Annals of the American Thoracic Society | 2021
Association Between Financial Conflicts of Interest and ILO Classifications for Black Lung Disease.
Abstract
RATIONALE\nThe US 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 (COI) may systematically bias physicians when they are classifying chest x-rays (CXRs) for the absence, presence and severity of pneumoconiosis.\n\n\nOBJECTIVE\nTo evaluate the direction and magnitude of association between financial COI of physicians participating in the FBLP and international standards for the classification of radiographs of pneumoconiosis.\n\n\nMETHODS\nAn epidemiologic assessment of black lung claims filed to the FBLP, 2000-2013, was conducted to determine physician classifications of radiographs. FBLP court decisions for years 2002-2019 (n=7,656) were used to evaluate financial COI 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).\n\n\nRESULTS\nOut of 63,780 radiograph classifications made by 264 physicians, 31.4% were read positive for simple pneumoconiosis and 3.6% were read as having progressive massive fibrosis (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 (CI95%: 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 (CI95%: 1.49, 1.52) and for finding PMF was 1.28 (CI95%: 1.26, 1.30).\n\n\nCONCLUSIONS\nThere was a strong association between source of payment and radiograph classification suggesting the importance of eliminating financial COI in what should be an objective determination of eligibility for Black Lung workers compensation benefits.