. With ex-tension of the length of work from one to ten years, the proportion of disabled persons grows both totally, and by sex (Table 2). T a b l e 2 Primary Disability by Length of Service and Sex for All Industrial Branches (Relative Share) Length of service Sex Men Women Total Up to 5 yrs 6 to 10 yrs 11 to 15 yrs Above 25 yrs 18.75 26.79 16.96 37.50 40.26 35.06 10.39 14.29 27.51 30.16 14.29 28.04 Total 100.C0 100.00 100.00 In length of. service ranging from 11 to 15 years, a reduction of disabb 1 ity in men and women alike is observed. Above 15 years, the percentage of primary disability is once again augmented, rather marked in men. The data of the research show also the influence exerted by age on pri-mary disability (Table 3). 126 I . Nikolaeva T a b l e 3 Primary Disability by Age Groups and Sex for AH Industrial Branches! (Relative Share) Age groups Sex Men Women Total Up to 29 yrs 30 to 39 yrs 40 to 49 yrs Above 50 yrs 8.93 15.18 32.14 43.75 3,90 22.08 45.35 28.57 6.88 17.98 37.57 37.57 Total 100.C0 100.00 100.0Э Up to the 50th year of life, primary disability shows a gradual rise until a plateau is reached after 50 years. The same regularity is observed in the various age groups of men. It is characteristic of women too, with a slight exception for the age above 50 years. The structure of primary disability by the three basic groups (Table 4) confirms the results of other investigators that group I disability is with the lowest relative share. In our series it is more than three times lower than group I I , and more than 15 lower than group I I I disability. In sex related aspect the same finding holds true. T a b l e 4 Primary Disability by Basic Groups and Sex (Relative Share) Basic group disabil ity Sex Men Womeu Total Group one Group two Group three 6.25 16.96 76.79 5.19 18.18 76.63 5.82 17.46 76.72 It is of interest to note the structure and incidence of primary disability by class of diseases, sex and industrial branch (Table 5). Diseases of the circulation organs rank first as primary disability cause — 26.46 per cent. Of them the highest relative share is assigned to chronic rheu­matic cardiopathy (6.88 per cent), hypertension (6.35 per cent), and cerebro­vascular syndrome (3.17 per cent). On the second place by relative share come accidents, injuries and poisonings (16.40 per cent), and on the third — di­seases of the nervous system and sensory organs — 14.29 per cent. Of the lat­ter, affections of the central nervous system predominate, followed by peri­pheral nerve lesions and inflammatory diseases of the eye. The fourth place is occupied by neoplasms, malignant tumours in particular. The proportion of musculoskeletal and connective tissue diseases is equal to that of neoplasms. Preliminary data concerning primary disability assessment. 127 T a b l e 5 Primary (Disability Structure by Class of Disease and Industrial Branch Industrial branch Class of disease Textile Machine-building Glass Chemical Total 1. Infectious diseases and parasitosis 2. Neoplasms 3. Endocrine and metabolic diseases 4. Psychoses and psychoneuroses 5. Diseases of nervous system and sensory organs 6. Disease of circulation organs 7. Diseases of respiratory system 8. Diseases of digestive system 9. Diseases of urogenital system 10. Diseases of skin and subcutaneous tissue 11. Disease of musculoskeletal system and connective tissue 12. Other specified and unspecified morbid conditions 13. Accidents, injuries and poisonings 14. Congenital anomalies 2.50 7.C;0 5.00 5.00 10.00 30.00 12.50 2.50 7.50 7.50 7.50 2.50 6.25 5.00 3.75 7.50 16.25 18,75 3.75 5.00 1.25 6.25 25.00 1.25 3.45 10.34 3.45 10.34 31.03 17.24 3.45 3.45 6.90 3.45 6.90 5.00 5.00 7.50 17.50 35.00 5.00 2.50 7.50 15.00 4.76 6.35 3.17 5.82 14.29 26.46 7.94 3.17 3.17 6.88 0.53 16.40 1.06 In this group arthritis and spondylitis followed by osteomyelitis, are the most frequent causes of disability. Psychoses and psychoneuroses (5.82 per cent) rank fifth, followed by infectious diseases and parasitoses (4.76 per cent). The seven classes of diseases listed above represent about 90 per cent (88.24 per cent) of primary disability morbigenous agents in the industrial bran-ches surveyed. A certain difference is noted in the classification of diseases (as basic causes of disability) by sex. In women affections of the circulatory organs, and especially hyperten-sion and chronic rheumatic cardiopathy, represent a very serious problem; diseases of the nervous system and sensory organs rank second. Here malig-nant neoplasms rank third while psychoses and psychoneuroses come to fore. In men accidents, injuries and poisonings rank first as a cause of pri-mary disability, second — diseases of the circulatory organs, followed by diseases of the nervous system and sensory organs. As compared to women, diseases of the respiratory system have a higher relative share, and rank fourth as causes of invalidity. The relative share of psychoses and psychoneuroses, neoformations, infectious diseases and parasitoses, diseases of endocrine glands and metabolic disorders is equal with that recorded in women. Special attention merit the data concerning primary disability by clas-ses of diseases, and by basic group of disability. It was found that more than half (54.55 per cent) of the causes for group I primary disability are assigned to malignant neoplasms. The second most frequent cause of disability in this group is hypertension and cerebrovascular syndromes. Diseases of the ner-vous system and sensory organs of which more than half involve the peri-128 I . Nikolaeva pheral nerves display an analogical relative share. Third some diseases of the urogenital system, nephritis and nephrosis in particular. Thus, the listed four classes of diseases condition group-one disability. The problems confronted in terms of diseases, assumed as causes of group I I primary disability, are rather different. In their classification by severity first rank diseases of the circulatory organs, second — accidents, injuries and poisonings, psychoses and psychoneuroses. These three classes of diseases alone account for 67.57 per cent of the morbid conditions causing group I I disability. Third rank endocrine diseases, and more particularly diabetes mellitus and digestive system diseases. In general outline group I I I disability is conditioned, with small excep-tions, by the same classes of diseases. The study of primary disability by clas-ses of diseases, and by basic group of severity is essential not merely from the point of view of medicine, but also from the point of view of economy, since pecuniary compensation of disabled persons from the different groups dif-fers in amount. The data concerning primary disability by class of diseases and by sex in the various industries have an essential practical bearing on the undertaking of concrete and effective medicosocial steps. Chemical industry Affections of the circulation organs, assumed as a cause of primary di-sability in this case, are with the highest relative share. By comparison with other industries, in chemical production they reach the highest level — 38 per cent. Diseases of the nervous system and sensory organs, placing second {17.50 per cent), are likewise a cause of disability in chemical industry. Ac-cidents, injuries and poisonings (15 per cent) are also noteworthy. Diseases of the three classes listed above alone represent 70 per cent of primary di-sability causes in the chemical industry. Also comparative high is the pro-portion of musculoskeletal and connective tissue lesions, psychoses and psy-choneuroses (7.80 per cent each). Machine-building In this branch of industry the accidents, injuries and poisonings consti-tute the most serious problem as factors causing disability. Compared to the other industries, here they reach the highest level — 25 per cent. The second important problem are diseases of the circulation organs — 18.75 per cent. Close to the latter is the proportion assigned to affections of the nervous sys-tem and sensory organs — 16.25 per cent. Fourth rank psychoses and psy-choneuroses — 7.50 per cent, followed by infectious diseases and parasitoses, musculoskeletal and connective tissue lesions, circulation and gastrointesti-nal disorders. It is worth noting that the main share of diseases conditioning primary disability in machine-building are at the expense of shipbuilding. Preliminary data concerning primary disability assessment. 129 Glass industry Here the relative share of diseases of the circulation organs, followed by respiratory system disorders, is the highest. Compared to other industries, in glass production they have the highest relative share. They rank second in textile industry too, whereas in chemical industry their proportion is in­significant. Special attention is focused on diseases of the nervous system, sensory organs and neoplasms. Musculoskeletal and connective tissue lesions, as well as injuries, accidents and poisonings should be by no means underestimated. Textile industry In the textile industry the problems confronted are practically analo­gical to those in glass industry — diseases of the circulation organs, respira­tory system, nervous system and sensory organs, neoplasms etc. The data submitted constitute a basis for setting up and realizing con­crete and effective medicosocial measures in the prophylaxis against primary disability, and in the endeavours to reduce its incidence in the main indus­trial branches of the district. R E F E R E N C E S 1. В и г д о р ч и к, Н. А. Инвалидность, 1924. — Е л и с е е в а , Т. Н. Разви* тие врачебно-трудовой експертизы в СССР и основные принципы ее в социалистических странах, М., 1965. — 3. К р о м, П. И. Инвалидность и факторы ее определягощие. Дис. канд., М., 1969. — 4. М а г а р и л, М. Ю. Статистика инвалидности и деятел­ности органов врачебно-трудовой экспертизы. Дис. докт., М., 1969. — 5. М а м и й, Ш. М. Соц.-гигиеническая характеристика инвалидности в Адыгее, Дис. канд., Красно­дар, 1974. — 6. С а з а н с к и й, С. М. Соц. гигиен, значение производств, травма­тизма как причина инвалидности рабочих и служащих. Дис. канд., Саратов, 1972. — 7. Ф р е й д л и н, С. Я- Здравоохранение Росс, фед., 1975, 4. Н Е К О Т О Р Ы Е П Р Е Д В А Р И Т Е Л Ь Н Ы Е Д А Н Н Ы Е И З У Ч Е Н И Я П Е Р В И Ч Н О Й И Н В А Л И Д Н О С Т И Р А Б О Ч И Х Х И М И Ч Е С К О Й , С Т Е К О Л Ь Н О Й , Т Е К С Т И Л Ь Н О Й П Р О М И Ы Ш Л Е Н Н О С Т И И М А Ш И Н О С Т Р О Е Н И Я В В А Р Н Е Н С К О М О К Р У Г Е Ив. Николаева Р Е З Ю М Е Проведено исследование первичной инвалидности за 1977 г. рабочих основных -отраслей промышленности — химической, машиностроения, текстильной и стеколь­н о й — в Варненском округе. Первичная инвалидность составляет 16,19%0. Самые вы­сокие показатели встречаются в текстильной промышлености — 24,13%0, в то время как отрасли промышлености с тяжелым производством, как например химическая и машиностроительная, показывают низкую частоту — 13,68%0, соотв. 15,86%0. Частота инвалидности в машиностроении и текстильной промышлености выше среди мужчин, а в химической и стекольной, чаще наблюдается инвалидность среди женщин. Удельный вес первично признанных инвалидами растет с увеличением длительности трудовой деятельности от 1 года до 10 лет. Самые высокие показатели существуют у мужчин с трудовым стажем превышающем 15 лет. Наименьший удельный вес в первой группе в 3 раза меньше, чем во второй группы и более 15 раз меньше третьей группы инвалидности. -9 Scripta scientifica medjca 

PRELIMINARY DATA CONCERNING PRIMARY DISABILITY ASSESSMENT IN WORKERS FROM THE CHEMICAL, GLASS AND TEXTILE INDUSTRY, AND MACHINE-BUILDING IN THE VARNA DISTRICT

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PRELIMINARY DATA CONCERNING PRIMARY DISABILITY ASSESSMENT IN WORKERS FROM THE CHEMICAL, GLASS AND TEXTILE INDUSTRY, AND MACHINE-BUILDING IN THE VARNA DISTRICT

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